京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20052号 / 医博第4160号 / 新制||医||1018(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 戸井 雅和, 教授 妹尾 浩, 教授 小川 修 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

L’infection par Helicobacter pylori touche environ la moitié de la population mondiale et est responsable de plusieurs pathologies gastro-intestinales incluant l’adénocarcinome gastrique. Les mécanismes de la carcinogénèse induite par H. pylori ne sont pas clairement élucidés. Mais, l’oncoprotéine CagA que possèdent certaines souches est très impliquée dans la carcinogénèse gastrique ; elle induit l’apparition d’un phénotype particulier, dit colibri, qui mime une transition épithélio-mésenchymateuse (EMT). De plus, CagA déstabilise les jonctions cellulaires en perturbant la E-cadhérine. Les objectifs de ces travaux ont été de déterminer si H. pylori induit une véritable EMT et si cette EMT est à l’origine de l’émergence de cellules souches cancéreuses (CSC). De plus, nous avons étudié le rôle joué par la protéine IQGAP1, protéine assurant le maintien des jonctions cellulaires, dans la carcinogénèse gastrique induite par H. pylori. Ces travaux ont montré que H. pylori induit une EMT in vitro. Cette EMT est à l’origine de l’émergence de cellules CD44high présentant les caractéristiques de CSC. L’étude du rôle de IQGAP1 au cours de la carcinogénèse gastrique liée à H. pylori a permis de déterminer son implication dans l’apparition de lésions néoplasiques dans un modèle de souris transgéniques hétérozygotes pour IQGAP1. En outre, IQGAP1 apparaît comme une protéine dont l’expression est modifiée par l’infection à H. pylori et par l’EMT induite par cette bactérie in vitro. Nos résultats permettent de mieux comprendre le mécanisme physiopathologique de l’adénocarcinome gastrique et seront potentiellement utiles au développement de nouvelles thérapeutiques anti-cancéreuses. / Helicobacter pylori infection is found in about half of the world population and is responsible for several gastrointestinal pathologies, including gastric adenocarcinoma. The mechanisms of the carcinogenesis due to H. pylori remain unclear. However, the link with gastric adenocarcinoma is partly due to the H. pylori CagA oncoprotein. CagA is responsible for a particular cell phenotype in vitro, the “hummingbird” phenotype which corresponds to an elongation of the cells, mimicking an epithelial to mesenchymal transition (EMT). EMT participates to carcinogenesis, and is involved in the generation of cancer stem cells (CSC). Moreover, CagA destabilize the cell junctions. This study aimed to determine wether H. pylori induces a true EMT, and if so, wether this EMT can generate CSCs. The role of IQGAP1, which is a scaffold protein involved in cell adhesion, was also studied in cases of gastric carcinogenesis due to H. pylori. We demonstrated that H. pylori induces an EMT in vitro. Moreover, we showed that this EMT is responsible for the emergence of CD44high cells which have the same characteristics as the CSCs. IQGAP1 has been identified as a protein implicated in neoplastic lesion development in a transgenic mouse model heterozygous for IQGAP1. Moreover, in vitro, the expression of IQGAP1 was modified by H. pylori infection and more specifically by the EMT induced by H. pylori. Our results allow a better understanding of gastric adenocarcinoma pathophysiology and will be helpful in developing new cancer chemotherapies.

