It has been posited that CagA is a marker for cag PAI, and if cag PAI is present the organism has the ability to encode for the entire machinery involved in horizontal transfer and export of proteins. In addition the presence of cag PAI gives a panorama of extensive genetic diversity to the microorganism. It possesses recombination and deletion points for foreign DNA which confer advantages on the bacteria, enabling them to acquire virulence factors such as dissemination of antibiotic resistance. Although several studies have posited a possible relationship between cagA + strains and the outcomes of diseases, this is still a matter for further research because the outcome does not depend solely on the organism, but also upon several additional factors.
Se ha planteado a cagA como un marcador de cag PAI, y si PAI está presente significa que el microorganismo tiene la capacidad de codificar para toda una maquinaria involucrada en transferencia horizontal y la exportación de proteínas, adicionalmente la presencia de cagPAI nos da un panorama de la amplia diversidad genética del microorganismo, al poseer puntos de recombinación y deleción de DNA foráneo confiriéndole ventajas a la bacteria, y permitirle adquirir factores de virulencia y por qué no, diseminación de la resistencia antibiótica.