Local and systemic immune response in Helicobacter pylori-associated chronic gastritis before and after treatment.
Ten patients with Helicobacter pylori-associated chronic gastritis were given combination therapy for 6 weeks with a bismuth subnitrate-containing compound and bacampicillin. The eradication rate was 40% 6 weeks after the end of treatment. Two patients remained H. pylori-negative at long-term follow-up after 6 and 17 months; that is, H. pylori was only eradicated in 20% of the patients after long-term observation. By dot blot and immunoblotting both urease and an urease-associated heat shock protein (HSP62) were found to be specific and constant immunodominant H. pylori antigens. The immunohistologic pattern showed induced expression of HLA-DR and HSP62, but not of ICAM-1, in all but two biopsy specimens of gastric epithelial cells. This study suggests i) that long-term observation is important when evaluating the efficacy of anti-H. pylori therapy; ii) that the immune defense mechanisms in the gastric mucosa differ from those in inflammatory conditions affecting other organs, where ICAM-1 and HLA-DR seem to be governed by a common regulator; and iii) that the immunopathologic effects of H. pylori may be caused by autologous and/or bacterial HSPs, which act as triggering factors in the development and persistence of the chronic inflammation in the gastric mucosa.
Engstrand
L
L
Dept. of Clinical Microbiology, University Hospital, Uppsala, Sweden.
Gustavsson
S
S
Schwan
A
A
Scheynius
A
A
D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D015815:Cell Adhesion Molecules / Q000032:analysis; D002908:Chronic Disease; D005260:Female; D005756:Gastritis / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology; D006684:HLA-DR Antigens / Q000032:analysis; D006360:Heat-Shock Proteins / Q000032:analysis; D016481:Helicobacter Infections / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D007150:Immunohistochemistry; D018799:Intercellular Adhesion Molecule-1; D008297:Male; D008875:Middle Aged
D015703:Antigens, CD; D015815:Cell Adhesion Molecules; D006684:HLA-DR Antigens; D006360:Heat-Shock Proteins; D018799:Intercellular Adhesion Molecule-1