Prevalence of Helicobacter pylori vacA, cagA and iceA genotypes in South African patients with upper gastrointestinal diseases

Clinical response to Helicobacter pylori infection may be determined by specific virulence-associated genotypes which varies geographically. The aim of this study was to investigate the diversity of putative virulence markers of H. pylori; cagA, vacA and iceA in the Eastern Cape Province of South Africa. One hundred H. pylori strains obtained from dyspeptic patients were used. Gastric biopsies were obtained from 254 dyspeptic patients. H. pylori was cultured and strains were studied. Bacterial genotypes cagA, vacA (s and m subtypes) and iceA were analysed by PCR using specific primers. CagA was identified in 90% of the strains investigated. Fifty-eight of the 100 strains had the vacA signal sequence genotype s1 and 26 had subtype s2. Combined vacA s1/s2 was detected in 16 of the strains. VacA middle region analysis showed that 8 (8%) strains were m1 while 50 were m2. Combined vacA m1/m2 was detected in 36 of the strains. s1m2 (20%) and s2m2 (20%) genotypes were the most common allelic combinations of the vacA gene among the strains. Multiple vacA genotypes were detected in this study. Twenty-six percent of the strains identified had both iceA1 and iceA2. All our strains tested positive for the ureC (glmM) gene. This study reveals a high prevalence of vacA, cagA and iceA2.     

Comparison of the Virulence Markers of Helicobacter Pylori and their Associated Diseases in Patients from Pakistan and Afghanistan

Background/Aim:

Helicobacter pylori is a Gram-negative bacteria, which is associated with development of gastroduodenal diseases. The prevalence of H. pylori and the virulence markers cytotoxin-associated gene A and E (cagA, cagE) and vacuolating-associated cytotoxin gene (vacA) alleles varies in different parts of the world. H. pylori virulence markers cagA, cagE, and vacA alleles in local and Afghan nationals with H. pylori-associated gastroduodenal diseases were studied.

Patients and Methods:

Two hundred and ten patients with upper gastrointestinal symptoms and positive for H. pylori by the urease test and histology were included. One hundred and nineteen were local nationals and 91 were Afghans. The cagA, cagE, and vacA allelic status was determined by polymerase chain reaction.

Results:

The nonulcer dyspepsia (NUD) was common in the Afghan patients (P = 0.025). In Afghan H. pylori strains, cagA was positive in 14 (82%) with gastric carcinoma (GC) compared with 29 (45%) with NUD (P = 0.006), whereas cagE was positive in 11 (65%) with GC and 4 (67%) with duodenal ulcer (DU) compared with 12 (18%) with NUD (P < 0.001 and 0.021, respectively). The vacA s1a/b1 was positive in 10 (59%) of GC compared with 20 (31%) in NUD (P = 0.033). In Pakistani strains, cagE was positive in 12 (60%) with GC, 7 (58%) with GU, 12 (60%) with DU compared with 11 (16%) with NUD (P < 0.001, 0.004, and < 0.001, respectively). In Pakistani strains, cagA/s1a/m1 was 39 (33%) compared with Afghans in 17 (19%) (P = 0.022). Moderate to severe mucosal inflammation was present in 51 (43%) Pakistani patients compared with 26 (28%) (P = 0.033) in Afghans. It was also associated with grade 1 lymphoid aggregate development in Pakistani patients 67 (56%) compared with 36 (40%) (P = 0.016) in Afghans.

Conclusion:

Distribution of H. pylori virulence marker cagE with DU was similar in Afghan and Pakistan H. pylori strains. Chronic active inflammation was significantly associated with Pakistani H. pylori strains.     

