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Streptococcus species enriched in the oral cavity of patients with RA are a source of peptidoglycan-polysaccharide polymers that can induce arthritis in mice
  1. Rabia Moentadj1,
  2. Yiwen Wang2,
  3. Kate Bowerman3,
  4. Linda Rehaume1,
  5. Hendrik Nel1,
  6. Paraic O Cuiv1,4,
  7. Juliette Stephens1,
  8. Amalina Baharom1,
  9. Muralidhara Maradana1,
  10. Vanessa Lakis1,
  11. Mark Morrison1,
  12. Timothy Wells1,
  13. Philip Hugenholtz3,
  14. Helen Benham1,5,
  15. Kim-Anh Le Cao2,
  16. Ranjeny Thomas1
  1. 1The University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  2. 2School of Mathematics and Statistics, Melbourne Integrative Genomics, The University of Melbourne, Melbourne, Victoria, Australia
  3. 3Australian Centre for Ecogenomics, The University of Queensland - Saint Lucia Campus, Saint Lucia, Queensland, Australia
  4. 4Current address: Microba Life Sciences, Translational Research Institute, Woolloongabba, QLD, Australia
  5. 5Department of Rheumatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  1. Correspondence to Professor Ranjeny Thomas, The University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; ranjeny.thomas{at}


Objectives Analysis of oral dysbiosis in individuals sharing genetic and environmental risk factors with rheumatoid arthritis (RA) patients may illuminate how microbiota contribute to disease susceptibility. We studied the oral microbiota in a prospective cohort of patients with RA, first-degree relatives (FDR) and healthy controls (HC), then genomically and functionally characterised streptococcal species from each group to understand their potential contribution to RA development.

Methods After DNA extraction from tongue swabs, targeted 16S rRNA gene sequencing and statistical analysis, we defined a microbial dysbiosis score based on an operational taxonomic unit signature of disease. After selective culture from swabs, we identified streptococci by sequencing. We examined the ability of streptococcal cell walls (SCW) from isolates to induce cytokines from splenocytes and arthritis in ZAP-70-mutant SKG mice.

Results RA and FDR were more likely to have periodontitis symptoms. An oral microbial dysbiosis score discriminated RA and HC subjects and predicted similarity of FDR to RA. Streptococcaceae were major contributors to the score. We identified 10 out of 15 streptococcal isolates as S. parasalivarius sp. nov., a distinct sister species to S. salivarius. Tumour necrosis factor and interleukin 6 production in vitro differed in response to individual S. parasalivarius isolates, suggesting strain specific effects on innate immunity. Cytokine secretion was associated with the presence of proteins potentially involved in S. parasalivarius SCW synthesis. Systemic administration of SCW from RA and HC-associated S. parasalivarius strains induced similar chronic arthritis.

Conclusions Dysbiosis-associated periodontal inflammation and barrier dysfunction may permit arthritogenic insoluble pro-inflammatory pathogen-associated molecules, like SCW, to reach synovial tissue.

  • rheumatoid arthritis
  • first-degree relatives
  • oral
  • microbiome
  • streptococci
  • cell walls

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  • RM, YW and KB are joint first authors.

  • PH, HB, K-ALC and RT are joint senior authors.

  • Handling editor Josef S Smolen

  • Twitter @YiwenWang_Eva

  • Correction notice This article has been corrected since it published Online First. Figures 1 and 2 have been updated.

  • Contributors Study concept and design: KB, PH, HB, KALC, RT. Acquisition and analysis and interpretation of data: All authors. Drafting of the manuscript: RM, KB, AB, RT. Critical revision of the manuscript for important intellectual content: All authors. Obtained funding: RT, PH, LMR.

  • Funding Supported by NHMRC grant 1071822 and 1159458, an Arthritis Australia project grant and by Mrs Joan Stagg, facilitated by Arthritis and Osteoporosis Tasmania. RT was supported by Arthritis Queensland and a NHMRC Senior Research Fellowship, LMR by a University of Queensland post-doctoral fellowship.

  • Competing interests None declared.

  • Patient and public involvement statement At what stage in the research process were patients/the public first involved in the research and how? Patients and the public were involved at the recruitment stage. How were the research question(s) and outcome measures developed and informed by their priorities, experience and preferences? No direct patient involvement. How were patients/the public involved in the design of this study? Not involved. How were they involved in the recruitment to and conduct of the study? Not involved. Were they asked to assess the burden of the intervention and time required to participate in the research? No. How were (or will) they be involved in your plans to disseminate the study results to participants and relevant wider patient communities (eg, by choosing what information/results to share, when and in what format)? Preliminary results were shared via a newsletter to the involved participants to inform them of study progress.

  • Patient consent for publication Not required.

  • Ethics approval Studies approved by Metro South Hospital and Health Service (HREC/94/QPAH/6), The University of Queensland (2012000275) and by Greenslopes Private Hospital (GREC 14/53) Human Research Ethics Committees.

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

  • Data availability statement Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. Assembled genomes and raw 16S rRNA gene amplicon sequencing data are available via NCBI BioProject PRJNA656387. Prokka annotated genomes available at Other data are available on request to corresponding author.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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