Molecular Evolution of the Helicobacter pylori Vacuolating Toxin Gene vacA

Helicobacter pylori is a genetically diverse organism that is adapted for colonization of the human stomach. All strains contain a gene encoding a secreted, pore-forming toxin known as VacA. Genetic variation at this locus could be under strong selection as H. pylori adapts to the host immune response, colonizes new human hosts, or inhabits different host environments. Here, we analyze the molecular evolution of VacA. Phylogenetic reconstructions indicate the subdivision of VacA sequences into three main groups with distinct geographic distributions. Divergence of the three groups is principally due to positively selected sequence changes in the p55 domain, a central region required for binding of the toxin to host cells. Divergent amino acids map to surface-exposed sites in the p55 crystal structure. Comparative phylogenetic analyses of vacA sequences and housekeeping gene sequences indicate that vacA does not share the same evolutionary history as the core genome. Further, rooting the VacA tree with outgroup sequences from the close relative Helicobacter acinonychis reveals that the ancestry of VacA is different from the African origin that typifies the core genome. Finally, sequence analyses of the virulence determinant CagA reveal three main groups strikingly similar to the three groups of VacA sequences. Taken together, these results indicate that positive selection has shaped the phylogenetic structure of VacA and CagA, and each of these virulence determinants has evolved separately from the core genome.Helicobacter pylori is a Gram-negative bacterium that persistently colonizes the human stomach. H. pylori induces a gastric mucosal inflammatory response known as superficial gastritis and is a risk factor for the development of peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma (2, 43). H. pylori is present in about half of all humans throughout the world.H. pylori strains from unrelated humans exhibit a high level of genetic diversity (5, 44). The population structure of H. pylori is panmictic, and the rate of recombination in H. pylori is reported to be among the highest in the Eubacteria (17, 44). Multilocus sequence analysis of housekeeping genes has revealed the presence of at least nine different H. pylori populations or subpopulations that are localized to distinct geographic regions (12, 27, 31). Analysis of these sequences suggests that H. pylori has spread throughout the world concurrently with the major events of human dispersal, and thus H. pylori is potentially a useful marker for the geographic migrations of human populations (12).One of the important virulence determinants of H. pylori is a secreted toxin known as VacA. VacA is a pore-forming toxin that causes multiple alterations in human cells, including cell vacuolation, depolarization of membrane potential, alteration of mitochondrial membrane permeability, apoptosis, activation of mitogen-activated protein kinases, inhibition of antigen presentation, and inhibition of T-cell activation and proliferation (8, 10, 15). Secreted by an autotransporter (type Va) secretion mechanism, VacA is translated as a 140-kDa protoxin that undergoes N- and C-terminal cleavage during the secretion process to yield an N-terminal signal sequence, a mature 88-kDa secreted toxin known as p88, a small secreted peptide with no known function (termed secreted alpha peptide, or SAP) (7), and a C-terminal beta-barrel domain (41, 47) (Fig. ​(Fig.1A).1A). Two domains of p88 VacA, p33 and p55, have been identified based on partial proteolysis of p88 into fragments of 33 kDa and 55 kDa, respectively (47) (Fig. ​(Fig.1A).1A). The N-terminal p33 domain (residues 1 to 311) is involved in pore formation while the p55 domain (residues 312 to 821) contains one or more cell-binding domains (14, 48). The isolated p55 domain binds to host cells less avidly than does the full-length p88 protein, and in contrast to p88, the isolated p55 domain is not internalized by cells (18, 48). These observations suggest that sequences in both the p33 and p55 domains mediate VacA interactions with the surface of cells.Open in a separate windowFIG. 