Abstract Gastric erosions are superficial mucosal breaks. With the exception of bleeding, they are considered harmless, but their aetiology, histopathology and long-term course have remained unknown and even the evolution of gastritis in patients with gastric erosions is unclear. The present study aimed to solve clinical significance and pathology of gastric erosions in a long-term follow-up study. Initially, 117 patients and 117 controls were studied in 1974–1981, and a follow-up study was performed in 1996. We evaluated the presence of Helicobacter pylori and Herpes simplex virus (HSV) infections, use of NSAIDs and alcohol, smoking, and assessed features of gastric histopathology. For follow-up, 52 patients and 66 controls were available. In the follow-up visit, 39% patients still had gastric erosions while 11% of the controls had developed erosions (p = 0.001). In H. pylori-positive subjects, peptic ulcer or a scar was more common in patients (17%) than in controls (4%, p = 0.006), but otherwise no increased morbidity or mortality was seen. High antibody titres against HSV predicted the persistence of erosions (p = 0.000), but H. pylori infection, use of NSAIDs, alcohol or smoking were not associated. Initially, inflammation was more active in the region of erosions than elsewhere in the antral mucosa, and more active inflammation in the erosion was associated with HSV seropositivity, H. pylori infection and the recent use of NSAIDs. Initially, H. pylori-positive subjects with chronic or recurrent erosions had higher scores of neutrophils compared to those with non-chronic/non-recurrent erosions. In H. pylori-positive subjects, body gastritis was initially less active in the patient group. With time, antral gastritis worsened only in the patient group. In H. pylori-negative subjects, there was no evolution of gastritis. These results show that a significant proportion of gastric erosions are chronic/recurrent but mostly without serious complications. However, H. pylori-positive patients have a significant risk to develop a peptic ulcer. A significant proportion of chronic gastric erosions is related to HSV infection. Focally enhanced inflammation modified by HSV or NSAID may be important in the pathogenesis of gastric antral erosions. Active inflammation in the erosions seems to predict their chronicity/recurrency. Patients with erosions share the characteristics of gastritis of the duodenal ulcer phenotype. / Tiivistelmä Eroosiot ovat mahalaukun pinnallisia limakalvovaurioita. Niitä pidetään vaarattomina lukuun ottamatta niihin liittyvää verenvuototaipumusta. Niiden etiologiaa, histopatologiaa ja taudinkulkua ei tunneta. Ei myöskään tiedetä eroosiopotilaiden mahan limakalvon tulehduksen kulkua. Tämän tutkimuksen tavoitteena oli selvittää mahalaukun eroosioiden kliininen merkitys ja patologia pitkäkestoisena seurantatutkimuksena. Alkujaan 117 potilasta ja 117 kontrollihenkilöä tutkittiin vuosina 1974–1981, ja seurantatutkimus tehtiin vuonna 1996. Selvitimme helikobakteerin ja Herpes simplex -viruksen (HSV) aiheuttamien infektioiden, tulehduskipulääkkeiden (NSAID) ja alkoholin käytön, sekä tupakoinnin esiintymistä. Lisäksi tutkimme histopatologisesti mahalaukun limakalvoa. Lopulta oli 52 potilaan ja 66 kontrollihenkilön aineisto käytettävissä. Seurantakäynnillä 39 prosentilla potilaista oli yhä mahalaukun eroosioita, kun taas kontrolliryhmästä vain 11 prosentilla oli kehittynyt eroosioita. Helikobakteeri -infektoituneilla maha- tai pohjukaissuolen haava/arpi oli yleisempää eroosioryhmässä (17 %) kuin kontrolleilla (4 %), mutta muuten ei esiintynyt lisääntynyttä sairastuvuutta tai kuolleisuutta. Tulehdus oli aktiivisempaa eroosioissa kuin viereisellä limakalvolla, ja tämä tulehdus liittyi korkeisiin HSV-vasta-ainetasoihin, helikobakteeri-infektioon ja NSAID:n käyttöön. Korkeat HSV-vasta-ainetasot ennustivat eroosioiden pysyvyyttä. Ensimmäisellä käynnillä aktiivinen tulehdus eroosioissa oli voimakkaampaa niillä helikobakteeri-infektoituneilla, joilla eroosiot olivat pysyviä kuin niillä, joilla eroosiot eivät uusineet. Helikobakteeri-infektoituneilla eroosiopotilailla mahalaukun runko-osan limakalvon tulehdus oli aluksi vähemmän aktiivista kuin vastaavilla kontrolliryhmän henkilöillä, mutta ajan myötä mahalaukun corpusosan limakalvon tulehdus voimistui vain eroosioryhmällä. Limakalvotulehdus ei edennyt helikobakteeri-infektoitumattomilla henkilöillä. Tulokset osoittavat, että merkittävä osa mahalaukun eroosioista on kroonisia/toistuvia, mutta enimmäkseen ilman vakavia komplikaatioita. Kuitenkin helikobakteeri-infektoituneilla eroosiopotilailla on merkittävä riski saada maha- tai pohjakaissuolen haava. HSV- infektio liittyy merkittävään osaan kroonisia mahalaukun eroosioita. Paikallisella tulehdusaktiivisuudella, jota HSV ja NSAID:n käyttö muokkaavat, saattaa olla tärkeä rooli eroosioiden synnyssä ja niiden kroonistumisessa. Eroosiopotilailla on samanlainen mahalaukun limakalvon tulehduksen jakauma kuin pohjakaissuolihaavaa sairastavilla.

