Which genotype of Helicobacter pylori—cagA or cagE—Is better associated with gastric Cancer risk? Lessons from an extremely high-risk area in Iran

• Published in: Infection, genetics and evolution Vol. 85; p. 104431
• Main Authors: Bakhti, Seyedeh Zahra, Latifi-Navid, Saeid, Gholizade Tobnagh, Shokufe, Yazdanbod, Kiana, Yazdanbod, Abbas
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2020
• Subjects: Ardabil; cagA; cagE; cagPAI; H. pylori; High-risk area; High-risk area; cagPAI; cagE; H. pylori; Ardabil; cagA
• ISSN: 1567-1348; 1567-7257
• DOI: 10.1016/j.meegid.2020.104431

The association of the H. pylori cagA- /cagE-positive genotypes with the risk of gastric cancer (GC) in Ardabil—a high-risk area in North-West Iran—was assessed. Genotyping was performed in DNA from fresh gastric biopsies (N = 218). Occurrence of H. pylori infection was 85.32% (186/218). The total frequency of the cagA+vs. cagA−, cagE+vs. cagE−, cagA+/cagE−vs. AGCs (all genotype combinations), cagA−/cagE+vs. AGCs, cagA−/cagE−vs. AGCs, cagA+/cagE+vs. AGCs, cagA+/cagE−vs. cagA−/cagE+, and cagA+/cagE+vs. cagA−/cagE− genotypes was 102/186 (54.8%), 89/186 (47.8%), 38/186 (20.4%), 25/186 (13.4), 59/186 (31.7%), 64/186 (34.4%), 38/63 (38.63%), and 64/123 (52.0%), respectively. The cagE+vs. cagE− (59.6% (65/109) in GC vs. 31.2% (24/77) in non-atrophic gastritis, NAG) and the cagA+/cagE+vs. cagA−/cagE− genotypes (66.7% (40/60) in GC vs. 38.1% (24/63) in NAG) showed an increased association with the risk of GC in Ardabil (odds ratio [OR] = 3.262, 95% confidence interval [CI]: 1.763–6.038, p = .0001 and OR = 3.250; 95% CI: 1.552–6.808, p = .002, respectively). We propose that the H. pylori cagE+ but not cagA+ genotype significantly increased the risk of GC in this extremely high-risk population. Therefore, it may play a significant role in determining H. pylori-related clinical outcome. •Ardabil is a very high-risk area of gastric cancer (GC) in North-West Iran.•The frequency of the H. pylori cagA+ and cagE+ genotypes was 54.8% and 47.8%, respectively.•The frequency of the H. pylori cagA+/cagE+vs. cagA−/cagE− genotypes was 52.0%.•The H. pylori cagE+ and cagA+/cagE+ genotypes strongly increased the risk of GC.•The H. pylori cagE+ genotype is a stronger predictor of GC than cagA+ in this high-risk population.