Helicobacter pylori BabA Expression, Gastric Mucosal Injury, and Clinical Outcome

Background & Aims: The blood grou Methods: We compared the ability of published PCR-based methods to assess BabA status with BabA immunoblotting and Lewis b (Leb) binding activity assays. We also used immunoblotting to examine the relationship between clinical presentation and levels of BabA expression. Results: Immunoblotting and Leb binding assays for 80 strains revealed 3 levels of BabA expression: BabA high producers (BabA-H) with Leb binding activity, BabA low producers (BabA-L) without Leb binding activity, and BabA-negative. BabA-negative strains lacked the babA gene. PCR methods to determine BabA status yielded poor results. babA1 sequences were never detected. BabA expression was examined in 250 strains from Western countries and 270 strains from East Asia. The results failed to confirm any relationship between triple-positive status (cagA-positive/vacA s1/BabA-H) and clinical outcome. BabA-negative strains typically were cagA-negative/vacA s2 and were associated with gastritis. BabA-L strains showed a higher level of mucosal injury and were associated more frequently with duodenal ulcer and gastric cancer than the other groups. Conclusions: Information gained from currently used PCR-based methods must be interpreted with caution. Leb binding activity does not accurately reflect the severity of mucosal damage or the clinical outcome. Quantitation of BabA expression revealed that Leb-nonbinding BabA-L strains are associated with higher levels of mucosal injury and clinical outcome.