e Helicobacter pylori exhibits a high level of intraspecies genetic diversity. In this study, we investigated whether the diversification of H. pylori is influenced by the composition of the diet. Specifically, we investigated the effect of a high-salt diet (a known risk factor for gastric adenocarcinoma) on H. pylori diversification within a host. We analyzed H. pylori strains isolated from Mongolian gerbils fed either a high-salt diet or a regular diet for 4 months by proteomic and whole-genome sequencing methods. Compared to the input strain and output strains from animals fed a regular diet, the output strains from animals fed a highsalt diet produced higher levels of proteins involved in iron acquisition and oxidative-stress resistance. Several of these changes were attributable to a nonsynonymous mutation in fur (fur-R88H). Further experiments indicated that this mutation conferred increased resistance to high-salt conditions and oxidative stress. We propose a model in which a high-salt diet leads to high levels of gastric inflammation and associated oxidative stress in H. pylori-infected animals and that these conditions, along with the high intraluminal concentrations of sodium chloride, lead to selection of H. pylori strains that are most fit for growth in this environment.
Helicobacter pylori is a Gram-negative bacterium that persistently colonizes the human stomach in half of the world's population (1, 2). H. pylori exhibits a high level of intraspecies genetic diversity, characterized by marked variation among strains in gene content, as well as a high level of variation in the nucleotide sequences of individual genes (3, 4). A high rate of allelic diversity is attributable to both a high mutation rate and intraspecies recombination (5, 6).Most H. pylori-infected persons remain asymptomatic, but the presence of this bacterium increases the risk of peptic ulcer disease and gastric cancer (1, 2, 7, 8). The clinical outcome of H. pylori infection is determined by a combination of bacterial, host, and environmental factors. For example, H. pylori strains containing the cag pathogenicity island (PAI) are associated with a higher risk of symptomatic disease than are strains that lack the cag PAI (9). One of the proteins encoded by the cag PAI, CagA, enters host cells and causes numerous cellular alterations linked to malignant transformation (10). The cag PAI also encodes multiple protein components of a type IV secretion system required for entry of CagA into host cells (11). H. pylori strains that secrete specific types of the VacA toxin are also linked to adverse disease outcome, in comparison to strains that secrete relatively nontoxic forms of the VacA protein (12, 13).One of the environmental factors associated with increased gastric cancer risk is a high-salt diet (14). Epidemiologic studies have demonstrated a link between high dietary salt consumption and increased gastric cancer risk in many parts of the world (15-17), and a high-salt diet also increases the gastric cancer risk in animal models (...