Helicobacter pylori: a major risk factor for endothelial dysfunction?

Association between Helicobacter pylori infection and kidney damage in patients with peptic ulcer

Background:Helicobacter pylori (H. pylori) is relevant to several renal diseases. Our previous research indicates that cytotoxin-associated gene A (CagA) of H. pylori increases secretion of serum immunoglobulin A1 (IgA1) and induces the underglycosylation of IgA1, one of the key factors causing IgA nephropathy. Here, we aimed to study the correlation between H. pylori infection and kidney damage in patients with peptic ulcer, and evaluate the effect of H. pylori eradication on kidney damage.

Methods:¹⁴C-urea breath test and rapid urease tests were applied to H. pylori infection detection. Random urine samples are subjected to the albumin–creatinine ratio (ACR) examination. The correlation between ACR and H. pylori infection was analyzed in patients with peptic ulcer and healthy controls. The levels of IgA and underglycosylated IgA1 in serum are also detected by enzyme-linked immunosorbent assay (ELISA) and Helix aspersa lectin (HAA) binding assay.

Results: (1) H. pylori infection rate in patients with peptic ulcer (88.14%) is significantly higher than that in healthy controls (42.68%). (2) There is a positive correlation between H. pylori infection and ACR abnormal in patients with peptic ulcer (p = .025), while showing a negative correlation in healthy individuals (p = .571). (3) Urinary ACR was uncorrelated with the severity of H. pylori infection in the 27 abnormal urinary ACR cases of the patients with peptic ulcer. (4) After H. pylori eradication, the ACR rates of H. pylori-positive patients with peptic ulcer were significantly decreased (p<.01).

Conclusions: (1) For the H. pylori-positive patients with peptic ulcer, H. pylori infection may be a risk factor resulting in kidney damage. (2) H. pylori eradication probably benefits to kidney damage relief and chronic kidney disease prevention.

Helicobacter pylori Infection is Associated with Occurrence of Proteinuria in Type 2 Diabetes Patients: A Systemic Review and Meta-Analysis

BACKGROUND

Type 2 diabetes (T2DM) patients are susceptible to Helicobacter pylori (HP), and it has been reported that the occurrence of proteinuria is associated with HP infection in T2DM patients; however, this view remains controversial. This meta-analysis aimed to explore the association between HP infection and the occurrence of proteinuria in T2DM patients. In addition, we hope to provide some recommendations to readers in clinical or related fields.

METHODS

Our meta-analysis was conducted with the methodology of the Cochrane Collaboration. Search strategies were formulated by relevant professionals. Case-control studies that compared the occurrence of proteinuria in T2DM patients with and without HP infection were involved in our meta-analysis. Relevant English or Chinese studies were searched on online databases before 2018, including PubMed, the Cochrane library, Medline, Google Scholar, the China National Infrastructure, and Wanfang database. The search strategies were "diabetic proteinuria, diabetic microalbuminuria, diabetic albuminuria, diabetic kidney disease, diabetic renal dysfunction, diabetic renal disease, diabetic nephropathy, diabetic complications, and diabetic mellitus, combined with HP." The quality of these involved articles was separately assessed by two investigators using the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) and associated 95% confidence intervals (CIs) were extracted and pooled using fixed-effects models.

RESULTS

Seven studies involving 1029 participants were included. The quality of these seven articles was all above five stars as assessed by NOS, and there was no significant publication bias in our meta-analysis. We found that T2DM patients with HP infection had a 2.00 times higher risk of the occurrence of proteinuria than patients without HP infection (OR: 2.00, 95% CI: 1.48-2.69).

CONCLUSIONS

Our analysis showed that HP infection was associated with the occurrence of proteinuria in T2DM patients. HP radical surgery might be a therapeutic option for protecting kidney function in patients with T2DM.

Frequency of Helicobacter pylori and cytotoxine associated gene A antibodies in patients with cardiac syndrome X

Background:

Cardiac syndrome X (CSX) is a condition in which patients have the pain of angina despite normal coronary angiogram. Recently, Helicobacter pylori (H. pylori) bacteria has been associated with CSX. However, there is no obvious data about the frequency of its virulent strain (cytotoxine associated gene A: CagA) in patients with CSX. We surveyed the frequency of H. pylori and CagA antibodies in patients with cardiac syndrome X and healthy controls.

Materials and Methods:

Plasma samples from 100 CSX patients (61 females and 39 males; mean age: 51.8 ± 12.3 years) and 100 healthy controls (61 females and 39 males; mean age: 48.9 ± 6.3 years) were tested for the presence of IgG antibody to H. pylori using enzyme linked immunosorbent assay (ELISA) method. Also, infected patients were determined by the presence of IgG antibody to CagA by ELISA method. Statistical analysis was carried out using chi-square test and independent samples T-test.

Results:

Ninety two percent (92/100) of patients were anti-H. pylori positive (anti-H. pylori+), while only 56.0% (56/100) of control group were anti-H. pylori+ (P<0.01). However, prevalence of anti-CagA positive (anti- CagA+) in H. pylori infected- CSX patients and control groups were 59.8% (55/92) and 60.7% (34/56), respectively (P>0.05).

Conclusion:

Thus, due to the high frequency of anti-H. pylori in CSX patients, and the probable causative effect of chronic infection in vascular diseases, it is suggested that H. pylori has a probable role in the pathogenesis of CSX.

H. pylori-Induced Higher C-Reactive Protein in Obese African Americans

African Americans are more susceptible to develop insulin resistance, obesity, Type 2 Diabetes, and coronary heart disease (CHD), and systemic inflammation is central to the pathophysiology of these chronic diseases. African Americans are also more likely to contract H. pylori (cagA) infections during their childhood. However, the contribution of H. pylori infection to the degree of overall systemic inflammation in these chronic diseases is not known. Therefore, we studied 46 apparently healthy African Americans, over 40 years of age who were, infected with H. pylori (cagA). These volunteers were assessed at baseline and after treatment with triple regimen drug therapy to eradicate H. pylori. All but 3 subjects were found to be free of this infection by urea breath test (UBT) after the treatment period. No hyperhomocysteinemia was found in these subjects and there were no significant changes in the level of homocysteine (tHcy), folate and B(12); however, CRP levels measured by high sensitivity assay showed a significant (p=0.02) decrease 2 months after the eradication. We further stratified CRP values according to the BMI < 27 and > 27. There was more profound reduction in CRP in the more obese group (i.e., BMI>27) from 54.26 ± 23.67 to 18.73 ± 17.39 mg/l (p=0.01), compared with the leaner subjects in whom CRP decreases from 8.88 ± 6.23 to 4.94 ± 6.21 mg/L (p=0.04), after eradication of the H. pylori (cagA) infection. The level of CRP, however, remained significantly higher in the obese subjects even after the eradication of this infection, indicative of a smaller residual influence of adiposity on CRP. Thus, a major component of systemic inflammation in African Americans may be attributable to chronic H. pylori infection.