The IntactdupACluster Is a More Reliable Helicobacter pylori Virulence Marker thandupAAlone
ABSTRACTThe duodenal ulcer promoting (dupA) gene, located in the plasticity region ofHelicobacter pylori, is associated with duodenal ulcer development.dupAwas predicted to form a type IV secretory system (T4SS) withvirgenes arounddupA(dupAcluster). We investigated the prevalence ofdupAanddupAclusters and clarified associations between thedupAcluster status and clinical outcomes in the U.S. population. In all, 245H. pyloristrains were examined using PCR to evaluate the status ofdupAand the adjacentvirgenes predicted to form T4SS, in addition to the status ofcagpathogenicity island (PAI). The associations betweendupAcluster status and interleukin-8 (IL-8) and IL-12 production were also examined. The presence ofdupAand all adjacentvirgenes were defined as a completedupAcluster. Many variations related to the status ofdupAanddupAcluster genes were identified. ConcurrentH. pyloriinfection and the presence of a completedupAcluster increases duodenal ulcer risk compared toH. pyloriinfection with incompletedupAcluster or without thedupAgene independent on thecagPAI status (adjusted odds ratio, 2.13; 95% confidence interval, 1.13 to 4.03). Gastric mucosal IL-8 levels were also significantly higher in the completedupAcluster group than in other groups (P= 0.01). In conclusion, although the causal relationship between thedupAcluster and duodenal ulcer development is not proved, the presence of a completedupAcluster but notdupAalone, is associated with duodenal ulcer development.