Aims-To investigate the prevalence of Helicobacterpylori in the saliva ofpatients infected with this bacterium. Methods-A novel polymerase chain reaction (PCR) assay was developed to detect Hpylori in saliva and gastric biopsy specimens from patients undergoing endoscopy. Results-Our PCR assay amplified a 417 base pair fragment of DNA from all 21 DNAs derived from Hpylon clinical isolates but did not amplify DNA from 23 non-H pylon strains. Sixty three frozen gastric biopsy and 56 saliva specimens were tested. H pylon specific DNA was detected by PCR in all 39 culture positive biopsy specimens and was also identified from another seven biopsy specimens which were negative by culture but positive by histology. H pylon specific DNA was identified byPCRin saliva specimens from 30 (75%) of 40 patients with H pylori infection demonstrated by culture or histological examination, or both, and in three patients without Hpylon infection in the stomach. Conclusion-The results indicate that the oral cavity harbours Hpylon and may be the source of infection and transmission.

More than 150 different RNA modifications have been detected in all kingdoms of life and 60 are known to decorate bacterial RNA. Among them, pseudouridine is universally conserved and one of the most abundant modifications present in bacterial stable RNAs such as tRNAs and rRNAs. In bacteria, the nucleotide is posttranscriptionally generated by dedicated enzymes called pseudouridine synthases (PUSs). With the advent of sophisticated deep-sequencing technologies, this modification has been identified in different types of RNA classes (tRNAs, rRNAs, mRNAs, snRNAs, and lncRNAs) in diverse eukaryotic organisms. However, these techniques have never been applied to bacteria, generating a knowledge gap about the location of the modified nucleotide in prokaryotic RNAs. Mutations or deletions of specific eukaryotic PUS enzymes are linked to human diseases and therefore their absence is deleterious for the correct function of the cell. However, deletion of tRNA or rRNA PUS enzymes in the bacterial model organism E. coli have not revealed any such drastic phenotypes, suggesting a different role and function of the modification itself and of the enzymes in different kingdoms of life. Since the roles of tRNA PUS enzymes in bacteria is still poorly understood, a functional characterization of these proteins is pursued in the Epsilonproteobacteria Campylobacter jejuni and Helicobacter pylori. While C. jejuni is the leading cause of bacterial foodborne gastroenteritis in humans, infection with H. pylori is associated with the development of gastric cancer. In particular, phenotypes were explored for the tRNA PUS enzymes TruA, TruB, and TruD in C. jejuni as well as TruA and TruD in H. pylori. Upon deletion of truD, a severe growth defect is observed for C. jejuni but not for H. pylori, highlighting a potential difference in function of the enzyme in the two related bacterial pathogens. Moreover, a genome-wide approach called Pseudo-seq is established and applied for RNA of these two pathogens, which allows, for the first time, the global identification of pseudouridine modifications at single-nucleotide resolution in the bacterial transcriptome. Applying Pseudo-seq in RNAs of wildtype and diverse PUS enzyme deletion mutants enabled the identification of the distinct RNA substrates of tRNA PUS enyzmes in C. jejuni and H. pylori. Hereby, the tRNA-Glu was determined to be the major tRNA substrate of TruD in C. jejuni. Interestingly, the tRNA-Glu is expressed as a single copy in the C. jejuni genome. To link the growth defect observed for a C. jejuni ∆truD mutant strain to the pseudouridine modification of the tRNA-Glu, a catalytically inactive TruD complementation was generated. This strain is unable to restore the tRNA-Glu modification but surprisingly, was able to complement the growth defect. The same observation was made for a cross-complementation with a copy of H. pylori TruD. This