Helena Enroth

Molecular characterization of the stomach microbiota in patients with gastric cancer and in controls

Persistent infection of the gastric mucosa by Helicobacter pylori can initiate an inflammatory cascade that progresses into atrophic gastritis, a condition associated with reduced capacity for secretion of gastric acid and an increased risk of developing gastric cancer. The role of H. pylori as an initiator of inflammation is evident but the mechanism for development into gastric cancer has not yet been proven. A reduced capacity for gastric acid secretion allows survival and proliferation of other microbes that normally are killed by the acidic environment. It has been postulated that some of these species may be involved in the development of gastric cancer; however, their identities are poorly defined. In this study, the gastric microbiota from ten patients with gastric cancer was characterized and compared with that from five dyspeptic controls using the molecular profiling approach terminal restriction fragment length polymorphism (T-RFLP), in combination with 16S rRNA gene cloning and sequencing. T-RFLP analysis revealed a complex bacterial community in the cancer patients that was not significantly different from that in the controls. Sequencing of 140 clones revealed 102 phylotypes, with representatives from five bacterial phyla (Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria and Fusobacteria). The data revealed a relatively low abundance of H. pylori and showed that the gastric cancer microbiota was instead dominated by different species of the genera Streptococcus, Lactobacillus, Veillonella and Prevotella. The respective role of these species in development of gastric cancer remains to be determined.

Correlation between cag Pathogenicity Island Composition and Helicobacter pylori-Associated Gastroduodenal Disease

ABSTRACT Helicobacter pylori infection is associated with a variety of outcomes ranging from seemingly asymptomatic coexistence to peptic ulcer disease and gastric cancer. The cag pathogenicity island (PAI) contains genes associated with a more aggressive phenotype and has been suggested to be a determinant of severe disease outcome. The cagA gene has served as a marker for the cag PAI. However, the presence of this single gene does not necessarily indicate the presence of a complete set of cag PAI genes. We have analyzed the composition of the cag PAI in 66 clinical isolates obtained from patients with duodenal ulcer, gastric cancer, and nonulcer dyspepsia. Hybridization of DNA to microarrays containing all the genes of the cag PAI showed that 76 and 9% of the strains contained all or none of the cag PAI genes, respectively. Partial deletions of the cag PAI were found in 10 isolates (15%), of which 3 were cagA negative. The ability to induce interleukin-8 (IL-8) production in AGS cells was correlated to the presence of a complete cag PAI. Strains carrying only parts of the island induced IL-8 at levels significantly lower than those induced by cag PAI-positive isolates. The presence of an intact cag PAI correlates with development of more severe pathology, and such strains were found more frequently in patients with severe gastroduodenal disease (odds ratio, 5.13; 95% confidence interval, 1.5 to 17.4). Partial deletions of the cag PAI appear to be sufficient to render the organism less pathogenic.

One stomach-one strain: Does Helicobacter pylori strain variation influence disease outcome ?

The aim of the study was to determine inter- andintrapatient variation of Helicobacter pylori strainsbased on genomic fingerprinting and cagA(cytotoxin-associated gene A) status. Ten bacterialcolonies from each of 10 patients with gastric cancer(GC), 10 with duodenal ulcer (DU), and 10 with gastritis(GI) were used. The presence of the putative adhesingene, the cagA gene, and the strain specific banding pattern obtained by arbitrary primed (AP-) PCRwas analyzed. Genomic fingerprinting showed extensiveinterpatient variation, but the banding patternsobtained from colonies from the same patient were always identical (intrapatient variation). In fivepatients, the cagA status varied between the coloniesdespite identical banding patterns. Among patients in adeveloped country such as Sweden, the proportion with multiple-strain infection of H. pylori islow, but subclones with differing cagA status existwithin the strain.