The high incidence of gastrointestinal cancers in the general population and the presence of premalignant dysplastic precursor lesions in the gastrointestinal tract make the gastrointestinal tract an ideal environment to study cancer clonality and clonal expansion. Background: Intestinal metaplastic (IM) glands in the human stomach are clonal, contain multiple stem cells and spread by fission. This mechanism of gland fission causes field cancerisation. We hypothesised that gastric adenocarcinoma (GA) progresses through a series of genetic events arising from a founder mutation. A process analogous to niche succession may also take place in the normal oesophagus. We hypothesise that oesophageal squamous cell cancer occurs by a process of field cancerisation of the oesophagus. RHBDF2 has been identified as the gene responsible for tylosis with oesophageal carcinoma (TOC). We hypothesise that RHBDF2 germline gain of function mutations might be lost during tumour progression in TOC and this might affect iRhom2 localisation in the cell. Methods and results: A cohort of 23 patients with dysplasia and a cohort of 51 GA patients were screened for genes accounting for 75% of all somatic mutations previously reported in GA. Only 13% of dysplastic patients and 31.4% of GA patients had mutations. Three dysplastic patients and six GA patients were analysed by microdissection. Small gastric cancer foci in a cohort of hereditary diffuse gastric cancer (HDGC) patients (n=5) were also screened by laser-capture microdissection (LCM) for mutations in TP53. A cohort of 30 patients was screened for common mutations in OSCC and for RHBDF2 mutations. 36.36% of the patients presented mutations. Three patients with mutations were randomly selected and areas of oesophageal squamous cell dysplasia and OSCC were analysed by LCM. Three TOC patients were also analysed by LCM and immunohistochemistry was performed for iRhom2 and ADAM17. Conclusions: The usual mutational events established for GA development during the metaplasiadysplasia- carcinoma sequence (MCS) do not fit the results from either of our two LCM mutation studies in the human stomach. Dysplasia was shown to be clonal and GA demonstrates genetic heterogeneity through clonal evolution. Field cancerisation could not be detected in HDGC using TP53 as a clonal marker. The low incidence of OSCC patients with mutations implies that other genes may be involved in the premalignant pathway leading to OSCC. Oesophageal squamous cell dysplasia and OSCC demonstrate clonal expansion through tumour progression. RHBDF2 mutations do not occur in sporadic OSCC but germline RHBDF2 mutations can be lost during tumour progression in TOC patients with LOH in 17q. Overall, the somatic mutation theory of carcinogenesis seems to hold true for both the progression to GA and OSCC, as both carcinomas seem to evolve from a single mutated stem cell and acquire genetic heterogeneity as the tumours evolve.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O cÃncer gÃstrico à a quarta neoplasia maligna mais freqÃente e a segunda causa de morte por cÃncer no mundo, registrando-se aproximadamente 934 mil novos casos e 700 mil mortes por ano. No Brasil, o cÃncer gÃstrico à o sexto tumor maligno mais freqÃente. Na regiÃo Nordeste à a segunda neoplasia mais freqÃente entre os homens e a quarta entre as mulheres, sendo que no estado do Cearà à a terceira neoplasia mais freqÃente. Dentre os agentes infecciosos, a bactÃria Helicobacter pylori (H. pylori), considerada pela OMS agente carcinogÃnico do grupo I, tem sido destacada, nas Ãltimas dÃcadas, visto sua relaÃÃo com a gastrite crÃnica ativa, com o desenvolvimento de Ãlceras gÃstricas e duodenais e aumento do risco de cÃncer gÃstrico. AlÃm da presenÃa, a variaÃÃo genÃtica das cepas de H. pylori parece influenciar na gravidade das doenÃas causadas pela infecÃÃo. O carÃter patogÃnico à dado pela presenÃa, em algumas cepas, da denominada ilha de patogenicidade, cag-PAI; um fragmento de DNA de 35-40 Kb cepa especÃfico, a qual possui uma sÃrie de genes associados a um virulento aparato secretÃrio. AlÃm disso, outro gene, denominado vacA, tambÃm apresenta-se como um importante fator de virulÃncia. Apesar dessas associaÃÃes nÃo hà ainda uma relaÃÃo direta entre a presenÃa desses genes com o processo tumorigÃnico. Uma das possÃveis explicaÃÃes