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

Orientador: A. Frederico N. de Magalhães / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-07-31T17:07:32Z (GMT). No. of bitstreams: 1 Reis_MaisaPrandodeMoura_M.pdf: 25147226 bytes, checksum: 894a70c9e21976c037bd3a83a1c37cc9 (MD5) Previous issue date: 2001 / Resumo: A dispepsia funcional é definida como dor abdominal ou desconforto, persistente ou recorrente, situado no abdome superior sem causas orgânicas ou bioquímicas que expliquem os sintomas. O objetivo desse estudo prospectivo, randomizado, duplo-cego, controlado com um ano de seguimento, foi determinar se a erradicação do Hp me1hora os sintomas dispépticos e os índices de ansiedade e depressão em pacientes com dispepsia funcional. Cinqüenta e três pacientes Hp-positivos com dispepsia funcional dos tipos "dismotilidade", "úlcera" e "refluxo" foram incluídos nesse estudo e receberam tratamento. Eram 11 homens e 42 mulheres,com idade média de 40.24, variando entre 18 e 65 anos. A infecção pelo Hp foi avaliada pelo teste da urease, da histologia e da cultura. Os pacientes foram distribuídos aleatoriamente em dois grupos de acordo com o tratamento: tetraciclina 500mg - 1 cápsula,4 vezes/dia,furazolidona200mg- 1 cápsula, 2 vezes/dia e subcitrato de bismuto 240mg - 1 cápsula, 3 vezes/dia (grupo droga-ativa) ou subcitrato de bismuto associado a placebos (grupo controle), ambos por 7 dias. A pesquisa do Hp foi realizada um mês e 12 meses após o término do tratamento, por meio do exame endoscópico, com co1heitade biópsias. A intensidade dos sintomas foi medida pela escala de Likert com variação de 1/5, onde 1 corresponde a sem problema e 5 corresponde a problema intenso. Os índices de ansiedade e depressão foram avaliados pela escala (HAD) na primeira avaliação e após 12 meses. Vinte e um pacientes apresentaram índices de ansiedade e depressão (39,6%). Vinte e oito pacientes (52,8%) integraram o grupo droga-ativa e 25 (47,2%) o grupo controle. A taxa de erradicação após um mês foi de 75% no grupo droga-ativa e de 0% no grupo controle. A melhora dos sintomas após um ano ocorreu em 14 (77,8%) pacientes erradicados e em 27 (77,1%) não erradicados. Os Índices de ansiedade e de depressão reduziram-se em 9 pacientes (36%), não apresentando relação com a erradicação do Hp. Concluúnos que, na dispepsia funcional, não há relação aparente entre a infecção pelo Hp e a intensidade dos sintomas dispépticos ou os Índices de ansiedade ou depressão / Abstract: Functional dyspepsia (FD) is defined as persistent or recurrent abdominal pain or discornfort centered in the upper abdomen in patients who have no detinite structural or biochemical explanation for their symptoms (e.g., peptic ulcer disease, gastroesophageal reflux, ma1ignancyor pancreaticobiliarydisease). The discovery of Helicobacter pylori has resulted in important advances in the management of dyspepsia.The role of Hp in functional dyspepsia is still controversial. Several studies have evaluated the effect of eradicating Hp infection on dyspeptic symptoms in patients with functional dyspepsia, but conflicting results and design flaws have been found. There is abundant evidence that psychological factors can be identified in most patients with functional diseases, inc1udingdyspepsia. This study aimed to determine whether Hp eradication therapy improves dyspeptic symptomsand anxiety/depressionrates. Fifty-three Hp-positive patients with functional dyspepsia were inc1uded and treated: 11 male and 42 female, mean age 40.24, between 18-65 years. The Hp infection was assessed by urease, histological and culture. Patients were randomly allocated to a 7- day treatment of tetracyclin 500mgx4, furazolidone 20mgx2 and bismuth subcitrate 240mgx3 (active-treatment group) or placebo associated to subcitrate