title: Relation between vacA subtypes, cytotoxin activity, and disease in Helicobacter pylori-infected patients from The Netherlands.
abstract: OBJECTIVE
  The vacuolating cytotoxin of Helicobacter pylori (H. pylori) is encoded by vacA, of which allelic variation has been described. In the U.S., H. pylori strains with the signal sequence allele s1a are associated with enhanced gastric inflammation and with peptic ulcer disease (PUD). The m1 middle region allele is linked with more severe gastric epithelial damage. However, the distribution of H. pylori genotypes and the association with disease may be different in other geographical areas. The aim of this study was to establish whether vacA types among H. pylori isolates from Dutch patients are associated with disease.
  
  
  METHODS
  The cytotoxin activity of the H. pylori isolates from 34 PUD patients and 46 patients with functional dyspepsia (FD) was assessed by an in vitro assay using HeLa cells as indicator cells. The vacA types and cagA status of the isolates were assessed by polymerase chain reaction (PCR).
  
  
  RESULTS
  vacA s1-type H. pylori displayed cytotoxin activity more frequently than s2 vacA-type H. pylori (p = 0.003). This difference was not significant when only cagA+ H. pylori were considered. H. pylori isolates with the m1 vacA type exhibited a higher cytotoxin activity, independent of cagA (p = 0.006). Ninety-four percent (32/34) of the PUD patients and 74% (34/46) of the FD patients were infected with s1 vacA-type H. pylori (p = 0.04). When only cagA+ H. pylori were considered, s1 vacA type was not associated with disease. In addition, neither the s1a nor s1b subtypes correlated with disease.
  
  
  CONCLUSIONS
  An association between vacA subtypes and disease could not be established in this patient population, due to the strong linkage between vacA s1 type and cagA.
authors.affiliation: Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Pan
authors.forename: R W
authors.initials: RW
authors.lastname: van der Hulst
authors.forename: G N
authors.initials: GN
authors.lastname: Tytgat
authors.forename: J
authors.initials: J
authors.lastname: Dankert
authors.forename: A
authors.initials: A
authors.lastname: van der Ende
mesh_terms: D000942:Antigens, Bacterial; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism / Q000502:physiology*; D004415:Dyspepsia / Q000382:microbiology; D005838:Genotype; D016481:Helicobacter Infections / Q000150:complications / Q000378:metabolism*; D016480:Helicobacter pylori / Q000235:genetics / Q000378:metabolism*; D006801:Humans; D009426:Netherlands; D010437:Peptic Ulcer / Q000382:microbiology
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C074689:VacA protein, Helicobacter pylori; C080866:cagA protein, Helicobacter pylori