The Difference of Serum Gastrin-17 Level Based on Gastritis Severity and Helicobacter Pylori Infection

BACKGROUND

Gastritis was defined as the histological presence of gastric mucosal inflammation. One of the most common aetiology was H. pylori. Gastrin-17 was a hormone that was secreted by G cells. H. pylori infection induced increased in gastrin-17 in gastritis. Therefore, this study was to investigate the relationship of gastrin-17 with gastritis severity and H. pylori infection.

AIM

To determine the difference in serum Gastrin-17 level based on gastritis severity and H. pylori infection.

METHODS

A cross-sectional study enrolling 45 patients with gastritis was conducted in Haji Adam Malik General Hospital between April and July 2018. Endoscopy and biopsy examinations were performed to confirm the diagnosis of gastritis. Gastritis severity was assessed using the Updated Sydney System. The presence of H. pylori infection was detected by a Campylobacter-like organism (CLO) examination. Gastrin-17 level and demographic data were also gathered. The analysis was done using Mann Whitney and Kruskal-Wallis test. P-value of < 0.05 was considered statistically significant.

RESULTS

Serum Gastrin-17 level was significantly different based on gastritis severity (P = 0.001 according to neutrophils infiltration and P = 0.023 according to degree of atrophy), H. pylori infection (P = 0.038), and combined gastritis severity and H. pylori infection (P < 0.001). Serum Gastrin-17 level was higher in subjects with severe neutrophils infiltration, without atrophy, and with H. pylori infection.

CONCLUSION

There was a significant difference in serum Gastrin-17 level based on gastritis severity and H. pylori infection.

Immunopathological and Modulatory Effects of Cag A+ Genotype on Gastric Mucosa, Inflammatory Response, Pepsinogens, and Gastrin-17 Secretion in Iraqi Patients infected with H. pylori.Open Access Maced J Med Sci. 2018;6:794-802. [PMID: 29875848 DOI: 10.3889/oamjms.2018.178] [Cited by in Crossref: 4] OBJECTIVETo determine the immunopathological correlation between Cag A+ H. pylori-specific IgG; pepsinogen I&II (PI&PII); gastrin-17 (G-17); status of gastric and duodenal mucosa and inflammatory activities on different gastroduodenal disorders.METHODOLOGYEighty gastroduodenal biopsies were taken from patients with gastroduodenal disorders for histopathological evaluation and H. pylori diagnosis. Serum samples were used for evaluation of gastric hormones and detection of H. pylori-specific IgG antibodies. The tissue expression of H. pylori Cag A gene was detected by in situ hybridisation.RESULTSH. pylori IgG antibodies were detected in (88.8%) of enrolled patients. According to Cag A gene expression, Significant difference (P value ˂ 0.05) was detected in levels of PG I; PGII, PG I/PG II among patients with gastric disorders. Serum G-17 level was negatively correlated with Cag A gene expression (P-value = 0.04). There was a significant correlation between H. pylori IgG and PG I; PG II; G-17. The current study revealed that corpus atrophic gastritis was diagnosed histologically with (5%) gastric ulcer cases; (3.75%) of duodenal ulcer cases; (3.75%) of duodenitis cases; (1.25%) of gastropathy cases and (8.75%) of gastritis cases. At the same time H. pylori gastritis diagnosed concurrently with (8.75%) of gastric ulcer cases; (11.25%) of duodenal ulcer cases; (17.5%) of gastropathy cases; (3.75%) of duodenitis cases and (2.5%) of prepyloric ulcer cases. A significant correlation was reported between the Immunopathological status of gastric mucosa and endoscopic mucosal finding among duodenal ulcer cases and gastritis cases only. A positive correlation was reported between serum levels of PGI; PGII; PGI/PGII; G-17; PMNs grade and Immunopathological status of the gastroduodenal mucosa of H. pylori Infected patients. A significant difference was reported in lymphocyte grades among gastric disorders without correlation with immunohistopathological changes in the mucosa (P-value = 0.002). A significant difference was reported in lymphocyte grades among different disorders according to H. pylori IgG. A significant difference was reported in serum level of PG I; PG II; PG I/PG II; G-17 according to PMN and lymphocyte grades (P-value ˂ 0.01). PMNs grades positively correlated with gastric Cag A expression; H. pylori IgG; PG II; G-17 levels. PG I; PG I/ PG II correlated with lymphocyte grades (P-value ˂ 0.05); while PGII has a negative correlation (P-value = 0.039).CONCLUSIONEndoscopic mucosal finding does not reflect exactly the actual immunopathological changes of gastric mucosa during H. pylori infection. Secretion of gastrin was not affected by the presence of Cag A in gastric tissue. Instead, the fluctuation in the hormone level appears to be due to the presence of H. pylori infection in gastric tissue. Gastric tissue infiltration with PMNs & lymphocytes inflammatory infiltrates has a direct effect on PGs and gastrin levels in serum of infected patients. The level of PG I; PG II; G-17 secretion correlated with the development of immune response against H. pylori and production of specific H. pylori IgG. Finally, H. pylori can modulate gastric secretions through Cag A dependent and independent pathways

