课件：科新公司幻灯.ppt

* This is an example of protein modification. Under certain conditions ( presence of the ezyme PAD) the amino acid arginine is converted to the aa citrulline and this confers antigenicity. In other words citrulline is a non standard aa as it is not incorporated into proteins during protein translation. It can however be generated by post-transitional modification of arginine residues by the enzyme PAD. * From a large cohort of samples the Dutch group reported that linear citrullinated peptides were highly specific for RA although the sensitivity was modest. * * In the next series of experiments the Dutch prepared cyclised citrullinated peptides to establish if this process could increase the sensitivity of CP in RA without impacting the specificity. They reported in 2000 that cyclic citrullinated peptides (CCP) were indeed superior to linear peptides (CP). * This table shows the improved sensitivity without loss of specificty of the CCP2 test versus the CCP1 test in RA and non-RA groups. There is also data available for RF and the key point is that CCP2 has similar sensitivity to RF but a much higher specificity. The RF test used here was a Nephlometric based assay. * This data was from Belgium where they compared CCP2 against RF and posed the question if the specificity of RF could be manipulated to be the same as anti-CCP2 what the sensitivity for RA would be. They reported that if both CCP2 and RF had a specificity of around 99% in early RA the sensitivity of RF IgM at this specificity would be 12.8% compared to 73.7% for anti-CCP2. * The sensitivity and specificity of CCP2 versus RF has been reported by several groups and all show superior perfromance of CCP2 against RF especially in terms of specificity. * A similar study was carried out in The Netherlands although the CCP testing was performed with the less sensitive First generation kit (CCP1). The data shows that although both Anti-CCP and RF were detected before the clinical symptoms a higher percent wer