High-Throughput Drug Screening Revealed That Ciclopirox Olamine Can Engender Gastric Cancer Stem-like Cells

Cancer stem cells (CSCs) are relevant therapeutic targets for cancer treatment. Still, the molecular circuits behind CSC characteristics are not fully understood. The low number of CSCs can sometimes be an obstacle to carrying out assays that explore their properties. Thus, increasing CSC numbers via small molecule-mediated cellular reprogramming appears to be a valid alternative tool. Using the SORE6-GFP reporter system embedded in gastric non-CSCs (SORE6-), we performed a high-throughput image-based drug screen with 1200 small molecules to identify compounds capable of converting SORE6- to SORE6+ (CSCs). Here, we report that the antifungal agent ciclopirox olamine (CPX), a potential candidate for drug repurposing in cancer treatment, is able to reprogram gastric non-CSCs into cancer stem-like cells via activation of SOX2 expression and increased expression of C-MYC, HIF-1α, KLF4, and HMGA1. This reprogramming depends on the CPX concentration and treatment duration. CPX can also induce cellular senescence and the metabolic shift from oxidative phosphorylation (OXPHOS) to glycolysis. We also disclose that the mechanism underlying the cellular reprogramming is similar to that of cobalt chloride (CoCl2), a hypoxia-mimetic agent.

Removal of mercury by silica-supported ionic liquids: Efficiency and ecotoxicological assessment

Anthropogenic impacts have affected the coastal environment and contributed to its contamination. Mercury (Hg) is widespread in nature and has been shown to be toxic in even the smallest amounts, negatively affecting not only the marine ecosystem but also the entire trophic chain due to its biomagnification. Mercury ranks third on the Agency for Toxic Substances and Diseases Registry (ATSDR) priority list and it is therefore imperative to develop more effective methods than those currently available to avoid the persistence of this contaminant in aquatic ecosystems. The present study aimed to evaluate the effectiveness of six different silica-supported ionic liquids (SIL) in removing Hg from contaminated saline water, under realistic conditions ([Hg] = 50 µg/L), and to ecotoxicologically evaluate the safety of the SIL-remedied water, using as test model the marine macroalga Ulva lactuca. The results revealed that SIL [Si][C3C1im][SCN] (250 mg/L) was the most effective in removing Hg from solution, with a efficiency up to 99 % in just 6 h, that enable to obtain < 1 µg/L Hg (European guideline in drinking water). U. lactuca exposed to either the SIL and/or the remedied water showed no significant changes in relative growth rate and chlorophyll a and b levels, compared to the control condition. Biomarker analysis (LPO, GSH, GSSG, SOD, GPx, CAT and GRed) also showed no significant changes in the biochemical performance of U. lactuca. Therefore, it could be assumed that water treatment with SIL or its presence in an aqueous environment does not pose toxicity levels that could inhibit the metabolism or cause cell damage to U. lactuca.

Factors influencing sorption of trace elements in contaminated waters onto ground nut shells

Biosorbent materials such as nut shells has been considered a promising alternative to the classic methods to remove potentially toxic elements from contaminated waters, improving water quality for other uses. The present study evaluated the sorption capacity of almond, hazelnut, pistachio and walnut shells for the single and simultaneous removal of As, Cd, Co, Hg, Ni, Pb and Zn from contaminated waters. The influence of key parameters such as sorbent dose, ionic strength (ultrapure water vs. mineral water), element competition (mono-vs. multi-element spiked solution) and initial element concentration (maximum allowed value in wastewater discharges and ten times lower) was assessed. Hazelnut shells stood out as the material with higher potential to remove Cd, Co, Hg, Ni, Pb and Zn in the tested conditions, achieving up to 99% of removal (Cd and Pb). Arsenic was not removed by none of the studied materials and the removal of Cr was only obtained in a simple matrix and in mono-element solution (41% of removal). An increase of matrix complexity negatively affected the sorption capacity of all the biosorbents in the removal of all the elements tested. The same behavior was obtained when the elements were simultaneously present in solution, with Pb, Cd and Hg being highly influenced by the presence of other elements. The increase in sorbent dose from 1 to 5 g/L allowed to at least duplicate the removal of Cd, Co, Ni and Zn by all the biosorbents. When decreasing the initial element concentration ten times the maximum allowed value in wastewater discharges, a significant increase of elements removal was attained, more pronounced for Hg and Pb. The possibility to change initial conditions towards high efficiencies validate the high potential of those biosorbents to be used in water remediation, with special focus on hazelnut shells, although other sorbents such as walnut or almond shells can be considered efficient with appropriate initial conditions and depending on the target elements to be removed.