bismuth 24Omgx3 (control group). Presence of Hp was assessed at one month after completion oftherapy and 12 months by endoscopic biopsies. Symptoms severity was measured using Likert scale ITom1= no problem to 5= very severe. Anxiety and depression were evaluated trough (HAD) scale at the first and at 12 months. Chi-square test, t Student's test and Fisher's exact test were used to compare the values of variables. The two groups were comparable. Anxiety and depression rates were positive in 21 patients (39,6 percent). Twenty-eight patients (52,8 percent) received the anti-Hp therapy and 25 (47,2 percent) received on1ybismuth . Helicobacterpylori eradicationrates at one month were 75 percent in active-treatment group and zero percent in control group. At 12 months, symptoms improvement was identified in 14 (77,8 percent) Hpnegative patients and in 27 (77,1 percent) Hp-positive patients. Anxiety and depression rates improved in 9 patients (36 percent), showing no relation with Hp eradication. We conclude that there is no evidence that curing Hp infection in patients with functional dyspepsia leads to relief of symtoms or anxiety and depression features / Mestrado / Clinica Medica / Mestre em Clinica Medica

Tesis para optar al Grado de Magíster en Ciencias Animales y Veterinarias mención en Patología Animal / RESUMEN Introducción: El síndrome ulceroso gástrico en equinos FSC se asocia principalmente a factores de manejo y alimentación, sin embargo al igual que en otras especies se ha postulado el eventual rol que pudiese jugar la presencia de Helícobacter pylorí en el desarrollo de esta enfermedad. El objetivo de este trabajo es evaluar en caballos que presenten la enfermedad la presencia de la bacteria y así contribuir al conocimiento de la etiopatogenia del cuadro. Material y Métodos: En 45 equinos con diagnóstico gastroscópico de úlcera gástrica se obtuvo una muestra de la lesión por biopsia, la cual fue sometida a test rápido de ureasa HE-PY Test (BIOS Chile), se seleccionaron aquellas muestras positivas con mayor carga bacteriana, en total 13, las cuales se analizaron mediante técnica de PCR, con un par de partidores HP01 y HP02 de secuencias conocidas. Los resultados se expresaron mediante distribución de frecuencias de los valores cualitativos. En las muestras al test de ureasa se usó prueba de hipótesis para muestras asociadas mediante distribución de X2 . En el caso de los elementos coincidentes se determinó la correlación de Spearman. Resultados y discusión: Las lesiones de la mucosa gástrica se clasificaron en cuatro grados: 25, 1 % grado1, 45%, 13,3% y 16,6% grados 2, 3 y 4 respectivamente. Los test de ureasa se clasificaron según tiempo que demoró en virar el color asociándolo a la carga bacteriana; 25% con ausencia de carga bacteriana, 38.3% carga bacteriana baja, 25 % moderada y 11 ,6% alta carga bacteriana. Aquellas muestras con alta carga bacteriana y el 50% de muestras con carga moderada fueron sometidas a PCR para H. pylorí, lo que arrojó como resultado un 14,3% de muestras positivas a H. pylorí, demostrando así una alta sensibilidad del test de ureasa, sin embargo una baja especificidad en el equino, debido al alto porcentaje de falsos positivos (85,7%). Conclusiones: Existe presencia de H. pylorí en el equino fina sangre de carrera asociado a lesión de mucosa gástrica. Un 48.8% de las muestras viraron antes de 24 hrs. lo que indica una moderada a alta carga bacteriana, asociada a grados 2, 3 y 4 de lesión en la mucosa gástrica. / SUMMARY lntroduction: The equine gastric ulcer syndrome is mainly associated with feeding and management factors, however, as in other species has been postulated the possible role that could play the presence of Helícobacter pylorí in the development of this disease. The aim of this study is to