Reciprocal impact of host factors and Helicobacter pylori genotypes on gastric diseases

AIM: To assess the impact of Helicobacter pylori (H. pylori) genotypes and patient age and sex on the development of gastric diseases.METHODS: H. pylori-infected patients (n = 233) referred to the endoscopy unit at Tehran University of Medical Sciences (Tehran, Iran) were diagnosed with chronic gastritis (CG), gastric ulcer (GU), or duodenal ulcer (DU). Brucella blood agar was used for biopsy cultures and H. pylori isolation under microaerobic conditions. H. pylori isolates were confirmed with biochemical tests and through amplification of the 16S rRNA gene. DNA was extracted from fresh cultures of the H. pylori isolates and used for amplification of vacA alleles and the cagA gene. Statistical analysis was performed to determine the association between H. pylori genotypes, age (< 40 years vs > 40 years) and sex of the patient, and gastric diseases.RESULTS: CG was the most prevalent gastric disease (113/233; 48.5%), compared to GU (64/233; 27.5%) and DU (56/233; 24%). More patients were male, and gastric diseases were more frequent in patients > 40 years (P < 0.05). The percentage of CG and GU patients that were male and female did not show a significant difference; however DU was more common in males (P < 0.05). Interestingly, a diagnosis of CG in patients > 40 years was more common in females (18.5%) than males (11.6%) (P = 0.05), whereas a diagnosis of GU or DU in patients > 40 years was more frequent in males (14.6% vs 10.7% and 12.4% vs 4.3%, respectively). Overall, genotyping of the H. pylori isolates revealed that the vacA s1 (82%), vacA m2 (70%), and cagA⁺ (72.5%) alleles were more frequent than vacA s2 (18%), vacA m1 (29.2%), and cagA^- (all P < 0.05). The vacA s1m2cagA⁺ genotype was the most prevalent within the three disease groups. vacA s1m2 frequency was 56.2% with a similar occurrence in all diagnoses, while vacA s1m1 appeared more often in DU patients (33.9%). A genotype of vacA s2m2 occurred in 15% of isolates and was more common in CG patients (21.2%); vacA s2m1 was the least common genotype (3%). The vacA s1 allele was found to be a risk factor for DU, vacA s2 for CG, and vacA s1 and vacA s2 for GU (all P < 0.05). The vacA s2m2 genotype was associated with the development of CG and GU compared to DU (P < 0.05). No correlation was found between vacA m or cagA and gastric diseases.CONCLUSION: The outcome of H. pylori infection is the result of interaction between bacterial genotypes and the age and sex of infected individuals.     

Clinical Relevance of cagE Gene from Helicobacter pylori Strains in Japan

It has been reported that H. pylori-containing cagE was associated with duodenal ulcer. The aims of the present study were to clarify the association between the cagE gene and clinical outcome and to analyze the relationship between the cagE gene and two other virulence factors—cagA and vacA—in two areas in Japan (Fukui and Okinawa) where the prevalence of duodenal ulcer and gastric cancer risk are quite different. Eighty of 81 isolates possessed the cagE gene, and all isolates possessed the cagA gene. The vacA genotype s1c/m1 was a major genotype in both areas in Japan. There was no significant association between cagE, cagA status, or vacA genotype and clinical outcome. Phylogenetic analysis of the cagE gene indicated that most Japanese isolates formed a different cluster from strains isolated in the West with an association with the vacA genotype. In conclusion, the strains with cagE, cagA, and the s1c/m1 genotype of vacA are predominant in Japan regardless of clinical outcome and construct a different phylogenetic cluster from those in the West.     

Helicobacter pylori Genotypes and Expression of Gastritis in Erosive Gastro-oesophageal Reflux Disease