à a presenÃa de outros genes que contribuam para o fenÃtipo mais grave ou maligno, principalmente associada a cag-PAI. Nesse contexto, o presente estudo objetivou investigar a freqÃÃncia de H. pylori genotipando quanto as variantes alÃlicas de vacA, a presenÃa dos genes cagA, cagE e virB11 e sua associaÃÃo com os dados clinico- patolÃgicos de adenocarcinoma gÃstricos de uma populaÃÃo do Estado do CearÃ. Para tanto, 101 casos de adenocarcinoma gÃstricos (68 homens e 33 mulheres), obtidos de dois hospitais de Fortaleza, foram analisados por PCR quanto à presenÃa de H. pylori e os genes estudados. A distribuiÃÃo do cÃncer gÃstrico por sexo, sÃtio anatÃmico do tumor e anÃlise histopatolÃgicas, de modo geral, reproduziram as tendÃncias da literatura mundial. A bactÃria esteve presente em 93% dos casos analisados. Os genes de H. pylori apresentaram as seguintes freqÃÃncias: vacAs1m1 (75,5%), vacAs1m2 (13,8%), vacAs2m1 (4,6%), vacA s2m2 (6,5%), cagA (64,9%), cagE (53,2%) e virB11 (60,6%). Esse dados sÃo os primeiros na literatura mundial citando a freqÃÃncia virB11 e o segundo para o gene cagE em cÃncer gÃstrico e indicam uma variaÃÃo de cepas circulantes quanto a presenÃa desses genes quando comparado esses dados com os de outras doenÃas gÃstricas. A combinaÃÃo mais freqÃente foi vacAs1m1cagA(+)cagE(+)virB11(+), encontrada em 36,2% dos casos analisados, sendo considerada a cepa mais patogÃnica. A integridade de cag-PAI foi verificada em 38,3% dos casos, quando considerados os trÃs marcadores estudados, entretanto, considerando-se pelo menos um marcador de lado direito (cagA e/ou cagE) e o marcador do lado esquerdo (virB11), a freqÃÃncia foi de 56,4%. A distribuiÃÃo dos genÃtipos de H. pylori em grupos demonstrou que a maior freqÃÃncia das cepas consideradas mais patogÃnicas foi em tumores do antro gÃstrico, nÃo houve predileÃÃo das variaÃÃes genotÃpicas por nenhum dos tipos histolÃgicos, alÃm de verificar-se a alta freqÃÃncia das cepas mais patogÃnicas nos estadiamentos II e IV, demonstrando a participaÃÃo de H. pylori na carcinogÃnese gÃstrica. / The gastric cancer is the fourth more frequent cancer, and the second cause of death for cancer in the world, recording approximately 934 thousand of new cases and 700 thousand of deaths a year. In Brazil, the gastric cancer is the sixth more frequent malignant tumor. In the Northeast area, it is the second more frequent cancer among the men and fourth among the women. In the state of Ceara, it is the third more frequent neoplasia. Among the infectious agents, the bacterium Helicobacter pylori (H. pylori), which is considered carcinogenic agent of the group I, has been pointed in the last decades because of the connection with activated chronic gastritis, with the development of peptic ulcers and duodenais, and the increase of the risk of gastric cancer. Besides the presence, genetic variation of the strains of H. pylori seems to influence in the seriousness of the disease caused by infection. The pathogenic character is given by the presence, in some cepas, of the called cag pathogenicity island, cag-PAI; one gene fragment of 35-40 Kb strain specific, which possess a series of genes associates to a virulent type IV secretion apparatus. Moreover, another gene, called vacA, it is presented as an important virulence factor. Despite these associations does not have still a direct relation enters the presence of these genes with the tumorigenic process. One of the possible explanations is the presence of other genes that contribute for fenotype more serious or malignant, mainly associates cag-PAI. In this context, the present study objectified to investigate the frequency of H. pylori genotyped how much the alelics variants of vacA the presence of the genes cagA, cagE and virB11 and its association with the clinic- pathological dates of gastric adenocarcinoma of one population of the Ceara State. For in such a way, 101 cases of gastric adenocarcinoma (68 men and 33 women), gotten of two hospitals of Fortaleza, had been analyzed by PCR how much to the presence of H. pylori and the studied genes. The distribution of the gastric cancer by sex, anatomical sites and the histopatologic analysis, in general way, had reproduced the trends of world-wide literature. The bacterium was present in 93% of the analyzed cases. The genes of H. pylori had presented