1.Analysis of VacA phylogeography. (A) The vacA gene encodes a 140-kDa protoxin, which undergoes cleavage to yield a signal sequence, a secreted 88-kDa toxin, a secreted alpha-peptide (SAP), and a C-terminal β-barrel domain. The mature 88-kDa VacA toxin contains two domains, designated p33 and p55. The midregion sequence that defines type m1 and m2 forms of VacA is located within p55. A 21-amino-acid insertion is present in m2 forms but not m1 forms of VacA. (B) Neighbor-joining phylogenetic tree of 100 amino acid sequences of VacA. Three major groups (designated groups 1 to 3) are evident. The chart shows the number of strains analyzed and characteristics of VacA protein sequences in each group of the tree. Group 1 comprises type m1 sequences mainly from non-Asian strains, group 2 comprises m1 sequences from Asian strains, and group 3 comprises m2 sequences from both Asian and non-Asian strains. See Fig. S1 in the supplemental material for a ladder-type version of this tree.All strains of H. pylori contain a chromosomal vacA gene, but individual strains differ considerably in levels of VacA activity (3, 8). Two studies analyzed vacA sequence encoding a fragment of the p33 domain and did not detect any recognizable phylogenetic structure (star or bush-type pattern), presumably due to the presence of extensive recombination (19, 44). Other studies analyzed different regions of VacA and detected polymorphisms that allow classification of vacA alleles into distinct families (designated s1/s2, i1/i2, and m1/m2) depending on the presence of signature sequences in different regions of VacA (3, 4, 39). Geographic differences have been detected within several of these vacA regions (22, 24, 29, 37, 51, 52, 55). In general, strains containing vacA alleles classified as s1, i1, or m1 have been associated with an increased risk of ulcer disease or gastric cancer compared to strains containing vacA alleles classified as s2, i2, or m2 (3, 13, 39).Another important H. pylori virulence factor is the secreted CagA effector protein. The cagA gene is localized within a 40-kb chromosomal region known as the cag pathogenicity island (PAI) (20). H. pylori strains expressing CagA are associated with a significantly increased risk for development of ulcer disease or gastric cancer compared to strains that lack the cagA gene (6). Upon entry into cells, CagA undergoes phosphorylation by host cell kinases and induces numerous alterations in cellular signaling, leading to the designation of CagA as a “bacterial oncoprotein” (20, 32).H. pylori strains that produce an active VacA protein (type s1 VacA) typically express CagA, and strains that produce inactive VacA proteins (type s2 VacA) typically lack the cagA gene (3). vacA and the cag PAI localize to distant sites on the H. pylori chromosome, and, therefore, the basis for this association has been unclear. Recently, several studies have reported that there are complex relationships between the cellular effects of VacA and CagA, whereby VacA can downregulate CagA''s effects on epithelial cells, or vice versa (1, 35, 46, 56). This functional interaction between VacA and CagA may represent a mechanism that allows H. pylori to minimize damage to gastric epithelial cells or minimize mucosal inflammation, thereby allowing it to persistently colonize the stomach.Although VacA is considered an important H. pylori virulence factor and hundreds of studies have classified H. pylori strains based on a vacA typing scheme, there has been very little effort to investigate the forces that drive vacA diversification, to analyze the evolutionary history of vacA, or to correlate vacA diversity with features of the VacA three-dimensional structure. Several important questions remain in studying the vacA gene: (i) Are the s1, i1, and m1 alleles (which are associated with an increased risk of gastroduodenal disease) more recently derived than the s2, i2, and m2 alleles? (ii) Are the geographic differences in vacA alleles driven by adaptive evolution or genetic drift? (iii) Does the evolutionary history of the vacA gene parallel the evolutionary history of the core genes used for MLST analysis, which are markers for ancient migrations of human populations?In the current study, we present a comprehensive analysis of the molecular evolution of vacA. Our analysis of VacA diversity indicates that VacA sequences are clustered into three main groups with distinct geographic distributions. By analyzing topological differences between vacA and housekeeping gene phylogenetic trees, we demonstrate that the vacA gene does not share the same evolutionary history as the core genome of H. pylori. We report that the evolution of VacA has been shaped by positive selection, and adaptive evolution is restricted to the p55 domain. Most of the sequence divergence corresponds to surface-exposed amino acids in the three-dimensional structure of the p55 domain. Finally, we note that there are similarities between the phylogenetic structure of the VacA and CagA trees, and we discuss the roles that positive selection pressures have played in the evolution of these two virulence determinants.     