Interleukin 1-β gene polymorphisms and risk of gastric cancer in Sweden

Objective. Helicobacter pylori (H. pylori) infection stimulates the production of interleukin (IL)-1β, a pro-inflammatory cytokine and suppressor of gastric acid secretion. As both inflammation and hypochlorhydria, which might facilitate proximal colonization of H. pylori and other bacterial species alike, have been implicated in gastric carcinogenesis, much attention has been directed to functional genetic polymorphisms that affect the production of IL-1β. The purpose of this study was to clarify the role of these polymorphisms. Material and methods. We analysed a population-based, case-control study in 5 Swedish counties and a hospital-based, case-control study conducted in 8 Swedish hospitals, with a total of 351 gastric cancer cases and 539 controls. The IL1B-31, IL1B-511 and IL1B+3954 biallelic polymorphisms were genotyped using pyrosequencing. The variable number of tandem repeats (VNTR) polymorphism of IL1-RN was analysed using polymerase chain reaction (PCR) followed by gel electrophoresis. Relative risks were estimated by odds ratios with 95% confidence intervals, derived from unconditional logistic regression. Results. The risk of gastric cancer was unrelated to genotype in all of the studied polymorphic loci, and the absence of any association was confirmed in both the population-based and hospital-based case-control studies. Analyses confined to histological subtypes (intestinal or diffuse) and site-specific tumours (cardia or distal stomach), as well as analyses stratified by H. pylori infection status and family history of gastric cancer, did not reveal any significant increases or decreases in risk. Conclusion. Our results do not lend support to the hypothesis that human genetic polymorphisms related to the production of IL-1β are associated with the risk of gastric cancer.

Does the method of Helicobacter pylori detection influence the association with gastric cancer risk

Background: The exact role of Helicobacter pylori as a causative agent of gastric cancer is still under debate. The aim of this study was to determine how the use of different diagnostic methods for detection of H. pylori influences the measures of prevalence of the infection and thus the association with risk of gastric adenocarcinoma. Methods: We included 72 cases and 324 controls in an endoscopy clinic-based matched case-control study. Culture of H. pylori and immunohistochemical staining were performed on gastric biopsies. Serum samples were tested for H. pylori IgG by conventional ELISA and by immunoblotting. Results: The overall prevalence of H. pylori was 68% based on all 4 diagnostic methods, 79% in the cases and 66% in the controls. Highest agreement, 91%, was observed between culture and immunohistochemistry with a Kappa value of 0.81. Immunoblotting detected the highest number of H. pylori -positive subjects in both cases and controls. The association of H. pylori positivity with gastric cancer was generally weaker and statistically non-significant using culture and immunohistochemistry compared with the serological tests, of which IgG ELISA yielded the higher odds ratio (OR 2.5, 95% confidence interval 1.4-4.4). Conclusion: The study shows that relative risk estimates for the association between H. pylori and gastric cancer risk are to some extent determined by the diagnostic method used to detect H. pylori infection.

Clustering of clinical strains of Helicobacter pylori analyzed by two-dimensional gel electrophoresis.

ABSTRACT Strain variations of Helicobacter pylori have been tested by numerous methods and compared among different patient groups. The aim of this study was to investigate whether H. pyloriexpresses disease-specific proteins that can be detected by two-dimensional polyacrylamide gel electrophoresis (2-D PAGE). H. pylori strains isolated from duodenal ulcer, gastric cancer, and gastritis patients were analyzed. Extensive variation in spot patterns was observed between the strains, but a dendrogram analysis revealed that some strains within each disease group clustered together. Eight proteins were sequenced and found in the H. pylori genome sequence. 2-D PAGE is a useful method for studies of protein expression and for highlighting the extensive strain variation that H. pylori exhibits.

Histology and culture results among subjects with antibodies to CagA but no evidence of Helicobacter pylori infection with IgG ELISA

Objective. Serological evidence of antibodies to cytotoxin-associated gene A (CagA) antigens may exist without concomitant Helicobacter pylori IgG enzyme linked immunosorbent assay (ELISA) seropositivity. In a recent case-control study, this serological pattern was strongly linked to stomach cancer, and it was hypothesized to represent “burned-out” CagA-positive infections. The aim of this analysis was to test this hypothesis. Material and methods. We used data from a Swedish endoscopy clinic-based case-control study with 64 gastric cancer cases and 281 age-matched and gender-matched non-cancer patients who had other gastric diseases or normal endoscopy. HM-CAP® ELISA and Helicoblot® 2.0 immunoblot results were compared with culture and histology. Results. Overall, 86 out of 345 (25%) subjects were CagA seropositive but ELISA seronegative. This proportion was similar among cancer and non-cancer patients. Current H. pylori infection could be verified by culture or histology in only 15% of these patients. Forty-three percent of subjects with this isolated CagA seropositivity had histological evidence of corpus and/or antral atrophy. This was higher than in those who were negative in both tests (15%), but lower than among those seropositive for both tests (53%). The percentage of isolated CagA-seropositive patients who had atrophy was similar among those with or without evidence of current infection. Conclusions. Although false-positive tests for CagA, or false-negative ELISA tests, may explain the serologic pattern in some of the subjects with isolated CagA seropositivity, healed infections are estimated to account for the majority. Unless the histology is often restituted after spontaneous disappearance of the infection, atrophy does not appear to be a mandatory intermediate step leading to this serology.

