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The aim of this research was to study whether and to what extent ChinesecagA -positiveHelicobacter pylori isolates differ from those in The Netherlands. Analysis of random amplified polymorphic DNA (RAPD)-PCR-assessed DNA fingerprints of chromosomal DNA of 24cagA -positiveH. pylori isolates from Dutch (n = 12) and Chinese (n = 10) patients yielded the absence of clustering. Based on comparison of the sequence of a 243-nucleotide part ofcagA , the Dutch (group I) and Chinese (group II)H. pylori isolates formed two separate branches with high confidence limits in the phylogenetic tree. These two clusters were not observed when the sequence of a 240-bp part ofglmM was used in the comparison. The number of nonsynonymous substitutions was much higher incagA than inglmM , indicating positive selection. The average levels of divergence ofcagA at the nucleotide and protein levels between group I and II isolates were found to be high, 13.3 and 17.9%, respectively. Possibly, the pathogenicity island (PAI) that has been integrated into the chromosome of the ancestor ofH. pylori now circulating in China contained a differentcagA than the PAI that has been integrated into the chromosome of the ancestor ofH. pylori now circulating in The Netherlands. We conclude that in China and The Netherlands, two distinctcagA -positiveH. pylori populations are circulating.

cagA -Positive Helicobacter pylori Populations in China and The Netherlands Are Distinct