indicates that there is a potential additional function of the TruD PUS enzyme in C. jejuni that is independent of the pseudouridine modification. Using a combination of deep-sequencing technologies (RIP-seq, RNA-seq, Ribo-seq, and CLIP-seq), the dual function of TruD is investigated. Overall, this study provides the first in-depth investigation into pseudouridylation of bacteria in general and the bacterial pathogens C. jejuni and H. pylori in particular. The work presented in this thesis reveals not only a global map of pseudouridine in tRNAs and rRNAs of the two bacteria but it also explores the function of the responsible tRNA PUS enzymes. In addition, this study provides evidence for a dual function of the C. jejuni PUS enzyme TruD that goes beyond its RNA modifying function. Future research could focus on unravelling the function of TruD and its potential interaction partners and thus reveal new mechanisms of regulation of a protein previously only described as an RNA modification enzyme. / Mehr als 150 verschiedene RNA-Modifikationen sind bislang in den unterschiedlichsten Organismen nachgewiesen worden, wovon 60 dieser Modifikationen in bakterieller RNA vorkommen. In Bakterien ist Pseudouridin eine der häufigsten Modifikationen, die in stabilen RNAs wie tRNAs und rRNAs zu finden sind. Hierbei wird das modifizierte Nukleotid auf posttranskriptioneller Ebene von speziellen Enzymen, den sogenannten Pseudouridin-Synthasen (PUS), generiert. Die Entwicklung und der Einsatz fortschrittlicher Deep-Sequencing Technologien ermöglichte es, Pseudouridin in unterschiedlichen RNA Klassen (tRNAs, rRNAs, mRNAs, snRNAs und lncRNAs) in verschiedenen eukaryotischen Organismen zu identifizieren. Diese Verfahren wurden jedoch noch nie auf Bakterien angewandt. Mutationen oder Deletionen spezifischer PUS Enzyme wurden im Menschen bereits mit der Entstehung von Krankheiten in Verbindung gebracht. Diese Enzyme sind daher für die korrekte Funktionsweise einer eukaryotischen Zelle unabdinglich. Nichtsdestotrotz führte die Deletion von tRNA oder rRNA PUS Enzymen im bakteriellen Modellorganismus Escherichia coli zu keinen solch drastischen Phänotypen. Dies wiederum deutet auf eine unterschiedliche Rolle und Funktion der Modifikation und der verantwortlichen Enzyme in verschiedenen Organismen hin. In der vorliegenden Arbeit werden tRNA PUS Enzyme der Epsilonproteobakterien Campylobacter jejuni und Helicobacter pylori funktionell charakterisiert. Der Lebensmittelkeim C. jejuni ist derzeit die häufigste Ursache für bakteriell verursachte Gastroenteritis im Menschen. Dahingegen wird eine H. pylori Infektion mit der Entwicklung von Magenkrebs in Verbindung gebracht. Insbesondere wurden die Funktionen der tRNA PUS Enzyme TruA, TruB und TruD in C. jejuni sowie TruA und TruD in H. pylori untersucht. Während die Deletion von TruD keine phänotypischen Auswirkungen in H. pylori hat, führt diese in C. jejuni zu einem Wachstumsdefekt. Dies weist auf eine möglicherweise unterschiedliche Funktion des Enzyms in den beiden verwandten bakteriellen Krankheitserregern hin. Zusätzlich beschreibt diese Arbeit die Etablierung und Anwendung von Pseudo-seq in C. jejuni und H. pylori, einem genomweiten Ansatz mittels dessen zum ersten Mal die globale Identifizierung von Pseudouridin Modifikationen auf Einzel-Nukleotid-Ebene im bakteriellen Transkriptom ermöglicht wird. Durch Pseudo-seq Analysen von wildtypischer RNA und RNA isoliert aus unterschiedlichen PUS Enzym Deletionen, konnten die RNA Substrate dieser Enzyme in C. jejuni und H. pylori ermittelt werden. Für TruD stellte sich dabei die tRNA-Glu als Hauptsubstrat heraus. Interessanterweise ist diese im Genom von C. jejuni nur als einzelne Kopie vorhanden. Da eine TruD Deletionsmutante in C. jejuni einen Wachstumsdefekt aufweist, wurde dieser Phänotyp in Zusammenhang mit dem Auftreten der Pseudouridin Modifikation an der tRNA-Glu untersucht. Zu diesem Zweck wurde ein TruD Komplementationsstamm generiert, der jedoch katalytisch