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Open Access 01-12-2015 | Research

Helicobacter pylori virulence genes in the five largest islands of Indonesia

Authors: Muhammad Miftahussurur, Ari Fahrial Syam, Dadang Makmun, Iswan Abbas Nusi, Lukman Hakim Zein, Zulkhairi, Fardah Akil, Willi Brodus Uswan, David Simanjuntak, Tomohisa Uchida, Pangestu Adi, Amanda Pitarini Utari, Yudith Annisa Ayu Rezkitha, Phawinee Subsomwong, Nasronudin, Yoshio Yamaoka

Published in: Gut Pathogens | Issue 1/2015

Abstract

Background

It remains unclear whether the low incidence of gastric cancer in Indonesia is due to low infection rates only or is also related to low Helicobacter pylori pathogenicity. We collected H. pylori strains from the five largest islands in Indonesia and evaluated genetic virulence factors.

Methods

The genotypes of H. pylori virulence factors were determined by polymerase chain reaction (PCR)-based sequencing. Histological severity of the gastric mucosa was classified into 4 grades, according to the updated Sydney system.

Results

A total of 44 strains were analyzed. Forty-three (97.7 %) were cagA-positive: 26 (60.5 %) were East-Asian-type-cagA, 9 (20.9 %) were Western-type-cagA, and 8 (18.6 %) were novel ABB-type, most of which were obtained from Papuan. EPIYT sequences were more prevalent than EPIYA sequences (P = 0.01) in the EPIYA-B motif of all types of cagA. The majority of cagA-positive strains (48.8 %, 21/43) had a 6-bp deletion in the first pre-EPIYA region. Subjects infected with East-Asian-type-cagA strains with a 6-bp deletion had significantly lower inflammation and atrophy scores in the corpus than those infected with Western-type-cagA strains (both P = 0.02). In total, 70.4 % of strains possessed the vacA s1m1 genotype and 29.5 % were m2. All strains from peptic ulcer patients were of the iceA1 genotype, which occurred at a significantly higher proportion in peptic ulcer patients than that in gastritis patients (55.3 %, P = 0.04). The double positive genotype of jhp0562/β-(1,3)galT was predominant (28/44, 63.6 %), and subjects infected with this type had significantly higher inflammation scores in the corpus than those with the jhp0562 negative/β-(1,3)galT positive genotype (mean [median]; 1.43 [1] vs. 0.83 [1], P = 0.04). There were significant differences in cagA and pre-EPIYA cagA type, oipA status, and jhp0562/β-(1,3)galT type among different ethnic groups (P < 0.05).

Conclusions

In addition to a low H. pylori infection rate, the low incidence of gastric cancer in Indonesia might be attributed to less virulent genotypes in predominant strains, which are characterized by the East-Asian-type-cagA with a 6-bp deletion and EPIYT motif, a high proportion of m2, dupA negative or short type dupA, and the jhp0562/β-(1,3)galT double positive genotype.

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Title: Helicobacter pylori virulence genes in the five largest islands of Indonesia
Authors: Muhammad Miftahussurur
Ari Fahrial Syam
Dadang Makmun
Iswan Abbas Nusi
Lukman Hakim Zein
Zulkhairi
Fardah Akil
Willi Brodus Uswan
David Simanjuntak
Tomohisa Uchida
Pangestu Adi
Amanda Pitarini Utari
Yudith Annisa Ayu Rezkitha
Phawinee Subsomwong
Nasronudin
Yoshio Yamaoka
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Gut Pathogens / Issue 1/2015
Electronic ISSN: 1757-4749
DOI: https://doi.org/10.1186/s13099-015-0072-2

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