title: Relation of CagA seropositivity to cagPAI phenotype and histological grade of gastritis in patients with Helicobacter pylori infection.
abstract: OBJECTIVE
  Infection with Helicobacter pylori (H pylori) possessing the cag pathogenicity island (PAI) has been associated with severe clinical outcome and CagA-antibody has been used to indicate cagPAI-positive infection. The aim of this study was to examine the accuracy of CagA seropositivity to indicate the virulence of the cagPAI in Japan.
  
  
  METHODS
  Sixty isolates of H pylori cultured from gastric biopsies were examined by polymerase chain reaction assays for the presence of cagA, cagE and VirD4. Anti-CagA IgG antibody in matching sera was tested by both ELISA and immunoblot assay. Histological grade of gastritis was graded according to the updated Sydney System.
  
  
  RESULTS
  Amongst 53 patients infected with cagA+/cagE+/VirD4+ strain, 38 were CagA seropositive. There were four patients infected with strains possessing incomplete cagPAI. Two out of three patients with cagA+/cagE-/VirD4- infection were CagA seropositive, while a patient with cagA-/cagE+/VirD4+ infection was CagA seronegative. Accuracy of ELISA to predict bacterial possession of cagA was 61.7% whereas 58.3% for cagE and VirD4. The immunoblot assay showed relatively higher sensitivity and showed better accuracy. The lower grade of gastric mucosal inflammatory infiltration was seen in false CagA-seronegative patients.
  
  
  CONCLUSIONS
  Some serodiagnosis does not seem to have enough accuracy to indicate virulence of cagPAI, particularly in infection of strains with incomplete cagPAI. The degree of gastric mucosal inflammation may affect the results of CagA serodiagnosis.
authors.affiliation: First Department of Internal Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan. tsimo-hki@umin.ac.jp
authors.forename: Tadashi
authors.initials: T
authors.lastname: Shimoyama
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Fukuda
authors.forename: Fumika
authors.initials: F
authors.lastname: Nakasato
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Mikami
authors.forename: Akihiro
authors.initials: A
authors.lastname: Munakata
mesh_terms: D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D000942:Antigens, Bacterial / Q000235:genetics* / Q000276:immunology*; D001426:Bacterial Proteins / Q000235:genetics* / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005756:Gastritis / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000382:microbiology* / Q000473:pathology*; D016480:Helicobacter pylori / Q000235:genetics* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012720:Severity of Illness Index; D014774:Virulence
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D015415:Biomarkers; C080866:cagA protein, Helicobacter pylori