The human pathogen Helicobacter pylori uses the host receptor ␣ 5  1 integrin to trigger inflammation in host cells via its cag pathogenicity island (cag PAI) type IV secretion system (T4SS). Here, we report that the H. pylori ImaA protein (HP0289) decreases the action of the cag PAI T4SS via tempering the bacterium's interaction with ␣ 5  1 integrin. Previously, imaA-null mutants were found to induce an elevated inflammatory response that was dependent on the cag PAI T4SS; here we extend those findings to show that the elevated response is independent of the CagA effector protein. To understand how ImaA could be affecting cag PAI T4SS activity at the host cell interface, we utilized the Phyre structural threading program and found that ImaA has a region with remote homology to bacterial integrinbinding proteins. This region was required for ImaA function. Unexpectedly, we observed that imaA mutants bound higher levels of ␣ 5  1 integrin than wild-type H. pylori, an outcome that required the predicted integrin-binding homology region of ImaA. Lastly, we report that ImaA directly affected the amount of host cell 1 integrin but not other cellular integrins. Our results thus suggest a model in which H. pylori employs ImaA to regulate interactions between integrin and the T4SS and thus alter the host inflammatory strength.KEYWORDS autotransporter proteins, inflammation, pathogenesis, secretion systems, virulence factors T he human pathogen Helicobacter pylori is one of the world's most common pathogens, chronically colonizing the stomachs of at least one-third of the world's population, with the populations of many countries experiencing rates of colonization of over 50% (1, 2). The outcomes of this infection vary on the basis of a combination of bacterial genetics, host genetics, and environmental factors (3). Ten to 15% of those infected go on to develop severe diseases, including ulcers and gastric adenocarcinoma (4-6). H. pylori-triggered diseases cause significant mortality and morbidity worldwide. For example, gastric adenocarcinoma killed over 700,000 people worldwide in 2012, and in the United States, 26,370 people were expected to have been diagnosed with this disease in 2016 (7,8).One of the main factors that influences the H. pylori disease outcome is whether a person is infected with a strain that possesses the cytotoxin-associated gene (cag) pathogenicity island (cag PAI). cag PAI-positive strains are associated with severe inflammation, peptic ulcers, and gastric cancer (9). The cag PAI encodes a type IV secretion system (T4SS), a large multiprotein system that triggers a host inflammatory response directly via interactions with the host cells (10) and also via delivery of proinflammatory cargo: the protein CagA and the bacterial molecule peptidoglycan (11,12).Given the cost and consequence of producing an active cag PAI T4SS, its function is controlled at several levels (2, 13, 14). While there is some transcriptional modulation