assess horses presenting disease the presence of bacteria and thus contribute to the understanding the pathogenesis. Material and Methods: In 45 horses with gastroscopic diagnosis of gastric ulcer was sampled by biopsy of the lesion, which underwent rapid urease test HE-PY Test (BIOS Chile), those positive samples were selected more bacteria! load, a total of 13, which was analyzed by PCR with a pair of primers HP01 and HP02 known sequences. The results were expressed as frequency distribution of qualitative values. In samples with urease test was used far hypothesis testing samples associated with X2 distribution. In the case of the matching elements are determined Spearman correlation. Results and discussion: The mucosal gastric lesions were classified into four grades: grade 1 25.1 %, 45%, 13.3% and 16.6% grade 2, 3 and 4 respectively. The urease test were classified as in turn delayed while associating color to bacteria! load, 25% with no bacteria!, low bacteria! presence 38.3%, 25% moderate and 11.6% high bacteria! presence. Those samples with high bacteria! presence and 50% samples with moderate bacteria! presence were subjected to PCR to H. pylorí, showing results in 14.3% of samples positive far H. pylorí, demonstrating high sensitivity of urease test, but low specificity in the horse, due to the high percentage of false positives (85.7%). Conclusions: The presence of H. pylorí in thoroughbred race horses associated with gastric mucosal lesion. A 48.8% of the samples within 24 hrs tacked. indicating a moderate to high bacteria! counts associated with degrees 2, 3 and 4 of gastric mucosal injury

Bacterial small non-coding RNAs (sRNAs) play fundamental roles in controlling and finetuning gene expression in a wide variety of cellular processes, including stress responses, environmental signaling and virulence in pathogens. Despite the identification of hundreds of sRNA candidates in diverse bacteria by genomics approaches, the mechanisms and regulatory capabilities of these posttranscriptional regulators have most intensively been studied in Gram-negative Gammaproteobacteria such as Escherichia coli and Salmonella. So far, almost nothing is known about sRNA-mediated regulation (riboregulation) in Epsilonproteobacteria, including the major human pathogen Helicobacter pylori. H. pylori was even thought to be deficient for riboregulation as none of the sRNAs known from enterobacteria are conserved in Helicobacter and since it lacks the major RNA chaperone Hfq, which is crucial for sRNA function as well as stability in many bacteria. Nonetheless, more than 60 cis- and trans-acting sRNA candidates were recently identified in H. pylori by a global RNA sequencing approach, indicating that this pathogen, in principle, has the capability to use riboregulation for its gene expression control. However, the functions and underlying mechanisms of H. pylori sRNAs remained unclear. This thesis focused on the first functional characterization and target gene identification of a trans-acting sRNA, RepG (Regulator of polymeric G-repeats), in H. pylori. Using in-vitro and in-vivo approaches, RepG was shown to directly base-pair with its C/Urich terminator loop to a variable homopolymeric G-repeat in the 5’ untranslated region (UTR) of the tlpB mRNA, thereby regulating expression of the chemotaxis receptor TlpB. While the RepG sRNA is highly conserved, the length of the G-repeat in the tlpB mRNA leader varies among different H. pylori isolates, resulting in a strain-specific tlpB regulation. The modification of the number of guanines within the G-stretch in H. pylori strain 26695 demonstrated that the length of the homopolymeric G-repeat determines the outcome of posttranscriptional control (repression or activation) of tlpB by RepG. This lengthdependent