title: Study of the cytoxin-associated gene a (CagA gene) in Helicobacter pylori using gastric biopsies of Iraqi patients.
abstract: OBJECTIVE
  The Helicobacter pylori CagA gene is a major virulence factor that plays an important role in gastric pathologies. The size variation of CagA gene, which is dependent on the 3' repeat region, contains one or more Glu-Pro-Ile-Tyr-Ala (EPIYA) motifs and CagA multimerization (CM) motifs. Four segments flanking the EPIYA motifs, EPIYA -A, -B, -C, or -D, were reported to play a crucial role in the pathogenesis of H. pylori infection. The aim was to determine the roles of EPIYA segments and CM motifs in gastroduodenal pathogenesis in an Iraqi population.
  
  
  METHODS
  Gastric biopsies were collected from 210 patients with gastritis, duodenal ulcer (DU), gastric ulcer (GU), and gastric cancer (GC). The EPIYA motif genotyping was determined by polymerase chain reaction and sequencing. The differences in age, gender, and CagA EPIYA motifs of H. pylori between GC, DU, GU and gastritis patients were analyzed using a χ(2) -test.
  
  
  RESULTS
  A total of 22 (45.8%) strains had three copies of EPIYA (ABC type), 2 (4.16%) had four copies (ABCC type), 6 (12.7%) had five copies (ABCCC type), 13 (27.08%) had two copies (AB type), 3 (6.25%) had the BC, and 2 (4.17%) had AC motif. The alignment of the deduced protein sequences confirmed that there were no East Asian type EPIYA-D sequences in Iraqi strains. A significant association was found between increase in number of EPIYA-C motifs and GU (P ≤ 0.01) compared with gastritis.
  
  
  CONCLUSIONS
  The structure of the 3' region of the CagA gene in Iraqi strains was Western type with a variable number of EPIYA-C and CM motifs. A significant association was found between increase in number of EPIYA-C motifs and GU compared with gastritis indicating predictive association with the severity of the disease. The GenBank accession numbers for the partial CagA nucleotide sequences determined in this study are JX164093-JX164112.
authors.affiliation: Genetic Engineering and Biotechnology Institute for Post Graduate Studies, Baghdad University, Baghdad, Iraq.
authors.forename: Elham A
authors.initials: EA
authors.lastname: Kalaf
authors.forename: Zahra M
authors.initials: ZM
authors.lastname: Al-Khafaji
authors.forename: Nahi Y
authors.initials: NY
authors.lastname: Yassen
authors.forename: Fadel A
authors.initials: FA
authors.lastname: Al-Abbudi
authors.forename: Saad N
authors.initials: SN
authors.lastname: Sadwen
mesh_terms: D000328:Adult; D020816:Amino Acid Motifs; D000942:Antigens, Bacterial / Q000235:genetics*; D001426:Bacterial Proteins / Q000235:genetics*; D001706:Biopsy; D005260:Female; D005756:Gastritis / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications / Q000382:microbiology*; D016480:Helicobacter pylori / Q000235:genetics* / Q000472:pathogenicity; D006801:Humans; D007493:Iraq; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D055503:Protein Multimerization; D012720:Severity of Illness Index; D013270:Stomach / Q000382:microbiology / Q000473:pathology*; D013274:Stomach Neoplasms / Q000382:microbiology* / Q000473:pathology; D013276:Stomach Ulcer / Q000382:microbiology* / Q000473:pathology
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C080866:cagA protein, Helicobacter pylori