Enzyme DNA methylation is an important biochemical process that imprints DNA with additional information. DNA methylation is catalyzed by S-adenosyl-L-methionine (AdoMet)-dependent methyltraferases (MTases). Prokaryotic DNA MTases are usually components of restriction-modification(R-M) systems that enable cells to resist propagation of foreign genomes that would otherwise kill them. Based on the position methyl group transfer on the bases in DNA, MTases are classified into two groups-exocyclic or amino MTases and endocyclic or ring MTases. The amino MTases methylate exocyclic amino nitrogen to form either N6-methyladenine or n4-methycytosine. N6-methyaladenine is mostly found in the genomes of bacteria, archaea protists and fungi. Helicobacter pylori is a gram-negative, flagellated, fastidious bacterium that colonizes the highly acidic environment of the gastric mucosa. Frequently and persistence of H.paylori infection in humans make it attractive model for studying the host- pathogen interaction mechanisms. Analysis of the genome sequence of H.pylori strains 26695, J99.HPAGI, and G27 revealed an abundance of restriction-modification (R-M) systems. Most of the R-M system genes are either conserved among the strains or specific to each strain. Strain specific genes are responsible for different phenotypes in several host adapted pathogens such as H.pylori. Many of the R-M gene homologues exhibit different usages of condon bias and lower G+C content from the average genes suggesting horizontal transfer of the R-M system genes in H. Pylori. Genome analysis of strain 26695 showed the presence of three putative type III R-M systems and hp0592-hp0593 constitutes one such type III R-M system. Based on the conserved motif arrangements, HP0593 MTases belongs to the subgroups of MTases. The amino acid sequence of HP0593 MTases has 38% sequence identity to Ecop11 MTases and EcoP151 MTase, both of which belongs to type IIIR-M systems therefore, it was important to study in detail previously unexplored role of this putative type III DNA MTase (HP0593) in H. Pylori. Investigation of methyltransferease activity and sequence specifically of putative DNA adenine MTase (HP0593) HP0593 (N6-adenine) - DNA MTase is a member of a type III R-M system in H. pylori strain 26695. HP0593 MTase has been cloned, over expressed and purified heterologously in Escherichia coli. Matrix-assisted laser desorption ionization mass spectrometry (MALDI-MS) was carried out with purified HP0593 and profile showed a single peak with expected molecular mass of 70.6kDa. The protein was determined as-5.8. HP0593 MTase exits predominantly as monomer and a small fraction as dimer in solution as determined by size exclusion chromatography and glutaraldehyde cross-linking studies. The recognition sequence of the purified MTase was determined as 5’GCAG-3’ and the target base of methylation is adenine. Dot-blot assay using antibodies that reacted specifically with DNA containing m6A modification confirmed that HP0593 MTase is an adenine specific MTase. Exocyclic MTase have a conserved catalytic motif (D/N/S/SPPY/F/W). Most interestingly, the amino acid sequence analysis of HP0593 MTase revealed the presence of a PCQ-like motif, which is the catalytic motif for C5-cytosine MTase in addition to DPPY motif. In order to check the role of both these MTase by glycine. HP0593 –Y107G and C54G mutant proteins were purified to near homogeneity. It was found that the Y107G mutant protein was catalytically inactive as compared to wild-type HP0593 MTase. On the other hand the C54G mutant protein was found to be as active as the wild-type HP0593 MTase indicating that HP0593 MTase is an adenine MTase and not a C5- cytosine MTase. Kinetic and catalytic properties of HP0593 DNA adenine methyltransferase DNA binding studies were carried out by electrophoretic mobility shift assay using DNA having cognate site and either in absence or presence of AdoHcy or sinefungin. In all the three cases two different DNA-protein complexes were observed-a fast running complex I and a slow running complex 2. It can be surmised that the fast running complex could be HP0593 monomer-DNA and the slow running complex could be a HP0593 dimer-DNA complex. With non specific DNA (lacking 5’-GCAG-3’ sequences) no complexes were formed even in the presence of cofactors. Based on the above observations it is suggested that a specific interactions of HP0593 MTase with DNA occurs on cognate recognition site. The activity of HP0593 MTase is optional at pH 5.5. This is a unique property in context of natural adaptation of H. pylori in its acidic niche. When initial velocities were plotted against varying concentrations of duplex DNA having a single 5’GCAG-3’ site a rectangular hyperbola was obtained confirming that HP0593 MTase obeys michaelis menten kinetics. From non-linear regression analysis of the plot of initial velocity versus DNA concentration Km (DNA) and kcat were calculated. Analysis of initial velocity with AdoMet as a substrate showed that two molecules of AdoMet bind to HP0593 MTase. The nonlinear dependence of methylation activity on enzyme concentration indicated that more than one molecule of methylation activity on enzyme concentration indicated that more than one molecule of enzyme is required for its activity. Metal ion cofactors such as CO 2, Mn2+ and Mg2+ stimulated the HP09593 MTase activity. As Mn2+ showed maximum stimulation of methyaltion activity compared to other metal ions, surface plasmon resonance spectroscopy was used to determine the kinetics of DNA binding by HP0593 MTase in the absence and presence of Mn2+. In the presence of Mn2+, HP0593 MTase showed~1000-fold increase in affinity to duplex DNA. DNA MTase bind substrates in random or sequential order. Preincubation study demonstrated that the preformed enzyme-DNA complex is competent than the preformed enzyme-AdoMet complex. This suggests that MTase binds to DNA first followed by AdoMet. Isotope partitioning analysis indicated that HP0593 MTase shows a distributive mechanism of methylation DNA having more than one recognition site. Effects of inactivation of HP0593 DNA MTase in Helicobacter pylori 26695 strain and its functional role. DNA dot-blot assay using hp0593 gene specific primer showed that this gene is present in 25.15% of the clinical strains checked suggesting that hp0593 is strain-specific gene. Strain-specific genes in many host-adapted pathogene impart strain specific phenotype. Wild-type 26695 strain grew slightly faster at the initial phase of growth in PH 4.5 compared to pH 7.4. A~5-fold enhanced level of hp0593 mRNA expression was growth under acidic condition HP0593 MTase could play an important role in H. pylori physiology through methylation. To elucidate the possible role(s) played by the MTase in H.pylori physiology, an hp0593 knock-out in 26695 strain was generated by chloramphenecol cassette mediated insertional gene inactivation. Growth kinetic study was carried out with both wild-type and hp0593 knock-out strain at pH7.4, the growth of the hp0593 strain. At pH 4.5 no major differences were observed in the growth compared to the wild-type hp0593 knock-out strain. To further investigate the effect of the knock-out, cell-morphology study was carried out after growing the strains at pH 7.4 till mid-exponential phase. Transmission electron microscopy studies reveled changes in cell shape, presence of sheathed structure and production of outer membrane vesicles (OMVs) in the hp0593 knock out strain. OMVs contain effectors molecules during infection helps in pathogenicity caused by H.pylori.This is the first report where inactivation of DNA MTase causes shedding of vesicles. OMVs are also known to modulate the production of IL-8 by gastic epitheial cells. To check weather H.pylori strains could produce IL-8, both wild-type and hp0593 knock-out strains were co-cultured with AGS cell infected with the hp0593 knock out strain. This was further confirmed by semi-quantitative RT-PCR analysis. To analyze the different phenotypes observed in the hp0593 knock-out strain, transcriptome profile were compared by microarray and RT-PCR analysis. In thehp0593 knock-out strain peptidologlycan and murein synthesis genes like pbp2, murC and neu4 showed upregulation which could be responsible for the changes in cell shape presence of sheathed structure and OMVs production. The RT-PCR data showed ~9-fold down-regulation of dank chaperone which might play a key role in slow growth phenotype in the hp0593 knock-out strain. Considering the occurrence of GCAG sequence in the potential promoter regions of physiologically important genes such as dank, neuA, murC, fliH, filP and cag5, the results presented in this study provide impetus for exploring the role of HP0593 DNA MTase in the cellular processes of H.pylori. However, R-M systems are not absolutely essential, but different methylation patterns may contribute to strain-specific epigenetic gene regulation and may contribute to variability among the strains.

