Helicobacter pylori and Gastric Cancer: Factors That Modulate Disease Risk

Less than 3 decades ago, Robin Warren and Barry Marshall definitively identified Helicobacter pylori by culturing an organism from gastric biopsy specimens that had been visualized for almost a century by pathologists (196). In 1994, H. pylori was recognized as a type I carcinogen, and now it is considered the most common etiologic agent of infection-related cancers, which represent 5.5% of the global cancer burden (239). In 2005, Marshall and Warren were awarded the Nobel Prize of Medicine for their seminal discovery of this bacterium and its role in peptic ulcer disease

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Helicobacter pylori and Gastric Cancer: Factors That Modulate Disease RiskCLINICAL MICROBIOLOGY REVIEWS, Oct. 2010, p. 713–739 Vol. 23, No. 40893-8512/10/$12.00 doi:10.1128/CMR.00011-10Copyright © 2010, American Society for Microbiology. All Rights Reserved. Helicobacter pylori and Gastric Cancer: Factors That Modulate Disease Risk Lydia E. Wroblewski,1* Richard M. Peek, Jr.,1,2,3 and Keith T. Wilson1,2,3Division of Gastroenterology, Department of Medicine,1 and Department of Cancer Biology,2 Vanderbilt University Medical Center, Nashville, Tennessee 37232, and Department of Veterans Affairs Medical Center, Nashville, Tennessee 372123 INTRODUCTION .......................................................................................................................................................714 Helicobacter pylori ....................................................................................................................................................714 Gastric Cancer ........................................................................................................................................................714 H. PYLORI VIRULENCE FACTORS .......................................................................................................................715 cag PAI .....................................................................................................................................................................715 CagA .........................................................................................................................................................................715 CagA phosphorylation-dependent host cell signaling....................................................................................716 CagA phosphorylation-independent host cell signaling ................................................................................716 Peptidoglycan...........................................................................................................................................................716 VacA Toxin...............................................................................................................................................................717 Consequences of VacA within the host cell.....................................................................................................717 Adhesins and OMPs...............................................................................................................................................717 BabA .....................................................................................................................................................................717 SabA and OipA ...................................................................................................................................................718 DupA.....................................................................................................................................................................718 FlaA.......................................................................................................................................................................718 HOST FACTORS........................................................................................................................................................718 Host Polymorphisms That Influence the Propensity toward Gastric Cancer Development ........................718 IL-1␤.....................................................................................................................................................................718 TNF-␣ ...................................................................................................................................................................719 IL-10 .....................................................................................................................................................................719 IL-8 .......................................................................................................................................................................719 COX-2.......................................................................................................................................................................719 Acid Secretion..........................................................................................................................................................720 Oxidative Damage...................................................................................................................................................721 Role of the host immune response in H. pylori-induced carcinogenesis .....................................................721 General Considerations for Innate and Adaptive Immunity............................................................................721 Innate immunity..................................................................................................................................................721 Adaptive immunity...................................................................................................................................... ...