targeting of a simple sequence repeat by a trans-acting sRNA represents a new twist in sRNA-mediated regulation and a novel mechanism of gene expression control, since it uniquely links phase variation by simple sequence repeats to posttranscriptional regulation. In almost all sequenced H. pylori strains, tlpB is encoded in a two gene operon upstream of HP0102, a gene of previously unknown function. This study provided evidence that HP0102 encodes a glycosyltransferase involved in LPS O-chain and Lewis x antigen production. Accordingly, this glycosyltransferase was shown to be essential for mice colonization by H. pylori. The coordinated posttranscriptional regulation of the tlpB-HP0102 operon by antisense base-pairing of RepG to the phase-variable G-repeat in the 5’ UTR of the tlpB mRNA allows for a gradual, rather than ON/OFF, control of HP0102 expression, thereby affecting LPS biosynthesis in H. pylori. This fine-tuning of O-chain and Lewis x antigen expression modulates H. pylori antibiotics sensitivity and thus, might be advantageous for Helicobacter colonization and persistence. Whole transcriptome analysis based on microarray and RNA sequencing was used to identify additional RepG target mRNAs and uncover the physiological role of this riboregulator in H. pylori. Altogether, repG deletion affected expression of more than 40 target gene candidates involved various cellular processes, including membrane transport and adhesion, LPS modification, amino acid metabolism, oxidative and nitrosative stress, and nucleic acid modification. The presence of homopolymeric G-repeats/G-rich sequences in almost all target mRNA candidates indicated that RepG hijacks a conserved motif to recognize and regulate multiple target mRNAs in H. pylori. Overall, this study demonstrates that H. pylori employs riboregulation in stress response and virulence control. In addition, this thesis has successfully established Helicobacter as a new model organism for investigating general concepts of gene expression control by Hfq-independent sRNAs and sRNAs in bacterial pathogens. / Bakterielle kleine, nicht-kodierende RNAs (sRNAs, engl. für small RNAs) spielen eine fundamentale Rolle in der Kontrolle und Feinabstimmung der Genexpression in Bakterien. Sie sind an einer Vielzahl von zellulären Prozessen, einschließlich der Adaption an unterschiedliche Stress- sowie Umweltbedingungen und der Virulenz von bakteriellen Pathogenen, beteiligt. Trotz der Identifizierung von Hunderten von sRNA-Kandidaten in diversen Bakterien durch genomweite Untersuchungsmethoden, wurden die regulatorischen Eigenschaften und Mechanismen dieser posttranskriptionellen Regulatoren bisher hauptsächlich in Gram-negativen Gammaproteobakterien wie Escherichia coli und Salmonella untersucht. Bislang ist nur wenig über sRNA-basierte Regulation (Riboregulation) in Epsilonproteobakterien, einschließlich dem weitverbreiteten Humanpathogen Helicobacter pylori, bekannt. Es wurde sogar angenommen, dass H. pylori über keine Art der Riboregulation verfügt, da keine der enterobakteriellen sRNAs in Helicobacter konserviert sind. Zudem konnte in diesem Erreger kein Homolog für das RNAChaperon Hfq, welches in vielen Bakterien essentiell für die Funktion und Stabilität von sRNAs ist, identifiziert werden. Nichtsdestotrotz wurden mit Hilfe einer globalen RNASequenzierungsstudie,die auf der Sequenzierung primärer Transkripte in einem Hochdurchsatzverfahren basiert, kürzlich mehr als 60 in cis- und in trans-agierende sRNAKandidaten in H. pylori identifiziert. Diese Transkriptomanalyse deutet darauf hin, dass H. pylori prinzipiell die Fähigkeit hat Riboregulation zur Kontrolle seiner Genexression zu nutzen. Die Funktionen und Mechanismen von sRNAs in H. pylori sind jedoch immer noch unklar. In der vorgelegten Arbeit wurde