[ES] De entre los patógenos emergentes presentes en agua, las bacterias del género Helicobacter son de las más alarmantes, ya que se encuentran directamente relacionadas con el cáncer gástrico y hepatobiliar y su epidemiología aún no está clara. Se ha planteado que H. pylori puede ser adquirida por diferentes vías de transmisión, entre las que se destaca el agua. Se ha demostrado su capacidad de supervivencia frente a los tratamientos comunes de desinfección de aguas. Por todo ello, en esta tesis se ha investigado la presencia de células viables, y por tanto infectivas, de H. pylori en aguas potables y de riego, mediante la mejora y la optimización de técnicas de cultivo y moleculares. Este trabajo se inició con la búsqueda de un medio de cultivo óptimo. Se obtuvieron resultados muy positivos con el medio de cultivo Agar Dent con sulfato de polimixina B, independientemente del origen de la muestra. Seguidamente, se desarrolló un método de pre-tratamiento con Propidium Monoazide y PEMAXTM para la detección y cuantificación de células de H. pylori viables, por PCR. Se confirmó que el PMA a una concentración de 50 µM y un periodo de incubación de 5 minutos sería la metodología óptima de tratamiento antes del análisis mediante qPCR. A continuación, se analizaron 20 muestras de agua residual. Mediante la técnica de cultivo, fue posible la detección de 4 colonias sospechosas de Helicobacter spp. y H. pylori, cuya identificación fue confirmada mediante amplificación y posterior secuenciación. La técnica DVC-FISH indico la presencia de células viables de Helicobacter spp. en 15 (75%) de las muestras. Respecto a la detección de células de H. pylori, mediante DVC-FISH y FISH, estos microorganismos se observaron en 10 (50%) y 11 (55%) de las 20 muestras analizadas, respectivamente. La técnica qPCR determino la presencia de H. pylori en las muestras, con un porcentaje de detección del 60%. Finalmente, mediante metagenómica de secuenciación dirigida, se analizó el microbioma de 16 muestras de aguas residuales. Los filos dominantes de las muestras analizadas fueron Proteobacteria, seguido de Bacteroidetes y Firmicutes. H. pylori se detectó en 6 muestras de aguas residuales. Además, se detectaron otras especies de Helicobacter spp., como H. hepaticus, H. pullorum y H. suis. Igualmente, mediante PCR se identificó el gen cagA en 5 muestras de agua residual y una de agua potable. Respecto el genotipo vacAs1, se observó en 4 muestras de agua residual; el genotipo vacAm1, se identificó en una muestra de agua potable y 2 de agua de riego. En las biopelículas analizadas, 2 fueron positivas para el tipo vacAm1, y otros dos para el gen de resistencia pbp1A. Del mismo modo se analizaron 45 muestras de heces. No se observaron colonias sospechosas en Agar Dent selectivo. Mediante qPCR se evidenció H. pylori en 41 muestras (45,56%). Fue posible cuantificar 10 muestras directas y 18 enriquecidas, con concentraciones entre 3,39*103 y 2,61*103 UG/mL, las restantes presentaban niveles superiores al umbral de fiabilidad (>35 ciclos). Por DVC-FISH se observaron células viables de H. pylori en 26 (57,78%) de las 45 muestras directas. La identificación de mutaciones en el 23S rDNA, de la resistencia a la claritromicina, mostro que el 37,79% de las muestras de heces presentaban células de H. pylori potencialmente resistentes. Mediante secuenciación dirigida y posterior análisis bioinformático se identificó H. pylori en 13 muestras directas y 13 muestras enriquecidas, y otras especies como H. hepaticus y H. pullorum. Por último, se evaluó la capacidad de H. pylori para formar biopelículas y su resistencia frente a los tratamientos comunes de desinfección. Se analizaron 27 biopelículas procedentes del sistema de distribución de agua potable para detectar la presencia de H. pylori mediante qPCR. El porcentaje de detección fue del 23%, siendo posible la cuantificación en 5 muestras, con concentraciones entre 7,32*101 y 1,16*101 unidades genómicas/mL. Los resultados obtenidos en esta Tesis confirman la existencia de células viables de H. pylori y otros Helicobacter spp. en aguas residuales tras su tratamiento, lo que significa un riesgo potencial para la Salud Pública. De igual forma se demuesta su presencia en muestras de heces, proporcionando un punto de partida para el estudio del riesgo que puede suponer para el ser humano la trasmisión fecal-oral de estas especies. Este trabajo también demuestra la capacidad de H. pylori de formar biopelículas y su resistencia frente a tratamientos comunes de desinfección y confirma su existencia en sistemas de distribución de agua potable. / [CAT] D'entre tots els patògens emergents presents en aigua, els bacteris del gènere Helicobacter són dels més alarmants, ja que es troben directament relacionats amb el càncer gàstric i hepatobiliar i la seua epidemiologia encara no és clara. S'ha plantejat que H. pylori es pot transmetre per diferents vies de transmissió, entre les quals destaca l¿aigua. S'ha demostrat la seua capacitat de supervivència enfront dels tractaments comuns de desinfecció d'aigües. Per tant, en aquesta tesi s'ha investigat la presència de cèl·lules viables, i per tant infectives, d' H. pylori en aigües potables i de reg, mitjançant la millora i l'optimització de tècniques de cultiu i moleculars. Aquest treball es va iniciar amb la cerca d'un cultiu òptim. Es van obtenir resultats molt positius amb el mitjà de cultiu Agar Dent amb sulfat de polimixina B, independentment de l'origen de la mostra. Seguidament, es va desenvolupar un mètode de pretractament amb Propidium Monoazide i PEMAXTM per a la detecció i quantificació exclusiva de cèl·lules d' H. pylori viables per PCR. Es va confirmar que el PMA a una concentració de 50 µM i un període d'incubació de 5 minuts seria la metodologia òptima de tractament abans de l'anàlisi mitjançant qPCR. A continuació, es van analitzar 20 mostres d'aigua residual. Mitjançant la tècnica de cultiu, va ser possible la detecció de 4 colònies sospitoses d' Helicobacter spp. i H. pylori, la identificació de la qual va ser confirmada mitjançant amplificació i posterior seqüenciació. La tècnica DVC-FISH va demostrar la presència de cèl·lules viables d' Helicobacter spp. en 15 (75%) de les mostres, sense necessitat d'un pas previ d'enriquiment. Respecte a la detecció de cèl·lules d' H. pylori, mitjançant DVC-FISH i FISH, aquests microorganismes es van observar en 10 (50%) i 11 (55%) de les 20 mostres analitzades, respectivament. La tècnica qPCR determinà la presència d' H. pylori a les mostres amb un percentatge de detecció del 60%. Finalment, mitjançant metagenòmica de seqüenciació dirigida, es va analitzar el microbioma de 16 mostres d'aigües residuals. Els talls dominants de les mostres analitzades van ser Proteobacteria, seguit de Bacteroidetes i Firmicutes. H. pylori es va detectar mitjançant aquesta tècnica en 6 mostres d'aigües residuals. A més, es van detectar altres espècies d' Helicobacter spp., com H. hepaticus, H. pullorum i H. suis. Igualment mediant PCR es va