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Background  The  babA2  gene along with the  cagA  and  vacA  of  Helicobacter pylori  has been considered as a risk factor for the disease outcome in certain populations. This study was aimed to understand the role of  babA2  of  H. pylori  with the background of  cagA  and  vacA  in disease manifestations in Indian sub population.    Methods  A total of 114  H. pylori  strains isolated from duodenal ulcer (DU) (n = 53) and non-ulcer dyspepsia (NUD) patients (n = 61) were  screened for the prevalence of these virulence markers by PCR. The comparative study of IL-8 production and apoptosis were done by co-culturing the AGS cell line with  H. pylori  strains with different genotypes. Adherence assay was performed with  babA2  positive and negative strains. Two isogenic mutants of  babA2  were constructed and the aforesaid comparative studies were carried out.    Results  PCR results indicated that 90.6 % (48/53), 82 % (50/61) and 73.6 % (39/53) strains from DU patients were positive for  cagA ,  vacA , and  babA2,  respectively. Whereas the prevalence of these genes in NUD subjects were 70.5 % (43/61); 69.8 % (37/53), and 65.6 % (39/61), respectively. Although adherence to AGS cells was comparable among strains with  babA2  positive and negative genotypes, but the triple positive strains could induce highest degree of IL-8 production and apoptosis, followed by the  cagA  − / vacA  − / babA2  +  strains and triple negative strains, respectively. The wild type strains showed significantly higher IL-8 induction as well as apoptosis in ex vivo than its isogenic mutant of  babA2 .    Conclusion  PCR study demonstrated that there was no significant association between the distribution of  babA2  genotype or of triple positive strains and disease outcome in this sub population. The adherence assay showed that there was no significant difference in the extent of adherence to AGS cells among  babA2  positive and negative strains. But the ex vivo study indicated that the triple positive or even the  babA2  only positive strains are involved in increased virulence. The wild type strains also exhibited increased virulence compared to the  babA2  mutant strains. This inconsistency demonstrated that bacterial genotype along with host genetic polymorphisms or other factors play important role in determining the clinical manifestation of  H. pylori  infections.

Helicobacter pylori strains harboring babA2 from Indian sub population are associated with increased virulence in ex vivo study