Abstract:
The present invention refers to citrullinated synthetic peptides derived from the histone H4 protein and their use in the diagnosis of autoimmune diseases,particularly Rheumatoid Arthritis (RA).

Description:
FIELD OF INVENTION 
       [0001]    The present invention refers to citrullinated synthetic peptides derived from the histone H4 protein and their use in the diagnosis of autoimmune diseases, particularly Rheumatoid Arthritis (RA). 
       STATE OF THE ART 
       [0002]    Rheumatoid arthritis (RA) is an inflammatory joint disease characterized by an autoimmune mechanism mediated by both T- and B-cells. Different autoantibodies can be detected in the biological fluids of RA patients. Some of these autoantibodies can be used for RA diagnosis and follow up. 
         [0003]    The best known RA biomarker is the rheumatoid factor (RF), a class of IgG or IgM antibodies directed against the Fc-region of the IgG isotype of immunoglobulins. However, RF is not a specific RA marker as it can be found also in other pathological conditions and in elderly healthy individuals. The discovery of the involvement of citrullinated (cit) epitopes in RA using anti-perinuclear factor and anti-keratin antibodies boosted the identification of novel highly specific RA biomarkers. Different citrullinated peptides and proteins have been used to set up specific and sensitive diagnostic assays allowing to recognize RA autoantibodies, thus generally named as anti-citrullinated peptide (CP) antibodies (ACPA) [US20020143143, US20070087380, EP1946109, US20070148704, WO2009007846, WO2009000077, WO2007017556, EP1456662, WO1999028344, WO2008132264]. Among all the proteins associated with RA, the following citrullinated sequences have been used in diagnostic assays: fibrin [C. Masson-Bessière et al. J. Immunol. 2001, 166, 4177], collagen II [H. Burkhardt et al. Eur. J. Immunol. 2005, 35, 1643], vimentin [E. R. Vossenaar et al. Arthritis Rheum. 2004, 50, 3485], filaggrin [US20090028885, U.S. Pat. No. 7,445,903, U.S. Pat. No. 6,890,720], and viral proteins [C. Anzilotti et al. J. Rheumatol. 2006, 33, 647; WO2004087747]. 
         [0004]    The sensitivity of the tests was increased by the use of filaggrin-derived synthetic cyclic citrullinated peptides (CCPs) [G. A. Schellekens et al. J. Clin. Invest. 1998, 101, 273] [WO1998022503] characterized by a structure that optimally exposes the citrullines for antibody binding. Presently, three generations of CCP tests have been developed: CCP1 (sensitivity 68%, specificity 98%) [G. A. Schellekens et al. Arthritis Rheum. 2000, 43, 155], CCP2 (sensitivity range 39-94%, specificity range 81-100%) [J. Avouac et al. Ann. Rheum. Dis. 2006, 65, 845], and CCP3 (sensitivity range 51-83%, specificity range 93-98%) [L. Lutteri et al. Clin. Chim. Acta 2007, 386, 76]. These RA diagnostic ELISAs are commercially available (Euro-Diagnostica, Arnhem, The Netherlands; Axis-Shield, Dundee, Scotland; (NOVA, San Diego, USA). 
         [0005]    Recently, the use of citrullinated sequences derived from proteins EBNA-1 (VCP1) and EBNA-2 (VCP2) of Epstein-Barr virus allowed the set up of diagnostic assays characterized by specificities and sensitivities comparable to the ones reported by CCP2 and CCP3 tests [F. Pratesi et al. Arthritis Rheum. 2006, 54, 733; C. Anzilotti et al. J. Rheumatol. 2006, 33, 647; WO2004087747; EP091767764]. Interestingly, the comparison of the performances of the tests based on CCP2, CCP3, VCP1, and VCP2 suggested that different citrullinated sequences can detect different subgroups of anti-CP antibodies in the same set of patients. These results confirmed the important role of the amino acid sequence surrounding citrulline residues in the formation of anti-CP epitopes, in contrast with the hypothesized exclusive role of the XG or XnonG unit (X=citrulline) [EP1693673]. 
         [0006]    Another class of proteins associated with other autoimmune diseases but not yet directly related to RA diagnosis is represented by histone proteins. Histones are constituents of the nucleosomes and are classified into six classes: H1, H2A, H2B, H3, H4, and H5. Sequences derived from H1 and H2B were used to detect autoantibodies in systemic lupus erythematosus, RA and systemic sclerosis [WO03044054]. Even if it is known that these proteins are natively deiminated and generally modified [K. Arita et al. PNAS 2006, 103, 5291; A. J. W. Zendman et al. Anal. Biochem. 2007, 369, 232], no histone citrullinated sequences have been, up to now, associated with RA. However, microarrays based on the use of modified histones (i.e. phosphorylated, methylated, acetylated, and ubiquitinated), but not citrullinated, were described for the detection of antibodies [WO07132177]. 
         [0007]    Osborne et al. [Biochemistry, 2007, 46(46), 13370-13381] describe the chemical synthesis of a histone H4 fragment (1-21) having a citrulline residue in positions 17 and 19 for enzymatic studies. 
         [0008]    Wysocka et al. [Frontiers in Bioscience, 2006, 11, 344-355] disclose histone H4 being citrullinated in vivo only at position 3 and having citrulline residues in positions 3, 17 and 19, obtainable by in vitro deamination. 
         [0009]    Hagiwara et al. [Biochemistry, 2005, 44(15), 5827-5834] disclose the histone H4 fragment (1-23) and (1-5) having Cit in position 3. 
         [0010]    WO 2009/147201 discloses binding agents, such as antibodies that specifically bind to citrullinated peptides, including enzymatically citrullinated histone H4. These binding agents are used in preventing or treating an autoimmune disease, in particular RA. 
         [0011]    WO2010/117694 discloses a sequence that is a combination of histone H4 fragments comprising a citrulline residue at positions 23 and 95. 
         [0012]    WO 2004/078098 discloses a peptide not related to histone proteins and mainly consisting of citrulline residues. 
       SUMMARY OF THE INVENTION 
       [0013]    The present invention relates to citrullinated synthetic peptides derived from the core histone protein H4 and their use for the diagnosis of autoimmune diseases, in particular, RA. The investigation of the role of histone deimination in RA led to the definition of a series of citrullinated sequences derived from H4. Such sequences are able to recognize autoantibodies specific for RA. The citrullinated peptides according to the invention derive from the amino acid sequence of the human H4, in particular from the sequence comprised between amino acid (aa) 1 to aa 50 (Swiss-Prot P62805 aa 2 to aa 51) of said sequence. 
         [0014]    It is therefore an object of the invention a peptide characterized by
       being antigenically effective and able to specifically bind autoimmune disease-specific antibodies and   comprising, from the amino to the carboxylic terminal, the amino acid sequence: S G X 1  G K G G K G L G K G G A K X 2  H X 3  K V L X 4  D N I Q G I T K P A I X 5  X 6  L A X 7  X 8  G G V K X 9  I S G L I (SEQ ID No. 1, Formula I, also named H4(1-50)), wherein the amino acids X 1 -X 9  are selected independently from an arginine residue or a citrulline residue and at least two of X 1 -X 9  are a citrulline residue, or a functional fragment thereof being at least 7 amino acid long.       
 