inaktiv ist und somit nicht in der Lage ist die Modifikation der tRNA-Glu wiederherzustellen. Überraschenderweise komplementierte dieser Stamm dennoch den Wachstumsdefekt. Eine ähnliche Beobachtung wurde bei einer Kreuzkomplementation mit einer Kopie von H. pylori TruD gemacht. Dies deutet darauf hin, dass das TruD PUS Enzym in C. jejuni möglicherweise eine zusätzliche Funktion unabhängig von der Pseudouridin Modifikation hat. Diese potentiell duale Funktion von TruD wird in dieser Arbeit durch die Anwendung einer Kombination von Deep-Sequencing Technologien (RIP-seq, RNA-seq, Ribo-seq und CLIP-seq) untersucht. Insgesamt stellt diese Studie die erste eingehende Untersuchung von Pseudouridin Modifikationen in Bakterien im Allgemeinen, und in den Krankheitserregern C. jejuni und H. pylori im Speziellen, dar. Die in dieser Arbeit vorgelegten Ergebnisse beschreiben nicht nur eine globale Kartierung von Pseudouridin Modifikationen in bakteriellen tRNAs und rRNAs sondern erforschen auch die Funktionen der für die Modifikation verantwortlichen tRNA PUS Enzyme. Darüber hinaus liefert diese Arbeit Hinweise auf eine duale Funktion des C. jejuni PUS Enzyms TruD, die über die Funktion als RNA-modifizierendes Enzym hinausgeht. Zukünftige Untersuchungen könnten sich dementsprechend darauf konzentrieren, die Funktion von TruD und seinen potenziellen Interaktionspartnern zu entschlüsseln. Dies könnte neue Erkenntnisse über Mechanismen der Regulierung eines Enzyms/Proteins liefern, das bislang nur als RNA modifizierendes Enzym beschrieben war.

La prévalence de l'infection à H. pylori a été évaluée chez 236 sujets, âgés de 20 à 74 ans, résidant dans 4 régions de culture intensive du Québec (Portneuf, Lanaudière, Ile d'Orléans, Nicolet) au cours de l'année 1995. Un test sérologique de type Elisa (Enzyme-Linked-Immunosorbent-Assay) fut utilisé afin de détecter la présence d'anticorps contre l'Helicobacter pylori dans le sérum des sujets et un questionnaire standardisé a été rempli par les participants à l'étude. La sérologie à H. pylori était positive chez 74 sujets (prévalence de 31,35 % ; IC à 95 % : 20,78 - 41,92 %). Elle était fortement associée, de façon positive, à l'âge (5,0 % pour les 20-34 ans et 60,87 % pour les 65 ans et plus, p <0,0001) et, de façon négative, avec le niveau d'éducation (14,29 % pour le niveau universitaire; 28,57 % pour le niveau collégial et 30,11 % pour le niveau primaire). Une analyse de régression logistique a permis de déterminer que seul l'âge était associé de façon significative à la prévalence de la maladie. Un test de tendance a permis de conclure que la séroprévalence à l'H. pylori croissait avec l'âge. Et pour chaque accroissement de l'âge de un an, la séroprévalence à l'H. pylori croissait de 1,07 %. Le faible taux de participation, la petite taille de l'échantillon ainsi que les informations réduites du questionnaire sont des limites importantes de l'étude qui doivent être prises en compte dans l'interprétation des résultats obtenus.

Cette thèse décrit la synthèse de l'asparagine et de la glutamine utilisés pour la biosynthèse des protéines chez Helicobacter pylori. La plupart des acides aminés (aa) sont liés à leur ARNt correspondant par les aminoacyl-ARNt synthétases (aaRS). Ces enzymes sont très spécifiques, et leur fonction est importante pour le décodage correct du code génétique. L'asparaginyl-ARNt synthétase et la glutaminyl-ARNt synthétases (AsnRS et GlnRS) sont l'une ou l'autre, ou les deux absentes de la plupart des bactéries, des archaea, et des organelles. Chez les bactéries et les organelles, des aaRS à double fonction nommées aaRS non-discriminantes (ND) participent avec une aminoacyl-ARNt amidotransférase, la GatCAB, à la formation du glutaminyl-ARNtGln et de l'asparaginyl-ARNtAsn. Les aaRS-ND, soit la glutamyl-ARNt synthétase-ND (ND-GluRS) et l'aspartyl-ARNt synthétase (ND-AspRS), forment l'aminoacyl-ARNt synonyme (Glu avec ARNtGlu) mais lient aussi l'acide aminé à l'ARNt de sa forme amidée (Glu avec ARNtGln). La GatCAB agit ensuite en transamidant le Glu-ARNtGln et l'Asp-ARNtAsn en Gln-ARNtGln et en Asn-ARNtAsn, respectivement. Chez H. pylori, la synthèse du Glu-ARNtGln est faite par une aaRS discriminante spéciale formant seulement le produit mésapparié. Cette GluGlnRS est aussi nommée GluRS2, puisque l'organisme possède une autre GluRS (GluRS1) discriminante formant seulement le Glu-ARNtGlu. La voie indirecte de la formation de l'Asn-ARNtAsn et du Gln-ARNtGln chez H. pylori et ses mécanismes de contrôle contre la mauvaise utilisation des aminoacyl-ARNt mésappariés est décrite. Tout d'abord, les premières évidences d'un channeling de l'Asp-ARNtAsn de l'AspRS-ND vers la GatCAB (Chapitre 3) mettent en scène la coopération entre ces deux enzymes permettant le contrôle de la molécule mésappariée. Une seconde publication montre la formation d'un complexe ternaire formé par la GluRS2, la GatCAB et l'ARNtGln et démontre comment ce complexe en coopération avec un rééchantillonage du substrat par la GluRS2 permettent un décodage plus fiable et plus efficace des codons Gln (Chapitre 5). Une troisième publication confirme la formation d'un complexe par l'AspRS-ND, la GatCAB et l'ARNtAsn (Chapitre 6). Ce complexe, ainsi que l'existence d'un second mode de liaison de l'ARNtAsn à l'AspRS-ND allant à l'encontre des caractéristiques connues de cette famille d'aaRS, augmentent la fidélité du décodage des codons Asn chez H. pylori. Au cours de ces travaux, en collaboration avec le groupe du Prof. Robert Chênevert (co-directeur de la thèse), des composés synthétiques ont été testés pour leur activité inhibitrice contre la GatCAB. Les premiers inhibiteurs de cette enzyme qui sont analogues à l'aa-ARNt, et le développement des méthodes de cette analyse, sont aussi présentés (Chapitres 3 et 4). / This work was focused on the formation of glutamine and asparagine used for protein biosynthesis in Helicobacter pylori. Most amino acids (aa) are linked to their cognate tRNAs by aminoacyl-tRNA synthetases (aaRS). These enzymes have a high specificity, and their function is key to the proper decoding of mRNA. One or both of the enzymes responsible for the formation of glutaminyl-tRNAGln and asparaginyl-tRNAAsn are absent from most bacteria, archaea, as well as organelles. In bacteria and organelles, dual-function aaRSs dubbed non-discriminating (ND), are used in conjunction with an aminoacyl-tRNA amidotransferase called GatCAB, to form these amidated aminoacyl-tRNAs. ND-AspRS forms the canonical Asp-tRNAAsp, but also Asp-tRNAAsn. Meanwhile, in H. pylori, the task of forming Glu-tRNAGln which is filled by an ND-GluRS in most organisms, is filled by a special, discriminating enzyme forming only the mismatched product. This GluGlnRS has been called GluRS2, the other, Glu-tRNAGlu forming enzyme being called GluRS1. Work is presented describing these two pathways in H. pylori. One publication was the first to provide data suggesting that ND-AspRS could provide Asp-tRNAAsn to GatCAB through substrate channeling (Chapter 3). The second showed formation of a ternary complex formed by GluRS2, GatCAB and tRNAGln, allowing efficient and correct decoding of Gln codons, including resampling of the substrate by GluRS2 (Chapter 5). A third manuscript confirms earlier results by describing the formation of a ternary complex formed by ND-AspRS, GatCAB and tRNAAsn (Chapter 6). This work also furthers our understanding of the kinetics of aminoacylation, by showing that ND-AspRS has two different behaviours, each one consistent with one of the two, evolutionarily unrelated families of aaRSs. Throughout my thesis, collaboration with the group of Prof. Robert Chênevert (co-director of this thesis) sought to design, synthesize and test compounds for inhibitory activity against GatCAB. The first inhibitors which are analogues of the aminoacyl-tRNA substrate for this enzyme, and the development process of the methods used to test them are described in Chapters 3 and 4).