identificar el gen cagA en 5 mostres d'aigua residual i una d'aigua potable. Respecte al genotip vacAs1, es va observar en 4 mostres d'aigua residual; el genotip vacAm1, es va identificar en una mostra d'aigua potable i 2 d'aigua de reg. En les biopel·lícules analitzades, 2 van ser positives per al tipus vacAm1, i altres dos per al gen de resistència pbp1A. De la mateixa manera es van analitzar 45 mostres de femta. No es van observar colònies sospitoses en Agar Dent selectiu. Mitjançant la tècnica qPCR es va demostrar la presència d'H. pylori en 41 mostres (45,56%). Va ser possible quantificar 10 mostres directes i 18 enriquides, amb concentracions d'entre 3,39*103 i 2,61*103 UG/ml, les restants presentaven nivells per damunt del llindar de fiabilitat (>35 cicles). Mitjançant DVC-FISH es van observar cèl·lules viables d' H. pylori en 26 (57,78%) de les 45 mostres directes. La detecció de mutacions en el 23S rDNA, específiques de la resistència a la claritromicina, va indicar que el 37,79% de les mostres de femta presentaven cèl·lules d' H. pylori potencialment resistents. Mitjançant seqüenciació dirigida i posterior anàlisi bioinformàtica es va identificar H. pylori en 13 mostres directes i 13 mostres enriquides, i altres espècies com H. hepaticus i H. pullorum. Finalment, es va avaluar la capacitat d' H. pylori per a formar biopel·lícules i la seua resistència enfront dels tractaments comuns de desinfecció. Es van analitzar 27 biopel·lícules procedents del sistema de distribució d'aigua potable per a detectar la presència d' H. pylori mitjançant qPCR. El percentatge de detecció va ser del 23%, sent possible la quantificació en 5 mostres corresponents a concentracions d’entre 7,32*101 i 1,16*101 unitats genòmiques/ml. Els resultats obtinguts en aquesta Tesi confirmen la presència de cèl·lules viables d' H. pylori i altres Helicobacter spp. en aigües residuals després del seu tractament, la qual cosa suposa un risc potencial per a la Salut Pública. D'igual forma, s'evidencia la seua presència en mostres de femta, proporcionant un punt de partida per a l'estudi del risc que la transmissió fecal-oral d'aquestes espècies pugui suposar per als humans. Aquest treball també demostra la capacitat d' H. pylori de formar biopel·lícules i la seua resistència enfront als tractaments comuns de desinfecció, i confirma la seua presència en sistemes de distribució d'aigua potable. / [EN] Among all the emergent pathogens in water, bacteria of the Helicobacter genus are among the most disturbing, as they are directly related to gastric and hepatobiliary cancer and their epidemiology is still unclear. It has been suggested that H. pylori can be acquired through different transmission routes, among which water stands out. Its ability to survive against common water disinfection treatments has been demonstrated. In addition, H. pylori can form insoluble biofilms, which favors its resistance to the different disinfection and potabilization treatments. Therefore, in this thesis has investigated the presence of viable cells, and therefore potentially infective, of H. pylori in drinking and irrigation waters, through the improvement and optimization of culture and molecular techniques. This work began with the development of an optimal culture medium. Positive results were obtained with the culture medium Agar Dent with polymyxin B sulfate. Subsequently, a pretreatment method with Propidium Monoazide and PEMAXTM was developed for the exclusive detection and quantification of viable H. pylori cells by PCR. It was confirmed that PMA at a concentration of 50 µM and an incubation period of 5 minutes, would be the optimal treatment methodology before analysis by qPCR. A total of 20 wastewater samples, aseptically collected at the outlet of the biological reactor and after disinfection treatment, were then analyzed. Using the culture technique, it was possible to detect 4 suspicious colonies of Helicobacter spp. and H. pylori, whose identification was confirmed by amplification and subsequent sequencing. DVC-FISH technique demonstrated the presence of viable Helicobacter spp. cells in 15 (75%) of the samples. Regarding the detection of H. pylori cells, by DVC-FISH and FISH, these microorganisms were observed in 10 (50%) and 11 (55%) of the 20 samples analyzed, respectively. The qPCR technique determined the presence of H. pylori in the samples with a detection rate of 60%. Finally, using deep-amplicon sequencing, the microbiome of 16 wastewater samples was analyzed. The dominant phylum in the samples analyzed were Proteobacteria, followed by Bacteroidetes and Firmicutes. H. pylori was detected by this technique in 6 wastewater samples. In addition, others Helicobacter spp., such as H. hepaticus, H. pullorum and H. suis were detected. PCR technique was used to identify the cagA gene in 5 wastewater samples and one drinking water sample. Regarding the vacAs1 genotype, it was observed in 4 samples of wastewater; the vacAm1 genotype, was identified in one drinking water sample and 2 irrigation water samples. In the biofilms analyzed, 2 were positive for the vacAm1 type, and two for the resistance gene pbp1A. Likewise, 45 stool samples were analyzed. No suspicious colonies were observed on selective Dent Agar. The qPCR technique demonstrated the presence of H. pylori in 41 samples (45.56%). It was possible to quantify 10 direct samples and 18 enriched samples, with concentrations between 3.39*103 and 2.61*103 GU/mL, the remaining samples had levels above the reliability threshold (>35 cycles). DVC-FISH showed viable H. pylori cells in 26 (57.78%) of the 45 direct samples. Detection of 23S rDNA mutations specific for clarithromycin resistance indicated that 37.79% of stool samples had potentially resistant H. pylori cells. Through Deep-amplicon sequencing and subsequent bioinformatics analysis, H. pylori was identified in 13 direct samples and 13 enriched samples, as well as other species such as H. hepaticus and H. pullorum. Finally, the ability of H. pylori to form biofilms and their resistance to common disinfection treatments was evaluated. Twenty-seven biofilms from the drinking water distribution system were also tested for the presence of H. pylori by qPCR. The detection rate was 23%, being possible the quantification in 5 samples corresponding to concentrations between 7.32*101 and 1.16*101 GU/mL. / Esta Tesis Doctoral ha sido posible gracias a las ayudas de carácter predoctoral: “Ayuda de conselleria para la contratación de personal investigador en formación -Irene Hortelano Martin (determinación del riesgo para el consumidor de la presencia de H. pylori y otros helicobacters patógenos en aguas de consumo mediante técnicas moleculares y metagenómica) (ACIF/2016/150) Generalitat Valenciana (2016-2019). Y a la financiación de los proyectos: “Helicobacter pylori y otros helicobacters patógenos en aguas y alimento: Desarrollo y aplicación de herramientas moleculares dirigidas a la evaluación del riesgo para el consumidor (REF. AGL2014-53875-R)”. Ministerio de Economía y Competitividad, España. “Determinación del riesgo para la salud pública debido a la presencia de H. pylori en agua y alimentos: Detección (AICO/2018/273)”. Generalitat Valenciana (2018-2020). / Hortelano Martín, I. (2021). Determinación del riesgo para el consumidor de la presencia de H. pylori y otros Helicobacter spp. patógenos en aguas de consumo mediante técnicas moleculares y metagenómica [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/178942 / TESIS

