Integrated Analysis of Virulence, Antimicrobial Resistance, and Gastric Mucosal Phenotype in Helicobacter pylori from a High-Risk Mongolian Population
8 affiliations
- 1Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
- 2Department of Gastroenterology and Hepatology, First Central Hospital of Mongolia, Ulaanbaatar 14210, Mongolia
- 3Department of Gastroenterology and Hepatology, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia
- 4Endoscopy Unit, Mongolia-Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar 13270, Mongolia
- 5Department of Endoscopy, Bayan-Ölgii Province General Hospital, Ölgii 83129, Mongolia
- 6Department of Gastroenterology and Endoscopy, UB Songdo Hospital, Ulaanbaatar 14210, Mongolia
- 7The Research Center for Global and Local Infectious Diseases (RCGLID), Oita University, Yufu 879-5593, Japan
- 8Gastroenterology and Hepatology Section, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
Abstract
Mongolia has one of the highest gastric cancer burdens worldwide, yet integrated data linking Helicobacter pylori virulence, antimicrobial resistance (AMR), and gastric mucosal phenotype remain limited, particularly in ethnically distinct populations such as Bayan-Ölgii. We conducted a prospective single-center study of patients undergoing upper gastrointestinal endoscopy, with mucosal assessment using the Kyoto classification and histological scoring based on the Updated Sydney System. H. pylori isolates were cultured, antimicrobial susceptibility was determined by agar dilution, and whole-genome sequencing of 43 isolates enabled analysis of virulence-associated genes, antimicrobial resistance determinants, and population structure. Among 107 patients, H. pylori infection was associated with higher Kyoto scores than in uninfected individuals (4.39 vs. 3.42, p = 0.01). Major virulence-associated determinants were widely distributed: cagA was detected in 81.4% of isolates, and all interpretable cagA-positive isolates carried Western-type EPIYA architectures. Among 10 predefined virulence markers evaluated in age- and sex-adjusted models, hopQ Type I and vacA d1 were associated with higher Kyoto scores, whereas vacA i1 was associated with lower Kyoto scores; all three associations remained significant after Benjamini–Hochberg false discovery rate correction. Phenotypic antimicrobial resistance among 34 isolates with available susceptibility data was observed for metronidazole (58.8%), clarithromycin (35.3%), amoxicillin (29.4%), levofloxacin (20.6%), and minocycline (2.9%). Whole-genome sequencing identified established resistance determinants for clarithromycin, levofloxacin, and metronidazole, together with additional resistance-associated or uncertain variants, particularly for metronidazole and amoxicillin. Population genomic analysis demonstrated heterogeneous ancestry, with most isolates showing affinity with hpNorthAsia and smaller subsets with hspAltai and other Eurasian-related lineages. These findings demonstrate substantial heterogeneity in antimicrobial resistance and genomic background, while specific virulence-associated genotypes were associated with variation in gastric mucosal phenotype. The heterogeneous, antibiotic-specific distribution of phenotypic resistance and genomic resistance-associated findings highlights the importance of locally informed antimicrobial strategies in Mongolia.
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BibTeX
@article{renchinsengee2026integrated,
title = {{Integrated Analysis of Virulence, Antimicrobial Resistance, and Gastric Mucosal Phenotype in Helicobacter pylori from a High-Risk Mongolian Population}},
author = {Namsrai Renchinsengee and Ayush Khangai and Saruuljavkhlan Batsaikhan and Gantuya Boldbaatar and Aigul Lazatkhan and Bayasgalan Luvsandagva and Amarbayasgalan Zagd and Bilguun Jargalsaikhan and Davaadorj Duger and Oyuntsetseg Khasag and Takashi Matsumoto and Yoshio Yamaoka},
journal = {Biomolecules},
year = {2026},
month = oct,
doi = {10.3390/biom16111542},
url = {https://www.mdpi.com/2218-273X/16/11/1542},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Integrated Analysis of Virulence, Antimicrobial Resistance, and Gastric Mucosal Phenotype in Helicobacter pylori from a High-Risk Mongolian Population
AU - Namsrai Renchinsengee
AU - Ayush Khangai
AU - Saruuljavkhlan Batsaikhan
AU - Gantuya Boldbaatar
AU - Aigul Lazatkhan
AU - Bayasgalan Luvsandagva
AU - Amarbayasgalan Zagd
AU - Bilguun Jargalsaikhan
AU - Davaadorj Duger
AU - Oyuntsetseg Khasag
AU - Takashi Matsumoto
AU - Yoshio Yamaoka
PY - 2026
DA - 2026/10/22
JO - Biomolecules
DO - 10.3390/biom16111542
UR - https://www.mdpi.com/2218-273X/16/11/1542
AB - Mongolia has one of the highest gastric cancer burdens worldwide, yet integrated data linking Helicobacter pylori virulence, antimicrobial resistance (AMR), and gastric mucosal phenotype remain limited, particularly in ethnically distinct populations such as Bayan-Ölgii. We conducted a prospective single-center study of patients undergoing upper gastrointestinal endoscopy, with mucosal assessment using the Kyoto classification and histological scoring based on the Updated Sydney System. H. pylori isolates were cultured, antimicrobial susceptibility was determined by agar dilution, and whole-genome sequencing of 43 isolates enabled analysis of virulence-associated genes, antimicrobial resistance determinants, and population structure. Among 107 patients, H. pylori infection was associated with higher Kyoto scores than in uninfected individuals (4.39 vs. 3.42, p = 0.01). Major virulence-associated determinants were widely distributed: cagA was detected in 81.4% of isolates, and all interpretable cagA-positive isolates carried Western-type EPIYA architectures. Among 10 predefined virulence markers evaluated in age- and sex-adjusted models, hopQ Type I and vacA d1 were associated with higher Kyoto scores, whereas vacA i1 was associated with lower Kyoto scores; all three associations remained significant after Benjamini–Hochberg false discovery rate correction. Phenotypic antimicrobial resistance among 34 isolates with available susceptibility data was observed for metronidazole (58.8%), clarithromycin (35.3%), amoxicillin (29.4%), levofloxacin (20.6%), and minocycline (2.9%). Whole-genome sequencing identified established resistance determinants for clarithromycin, levofloxacin, and metronidazole, together with additional resistance-associated or uncertain variants, particularly for metronidazole and amoxicillin. Population genomic analysis demonstrated heterogeneous ancestry, with most isolates showing affinity with hpNorthAsia and smaller subsets with hspAltai and other Eurasian-related lineages. These findings demonstrate substantial heterogeneity in antimicrobial resistance and genomic background, while specific virulence-associated genotypes were associated with variation in gastric mucosal phenotype. The heterogeneous, antibiotic-specific distribution of phenotypic resistance and genomic resistance-associated findings highlights the importance of locally informed antimicrobial strategies in Mongolia.
SN - 2218-273X
ER -