OBJECTIVE

To determine the immunopathological correlation between Cag A+ H. pylori-specific IgG; pepsinogen I&II (PI&PII); gastrin-17 (G-17); status of gastric and duodenal mucosa and inflammatory activities on different gastroduodenal disorders.

METHODOLOGY

Eighty gastroduodenal biopsies were taken from patients with gastroduodenal disorders for histopathological evaluation and H. pylori diagnosis. Serum samples were used for evaluation of gastric hormones and detection of H. pylori-specific IgG antibodies. The tissue expression of H. pylori Cag A gene was detected by in situ hybridisation.

RESULTS

H. pylori IgG antibodies were detected in (88.8%) of enrolled patients. According to Cag A gene expression, Significant difference (P value ˂ 0.05) was detected in levels of PG I; PGII, PG I/PG II among patients with gastric disorders. Serum G-17 level was negatively correlated with Cag A gene expression (P-value = 0.04). There was a significant correlation between H. pylori IgG and PG I; PG II; G-17. The current study revealed that corpus atrophic gastritis was diagnosed histologically with (5%) gastric ulcer cases; (3.75%) of duodenal ulcer cases; (3.75%) of duodenitis cases; (1.25%) of gastropathy cases and (8.75%) of gastritis cases. At the same time H. pylori gastritis diagnosed concurrently with (8.75%) of gastric ulcer cases; (11.25%) of duodenal ulcer cases; (17.5%) of gastropathy cases; (3.75%) of duodenitis cases and (2.5%) of prepyloric ulcer cases. A significant correlation was reported between the Immunopathological status of gastric mucosa and endoscopic mucosal finding among duodenal ulcer cases and gastritis cases only. A positive correlation was reported between serum levels of PGI; PGII; PGI/PGII; G-17; PMNs grade and Immunopathological status of the gastroduodenal mucosa of H. pylori Infected patients. A significant difference was reported in lymphocyte grades among gastric disorders without correlation with immunohistopathological changes in the mucosa (P-value = 0.002). A significant difference was reported in lymphocyte grades among different disorders according to H. pylori IgG. A significant difference was reported in serum level of PG I; PG II; PG I/PG II; G-17 according to PMN and lymphocyte grades (P-value ˂ 0.01). PMNs grades positively correlated with gastric Cag A expression; H. pylori IgG; PG II; G-17 levels. PG I; PG I/ PG II correlated with lymphocyte grades (P-value ˂ 0.05); while PGII has a negative correlation (P-value = 0.039).

CONCLUSION

Endoscopic mucosal finding does not reflect exactly the actual immunopathological changes of gastric mucosa during H. pylori infection. Secretion of gastrin was not affected by the presence of Cag A in gastric tissue. Instead, the fluctuation in the hormone level appears to be due to the presence of H. pylori infection in gastric tissue. Gastric tissue infiltration with PMNs & lymphocytes inflammatory infiltrates has a direct effect on PGs and gastrin levels in serum of infected patients. The level of PG I; PG II; G-17 secretion correlated with the development of immune response against H. pylori and production of specific H. pylori IgG. Finally, H. pylori can modulate gastric secretions through Cag A dependent and independent pathways.

Serum pepsinogen concentration as an index for Helicobacter pylori eradication

AIM: To investigate the utilization of serum pepsinogen (PG) as an index for Helicobacter eradication.