Background: Epidemiological studies suggest a negative association between Helicobacter pylori and gastro-oesophageal reflux disease (GORD). Moreover, cagA-positive strains are reported to protect from complications of GORD. The aim of this study was to determine virulence factors (cagA, vacA and iceA) of H. pylori strains and the pattern of gastritis in patients with GORD in comparison with patients with duodenal ulcer (DU) or functional dyspepsia (FD). Methods:H. pylori strains isolated from gastric biopsies of 105 consecutive patients with mild to moderate erosive GORD (n?=?35, LA grade A-B), and from sex- and age-matched patients with DU (n?=?35) or FD (n?=?35 without reflux symptoms) were investigated. CagA, vacA, and iceA genotypes were determined by PCR analysis of the isolates. Gastritis was classified in accordance with the updated Sydney classification. Results: The prevalence of all three H. pylori virulence factors was higher in patients with GORD (cagA[Formula: See Text] 80%, vacA s1 77%, iceA1 71%) and DU (cagA[Formula: See Text] 83%, vacA s1 80%, iceA1 74%) than in patients with FD (cagA[Formula: See Text] 40%, vacA s1 49%, iceA1 46%). Gastritis activity in the antrum and corpus did not differ between the three groups. However, lymphocytic infiltration of the gastric antral mucosa was more pronounced in DU patients than in those with GORD or FD. Conclusions:H. pylori strains obtained from patients with mild to moderate erosive GORD show a virulence pattern similar to that found in DU patients. The presence of these virulence factors does not appear to protect against erosive lesions in the oesophagus.     

Helicobacter pylori Genotypes Are Associated with Clinical Outcome in Portuguese Patients and Show a High Prevalence of Infections with Multiple Strains

Background: Clinical outcome of Helicobacter pylori infection is associated with virulence-associated bacterial genotypes. This study assessed the relationships between vacA, cagA and iceA genotypes and gastric diseases in Portuguese patients. Methods: A total of 319 patients were endoscoped and gastric biopsy specimens were studied by PCR and reverse hybridization (LiPA^TM). Results:vacA genotypes s1/ m1, s1/m2 and s2/m2 were observed in 53%, 14.5% and 32.5% of the cases, respectively. The majority (93.4%) of the s1 cases were s1b and 6.6% were s1a. Multiple vacA genotypes were found in 37.3% of the cases. Gastric ulcer and gastric carcinoma were associated with the presence of vacA s1 (P = 0.008 and P &lt; 0.001, respectively) and vacA m1 genotypes (P = 0.007 and P &lt; 0.001, respectively). Duodenal ulcers were associated with vacA s1 (P &lt; 0.001) but not with the vacA m genotype (P = 0.221). cagA was present in 71.2% of the cases and was associated with duodenal ulcer (P &lt; 0.001), gastric ulcer (P = 0.009) and gastric carcinoma (P &lt; 0.001). iceA1 was found in 27.3% and iceA2 in 32.3% of the cases. In 36.7% of the isolates both iceA alleles were found, and 3.8% were negative for iceA. The iceA genotype was not associated with clinical outcome. Conclusions:vacA s1 and cagA + H. pylori strains are associated with duodenal ulcer, gastric ulcer or gastric carcinoma. vacA m1 is associated with gastric ulcer or carcinoma but not with duodenal ulcer. Infection with multiple H. pylori strains is remarkably high in Portugal and is more frequent in duodenal ulcer patients.     

Ethnicity association of Helicobacter pylori virulence genotype and metronidazole susceptibility