the following frequencies: vacAs1m1 (75,5%), vacAs1m2 (13,8%), vacAs2m1 (4,6%), vacA s2m2 (6,5%), cagA (64,9%), cagE (53,2%) and virB11 (60,6%). These data are the first ones in world-wide literature citing the frequency of virB11 and as for the gene cagE in gastric cancer and indicate a circulating variation of strains how much the presence of these genes when compared these data with the ones of other gastric diseases. The most frequent combination was vacAs1m1cagA(+)cagE(+)virB11(+), found in 36,2% of the analyzed cases, being considered strain more pathogenic. The integrity of cag-PAI was verified in 38,3% of the cases, when considered the three studied markers, however, considering at least one marker of right side (cagA and/or cagE) and the marker of the left side (virB11), the frequency was of 56,4%. The distribution of the genotypes of H. pylori in groups demonstrated that the biggest frequency of strains considered more pathogenic was in tumors of the gastric antrum, did not have predilection of the genotypic variations for none of the histologic types, besides verifying it high frequency of more pathogenic strains in tumor stage II and IV, demonstrating to the participation of H. pylori in gastric carcinogenesis.

L’infection par Helicobacter pylori touche environ la moitié de la population mondiale et est responsable de plusieurs pathologies gastrointestinales incluant l’adénocarcinome gastrique. Le développement récent d’un modèle d’étude chez l’animal a permis d’identifier la nature des cellules à l’origine de la transformation cancéreuse en réponse à l’infection chronique par Hélicobacter. Les cellules souches mésenchymateuses de la moelle osseuse (MSC) seraient recrutées au niveau de la muqueuse gastrique afin de reconstituer, par un mécanisme de différenciation épithéliale, les glandes lésées par l’infection. L’adénocarcinome gastrique se développerait à partir des glandes reconstituées par les MSC. Les objectifs de ces travaux ont été d’analyser, in vitro par une approche séquentielle, les différentes étapes responsables de l’initiation tumorale incluant le recrutement des MSC au niveau gastrique, leur différenciation en cellules épithéliales et leur transformation tumorale lors de l’infection par H. pylori. Ces travaux ont tout d’abord démontré que les cellules épithéliales infectées par H. pylori peuvent recruter les MSC après sécrétion de certaines chimiokines. Nous avons ensuite montré que les MSC sont capables de fusionner avec les cellules épithéliales gastriques aboutissant à l’obtention de cellules épithéliales dérivées des MSC. Finalement, les interactions entre H. pylori et les MSC ont été étudiées et ont fourni des premiers éléments de compréhension des mécanismes de l’initiation tumorale. Nos résultats permettent de mieux comprendre le mécanisme physiopathologique de l’adénocarcinome gastrique et seront utiles à la compréhension d’autres cancers dans lesquels le rôle des MSC comme cellules initiatrices de tumeur est suggéré. / Helicobacter pylori infection is found in about half of the world population and can induce several gastrointestinal pathologies including gastric adenocarcinoma. An animal model recently led to the hypothesis of a cellular origin for the cancer initiating cells after Helicobacter infection. Bone marrow-derived mesenchymal stem cells (MSC) are believed to be recruited in the gastric mucosa in order to repair the damages due to infection, by an epithelial differentiation. Gastric carcinoma may rise from MSC reconstituted gastric glands. This study aimed to analyze, by sequential in vitro approaches, the different steps allowing tumor initiation including MSC recruitment by infected epithelial cells, epithelial differentiation of MSC, and cancer marker appearance after H. pylori infection. We first demonstrated that H. pylori infected epithelial cells may recruit MSC by a secretion of cytokines. We then showed that MSC fuse with gastric epithelial cells leading to MSC-derived epithelial cells. Finally, we studied the interaction between H. pylori and epithelial cells providing a preliminary explanation for cancer initiation. Our results allow a better understanding of gastric adenocarcinoma pathophysiology and will be helpful for the understanding of other cancers in which the role of MSC as cancer initiating cells is suspected.

