The Helicobacter pylori virulence factors CagA and VacA are implicated in the development of gastroduodenal diseases. Most strains possessing CagA also possess the more virulent vacuolating form of VacA. This study assessed the significance of possession of both virulence factors in terms of their effect on gastric epithelial cells, using a set of minimally passaged, isogenic VacA, CagA and CagE mutants in H. pylori strains 60190 and 84-183. The cagA and cagE mutants were found to significantly increase VacA-induced vacuolation of epithelial cells, and the vacA mutants significantly increased CagA-induced cellular elongations, compared with wild-type strains, indicating that CagA reduces vacuolation and VacA reduces hummingbird formation. Although epithelial cells incubated with the wild-type H. pylori strains may display both vacuolation and hummingbird formation, it was found that (i) hummingbird length was significantly reduced in vacuolated cells compared with those without vacuolation; (ii) the number of vacuoles was significantly reduced in vacuolated cells with hummingbird formation compared with those without hummingbirds; and (iii) cells displaying extensive vacuolation did not subsequently form hummingbirds and vice versa. VacA did not affect the phosphorylation of CagA. These data show that VacA and CagA downregulate each other's effects on epithelial cells, potentially allowing H. pylori interaction with cells whilst avoiding excessive cellular damage.
INTRODUCTIONHelicobacter pylori strains infect the stomachs of half of the world's population. They cause gastritis and gastric and duodenal ulceration, and are a major risk factor for the development of mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma. A number of virulence factors are associated with disease outcome, including the vacuolating cytotoxin (VacA) and the possession of the cytotoxin-associated gene pathogenicity island (cag PAI) comprising 27-31 genes (Censini et al., 1996).The vacA gene is present in virtually all strains of H. pylori but is polymorphic (Atherton et al., 1997), comprising variable signal regions (type s1 or s2) and mid-regions (type m1 or m2). Type s1/m1 VacA causes more epithelial cell damage than type s1/m2, whereas type s2/m2 and the rare s2/m1 are non-toxic due to the presence of a short 12-residue hydrophilic extension on the s2 form . VacA forms anion-selective channels within artificial membranes (Czajkowsky et al., 1999) and is assumed to do the same in vivo, increasing permeability to anions and urea (Tombola et al., 2001). Endocytosis of VacA channels leads to the formation of large vacuoles within the late endosome-lysosome compartment.The cag PAI encodes a type IV secretory system that causes inflammation by activation of NF-kB and secretion of cytokines and chemokines such as interleukin 8 (IL-8) Censini et al., 1996;Keates et al., 1997;Viala et al., 2004;Brandt et al., 2005), and facilitates the translocation of CagA into the cytosol of epithelial cells, where it becomes tyrosine phosp...