AIM:To characterise the cag pathogenicity island in Helicobacter pylori(H.pylori) isolates by analysing the strains’ vacA alleles and metronidazole susceptibilities in light of patient ethnicity and clinical outcome.METHODS:Ninety-five H.pylori clinical isolates obtained from patients with dyspepsia living in Malaysia were analysed in this study.Six genes in the cagPAI region(cagE,cagM,cagT,cag13,cag10 and cag67) andvacA alleles of theH.pylori isolates were identified by polymerase chain reaction.The isolates’ metronidazole susceptibility was also determined using the E-test method,and the resistant gene was characterised by sequencing.RESULTS:More than 90% of the tested isolates had at least one gene in the cagPAI region,and cag67 was predominantly detected in the strains isolated from the Chinese patients,compared with the Malay and Indian patients(P < 0.0001).The majority of the isolates(88%) exhibited partial deletion(rearrangement) in the cagPAI region,with nineteen different patterns observed.Strains with intact or deleted cagPAI regions were detected in 3.2% and 8.4% of isolates,respectively.The prevalence of vacA s1m1 was significantly higher in the Malay and Indian isolates,whereas the isolates from the Chinese patients were predominantly genotyped as vacA s1m2(P = 0.018).Additionally,the isolates from the Chinese patients were more sensitive to metronidazole than the isolates from the Malay and Indian patients(P = 0.047).Although we attempted to relate the cagPAI genotypes,vacA alleles and metronidazole susceptibilities to disease outcome,no association was observed.The vacA alleles were distributed evenly among the strains with intact,partially deleted or deleted cagPAI regions.Interestingly,the strains exhibiting an intact cagPAI region were sensitive to metronidazole,whereas the strains with a deleted cagPAI were more resistant.CONCLUSION:Successful colonisation by different H.pylori genotypes is dependent on the host’s genetic makeup and may play an important role in the clinical outcome.     

Infection with Helicobacter pylori strains carrying babA2 and cagA is associated with an increased risk of peptic ulcer disease development in Iraq

Background and study aimSeveral genes of Helicobacter pylori, such as vacA, cagA, iceA and babA, have been reported to significantly increase the risk of gastrointestinal diseases. The aim of this study was to study the relationship between H. pylori virulence factors and clinical outcomes and identify the independent markers of peptic ulcer disease in Iraq.Patients and methodsDNA was extracted from specimens taken from 154 unselected H. Pylori positive Iraqi patients. Genotyping was performed by the polymerase chain reaction (PCR), using specific primers for cagA, vacA (s, m), iceA and babA2 genes.ResultsA total of 56 (82%) peptic ulcer disease (PUD) patients carried cagA+ strains, significantly more than the 56 (65%) non-ulcer disease (NUD) patients (p = 0.017). The difference in the prevalence of babA2 positivity was significant between patients with NUD (33.7%) and PUD (58.8%) (p = 0.002). In addition, babA2 was associated as an independent factor, with PUD (p = 0.005; odds ratio (OR) = 0.4; confidence interval (CI) = 0.18–0.68) followed by cagA (p = 0.05; OR = 0.4; CI = 0.18–0.85). Forty-five isolates (29%) were typed as ‘triple positive’ strains, and their presence was significantly associated with PUD (p = 0.001).ConclusionThe cagA and babA2 genotypes might be considered as useful markers for PUD patients. However, iceA1 and iceA2 seem not to be good markers for the disease. The presence of H. pylori strains with triple-positive status is of high clinical relevance to H. pylori-associated diseases.     

In vitro effect of amoxicillin and clarithromycin on the 3’ region of cagA gene in Helicobacter pylori isolates

AIM:To evaluate the in vitro effect of amoxicillin and clarithromycin on the cag pathogenicity island(cag PAI).METHODS:One hundred and forty-nine clinical isolates of Helicobacter pylori(H.pylori)cultured from gastric biopsies from 206 Colombian patients with dyspeptic symptoms from a high-risk area for gastric cancer were included as study material.Antimicrobial susceptibility was determined by the agar dilution method.Resistant isolates at baseline and in amoxicillin and clarithromycin serial dilutions were subjected to genotyping(cagA,vacA alleles s and m),Glu-Pro-Ile-Tyr-Ala(EPIYA)polymerase chain reaction and random amplified polymorphic DNA(RAPD).Images of the RAPD amplicons were analyzed by Gel-Pro Analyzer 4.5program.Cluster analyses was done using SPSS 15.0statistical package,where each of the fingerprint bands were denoted as variables.Dendrograms were designed by following Ward’s clustering method and the estimation of distances between each pair of H.pylori isolates was calculated with the squared Euclidean distance.RESULTS:Resistance rates were 4%for amoxicillin and 2.7%for clarithromycin with 2%double resistances.Genotyping evidenced a high prevalence of the genotype cagA-positive/vacA s1m1.The 3’region of cagA gene was successfully amplified in 92.3%(12/13)of the baseline resistant isolates and in 60%(36/60)of the resistant isolates growing in antibiotic dilutions.Upon observing the distribution of the number of EPIYA repetitions in each dilution with respect to baseline isolates,it was found that in 61.5%(8/13)of the baseline isolates,a change in the number of EPIYA repetitions lowered antibiotic pressure.The gain and loss of EPIYA motifs resulted in a diversity of H.pylori subclones after bacterial adjustment to changing conditions product of antibiotic pressure.RAPD PCR evidenced the close clonal relationship between baseline isolates and isolates growing in antibiotic dilutions.CONCLUSION:Antibiotic pressure does not induce loss of the cag pathogenicity island,but it can leadin most cases-     