         [0017]    The peptides as described in the invention and possessing at least two citrulline residues were demonstrated to be very suitable for the specific diagnosis of RA. Shorter peptide sequences comprising at least seven a.a. residues and derived from H4(1-50) (Formula I) are of particular interest. 
         [0018]    Preferably, the peptide is a functional fragment of SEQ ID No. 1 and comprises the amino acid sequence S G X 1  G K G G K G L G K G G A K X 2  H X 3  K (aa 1 to aa 20 of SEQ ID No. 1)or G A K X 2  H X 3  K V L X 4  D N I Q G I T K P A I (aa 14 to aa 34 of SEQ ID No. 1, also named H4(14-34)) or K P A I X 5  X 6  L A X 7  X 5  G G V K X 9  I S G L I (aa 31 to aa 50 of SEQ ID No. 1, also named H4(31-50)) wherein the amino acids X 1 -X 9  are selected independently from an arginine residue or a citrulline residue, and at least two of X 1 -X 7  are a citrulline residue, or a functional fragment thereof being at least 7 amino acid long. 
         [0019]    Preferably, the peptide comprises the sequence S G Cit G K G G K G L G K G G A K Cit H Cit K V L Cit D N I Q G I T K P A I Cit Cit L A Cit Cit G G V K Cit I S G L I (SEQ ID No. 1 wherein all of X 1 -X 9  are citrulline (Cit) residues, Formula II) or a functional fragment thereof being at least 7 amino acid long. 
         [0020]    Preferably, the peptide comprises the sequence selected from the group of S G Cit G K G G K G L G K G G A K Cit H Cit K (aa 1 to aa 20 of SEQ ID No. 1 wherein X 1 -X 3  are citrulline (Cit) residues, Formula III), G A K Cit H Cit K V L Cit D N I Q G I T K P A I (aa 14 to aa 34 of SEQ ID No. 1 wherein X 2 -X 4  are citrulline (Cit) residues, Formula IV), K P A I Cit Cit L A Cit Cit G G V K Cit I S G L I (aa 31 to aa 50 of SEQ ID No. 1 wherein X 5 -X 9  are citrulline (Cit) residues, Formula V) or a functional fragment thereof being at least 7 amino acid long. 
         [0021]    Preferably, the peptide as indicated above is of linear form or in the form of multimeric branched peptide or of other conjugated complex. 
         [0022]    The multimeric branched peptide preferably consists of:
       a MAP nucleus structure;   a linear peptide having an amino acid sequence of formula III, IV, and/or V linked through a chemical bond to each of amino terminal residues of the MAP nucleus structure, wherein the linear peptides are equal or different each others.       
 
         [0025]    According to the invention a MAP nucleus structure is: 
         [0000]    
       
                 
         
             
             
         
       
     
         [0026]    wherein X is an amino acid having at least two amino functional residues, Y is an amino acid selected from the group of alanine and/or glycine and/or a molecule used as spacer, m is 0 or 1, n 1  n 2  n 3  n 4  are integer numbers comprised between 0 and 10, and wherein bonds are carbamido bonds. 
         [0027]    A MAP or conjugate comprising a plurality of copies of a citrullinated linear synthetic peptide or of an antigenically effective fragment derived therefrom as described above, bound to an immunologically inert amino-acid core, therefore also falls within the scope of the present invention. 
         [0028]    Still preferably, the peptide comprises four identical copies of the peptide as described above. 
         [0029]    In a preferred embodiment the peptide is selected from the group of: 
         [0030]    (S G Cit G K G G K G L G K G G A K Cit H Cit K) 4  K 2  K beta (Formula VI): 
         [0000]    
       
                 
         
             
             
         
       
     
         [0031]    (G A K Cit H Cit K V L Cit D N I Q G I T K P A I) 4  K 2  K beta (Formula VII), 
         [0000]    
       
                 
         
             
             
         
       
     
         [0000]    or 
         [0032]    (K P A I Cit Cit L A Cit Cit G G V K Cit I S G L I) 4  K 2  K beta (Formula VIII), 
         [0000]    
       
                 
         
             
             
         
       
     
         [0033]    wherein Cit is a citrulline residue and betaA is a beta-alanine residue. 
         [0034]    Preferably the peptide is characterized by being antigenically effective and able to specifically bind rheumatoid arthritis-specific antibodies. 
         [0035]    It is a further object of the invention a method for the diagnosis of an autoimmune disease in a subject comprising the step of detecting antibodies specific for the autoimmune disease in a biological sample by
       reacting under proper conditions said biological sample with at least one peptide of the invention to produce a complex;   detecting the complex.       
 
