Rachael J. Thomas

Functional association between the Helicobacter pylori virulence factors VacA and CagA

The Helicobacter pylori virulence factors CagA and VacA are implicated in the development of gastroduodenal diseases. Most strains possessing CagA also possess the more virulent vacuolating form of VacA. This study assessed the significance of possession of both virulence factors in terms of their effect on gastric epithelial cells, using a set of minimally passaged, isogenic VacA, CagA and CagE mutants in H. pylori strains 60190 and 84-183. The cagA and cagE mutants were found to significantly increase VacA-induced vacuolation of epithelial cells, and the vacA mutants significantly increased CagA-induced cellular elongations, compared with wild-type strains, indicating that CagA reduces vacuolation and VacA reduces hummingbird formation. Although epithelial cells incubated with the wild-type H. pylori strains may display both vacuolation and hummingbird formation, it was found that (i) hummingbird length was significantly reduced in vacuolated cells compared with those without vacuolation; (ii) the number of vacuoles was significantly reduced in vacuolated cells with hummingbird formation compared with those without hummingbirds; and (iii) cells displaying extensive vacuolation did not subsequently form hummingbirds and vice versa. VacA did not affect the phosphorylation of CagA. These data show that VacA and CagA downregulate each others effects on epithelial cells, potentially allowing H. pylori interaction with cells whilst avoiding excessive cellular damage.

Galectin‐3 binds to Helicobacter pylori O‐antigen: it is upregulated and rapidly secreted by gastric epithelial cells in response to H. pylori adhesion

Helicobacter pylori causes gastritis and some infections result in peptic ulceration, gastric adenocarcinoma or gastric lymphoma. A critical step in the pathogenesis of these diseases is the ability of H. pylori to adhere to gastric epithelial cells. A role for the lipopolysaccharide O‐antigen side‐chain in this process has previously been identified. In this study, evidence is presented that the receptor recognized by the O‐antigen side‐chain is galectin‐3, a β‐galactoside‐binding lectin. A variety of functions have been ascribed to galectin‐3 including modulation of extracellular adhesion and chemotaxis of monocytes and neutrophils. Expression of galectin‐3 is upregulated by gastric epithelial cells following adhesion of H. pylori, suggesting that in addition to colonization this protein also plays a role in the host response to infection. Upregulation of galectin‐3 is inhibited by treating gastric epithelial cells with the mitogen‐activated protein kinase (MAPK) inhibitors U0126 or PD098059 and does not occur in cells infected with either H. pylori cagE or cagA isogenic mutants. This implies that H. pylori‐mediated expression of galectin‐3 is dependent on delivery of CagA into the host cell cytosol and the subsequent stimulation of MAPK signalling. A further consequence of H. pylori adhesion is that it elicits a rapid release of galectin‐3 from infected cells. A role for this phenomenon in initiating the trafficking of phagocytic cells to the site of infection is discussed.

Helicobacter pylori upregulates matrilysin (MMP-7) in epithelial cells in vivo and in vitro in a Cag dependent manner

Background and aims: Matrix metalloproteinase-7 (MMP-7) is important in normal and pathological remodelling of epithelial-matrix interactions, and is upregulated in gastric cancer. Helicobacter pylori infection is the first stage in gastric carcinogenesis, and therefore our aim was to determine if H pylori upregulated gastric MMP-7 expression and if this was affected by strain virulence. Methods: We took gastric biopsy specimens at endoscopy from H pylori infected (n = 17) and uninfected (n = 18) patients and assessed MMP-7 expression by ELISA, real time polymerase chain reaction (PCR), and immunohistochemistry (concentrating on epithelial cells in the proliferative zone). We PCR typed H pylori for cagE and vacA. We performed H pylori/cell line coculture studies with wild-type pathogenic and non-pathogenic H pylori strains and with CagE− and VacA− isogenic mutants. Results: Gastric biopsy specimens from H pylori+ patients expressed higher levels of MMP-7 at the protein and mRNA levels in the antrum and corpus (for example, by ELISA: H pylori+ 0.182 OD units vH pylori− 0.059; p = 0.009 antrum). Epithelial cells from H pylori+ patients stained more intensely for MMP-7 than those from uninfected patients, including in the proliferative zone containing pluripotent cells (p<0.03 antrum, p<0.04 body). Upregulation of MMP-7 in epithelial cells was confirmed at the protein and mRNA levels by H pylori/cell line coculture. These experiments also showed that MMP-7 upregulation was dependent on an intact H pyloricag pathogenicity island but not on the vacuolating cytotoxin. Conclusion: We speculate that increased expression of MMP-7 in H pylori gastritis may contribute to gastric carcinogenesis.

Helicobacter pylori-induced homotypic phagosome fusion in human monocytes is independent of the bacterial vacA and cag status.