Nutshells as Efficient Biosorbents to Remove Cadmium, Lead, and Mercury from Contaminated Solutions

The release of potentially toxic elements into the environment, and their effects on aquatic ecosystems still present a real threat. To avoid such contamination, the use of biological sorbents as an alternative to conventional and expensive water remediation techniques has been proposed. The present study evaluated the potential of 0.5 g L-1 of peanut, hazelnut, pistachio, walnut, and almond shells to remove the requisite concentrations of cadmium (Cd), lead (Pb), and mercury (Hg) from contaminated water. Hazelnut shells were identified as the sorbent with the highest potential and were evaluated in mono- and multi-contaminated mineral water. The influence of sorbent-intrinsic and solution-intrinsic characteristics were assessed. Differences among sorbents were attributed to varying percentages of their main components: cellulose, hemicellulose, and lignin. Matrix complexity increase caused a decrease in Cd removal, presumably due to the diminution in electrostatic interaction, and complexation with anions such as Cl-. When simultaneously present in the solution, contaminants competed, with Pb showing higher affinity to the sorbent than Hg. High efficiencies (>90%) obtained for hazelnut shells for all elements in ultrapure water and for Pb and Hg in mineral water) reveals the high potential of this low-cost and abundant waste for use in the remediation of contaminated waters (circular economy).

The Relevance of Transcription Factors in Gastric and Colorectal Cancer Stem Cells Identification and Eradication

Gastric and colorectal cancers have a high incidence and mortality worldwide. The presence of cancer stem cells (CSCs) within the tumor mass has been indicated as the main reason for tumor relapse, metastasis and therapy resistance, leading to poor overall survival. Thus, the elimination of CSCs became a crucial goal for cancer treatment. The identification of these cells has been performed by using cell-surface markers, a reliable approach, however it lacks specificity and usually differs among tumor type and in some cases even within the same type. In theory, the ideal CSC markers are those that are required to maintain their stemness features. The knowledge that CSCs exhibit characteristics comparable to normal stem cells that could be associated with the expression of similar transcription factors (TFs) including SOX2, OCT4, NANOG, KLF4 and c-Myc, and signaling pathways such as the Wnt/β-catenin, Hedgehog (Hh), Notch and PI3K/AKT/mTOR directed the attention to the use of these similarities to identify and target CSCs in different tumor types. Several studies have demonstrated that the abnormal expression of some TFs and the dysregulation of signaling pathways are associated with tumorigenesis and CSC phenotype. The disclosure of common and appropriate biomarkers for CSCs will provide an incredible tool for cancer prognosis and treatment. Therefore, this review aims to gather the new insights in gastric and colorectal CSC identification specially by using TFs as biomarkers and divulge promising drugs that have been found and tested for targeting these cells.

Dual nanofibrillar-based bio-sorbent films composed of nanocellulose and lysozyme nanofibrils for mercury removal from spring waters

The present study explores the preparation of dual nanofibrillar-based bio-sorbent films composed of cellulose nanofibrils (CNFs) and lysozyme nanofibrils (LNFs) for application in the removal of Hg(II) from aqueous solutions. The free-standing films were fabricated via simple vacuum filtration of water suspensions of CNFs and LNFs and disclose good mechanical and thermal properties. The Hg(II) removal efficiency was evaluated by atomic fluorescence spectroscopy in ultra-pure and natural spring waters contaminated with environmental realistic levels of mercury (50 μg L^-1). The removal efficiency is pH-dependent reaching a maximum of 99 % after 24 h at a pH value close to the isoelectric point of the protein. Under the experimental conditions, the sorption kinetics are well described by the pseudo-second-order and Elovich models, suggesting a chemisorption mechanism. These results demonstrate the ability of the dual nanofibrillar-based films to remove Hg(II) from water samples reaching a residual concentration lower than the guideline value for water intended for human consumption (1 μg L^-1). Therefore, the CNFs/LNFs bio-sorbents might be a solution to treat low-concentrated mercury-contaminated waters.