         [0038]    Higher sensitivity and specificity of the method is obtained when the peptides are used in the form of MAPs or of other conjugated complex, in particular in the form of tetravalent MAPs. 
         [0039]    It was found that a method based on the use of a MAP of citrullinated peptides of formula VI, VII, or VIII gives the highest sensitivity and specificity in a test for detecting specific RA antibodies. Thus, preferably the biological sample is reacted with at least one peptide of the invention of formula III, IV, V, VI, VII, or VIII. In another preferred embodiment a method is based on the combined use of peptides of formula III, IV, and V or on the combined use of MAP of formula VII and MAP of formula VIII for detecting specific RA antibodies. 
         [0040]    Preferably the biological sample is reacted with the peptide comprising the sequence (G A K Cit H Cit K V L Cit D N I Q G I T K P A I) 4  K 2  K betaA, 
         [0000]    
       
                 
         
             
             
         
       
     
         [0000]    and the peptide comprising the sequence 
         [0041]    (K P A I Cit Cit L A Cit Cit G G V K Cit I S G L I) 4  K 2  K betaA, 
         [0000]    
       
                 
         
             
             
         
       
     
         [0042]    wherein Cit is a citrulline residue and betaA is a beta-alanine residue. 
         [0043]    Still preferably the method is an immunological assay. 
         [0044]    It is another object of the invention a kit for the diagnostic of an autoimmune disease comprising at least one peptide as indicated above, or a functional fragment thereof being at least 7 amino acid long. 
         [0045]    Preferably the kit comprises the peptide comprising the sequence (G A K Cit H Cit K V L Cit D N I Q G I T K P A I) 4 K 2 K betaA, 
         [0000]    
       
                 
         
             
             
         
       
     
         [0000]    and the peptide comprising the sequence 
         [0046]    (K P A I Cit Cit L A Cit Cit G G V K Cit I S G L I) 4  K 2  K betaA, 
         [0000]    
       
                 
         
             
             
         
       
     
         [0047]    wherein Cit is a citrulline residue and betaA is a beta-alanine residue. 
         [0048]    In particular the kit allows the detection of anti-CP antibodies in biological fluids. The kit comprises one of the citrullinated peptides as defined above or a functional fragment thereof, and at least one further reagent. Preferably, the further reagent is an anti-human immunoglobulin conjugated to an enzyme capable of reacting with a chromogenic substrate. The kit may also comprise instructions for use. 
         [0049]    Preferably the method of the invention and/or the kit of the invention are for the diagnosis of rheumatoid arthritis. 
         [0050]    It is another object of the invention an antibody directed against the peptide as describe above for use in diagnostic assays for an auto-immune disease. 
         [0051]    Preferably, the auto-immune disease is rheumatoid arthritis. 
         [0052]    For diagnostic applications, the peptides as described in the invention can be used to detect specific antibodies present in biological fluids of RA patients. In another preferred embodiment, the peptides can be used to detect circulating and tissue-infiltrating auto-reactive B- and T-cells. 
         [0053]    In another embodiment of the present invention, the peptides as above disclosed, bound to appropriate resins, can be used for antibody removal. 
         [0054]    An antibody present in the biological fluids of autoimmune patients will bind to the peptides of the invention. As indicated above, the citrullinated peptides of the invention, both in linear form and in MAP form, are particularly suitable to be used as antigens in an assay to detect the presence and/or to measure the levels of autoimmune disease-specific antibodies, such as anti-CP antibodies, in a sample of a biological fluid. 
         [0055]    In order to perform the assay, the peptides can be adsorbed or covalently linked or modified with a carrier to bind it to a solid support (e.g. chips, microspheres, gold, polystyrene, reactor vessels or wells, micro-titre plate). In a first step of the method, the sample of the biological fluid to be analyzed is placed in contact and incubated with the peptide of the invention that may be linked to the solid support. Autoimmune disease-specific antibody, such as anti-CP antibodies, that are possibly present in the sample are thus specifically bound to the peptide of the invention, producing an antigen/antibody complex. The anti-CP antibodies to be detected in the immunoassay are IgG, IgA, or IgM immunoglobulins. The evaluation of the presence and the quantity of the antigen/antibody complex can be performed with a spectroscopic, a piezoelectric, or an electrochemical biosensor. 
         [0056]    The above described method may be an immunological assay in which an indicator antibody, like an anti-human immunoglobulin, is conjugated to an enzyme and is added to measure the antibody titer by a spectroscopic transducer. 
         [0057]    It was found that a method based on the use of a MAP of citrullinated peptides of formula VI, VII, or VIII gives the highest sensitivity and specificity in a test for detecting specific RA antibodies. Thus, preferably the biological sample is reacted with at least one peptide of the invention of formula III, IV, V, VI, VII, or VIII. In another preferred embodiment a method is based on the combined use of peptides of formula III, IV, and V or on the combined use of MAP of formula VII and MAP of formula VIII for detecting specific RA antibodies. 
         [0058]    In the present invention antigenically effective means that the peptide, or a functional fragment thereof is able to specifically bind autoimmune disease-specific antibodies. In particular, the peptide or the functional fragment thereof is able to specifically bind rheumatoid arthritis-specific antibodies. 
     
    
     
       DETAILED DESCRIPTION OF THE INVENTION 
         [0059]    The invention will be now illustrated by means of non limiting examples referring to the following figures. 
           [0060]      FIG. 1 . Anti-CP antibodies purified from two different representative sera of RA patients using peptide [Cit 17 ,Cit 19 ,Cit 23 ]H4(14-34) (i.e aa 14 to aa 34 of SEQ ID No. 1 wherein X 2 -X 4  are citrulline (Cit) residues, formula IV), the non citrullinated sequence H4(14-34), and an unrelated control MAP of sequence (EEEDEDMGFGLFD) 4 -K 2 -K-betaA (SEQ ID No. 2). Anti-citrullinated peptide antibodies (ACPA) purification was achieved using the citrullinated peptide [Cit 17 ,Cit 19 ,Cit 23 ]H4(14-34) (formula IV). By contrast, the non citrullinated sequence H4(14-34) and the control MAP did not detect any IgG antibody in the two RA sera. 
           [0061]      FIG. 2 . Anti-CP antibodies purified from two different representative sera of RA patients using peptide [Cit 35 ,Cit 36 ,Cit 39 ,Cit 40 ,Cit 45 ]H4(31-50) (i.e, aa 31 to aa 50 of SEQ ID No. 1 wherein X 5 -X 9  are citrulline (Cit) residues, formula V), the non citrullinated sequence H4(31-50), and an unrelated control MAP of sequence (EEEDEDMGFGLFD) 4 -K 2 -K-betaA (SEQ ID No. 2). ACPA purification was achieved using the citrullinated peptide [Cit 35 ,Cit 36 ,Cit 39 ,Cit 40 ,Cit 45 ]H4(31-50) (formula V). By contrast, the non citrullinated sequence H4(31-50) and the control MAP did not detect any IgG antibody in the two RA sera. 
           [0062]      FIG. 3 . Mean of the antibody titer for the RA and the NHS groups to differently citrullinated sequences of H4(14-34). 
           [0063]      FIG. 4 . Mean of the antibody titer for the RA and the NHS groups to differently citrullinated sequences of H4(31-50). 
           [0064]      FIG. 5 . Mean of the antibody titer for the RA and the NHS groups to citrullinated overlapping peptides comprised in the H4(1-50). 
       
