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Objetivo: Resumir y analizar la evidencia científica disponible sobre el efecto de la adición de productos lácteos fermentados al tratamiento de la erradicación de H. pylori en adultos. Diseño: Se realizará una revisión sistemática.

We have recently developed a new PCR assay for the detection of H. pylori. In this study, the polymerase chain reaction (PCR) assay was used to detect H. pylori in 88 gastric biopsy, 85 saliva, and 71 fecal specimens from 88 patients. H. pylori infection was confirmed in 71 of 88 patients by culture and/or histological stain of gastric biopsies. Serum IgG antibody to H. pylori was also measured and resulted in 97% sensitivity and 94% specificity. H. pylori DNA was detected by the PCR assay in gastric biopsy specimens from all 71 patients (100% sensitivity) with proven gastric H. pylori infection but not from 17 noninfected patients (100% specificity). In saliva specimens, H. pylori DNA was identified in 57 of the 68 patients (84%) with proven gastric H. pylori infection and in three of the 17 patients without gastric H. pylori infection. However, the PCR assay was only able to detect H. pylori DNA in the feces from 15 of 61 patients (25%) with proven gastric H. pylori infection and one of the 10 patients without gastric H. pylori infection. The results show that the PCR assay is reliable for detecting the presence of H. pylori in gastric biopsy and saliva specimens. The data indicate that H. pylori exists in a higher prevalence in saliva than feces and that the fecal-oral route may be an important means of transmission of this infection in developing countries but not as significant as previously suspected in the developed countries. It is likely that the oral-oral route is more prominent.

Modification of the lipid A domain of lipopolysaccharide (LPS) has been reported to contribute to the virulence and pathogenesis of various Gram-negative bacteria. The Kdo (3-deoxy-D-manno-octulosonic acid)-lipid A domain of Helicobacter pylori LPS shows several differences to that of Escherichia coli. It has fewer acyl chains, a reduced number of phosphate groups, much lower immunobiological activity, and only a single Kdo sugar is attached to the disaccharide backbone. However, H. pylori synthesizes a minor lipid A species resembling that of E. coli, which is both bis-phosphorylated and hexa-acylated suggesting that the major species results from the action of specific modifying enzymes. This work describes two enzymes, a lipid A phosphatase and a phosphoethanolamine transferase, involved in the periplasmic modification of the 1-position of H. pylori lipid A. Furthermore, we report a novel Kdo trimming enzyme that requires prior removal of the 1-phosphate group for enzymatic activity. Discovery of the enzymatic machinery involved in the remodeling of H. pylori LPS will help unravel the importance of these modifications in H. pylori pathogenesis.d.

Although it is fairly well accepted that Helicobacter pylori infection plays a significant role in causing gastric cancer, the exact mechanisms involved in its pathogenesis are unclear. We have examined the relationship between H. pylori infection and oncogene expression in different stages of disease progression from precursor lesions to gastric carcinoma. We used Diff-Quik stain to diagnose H. pylori infection and immunohistochemical stains against c-erbB-2, p53, ras, c-myc, and bcl-2 to determine expression of oncogenes. H. pylori infection was found in all cases of chronic gastritis, atrophic gastritis, intestinal metaplasia, and early gastric carcinoma, and in 16 of 30 (53%) cases of advanced gastric carcinoma. Overexpression of c-erbB-2 was found in 2 (7%) cases of advanced gastric carcinoma, which were H. pylori negative. Suppressor gene, p53, was overexpressed in 3 (30%) cases of intestinal metaplasia, 2 (33%) cases of early gastric carcinoma, and 18 (60%) cases of advanced gastric carcinoma. Of these 18 p53-positive advanced gastric cancer cases, 11 (61%) were H. pylori positive. Expression of ras p21 was found in 4 (40%) cases of H. pylori-negative normal mucosa, 10 (100%) cases of chronic gastritis, 1 (10%) case of atrophic mucosa, 6 (60%) cases of intestinal metaplasia, 2 (33%) cases of nonneoplastic mucosa adjacent to early gastric carcinoma, and 7 (23%) nonneoplastic mucosa adjacent to advanced gastric carcinoma, all of which showed H. pylori. No evidence of expression of either c-myc or bcl-2 was detected in any of the above-mentioned samples. The data suggest that H. pylori infection may increase expression of ras p21 proteins and induce p53 suppressor gene mutation early in the process of gastric carcinogenesis.

京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13196号 / 論社医博第12号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 福原 俊一, 教授 小泉 昭夫, 教授 佐藤 俊哉 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

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.

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).

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.