title: Correlation of Helicobacter pylori genotypes with gastric histopathology in the central region of a South-European country.
abstract: BACKGROUND
  Outcome of Helicobacter pylori (H. pylori) infection results from interaction of multiple variables including host, environmental and bacterial-associated virulence factors.
  
  
  OBJECTIVE
  This study aimed to investigate the correlation of cagA, cagE, vacA, iceA and babA2 genotypes with gastric histopathology and disease phenotype in the central region of a South-European country.
  
  
  METHODS
  This prospective study involved 148 infected patients (110 female; mean age 43.5 ± 13.4 years) submitted to endoscopy with corpus and antrum biopsies. H. pylori was cultured and DNA extracted from the isolates. Genotypes were determined by PCR. Histopathological features were graded according to the updated Sydney system and OLGA/OLGIM classification. Only patients with single H. pylori genotypes and complete histopathological results were included.
  
  
  RESULTS
  Antrum samples presented higher degrees of atrophy, intestinal metaplasia, chronic inflammation and neutrophil activity. Genotype distribution was as follows: cagA-31.8 %; cagE-45.9 %; vacA s1a-24.3 %; vacA s1b-19.6 %; vacA s1c-0.7 %; vacA s2-55.4 %; vacA m1-20.9 %; vacA m2-79.1 %; vacA s1m1-18.9 %; vacA s1m2-25.7 %; vacA s2m1-2 %; vacA s2m2-53.4 %; iceA1-33.8 %; iceA2-66.2 %; babA2-12.2 %. CagA genotype was significantly associated with higher degrees of intestinal metaplasia, neutrophil activity, chronic inflammation and OLGIM stages. BabA2 was linked with higher H. pylori density. Strains with vacA s1m1 or vacA s1m1 + cagA positive genotypes had a significant association with peptic ulcer and vacA s2m2 with iron-deficient anemia.
  
  
  CONCLUSIONS
  cagA, vacA s1m1 and babA2 genotypes are relatively rare in the central region of Portugal. cagA-positive strains are correlated with more severe histopathological modifications. This gene is commonly associated with vacA s1m1, and such isolates are frequently found in patients with peptic ulcer.
authors.affiliation: Gastroenterology Department, Coimbra University Hospital Centre, Praceta Mota Pinto e Avenida Bissaya Barreto, 3000-075, Coimbra, Portugal, nunoperesalmeida@gmail.com.
authors.forename: Nuno
authors.initials: N
authors.lastname: Almeida
authors.forename: Maria Manuel
authors.initials: MM
authors.lastname: Donato
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Romãozinho
authors.forename: Cristina
authors.initials: C
authors.lastname: Luxo
authors.forename: Olga
authors.initials: O
authors.lastname: Cardoso
authors.forename: Maria Augusta
authors.initials: MA
authors.lastname: Cipriano
authors.forename: Carol
authors.initials: C
authors.lastname: Marinho
authors.forename: Alexandra
authors.initials: A
authors.lastname: Fernandes
authors.forename: Carlos
authors.initials: C
authors.lastname: Sofia
mesh_terms: D018829:Adhesins, Bacterial / Q000235:genetics; D000293:Adolescent; D000328:Adult; D000368:Aged; D000942:Antigens, Bacterial / Q000235:genetics; D001426:Bacterial Proteins / Q000235:genetics*; D005260:Female; D005756:Gastritis / Q000235:genetics / Q000382:microbiology* / Q000473:pathology; D016481:Helicobacter Infections / Q000235:genetics* / Q000473:pathology*; D016480:Helicobacter pylori / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011174:Portugal; D011446:Prospective Studies; D016036:Seroepidemiologic Studies; D013270:Stomach / Q000473:pathology; D014774:Virulence; D055815:Young Adult
chemical_list: D018829:Adhesins, Bacterial; D000942:Antigens, Bacterial; C400429:BabA protein, Helicobacter pylori; D001426:Bacterial Proteins; C103937:PicB protein, Helicobacter pylori; C074689:VacA protein, Helicobacter pylori; C080866:cagA protein, Helicobacter pylori