    
    
     EXAMPLES 
     Example 1 
     Peptide Synthesis 
       [0065]    Peptides were synthesized using a Wang resin preloaded with the C-terminal amino acid of the sequence or with the MAP core and following the Fmoc/tBu solid-phase peptide strategy [R. B. Merrifield J. Am. Chem. Soc. 1963, 85, 2149; E. Atherton et al. Oxford: IRL Press 1989; J. P. Tam Proc. Natl. Acad. Sci. USA 1988, 85, 5409]. Fmoc deprotections were carried out in 20 min with 20% piperidine in DMF. Coupling reactions were performed by treating the resin for 45 min with a 0.5 M solution of the Fmoc-protected amino acids and HOBt in DMF (2.5 equiv), a 0.5 M solution of TBTU in DMF (2.5 equiv), and 4 M NMM in DMF (5 equiv). Peptide cleavage from the resin and deprotection of the amino acid side chains were carried out in 3 h with TFA/thioanisole/ethanedithiol/phenol/H 2 O (82.5:5:2.5:5:5). The crude products were precipitated with cold Et 2 O, centrifuged, and lyophilized. The pure peptides were obtained by HPLC in a purity &gt;95% and characterized by mass spectrometry (ESI-Orbitrap and/or MALDI-TOF). 
       Example 2 
     ELISA for the Determination of Anti-Citrullinated Peptide Antibodies 
       [0066]    The MAP of the citrullinated peptide antigens according to the invention was diluted to a concentration of 10 μg/ml in phosphate buffered saline (PBS) and loaded into the wells of a polystyrene micro-titration plate (50 μl/well). The plate was left overnight at +4° C. to permit interaction between peptide and plastics; however, it may be incubated at 37° C. for 1-2 hours with the same result. Upon completion of the coating period, the wells containing the antigen, plus an equal number of wells which were used as controls, were treated for 1 hour at room temperature (RT) with 3% bovine serum albumin (BSA) in PBS. The patients&#39; serum samples (diluted 1:200 in a buffer constituted by 1% BSA, 0.05% Tween X-100 in PBS) were then loaded onto the plate (50 μl/well) and left to incubate for 3 hours at RT. After the incubation period, one washing was performed with 1% PBS Tween X-100 and two washings were performed with PBS (150 μl/well). An anti human-IgG, IgM or IgA antibody conjugated to the enzyme alkaline phosphatase in 1% PBS BSA, 0.05% Tween X-100, was used to show that the antigen/antibody reaction had taken place. The antibody (50 μl/well) was then incubated for 3 hours at RT with agitation. Upon completion of the incubation, after three washings as described above, the alkaline phosphatase substrate (p-nitrophenyl phosphate) was added to the wells and, in the presence of the enzyme, it produced a yellow product measurable by spectrophotometric techniques at a wavelength of 405 nm; its quantity was proportional to the titre of antibodies bound. The results of the test were expressed as the percentage of positivity, calculated by dividing the absorbance of each serum sample by the absorbance of a positive serum sample the value of which was set arbitrarily at 100. 
         [0067]    Serum samples of 97 patients suffering from RA and of 34 normal healthy subjects (NHS) were tested by this method using the peptide of formula III, IV, or V. 
         [0068]    A result that was greater than 97.5 th  percentile of the normal control sera group is defined as positive, data are reported in Table 1. 
         [0000]    
       
         
               
             
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 Number of positive sera over total sera tested 
               
               
                 for peptides of formula III, IV, and V. 
               
             
          
           
               
                   
                   
                 RA 
                   
               
               
                   
                 Formula 
                 (% RA positive sera) 
                 NHS 
               
               
                   
                   
               
               
                   
                 III 
                 20/97 (21%) 
                 2/34 
               
               
                   
                 IV 
                 10/97 (10%) 
                 2/34 
               
               
                   
                 V 
                 12/97 (12%) 
                 2/34 
               
               
                   
                   
               
             
          
         
       
     
         [0069]    Serum samples of 101 patients suffering from RA and of 48 NHS were tested by this method using the MAPs of formula VI, VII, or VIII. 
         [0070]    Moreover, 91 serum samples of disease controls other than RA (systemic sclerosis, mixed cryoglobulinemia, systemic lupus erythematosus, ankylosing spondylitis, and psoriatic arthritis) were tested by this method using MAPs of formula VI, VII or VIII, which showed the most interesting reactivities. 
         [0071]    A result that was greater than 97.5 th  percentile of the normal control sera group (NHS) is defined as positive, data are reported in Table 2. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 Number of positive sera over total sera tested for MAP 
               
               
                 peptides of formula VI, VII, and VIII. 
               
             
          
           
               
                 Formula 
                 RA positive sera 
                 NHS 
                 Ssc 
                 MC 
                 SLE 
                 AS 
                 PA 
               
               
                   
               
               
                 VI 
                 28/101 
                 2/48 
                 3/7 
                 1/12 
                 6/48 
                 5/12 
                 1/12 
               
               
                 VII 
                 65/101 
                 2/48 
                 1/7 
                 0/12 
                 3/48 
                 0/12 
                 0/12 
               
               
                 VIII 
                 61/101 
                 1/48 
                 0/7 
                 0/12 
                 1/48 
                 1/12 
                 0/12 
               
               
                   
               
               
                 *wherein: RA = rheumatoid arthritis, NHS = normal healthy subjects, Ssc = systemic sclerosis, MC = mixed cryoglobulinemia, SLE = systemic lupus erythematosus, AS = ankylosing spondylitis, PA = psoriatic arthritis. 
               
