CagA antigen of helicobacter pylori and coronary instability: Insight from a clinico- pathological study and a meta-analysis of 4241 cases Francesco Franceschi,

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CagA antigen of helicobacter pylori and coronary instability: Insight from a clinico- pathological study and a meta-analysis of 4241 cases Francesco Franceschi, Giampaolo Niccoli, Giuseppe Ferrante, Antonio Gasbarrini, Alfonso Baldi, Marcello Candelli, Florinda Feroce, Nathalie Saulnier, Micaela Conte, Davide Roccarina, Gaetano A. Lanza, Giovanni Gasbarrini, Silveri Nicolò Gentiloni, Filippo Crea Atherosclerosis Volume 202, Issue 2, Pages 535-542 (February 2009) DOI: 10.1016/j.atherosclerosis.2008.04.051 Copyright © 2008 Elsevier Ireland Ltd Terms and Conditions

Fig. 1 (Panel A) Titre of antibodies anti-urease B of H. pylori in patients with stable angina (SA), unstable angina (UA), normal coronary arteries (NCA) and blood donors (BD). Individual values are shown. The horizontal line across the points represents the mean. The dotted line represents the cut-off for seropositivity to H. pylori. No significant difference among the groups was present. (Panel B) Titre of antibodies anti-CagA of H. pylori in patients with stable angina (SA), unstable angina (UA), normal coronary arteries (NCA) and blood donors (BD). Individual values are shown. The horizontal line across the points represents the mean. The dotted line represents the cut-off for seropositivity to CagA. The titre of antibodies anti-CagA is significantly higher in patients with UA compared to those with SA, NCA or BD. Atherosclerosis 2009 202, 535-542DOI: (10.1016/j.atherosclerosis.2008.04.051) Copyright © 2008 Elsevier Ireland Ltd Terms and Conditions

Fig. 2 Anti-CagA antibodies immunoreacted (black arrows) with fibroblasts and lymphocytes localized inside coronary atherosclerotic plaques obtained by either patients with stable angina (panel A) or unstable angina (panel B). Conversely, no reactions were observed when staining the samples without the primary antibody (panel C and D). Atherosclerosis 2009 202, 535-542DOI: (10.1016/j.atherosclerosis.2008.04.051) Copyright © 2008 Elsevier Ireland Ltd Terms and Conditions

Fig. 3 Forest plots showing odds ratio of acute coronary events in CagA negative compared to CagA-positive patients. Data refer to single study and overall summary estimate. Atherosclerosis 2009 202, 535-542DOI: (10.1016/j.atherosclerosis.2008.04.051) Copyright © 2008 Elsevier Ireland Ltd Terms and Conditions

Fig. 4 Forest plots showing odds ratio of acute coronary events in CagA negative compared to CagA-positive patients in the subgroup analysis according to the type of odds ratio estimate: crude vs adjusted for confounding factors. Atherosclerosis 2009 202, 535-542DOI: (10.1016/j.atherosclerosis.2008.04.051) Copyright © 2008 Elsevier Ireland Ltd Terms and Conditions