METHODS: Serum PGI and PGⅡ concentrations were detected with immunoradiometric assay (IRMA) in 359 patients with H. pylori infection, who were treated for eradication by routine triple therapy, before and 1, 5 and 18 mos after treatment. Three methods were used to determine the result of eradication: HE staining, Hp-DNA PCR and ELISA analysis.

RESULTS: Compared to serum level before treatment, serum PGI and PGⅡ concentrations decreased significantly in the eradication group (64.52±31.74 vs 48.02±25.69 μg/L, P < 0.01; 11.22±6.12 vs 7.58±5.41 μg/L, P < 0.01), and PGI/II ratio also increased significantly (6.54±3.57 vs 7.96±4.39, P < 0.01). Serum PGI and PGⅡ levels decreased after eradication in different disease groups. 1 and 5 mos after treatment, serum PGI and PGⅡconcentrations in the eradication group were significantly lower than those before treatment (PGI: 66.83±28.04 vs 52.54±27.96 μg/L, P < 0.01; 11.85±4.91 vs 6.55±3.59 μg/L, P < 0.01; PGII: 60.19±29.30 vs 43.94±26.27 μg/L; 10.93±6.12 vs 6.66±5.30 μg/L, P < 0.01), and PGI/Ⅱratio were significantly higher than the latter (5.84±2.38 vs 8.95±4.61, P < 0.01; 6.60±4.21 vs 8.35±4.82, P < 0.01); The marked drop was found with PGI/Ⅱratio 18 mos after treatment (68.12±36.05 vs 50.11±23.50 μg/L, P < 0.01). There were no remarkable changes with serum PG concentrations in uneradication group.

CONCLUSION: Serum pepsinogen levels are suitable for determining the effect of H. pylori eradication. PGI/Ⅱ ratio can be used as a good marker for determination in the early eradication.

Preventive effects of gastric mucosal protective on H. pylori CCS-induced gastric mucosal lesion in rats

AIM: To determine the roles of H. pylori concentrated culture supernatants (CCS) on the gastric mucosa of mouse and to investigate the protective effects of gastric mucosal protectives sucrafate and sanjiuweitai on CCS-induced gastric mucosal lesion in Balb/c rats.

METHODS: Fifty-six healthy male Balb/c rats were randomly divided into seven groups: normal saline control (Ⅰ), injured simply (ⅡA, ⅡB), sucrafate pretreatment (ⅡA, ⅡB), sanjiuweitai pretreatment (ⅡA, ⅡB). Group A was dealt with small amounts of CCS and group B with large amounts of CCS. CCS were drawn from cytotoxic H. pylori strain (NCTC11637). The four protective groups were pretreated with sucrafate and sanjiuweitai separately, and then infused orally with different amounts of CCS. The pathological changes on histological sections and ultrastructural sections of gastric mucosa were assessed under microscope or electron microscope. The epithelial damage scoring (EDS) of the gastric mucosa was measured.

RESULTS: The management with large amounts of CCS from cytotoxic strains induced various epithelial lesions, which included vacuolation, erosions, ulcers and loss of gastric gland architecture. Infiltration of inflammatory cells in the lamina propria was not significant. At ultrastructural level, there was the presence of intracytoplasmic vacuoles, dilation of endoplasmic reticulum and mitochondrion, increasing of phagolysosomes, loose connection between cells and degenerative changes of microvilli. Small amounts of CCS from cytotoxic strain induced epithelial lesions less seriousey than large amounts of CCS. The results of the EDS of the gastric mucosa in the groups Ⅰ, ⅡA, ⅡB, ⅢA, ⅢB, ⅣA and ⅣB arranged successively as follows, 1.13±0.35, 2.25±0.46, 3.63±0.52, 1.25±0.46, 1.75±0.71, 1.50±0.53 and 1.63±0.74 respectively. A remarkable protection was found in gastric mucosa pretreated with sucrafate and sanjiuweitai. In comparison with the purely injured group, the EDS of the gastric mucosa descended significantly (P<0.05).

CONCLUSION: Cytotoxin has an important role in the induction of gastric mucosa lesions, but not in eliciting obvious inflammation; The gastric mucosal protection of sucrafate and sanjiuweitai against CCS-induced gastric mucosal lesion in rats is significant.

