Abstract

Background: Allelic variation of the virulence genes, vacA and cagA, as the most important virulence associated genes play an important role in the pathogenesis of severe gastrointestinal disease. Objective: The aim of the present study was to identify the diversity of the virulence genes in patients with Gastric Cancer (GC), who were referred to the gastro-endoscopy unit of Imam Khomeini Hospital, Ahvaz Jundishapur University of medical science, Ahvaz, Iran. Methods: Gastric biopsy specimens from 301 patients suspected to gastrointestinal disorders, were analyzed for H. pylori using molecular and phenotypical methods (culture, and biochemical test (catalase, oxidase and urease tests)). Results: Among 201 PCR positive for H. pylori, using histopathological methods, 22 (10.9) patients had GC. Presence of vacA gene in our H. pylori strains was 100 (201/201), while the most virulent vacA s1 allele was detected in 82.6 isolates, and the mid region vacA m1 was found in 39.8 isolates. The vacA s1/m1 genotype was the most virulent allelic combination in GC and Peptic Ulcer Disease (PUD) in 68.2 and 50, respectively. The cagA gene was detected in 66.7 isolates. Among the cagA positive isolates, EPIYA-ABC motif was the most common motif in the GC (66.7), PUD (55.6) and Erosive Gastroduodenitis (EG) samples (55.2), while EPIYA-ABCC was the most common motif (58.7) in the Non-Ulcer Dyspepsia (NUD) samples. The vacA s1m1/cagA(+) combination was detected in GC (73.3) and PUD (51.9), while vacA s1m2/cagA(+) presented in the NUD and EG samples in 77.8 and 62.1, respectively. Conclusion: In this work, Western type (EPIYA-ABC and ABCC motifs) cagA, vacA s1m1 combinations have been demonstrated as the dominant genotype in the tested Ahvazian H. Pylori strains. Also the participation of cagA gene and vacA s1m1 genotype in development and severity of gastric disorder was well evident. Therefore, infection with H. pylori strain containing the cagA gene or the vacA s1m1 genotypes could be associated with increased risk of GC. This is the first study in our area that reports the high incidence and diversity of allelic combination of cagA and vacA genes in gastroduodenitis patients.