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. 2011 Oct 19;6(10):e26265. doi: 10.1371/journal.pone.0026265

Figure 5. Schematic diagram of the DU development in children upon H. pylori infection.

Figure 5

The virulence of the pediatric PUD-associated H. pylori strains results from a synergy between their natural ability to better adapt to the hostile human stomach and their virulence factors. Adaptation is ensured by: higher motility (↑ FlaA, ↑ FlgE, ↓ HELP_0944, ↑ HPAG1_1081, and ↑ HPG27_1480), higher ability to survive under low pH conditions (↑ UreA and B and ↑ putative aldo-keto reductase), better antioxidant defenses against inflammation (↑ Pfr, ↑ NapA and ↓ KatA), modified metabolism (↓ HyuA, ↓ AspA, ↑ Pgk, ↓ ScoA and B, ↑AroQ, ↓ Porγ, ↑ FldA, ↓ RpsA and ↓ CysS), adhesion (indicated by a anchor) mediated by “on” OipA and HomB. Virulence factors (indicated by a bomb): cagA and VacAs1. 1 – Infection; 2 – Host response (acid hypersecretion and inflammation); 3 – duodenal acid injury (Duodenal Ulcer, indicated by an explosion symbol). Dotted arrow - Time line.