L’infection chronique par Helicobacter pylori touche plus de la moitié de la population mondiale et est la principale cause connue de l’adénocarcinome gastrique. La metformine, un antidiabétique oral, est de plus en plus étudiée pour ses propriétés antitumorales dans de nombreux types de cancers. Cependant, ses effets potentiels ont très peu été étudiés dans le cancer gastrique. Des expériences réalisées sur des lignées cellulaires cancéreuses gastriques et des tumeurs de patients amplifiées par xénogreffe chez la souris (PDX), ont permis de confirmer les propriétés antitumorales de la metformine. La metformine, en traitement préventif et curatif, diminue la capacité de formation des tumorsphères, l’expression des marqueurs de CSC gastriques, et la capacité d’auto-renouvellement propre aux CSC. Dans un second temps, nous avons montré que la metformine est capable d’inhiber la croissance bactérienne de H. pylori invitro et in vivo. Enfin, les effets de l’infection par H. pylori ont été étudiés sur la voie de signalisation mTOR par la réalisation d’une analyse transcriptomique et de western-blots sur des lignées cellulaires gastriques. Ceci a permis de démontrer que H. pylori inhibe le complexe mTORC1.Pour conclure, ce travail de thèse a permis i) de démontrer la capacité de la metformine à cibler les CSC gastriques, ii) de découvrir une nouvelle propriété antibactérienne de la metformine vis-à-vis de H. pylori, iii) de démontrer que H. pylori inhibe la voie de signalisation mTOR. / Chronic infection with Helicobacter pylori affects more than half of the world's population and is the main known cause of gastric adenocarcinoma. Metformin is an oral antidiabetic drug used to treat type 2 diabetes patients, and is being increasingly studied for its antitumoral properties in several cancer types. However, its potential effects in gastric cancer have not been thoroughly studied. Experiments performed on gastric cancer cell lines and patient-derived gastric carcinoma xenografts (PDX), have confirmed the antitumoral properties of metformin. Metformin, in preventive and curative treatment, decreases the tumorsphere formation, the expression of gastric CSC markers and the self-renewal capacity of CSC. In a second time, we have shown that metformin is able to inhibit the bacterial growth of H. pylori in vitro and in vivo. Finally, the effects of the H. pylori infection have been studied on the mTOR signaling pathway using a transcriptomic analysis and western blots, performed on gastric cancer cell lines. These show the ability of H. pylori to inhibit mTORC1.To conclude, this thesis work allowed i) to demonstrate the ability of metformin to target gastric CSCs, ii) to discover a new antimicrobial property of metformin against H. pylori, iii) to demonstrate that H. pylori inhibits the mTOR signaling pathway.