             
          
         
       
     
         [0072]    The overall sensitivity and specificity of the three assays are shown in the following Table 3. 
         [0000]    
       
         
               
             
               
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 Sensitivity and specificity of the assays based 
               
               
                 on the peptide of formula VI, VII, VIII. 
               
             
          
           
               
                   
                 Formula 
                 Sensitivity 
                 Specificity** 
               
               
                   
                   
               
               
                   
                 VI 
                 28% 
                 85% 
               
               
                   
                 VII 
                 65% 
                 96% 
               
               
                   
                 VIII 
                 60% 
                 98% 
               
               
                   
                   
               
               
                   
                 **Determined on the NHS and the disease control populations indicated in Table 2 
               
             
          
         
       
     
         [0073]    An epitope mapping of the full protein H4 was performed and the data showed that the N-terminal part, H4(1-50), comprising peptide of formula I differently citrullinated corresponded to the antigenic portion of the molecule. In particular, the citrullinated C-terminal portion of H4(1-50) is highly reactive and data reported in Tables 1-3 demonstrate that the sequences of formula III-VIII can be used to recognize RA sera. 
         [0074]    It is noteworthy that until now, histones and their citrullination have never been associated with RA, whereas reactivity towards antibodies present in SLE patients&#39; sera is well known [WO03044054]. Data reported in Table 3 demonstrate a very good sensitivity and specificity of sequences of formula VII and VIII for RA. Very interestingly and surprisingly, neither the MAP of formula VII nor the MAP of formula VIII showed a significant reactivity in detecting specific antibodies in SLE patients sera. Therefore, the authors of the present invention demonstrate the unexpected correlation between citrullinated peptide sequences comprising the H4(1-50) region and the specific recognition of autoantibodies in RA patients sera. Thus, such peptides are biomarkers of the disease. 
         [0075]    In addition, the sequences object of the present invention don&#39;t overlap any one of the proteins or peptides already used to detect anti-CP antibodies (e.g. fibrin, collagen II, vimentin, filaggrin, viral proteins, and synthetic OCPs). This demonstrates the innovative role of the peptide sequences derived from H4(1-50) to recognize anti-CP antibodies with 63-67% of sensitivity and 96-97% of specificity in the case of MAPs of formula VII and VIII. 
       Example 3 
     Diagnostic Properties of an ELISA Based on the Contemporary Use of the MAP of Formula VII and of the MAP of Formula VIII 
       [0076]    To achieve a highly sensitive immunoassay, an equimolar mixture of MAP of formula VII and MAP of formula VIII was allowed to adsorb to 96-wells microtitre plates for 4 h at r.t. The test was then performed as described in example 2. 
         [0077]    Analysing a second independent population of 147 RA patients tested for antibodies towards MAP peptides of formula VII and VIII, the authors found that:
        87/147 (59%) RA patients recognize the peptide of formula VII;    89/147 (61%) RA patients recognize the peptide of formula VIII.       
 
         [0080]    Analysing more in details this RA patients population positive either to peptide of formula VII or to peptide of formula VIII the authors found that:
        71/147 (48%) react with both peptides of formula VII and VIII;    16/147 (11%) sera are positive only to the peptide of formula VII;    18/147 (12%) sera are positive only to the peptide of formula VIII       
 
         [0084]    Thus, the combined use of citrullinated peptide MAP of formula VII and citrullinated MAP of formula VIII improves the diagnostic performances of the test in respect of the single peptide based assays. The combined use leads to a RA high sensitive diagnostic assay ( 105/147—71.5% RA positive sera) as the two antibody populations identified in RA sera are overlapped but different. 
       Example 4 
     Purification of Anti-Citrullinated Peptides Antibodies and Uses Thereof 
       [0085]    Anti-CP antibodies can be purified from serum of RA patients by means of affinity chromatography procedures. 
         [0086]    A citrullinated peptide or MAP according to the present invention was conjugated to CNBr-activated sepharose according to standard procedures known by one skilled in the art. Total immunoglobulins from sera containing anti-CP antibodies were precipitated with 50% saturated ammonium sulfate; the precipitates were dissolved in phosphate buffer (pH 7.4) and dialyzed overnight against PBS. Enriched immunoglobulin preparations were applied to the column, and the flow through was collected for subsequent analysis. The column was extensively washed with 20 mM Na 2 HPO 4 , 150 mM NaCl (pH 7.2), and the antibodies bound to the column were eluted by 0.1 M glycine buffer (pH 2.8) (0.5 ml/fraction), immediately neutralized with 50 μl Tris 1M (pH 8.0), and dialyzed overnight against PBS. The anti-CP antibody content in the eluates and flowthrough was tested by ELISA ( FIGS. 1 and 2 ). 
         [0087]      FIG. 1  shows that ACPA purification was achieved using the citrullinated peptide [Cit 17 ,Cit 19 ,Cit 23 ]H4(14-34) (formula IV). By contrast, the non citrullinated sequence H4(14-34) and the control MAP did not detect any IgG antibody in the two RA sera.  FIG. 2  shows that ACPA purification was also achieved using the citrullinated peptide [Cit 35 ,Cit 36 ,Cit 39 ,Cit 40 ,Cit 45 ]H4(31-50) (formula V). By contrast, the non citrullinated sequence H4(31-50) and the control MAP did not detect any IgG antibody in the two RA sera. 
         [0088]    Such purified antibodies can be used as controls in solid-phase assays using citrullinated antigens. 
       Example 5 
     Role of the Number and Position of Citrullines 
       [0089]    The role of the number and of the position of citrullines inside H4(1-50) sequence in the detection of specific antibodies in RA sera was investigated by means of differently citrullinated peptides ( FIGS. 3-4 ). 
         [0000]    
       
         
               
             
               
               
             
           
               
                 TABLE 4 
               
             
             
               
                   
               
               
                 Citrullinated peptides 
               
             
          
           
               
                 Sequence name 
                 Sequence 
               
               
                   
               
               
