Interestingly, dysbiosis of gut microbiota was described not only in RA1, 22 but also in APS.23 This dysbiosis induces not only protein citrullination22 but also a conformational change of β2GPI, that exposes a cryptic epitopes in domain I of β2GPI23 and therefore aβ2GPI synthesis.24 The gene discussed is APOH; the disease is autoimmune polyendocrinopathy.