In dieser Arbeit wurden Genexpressionsprofile diffuser und intestinaler Magenadenokarzinome mittels Microarray-Technik erstellt. Der intestinale Typ konnte als stark proliferierender Tumor mit signifikanter Überexpression von zellzyklusrelevanten Genen definiert werden, während der diffuse Typ als stark stromaabhängig mit signifikanter Überexpression von Genen der extrazellulären Matrix hervortrat. Thrombospondin 4 (THBS4) wurde dabei als das am stärksten differentiell exprimierte Gen identifiziert, wobei seine mRNA in diffusen Tumoren eminent überexprimiert wird. Immunhistochemische Studien bestätigten diese starke Überexpression auf Proteinebene und zeigten, dass THBS4 eine übermäßig angereicherte extrazelluläre Komponente des Tumorstromas ist. Kolokalisierungsstudien zeigten zudem, dass THBS4-positive Zellen auch positiv für Vimentin und Smooth muscle actin (alpha) sind. Diese Ergebnisse belegen, dass THBS4 von Tumor-assoziierten Fibroblasten (TAF) exprimiert wird. Dies konnte durch zusätzliche in vitro Experimente bestätigt werden, die aufzeigten, dass TAF von diffusen Tumoren eine stärkere THBS4-mRNA Expression aufweisen als normale Fibroblasten des Magens. Abschließend konnten in vitro Kokultur-Studien aufdecken, dass die THBS4-Expression in Fibroblasten durch Tumorzellen diffuser Magentumore transkriptionell stimuliert wird. Metastasenbefall regionaler Lymphknoten (N+) ist bei den meisten Magenadenokarzinomdiagnosen bereits vorhanden. Dieser ist der stärkste derzeit verfügbare Parameter zur Abschätzung der Prognose, reicht aber für eine eindeutige Vorhersage nicht aus. Um ergänzende molekulare Prognoseindikatoren zu identifizieren, wurden aus den Microarray-Daten Gene, deren Expression mit dem klinischen Verlauf von N+ Patienten korreliert, extrahiert. Einige dieser Gene, z.B. RAN binding protein 17 und ras-related associated with diabetes, konnten mittels quantitativer real-time PCR als Marker für verkürztes progressionsfreies Überleben validiert werden. / In this work, gene expression profiles of diffuse and intestinal-type gastric adenocarcinomas were established using the microarray technique. The intestinal type was identified to be a highly proliferative entity with significant overexpression of cell cycle-relevant genes, whereas the diffuse type was proven to be strongly stroma-dependent with significant overexpression of extracellular matrix genes. Thrombospondin 4 (THBS4) was identified as the gene most differentially expressed between the two types with vast mRNA overexpression in diffuse-type tumors. Immunohistochemical studies proved overexpression on protein level and elucidated that THBS4 is a heavily accumulated extracellular constituent of the tumor stroma. Colocalization studies uncovered that THBS4-positive cells are also positive for vimentin and alpha-smooth muscle actin. These data signify that THBS4 is expressed by subpopulations of cancer-associated fibroblasts (CAFs). This was further evidenced by in vitro experiments demonstrating that THBS4 mRNA expression is increased in CAFs of diffuse-type tumors compared to normal gastric fibroblasts. Finally, in vitro coculture studies revealed that transcriptional THBS4 expression in fibroblasts is stimulated by diffuse-type gastric tumor cells. Metastatic involvement of regional lymph nodes (N+) usually accompanies diagnosis of gastric adenocarcinoma and is currently considered the most important parameter for assessment of prognosis. However, estimation of prognosis based on this parameter alone is not sufficiently reliable. In order to identify additional molecular prognosis markers, genes whose expression correlates with clinical outcome of N+ patients were extracted from the microarray data. Via quantitative real-time PCR, several genes, e.g. RAN binding protein 17 and ras-related associated with diabetes, were successfully validated to allow an expression-based stratification of patients with respect to disease-free survival.