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Journal of Translational Medicine

Open Access

Expression of 9G4 idiotope on autoantibodies to citrullinated peptides in patients with early inflammatory arthritis and established rheumatoid arthritis

  • Rita A Moura1,
  • Inmaculada de la Torre2,
  • Maria J Leandro3,
  • Jonathan CW Edwards3,
  • João E Fonseca1, 4 and
  • Geraldine Cambridge3
Journal of Translational Medicine201210(Suppl 3):P30

Published: 28 November 2012


Rheumatoid ArthritisCitrullinatedEarly Rheumatoid ArthritisImmunoglobulin Heavy ChainHeavy Chain Gene


The expression of VH4 gene family during immunoglobulin heavy chain synthesis has been detected in autoimmune diseases. In particular, the rat monoclonal antibody 9G4 detects VH4-34-encoded immunoglobulins and B cells expressing these antibodies as surface receptor (autoreactive 9G4+ B cells).


To determine whether autoantibodies commonly associated with rheumatoid arthritis (RA) express 9G4 idiotope (9G4-Id).

Patients and methods

Serum from 27 patients with established RA and 46 polyarthritis patients (<6 weeks duration) of whom 23/46 were subsequently diagnosed with RA (Early RA, ERA) and 23/46 with other arthritis (Early Non-RA, ENRA) was studied. 9G4-Id detection on anti-CCP, anti-tetanus toxoid (TT), Pneumococcal capsular polysaccharide (PCP) antibodies and total serum IgG and IgM was measured by ELISA.


23/27 patients with established RA had anti-CCP antibodies, 8 of whom had 9G4+ anti-CCP. All were positive for both IgM and IgG anti-CCP. 9G4-Id detection levels correlated more closely with IgM than IgG-CCP. In ERA group, 15/23 patients had anti-CCP and 4/23 had 9G4+ anti-CCP. All 4 patients had both IgM and IgG anti-CCP. In ENRA, only one patient had 9G4+ IgM anti-CCP, albeit at low titer. 9G4-Id was not detected on TT or PCP antibodies.


We describe for the first time the expression of VH4-34 heavy chain gene by autoantibodies to citrullinated peptides early after RA onset. In established RA, the expression of VH4-34 gene by anti-CCP antibodies is positively correlated with their titer, particularly with IgM-CCP. Therefore, we suggest that the expansion of CCP-specific B cell clones may be due to robust expansion of un-switched B cell clones, possibly including those in the splenic marginal zone or their analogous.

Authors’ Affiliations

Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
Rheumatology Dept., Gregorio Marañón Hospital, Madrid, Spain
Centre for Rheumatology, Division of Medicine, University College London, London, UK
Rheumatology Dept., Centro Hospitalar de Lisboa Norte, EPE, Hospital de Santa Maria, Lisbon, Portugal


© Moura et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.