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H. pylori is known to cause severe gastricdiseases, including peptic ulcers and gastric cancers, and alink has also been suggested with iron-deficiency anemia(IDA). However, little is known about the pathogenesis of H.pylori-associated IDA. In the present study, to determinewhether H. pylori strains are correlated with the prevalence ofIDA, we analyzed and compared the sequences of the napAgenes encoding a bacterioferritin-like protein in H. pyloristrains. A total of 20 H. pylori strains were isolated fromantral biopsies of patients with and without IDA, and thenapA genes amplified from the genomic DNA were sequenced.A comparison of the deduced amino acid sequences for NapArevealed two sites with major variations. At residue 70, fiveout of the 12 non-IDA strains (41.7%) contained serine, whileonly one of the 8 IDA strains (12.5%) contained serine,indicating a significantly higher frequency of serine in thenon-IDA strains. In addition, the NapA proteins from all 17Western strains available on Web sites were found to containserine residues at this position. Meanwhile, the other majorvariation was located at residue 73, where all eight IDAstrains (100%) contained leucine, while this was only true foreight of the 12 non-IDA strains (66.7%). Therefore, theseresults indicated that the strains within each group were moregenetically related to each other than to strains in the othergroup. When the expression level of the napA genes in the H.pylori strains was measured using RT-PCR, no significantdifference was observed between the two groups, suggestinga similar intensity for the inflammatory responses induced bythe NapA protein among the strains. Consequently, whentaken together, the present data suggest that the occurrence ofH. pylori-associated IDA may be partly determined by theinfecting H. pylori strain, and the non-IDA strains are moreclosely related to Western strains than the IDA strains.

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