Identification of a 23S rRNA Gene Mutation in Clarithromycin-Resistant Helicobacter pylori

Background Transition mutations (A-G) at residue 2143, cognate to position 2058 in the Escherichia coli 23S rRNA gene, have been shown to confer resistance to macrolides in Helicobacter pylori. This study reports the finding that transversion mutations (A-C) can occur at 2143 as well.
Materials and Methods. Three clarithromycin-resistant H. pylori isolated from three different patients after treatment with clarithromycin were analyzed for point mutations by cycle sequencing of a 163-bp amplified region surrounding residue 2143 within the conserved loop of the 23S rRNA gene.
Results. Nucelotide sequence comparisons of a 163-bp amplified product revealed that A-C transversion mutations occurred at position 2143. H. pylori isolated from the patients prior to treatment were susceptible to clarithromycin and displayed no polymorphism at 2143.
Conclusion. This is the first report to show that A-C transversion mutations at position 2143 can confer resistance to clarithromycin in H. pylori and further support the role that mutations at position 2143 play in conferring macrolide resistance in H. pylori.     

iNOS基因与幽门螺杆菌相关胃癌关系的研究进展

幽门螺杆菌已被世界卫生组织列为胃癌的第一类致癌物。毒力因子、宿主遗传因素和环境因素共同影响着幽门螺杆菌的致胃癌作用。近年来的研究表明,宿主的iNOS基因多态性可能在胃癌的发生、发展中起到一定作用。文章将就该方面的研究进展进行综述。     

Helicobacter pylori in pediatrics

This article reviewed the important publications on Helicobacter pylori research with children between April 2010 and March 2011. The most interesting studies in the last year lend further weight to the evidence for vertical transmission of H. pylori. The discovery of a potential role for jhp0562, the gene which encodes for the cell envelope protein glycosyltransferase, in the progression to peptic ulcer disease is also very interesting as it may provide a novel way to distinguish children at risk of peptic ulcer disease from those who are not, and so determine those who requires treatment to eradicate H. pylori. The rise in non-H. pylori-associated ulcers and erosions continues to be reported with no apparent risk factors for these ulcers identified to date. High levels of treatment failure continue to be reported, and there remains an urgent need for more effective treatment regimes for children.     

Helicobacter pylori in Pediatrics

This review summarizes important pediatric studies published from April 2011 up to March 2012. Proteomics profile of ulcerogenic Helicobacter pylori strains was defined in the most interesting study of the last year. The antigen stool test is becoming the "gold standard" in prevalence studies, and according to the last epidemiologic studies, the prevalence of H.?pylori infection in childhood is not decreasing any more in the developed world. The resistance rate of H.?pylori strains is high in children. Therefore, among other important issues concerning H.?pylori in pediatrics, guidelines published by ESPGHAN and NASPGHAN last year also recommended culture and susceptibility testing before first-line treatment in areas with high or unknown antibiotic resistance rates.     

幽门螺杆菌重组vacA-ctxB蛋白的基因克隆与表达

目的构建幽门螺杆菌(H.pylori)vacA毒性片段与霍乱毒素B亚单位(ctxB)基因的原核表达载体,并诱导表达VCTB重组蛋白,为制备防治H.pylori感染的口服疫苗奠定基础。方法以H.pylori基因组DNA为模板,PCR扩增vacA毒性片段基因,克隆至质粒pQE30中,获得重组质粒pQE30-vacA。再以pET32(a) -ctxB质粒为模板PCR扩增ctxB目的基因并插入pQE30-vacA中,构建含双基因的表达质粒pQE-vctB。克隆至大肠埃希菌Top10,并在DH5α中诱导表达。SDS-PAGE分析表达结果,Ni-NTA柱纯化后Western blot鉴定其抗原性,免疫家兔后ELISA法检测血清中VacA和CtxB抗体鉴定其免疫原性。结果vacA的DNA片段为723 bp左右。ctxB基因的DNA片段为372 bp左右,与预计长度相符合。测序结果vctB融合基因由1092 bp组成,编码364个氨基酸残基的多肽,与基因文库相符。表达蛋白VCTB经SDS-PAGE分析,相对分子量为40 000,与预期的一致;表达量约占菌体总蛋白的20%,提纯后SDS-PAGE分析可见单一条带,纯度可达92%以上。Western blot鉴定能与抗VacA人血清发生特异性反应,ELISA测定能与抗ctxB兔血清发生特异性反应。结论含vctA和ctxB融合基因的表达载体构建成功,并在大肠埃希菌DH5α中表达了重组蛋白质VCTB,表达蛋白具有良好的抗原性和免疫原性,可用于制备口服疫苗。     

Helicobacter pylori Infection and Family History of Gastric Cancer Decrease Expression of FHIT Tumor Suppressor Gene in Gastric Mucosa of Dyspeptic Patients

Background:  The expression of a fragile histidine triad (FHIT) protein is lost in stomach tumors. The study aimed at determining whether FHIT expression is affected by Helicobacter pylori infection, strain virulence ( vacA and cagA genes) and histopathological changes in the gastric mucosa of patients with functional dyspepsia having first-degree relatives with gastric cancer.
Materials and Methods:  Eighty-eight never-smoking patients with functional dyspepsia were selected for the study, and 48 of them had first-degree relatives with gastric cancer. Bacterial DNA amplification was used to identify H. pylori colonization. The level of FHIT gene expression was determined by qRT-PCR (mRNA) and Western blot (FHIT protein) analyses.
Results:  For patients having first-degree relatives with gastric cancer FHIT expression was lower (mRNA by ca. 40–45% and protein by 30%) compared with the control patients ( p  < .05). H. pylori infection decreased the FHIT mRNA level by 10–35% and the protein level by 10–20%. Bacterial strain vacA (+) cagA (+) lowered FHIT mRNA by ca. 30–35% in the antrum samples of both groups and in corpus samples of patients with first-degree relatives with gastric cancer ( p  < .05). The FHIT mRNA level was twice as high in control H. pylori- negative patients with intestinal metaplasia, compared with those with non-atrophic gastritis.
Conclusions:  The decreased FHIT gene expression associated with hereditary factors and with H. pylori infection, especially with vacA (+) cagA (+)-positive strains, may be related to gastric carcinoma development.     