Prevalence of Helicobacter pylori vacA, cagA, cagE, iceA and babA2 genotypes in Thai dyspeptic patients.

OBJECTIVES: To investigate the prevalence of the vacA, cagA, cagE, iceA, and babA2 genotypes in Helicobacter pylori strains isolated from Thai dyspeptic patients, and to determine whether any correlation exists between these genotypes and clinical manifestations. METHODS: Helicobacter pylori was examined in 112 patients (62 with non-ulcer dyspepsia (gastritis), 34 with peptic ulcer disease, and 16 with gastric cancer (GCA)), detected by culture or direct detection from gastric biopsies. Allelic variants of the vacA, cagA, cagE, iceA, and babA2 genotypes were identified by using the polymerase chain reaction. RESULTS: The positive rates for the vacAs1, vacAs2, cagA, cagE, iceA1, iceA2, and babA2 genes in H. pylori of dyspeptic patients were 100%, 0%, 98.2%, 88.4%, 45.5%, 33.1%, and 92%, respectively. The allelic variant vacAs1m1 was more prevalent (58%) than vacAs1m2 (42%). The cagA and cagE genes were commonly found together (87.5%). The most predominant genotypes were vacAs1m1, cagA, cagE, iceA1, and babA2. The various genes alone or in combination had no statistically significant association with the clinical outcomes (p>0.05). CONCLUSION: Neither single gene nor combination of vacA, cagA, cagE, iceA, and babA2 genes was significantly helpful in predicting the clinical outcome of H. pylori infection in Thai patients. The high prevalence of these genes in H. pylori isolated from Thai patient groups suggests that H. pylori strains are geographically dependent.     

幽门螺杆菌不同基因型和基因亚型与甲硝唑耐药性的研究

目的研究Helicobacter pylori菌株本身的毒力差异是否与H.pylori菌株对甲硝唑的敏感性有关。方法 用E-test方法检测109株H.pylori菌株对甲硝唑的敏感性;PCR检测H.pylori菌株不同的vacA基因亚型、cagA、iceA和babA2基因型。结果 云南地区甲硝唑耐药率为67.89％;vacA、cagA、iceAl、babA2基因的各种基因亚型和基因型在H.pylori菌株甲硝唑耐药率上无显著性差异。结论 H.pylori菌株本身的毒力差异与H.pylori菌株对甲硝唑的敏感性无关。     

