Encoded by the PADI4 gene on chromosome 1 (1p36.13), PAD4 is a 663-amino acid protein with a molecular weight of ~74 kDa .
Requires calcium ions for activation, binding five calcium ions per subunit .
Regulates epigenetic modifications by deiminating histones H3 and H4, counteracting arginine methylation .
Expressed in granulocytes, monocytes, neutrophils, and RA synovial tissues .
Prevalence: Detected in 22–45% of RA patients, compared to ≤13% in other autoimmune diseases (e.g., SLE, Sjögren’s syndrome) .
Association with Disease Features:
| Autoantibody | RA Patients (n=82) | First-Degree Relatives (n=147) |
|---|---|---|
| Anti-PAD4 | 29.3% | 1.4% |
| Anti-CCP | 84.0% | 27.1% |
| Rheumatoid Factor | 86.5% | 19.1% |
Enhancement of Citrullination: A subset of anti-PAD4 antibodies (e.g., anti-PAD3/4 cross-reactive) activate PAD4 by lowering its calcium requirement, amplifying citrullination and autoantigen production .
Immune Complex Formation: PAD4 antibodies may stabilize the enzyme or form immune complexes, contributing to chronic inflammation .
| Antibody Type | Function | Example Antibodies |
|---|---|---|
| Agonistic | Activate PAD4 at low calcium | hA288, hA362 |
| Inhibitory | Block enzymatic activity | hI281, hI364 |
| Neutral | Bind without functional impact | Not specified |
Early RA: Anti-PAD4-positive patients show greater improvement in DAS28 after treatment () .
Established RA: Anti-PAD4 predicts better response to tofacitinib ± methotrexate vs. methotrexate alone () .
| Parameter | Early RA (Anti-PAD4+) | Established RA (Anti-PAD4+) |
|---|---|---|
| Baseline Joint Damage | No association | Significant association |
| DAS28 Improvement | 22–23% greater | Comparable across treatments |
| Radiographic Progression | Not assessed | Reduced with biologics |
Here’s a structured collection of research-focused FAQs on PAD4 antibodies, synthesized from current literature and tailored for academic investigators:
Key considerations:
Contradiction: Smoking correlates with severe RA but shows no direct link to PAD4 antibody development (p = 0.04 for reduced smoking in anti-PAD3/4+ vs. PAD4– groups) .
Methodological adjustments:
Stratify analyses by antibody subtype (PAD4 mono-reactive vs. PAD3/4 cross-reactive).
Incorporate multi-omics (e.g., proteomics, transcriptomics) to disentangle gene-environment interactions.
Pre-adsorb sera with PAD3 protein to isolate PAD4-specific antibodies .
Validate findings using orthogonal methods (e.g., ELISA + immunoprecipitation).