Environmental Isolates of Aeromonas spp. Harboring the cagA-Like Gene of Helicobacter pylori

We investigated the presence of cagA-like gene of Helicobacter pylori in environmental isolates of Aeromonas spp. from different water samples of Calcutta, India, by colony hybridization using a cagA-specific DNA probe and by PCR with cagA-specific primers. Nucleotide sequencing of five PCR products revealed 97 to 98% homology to canonical cagA of H. pylori 26695 as well as to four clinical H. pylori strains from Calcutta. The cagA-like gene of the environmental isolates was unstable in laboratory conditions and tended to be lost upon subculturing.     

Helicobacter pylori cagA Gene Polymorphism Affects the Total Antioxidant Capacity of Human Saliva

Background:  We aimed to evaluate the total antioxidant capacity (TAC) of saliva in healthy Helicobacter pylori -positive and negative saliva individuals.
Materials and Methods:  A total of 102 human saliva samples were checked for the presence of H. pylori DNA ( ureA and cagA gene fragments).
TAC of saliva was estimated by ABTS radical cation (ABTS^{• +} ) decolorization assay.
Results:  PCR analysis revealed that 36 subjects were ureA-/cagA- , 24 were ureA+/cagA- and 42 were ureA+/cagA+ . Smoking habits had no evident effect on H. pylori infection.
We found that TAC of the ureA-/cagA- material, after 10 seconds reaction reflecting fast-reacting antioxidants, was significantly higher than of ureA+/cagA- and ureA+/cagA+ samples (p < .01 and p < .001, respectively). Similar results were obtained for reaction time of 3 minutes measuring slow-reacting antioxidants (p < .001). We also estimated ureA+/cagA- and ureA+/cagA+ samples alone and reported a statistically significant decrease in the TAC_3min value of ureA+/cagA+ compared with ureA+/cagA- samples (p < .05).
Conclusions:  Our data demonstrated that altered redox equilibrium may be associated with more frequent occurrence of H. pylori in the saliva samples.     

Helicobacter pylori catalase

Helicobacter pylori is the major aetiological agent of gastroduodenitis in humans. Due to the potential importance of catalase in the growth and survival of Helicobacter pylori on the surface of inflamed mucosae, we have characterized catalase from H. pylori as a prelude to further studies on the function of the enzyme in vivo. The catalase activity of H. pylori was significantly affected by the presence of blood, serum or erythrocytes in the growth medium: the greatest activity was expressed when the bacterium was grown on medium containing serum. H. pylori catalase is a tetramer with a subunit Mr of 50,000. The enzyme had a pI of 9.0-9.3, was active over a broad pH range and was stable at 56 degrees C. It was non-competitively inhibited by sodium azide, and had no detectable peroxidase activity. The Km for the purified catalase was measured as 43 +/- 3 mM-H2O2 and the V as 60 +/- 3 mmol H2O2 min-1 (mg protein)-1. The native catalase has absorption maxima at 280 nm and 405 nm with further minor shoulders or peaks at 510 nm, 535 nm and 625 nm, consistent with the presence of an iron-porphyrin prosthetic group.     

Helicobacter pylori motility

Motility is essential for Helicobacter pylori colonization. This review discusses the biochemistry, genetics and genomics of the H. pylori flagellum, and compares these features with well-characterized bacteria.     

Childhood Hygienic Practice and Family Education Status Determine the Prevalence of Helicobacter pylori Infection in Iran