Les microARNs, régulateurs post-transcriptionnels de l’expression des gènes eucaryotes, sont impliqués dans la défense contre les pathogènes. Afin de favoriser leur multiplication, les virus et les bactéries ont développé des stratégies pour altérer la voie des miRNAs. Dans ce travail, nous avons montré que Helicobacter pylori, une bactérie responsable chez l’Homme de pathologies gastriques sévères, telles que l’ulcère ou le cancer, réprime un cluster de microARNs spécifique des cellules souches embryonnaires dans une lignée épithéliale gastrique. En utilisant une technique de séquençage à haut débit, nous avons identifié miR-372 comme le miRNA le plus exprimé dans cette lignée gastrique. Avec miR-373, miR-372 permet la prolifération cellulaire réprimant l’expression d’un inhibiteur du cycle cellulaire, the LArge Tumor Suppressor 2 (LATS2). Au cours de l’infection par H. pylori, l’expression de miR-372&373 est réprimée, provoquant une accumulation de LATS2 et un arrêt du cycle cellulaire. De manière importante, la répression de ces miRNAs est dépendante de la translocation de l’effecteur bactérien CagA dans la cellule hôte. Ces données constituent un nouvel exemple d’interaction hôte-pathogène impliquant les miRNAs et ont identifié le couple LATS2/miR-372&373 comme un mécanisme inattendu dans l’arrêt du cycle cellulaire observé au cours de l’infection. Ce mécanisme pourrait refléter l’inhibition de l’auto-renouvellement de l’épithélium gastrique, processus impliqué dans la défense contre les infections bactériennes. / MicroRNAs, post-transcriptionnal regulators of eukaryotic gene expression, are implicated in host defense against pathogens. Viruses and bacteria have evolved strategies to suppress miRNA functions with the aim to establish a sustainable infection. In this work, we report that Helicobacter pylori, a bacterium responsible for severe human gastric inflammatory diseases and cancers, down-regulates an embryonic-specific microRNAs cluster in a gastric epithelial cell line. We reveal by using a deep sequencing approach that hsa-miR-372 is the most abundant miRNA expressed in this gastric cell line where, together with hsa-miR-373, it promotes cell proliferation by silencing the expression of a cell cycle inhibitor, the LArge Tumor Suppressor 2 (LATS2). Upon H. pylori infection, miR-372&373 synthesis is inhibited, leading to the derepression of LATS2 and thus, to a cell cycle arrest at the G1/S transition. Importantly, this down-regulation of a specific cell cycle-regulating microRNA is dependent on the translocation of the bacterial effector CagA into the host cells. These data constitute a novel example of host-pathogen interplay involving microRNAs and unveil the couple LATS2/miR-372&373 as an unexpected mechanism in infection-induced cell cycle arrest in proliferating gastric cells which may be relevant of inhibition of gastric epithelium renewal, a major host defense mechanism against bacterial infections.

O câncer gástrico já foi descrito associado com Helicobacter pylori e Mycoplasma hyorhnis. Em vista disso, este trabalho avaliou a presença de Mollicutes, M. hyorhinis e H. pylori e suas correlações com câncer gástrico. Foram obtidas 120 amostras de biopsias gástricas embebidas em parafina em Vitória da Conquista - BA, armazenadas no período de 2006-2016. Destes 80 eram de pacientes com câncer gástrico. Para a extração de DNA foi utilizado um kit comercial com desparafinização prévia. A PCR convencional foi aplicada para detecção de Mollicutes, H. pylori e M. hyorhinis, que também foi detectado por qPCR e imuno-histoquímica. Os dados obtidos foram avaliados pelos testes estatísticos de Pearson (X2) e de Mann-Whitney (p 0,05). O grupo controle apresentou maior frequência de Mollicutes (12,3%) e M. hyorhinis (11,0%). H. pylori foi detectado no grupo caso (8,2%) e mas teve maior frequência no grupo controle (22,5%). Não houve coinfecção de Mollicutes, M. hyorhinis e H. pylori no grupo caso, mas o grupo controle apresentou maior prevalência de H. pylori, com associação estatisticamente significativa (p < 0,001). Estes resultados podem direcionar para um aprimoramento de controle e conhecimento de micoplasmas e sua relevância em fenótipos malignos. / Gastric cancer has already been described associated with Helicobacter pylori and Mycoplasma hyorhnis. In view of this, this study evaluated the presence of Mollicutes, M. hyorhinis e H. pylori and its correlations with gastric cancer. 120 samples of gastric biopsies embedded in paraffin were obtained in Vitória da Conquista - BA, stored in the 2006-2016. Of these, 80 were patients with gastric cancer. For DNA extraction a commercial kit with prior dewaxing was used. Conventional PCR was applied for detection of Mollicutes, H. pylori and M. hyorhinis, it which was also detected by qPCR and immunohistochemistry. The data were evaluated by the Pearson (X2) and Mann-Whitney statistical tests (p 0,05). The control group had a higher frequency of Mollicutes (12,3%) and M. hyorhinis (11,0%). H. pylori was detected in the case group (8,2%), but had a higher frequency in the control group (22,5%). There was no coinfection of Mollicutes, M. hyorhinis and H. pylori in the case group, but the control group had a higher prevalence of H. pylori, with a statistically significant association (p < 0,001). These results may lead to improved control and knowledge of mycoplasmas and their relevance to malignant phenotypes.