                 H4(14-34) 
                 GAKRHRKVLRDNIQGITKPAI 
               
               
                   
                 (aa 14 to aa 34 of SEQ ID 
               
               
                   
                 No. 1 wherein X 2 -X 4  are 
               
               
                   
                 arginine residues) 
               
               
                   
               
               
                 [Cit 17 ]H4(14-34) 
                 GAKCitHRKVLRDNIQGITKPAI 
               
               
                   
                 (aa 14 to aa 34 of SEQ ID 
               
               
                   
                 No. 1 wherein X 2  is Cit 
               
               
                   
                 and X 3 -X 4  are arginine 
               
               
                   
                 residues) 
               
               
                   
               
               
                 [Cit 19 ]H4(14-34) 
                 GAKRHCitKVLRDNIQGITKPAI 
               
               
                   
                 (aa 14 to aa 34 of SEQ ID 
               
               
                   
                 No. 1 wherein X 3  is Cit 
               
               
                   
                 and X 2  and X 4  are arginine 
               
               
                   
                 residues) 
               
               
                   
               
               
                 [Cit 23 ]H4(14-34) 
                 GAKRHRKVLCitDNIQGITKPAI 
               
               
                   
                 (aa 14 to aa 34 of SEQ ID 
               
               
                   
                 No. 1 wherein X 4  is Cit 
               
               
                   
                 and X 2  and X 3  are arginine 
               
               
                   
                 residues) 
               
               
                   
               
               
                 [Cit 17 , 
                 GAKCitHCitKVLRDNIQGITKPAI 
               
               
                 Cit 19 ]H4(14-34) 
                 (aa 14 to aa 34 of SEQ ID 
               
               
                   
                 No. 1 wherein X 2  and X 3   
               
               
                   
                 are Cit and X 4  is arginine) 
               
               
                   
               
               
                 [Cit 17 , 
                 GAKCitHRKVLCitDNIQGITKPAI 
               
               
                 Cit 23 ]H4(14-34) 
                 (aa 14 to aa 34 of SEQ ID 
               
               
                   
                 No. 1 wherein X 2  and X 4   
               
               
                   
                 are Cit and X 3  is arginine 
               
               
                   
               
               
                 [Cit 19 , 
                 GAKRHCitKVLCitDNIQGITKPAI 
               
               
                 Cit 23 ]H4(14-34) 
                 (aa 14 to aa 34 of SEQ ID 
               
               
                   
                 No. 1 wherein X 3  and X 4   
               
               
                   
                 are Cit and X 2  is arginine 
               
               
                   
               
               
                 [Cit 17 , Cit 19 , 
                 GAKCitHCitKVLCitDNIQGITKPAI, 
               
               
                 Cit 23 ]H4(14-34) 
                 formula IV 
               
               
                   
               
               
                 H4(31-50) 
                 KPAIRRLARRGGVKRISGLI 
               
               
                   
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 5 -X 9  are 
               
               
                   
                 arginine residues) 
               
               
                   
               
               
                 [Cit 35 ]H4(31-50) 
                 KPAICitRLARRGGVKRISGLI 
               
               
                   
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 5  is Cit and 
               
               
                   
                 X 6 -X 9  are arginine residues) 
               
               
                   
               
               
                 [Cit 36 ]H4(31-50) 
                 KPAIRCitLARRGGVKRISGLI 
               
               
                   
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 6  is Cit and 
               
               
                   
                 X 5  and X 7 -X 9  are arginine 
               
               
                   
                 residues) 
               
               
                   
               
               
                 [Cit 39 ]H4(31-50) 
                 KPAIRRLACitRGGVKRISGLI 
               
               
                   
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 7  is Cit and 
               
               
                   
                 X 5 -X 6  and X 8 -X 9  are arginine 
               
               
                   
                 residues) 
               
               
                   
               
               
                 [Cit 40 ]H4(31-50) 
                 KPAIRRLARCitGGVKRISGLI 
               
               
                   
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 8  is Cit and 
               
               
                   
                 X 5 -X 7  and X 9  are arginine 
               
               
                   
                 residues) 
               
               
                   
               
               
                 [Cit 45 ]H4(31-50) 
                 KPAIRRLARRGGVKCitISGLI 
               
               
                   
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 9  is Cit 
               
               
                   
                 and X 5 -X 8  are arginine 
               
               
                   
                 residues) 
               
               
                   
               
               
                 [Cit 35 , 
                 KPAICitRLARCitGGVKRISGLI 
               
               
                 Cit 40 ]H4(31-50) 
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 5  and X 8   
               
               
                   
                 are Cit and X 6 -X 7  and X 9   
               
               
                   
                 are arginine residues) 
               
               
                   
               
               
                 [Cit 36 , 
                 KPAIRCitLARCitGGVKRISGLI 
               
               
                 Cit 40 ]H4(31-50) 
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 6  and X 8   
               
               
                   
                 are Cit and X 5 , X 7  and X 9   
               
               
                   
                 are arginine residues) 
               
               
                   
               
               
                 [Cit 39 , 
                 KPAIRRLACitCitGGVKRISGLI 
               
               
                 Cit 40 ]H4(31-50) 
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 7  and X 8   
               
               
                   
                 are Cit and X 5 -X 6  and X 9   
               
               
                   
                 are arginine residues) 
               
               
                   
               
               
                 [Cit 40 , 
                 KPAIRRLARCitGGVKCitISGLI 
               
               
                 Cit 45 ]H4(31-50) 
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 8  and X 9   
               
               
                   
                 are Cit and X 5 -X 7  are 
               
               
                   
                 arginine residues) 
               
               
                   
               
               
                 [Cit 35 , Cit 36 , 
                 KPAICitCitLARCitGGVKRISGLI 
               
               
                 Cit 40 ]H4(31-50) 
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 5 , X 6  and X 8   
               
               
                   
                 are Cit and X 7  and X 9  are 
               
               
                   
                 arginine residues) 
               
               
                   
               
               
                 [Cit 35 , Cit 39 , 
                 KPAICitRLACitCitGGVKRISGLI 
               
               
                 Cit 40 ]H4(31-50) 
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 5 , X 7  and X 8   
               