Background: Management of Helicobacter pylori , a causative agent of gastrointestinal diseases is an important health problem in most countries. The main reasons include poorly defined epidemiological status and unrecognized mode of bacterial transmission. Our objective was to investigate the prevalence of H. pylori infection in a representative population of Iran and to evaluate possible risk factors for the H. pylori infection.
Materials and methods: In this cross-sectional study, 2561 healthy individuals aged 18–65 years (mean age, 35.5 years) were selected out of 12,100,000 inhabitants of Tehran province by cluster sampling. Infection with H. pylori was evaluated by detection of anti- H. pylori IgG antibody in serum. Sociodemographic status of each subject was determined by filling up a questionnaire.
Results: Prevalence of H. pylori infection was 69% and was correlated with increasing age. The highest infection rate (79.2%) was seen in individuals 46–55 years old. No association was detected between H. pylori positivity and gender. Low education of the study subjects; low father's and mother's education; poor tooth brushing habit; crowded families in childhood; and lack of household bath, hygienic drinking water, and swage disposal facility in childhood were determined as possible risk factors.
Conclusions: The rate of prevalence of H. pylori infection was higher than developed countries. Low socioeconomic status, poor sanitary indications, and crowded families in childhood were related to high prevalence of H. pylori infection in Iran. Accordingly, fecal–oral and oral–oral routes could be considered as the main pathways of transmission of H. pylori .     

淮南地区幽门螺杆菌感染个体菌株基因多态性与感染结局的影响

目的:探讨淮南地区幽门螺杆菌感染个体菌株基因多态性及其与感染结局的影响。方法:选取125例幽门螺杆菌(H.pylori,HP)感染的慢性胃炎、消化性溃疡患者,常规获取胃窦、胃体部粘膜,进行HP分离、培养,提取HP基因组DNA,采用随机扩增多态性DNA(RAPD)指纹分析法检测菌株基因多态性;125例患者均给予质子泵抑制、H2受体拮抗剂、铋剂为基础的三联或四联疗法治疗,治疗后4~6周进行14C-尿素呼气试验评估Hp根除情况;获取HP根除失败患者的胃窦、胃体黏膜进行HP分离、培养、鉴定,并采用RAPD指纹分析法检测菌株来源,评估HP基因多态性对治疗结局的影响。结果:cagA、iceA1、iceA2、vacAs1、vacAm1、babA2阳性率分别为92.80%、36.00%、93.60%、93.60%、29.50%、53.50%,cagA、iceA2、vacAs阳性率均高于其他基因类型阳性率(P0.05或P0.01),其他基因类型阳性率比较差异无统计学意义(P0.05)。经治疗后HP根除率为86.4%(107/125),14.4%(18/125)根除失败;18例根除失败患者中,15例患者治疗前后的菌株具有相同的指纹图谱,证实为原菌株复发,其中cagA、iceA1、iceA2、vacAs1、vacAm1、babA2阳性率分别为93.33%、13.33%、86.67%、93.33%、6.67%、20.00%,cagA、iceA2、vacAs阳性率均高于其他基因类型阳性率(P0.05或P0.01)。结论:cagA+、vacAs+、iceA2+为淮南地区HP感染的优势基因型,该基因型易导致HP根除失败;未发现babA2与HP感染结局存在相关性。     

Association between TNFA Gene Polymorphisms and Helicobacter pylori Infection: A Meta-Analysis

Background

Several host genetic factors are thought to affect susceptibility to Helicobacter pylori infection-related diseases, including tumor necrosis factor (TNF)-α. Previous studies have evaluated the association between TNFA gene polymorphisms and H. pylori infection, but the results were inconclusive. We conducted this meta-analysis to clarify the association between TNFA polymorphisms and H. pylori infection.

Methods

Published literature within PubMed, Embase, and the Cochrane Library were used in our meta-analysis. Data were analyzed with the Stata13.1 software package using pooled odds ratios (ORs) with 95% confidence intervals (CI).

Results

A total of 24 studies were included in our study. The TNFA -308G>A polymorphism was associated with decreasing H. pylori infection (AA vs. AG+GG, OR = 0.64, 95% CI = 0.43–0.97; AA vs. GG, OR = 0.64, 95% CI = 0.43–0.97). A significantly decreased risk was also found for -1031T>C polymorphism (CC vs. CT+TT, OR = 0.61, 95% CI = 0.44–0.84). -863C>A polymorphism was associated with increasing risk of H. pylori infection (AA+AC vs. CC, OR = 1.47, 95% CI = 1.16–1.86; A allele vs. C allele, OR = 1.40, 95% CI = 1.14–1.72). There was no significant association between -857C>T polymorphism and H. pylori infection. When stratified analysis was conducted on H. pylori infection detection methods, -857C>T and -863C>A polymorphisms were associated with H. pylori infection for the non-ELISA subgroup. When stratified for ethnicity or study design, -863C>A significantly increased the risk and -1031T>C decreased the risk for the Asian subgroup and hospital-based subgroup.

Conclusion

Results of our meta-analysis demonstrate that TNFA -308G>A and -1031 T>C polymorphisms may be protective factors against H. pylori infection, and -863C>A may be a risk factor, especially in Asian populations. Further studies with larger sample sizes are required to validate these results.