Foram estudados 83 pacientes com esofagite erosiva graus I e II, pela classificação de Savary-Miller modificada, divididos em 3 grupos. Um sem Helicobacter pylori, dois outros com Helicobacter pylori, com e sem o gene cagA. Avaliou-se a participação da bactéria e de seu gene cagA, associados à estudo histopatológico de antro e corpo e à gastrinemia basal, na cicatrização da mucosa do esôfago após tratamento com pantoprazol 40 mg ao dia por 6 semanas. Verificou-se que a presença do Helicobacter pylori, independentemente da presença do gene cagA, facilita a cicatrização esofágica. Indivíduos com gastrinemias maiores também tendem a cicatrizar melhor. Não houve relação do resultado do estudo histopatológico com a resposta terapêutica / Eighty three patients with grade I-II of the modified Savary-Miller classification have been studied. They were divided in three groups. One without Helicobacter pylori infection, two with the bacterium, one with and other without the cagA gene. We verified the influence of cagA status, histopathology of antrum and body of the stomach and gastrinemia in the esophageal healing rates after treatment with pantoprazole 40 mg once a day for six weeks. Helicobacter pylori presence but not cagA status and gastrinemia led to better healing rates. Histopathology of the gastric mucosa did not influence the response

O Helicobacter pylori, é tido como o principal fator de risco para o carcinoma gástrico. Diferentes estudos experimentais em animais procuram relacionar essa carcinogênese a outros fatores carcinógenos sem sucesso. Neste estudo, procurou-se avaliar-se em ratos, se há correlação entre o refluxo duodenogástrico, o Helicobacter pylori e o desenvolvimento do câncer gástrico ou de seus precursores. Para tal, realizou-se nos três grupos de ratos (n de dez por grupo) as técnicas de: piloroplastia precedida de infecção, gastrectomia subtotal precedida de infecção e um grupo no qual foi praticada apenas a infecção. Apois seis meses, analisou-se as alterações da mucosa, comparando-se os três grupos. As alterações da mucosa pesquisadas foram as seguintes: gastrites, metaplasias, displasias e neoplasias epiteliais. Ao término do estudo, foi encontrado, no grupo submetido a piloroplastia precedida de infecção um alto percentual de alterações epiteliais. Conclui-se que, no rato, a operação de piloroplastia, levou ao maior desenvolvimento da população do Helicobacter pylori, que se relaciona com as lesões pré- malignas e o adenocarcinoma gástrico. / Helicobacter pylori is considered the main risk factor for gastric carcinoma. Different experimental studies in animals seek to relate this carcinogenesis to other carcinogenic factors without success. This study sought to evaluate in rats, if there was a correlation between duodenogastric reflux, Helicobacter pylori and the development of gastric cancer or its precursors. To this end, it was carried out in three groups of rats the techniques: pyloroplasty, subtotal gastrectomy and only infection. After six months, the changes in mucosa were analyzed comparing the three groups. The mucosal changes reseached were: gastritis, metaplasia, dysplasia and epithelial neoplasms. At the end of the study, was found in the group that underwent pyloroplasty a high percentage of epithelial alterations and these correlated with the population of Helicobacter pylori. It is concluded that in the rat, the operation of pyloroplasty led to increased colonization of the population of Helicobacter pylori and is related with the development of benign lesions and gastric cancer.

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.

Lam, Kwok Ho. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 149-159). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.