Clinical evaluation of commercial nucleic acid amplification tests in patients with suspected sepsis.

BackgroundSepsis is a serious medical condition requiring timely administered, appropriate antibiotic therapy. Blood culture is regarded as the gold standard for aetiological diagnosis of sepsis, but it suffers from low sensitivity and long turnaround time. Thus, nucleic acid amplification tests (NAATs) have emerged to shorten the time to identification of causative microbes. The aim of the present study was to evaluate the clinical utility in everyday practice in the emergency department of two commercial NAATs in patients suspected with sepsis.MethodsDuring a six-week period, blood samples were collected consecutively from all adult patients admitted to the general emergency department for suspicion of a community-onset sepsis and treated with intravenous antibiotics. Along with conventional blood cultures, multiplex PCR (Magicplex™) was performed on whole blood specimens whereas portions from blood culture bottles were used for analysis by microarray-based assay (Prove-it™). The aetiological significance of identified organisms was determined by two infectious disease physicians based on clinical presentation and expected pathogenicity.ResultsAmong 382 episodes of suspected sepsis, clinically relevant microbes were detected by blood culture in 42 episodes (11%), by multiplex PCR in 37 episodes (9.7%), and by microarray in 32 episodes (8.4%). Although moderate agreement with blood culture (kappa 0.50), the multiplex PCR added diagnostic value by timely detection of 15 clinically relevant findings in blood culture-negative specimens. Results of the microarray corresponded very well to those of blood culture (kappa 0.90), but were available just marginally prior to blood culture results.ConclusionsThe use of NAATs on whole blood specimens in adjunct to current culture-based methods provides a clinical add-on value by allowing for detection of organisms missed by blood culture. However, the aetiological significance of findings detected by NAATs should be interpreted with caution as the high analytical sensitivity may add findings that do not necessarily corroborate with the clinical diagnosis.

Statistical model of the interactions between Helicobacter pylori infection and gastric cancer development.

Background. The bacterium Helicobacter pylori is associated with a number of gastrointestinal diseases, such as gastric ulcer, duodenal ulcer and gastric cancer. Several histological changes may be observed during the course of infection; some may influence the progression towards cancer. The aim of this study was to build a statistical model to discover direct interactions between H. pylori and different precancerous changes of the gastric mucosa, and in what order and to what degree those may influence the development of the intestinal type of gastric cancer.

Cancer-associated strains of Helicobacter pylori stimulate DNA synthesis in IEC-6 cells

Objective To determine whether water extracts of Helicobacter pylori strains, which express CagA, can influence DNA synthesis in untransformed intestinal epithelial cells in vitro. Design We used water extracts produced from H. pylori strains (A, B, C), collected from gastric mucosa of gastric cancer patients. Strain A was CagA+/VacA+ whereas strains B and C were CagA+/VacA-. Water extracts from Helicobacter mustelae and Escherichia coli were used as controls. Methods IEC-6 cells (small intestinal epithelial cell line from germ-free rats) were incubated with various concentrations of the bacterial extracts for 24 h. The cells were labelled with [3H]methylthymidine for 4 h and thereafter processed for autoradiography. DNA synthesis was evaluated by the labelling index (Ll%). Results Water extracts from CagA-positive strains of H. pylori, with or without the capacity to produce vacuolating toxins, increased the LI in a dose-related manner (P< 0.05). The water extracts of E. coli significantly increased the LI (P< 0.001), whereas the water extracts of H. mustelae did not affect DNA synthesis. Conclusions Cancer-associated, CagA-positive strains of H. pylori stimulate DNA synthesis in epithelial cells in vitro, independently of their ability to produce VacA toxin. Our findings suggest that unknown mitogenic components of H. pylori may contribute to the increased cell proliferation observed in the histological stages preceding gastric cancer.