               
                   
                 are Cit and X 6  and X 9  are 
               
               
                   
                 arginine residues) 
               
               
                   
               
               
                 [Cit 35 , Cit 40 , 
                 KPAICitRLARCitGGVKCitISGLI 
               
               
                 Cit 45 ]H4(31-50) 
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 5 , X 8  and X 9   
               
               
                   
                 are Cit and X 6  and X 7  are 
               
               
                   
                 arginine residues) 
               
               
                   
               
               
                 [Cit 36 , Cit 39 , 
                 KPAIRCitLACitCitGGVKRISGLI 
               
               
                 Cit 40 ]H4(31-50) 
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 6 , X 7  and X 8   
               
               
                   
                 are Cit and X 5  and X 9  are 
               
               
                   
                 arginine residues) 
               
               
                   
               
               
                 [Cit 36 , Cit 40 , 
                 KPAIRCitLARCitGGVKCitISGLI 
               
               
                 Cit 45 ]H4(31-50) 
                 (aa 31 to aa 50 of SEQ ID 
               
               
                   
                 No. 1 wherein X 6 , X 8  and X 9   
               
               
                   
                 are Cit and X 5  and X 7  are 
               
               
                   
                 arginine residues) 
               
               
                   
               
               
                 [Cit 35 , Cit 36 , 
                 KPAICitCitLACitCitGGVKRISGLI 
               
               
                 Cit 39 ,  
                 (aa 31 to aa 50 of SEQ ID 
               
               
                 Cit 40 ]H4(31-50) 
                 No. 1 wherein X 5 -X 8  are Cit 
               
               
                   
                 and X 9  is arginine) 
               
               
                   
               
               
                 [Cit 35 , Cit 36 , 
                 KPAICitCitLARCitGGVKCitISGLI 
               
               
                 Cit 40 ,  
                 (aa 31 to aa 50 of SEQ ID 
               
               
                 Cit 45 ]H4(31-50) 
                 No. 1 wherein X 5 -X 6  and X 8 -X 9   
               
               
                   
                 are cit and X 7  is arginine) 
               
               
                   
               
               
                 [Cit 35 , Cit 39 , 
                 KPAICitRLACitCitGGVKCitISGLI 
               
               
                 Cit 40 ,  
                 (aa 31 to aa 50 of SEQ ID 
               
               
                 Cit 45 ]H4(31-50) 
                 No. 1 wherein X 5 , X 7  and 
               
               
                   
                 X 8 -X 9  are Cit and X 6  is 
               
               
                   
                 arginine) 
               
               
                   
               
               
                 [Cit 36 , Cit 39 , 
                 KPAIRCitLACitCitGGVKCitISGLI 
               
               
                 Cit 40 ,  
                 (aa 31 to aa 50 of SEQ ID 
               
               
                 Cit 45 ]H4(31-50) 
                 No. 1 wherein X 6 -X 9  are Cit 
               
               
                   
                 and X 5  is arginine) 
               
               
                   
               
               
                 [Cit 35 , Cit 36 , 
                 KPAICitCitLACitCitGGVKCitISGLI, 
               
               
                 Cit 39 , Cit 40 , 
                 formula V 
               
               
                 Cit 45 ]H4(31-50) 
                   
               
               
                   
               
               
                 [Cit 3 , Cit 17 , 
                 SGCitGKGGKGLGKGGAKCitHCitK, 
               
               
                 Cit 19 ]H4(1-20) 
                 formula III 
               
               
                   
               
               
                 [Cit 23 ]H4(19-28) 
                 RKVLCitDNIQG 
               
               
                   
                 (aa 19 to aa 28 of SEQ ID 
               
               
                   
                 No. 1 wherein X 4  is Cit 
               
               
                   
                 and X 3  is arginine) 
               
               
                   
               
               
                 [Cit 19 , Cit 23 , 
                 CitKVLCitDNIQGITKPAICitCitLA 
               
               
                 Cit 35 ,  
                 (aa 19 to aa 38 of SEQ ID 
               
               
                 Cit 36 ]H4(19-38) 
                 No. 1 wherein X 3 -X 6  are Cit) 
               
               
                   
               
               
                 [Cit 23 , Cit 35 ,  
                 LCitDNIQGITKPAICitCitLACitCitG 
               
               
                 Cit 36 , Cit 39 ,  
                 (aa 22 to aa 41 of SEQ ID 
               
               
                 Cit 40 ]H4(22-41) 
                 No. 1 wherein X 4 -X 8  are Cit) 
               
               
                   
               
               
                 [Cit 23 , 
                 RKVLCitDNIQGKRQGCitTLYG 
               
               
                 Cit 95 ]H4 
                 SEQ ID No. 3 
               
               
                 (19-28)-(91-99) 
               
               
                   
               
             
          
         
       
     
         [0090]    Serum samples of 14 RA patients and 23 NHS were tested by ELISA using the method described in example 2. Results were analyzed determining the cutoff value as the OD mean of the NHS sera plus two standard deviations and then expressed as index (OD sample/OD cutoff). Results are positive if the index is above 1.0. The mean of the antibody titer for the RA and the NHS groups to the differently citrullinated peptides H4(14-34) and H4(31-50) is reported in  FIGS. 3 and 4 , respectively. 
         [0091]    For the sequence H4(14-34) it was found that at least two citrullines are necessary to discriminate between RA and NHS patients ( FIG. 3 ). As expected, the non citrullinated H4(14-34) did not show any reactivity. In addition, the introduction of a single citrulline residue in the H4(14-34) showed that one deiminated arginine is not enough to allow the detection of ACPA. This result suggests an active role of the amino acids flanking the citrulline in antibody recognition. 
         [0092]    By contrast, the introduction of two citrulline residues allows the discrimination between RA and NHS patients. 
         [0093]    In particular, the peptide [Cit 17 ,Cit 23 ]H4(14-34) is the most active di-citrullinated peptide. Therefore, for the sequence H4(14-34), the presence of two citrullines is the minimal requirement for the recognition of ACPA in RA sera. It should be noted that the best discrimination between RA and NHS sera is achieved when all the three arginine present in the H4(14-34) sequence are deiminated. 
         [0094]    Data reported in  FIG. 4  for H4(31-50) confirmed that the absence of citrullines did not allow to detect any ACPA and to discriminate between RA and NHS. The introduction of one citrulline showed a reactivity only for [Cit 40 ]H4(31-50), suggesting a possible role of deimination of position 40 in ACPA recognition. Among the di-citrullinated peptides, [Cit 35 ,Cit 40 ]H4(31-50) is the most reactive sequence. This finding strongly demonstrates the addictive effect of two citrullines. H4(31-50) derivatives containing three or four citrullines are able to discriminate between RA and NHS sera but are less preferred because not as sensitive as [Cit 35 ,Cit40]H4(31-50) and [Cit 35 ,Cit 36 ,Cit 39 ,Cit 40 ,Cit 45 ]H4(31-50) (formula V). 
       Example 6 
     Analysis of the Antigenic Determinants 
       [0095]    The presence of the antigenic determinants inside the H4(1-50) sequence was investigated using overlapping peptides selected in order to contain the maximum number of citrullines per sequence (Table 5 and  FIG. 5 ). 
         [0000]    
       