Simultaneous removal of trace elements from contaminated waters by living Ulva lactuca

This work shows the capabilities of living seaweed, Ulva lactuca, to remove As, Cd, Pb, Cu, Cr, Hg, Mn and Ni from contaminated waters. Experiments were performed with three algal doses (1.5, 3.0 and 6.0 g L^-1, FW), two ionic strengths (salinity 15 and 35), and trace element concentrations corresponding to the maximum allowed values in wastewaters. The highest removals were obtained with the algal dose of 6 g L^-1, with efficiencies varying between 48% for As and 98% for Hg, after 24 to 72 h. Salinity showed no effect on the removal efficiency. Overall, Elovich model was the best in describing the kinetics of the process, except for Hg, where pseudo-second-order model performed better. The use of extractions with EDTA (0.001, 0.01 to 0.1 mol L^-1) has clarified that most of the Hg (≈98%) and Cr (≈80%) crossed the macroalgae walls, while Ni, Cd and As were retained at the surface (between 60 and 80%). These results support the hypothesis that macroalgae-based technologies may be a viable, cost-effective, and greener option to reduce the rejection of priority hazardous substances in contaminated waters.

Rare earth elements in mud volcano sediments from the Gulf of Cadiz, South Iberian Peninsula

Eight gravity cores (GC) were retrieved from the deep mud volcanoes Sagres, Bonjardim, Soloviev and Porto in the Gulf of Cadiz. Cores with 137 to 317 cm long were sliced in intervals of 15 to 20 cm thickness, and 46 samples were analyzed for grain size distribution, loss on ignition, Al, Fe, Ca, Mg, Mn, Sr, Ba and the rare earth elements (REE) La, Ce, Pr, Nd, Sm, Eu, Gd, Dy, Ho, Er, Tm, Yb and Lu. REE profile normalized to Post-Archean Australian Average Shale (PAAS) was dominated by a mid-REE bulge with a pronounced Eu enhancement. Sediment reducing conditions resulting from the anaerobic oxidation of methane probably contributed to the positive-Eu anomaly (1.18-2.19, PAAS normalization). Most likely, reactions near the sulfate-methane transition zone such as the precipitation of barium sulfate found at layers around 50-cm depth explain the enhancement of Eu/Eu* ratios. The Ce anomalies (0.93-1.09) were almost absent.

Major, minor, trace and rare earth elements in sediments of the Bijagós archipelago, Guinea-Bissau

Sixty sediment samples from four sites in the Bijagós archipelago were characterized for fine fraction, loss on ignition, major, minor and trace elemental composition (Al, Fe, Ca, Mg, Ti, P, Zr, Mn, Cr, Sr, Ba, B, V, Li, Zn, Ni, Pb, As, Co, U, Cu, Cs and Cd), and the elements of the La-Lu series. Element concentrations were largely explained by the Al content and the proportion of fine fraction content, with the exception of Ca and Sr. Sediments showed enhanced Ti, U, Cr, As and Cd concentrations with respect to estimated upper crust values, most likely mirroring a regional signature. Rare earth elements were in deficit relatively to the North American Shale Composite (NASC), mainly in coarser material. No pronounced Ce-anomaly was observed, while Eu-anomalies were positive in most analyzed sediments.

Evidence for contrasting accumulation pattern of cadmium in relation to other elements in Senilia senilis and Tagelus adansoni from the Bijagós archipelago, Guinea-Bissau

Shellfish harvesting in intertidal areas is a widespread and economically important activity in many countries across West Africa. However, in some areas, there is virtually no information concerning the levels of contaminants (and other elements related to nutritional aspects) in the harvested species. We collected sediments and several individuals of the West African bloody cockle Senilia senilis and of the razor clam Tagelus adansoni during the dry season of 2015 nearby three islands in the Bijagós archipelago, Guinea-Bissau. Aluminium, Ca, Fe, Mg, As, Cd, Co, Cr, Cu, Mn, Ni, Pb and Zn were determined in sediments and whole soft tissues of the two bivalves. Sediments showed uniformly low trace element concentrations, pointing to an ecosystem with low levels of trace element contamination. T. adansoni presented higher concentrations of most elements than S. senilis, with the exception of Cd that showed up to 40 times higher values in S. senilis than in T. adansoni from the same sites. Furthermore, Cd concentrations (25±8.7 mg kg^-1, dw) in S. senilis are clearly above the maximum level established for human consumption. Future studies should clarify whether biological factors are the major responsible for this unusual situation.