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L'infection par Helicobacter pylori provoque une inflammation qui peut persister de façon asymptomatique ou évoluer vers de nombreuses pathologies gastroduodénales sévères telles que les ulcères gastroduodénaux, le lymphome du MALT et le cancer gastrique. L'îlot de pathogénicité cag est l'un des facteurs de virulence majeurs de cette bactérie. Plusieurs cytokines et peptides antimicrobiens sont impliqués dans la modulation de la réponse inflammatoire de la muqueuse épithéliale gastrique lors de l'infection par H. pylori. Ce travail a porté sur l'étude des interactions entre H. pylori et les cellules épithéliales gastriques. L'étude in vivo sur un modèle murin d'infection a permis de décrire un profil de la réponse antimicrobienne liée à cette bactérie. Une production accrue de S100A9 pourrait être impliquée dans l'échec d'implantation et de colonisation de la bactérie dans la muqueuse gastrique murine. Nous avons également établi un protocole de culture primaire de cellules épithéliales gastriques humaines à partir d'estomacs obtenus après gastrectomie partielle chez des sujets atteints d'obésité morbide. Cette étude a permis de modéliser in vitro la réponse inflammatoire et antimicrobienne de la muqueuse gastrique humaine après infection par H. pylori. L'induction cag-dépendante d'un panel de médiateurs inflammatoires et antimicrobiens par les cellules épithéliales gastriques exposées à H. pylori confirme l'implication de ce facteur au cours de la réponse inflammatoire précoce. Des cellules gastriques à phénotype de cellules souches ont également été isolées et des caractérisations phénotypiques et moléculaires ont été initiées pour déterminer leur nature. Les modèles cellulaires développés au cours de cette étude permettent une meilleure compréhension des interactions entre H. pylori et les cellules épithéliales gastriques.

H. pylori has a panmictic population structure due to high genetic diversity. The homoplasy index for H. pylori is 0.85 (where 0 represents a completely clonal organism and 1.0 indicates a freely recombining organism) which is much higher than homoplasy index for E. coli (0.26) or naturally competent Neisseria meningitides (0.34). It undergoes both inter as well as intra strain transformation. Intergenomic recombination is subject to strain specific restriction in H. pylori. Hence, a high homoplasy index means that competence predominates over restriction in H. pylori. Annotation of the genomes of H. pylori strains 26695 and J99 show the presence of nearly two dozen R-M systems out of which 16 were postulated to be Type II for J99. H. pylori has been described to be an ideal model system for understanding the equilibrium between competing tension of genomic integrity and diversity (42). R-M systems allow some degree of sexual isolation in a population of competent cells by acting as a barrier to transformation. The mixed colonizing population of H. pylori has a polyploidy nature where each H. pylori strain adds to ‘ploidy’ of the colonizing population. Maintenance of polyploidy nature of mixed colonizing population in a selective niche of stomach needs a barrier to free gene flow. Restriction barrier maintains a polyploidy nature of H. pylori population which is considered as yet another form of genetic diversity helping in persistence of infection. Thus, according to the model proposed by Kang and Blaser, where H. pylori are considered as perfect gases like bacterial population, transformation and restriction both add to genetic diversity of the organism. Again, restriction barriers are not completely effective, which could be due to cellular regulation of restriction system. Thus, a perfect balance between restriction and transformation in turn regulates the gene flow to equilibrate competition and cooperation between various H. pylori strains in a mixed population. RecA, DprA and DprB have been shown to be involved in the presynaptic pathway for recombination substrates brought in through the Com system. Biochemical characterization of HpDprA, during this study revealed its ability to bind to ssDNA and dsDNA. Binding of HpDprA to both ssDNA as well as dsDNA results in large nucleoprotein complex that does not enter the native PAGE. However, DNA trapped in the wells could be released by the addition of excess of competitor DNA, illustrating that the complex are formed reversibly and do not represent dead-end reaction products. Transmission electron microscopy for SpDprA interaction with ssDNA established that a large nucleoprotein complex consisting of a network of several DNA molecules bridged by DprA is formed which is retained in the well. A large DNA-protein complex that sits in the well has also been observed with other DNA binding proteins like RecA. It has been observed for ssDNA binding protein (SSB) that they bind non-specifically to dsDNA under low salt condition (20 mM NaCl) in the absence of Mg2+. The non specific binding of SSB to dsDNA was prevented under high salt conditions (200 mM NaCl) or in the presence of Mg2+. HpDprA interaction with both ssDNA and dsDNA was stable under high salt condition (200 mM NaCl) and in the presence of Mg2+ indicating that these interactions are specific. The interaction of HpDprA with dsDNA is significant since dsDNA plays an important role in natural transformation of H. pylori. The pathway of transformation by dsDNA is highly facilitated (nearly 1000 fold) as compared to ssDNA. However, dsDNA is a preferred substrate for REases which are a barrier to horizontal gene transfer. This implies that the decision of ‘restriction’ or ‘facilitation for recombination’ of incoming DNA might be taken before the conversion of dsDNA into ssDNA. The incoming DNA has been shown to be in the double-stranded form in periplasm and in single-stranded form in cytoplasm. Hence, the temporal and spatial events surrounding endonuclease cleavage remain to be understood. Taken together, these results suggest a very important role of dsDNA in natural transformation in H. pylori. Hence, binding and protection of dsDNA by HpDprA is possibly of crucial importance in the success of natural transformation process of the organism. DprA is characterized by presence of a conserved DNA binding domain. The DNA binding domain adopts a Rossman fold like topology spanning most region of the protein. Rossman fold consists of alternating alpha helix and beta strands in the topological order of β-α-β-α-β. It generally binds to a dinucleotide in a pair