Expression of Helicobacter pylori Hsp60 protein and its immunogenicity

AIM: To express Hsp60 protein of H pylori by a constructed vector and to evaluate its immunogenicity.

METHODS: Hsp60 DNA was amplified by PCR and inserted into the prokaryotie expression vector pET-22b (+), which was transformed into BL21 (DE3) E.coli strain to express recombinant protein. Immunogenicity of expressed Hsp60 protein was evaluated with animal experiments.

RESULTS: DNA sequence analysis showed Hsp60 DNA was the same as GenBank’s research. Hsp60 recombinant protein accounted for 27.2% of the total bacterial protein, and could be recognized by the serum from H pylori infected patients and Balb/c mice immunized with Hsp60 itself.

CONCLUSION: Hsp60 recombinant protein might become a potential vaccine for controlling and treating H pylori infection.

Construction of hpaA gene from a clinical isolate of Helicobacter pylori and identification of fusion protein

AIM: To clone hpaA gene from a clinical strain of Helicobacter pylori and to construct the expression vector of the gene and to identify immunity of the fusion protein.

METHODS: The hpaA gene from a clinical isolate Y06 of H. pylori was amplified by high fidelity PCR. The nucleotide sequence of the target DNA amplification fragment was sequenced after T-A cloning. The recombinant expression vector inserted with hpaA gene was constructed. The expression of HpaA fusion protein in E.coli BL21(DE3) induced by IPTG at different dosages was examined by SDS-PAGE. Western blot with commercial antibody against whole cell of H. pylori as well as immunodiffusion assay with self-prepared rabbit antiserum against HpaA fusion protein were applied to determine immunity of the fusion protein. ELISA was used to detect the antibody against HpaA in sera of 125 patients infected with H. pylori and to examine HpaA expression of 109 clinical isolates of H. pylori.

RESULTS: In comparison with the reported corresponding sequences, the homologies of nucleotide and putative amino acid sequences of the cloned hpaA gene were from 94.25%-97.32% and 95.38%-98.46%, respectively. The output of HpaA fusion protein in its expression system of pET32a-hpaA-BL21(DE3) was approximately 40% of the total bacterial proteins. HpaA fusion protein was able to combine with the commercial antibody against whole cell of H. pylori and to induce rabbit producing specific antiserum with 1:4 immunodiffusion titer after the animal was immunized with the fusion protein. 81.6% of the serum samples from 125 patients infected with H. pylori (102/125) were positive for HpaA antibody and all of the tested isolates of H. pylori (109/109) were detectable for HpaA.

CONCLUSION: A prokaryotic expression system with high efficiency of H. pylorihpaA gene was successfully established. The HpaA expressing fusion protein showed satisfactory immunoreactivity and antigenicity. High frequencies of HpaA expression in different H. pylori clinical strains and specific antibody production in H. pylori infected patients indicate that HpaA is an excellent and ideal antigen for developing H. pylori vaccine.

Overexpression of c-fos in Helicobacter pylori-induced gastric precancerosis of Mongolian gerbil

AIM: To explore dysregulation of c-fos in several human malignancies, and to further investigate the role of c-fos in Helicobacter pylori (H. pylori)-induced gastric precancerosis.

METHODS: Four-week-old male Mongolian gerbils were employed in the study. 0.5 mL 1 × 10⁸ cfu·L^-1 suspension of H. pylori NCTC 11637 in Brucella broth were inoculated orally into 20 Mongolian gerbils. Another 20 gerbils were inoculated with Brucella broth as controls. 10 of the infected gerbils and 10 of the non-infected control gerbils were sacrificed at 25 and 45 weeks after infection. The stomach of each gerbil was removed and opened for macroscopic observation. The expression of c-fos was analyzed by RT-PCR and immunohistochemical studies in H. pylori-induced gastric precancerosis of Mongolian gerbil. Half of each gastric antrum mucosa was dissected for RNA isolation and RT-PCR. β-actin was used as the housekeeping gene and amplified with c-fos as contrast. PCR products of c-fos were analyzed by gel image system and the level of c-fos was reflected with the ratio of c-fos/β-actin. The immunostaining for c-fos was conducted using monoclonal antibody of c-fos and the StreptAvidin-Biotin-enzyme Complex kit.

