Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2023; 29(1): 190-199
Published online Jan 7, 2023. doi: 10.3748/wjg.v29.i1.190
Impact of Helicobacter pylori virulence markers on clinical outcomes in adult populations
Halim Roshrosh, Hanan Rohana, Maya Azrad, Tamar Leshem, Segula Masaphy, Avi Peretz
Halim Roshrosh, Segula Masaphy, Applied Mycology and Microbiology, Migal, Kiryat Shemona 1101202, Israel
Hanan Rohana, Maya Azrad, Tamar Leshem, Avi Peretz, Department of Microbiology, Padeh Poriya Medical Center, Tiberias 111508, Israel
Author contributions: Roshrosh H, Rohana H, and Peretz A contributed to conceptualization; Roshrosh H, Rohana H, Azrad M, and Leshem T contributed to data curation; Roshrosh H, Rohana H, Azrad M, Leshem T, and Peretz A contributed to formal analysis; Roshrosh H, Rohana H, and Leshem T contributed to investigation and methodology; Leshem T, Azrad M, and Peretz A contributed to project administration and supervision; Roshrosh H, Rohana H, and Leshem T contributed to validation; Roshrosh H, Rohana H, and Leshem T contributed to visualization; Roshrosh H, Rohana H, Azrad M, and Peretz A contributed to writing the original draft; Roshrosh H, Rohana H, Azrad M, Leshem T, and Peretz A contributed to reviewing and editing; All authors read and agreed to the published version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Helsinki Committee of the Baruch Padeh Medical Center, Poriya (Approval No. POR 0007-20).
Informed consent statement: The Institutional Review Board committee waived the need for participant approval.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The data presented in this study are available on request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maya Azrad, PhD, Research Scientist, Department of Microbiology, Padeh Poriya Medical Center, Lower Galillee Israel, Tiberias 111508, Israel. mazrad@poria.health.gov.il
Received: August 16, 2022
Peer-review started: August 16, 2022
First decision: October 20, 2022
Revised: November 2, 2022
Accepted: November 21, 2022
Article in press: November 21, 2022
Published online: January 7, 2023
Abstract
BACKGROUND

In recent years, associations between specific virulence markers of Helicobacter pylori (H. pylori) and gastrointestinal disorders have been suggested.

AIM

To investigate the presence of virulence factors including vacuolating cytotoxin A genotypes (s1m1, s1m2, s2m1, and s2m2), cytotoxin-associated gene A (CagA), and urease activity in H. pylori strains isolated from Arab and Jewish populations in northern Israel and to assess associations between these factors and patients’ demographics and clinical outcomes.

METHODS

Patients (n = 108) who underwent gastroscopy at the Baruch Padeh Medical Center, Poriya due to symptomatic gastroduodenal pathologies as part of H. pylori diagnosis were enrolled in the study. Gastric biopsy specimens were collected from the antrum of the stomach. Clinical condition was assessed by clinical pathology tests. Bacteria were isolated on modified BD Helicobacter Agar (BD Diagnostics, Sparks, MD, United States). Bacterial DNA was extracted, and PCR was performed to detect CagA and vacuolating cytotoxin A genes. Urease activity was assessed using a rapid urease test.

RESULTS

A significant correlation was found between disease severity and patient ethnicity (P = 0.002). A significant correlation was found between CagA presence and the s1m1 genotype (P = 0.02), which is considered the most virulent genotype. Further, a higher level of urease activity was associated with isolates originating from the Jewish population. Moreover, higher urease activity levels were measured among CagA-/s1m1 and CagA-/s2m2 isolates.

CONCLUSION

Our study highlights the importance of incorporating molecular methods for detection of virulence markers of H. pylori in order to tailor optimal treatments for each patient. Further investigation should be performed regarding associations between H. pylori virulence factors and ethnicity.

Keywords: Helicobacter pylori, Virulence factors, Vacuolating cytotoxin A, Cytotoxin-associated gene A, Urease activity

Core Tip: In recent years, associations have been found between virulence markers of Helicobacter pylori and gastrointestinal disorders. In parallel, several physicians in northern Israel noted a higher treatment failure rate among Arab patients compared to Jewish patients. This work found a significant correlation between disease severity and patient ethnicity (P = 0.002). Further, a higher level of urease activity was associated with isolates originating from the Jewish population. Moreover, higher urease activity levels were measured among CagA-/s1m1 and CagA-/s2m2 isolates. These findings are expected to advance personalization of treatment to specific strains based on their virulence factors.