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Upon tight binding to gastric epithelial cells, adhesins employ a range of effector proteins, including vacuolating cytotoxin A (VacA), cytotoxin-associated gene A (CagA), and cytotoxin-associated gene L protein (CagL), to manipulate host cell signaling and alter the behavior of gastric epithelial cells, thus promoting long-term colonization (Salama et al., 2013)

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