A macroalgae-based biotechnology for water remediation: Simultaneous removal of Cd, Pb and Hg by living Ulva lactuca

Metal uptake from contaminated waters by living Ulva lactuca was studied during 6 days, under different relevant contamination scenarios. In mono-metallic solutions, with concentrations ranging from 10 to 100 μg L^-1 for Hg, 10-200 μg L^-1 for Cd, and 50-1000 μg L^-1 for Pb, macroalgae (500 mg L^-1, d.w.) were able to remove, in most cases 93-99% of metal, allowing to achieve water quality criteria regarding both surface and drinking waters. In multi-metallic solutions, comprising simultaneously the three metals, living macroalgae still performed well, with Hg removal (c.a. 99%) not being significantly affected by the presence of Cd and Pb, even when those metals were in higher concentrations. Removal efficiencies for Cd and Pb varied between 57 and 96%, and 34-97%, respectively, revealing an affinity of U. lactuca toward metals: Hg > Cd > Pb. Chemical quantification in macroalgae, after bioaccumulation assays demonstrated that all Cd and Hg removed from solution was really bound in macroalgae biomass, while only half of Pb showed to be sorbed on the biomass. Overall, U. lactuca accumulated up to 209 μg g^-1 of Hg, up to 347 μg g^-1 of Cd and up to 1641 μg g^-1 of Pb, which correspond to bioconcentration factors ranging from 500 to 2200, in a dose-dependent accumulation. Pseudo-first order, pseudo-second order and Elovich models showed a good performance in describing the kinetics of bioaccumulation, in the whole period of time. In the range of experimental conditions used, no mortality was observed and U. lactuca relative growth rate was not significantly affected by the presence of metals. Results represent an important contribution for developing a macroalgae-based biotechnology, applied for contaminated saline water remediation, more "green" and cost-effective than conventional treatment methods.

Bioaccumulation of Hg, Cd and Pb by Fucus vesiculosus in single and multi-metal contamination scenarios and its effect on growth rate

Results of 7-days exposure to metals, using environmentally realistic conditions, evidenced the high potential of living Fucus vesiculosus to remove Pb, Hg and Cd from contaminated salt waters. For different contamination scenarios (single- and multi-contamination), ca 450 mg L-1 (dry weight), enable to reduce the concentrations of Pb in 65%, of Hg in 95% and of Cd between 25 and 76%. Overall, bioconcentration factors ranged from 600 to 2300. Elovich kinetic model described very well the bioaccumulation of Pb and Cd over time, while pseudo-second-order model adjusted better to experimental data regarding Hg. F. vesiculosus showed different affinity toward studied metals, following the sequence order: Hg > Pb > Cd. Analysis of metal content in the macroalgae after bioaccumulation, proved that all metal removed from solution was bound to the biomass. Depuration experiments reveled no significant loss of metal back to solution. Exposure to contaminants only adversely affected the organism's growth for the highest concentrations of Cd and Pb. Findings are an important contribute for the development of remediation biotechnologies for confined saline waters contaminated with trace metal contaminants, more efficient and with lower costs than the traditional treatment methods.

Reflected Light from Giant Planets in Habitable Zones: Tapping into the Power of the Cross-Correlation Function

The direct detection of reflected light from exoplanets is an excellent probe for the characterization of their atmospheres. The greatest challenge for this task is the low planet-to-star flux ratio, which even in the most favourable case is of the order of 10-4 in the optical. This ratio decreases even more for planets in their host's habitable zone, typically lower than 10-7. To reach the signal-to-noise level required for such detections, we propose to unleash the power of the Cross Correlation Function in combination with the collecting power of next generation observing facilities. The technique we propose has already yielded positive results by detecting the reflected spectral signature of 51 Pegasi b (see Martins et al. 2015). In this work, we attempted to infer the number of hours required for the detection of several planets in their host's habitable zone using the aforementioned technique from theoretical EELT observations. Our results show that for 5 of the selected planets it should be possible to directly recover their reflected spectral signature.