Following reports that a VacA+cag+ toxigenic but not a VacA–cag– non‐toxigenic Helicobacter pylori strain induced homotypic phagosome fusion in murine macrophages, we addressed that phenomenon in human cells. Mononuclear phagocytes and epitheloid cells were challenged with H. pylori strains of different vacA and cag genotypes and with VacA– and Cag– isogenic mutants, and chased in the absence or presence of signal transduction modulators. Electron microscopy revealed that, in monocytes: (i) homotypic phagosome fusion was frequently induced by all live H. pylori strains investigated but not by exogenous VacA; (ii) phagosomes containing bacteria fused, but not those containing latex beads; (iii) fusion resulted in communal compartments resembling giant multivesicular bodies; and (iv) formation of these compartments was blocked by inhibiting the host cell regulators PI 3‐kinase, phospholipase C and p42 MAP kinase. Whereas some internalized bacteria remained viable 1 h after uptake, none survived a 24 h period. In contrast to monocytes, infected epitheloid cells rarely developed communal compartments. In combination, these results demonstrate that, in human monocytes, the H. pylori‐induced homotypic phagosome fusion depends on neither the vacuolating cytotoxin VacA nor the cag pathogenicity island of H. pylori and does not result in prolonged intracellular survival.

Dynamic Transmission of Numerous Anaplasma phagocytophilum Genotypes among Lambs in an Infected Sheep Flock in an Area of Anaplasmosis Endemicity

ABSTRACT The transmission dynamics of Anaplasma phagocytophilum strains circulating within juvenile members of a sheep flock grazing on an Ixodes ricinus-infested pasture in southern Norway were monitored. PCR-based detection of the bacterial p44 fragments in the blood of 16 lambs sampled weekly for 16 weeks following their release into pasture revealed rickettsemia in all animals, with an increasing proportion of infected animals as the survey progressed. Comparison of partial msp4 sequences obtained from infected blood samples revealed 24 distinct genotypes, some of which were repeatedly encountered, occurring in up to six sheep over a 14-week period, whereas others were observed only once. Individual sheep were infected by up to five distinct genotypes, with a specific genotype being encountered for between one and three consecutive weeks, and in some sheep, genotypes detected early in the study were also present in later samples. In general, detection of A. phagocytophilum by PCR correlated well with the observation of infected neutrophils in blood smears. Together these results reveal a previously unrecognized diversity of A. phagocytophilum strains simultaneously circulating within an infected population in an area of endemicity and are consistent with a remarkably dynamic transmission of strains among infected animals.

Toxigenic Helicobacter pylori Infection Precedes Gastric Hypochlorhydria in Cancer Relatives, and H. pylori Virulence Evolves in These Families

Purpose:Helicobacter pylori infection by virulent strains is associated with gastric adenocarcinoma. We aimed to determine whether infection with virulent H. pylori preceeded precancerous gastric hypochlorhydria and atrophy in gastric cancer relatives and quantify the extent of virulence factor evolution. Experimental Design:H. pylori strains from 51 Scottish gastric cancer relatives were characterized by genetic fingerprinting and typing the vacuolating cytotoxin gene (vacA), the cytotoxin-associated gene (cagA), and housekeeping genes. We phenotyped strains by coculture with gastric epithelial cells and assessing vacuolation (microscopy), CagA tyrosine phosphorylation (immunoblot), and interleukin-8 secretion (ELISA). Results: Toxigenic (vacA type s1/m1) H. pylori was associated with precancerous gastric hypochlorhydria (P < 0.01). Adult family members with this type of H. pylori had the same strain as currently noncohabiting adult family members in 68% cases, implying acquisition during childhood from each other or a common source. We analyzed different isolates of the same strain within families and showed that H. pylori commonly microevolved to change virulence: this occurred in 22% individuals and a striking 44% cases where the strain was shared within families. Microevolution in vacA occurred by extragenomic recombination and in cagA by this or duplication/deletion. Microevolution led to phenotypic changes in virulence. Passage of microevolved strains could be tracked within families. Conclusions: Toxigenic H. pylori infection precedes and so likely causes gastric hypochlorhydria, suggesting that virulent H. pylori increases cancer risk by causing this condition. Microevolution of virulence genes is common within families of gastric cancer patients and changes H. pylori virulence.