RESULTS: H. pylori was constantly found in all infected animals in this study. After infection of H. Pylori for 25 weeks, ulcers were observed in the antral and the body of stomach of 60% infected animals (6/10). Histological examination showed that all animals developed severe inflammation, especially in the area close to ulcers, and multifocal lymphoid follicles appeared in the lamina propria and submucosa. After infection of H. Pylori for 45 weeks, severe atrophic gastritis in all infected animals, intestinal metaplasia in 80% infected animals (8/10) and dysplasia in 60% infected animals (6/10) could be observed. C-fos mRNA levels were significantly higher after infection of H. pylori for 25 weeks (1.84 ± 0.79), and for 45 weeks (1.59 ± 0.37) than those in control-animals (0.74 ± 0.22, P < 0.01). C-fos mRNA levels were increased 2.5-fold by 25th week (P < 0.01) and 2.1-fold by 45th week (P < 0.01) in precancerosis induced by H. pylori, when compared with normal gastric epithelium of Mongolian gerbil. Immunohistochemical staining revealed exclusive nuclear staining of c-fos. Furthermore, there was a sequential increase in c-fos positive cells from normal epithelium to precancerosis.

CONCLUSION: The study suggested that overexpression of c-fos occurs relatively early in gastric tumorigenesis in this precancerosis model induced by H. pylori.

Intravenous chemotherapy for resected gastric cancer: meta-analysis of randomized controlled trials

AIM: To assess the safety and efficacy of different intravenous chemotherapeutic regimens in patients with gastric carcinomas who had undergone gastrectomy.

METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. Language was restricted to Chinese and English. RCTs were identified from Medline and Embase (1980-2001/4), and Chinese Bio-medicine Database (1990-2001/1). Literature references were checked at the same time. We included randomized and quasi-randomized trials comparing the efficacy of intravenous chemotherapy after gastrectomy with that of surgery alone in patients with confirmed gastric carcinomas who had undergone gastrectomy. Selection criteria were: randomized or quasi-randomized trials with following-up results; Trials could be double-blind, single-blind or not blind; Chemotherapy groups were given intravenous chemotherapy after gastrectomy without neo-adjuvant chemotherapy, intraperitoneal hyperthermic perfusion, radiotherapy or chemoimmunotherapy; Controlled group included those receiving gastrectomy alone. The following data were extracted: the number of survival and death by the end of the follow-up; the different agents and doses of the intravenous chemotherapy; the baseline of the chemotherapy group and the controlled arm; the serious adverse events; the statistical consideration; cost-effectiveness analysis. The statistical analysis was performed by RevMan4.1 software which was provided by the Cochrane Collaboration. A P value of < 0.05 was considered statistically significant. Meta-analysis was done with random effects model. Heterogeneity was checked by chi-square test. Sensitivity analysis was performed by excluding the trials in which Jadad-scale was only 1 score. The result was expressed with odds ratio (OR) for the categorical variable.

RESULTS: Fourteen trials involving 4543 patients were included. Meta-analysis was done with random effects model Heterogeneity and sensitivity analysis were performed also. The effect of intravenous chemotherapy after gastrectomy was better than surgery alone (odds ratio 0.56, 95%CI 0.40-0.79). There was a significant difference between the two groups by u-test (P = 0.0008). Sensitivity analysis revealed the same difference (odds ratio 0.81, 95%CI 0.70-0.94). Of fourteen trials, only three studies were of high quality according to the Jadad-scale (with three score). There was one meta-analysis trial and the others, about ten trials, were of low quality. There was no trial which mentioned sample-size calculation, allocation concealment, intention-to-treat analysis. Most of the trials didn’t describe the blind-procedure. There were five trials which detailed the side-effects according to the toxicity grade by WHO standard. The side-effects halting treatment were haematologic and biochemical toxicity, debilitating nausea and vomiting. There were two patients died of chemotherapy toxicity.

CONCLUSION: Based on the review, intravenous chemotherapy after gastrectomy may have positive treatment effect on gastric cancer. However, the evidence is not strong because of the general low methodologic quality of the RCTs. Therefore, we can’t make the conclusion that intravenous chemotherapy after gastrectomy may have better treatment effect on gastric cancer than that of surgery alone. Rigorously designed, randomised, double-blind, placebo-controlled trials are required.