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O carcinoma gÃstrico à a segunda causa de morte por cÃncer no mundo. No Cearà à o segundo mais freqÃente entre os homens e o terceiro entre as mulheres. Dos cÃnceres gÃstricos os adenocarcinomas representam em torno de 95%. A doenÃa tem sido associada a fatores genÃticos e ambientais sendo demonstrada Ãntima relaÃÃo com a infecÃÃo por Helicobacter pylori, principalmente associada à presenÃa do gene cagA e genÃtipos vacAs1m1. Entretanto, apesar dos mecanismos pelos quais a bactÃria promove a carcinogÃnese gÃstrica ainda nÃo estarem esclarecidos, uma das hipÃteses seria atravÃs da inativaÃÃo de supressores tumorais. O objetivo do presente trabalho foi verificar, em adenocarcinomas gÃstricos, se a presenÃa de H. pylori, e de seus genes cagA e vacA, està relacionada com a mutaÃÃo e/ou alteraÃÃo na expressÃo protÃica dos supressores tumorais p53 e p27. Neste estudo, 74 amostras de pacientes foram analisadas quanto à presenÃa de H. pylori, cagA+ e os genÃtipos de vacA, pela reaÃÃo em cadeia da polimerase (PCR). A anÃlise mutacional do gene p53 foi realizada por PCR-SSCP e a detecÃÃo da mutaÃÃo/superexpressÃo do p53 e expressÃo da proteÃna p27 pelo mÃtodo imunohistoquÃmico. A bactÃria foi detectada em 95% das amostras, das quais 63% eram cagA(+). Dentre os alelos de vacA, observou-se predomÃnio de s1 (74%) e m1 (82%), associados em 69% dos casos. Na anÃlise mutacional do p53 verificou-se que 72% dos casos exibiram alteraÃÃo no padrÃo de mobilidade eletroforÃtica, sendo esta associada significativamente à presenÃa do gene cagA. Por outro lado, apenas 29% dos casos apresentaram detecÃÃo pelo mÃtodo imunohistoquÃmico, nÃo sendo encontrada associaÃÃo com a H. pylori. A proteÃna p27 demonstrou acentuada reduÃÃo em sua expressÃo (detectada em apenas 19% dos casos), nÃo demonstrando atividade compensatÃria em relaÃÃo à proteÃna p53 mutada e sem associaÃÃo estatÃstica dos casos negativos com a presenÃa da H. pylori. Finalmente, os resultados sugerem que estes supressores simultaneamente inativados podem ser o ponto chave da desregulaÃÃo do ciclo celular que, associados a outros fatores, favoreÃam o desenvolvimento e progressÃo dos adenocarcinomas gÃstricos. Hà indÃcios de que a presenÃa bacteriana, e dos seus genes cagA(+) e vacA/s1m1, possam influenciar, de forma nÃo esclarecida, as alteraÃÃes moleculares ocorridas nos supressores tumorais p53 e p27. / Gastric carcinoma is the second cause of death by cancer in the world. On State of Ceara-Brazil is the second most frequent type of cancer in men and third in women. Adenocarcinomas account for approximately 95% of all malignant gastric neoplasms. It has been associated to genetic and environmental factors and a intimate relationship between the infection by the bacteria Helicobacter pylori and the gastric carcinoma have been related. The presence of the cagA gene and specific genotypes (s1m1) of the gene vacA have been detected in more pathogenic strains. Although the precise molecular mechanisms by which H. pylori could promote the process of gastric carcinogenesis are under investigation, one hypothesized mechanism involves the tumor supressor genes inactivation. The aim of the present study was to verify if the presence of Helicobacter pylori, cagA and vacA genes is related to mutations in the tumor supressor gene p53 and altered expression of p53 and p27 proteins in gastric adenocarcinomas. Seventy-four (74) samples were analyzed to detect the presence of H. pylori, cagA and genotypes of vacA by Polymerization Chain Reaction (PCR). The mutational analysis of p53 gene was performed by PCR-SSCP (Polymerization Chain Reaction for analysis of the Single-strand Conformation Polymorphism). Analysis of mutation or overexpression of p53 protein and p27 expression was detected by the immunohistochemical method. The bacteria was detected in 95% of the samples, 63% was cagA(+). Among the vacA allele it was observed prevalence of s1 (74%) and m1 (82%), associated in 69% of the cases. Mutation analysis of p53 demonstrated 72% of the cases with altered electrophoretic mobility; The alterations were significatively more frequent in the presence of the cagA gene. Immunohistochemical analysis detected only 29% of cases with the expression of p53 protein. The protein p27 showed accentuated reduction in its expression (detected in only 19% of the cases), it has not demonstrated compensatory activity in relation to the p53 altered protein, neither association to H. pylori presence. Finally, these data suggest that simultaneous inactivation of these tumor suppressors genes may be the key point of deregulation of the cellular cycle that, associated to the other factors, favor the development and progression of the gastric cancer. There is some evidence that the bacterial presence, cagA and vacA/s1m1 genes, may influence, in a not understood way, the alterations observed in the tumor suppressors p53 and p27.