Estimation of mercury background values in sediment and biota of the Bijagós archipelago, Guinea-Bissau

This work evaluates the mercury (Hg) contamination status (sediments and biota) of the Bijagós archipelago, off the coast of Guinea-Bissau. Sediments exhibited very low concentrations (<1-12ngg(-1)), pointing to negligible sources of anthropogenic Hg in the region. Nevertheless, Hg is well correlated to the fine fraction, aluminium, and loss on ignition, indicating the effect of grain size and organic matter content on the presence of Hg in sediments. Mercury in the bivalves Tagelus adansoni and Senilia senilis did not vary considerably among sites, ranging within narrow intervals (0.09-0.12 and 0.12-0.14μgg(-1) (dry weight), respectively). Divergent substrate preferences/feeding tactics may justify slight differences between species. The value 11ngg(-1) is proposed as the sediment background concentration for this West-African coastal region, and concentrations within the interval 8-10ngg(-1) (wet weight) may be considered as reference range for S. senilis and T. adansoni in future monitoring studies.

Comparative study on metal biosorption by two macroalgae in saline waters: single and ternary systems

The biosorption capability of two marine macroalgae (green Ulva lactuca and brown Fucus vesiculosus) was evaluated in the removal of toxic metals (Hg, Cd and Pb) from saline waters, under realistic conditions. Results showed that, independently of the contamination scenario tested, both macroalgae have a remarkable capacity to biosorb Hg and Pb. In single-contaminant systems, by using only c.a. 500 mg of non-pre-treated algae biomass (size <200 μm) per litter, it was possible to achieve removal efficiencies between 96 and 99 % for Hg and up to 86 % for Pb. Despite the higher removal of Hg, equilibrium was reached more quickly for Pb (after 8 h). In multi-contaminant systems, macroalgae exhibited a similar selectivity toward the target metals: Hg > Pb> > Cd, although Pb removal by U. lactuca was more inhibited than that achieved by F. vesiculosus. Under the experimental conditions used, none of the macroalgae was effective to remove Cd (maximum removal of 20 %). In all cases, the kinetics of biosorption was mathematically described with success. Globally, it became clear that the studied macroalgae may be part of simple, efficient, and cost-effective water treatment technologies. Nevertheless, Fucus vesiculosus has greater potential, since it always presented higher initial sorption rates and higher removal efficiencies.

A Pragmatic Bayesian Perspective on Correlation Analysis : The exoplanetary gravity - stellar activity case

We apply the Bayesian framework to assess the presence of a correlation between two quantities. To do so, we estimate the probability distribution of the parameter of interest, ρ, characterizing the strength of the correlation. We provide an implementation of these ideas and concepts using python programming language and the pyMC module in a very short (∼ 130 lines of code, heavily commented) and user-friendly program. We used this tool to assess the presence and properties of the correlation between planetary surface gravity and stellar activity level as measured by the log([Formula: see text]) indicator. The results of the Bayesian analysis are qualitatively similar to those obtained via p-value analysis, and support the presence of a correlation in the data. The results are more robust in their derivation and more informative, revealing interesting features such as asymmetric posterior distributions or markedly different credible intervals, and allowing for a deeper exploration. We encourage the reader interested in this kind of problem to apply our code to his/her own scientific problems. The full understanding of what the Bayesian framework is can only be gained through the insight that comes by handling priors, assessing the convergence of Monte Carlo runs, and a multitude of other practical problems. We hope to contribute so that Bayesian analysis becomes a tool in the toolkit of researchers, and they understand by experience its advantages and limitations.