Helicobacter pylori Endemic and Gastric Disease

H. pylori infection of the stomach is widespread among human populations including Iranians and is considered to play a major role in the pathogenesis of gastric diseases such as peptic ulcer, adenocarcinoma, and MALT lymphoma. The association between H. pylorivirulence markers and disease has been studied in other populations around the world. The aim of this study was to investigate the distribution of H. pylori vacA and cagA genotypes and their association with clinical outcomes in Iran. H. pylori was cultured from gastric biopsy specimens obtained from 137 Iranian patients (58 with duodenal ulcer, 61 with nonulcer dyspeptic [NUD], and 18 with gastric adenocarcinoma). The vacA alleles and cagA genotypes were determined by PCR. The vacA sl allele was present in 107 of the 137 subjects (78%). Multiple strains (m1 and m2) were detected in H. pylori isolates from the patients. VacA s1 genotypes were more frequent in patients with peptic ulcer (46/58; 79%) than in NUD patients (47/61; 77%). CagA was present in 44% of the patients. NUD patients had a frequency of cagA positivity similar to that of the overall population (46%). CagA was present more frequently more than cagA-negative (20% vs. 8%, respectively) in patients with gastric carcinoma (20%) than cagA-negative in patients with gastric carcinoma (8%). This is the first comprehensive study to demonstrate the frequency of colonization with mixed strain, vacA s1, m1 and m2 as the dominant genotype in these Iranian patients, where a high rate of H. pylori infection exists and is similar to the region with a low rate of H. pylori infection. Therefore, host genetics, environmental factors, and the substantial genetic heterogeneity among different H. pylori strains may contribute to the different clinical outcomes.     

Clinical implications and prevalence of cagA,cagE and cagT genes in the pathogenicity island of Helicobacter pylori strains isolated from Shanghai patients

OBJECTIVE : The cag pathogenicity island (cag PAI) has been reported to be the major factor controlling the virulence of Helicobacter pylori and has been associated with clinical outcome after H. pylori infection. The role of cag PAI genes in the pathogenicity of H. pylori infection remains to be established. The aim of the present study was to investigate: (i) the prevalence of cagA, cagE and cagT, the representative genes of cag PAI status, in H. pylori strains isolated from patients with various gastroduodenal diseases in the Shanghai region; and (ii) the relationship between the presence of these genes and different gastroduodenal diseases. METHODS : Ninety‐nine H. pylori strains were isolated from patients with chronic superficial gastritis (17), chronic atrophic gastritis (21), gastric ulcers (19), duodenal ulcers (23) and gastric cancer (19). The prevalence of the cagA, cagE, and cagT genes was studied in these strains by using the polymerase chain reaction (PCR) method. RESULTS : The total prevalences of cagA, cagE and cagT genes were 84.8, 99 and 84.8%, respectively, in the 99 strains of H. pylori tested. There was no significant difference in the prevalence of cagA, cagE or cagT in H. pylori isolated from different gastroduodenal diseases (all P > 0.05). Of the 98 cagE‐positive isolates, 14 (14.3%) were cagA negative. Only one of 99 isolates was negative for both cagE and cagA. Of the 84 cagT‐positive strains, two were cagA negative. CONCLUSIONS : Most of the H. pylori isolates in the Shanghai region may have intact cag PAI. It was found that cagE, but not cagA, could be used as a marker for the presence of cag PAI. There is no correlation between the integrity of cag PAI and the clinical outcome after infection with H. pylori.     

Effect of Helicobacter pylori and its Virulence Factors on Portal Hypertensive Gastropathy and Interleukin (IL)-8, IL-10, and Tumor Necrosis Factor-alpha Levels

Background/Aim:

We aimed to assess the influence of Helicobacter pylori and its virulent factors, cytotoxin associated gene (cag) A and E, on portal hypertensive gastropathy (PHG) and the levels of interleukin (IL)-8, IL-10, and tumor necrosis factor-alpha (TNF-α).

Patients and Methods:

The patients with cirrhosis underwent screening endoscopy and the lesions related to PHG were graded. Biopsies were obtained for histology, and polymerase chain reaction (PCR) of H. pylori 16S rRNA, cagA, cagE, and tissue cytokine levels was carried out. Absent or mild PHG was compared with moderate to severe PHG.