Localization of neurokinin B receptor in mouse gastrointestinal tract

AIM: To observe the location of neurokinin receptor (NK3r) in the mouse gastrointestinal tract.

METHODS: The abdomens of 8 male Kunming mice were opened under anaesthesia with sodium pentobarbital. The exposed gut organs were kept moisture and temperature at the same time. Then the esophagus, jejulum, ileum, colon, etc were respectively cut and the segments from the stomach to the distal colon were opened along the mesenteric border. A circular 4 mm-6 mm enteric part(pieces of 1 cm² were to be prepared) and mucosa and submucosa were removed, then the longitudinal muscle layer was pulled off from the circular muscle layer under microphotograph. They were rinsed in 50 nmol·L^-1 potassium phosphate-buffered saline(PBS). Immunohistochemistry and immunoreactive fluorescence were used in the staining procedures.

RESULTS: There was not NK3r-Like(-Li) positive material on the smooth muscle cells of the esophagus, stomach, and intestines and other regions. The nerve cell bodies with immunoreactivity for NK3r were mainly distributed in the submucousal nerve plexus or myenteric nerve plexus of the gastrointestinal tract except for the esophagus, stomach and rectum. The reaction product was located on the surface of the nerve cell plasma. It was occasionally observed in the cell plasma endosomes, but was very weakly stained. Among the NK3-like positive neurons in the plexus,the morphological type in many neurons appeared like Dogiel II type cells. Some neuron cell bodies were big, having many profiles, some were long ones or having grading structure. Cell body diameter was about 10 μm-46 μm and 8 μm-42 μm in myenteric plexus and submucous plexus.

CONCLUSION: This study not only described the distribution of neurokinin B receptor in the mouse gut in detail, but also provided a morphological basis for deducing the functional identity of the NK3r-LI immunoreactivity neurons, suggesting the possibility that these neurons were closely related to gastrointestinal tract contraction and relaxing activity.

Overexpression of cyclin E in Mongolian gerbil with Helicobacter pylori- induced gastric precancerosis

AIM: To explore dysregulation of cyclin E in malignancies, and to further investigate the role of cyclin E in Helicobacter pylori (H. pylori)-induced gastric precancerosis.

METHODS: Four-week-old specific pathogen-free male Mongolian gerbils were employed in the study. 0.5 mL 1 × 10⁸ cfu·L^-1 suspension of H. pylori NTCC11637 in Brucella broth was inoculated orally into each of 20 Mongolian gerbils, and a further 20 gerbils were inoculated with Brucella broth as controls. 10 of the infected gerbils and 10 of the non-infected control gerbils were sacrificed at 25, 45 wk after infection. The expression of cyclin E was analyzed by RT-PCR and immunohistochemical studies with monoclonal antibody to cyclin E in Mongolian gerbil of H. pylori-induced gastric precancerosis.

RESULTS: H. pylori was constantly detected in all infected animals throughout the study. At 25 wk after infection of H. pylori. ulcers were observed in the antral and body of stomach (n = 6). Histological examination showed that all animals developed severe inflammation and multifocal lymphoid follicles appeared in the lamina propria and submucosa of gastric antrum. At 45 wk after infection of H. pylori, severe atrophic gastritis (n = 10). intestinal metaplasia (n = 8) and dysplasia (n = 6) could be observed. Cyclin E mRNA levels were significantly more at 25 wk after infection of H. pylori (1.27 ± 0.26), and at 45 wk after infection of H. pylori ( 1.82 ± 0.39) than control-animals (0.59 ± 0.20,P < 0.01); cyclin E mRNA levels were evaluated by 2.2-fold at 25 wk (P < 0.01) and 3.1-fold at 45 wk (P < 0.01) precancerosis induced by H. pylori, when compared with control gastric epithelium of Mongolian gerbil. Immunohistochemical staining revealed exclusive nuclear staining of cyclin E. Furthermore, there was a sequential increase in cyclin E positive cells from normal epithelium to precancerosis.

CONCLUSION: Overexpression of cyclin E occurs relatively early in gastric tumorigenesis in this model.