as a single Rossman fold can bind to a mononucleotide only. All homologous DprA proteins characterized till date show that in addition of the prominent Rossman fold domain they consist one or more smaller domains. RpDprA consists two more domains other than the Rossman fold domain i.e., N- terminal SAM (sterile alpha motif) domain and a C-terminal DML-1 like domain. SpDprA consist of an N-terminal SAM domain other than Rossman fold domain. While the main function of Rossman fold is to bind DNA, the supplementary domains are highly variable in sequences and functions. For example, the SAM domain in S. pneumoniae plays a key role in shut-off of competence by directly interacting with ComE~P. HpDprA consist of an N-terminal Rossman fold domain and a C-terminal DML-1 like domain. Both these domains are found to be prominently α-helical in nature. Amino acid sequence analysis of the protein suggests that NTD is basic and CTD is acidic in nature. NTD is sufficient for binding with ssDNA and dsDNA, while CTD plays an important role in formation of higher order polymeric complex with DNA. For HpDprA and SpDprA, dimerization site was mapped in Rossman fold domain. Gel filtration data revealed an important observation that HpDprA can exist as a monomer (dominant species at lower concentration) as well as a dimer (dominant species at higher concentration) in solution. However, the exchange between these two forms is very fast resulting in a single peak of elution. Since, HpDprA binds to DNA in dimeric form, the dimer species will be favoured in presence of DNA. Hence, even at lower concentrations HpDprA will be mainly a dimer in presence of DNA. Interestingly, both domains of HpDprA i.e., NTD and CTD were able to form dimers but no higher oligomeric form. On the other hand, HpDprA was seen to form oligomeric forms higher than dimer in gluteraldehyde cross linking assay. The strength of CTD dimer was much lower that NTD dimer, therefore it could be proposed that there are two sites of interaction present in HpDprA - a primary interaction site (N-N interaction) and a secondary interaction site (C-C interaction). The N-N interaction is responsible for dimer formation but further oligomerization of HpDprA necessitates the interaction of two dimers using C-C interaction site. It was shown that NTD binds to ssDNA but forms lower molecular weight complex. SPR analysis of DprA and NTD – DNA interaction pointed out that deletion of CTD leads to faster dissociation of the protein from DNA. Concomitantly, reduction in binding affinity was observed for both ss and ds DNA upon deletion of CTD from full length protein. These results suggest that CTD does play an important role in interaction of full length HpDprA with DNA. Two possible roles of CTD were proposed by Wang et al (2014) group to explain their observation of formation of lower molecular weight complex in absence of CTD. (i) CTD possesses a second DNA binding site but much weaker than site present in NTD. (ii) CTD is not involved in DNA binding but mediates nucleoprotein complex formation through protein – protein interaction. EMSA and SPR analysis with purified CTD protein confirmed that there is no secondary DNA binding site present in CTD. As discussed above, it was observed that CTD can mediate interaction between two HpDprA through C-C interaction. Since the interaction is weaker it is lesser likely to be responsible for dimer formation but in trimer or higher oligomeric form of HpDprA, the presence of N-N interaction will facilitate and stabilize C-C interaction. These observations together bring forward an interesting model for HpDprA – DNA interaction. HpDprA forms dimer through N-N interaction (favourably in presence of DNA) and many HpDprA dimers bind to DNA owing to their high affinity and sequence independent nature of binding. These dimers interact with each other through C-C interaction resulting in higher molecular weight nucleoprotein complex. HpDprA - DNA complex formation is slower than NTD – DNA complex but the former one is more stable (Fig. 2). According to the above proposed model there are two binding events (DNA – protein and protein – protein) in case of HpDprA – DNA complex formation and hence it would take longer time than NTD-DNA complex formation which involves only one binding event. But the resulting higher order complex with HpDprA – DNA would be much more stable. NTD is able to offer equally efficient protection from nuclease to ssDNA and dsDNA (Fig. 7). This shows that NTD alone is sufficient to completely coat single molecule DNA. AFM images confirm the difference in binding pattern of HpDprA full length protein and NTD. As can be seen in Fig. 8F, NTD binds a DNA molecule by entirely occupying all the available space but forms nucleoprotein filaments isolated from each other. In contrast to full length HpDprA, which forms tightly packed, condensed, extensively cross linked polynucleoprotein complexes, NTD forms much thinner complexes with DNA. In the electron micrographs of SpDprA – DNA complex, extensive cross filament interaction was observed resulting in a dense molecular aggregate. Similar kinds of complexes with DNA were also observed for Bacillus subtilis DprA in atomic force microscope images. Thus, it could be proposed that HpDprA binds to a single DNA molecule (single strand or double strand) mainly as a dimer formed through N-N interaction. Such multiple individual nucleoprotein filaments come together and interact with each other through C- C interaction resulting in dense and intricate poly – nucleoprotein complex. HpDprA is proposed to undergo conformational changes from closed state to open state in presence of ssDNA. In agreement with this, structural transition (resulting in reduction of α-helicity of the protein) was observed in presence of ssDNA. Similar structural transitions were observed for dsDNA indicating possibly a common mode of interaction for both forms of DNA. Further, mutation of the residues shown to be involved in binding ssDNA from crystallographic data, resulted in decrease of binding affinity with dsDNA as well. The fold reduction in binding affinity of dsDNA was lower than that for ssDNA despite that it is obvious that the same positively charged pocket which is primarily involved in ssDNA interaction is also responsible (atleast partially) for binding with dsDNA. However, the residues crucial for interaction with these two forms of DNA may be different. Both DprA and R-M systems have been shown to have presynaptic role in natural transformation process. While DprA has a protective role, R-M systems have an inhibitory role for incoming DNA suggesting a functional interaction between them. Results of this study show that HpDprA interacts with dsDNA, inhibits Type II restriction enzymes from acting on it and at the same time stimulates the activity of MTases resulting in increased methylation of bound DNA. This observation is of significance from the view of genetic diversity as the only way a bacterial cell