Mechanisms of Helicobacter pylori infection: bacterial factors.

Since the discovery of H. pylori in 1982 (MARSHALL 1983; WARREN 1983), research on the mechanisms of virulence of H. pylori has advanced substantially. It is now well established that urease and flagella are virulence factors of H. pylori. Although known for some time to be toxic to epithelial cells in vitro, VacA has only recently been established as a virulence factor. The cag pathogenicity island has also emerged as another virulence contender, although the specific genes involved in virulence are still being determined. Other possible virulence factors, not yet confirmed by gene disruptions, are hapA, katA, sodA, cagA, and iron-regulated genes. As of yet, no adhesins have been confirmed as being important for in vivo survival of H. pylori. With the sequence of the H. pylori genome in hand, it should be possible to more easily determine the role of specific genes in virulence. Genes of immediate interest are the OMPs, which may under go phase and antigenic variation and may represent adhesins. Additionally, virulence-related orthologs and vacA-related genes may provide some interesting findings. Once we define the genes that contribute to H. pylori virulence, we may be able to more easily develop novel therapeutic drugs or vaccines to treat and prevent H. pylori infection.