Correlation of the Helicobacter pylori adherence factor BabA with duodenal ulcer disease in four European countries

Infection by Helicobacter pylori expressing the BabA adhesin is influenced by the secretor phenotype

Helicobacter pylori (Hp) infects half the world's population and causes diverse gastric lesions, from gastritis to gastric cancer. Our aim was to evaluate the significance of secretor and Lewis status in infection and in vitro adherence by Hp expressing BabA adhesin. We enrolled 304 Hp-infected individuals from Northern Portugal. Gastric biopsies, blood and saliva were collected. Polymerase chain reaction (PCR) and immunofluorescence were used to detect BabA+ Hp in gastric biopsies. In vitro adherence by a BabA expressing Hp strain to gastric biopsies was performed. Secretor status was identified by Ulex, a lectin that recognizes secretor-dependent glycan structures in saliva and in gastric mucosa, and by Lewis(a/b) antibodies, and indirectly by identification of an inactivating mutation in the FUT2 gene (G428A). BabA status of infecting Hp was associated with CagA and VacAs1 (p < 0.05), intercellular localization of Hp (p < 0.01) and the presence of intestinal metaplasia (p < 0.05) and degenerative alterations (p < 0.005) in the biopsies. BabA was associated (p < 0.05) with Ulex staining of gastric biopsies and, although not significantly, to absence of homozygosity for FUT2 G428A inactivating polymorphism. In vitro Hp adherence was higher in cases wild-type or heterozygous for FUT2 G428A mutation (p < 0.0001), cases staining for Ulex (p < 0.0001) and a(-)b+ and a(-)b(-) secretor phenotypes (p < 0.001). In conclusion, BabA+ Hp infection/adhesion is secretor-dependent and associated with the severity of gastric lesions.

Expression of Helicobacter pylori virulence factors and associated expression profiles of inflammatory genes in the human gastric mucosa

Helicobacter pylori virulence factors have been suggested to be important in determining the outcome of infection. The H. pylori adhesion protein BabA2 is thought to play a crucial role in bacterial colonization and in induction of severe gastric inflammation, particularly in combination with expression of CagA and VacA. However, the influence of these virulence factors on the pathogenesis of H. pylori infection is still poorly understood. To address this question, the inflammatory gene expression profiles for two groups of patients infected with triple-negative strains (lacking expression of cagA, babA2, and vacAs1 but expressing vacAs2) and triple-positive strains (expressing cagA, vacAs1, and babA2 but lacking expression of vacAs2) were investigated. The gene expression patterns in the antrum gastric mucosa from patients infected with different H. pylori strains were very similar, and no differentially expressed genes could be identified by pairwise comparisons. Our data thus suggest that there is a lack of correlation between the host inflammatory responses in the gastric mucosa and expression of the babA2, cagA, and vacAs1 genes.

Helicobacter pylori BabA expression, gastric mucosal injury, and clinical outcome

BACKGROUND & AIMS

The blood grou.

METHODS

We compared the ability of published PCR-based methods to assess BabA status with BabA immunoblotting and Lewis b (Le(b)) binding activity assays. We also used immunoblotting to examine the relationship between clinical presentation and levels of BabA expression.

RESULTS

Immunoblotting and Le(b) binding assays for 80 strains revealed 3 levels of BabA expression: BabA high producers (BabA-H) with Le(b) binding activity, BabA low producers (BabA-L) without Le(b) binding activity, and BabA-negative. BabA-negative strains lacked the babA gene. PCR methods to determine BabA status yielded poor results. babA1 sequences were never detected. BabA expression was examined in 250 strains from Western countries and 270 strains from East Asia. The results failed to confirm any relationship between triple-positive status (cagA-positive/vacA s1/BabA-H) and clinical outcome. BabA-negative strains typically were cagA-negative/vacA s2 and were associated with gastritis. BabA-L strains showed a higher level of mucosal injury and were associated more frequently with duodenal ulcer and gastric cancer than the other groups.

CONCLUSIONS

Information gained from currently used PCR-based methods must be interpreted with caution. Le(b) binding activity does not accurately reflect the severity of mucosal damage or the clinical outcome. Quantitation of BabA expression revealed that Le(b)-nonbinding BabA-L strains are associated with higher levels of mucosal injury and clinical outcome.

Inflammation, immunity, vaccines for Helicobacter infection

The reason why some individuals remain Helicobacter pylori infected for life but without any symptoms while others develop severe diseases is only partially clarified. Presumably, it depends on multifactorial interactions among host immunologic and physiologic factors, bacterial virulence determinants, and environmental influences modulating the host response. Much effort has been made to identify host genetic factors that may explain an individual susceptibility of the host to H. pylori infection. The identification of H. pylori determinants and the elucidation of their role in modifying the host immune responses were further delineated. The ability of H. pylori to overcome the defense mechanisms on mucosal surfaces as well as to modulate the immune response by interfering with host recognition and transduction systems has been shown. Also new bacterial anti-inflammatory defense systems have been described. Findings in experimental animal models and humans with natural H. pylori infection suggested a double role of regulatory T cells in the course of H. pylori infection: protecting the infected host against excessive gastric inflammation and, in contrast, promoting bacterial colonization.

Multiple chromosomal loci for the babA gene in Helicobacter pylori

Helicobacter pylori babA encodes an outer membrane protein that binds to fucosylated Lewis b blood group antigen. We analyzed a panel of 35 H. pylori strains and identified three possible chromosomal loci for babA. There was a significant association between the presence of babA and the presence of cagA (P = 0.0001). Phylogenetic analysis of babA alleles revealed two divergent families of signal sequences. Among 17 strains in which an intact in-frame babA allele was identified, 10 expressed a detectable BabA protein. Expression of a BabA protein and the Lewis b-binding phenotype were not dependent on the chromosomal locus of babA. These data indicate that there is marked heterogeneity among H. pylori strains in babA genetic content and BabA expression.

Helicobacter pylori adhesion to carbohydrates

Adherence of bacterial pathogens to host tissues contributes to colonization and virulence and typically involves specific interactions between bacterial proteins called adhesins and cognate oligosaccharide (glycan) or protein motifs in the host that are used as receptors. A given pathogen may have multiple adhesins, each specific for a different set of receptors and, potentially, with different roles in infection and disease. This chapter provides strategies for identifying and analyzing host glycan receptors and the bacterial adhesins that exploit them as receptors, with particular reference to adherence of the gastric pathogen Helicobacter pylori.