Results:

One hundred and forty patients with cirrhosis were studied; males numbered 92 and the mean age of the patients was 50.3 ± 12.0 years, H. pylori positivity in 87 (62.1%) patients was associated with male gender (P = 0.032), younger age (P = 0.029), hepatitis D etiology (P = 0.005), higher serum albumin (0.000), lower Child Pugh score (P = 0.001), and lower portal vein diameter (P = 0.001). There was no significant difference in the levels of TNF-α and IL-8. However, a decrease in the anti-inflammatory cytokine IL-10 was noted with moderate to severe gastropathy. Four H. pylori strains were positive for both cagA and cagE, while four were positive for cagA only. All the four patients with both virulent factors had mild gastropathy only.

Conclusion:

The presence of H. pylori infection neither affected the severity of PHG nor augmented the IL-8 and TNF-α levels. There was a decline of virulent H. pylori strains and IL-10 levels in patients with advanced PHG.     

Diversidad de los genotipos vacA y cagA de Helicobacter pylori y expresión de interferón gamma en pacientes con gastritis crónica y cáncer gástrico

BackgroundHelicobacter pylori (H. pylori) is the main risk factor for the development of chronic gastritis, gastric ulcer, and gastric cancer. In H. pylori-infected individuals, the clinical result is dependent on various factors, among which are bacterial components, the immune response, and environmental influence.AimsTo compare IFN-γ expression with the H. pylori vacA and cagA genotypes in patients with chronic gastritis and patients with gastric cancer.MethodsNinety-five patients diagnosed with chronic gastritis and 20 with gastric cancer were included in the study. Three gastric biopsies were taken; one was used for the molecular detection and genotyping of H. pylori; another was fixed in absolute alcohol and histologic sections were made for determining IFN-γ expression through immunohistochemistry.ResultsNo differences were found in the cells that expressed IFN-γ between the patients with chronic gastritis (median percentage of positive cells: 82.6% in patients without H. pylori and 82% in infected persons) and those with gastric cancer (70.5% in H. pylori-negative patients and 78.5% in infected persons). IFN-γ expression was 69% in chronic gastritis patients infected with H. pylori vacAs2m2/cagA^-, it was 86.5% in patients infected with H. pylori vacAs1m2/cagA^-, 86.5% in vacAs1m1/cagA^-, and 82% in vacAs1m1/cagA⁺. Similar data were found in the patients with gastric cancer.ConclusionsIFN-γ expression varied depending on the H. pylori vacA and cagA genotype, but not in accordance with the presence of chronic gastritis or gastric cancer.     

H pylori iceA alleles are disease-specific virulence factors

AIM: To characterize and compare genotype profiles of H pylori strains isolated from patients with chronic gastritis and duodenal ulcer in western part of Turkey. METHODS: A total of 46 patients [30 chronic gastritis (CG) and 16 duodenal ulcer (DU)] who had undergone endoscopy because of dyspeptic complaints were studied. The antral biopsy specimens were evaluated for the presence of H pylori by rapid urease test and culture, and the genotype profiles were determined by real-time PCR. RESULTS: The cagA gene was observed in 43 (93.5%) isolates. The vacA s1m2 genotype was the predominant subtype, found in 63.3% and 68.7% of isolates in patients with CG and DU, respectively. Twenty (66.6%) isolates from patients with CG were iceA2 positive while the iceA1 was predominant in those with DU (68.8%). In terms of the association of the iceA alleles to other genes, both alleles were significantly associated with the cagA vacA s1m2 genotype. CONCLUSION: The prevalent circulating genotypes in CG and DU were cagA vacA s1m2 iceA2 and cagA vacA s1m2 iceA1 genotype, respectively. It was found that cagA vacA s1m2 genotype seems to be common virulence factors in both CG and DU while iceA alleles show specificity for gastroduodenal pathologies in this study.     

cagA and vacA in strains of Helicobacter pylori from ulcer and non-ulcerative dyspepsia patients

Background

The cytotoxin associated gene A (cagA), and the vacuolating cytotoxin gene A (vacA) of Helicobacter pylori have been associated to phenotypic characteristics of virulence. The objectives of this study were to detect the presence of cagA and to characterize the allelic variants of vacA in 63 strains of H. pylori isolated from colonized individuals with different clinical outcomes.

