Helicobacter pyloriinfection induces a reversible expression of the CDX2 transcription factor protein in human gastric epithelium

Matti Vauhkonen MDa*, Hanna Vauhkonenb & Pentti Sipponenca Department of Medicine, Helsinki University Hospital (HUCH), Jorvi Hospital, Espoo, Finlandb Department of Pathology, Haartman Institute and HUSLAB, Helsinki University and Helsinki University Hospital (HUCH), Helsinki, Finlandc Department of Pathology, HUSLAB, Helsinki University Hospital (HUCH), Jorvi Hospital, Espoo, Finland† Correspondence: Matti Vauhkonen, Department of Medicine, HUCH, Jorvi Hospital, Turuntie 150, FI-02740, Espoo, Finland, +358 98 6181 5323, +358 9 8615 954 matti.vauhkonen@hus.fiObjective. The homeobox gene CDX2 is implicated in the appearance of intestinal metaplasia in Helicobacter pylori gastritis. The aim of this study was to investigate whether CDX2 expression in gastric mucosa occurs before the appearance of overt intestinal metaplasia in H. pylori gastritis, and whether or not this expression is reversible. Material and methods. CDX2 was studied by immunohistochemistry in a cohort of 38 patients with H. pylori gastritis before and after eradication (mean follow-up 6.3 years) of H. pylori. A cohort of 49 individuals with healthy stomachs was analysed as a control. Results. In the control group no immunostaining of CDX2 in the epithelial cells of the gastric body was found, while in 57% of the cases a mild, aberrant nuclear immunostaining of CDX2 in the non-metaplastic epithelial cells in antrum, designated as “positive staining of single cells” (PSSC), was found. In H. pylori gastritis, the PSSC was seen in antrum and corpus in 100% and 26% of the cases, respectively. The prevalence of antral PSSC was significantly increased (on average by 4-fold) in H. pylori gastritis as compared with controls. After eradication of H. pylori, the prevalence of PSSC decreased significantly in antrum but not in corpus. Conclusions. Expression of CDX2 at low intensity is common in the epithelium of normal antrum, and this expression is enhanced in H. pylori gastritis. Expression of CDX2 is reversible at least in antrum after eradication of H. pylori infection.