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Anti-cyclic citrullinated peptide antibodies are a collection of anti-citrullinated protein antibodies and contain overlapping and non-overlapping reactivities
  1. Andreea Ioan-Facsinay1,
  2. Hanane el-Bannoudi1,
  3. Hans U Scherer1,
  4. Diane van der Woude1,
  5. Henri A Ménard2,
  6. Maximilien Lora2,
  7. Leendert A Trouw1,
  8. Tom W J Huizinga1,
  9. Rene E M Toes1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Division of Rheumatology, McGill University Health Center, Montreal, Quebec, Canada
  1. Correspondence to Dr Andreea Ioan-Facsinay, Department of Rheumatology, Leiden University Medical Center, C1-R, Albinusdreef 2, Leiden 2333 ZA, The Netherlands; a.ioan{at}


Objective Anti-citrullinated protein antibodies (ACPA) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are a hallmark of rheumatoid arthritis and are believed to play a role in disease pathogenesis. These antibodies are typically detected in ELISA with citrullinated peptides (eg, CCP2) or proteins as antigens. The absolute concentration of anti-CCP antibodies in serum is unknown. Although antibodies to several citrullinated proteins can mainly be detected within anti-CCP-positive sera, it is currently unknown whether anti-CCP antibodies are in fact ACPA. Likewise, it is unknown to what extent antibody responses to different citrullinated antigens are crossreactive.

Methods An affinity purification method was established in which citrullinated antigen-specific antibodies were eluted from ELISA plates and then used for detection of other citrullinated antigens in ELISA or western blot. For additional crossreactivity studies, ELISA-based inhibition assays were performed with citrullinated or control peptides as inhibitors.

Results The concentration of anti-CCP IgG antibodies was estimated to be at least 30 μg/ml in patients with high anti-CCP levels (>1600 μg/ml). Affinity-purified anti-CCP antibodies were able to recognise citrullinated fibrinogen (cit-fib) and citrullinated myelin basic protein (cit-MBP) on western blot. Furthermore, antibodies specific for cit-fib and cit-MBP were crossreactive. However, additional crossreactivity studies indicated that non-overlapping antibody responses to citrullinated peptides can also exist in patients.

Conclusions This report shows for the first time that anti-CCP antibodies recognise multiple citrullinated proteins and are thus a collection of ACPA. More importantly, the data indicate that different ACPA responses are crossreactive, but that crossreactivity is not complete, as distinct non-crossreactive responses can also be detected in patients with RA.

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  • Funding This work was financially supported by EU FP6 programme Autocure and FP7 programme Masterswitch, a grant from Centre for Medical Systems Biology (CMSB) within the framework of The Netherlands Genomics Initiative (NGI), the Dutch Arthritis Association and the Dutch Organisation for Scientific Research (VENI grant 916.46.079 to AIF, VENI grant to LAT and VICI grant to REMT) and the Canadian Institutes for Health Research (HAM).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the LUMC, The Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.