Infecção por Helicobacter pylori: uma visão geral dos mecanismos das adesinas na interação com o hospedeiro
##plugins.themes.bootstrap3.article.sidebar##
Publicado
Jul 30, 2025
##plugins.themes.bootstrap3.article.main##
Resumo
Objetivo: Sumarizar os avanços recentes relacionados ao papel das adesinas de H. pylori e sua interação com o hospedeiro humano. Métodos: Revisão integrativa da literatura realizada nas bases de dados PubMed, Scopus e Embase, Web of Science e BVS. Foram utilizados os descritores DeCS/MeSH “Helicobacter pylori”, “adhesins”, “outer membrane proteins” e seus termos alternativos, combinados por operadores booleanos. Resultados: Após os critérios de elegibilidade foram incluídos 21 artigos. As adesinas BabA, OipA e SabA foram associadas à gastrite crônica, úlcera péptica e câncer gástrico. BabA apresentou prevalência variável (3% a 91,5%). OipA foi associado à inflamação gástrica, metaplasia intestinal e maior risco de doenças, com prevalência entre 34,6% e 100% nos estudos. SabA foi associada a gastrite crônica e lesões avançadas. HopQ, SabB e AlpA/B foram evidenciadas como fatores importantes na adesão bacteriana e manutenção da infecção. Considerações finais: As adesinas de H. pylori atuam na colonização do epitélio gástrico e na modulação das respostas inflamatórias, sendo alvos promissores para o desenvolvimento de estratégias diagnósticas, prognósticas e terapêuticas. No entanto, a variabilidade genética dessas proteínas entre cepas e populações reforça a necessidade de estudos in vivo e multicêntricos para validar a aplicabilidade clínica dessas adesinas.
##plugins.themes.bootstrap3.article.details##
Como Citar
SilvaM. O., Santos-DutraH. C. de O., MacielD. N., & BarbosaM. S. (2025). Infecção por Helicobacter pylori: uma visão geral dos mecanismos das adesinas na interação com o hospedeiro. Revista Eletrônica Acervo Saúde, 25(7), e20905. https://doi.org/10.25248/reas.e20905.2025
Seção
Artigos Originais
Copyright © | Todos os direitos reservados.
A revista detém os direitos autorais exclusivos de publicação deste artigo nos termos da lei 9610/98.
Reprodução parcial
É livre o uso de partes do texto, figuras e questionário do artigo, sendo obrigatória a citação dos autores e revista.
Reprodução total
É expressamente proibida, devendo ser autorizada pela revista.
Referências
1. AKCELIK-DEVECI S, et al. Identification of interaction partners of outer inflammatory protein A: Computational and experimental insights into how Helicobacter pylori infects host cells. PLoS One, 2024; 19(10): e0300557.
2. ANSARI S, YAMAOKA Y. Survival of Helicobacter pylori in gastric acidic territory. Helicobacter, 2017; 22(4): e12386.
3. ASMAH RH, et al. Characterization of Helicobacter pylori iceA and babA2 virulence genes in dyspeptic patients at a teaching hospital in Ghana. The Pan African Medical Journal, 2024; 47: 204, 2024.
4. BÄCKSTRÖM A, et al. Metastability of Helicobacter pylori bab adhesin genes and dynamics in Lewis b antigen binding. Proc Natl Acad Sci U S A, 2004; 101(45): 16923-16928.
5. BAJ J, et al. Helicobacter pylori virulence factors—mechanisms of bacterial pathogenicity in the gastric microenvironment. Cells, 2020; 10(1): 27.
6. BARTPHO TS, et al. Precancerous gastric lesions with Helicobacter pylori vacA+/babA2+/oipA+ genotype increase the risk of gastric cancer. Biomed Res Int, 2020; 2020: 7243029.
7. BEZERRA TMO, et al. Prevalence of cagA, cagM, vacA and oipA genes in isolates of Helicobacter pylori obtained from hospital patients in Northeast Brazil. Braz J Microbiol, 2024; 55: 2631–2641.
8. BUGAYTSOVA JA, et al. Helicobacter pylori adapts to chronic infection and gastric disease via pH-responsive BabA-mediated adherence. Cell Host Microbe, 2017; 21(3): 376-389.
9. BOONYANUGOMOL W, et al. Heterogeneity of Helicobacter pylori bab genotypes and their association with clinical outcomes in Korean gastroduodenal patients. New Microbiologica, 2021; 44(3): 155-160.
10. BUSTOS-FRAGA S, et al. Prevalence of Helicobacter pylori genotypes: cagA, vacA (m1), vacA (s1), babA2, dupA, iceA1, oipA and their association with gastrointestinal diseases. A cross-sectional study in Quito-Ecuador. BMC gastroenterology, 2023; 23(1): 197.
11. COVER TL, BLASER MJ. Helicobacter pylori in health and disease. Gastroenterology, 2009; 136(6): 1863-1873.
12. DABIRI H, et al. Prevalence of Helicobacter pylori vacA, cagA, cagE, oipA, iceA, babA2 and babB genotypes in Iranian dyspeptic patients. Microb Pathog, 2017; 105: 226-230.
13. DOOHAN D, et al. Helicobacter pylori BabA–SabA key roles in the adherence phase: The synergic mechanism for successful colonization and disease development. Toxins (Basel), 2021; 13(7): 485.
14. DOOYEMA SDR, et al. Helicobacter pylori-Induced TLR9 activation and injury are associated with the virulence-associated adhesin HopQ. The Journal of Infectious Diseases, 2021; 224(2): 360-365.
15. FAGOONEE S, PELLICANO R. Helicobacter pylori: molecular basis for colonization and survival in gastric environment and resistance to antibiotics. A short review. Infect Dis (Lond), 2019; 51(6): 399-408.
16. FANG M, et al. Distribution characteristics of the sabA, hofC, homA, homB and frpB-4 genes of Helicobacter pylori in different regions of China. PLoS One, 2022; 17(5): e0268373.
17. FARSIMADAN M, et al. Evaluation of Helicobacter pylori genotypes in obese patients with gastric ulcer, duodenal ulcer, and gastric cancer: an observational study. Dig Dis, 2022; 40(3): 355-361.
18. FARZI N, et al. Genetic diversity and functional analysis of oipA gene in association with other virulence factors among Helicobacter pylori isolates from Iranian patients with different gastric diseases. Infect Genet Evol, 2018; 60: 26-34.
19. FEILI O, et al. Contrasting association of Helicobacter pylori oipA genotype with risk of peptic ulceration and gastric cancer. Infection, Genetics and Evolution, 2021; 89: 104720.
20. GHOLAMHOSSEINZADEH E, et al. Frequency of significant virulence genes in gastric biopsies of Helicobacter pylori-positive patients with gastritis. AMB Express, 2023; 13(1): 67.
21. GUZMÁN, Jesús et al. Helicobacter pylori cagA, vacA, iceA and babA genotypes from Peruvian patients with gastric intestinal metaplasia. Cancers, 2024; 16(8): 1476.
22. GUR C, et al. The Helicobacter pylori HopQ outermembrane protein inhibits immune cell activities. Oncoimmunology, 2019; 8(2): e1553487.
23. HARVEY VC, et al. Repetitive sequence variations in the promoter region of the adhesin-encoding gene sabA of Helicobacter pylori affect transcription. J Bacteriol, 2014; 196(19): 3421-3429.
24. HEDAYATI MA, SALAVATI S. Transcriptional profile of Helicobacter pylori virulence genes in patients with gastritis and gastric cancer. Can J Infect Dis Med Microbiol, 2021; 2021: 1309519.
25. HORRIDGE DN, et al. Outer inflammatory protein a (OipA) of Helicobacter pylori is regulated by host cell contact and mediates CagA translocation and interleukin-8 response only in the presence of a functional cag pathogenicity island type IV secretion system. Pathog Dis, 2017; 75(9): ftx113.
26. HOOI JKY et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. GASTROENTEROLOGY, 2017; 153(2): 420-429.
27. ILVER D, et al. Helicobacter pylori adhesin binding fucosylated histo-blood group antigens revealed by retagging. Science, 1998; 279(5349): 373-377.
28. JAVAHERI A, et al. Helicobacter pylori adhesin HopQ engages in a virulence-enhancing interaction with human CEACAMs. Nat Microbiol, 2016; 2: 16189.
29. KABLE ME, et al. Host determinants of expression of the Helicobacter pylori BabA adhesin. Sci Rep, 2017; 7: 46499.
30. KIM A, et al. Geographic diversity in Helicobacter pylori oipA genotype between Korean and United States isolates. Journal of Microbiology, 2021; 59: 1125-1132.
31. KPOGHOMOU MA, et al. Association of Helicobacter pylori babA2 gene and gastric cancer risk: a meta-analysis. BMC Cancer, 2020; 20: 1-7.
32. LANDARANI Z, et al. Immunological detection of 34 KDa outer membrane protein as a functional form of OipA in clinical isolates of Helicobacter pylori. Iran J Microbiol, 2014; 6(5): 324-329.
33. LEE DH, et al. Increased risk of severe gastric symptoms by virulence factors vacAs1c, alpA, babA2, and hopZ in Helicobacter pylori infection. J Microbiol Biotechnol, 2021; 31(3): 368-374.
34. MACIEL DN, et al. Gene de virulência oipA de Helicobacter pylori como marcador molecular de gastropatias severas. Arquivos de Gastroenterologia, 2024; 61: e23110.
35. MATSUO Y, et al. Helicobacter pylori outer membrane protein-related pathogenesis. Toxins, 2017; 9(3): 101.
36. MURRAY LJ, et al. Epidemiology of Helicobacter pylori infection among 4742 randomly selected subjects from Northern Ireland. Int J Epidemiol, 1997; 26(4): 880-887.
37. NGUYEN QA, et al. Effects of Helicobacter pylori adhesin HopQ binding to CEACAM receptors in the human stomach. Front Immunol, 2023; 14: 1113478.
38. PEREIRA JN, et al. Prevalence of Helicobacter pylori cagA and sabA Genotypes in Patients with Gastric Disease. Adv Microbiol, 2019; 9: 239-247.
39. ROBERTS JR, et al. Subdomains of the Helicobacter pylori Cag T4SS outer membrane core complex exhibit structural independence. Life Sci Alliance, 2024; 7: e202302560.
40. SALLAS ML, et al. Status (on/off) of oipA gene: their associations with gastritis and gastric cancer and geographic origins. Arch Microbiol, 2019; 201(1): 93-97.
41. SANAEI MJ, et al. Up-regulated CCL18, CCL28 and CXCL13 expression is associated with the risk of gastritis and peptic ulcer disease in Helicobacter pylori infection. Am J Med Sci, 2021; 361(1): 43-54.
42. SARUULJAVKHLAN B, et al. Study of Helicobacter pylori isolated from a high-gastric-Cancer-risk Population: unveiling the Comprehensive Analysis of Virulence-Associated genes including Secretion Systems, and genome-wide Association study. Cancers, 2023; 15(18): 4528.
43. SEDARAT Z, TAYLOR-ROBINSON AW. Helicobacter pylori Outer Membrane Proteins and Virulence Factors: Potential Targets for Novel Therapies and Vaccines. Pathogens, 2024; 13(3): 392.
44. SHOKRI SHIRVANI J, et al. Expression Assessment of the Helicobacter pylori babA and sabA Genes in Patients with Peptic Ulcer, Duodenal Ulcer and Gastric Cancer. Int J Mol Cell Med, 2023; 12: 2023.
45. SINGH S, et al. Molecular characterization and phylogenetic analysis of babA gene of Helicobacter pylori isolated from Indian patients with gastrointestinal diseases. Gene, 2024; 920: 148526.
46. ŠTERBENC A, et al. Helicobacter pylori virulence genes. World J Gastroenterol, 2019; 25(33): 4870-4884.
47. SVARVAL AV, et al. Genetic polymorphisms of Helicobacter pylori clinical isolates in St. Petersburg, Russia. Инфекция и иммунитет, 2022; 12(2): 315-322.
48. TEGTMEYER N, et al. Expression of CEACAM1 or CEACAM5 in AZ‐521 cells restores the type IV secretion deficiency for translocation of CagA by Helicobacter pylori. Cell Microbiol, 2019; 21(7): e12965.
49. TENG KW, et al. Helicobacter pylori employs a general protein glycosylation system for the modification of outer membrane adhesins. Gut Microbes, 2022; 14(1): 2130650.
50. TEYMOURNEJAD O, et al. Binding of the Helicobacter pylori OipA causes apoptosis of host cells via modulation of Bax/Bcl-2 levels. Sci Rep, 2017; 7: 8036.
51. THAI THN, et al. Genetic diversity of the oipA gene among Helicobacter pylori isolates and clinical outcome in Vietnam. Infect Genet Evol, 2023; 112: 105438.
52. WAGNER EGH, HOLMQVIST E. The Length of a DNA T-Tract Modulates Expression of a Virulence-Regulating sRNA. Mol Cell, 2020; 80(2): 175-177.
53. XIA R, et al. Pathogenic interactions between Helicobacter pylori adhesion protein HopQ and human cell surface adhesion molecules CEACAMs in gastric epithelial cells. Iran J Basic Med Sci, 2019; 22(7): 710-715.
54. XU C, et al. Virulence of Helicobacter pylori outer membrane proteins: an updated review. Eur J Clin Microbiol Infect Dis, 2020; 39: 1821–1830.
55. XUE Z, et al. Geographic distribution of the cagA, vacA, iceA, oipA and dupA genes of Helicobacter pylori strains isolated in China. Gut pathogens, 2021; 13(1): 39.
56. YAKOOB J, et al. Helicobacter pylori outer membrane protein and virulence marker differences in expatriate patients. Epidemiol Infect, 2016; 144: 2200–2208.
57. YANOVICH OO, et al. Genetic Diversity and Functional Status of the oipA Gene of Helicobacter pylori. Its Association with Genes of the Pathogenicity Island in Patients with Gastroduodenal Diseases in the Republic of Belarus. Molecular Genetics, Microbiology and Virology,2022; 37(4): 173-178.
58. ZHAO Q, et al. Prevalence of Helicobacter pylori babA, oipA, sabA, and homB genes in isolates from Chinese patients with different gastroduodenal diseases. Med Microbiol Immunol, 2020; 209: 565–577
2. ANSARI S, YAMAOKA Y. Survival of Helicobacter pylori in gastric acidic territory. Helicobacter, 2017; 22(4): e12386.
3. ASMAH RH, et al. Characterization of Helicobacter pylori iceA and babA2 virulence genes in dyspeptic patients at a teaching hospital in Ghana. The Pan African Medical Journal, 2024; 47: 204, 2024.
4. BÄCKSTRÖM A, et al. Metastability of Helicobacter pylori bab adhesin genes and dynamics in Lewis b antigen binding. Proc Natl Acad Sci U S A, 2004; 101(45): 16923-16928.
5. BAJ J, et al. Helicobacter pylori virulence factors—mechanisms of bacterial pathogenicity in the gastric microenvironment. Cells, 2020; 10(1): 27.
6. BARTPHO TS, et al. Precancerous gastric lesions with Helicobacter pylori vacA+/babA2+/oipA+ genotype increase the risk of gastric cancer. Biomed Res Int, 2020; 2020: 7243029.
7. BEZERRA TMO, et al. Prevalence of cagA, cagM, vacA and oipA genes in isolates of Helicobacter pylori obtained from hospital patients in Northeast Brazil. Braz J Microbiol, 2024; 55: 2631–2641.
8. BUGAYTSOVA JA, et al. Helicobacter pylori adapts to chronic infection and gastric disease via pH-responsive BabA-mediated adherence. Cell Host Microbe, 2017; 21(3): 376-389.
9. BOONYANUGOMOL W, et al. Heterogeneity of Helicobacter pylori bab genotypes and their association with clinical outcomes in Korean gastroduodenal patients. New Microbiologica, 2021; 44(3): 155-160.
10. BUSTOS-FRAGA S, et al. Prevalence of Helicobacter pylori genotypes: cagA, vacA (m1), vacA (s1), babA2, dupA, iceA1, oipA and their association with gastrointestinal diseases. A cross-sectional study in Quito-Ecuador. BMC gastroenterology, 2023; 23(1): 197.
11. COVER TL, BLASER MJ. Helicobacter pylori in health and disease. Gastroenterology, 2009; 136(6): 1863-1873.
12. DABIRI H, et al. Prevalence of Helicobacter pylori vacA, cagA, cagE, oipA, iceA, babA2 and babB genotypes in Iranian dyspeptic patients. Microb Pathog, 2017; 105: 226-230.
13. DOOHAN D, et al. Helicobacter pylori BabA–SabA key roles in the adherence phase: The synergic mechanism for successful colonization and disease development. Toxins (Basel), 2021; 13(7): 485.
14. DOOYEMA SDR, et al. Helicobacter pylori-Induced TLR9 activation and injury are associated with the virulence-associated adhesin HopQ. The Journal of Infectious Diseases, 2021; 224(2): 360-365.
15. FAGOONEE S, PELLICANO R. Helicobacter pylori: molecular basis for colonization and survival in gastric environment and resistance to antibiotics. A short review. Infect Dis (Lond), 2019; 51(6): 399-408.
16. FANG M, et al. Distribution characteristics of the sabA, hofC, homA, homB and frpB-4 genes of Helicobacter pylori in different regions of China. PLoS One, 2022; 17(5): e0268373.
17. FARSIMADAN M, et al. Evaluation of Helicobacter pylori genotypes in obese patients with gastric ulcer, duodenal ulcer, and gastric cancer: an observational study. Dig Dis, 2022; 40(3): 355-361.
18. FARZI N, et al. Genetic diversity and functional analysis of oipA gene in association with other virulence factors among Helicobacter pylori isolates from Iranian patients with different gastric diseases. Infect Genet Evol, 2018; 60: 26-34.
19. FEILI O, et al. Contrasting association of Helicobacter pylori oipA genotype with risk of peptic ulceration and gastric cancer. Infection, Genetics and Evolution, 2021; 89: 104720.
20. GHOLAMHOSSEINZADEH E, et al. Frequency of significant virulence genes in gastric biopsies of Helicobacter pylori-positive patients with gastritis. AMB Express, 2023; 13(1): 67.
21. GUZMÁN, Jesús et al. Helicobacter pylori cagA, vacA, iceA and babA genotypes from Peruvian patients with gastric intestinal metaplasia. Cancers, 2024; 16(8): 1476.
22. GUR C, et al. The Helicobacter pylori HopQ outermembrane protein inhibits immune cell activities. Oncoimmunology, 2019; 8(2): e1553487.
23. HARVEY VC, et al. Repetitive sequence variations in the promoter region of the adhesin-encoding gene sabA of Helicobacter pylori affect transcription. J Bacteriol, 2014; 196(19): 3421-3429.
24. HEDAYATI MA, SALAVATI S. Transcriptional profile of Helicobacter pylori virulence genes in patients with gastritis and gastric cancer. Can J Infect Dis Med Microbiol, 2021; 2021: 1309519.
25. HORRIDGE DN, et al. Outer inflammatory protein a (OipA) of Helicobacter pylori is regulated by host cell contact and mediates CagA translocation and interleukin-8 response only in the presence of a functional cag pathogenicity island type IV secretion system. Pathog Dis, 2017; 75(9): ftx113.
26. HOOI JKY et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. GASTROENTEROLOGY, 2017; 153(2): 420-429.
27. ILVER D, et al. Helicobacter pylori adhesin binding fucosylated histo-blood group antigens revealed by retagging. Science, 1998; 279(5349): 373-377.
28. JAVAHERI A, et al. Helicobacter pylori adhesin HopQ engages in a virulence-enhancing interaction with human CEACAMs. Nat Microbiol, 2016; 2: 16189.
29. KABLE ME, et al. Host determinants of expression of the Helicobacter pylori BabA adhesin. Sci Rep, 2017; 7: 46499.
30. KIM A, et al. Geographic diversity in Helicobacter pylori oipA genotype between Korean and United States isolates. Journal of Microbiology, 2021; 59: 1125-1132.
31. KPOGHOMOU MA, et al. Association of Helicobacter pylori babA2 gene and gastric cancer risk: a meta-analysis. BMC Cancer, 2020; 20: 1-7.
32. LANDARANI Z, et al. Immunological detection of 34 KDa outer membrane protein as a functional form of OipA in clinical isolates of Helicobacter pylori. Iran J Microbiol, 2014; 6(5): 324-329.
33. LEE DH, et al. Increased risk of severe gastric symptoms by virulence factors vacAs1c, alpA, babA2, and hopZ in Helicobacter pylori infection. J Microbiol Biotechnol, 2021; 31(3): 368-374.
34. MACIEL DN, et al. Gene de virulência oipA de Helicobacter pylori como marcador molecular de gastropatias severas. Arquivos de Gastroenterologia, 2024; 61: e23110.
35. MATSUO Y, et al. Helicobacter pylori outer membrane protein-related pathogenesis. Toxins, 2017; 9(3): 101.
36. MURRAY LJ, et al. Epidemiology of Helicobacter pylori infection among 4742 randomly selected subjects from Northern Ireland. Int J Epidemiol, 1997; 26(4): 880-887.
37. NGUYEN QA, et al. Effects of Helicobacter pylori adhesin HopQ binding to CEACAM receptors in the human stomach. Front Immunol, 2023; 14: 1113478.
38. PEREIRA JN, et al. Prevalence of Helicobacter pylori cagA and sabA Genotypes in Patients with Gastric Disease. Adv Microbiol, 2019; 9: 239-247.
39. ROBERTS JR, et al. Subdomains of the Helicobacter pylori Cag T4SS outer membrane core complex exhibit structural independence. Life Sci Alliance, 2024; 7: e202302560.
40. SALLAS ML, et al. Status (on/off) of oipA gene: their associations with gastritis and gastric cancer and geographic origins. Arch Microbiol, 2019; 201(1): 93-97.
41. SANAEI MJ, et al. Up-regulated CCL18, CCL28 and CXCL13 expression is associated with the risk of gastritis and peptic ulcer disease in Helicobacter pylori infection. Am J Med Sci, 2021; 361(1): 43-54.
42. SARUULJAVKHLAN B, et al. Study of Helicobacter pylori isolated from a high-gastric-Cancer-risk Population: unveiling the Comprehensive Analysis of Virulence-Associated genes including Secretion Systems, and genome-wide Association study. Cancers, 2023; 15(18): 4528.
43. SEDARAT Z, TAYLOR-ROBINSON AW. Helicobacter pylori Outer Membrane Proteins and Virulence Factors: Potential Targets for Novel Therapies and Vaccines. Pathogens, 2024; 13(3): 392.
44. SHOKRI SHIRVANI J, et al. Expression Assessment of the Helicobacter pylori babA and sabA Genes in Patients with Peptic Ulcer, Duodenal Ulcer and Gastric Cancer. Int J Mol Cell Med, 2023; 12: 2023.
45. SINGH S, et al. Molecular characterization and phylogenetic analysis of babA gene of Helicobacter pylori isolated from Indian patients with gastrointestinal diseases. Gene, 2024; 920: 148526.
46. ŠTERBENC A, et al. Helicobacter pylori virulence genes. World J Gastroenterol, 2019; 25(33): 4870-4884.
47. SVARVAL AV, et al. Genetic polymorphisms of Helicobacter pylori clinical isolates in St. Petersburg, Russia. Инфекция и иммунитет, 2022; 12(2): 315-322.
48. TEGTMEYER N, et al. Expression of CEACAM1 or CEACAM5 in AZ‐521 cells restores the type IV secretion deficiency for translocation of CagA by Helicobacter pylori. Cell Microbiol, 2019; 21(7): e12965.
49. TENG KW, et al. Helicobacter pylori employs a general protein glycosylation system for the modification of outer membrane adhesins. Gut Microbes, 2022; 14(1): 2130650.
50. TEYMOURNEJAD O, et al. Binding of the Helicobacter pylori OipA causes apoptosis of host cells via modulation of Bax/Bcl-2 levels. Sci Rep, 2017; 7: 8036.
51. THAI THN, et al. Genetic diversity of the oipA gene among Helicobacter pylori isolates and clinical outcome in Vietnam. Infect Genet Evol, 2023; 112: 105438.
52. WAGNER EGH, HOLMQVIST E. The Length of a DNA T-Tract Modulates Expression of a Virulence-Regulating sRNA. Mol Cell, 2020; 80(2): 175-177.
53. XIA R, et al. Pathogenic interactions between Helicobacter pylori adhesion protein HopQ and human cell surface adhesion molecules CEACAMs in gastric epithelial cells. Iran J Basic Med Sci, 2019; 22(7): 710-715.
54. XU C, et al. Virulence of Helicobacter pylori outer membrane proteins: an updated review. Eur J Clin Microbiol Infect Dis, 2020; 39: 1821–1830.
55. XUE Z, et al. Geographic distribution of the cagA, vacA, iceA, oipA and dupA genes of Helicobacter pylori strains isolated in China. Gut pathogens, 2021; 13(1): 39.
56. YAKOOB J, et al. Helicobacter pylori outer membrane protein and virulence marker differences in expatriate patients. Epidemiol Infect, 2016; 144: 2200–2208.
57. YANOVICH OO, et al. Genetic Diversity and Functional Status of the oipA Gene of Helicobacter pylori. Its Association with Genes of the Pathogenicity Island in Patients with Gastroduodenal Diseases in the Republic of Belarus. Molecular Genetics, Microbiology and Virology,2022; 37(4): 173-178.
58. ZHAO Q, et al. Prevalence of Helicobacter pylori babA, oipA, sabA, and homB genes in isolates from Chinese patients with different gastroduodenal diseases. Med Microbiol Immunol, 2020; 209: 565–577