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Virulence factor genotypes of Helicobacter pylori affect cure rates of eradication therapy

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  • Published:
Archivum Immunologiae et Therapiae Experimentalis Aims and scope

Abstract

The cure rates of Helicobacter pylori infection by using a combination of a proton pump inhibitor (PPI) and antimicrobial agents are mainly influenced by bacterial susceptibility to antimicrobial agents and the magnitude of acid inhibition during the treatment. Currently used empirical triple therapies do not reliably produce a ≥80% cure rate on an intention-to-treat basis. Therefore, tailored regimens based on relevant microbiological findings and pharmacogenomics are recommended for attaining an acceptable ≥95% cure rate. Recently, virulence factors of H. pylori, such as cagA and vacA, are reported to be major factors determining the cure rates. Individuals infected with strains with cagA-negative and vacA s2 genotypes have significantly increased risk of eradication failure of H. pylori infection. These virulence factors enhance gastric mucosal inflammation and are associated with the development of peptic ulcer and gastric cancer. H. pylori virulence factors induce proinflammatory cytokines, such as interleukin (IL)-1, IL-8, and tumor necrosis factor (TNF)- which influence mucosal inflammation and/or gastric acid secretion. When physicians select an H. pylori eradication regimen with an acceptable cure rate, they might need to consider H. pylori virulence factors, especially cagA and vacA.

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Abbreviations

CYP2C19:

cytochrome P450 2C19

H_2RA:

histamine 2-receptor antagonist

IL:

interleukin

MDR1:

multidrug resistance transporter-1

PPI:

proton pump inhibitor

OipA:

outer inflammatory protein

PAI:

pathogenicity island

TNF:

tumor necrosis factor

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  1. Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA

    Mitsushige Sugimoto & Yoshio Yamaoka (M.D., Ph.D.)

  2. Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., (111D) Rm 3A-320, Houston, TX, 77030, USA

    Yoshio Yamaoka (M.D., Ph.D.)

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Correspondence to Yoshio Yamaoka.

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Sugimoto, M., Yamaoka, Y. Virulence factor genotypes of Helicobacter pylori affect cure rates of eradication therapy. Arch. Immunol. Ther. Exp. 57, 45–56 (2009). https://doi.org/10.1007/s00005-009-0007-z

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