Latin America: ripe for cutting-edge research proposals for prevention and control of Helicobacter pylori
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COMMENTARY
Latin America: ripe for cutting-edge research proposals for prevention and control of Helicobacter pylori Eduardo Lazcano-Ponce • Marı´a Elena Martı´nez
Ó The Author(s) 2013. This article is published with open access at Springerlink.com
One of the greatest areas of scientific progress has been the identification of certain infectious agents that are implicated in the carcinogenic process. This new knowledge has had broad repercussions not only in the application of new primary prevention options, such as prophylactic vaccines, but also in the definition of infection biomarkers that can be used as screening alternatives or as prognostic markers for neoplasia. We now know that chronic infection with the pathogenic bacteria Helicobacter pylori (H. pylori) is associated with gastrointestinal tract disorders, ranging from chronic gastritis to gastric adenocarcinoma; there is also evidence of a possible association with gastric lymphoma and peptic ulcer. Published reports support the existence of geographic regions where this bacterium is endemic and where H. pylori colonization occurs at a very early age in populations living in precarious sanitary conditions. For this reason, gastric cancer is one of the most common cancers in the world in low-resource countries and, as noted in the accompanying articles [1, 2], one with great heterogeneity in terms of incidence and mortality in Latin America. As a result, this geographic region constitutes a fascinating setting for research and provides unique and important opportunities for gastric cancer prevention.
E. Lazcano-Ponce (&) Centro de Investigacio´n en Salud Poblacional, Instituto Nacional de Salud Pu´blica, Universidad No. 655 Col. Santa Marı´a Ahuacatitla´n, Cerrada Los Pinos y Caminera, C.P. 62100 Cuernavaca, Morelos, Mexico e-mail: [email protected] M. E. Martı´nez Moores UCSD Cancer Center, Room 3023, 3855 Health Sciences Drive, #0901, University of California, La Jolla, San Diego, CA 92093-0901, USA e-mail: [email protected]
From a public health perspective, there are currently two major lines of research and action in regard to H. pylori and gastric cancer. On the one hand, we should gain a more precise understanding of the natural history of H. pylori infection and, as a consequence, learn about the triggering mechanism(s) related to chronic exposure in the development of gastric adenocarcinoma. However, we also know that reducing future incidence of gastric cancer is possible by improving the living conditions of the general population from a hygienic perspective, as confirmed by Porras et al. [3] in this special edition. Evidence now exists, which established H. pylori as a part of normal human microbiota [4]. This line of work indicates that this bacterium has a special tropism for gastric mucosa, that strains with toxic potential exist, and that the bacteria secrete proteins such as vacA [5], which produce vacuolization in cultures of human epithelial cells as well as increased capacity to modify molecules. Given the existing evidence from b
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