         
               
             
               
               
             
           
               
                 TABLE 5 
               
               
                   
               
               
                 Overlapping peptides used to define the antigenic  
               
               
                 determinants in H4(1-50). 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 [Cit 3 , Cit 17 ,  
                 SGXGKGGKGLGKGGAKXHXK 
               
               
                 Cit 19 ]H4(1-20) 
                   
               
               
                   
               
               
                 [Cit 17 , Cit 19 ,  
                              GAKXHXKVLXDNIQGITKPAI 
               
               
                 Cit 23 ]H4(14-34) 
                   
               
               
                   
               
               
                 [Cit 23 ]H4(19-28) 
                                   RKVLXDNIQG 
               
               
                   
               
               
                 [Cit 19 , Cit 23 , 
                                   XKVLXDNIQGITKPAIXXLA 
               
               
                 Cit 35 , Cit 36 ]H4(19-38) 
                   
               
               
                   
               
               
                 [Cit 23 , Cit 35 , Cit 36 , 
                                      LXDNIQGITKPAIXXLAXXG 
               
               
                 Cit 39 , Cit 40 ]H4(22-41) 
                   
               
               
                   
               
               
                 [Cit 35 , Cit 36 , Cit 39 , 
                                               KPAIXXLAXXGGVKXISGLI 
               
               
                 Cit 40 , Cit 45 ]H4(31-50) 
               
               
                   
               
               
                 X = Cit 
               
             
          
         
       
     
         [0096]    The study was performed on the linear peptides: [Cit 3 ,Cit 17 ,Cit 19 ]H4(1-20) (aa 1 to aa 20 of SEQ ID No. 1 wherein X 1 -X 3  are citrulline (Cit) residues, formula III), [Cit 17 ,Cit 19 ,Cit 23 ]H4(14-34) (aa 14 to aa 34 of SEQ ID No. 1 wherein X 2 -X 4  are citrulline (Cit) residues, formula IV), [Cit 23 ]H4(19-28) (aa 19 to aa 28 of SEQ ID No. 1 wherein X 4  is a citrulline residue), [Cit 19 ,Cit 23 ,Cit 35 ,Cit 36 ]H4(19-38) (aa 19 to aa 38 of SEQ ID No. 1 wherein X 3 -X 6  are a citrulline residue), [Cit 23 ,Cit 35 ,Cit 36 ,Cit 39 ,Cit 40 ]H4(22-41) (aa 22 to aa 41 of SEQ ID No. 1 wherein X 4 -X 8  are a citrulline residue), [Cit 35 ,Cit 36 ,Cit 39 ,Cit 40 ,Cit 45 ]H4(31-50) (aa 31 to aa 50 of SEQ ID No. 1 wherein X 5 -X 9  are citrulline (Cit) residues, formula V). 
         [0097]    Serum samples of 18 RA patients and 23 NHS were tested by ELISA using the method described in example 2. Results were analyzed determining the cutoff value as the OD mean of the NHS sera plus two standard deviations and then expressed as index (OD sample/OD cutoff). Results are positive if the index is above 1.0. The mean of the antibody titer for the RA and the NHS groups to peptides is reported in  FIG. 5 . 
         [0098]    Discrimination between RA and NHS sera was obtained with peptides of formulae III-V, but not with [Cit 19 ,Cit 23 ,Cit 35 ,Cit 36 ]H4(1 9-38) or [Cit 23 ,Cit 35 ,Cit 36 ,Cit 39 ,Cit 40 ]H4(22-41). Interestingly, the sequences [Cit 19 ,Cit 23 ,Cit 35 ,Cit 36 ]H4(19-38) and [Cit 23 ,Cit 35 ,Cit 36 ,Cit 39 ,Cit 40 ]H4(22-41) are less reactive although they contain more citrullines than [Cit 3 ,Cit 17 ,Cit 19 ]H4(1-20) and [Cit 17 ,Cit 19 ,Cit 23 ]H4(14-34). This result suggests the importance of the amino acids flanking the citrulline residues. The peptide [Cit 35 ,Cit 36 ,Cit 39 ,Cit 40 ,Cit 45 ]H4(31-50) (formula V) showed the best reactivity in this series. 
         [0099]    In this experiment, the peptide [Cit 23 ,Cit 95 ]H4(19-28)-(91-99), Arg 19 -Lys-Val-Leu-Cit-Asp-Asn-Ile-Gln-Gly 28 -Lys 91 -Arg-Gln-Gly-Cit-Thr-Leu-Tyr-Gly 99  (SEQ ID No. 4), was synthesized and tested on the same set of sera to compare its reactivity with the molecules object of the present invention and comprised in the H4(1-50) sequence. No significant discrimination between the RA and NHS sera was observed using [Cit 23 ,Cit 95 ]H4(19-28)-(91-99) or using the peptide [Cit 23 ]H4(19-28). This data suggest that the antigenic determinants in the histone H4 protein are located in the 1-50 region. 
         [0100]    Considering also the data reported in Table 3, the presence of two different antigenically effective domains can be hypothesized to be located inside the H4(1-50) in the 17-23 and 35-45 regions.