{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:01:08Z","timestamp":1790834468719,"version":"4.1.0"},"reference-count":73,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The \u201cmucosal origins hypothesis\u201d posits that mucosal sites, such as the gut, are initial sites where immune responses first develop that may, months to years later, result in clinical rheumatoid arthritis (RA). Our goal here was to conduct a discovery-based, hypothesis-generating study using samples from a relatively small number of patients to implicate previously unrecognized highly IgA-coated commensal flora that may have a role in RA pathogenesis (primary outcome). The secondary supporting outcomes were to determine whether HLA-DR-presented microbial peptides from such flora could be identified in synovial tissue and to determine T and B cell responses to these peptides and citrullinated proteins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Highly IgA-coated bacteria taxa were identified in RA patients\u2019 stool samples by 16s rRNA sequencing; HLA-DR-presented peptides derived from the most common, highly IgA-coated microbes were identified from synovial tissue by liquid chromatography\u2013tandem mass spectrometry; T cell responses to the identified microbial and human mimic epitopes were determined by IFN\u03b3 ELISpot assays, and citrullinated IgG and IgA antibodies to implicated microbial and human proteins were measured by ELISA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 32 RA patients, 28 (88%) had highly IgA-coated\n                      <jats:italic>Akkermansia muciniphila<\/jats:italic>\n                      (\n                      <jats:italic>Am<\/jats:italic>\n                      ) in stool samples. HLA-DR presentation of peptides derived from two\n                      <jats:italic>Am<\/jats:italic>\n                      proteins, including the molecular chaperone DnaK protein (\n                      <jats:italic>Am<\/jats:italic>\n                      -cDnaK), was identified from RA synovial tissue, suggesting that the microbe or its components may reach the joints. Eight of 21 patients (38%) had T cell responses to the\n                      <jats:italic>Am<\/jats:italic>\n                      -cDnaK peptide and a human heat shock protein-mimic peptide (Hu-HSPA5) and\/or IgG antibodies to citrullinated forms of these proteins. Reactivity was found primarily in pre-RA and early RA soon after transition to clinical RA and less commonly during later flares of arthritis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      These data implicate\n                      <jats:italic>Am<\/jats:italic>\n                      as a candidate gut commensal involved in RA pathogenesis and may serve as a compass for planning larger studies to test the hypothesis that\n                      <jats:italic>Am<\/jats:italic>\n                      , as well as certain other highly IgA-coated commensal flora or their components, may sometimes reach joints where they initiate or enhance autoimmune T cell responses via epitope mimicry and epitope spreading, leading to antibody responses to citrullinated host proteins in joints.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1917757","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:41:42Z","timestamp":1790833302000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Identification of Akkermansia muciniphila as a candidate gut commensal involved in the pathogenesis of rheumatoid arthritis"],"prefix":"10.3389","volume":"17","author":[{"given":"Lucy M.","family":"Curham","sequence":"first","affiliation":[{"name":"Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Korawit","family":"Kanjana","sequence":"additional","affiliation":[{"name":"Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General 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