erstmals eine in trans-agierende sRNA, RepG (Regulator of polymeric G-repeats), in Helicobacter charakterisiert sowie dessen zelluläre Zielgene identifiziert. Mit Hilfe diverser in-vitro und in-vivo Analysen konnte gezeigt werden, dass der C/U-reiche Transkriptionsterminatorloop von RepG direkt an eine variable, repetitive G-Sequenz in der 5‘ untranslatierten Region (UTR) der tlpB mRNA bindet. Durch diese direkte sRNA-mRNA Interaktion wird die Expression des Chemotaxis Rezeptors TlpB reguliert. Im Gegensatz zu einer hohen Konservierung der Sequenz der RepG sRNA, variiert die Länge des G-Stretches im 5‘ UTR der tlpB mRNA zwischen unterschiedlichen H. pylori Isolaten. Diese Längenvariation resultiert in einer Stamm-spezifischen Regulation der TlpB Expression. Die Modifikation der Anzahl der Guanin-Basen im G-Stretch des H. pylori Stammes 26695 demonstrierte, dass die Länge der repetitiven G-Sequenz das Ergebnis der posttranskriptionellen Regulation (Repression oder Aktivierung) von tlpB durch RepG beeinflusst. Die hier beschriebene Längen-abhängige Interaktion zwischen einer in transagierenden sRNA und einer einfachen, repetitiven Sequenz repräsentiert nicht nur ein neues Konzept für die Genregulation durch sRNAs, sondern stellt auch einen neuen Mechanismus der Genexpressionskontrolle dar. Darüber hinaus, veranschaulicht die hier beschriebene sRNA-mRNA Interaktion eine bislang einzigartige Verknüpfung von Phasenvariation durch hochvariabel, repetitive Sequenzen mit Genregulation durch sRNAs. In nahezu allen sequenzierten H. pylori Stämmen ist das tlpB Gen in einem Operon zusammen mit einem Gen mit bisher unbekannter Funktion, HP0102, kodiert. In dieser Arbeit konnte gezeigt werden, dass HP0102 für eine Glykosyltransferase kodiert, die an der Synthese der O-Seitenketten des LPS und des Lewis x Antigens in H. pylori beteiligt ist. Darüber hinaus konnte demonstriert werden, dass diese Glykosyltransferase für die Kolonisierung des murinen Magens durch H. pylori essentiell ist. Die koordinierte, posttranskriptionelle Regulation des tlpB-HP0102 Operons, welche durch antisense Basenpaarung zwischen RepG und der phasen-variablen, repetitiven G-Sequenz im 5‘ UTR der tlpB mRNA vermittelt wird, ermöglicht eine graduelle Kontrolle der Genexpression von HP0102, und somit Einflussnahme auf die LPS Biosynthese in H. pylori. Diese Feinabstimmung der LPS O-Seitenketten und Lewis x Antigen Expression beeinflusst die Resistenz von H. pylori gegen diverse Antibiotika und könnte somit sowohl für die Kolonisierung als auch für die persistente Infektion des Wirts durch H. pylori vorteilhaft sein. Um Einblicke in die physiologische Funktion von RepG zu gewinnen, wurden in einer genom-weiten Transkriptomanalyse mittels Microarray und RNA-Sequenzierung weitere Zielgene von RepG bestimmt. Insgesamt beeinflusste die Deletion von repG die Expression von mehr als 40 potentiellen Zielgenen, welche an diversen zellulären Prozessen beteiligt sind, wie z.B. Membrantransport und Adhäsion, Aminosäure- und Nukleinsäure-Metabolismus, oxidative und nitrosative Stressantwort sowie LPS Modifizierung. Die Identifizierung von homopolymeren G-Stretchen bzw. G-reichen Sequenzen in allen ZielmRNAs deutet darauf hin, dass RepG ein konserviertes Motiv bindet, um mehrere Zielgene in H. pylori zu erkennen und zu regulieren. Zusammenfassend zeigt diese Arbeit, dass H. pylori Riboregulation basierend auf sRNAs nutzt, um seine Genexpression in unterschiedlichen Stress- und Virulenzbedingungen zu regulieren. Darüber hinaus hat diese Studie Helicobacter als neuen Modelorganismus für die Untersuchung genereller Wirkungsweisen Hfq-unabhängiger sRNAs und sRNAs in bakteriellen Pathogenen etabliert.

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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