Core-shell magnetite-silica dithiocarbamate-derivatised particles achieve the Water Framework Directive quality criteria for mercury in surface waters

The sorption capacity of nanoporous titanosilicate Engelhard titanosilicate number 4 (ETS-4) and silica-coated magnetite particles derivatised with dithiocarbamate groups towards Hg(II) was evaluated and compared in spiked ultra-pure and spiked surface-river water, for different batch factors. In the former, and using a batch factor of 100 m(3)/kg and an initial Hg(II) concentrations matching the maximum allowed concentration in an effluent discharge, both materials achieve Hg(II) uptake efficiencies in excess of 99 % and a residual metal concentration lower than the guideline value for drinking water quality. For the surface-river water and the same initial concentration, the Hg(II) uptake efficiency of magnetite particles is outstanding, achieving the quality criteria established by the Water Framework Directive (concerning Hg concentration in surface waters) using a batch factor of 50 m(3)/kg, while the efficiency of ETS-4 is significantly inferior. The dissimilar sorbents' Hg(II) removal efficiency is attributed to different uptake mechanisms. This study also highlights the importance of assessing the effective capacity of the sorbents under realistic conditions in order to achieve trustable results.

Removal of mercury (II) by dithiocarbamate surface functionalized magnetite particles: application to synthetic and natural spiked waters

In order to take advantage of the high affinity between mercury and sulphur, magnetite (Fe(3)O(4)) particles functionalized with dithiocarbamate groups (CS(2)(-)), were synthesized to be used as a new type of sorbent to remove Hg (II) from synthetic and natural spiked waters. The effectiveness of this type of sorbent was studied, and its potential as cleanup agent for contaminated waters was assessed. Batch stirred tank experiments were carried out by contacting a volume of solution with known amounts of functionalized Fe(3)O(4) particles, in order to study the effect of sorbent dose, salinity, and the kinetics and the equilibrium of this unit operation. A complete Hg (II) removal (ca. 99.8%) was attained with 6 mg/L of magnetic particles for an initial metal concentration of 50 μg/L. It was confirmed that highly complex matrices, such as seawater (ca. 99%) and river water (ca. 97%), do not affect the removal capacity of the functionalized magnetic particles. Concerning isotherms, no significant differences were observed between two- and three-parameter models (P = 0.05%); however, Sips isotherm provided the lowest values of SS and S(x/y), predicting a maximum sorption capacity of 206 mg/g, in the range of experimental conditions under study. The solid loadings measured in this essay surmount the majority of the values found in literature for other type of sorbents.

Silica coated magnetite particles for magnetic removal of Hg2+ from water

The magnetic removal of Hg(2+) from water has been assessed using silica coated magnetite particles. The magnetite particles were first prepared by hydrolysis of FeSO(4) and their surfaces were modified with amorphous silica shells that were then functionalized with organic moieties containing terminal dithiocarbamate groups. Under the experimental conditions used, the materials reported here displayed high efficiency for Hg(2+) uptake (74%) even at contaminant levels as low as 50 μg l(-1). Therefore these eco-nanomagnets show great potential for the removal of heavy metal ions of polluted water, via magnetic separation.

Helicobacter pylori genotypes may determine gastric histopathology

The outcome of Helicobacter pylori infection has been associated with specific virulence-associated bacterial genotypes. The present study aimed to investigate the gastric histopathology in Portuguese and Colombian patients infected with H. pylori and to assess its relationship with bacterial virulence-associated vacA, cagA, and iceA genotypes. A total of 370 patients from Portugal (n = 192) and Colombia (n = 178) were studied. Corpus and antrum biopsy specimens were collected from each individual. Histopathological features were recorded and graded according to the updated Sydney system. H. pylori vacA, cagA, and iceA genes were directly genotyped in the gastric biopsy specimens by polymerase chain reaction and reverse hybridization. Despite the significant differences between the Portuguese and Colombian patient groups, highly similar results were observed with respect to the relation between H. pylori genotypes and histopathology. H. pylori vacA s1, vacA m1, cagA+ genotypes were significantly associated with a higher H. pylori density, higher degrees of lymphocytic and neutrophilic infiltrates, atrophy, the type of intestinal metaplasia, and presence of epithelial damage. The iceA1 genotype was only associated with epithelial damage in Portuguese patients. These findings show that distinct H. pylori genotypes are strongly associated with histopathological findings in the stomach, confirming their relevance for the development of H. pylori-associated gastric pathology.

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).

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 < 0.001, respectively) and vacA m1 genotypes (P = 0.007 and P < 0.001, respectively). Duodenal ulcers were associated with vacA s1 (P < 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 < 0.001), gastric ulcer (P = 0.009) and gastric carcinoma (P < 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.