Effects of Helicobacter pylori on the cadherin–catenin complex

Background: The cadherin–catenin complex is the key component of the adherens junction in epithelial cells, and changes in this complex are implicated in gastric adenocarcinoma. Germline mutations in E-cadherin have been described in diffuse-type gastric adenocarcinoma. Helicobacter pylori infection is the first stage in gastric carcinogenesis. Aims: To determine whether H pylori was associated with changes in the complex, and whether this was affected by virulence of the strain. Methods: Epithelial cell lines were cultured with H pylori using the wild-type pathogenic and non-pathogenic strains and CagE null and VacA null isogenic mutants. Gastric biopsy specimens at endoscopy were obtained from patients with (n = 17) and without (n = 15) H pylori infection, and E-cadherin and β–catenin expression was assessed by immunohistochemistry. H pylori was typed by polymerase chain reaction from these patients for CagE and VacA. Results: In vitro studies showed that coculture with a pathogenic strain of H pylori led to disruption of epithelial junctional β-catenin expression, but without evidence of nuclear translocation or signalling. This effect was independent of a functional Cag pathogenicity island and vacuolating activity, but dependent on live bacteria. No marked differences in β-catenin or E-cadherin expression were seen in gastric biopsy specimens in patients with and without H pylori infection. Conclusion: Acute H pylori infection disrupts junctional β-catenin in vitro, but chronic infection by H pylori has no effect on E-cadherin and β-catenin expression, as seen in gastric biopsy specimens at the initial gastritis stage of the proposed Correa pathway of gastric carcinogenesis. A later effect at the later stages of atrophy or intestinal metaplasia cannot be ruled out.

Tyrosine Phosphorylation of CagA from Chinese Helicobacter pylori Isolates in AGS Gastric Epithelial Cells

ABSTRACT Helicobacter pylori strains possessing the cag pathogenicity island (PaI) are associated with the development of gastroduodenal diseases, including gastric cancer. cag PaI products induce the secretion of interleukin-8 (IL-8) from epithelial cells and facilitate the translocation of CagA into the cell cytosol. In East Asia, where the incidence of gastric cancer is high, most strains possess the cag PaI. To date, however, no cag PaI phenotypic data have been provided for strains isolated in mainland China. Here we used 31 Chinese strains to determine the genotypic and phenotypic status of the cag PaI. All strains possessed cagA and cagE, and we observed a variation in the length of cagA variable regions. Nucleotide sequencing of the cagA variable region revealed that CagA was of two types, a short “Western” form with two tyrosine phosphorylation sites and a longer “East Asian” form with three tyrosine phosphorylation sites. Coculture of strains with AGS epithelial cells showed that strains could induce IL-8 secretion from the cells and that CagA with three phosphorylation sites became more phosphorylated than that with two and could induce significantly (P < 0.001) more cells to elongate. We hypothesize that the preponderance of the more active East Asian form of cagA may underlie the high rate of gastric cancer in China.

Recurrent Bacteraemia in Sheep Infected Persistently with Anaplasma phagocytophilum

Following experimental or natural infection with Anaplasma phagocytophilum, the causative agent of tick-borne fever (TBF), sheep may be infected persistently for several months or years. In the present study, quantitative real-time polymerase chain reaction was used to investigate the duration and magnitude of primary bacteraemia and to establish whether the organism is present continuously in the peripheral blood after the period of primary bacteraemia and the cessation of clinical signs. Persistent infection was characterized by a clearly defined period of primary bacteraemia followed by recurrent cycles of bacteraemia, usually lasting a few days and of lower magnitude, interspersed by negative periods of variable duration in which bacterial DNA could not be detected. During a 150-day period of consecutive sampling of four sheep, A. phagocytophilum was detected on 64.25 ± 4.9 occasions, which means that on average bacterial DNA was detected in 42.8 ± 3.3 percent of all samples, with the positive days falling into 15-20 distinct cycles. Primary bacteraemia lasted for 15.5 ± 2.33 days, but secondary and subsequent cycles of bacteraemia were short-lived, with 61% of the cycles lasting only 1-2 days and 39% lasting for 3 or more days. Secondary and subsequent cycles of bacteraemia were not accompanied by febrile responses or other clinical features of TBF. For three animals, bacterial DNA was detected at 311, 318 and 358 days post infection, indicating the long-term persistence of A. phagocytophilum within peripheral blood.

Expression of p44 variant-specific antibodies in sheep persistently infected with Anaplasma phagocytophilum

Sheep infected with Anaplasma phagocytophilum, the causative agent of tick-borne fever (TBF), develop humoral immune responses 7-14 days after infection. Those individuals that survive acute TBF develop persistent infection, which may last for several months or even for life. The persistence of infection and recurrent bacteraemia is thought to be due to p44-mediated antigenic variation. The present study mapped linear B-cell epitopes within the hypervariable region (HVR) of the surface membrane protein P44 and investigated whether the development of antibodies against B cell epitopes within the HVR was preceded by the expression of p44 variants. Serum samples obtained from five sheep infected with the Old Sourhope strain of A. phagocytophilum (AP-OS) were used to detect antibody reactivity against 20-mer overlapping synthetic peptides spanning the HVR of two p44 variants which were expressed during primary bacteraemia and 3 variants expressed during secondary bacteraemia. The results showed that all five p44 variants of AP-OS have dominant B-cell epitopes residing mainly in the 3rd and 7th of the 10-11 peptides mapping each HVR. Antibody reactivity against peptides of the HVR of all the variants was characterised by a gradual rise, reaching peak levels in samples obtained 24 days post-inoculation (dpi) followed by a gradual decline. Anamnestic responses to whole cell antigens and to some of the dominant antigenic epitopes were detected in some of the animals, which were monitored for 52 weeks.