discriminates between self and nonself DNA is through the pattern of methylation. Binding of HpDprA to incoming DNA inhibits its access to restriction endonucleases but not to methyltransferases. As a result DNA will be methylated with the same pattern as that of the host cell. Hence, it no longer remains a substrate for restriction enzymes. HpDprA thus, effectively alleviates the restriction barrier. However, it remains to be understood as to how DNA in complex with HpDprA, while not accessible to REases or other cellular nucleases, is accessible to a MTase? A possible explanation could be that HpDprA interacts with MTase and recruits it on DNA. It has been shown that there is a overlap between DprA dimerization and RecA interaction interfaces and in presence of RecA, DprA-DprA homodimer is replaced with DprA-RecA heterodimer allowing RecA nucleation and polymerization on DNA followed by homology search and synapsis with the chromosome. A similar scenario can be thought for interaction of HpDprA with the MTase. R-M systems play an important role in protection of genomic DNA from bacteriophage DNA. Hence, downregulation of restriction barrier by HpDprA may not be desirable by host during the entire life cycle. Therefore, the expression of HpDprA, which is ComK dependent and that which takes place only when competence is achieved is noteworthy. In H. pylori, DNA damage induces genetic exchange via natural competence. Direct DNA damage leads to significant increase in intergenomic recombination. Taken together it can be proposed that when genetic competence is induced, R-M systems are down regulated to allow increased genetic exchange and thus, increasing adaptive capacity in a selective environment of stomach. There is an evolutionary arms race between bacterial genomes and invading DNA molecules. R-M systems and anti-restriction systems have co-evolved to maintain an evolutionary balance between prey and predator. Phages and plasmids employ anti-restriction strategies to avoid restriction barrier by a) DNA sequence alteration, b) transient occlusion of restriction sites and c) subversion of restriction-modification activities. DNA binding proteins have been shown to bind and occlude restriction sites. On the other hand, λ Ral protein alleviates restriction by stimulating the activity of Type IA MTases. The observations of MTase stimulation and site occlusion of restriction sites by HpDprA appears to be analogous to anti restriction strategies, otherwise employed by bacteriophages. Thus, DprA could be a unique bacterial anti-restriction protein used by H. pylori for downregulating its own R-M systems to maintain the balance between fidelity and diversity. In conclusion, HpDprA has unique ability to bind to dsDNA in addition ssDNA but displays higher affinity towards ssDNA. Binding of HpDprA to DNA results in a compact complex that is inert to the activity of nucleases. A novel site of oligomerization for HpDprA was observed which suggests the role of C-C interaction in inter-nucleoprotein filament interaction. It would be interesting to further study the effects of CTD deletion on the transformation efficiency of H. pylori, to understand these mechanisms better. It has been well demonstrated that R-M systems offer a barrier to incoming DNA, but our understanding of the regulation of R-M systems has been poor. While other factors like regulation of cellular concentration of restriction enzymes and conversion of dsDNA into ssDNA might play crucial roles in striking the perfect balance between genome diversity and integrity, one of the factors that regulate R-M systems could be DprA.

Le rôle majeur de l’Helicobacter pylori dans l’étiopathogénie des maladies gastroduodénales (gastrite, ulcère gastrique et duodénal, lymphome gastrique) est bien établi aujourd’hui. L’OMS l’a reconnue comme jouant un rôle important dans la survenue des lésions cancéreuses gastriques. La prévalence de l’infection à H. pylori varie selon les pays de 20% à 90% avec des taux supérieurs à 60% dans les pays en développement, dont le Bénin. Les méthodes usuelles de diagnostic sont soit invasives nécessitant une endoscopie gastrique avec biopsies (test rapide à l’urée, histologie, culture et PCR), soit non-invasives (test respiratoire à l’urée marquée au carbone, sérologie, et détection de l’antigène dans les selles). La trithérapie associant un inhibiteur de la pompe à protons (IPP) et deux antibiotiques choisis parmi l’amoxicilline, la clarithromycine et le métronidazole est recommandée pour son traitement. La survenue de résistance des souches H. pylori aux différents antibiotiques devient une cause majeure de l’échec des régimes d’éradication.<p>Afin d’évaluer l’applicabilité et l’efficacité des régimes thérapeutiques recommandés en pratique courante, et à partir d’une étude de cohorte prospective, nous avons étudié la prévalence de l’infection à H. pylori chez les patients consultant à la clinique de Gastroentérologie de l’hôpital universitaire Erasme à Bruxelles, déterminé son taux de résistance primaire aux antibiotiques, et évalué le taux d’éradication d’H. pylori par la trithérapie. Nous avons aussi évalué la performance du test de détection de l’antigène d’H. pylori dans les selles pour le diagnostic chez l’adulte (avant traitement) comparé avec les méthodes de référence (culture, histologie), également dans le contrôle de l’éradication.<p>Au Bénin, nous avons évalué à partir d’une étude transversale prospective, la prévalence de l’infection à H. pylori dans une population en milieu urbain et rural. Nous avons déterminé la distribution par famille des sujets infectés, ainsi que l’influence des variables démographiques individuelles, et les caractéristiques socio-économiques familiales sur le risque de l’infection.<p>La prévalence de résistance primaire à la clarithromycine et au métronidazole fut observée respectivement dans 3% et 31% des souches isolées. Aucune résistance primaire à l’amoxicilline et à la tétracycline n’a été observée.<p>Les analyses en intention de traiter, ont montré que H. pylori a été éradiqué chez 80% des patients inclus dans l’étude thérapeutique. Le taux d’échec d’éradication fut de 20%. Comparé au 14C-TRU, le test HpSA avait une sensibilité de 100%, une spécificité de 91%, VPP de 69%, VPN de 100%. De même, la sensibilité du test HpSA par rapport aux deux méthodes usuelles (culture et histologie) est de 96.5% pour une spécificité de 91.2%, une VPP de 90.3% et une VPN de 96.8%. <p>Au Bénin, la prévalence de H. pylori était de 75.4% en ville et de 72.3% dans le village (p = 0.459). Aucune association n’a été observée avec l’âge, le sexe, le niveau d’instruction, la taille du ménage, l’activité économique ou le mode d’approvisionnement en eau potable. Le taux d’infection était plus élevé chez les enfants dont les parents étaient infectés et chez ceux ayant une mère H. pylori positive (p < 0.001). L’analyse multivariée par régression logistique a montré que la densité d’occupation des dortoirs [OR (95%) = 9.82 (4.13-23.31)] p < 0.001), et le statut des mères dans le ménage ([OR (95%) = 3.85 (1.53-9.67)] p < 0.001) étaient les prédicteurs indépendants de l’infection par H. pylori. Le risque de l’infection chez les enfants était 13 fois plus élevé quand les deux parents sont simultanément positifs OR (95% CI) = 13.6 (3.63-51.22), il l’était respectivement de 5.3 (1.52-18.45); 2.7 (0.47-15.44), quand la mère et le père sont positifs p < 0.001. Aussi le risque d’infection à H. pylori comparé aux enfants qui dorment seul dans leur chambre, était élevé pour ceux qui dorment avec un ou deux personnes OR (95% CI) = 5.2 (1.08-25.16), p < 0.05, et plus élevé chez les enfants qui dorment à 4 ou plus OR (95% CI) = 16.6 (2.66-103.44), p < 0.005, comparé à ceux qui dorme seuls. Donc, le contact avec des personnes infectées au sein de la famille et la vie en promiscuité, étaient associés avec un risque d’infection plus élevé indiquant une transmission intrafamiliale de l’infection par H. pylori.