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Suicide journey of H. pylori through gastric carcinogenesis: the role of non-H. pylori microbiome and potential consequences for clinical practice

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Abstract

Despite being one of the most studied cancer-related infections, the relationship between Helicobacter pylori infection and gastric adenocarcinoma (GC) remains, in some points, obscure. Based on a critical analysis of the available literature regarding stomach microbiota, we aimed to shed light to a possible new interpretation of the current understanding about the Helicobacter pylori-related GC carcinogenesis. We analyzed data from the literature on Helicobacter pylori and other potential carcinogenic pathogens, in both benignant conditions and gastric adenocarcinoma. Helicobacter pylori is the dominant microorganism in benignant conditions as non-complicated gastritis. In atrophic gastritis, metaplasia and, mainly, in gastric adenocarcinoma, a strong reduction in Helicobacter pylori abundance, and increased occurrence of other microorganisms is strongly demonstrated by metagenomic experiments. While causing peptic disease and keeping the stomach’s high acidity, Helicobacter pylori infection avoids gastric infection by carcinogenic intestinal microbiota. Nevertheless, Helicobacter pylori persistence may also provoke an atrophic gastritis, a condition that causes its own decline, due to a microenvironment modification, including reduced acidity, resulting in Helicobacter pylori substitution by a cancer-prone microbiota. This new interpretation might result in a dramatic modification on clinical management of Helicobacter pylori-related gastric disease.

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Acknowledgments

We acknowledge Universidade Federal do Pará (PROPESP and Fadesp) for technical support and Conselho Nacional de Desenvolvimento Científico e Teconlógico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) for fellowship support.

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Authors and Affiliations

  1. Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Rua dos Mundurucus, 4487, Guamá, Belém, Pará, 66073-000, Brazil

    Paulo Pimentel de Assumpção, Taíssa Maíra Thomaz Araújo, Williams Fernandes Barra, André Salim Khayat & Geraldo Ishak

  2. Programa de Pós-Graduação em Génetica e Biologia Molecular, Universidade Federal do Pará, Rua Augusto Corrêa, 01, Guamá, Belém, Pará, 66075-110, Brazil

    Paula Baraúna de Assumpção

  3. Departamento de Cirurgia Oncológica, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815, Bela Vista, São Paulo, São Paulo, 01327-001, Brazil

    Carolina Baraúna Assumpção

  4. Departamento de Cirurgia Oncológica, Alameda dos Lírios, Hospital Geral de Guarulhos, 300, Parque Cecap, Guarulhos, São Paulo, 07190-012, Brazil

    Carolina Baraúna Assumpção

  5. Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Rua dos Mundurucus, 4487, Guamá, Belém, Pará, 66073-000, Brazil

    Geraldo Ishak

  6. Laboratório de Genômica Médica, AC Camargo Cancer Center, Rua Tamandaré, 753, Liberdade, São Paulo, São Paulo, 04002-010, Brazil

    Diana Noronha Nunes & Emmanuel Dias-Neto

  7. Instituto Alfa de Gastroenterologia do Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 110, Santa Efigênia, 30130-100, 31270-901, Belo Horizonte, Minas Gerais, Brazil

    Luiz Gonzaga Vaz Coelho

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  1. Paulo Pimentel de Assumpção
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de Assumpção, P.P., Araújo, T.M.T., de Assumpção, P.B. et al. Suicide journey of H. pylori through gastric carcinogenesis: the role of non-H. pylori microbiome and potential consequences for clinical practice. Eur J Clin Microbiol Infect Dis 38, 1591–1597 (2019). https://doi.org/10.1007/s10096-019-03564-5

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