Methods

38 strains were isolated from patients with non-ulcerative dyspepsia (NUD) and 25 were isolated from colonized individuals with peptic ulcers. The genotypic characterization was carried out utilizing PCR methodology. The presence of the cagA gene was detected using two set of primers from the middle conservative region of the cagA, and primers for the signal and middle region were used for the genotyping of vacA

Results

The presence of cagA showed similar rates in strains from peptic ulcers (60%) and NUD patients (55%). Also similar was the prevalence of the allelic form s1 of vacA between the strains obtained from ulcers or NUD patients. However, the combination cagA+/vacA s1m1 was found more frequently among the H. pylori strains from peptic ulcer patients (52%) than among strains isolated from NUD patients (26%), this difference was statistically significant (p = 0.035).

Conclusions

The presence of either cagA or the allelic variant s1 vacA alone do not have a predictive value as as a risk markers of severe gastric pathologies in the Chilean population. However, being infected by a H. pylori strain with the genotype cagA+/vacA s1m1 may be associated to an increased risk of acquiring a peptic ulcer disease.     

Evaluation of <Emphasis Type="Italic">Helicobacter?pylori vacA</Emphasis> Genotypes in Iranian Patients with Peptic Ulcer Disease

Helicobacter pylori is the major cause of active chronic gastritis and peptic ulcers in humans and has been linked to gastric carcinoma and lymphoma. The vacuolating cytotoxin vacA and cag pathogenicity island (cag PAI) are two identified virulence factors that are considered to have an important role in the pathogenesis of H. pylori infection. The aim of this study is to investigate the H. pylori vacA alleles in Iranian patients with peptic ulcer disease. In order to investigate this, biopsy specimens were obtained from 84 patients with gastric ulcer, gastritis, and duodenal ulcer. DNA extraction and PCR were used to detect the presence or absence of glmM, cagA and to assess the polymorphism of vacA. Of the 77 glmM PCR-positive biopsy specimens, 55 (71%) had the vacA signal sequence genotype s1, and 22 (29%) had subtype s2. vacA mid-region analysis revealed that 31 (40%) were vacA m1 and 46 (60%) were m2. The presence of the cagA gene correlated with vacA signal sequence type s1, whereas type s2 was predominantly found in cagA-negative samples (P < 0.001). Thus, the detection of vacA and cagA, virulence markers described in several clinical outcomes may be used to help the treatment and prevention of H. pylori in Iran.     

上海地区幽门螺杆菌菌株iceA、babA2基因型与临床的关系

目的检测上海地区幽门螺杆菌(Hp)感染患者中Hp菌株iceA、babA2的分布特征，探讨与Hp临床感染结局相关的菌株基因型。方法141株Hp菌株分离自43例慢性胃炎(CG)、47例十二指肠球部溃疡(DU)、30例胃溃疡(GU)和21例非贲门部胃癌患者的胃镜活检标本。采用PCR方法检测Hp菌株的iceA、babA2、cagA和vacA基因型。结果141株Hp菌株中，iceA1、iceA2和babA2的总检出率分别为74．5％(105／141)、15．6％(22／141)和63．8％(90／141)，其中2例(1．4％)为iceA1、iceA2均阳性，16例(11．3％)为iceA1、iceA2均阴性。DU组的babA2检出率显著高于GU组(74．5％比50．0％。P=0．028)，DU组的cagA^ ／babA2^ 检出率亦显著高于GU组(70．2％比46．7％，P=0．039)。其余疾病组之间的babA2检出率差异无显著性。未发现不同临床疾病与iceA基因型的相关性。结论上海地区Hp感染者的菌株基因型主要是iceA1^ ／babA2^ ，babA2在DU和GU的发病机制中起不同作用。未发现iceA亚型与Hp临床感染结局有相关性。