<p>En conclusion, nos résultats montrent une séroprévalence encore élevée de l’infection à H. pylori dans la population béninoise. Une surveillance de l’épidémiologie accompagnée de mesures de prévention ciblées sur les facteurs potentiels de risque de l’infection doit être poursuivie. La validation du test de détection de l’antigène dans les selles avant traitement et dans le contrôle de l’éradication de la bactérie pour le suivi thérapeutique des patients infectés, est une alternative intéressante notamment au Bénin. Le taux de résistance primaire pour le métronidazole est actuellement stable en Belgique, alors que la prévalence de la résistance à la clarithromycine mérite d’être précisée par d’autres études multicentriques. La trithérapie classique à base d’inhibiteur de la pompe à protons–amoxicilline-clarithromycine reste recommandable en première intention. La surveillance épidémiologique de l’infection basée sur la prévalence locale des souches clarithro-résistantes et métronidazole-résistantes devrait être poursuivie.<p><p><p><p><p><p><p><p><p><p><p>SUMMARY OF THE THESIS<p>The major role of H. pylori in the etiopathogeny of various gastroduodenal diseases (gastritis, gastric and duodenal ulcers, gastric lymphoma) is well established today. The World Health Organization concluded that H. pylori plays a causal role in the chain of events leading to cancer of the stomach.<p>The prevalence of H. pylori infection varies by country from 20% to 90%, with higher prevalence rates over 60% observed in developing countries, including Bénin. The usual methods allowing the diagnosis of the gastric infection by H. pylori are either invasive, requiring a gastric endoscopy and biopsies (fast urease test, anatomopathological examination, culture and PCR), or noninvasive (breath test with 13C or 14C marked urea, serology and stool antigen detection). Triple therapy associating a proton pump inhibitor (PPI) with two antibiotics, chosen between amoxicillin, clarithromycin and metronidazole, is currently recommended. Resistance of H. pylori strains to antibiotics becomes a major determinant in the failure of eradication of regimens.<p>To evaluate the applicability and efficacy of the therapeutic recommendations in our pratice, based on a prospective study, we studied the prevalence of H. pylori infection in the outpatient population of the Gastroenterology clinic at the Erasme University hospital in Brussels, determined its rate of primary resistance to antimicrobial agents and evaluated the rate of eradication of H. pylori by triple therapy. We also evaluated the performance of a stool antigen detection test for the diagnosis of H. pylori infection in adults (before treatment) compared with reference methods (culture and histology) as well as in control of eradication.<p>In Benin, we evaluated by a cross-sectional study the prevalence of the infection with H. pylori in the population living in urban and rural environment. We determined the family distribution of infected subjects as well as the influence of individual demographic variables and of the socio-economic family characteristics on the risk of infection.<p>In Brussels, primary resistance to clarithromycin and metronidazole was observed in 3% and 31% of the isolates, respectively. No primary resistance to amoxicillin and tetracycline was observed. By intention to treat analysis, H. pylori was eradicated in 80% of patients included in the therapeutic study. The rate of eradication failure was 20%. In comparison with 14C-Urea breath test, the H. pylori Stool Antigen test showed a sensitivity of 100%, a specificity of 91 %, PPV of 69%, and NPV of 100%. Compared to the reference methods (culture and histology), the HpSA test had a sensitivity of 96.5% and a specificity of 91.2%. PPV of 90.3% and NPV of 96.8%. <p>In Benin, the prevalence of H. pylori antibodies was 75.4% in town and 72.3% in the village (P= 0.459). No association was found between infection and age, sex, education level, size of the household, economic activity or source of drinking water. The infection rate was higher in children of parents who were both infected and also in those whose mother was infected (p < 0.001). By logistic regression analysis, the density of occupation of dormitories (more than three persons sharing dormitory, [OR (95%) = 9.82 (4.13-23.31)] p < 0.001), and mother status within the household ( [OR (95%) = 3.85 (1.53-9.67) ] p < 0.001), were independent predictors for H. pylori infection. The risk of H. pylori infection in children was 13 times higher when the two parents were simultaneously positive: OR (95% CI) = 13.6 (3.63-51.22) and it was respectively of 5.3 (1.52-18.45); 2.7 (0.47-15.44), when mother and father were positive p < 0.001. H. pylori infection risk in children was higher for a sharing a dormitory with one or two persons, OR (95% CI) = 5.2 (1.08-25.16), p < 0.05 and was even higher if a dormitory of 4 persons or more, OR (95% CI) = 16.6 (2.66-103.44), p < 0.005 as compared to sleeping alone. Family contact with infected persons and crowded living conditions were associated with increased risk of infection consistent with intrafamilial H. pylori transmission.<p>In conclusion, our results confirm a still high H. pylori seroprevalence in population in Benin. An epidemiolgic survey with prevention mesures targeted on potential risk predictors should be going on. Validation of antigen detection test in patients stools before treatment and for eradication control could be an interested alternative, notably in Benin. Primary resistance rate on metronidazole is stable today in Belgium, though the resistance prevalence on clarithromycin should be determined by other multicentric studies. Standard triple therapy by (PPI)-amoxicillin-clarithromycin is still recommended in first intention to treat. Epidemiological survey of infection based on local prevalence of claritromycin-resistant and metronidazole-resistant strains should be continued.<p><p><p><p><p><p> / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished