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Background  The putative  H. pylori  pathogenicity-associated factor  dupA  has been associated with IL-8 induction  in vitro , and duodenal ulcer (DU) and gastric cancer (GC) development in certain populations, but this association is inconsistent between studies. We aimed to investigate  dupA  prevalence in clinical isolates from Sweden, Australia and from ethnic Chinese, Indians and Malays resident in Malaysia and Singapore and to examine the association with DU and GC. In addition we investigated the sequence diversity between isolates from these diverse groups and compared the level of IL-8 secretion in isolates possessing and lacking  dupA .    Methods  PCR primers were designed to amplify over the C/T insertion denoting a continuous  dupA . PCR products from 29 clinical isolates were sequenced and compared with sequences from three additional strains obtained from GenBank. Clinical isolates from 21 Malaysian patients (8  dupA -positive, 14  dupA -negative) were assessed for their ability to induce IL-8 in AGS cells  in vitro . Statistical analysis was performed using Fisher's exact test.    Results  The prevalence of  dupA  in isolates from Swedish functional dyspepsia (FD) control patients (65%, 13/20) was higher and in isolates from Indian FD patients (7.1%, 3/42) was lower as compared with isolates from Chinese (28.9%, 13/49, P = 0.005, P = 0.025), Malay (35.7%, 5/14, P = 0.16, P = 0.018) and Australian (37.8%, 17/45, P = 0.060, P < 0.001) FD patients.  dupA  was associated with DU and GC development in Chinese with 62.5% (10/16) and 54.6% (12/22) of isolates possessing  dupA  respectively as compared with FD controls (28.9%) (P = 0.015, P = 0.032). No significant difference in prevalence of  dupA  between FD controls, DU (63.6%, 7/11) and GC (61.9%, 13/21) cases (P = 1.000) was observed in the Swedish population. Sequence analysis revealed a pairwise variation of 1.9% and all isolates possessed the C/T insertion. The average IL-8 induction was 1330 pg/mL for  dupA -positive isolates and 1378 pg/mL for  dupA -negative isolates.    Conclusion  Although  dupA  is highly conserved when present, we identified no consistent association between  dupA  and DU or GC development across the ethnic groups investigated, with the  dupA  prevalence in control groups varying significantly. Our results would suggest that in the clinical isolates investigated  dupA  is not associated with IL-8 induction  in vitro .

gut pathogens

The prevalence of the duodenal ulcer promoting gene (dupA) in Helicobacter pylori isolates varies by ethnic group and is not universally associated with disease development: a case-control study