Revisiting Therapeutic Strategies for H. pylori Treatment in the Context of Antibiotic Resistance: Focus on Alternative and Complementary Therapies

The prevalence of Helicobacter pylori infection remains significant worldwide and it depends on many factors: gender, age, socio-economic status, geographic area, diet, and lifestyle. All successful infectious diseases treatments use antibiotic-susceptibility testing, but this strategy is not currently practical for H. pylori and the usual cure rates of H. pylori are lower than other bacterial infections. Actually, there is no treatment that ensures complete eradication of this pathogen. In the context of an alarming increase in resistance to antibiotics (especially to clarithromycin and metronidazole), alternative and complementary options and strategies are taken into consideration. As the success of antibacterial therapy depends not only on the susceptibility to given drugs, but also on the specific doses, formulations, use of adjuvants, treatment duration, and reinfection rates, this review discusses the current therapies for H. pylori treatment along with their advantages and limitations. As an alternative option, this work offers an extensively referenced approach on natural medicines against H. pylori, including the significance of nanotechnology in developing new strategies for treatment of H. pylori infection.     

Vegetable Extracts and Nutrients Useful in the Recovery from Helicobacter pylori Infection: A Systematic Review on Clinical Trials

Helicobacter pylori (H. pylori) infections affect almost half of the world’s population, with gradually increasing incidence in developed countries. Eradication of H. pylori may provide significant benefits to the affected individual by healing a number of gastrointestinal and extra-digestive disorders. But due to increased microbial resistance and lack of patient adherence to the therapy, the eradication rate of H. pylori is below 80% with current pharmacological therapies. The usage of botanicals for their therapeutic purposes and medicinal properties have been increased in last decades. They can be use as alternative H. pylori treatments, especially against drug-resistant strains. Epidemiological studies have revealed that people with lower vegetable and micronutrient intake may be at increased risk of H. pylori infection. We have undertaken a review of clinical trials to evaluate the efficacy of vegetable extracts and micronutrients in patients with H. pylori. Various databases, such as Google Scholar, PubMed, Scopus, Web of Science, and the Cochrane Library, were searched for the articles published in English. A total of 24 clinical studies (15 for vegetable extracts and 9 for micronutrients) were selected to be reviewed and summarized in this article. Vegetable extracts (Broccoli sprouts, curcumin, Burdock complex, and Nigella sativa) and micronutrients (vitamin C and E) were not found to be as effective as single agents in H. pylori eradication, rather their efficacy synergized with conventional pharmacological therapies. Conversely, GutGard was found to be significantly effective as a single agent when compared to placebo control.     

Immune stimulating activity of an atrophic rhinitis vaccine associated to pegylated chitosan microspheres in vitro

It has previously been found that chitosan microspheres are easily aggregated due to their physical and storage instabilities. In this study, to overcome their instability, chitosan was covalently conjugated with poly(ethylene glycol). Pegylated chitosan microspheres were prepared through the ionic gelation process of pegylated chitosan with tripolyphosphate. Bordetella bronchiseptica dermonecrotoxin, major virulence factor of atrophic rhinitis causative agent, was loaded onto pegylated chitosan microspheres for nasal vaccination. Average particle sizes of Bordetella bronchiseptica dermonecrotoxin-loaded pegylated chitosan microspheres were 5.47 µm. Microspheres obtained from pegylated chitosan microspheres were physically more stable than those from chitosan microspheres, and Bordetella bronchiseptica dermonecrotoxin-loaded pegylated chitosan microspheres released more Bordetella bronchiseptica dermonecrotoxin than Bordetella bronchiseptica dermonecrotoxin-loaded chitosan microspheres in vitro. Macrophage RAW264.7 cells stimulated with Bordetella bronchiseptica dermonecrotoxin-loaded pegylated chitosan microspheres gradually secreted tumor necrosis factor α and nitric oxide, suggesting that pegylated chitosan microspheres are very promising vaccine delivery systems. Copyright © 2007 John Wiley & Sons, Ltd.     

Malonylchitosan Microspheres as a Matrix for Oral Enrofloxacin Delivery

Summary: The purpose of this study was to produce malonylchitosan microspheres to be used as a pH sensitive matrix for the controlled delivery of drugs. Chitosan microspheres were obtained by the coacervation–phase separation method. The microspheres were then treated with malonic acid to obtain amidified chitosan microspheres. The resulting malonylchitosan microspheres were characterized by means of elemental analysis (CHN), infrared spectroscopy, conductometric titration and scanning electron microscopy (SEM). The data obtained from infrared spectroscopy, elemental analysis and conductometric titration of amino groups were consistent with the N-substitution of malonyl groups in the chitosan microspheres. In vivo studies for controlled delivery of enrofloxacin were performed in male Wistar rats and the results indicated increase and prolonged blood levels with delayed peak and improved bioavailability for malonylchitosan microspheres compared to commercial tablets.     

Einem Leib‐ und Magenfeind zum Abschied

More than half of the world population is infected with Helicobacter pylori. Mostly this uninvited guest lives a quiet life in our stomachs but can still cause a lot of trouble. In order to survive at pH = 1 it has developed a superb strategy to deal with the superior strength of hydrochloric acid. Its main weapons are the acid‐base theory and a potent urease. This enzyme hydrolyzes urea to ammonia and carbon dioxide which helps H. pylori keep the pH in its direct vicinity at a comfortable value. To get rid of H. pylori we also use acid‐base‐theory plus antibiotics and clever ways to double‐check the therapeutic success. Even after winning the battle we have to admit that H. pylori is a remarkable chemist and deserves our full respect.     

Process for detecting <Emphasis Type="Italic">Helicobacter pylori</Emphasis> using aliphatic amides

Helicobacter pylori diagnosis is fundamental in the management of gastrointestinal pathologies, whose current clinical guidelines support a non-invasive ‘test-and-treat’ strategy. As such, the present work reports the basis of a new, low-cost, specific breath test based on the detection of volatile carboxylic acids resulting from the hydrolysis of short-chain aliphatic amides by H. pylori amidases. Propionamide and butyramide, which are metabolized by amidases to propionic and butyric acids, were elected for this study. Conditions for the extraction of these acids from a vapour phase were optimized concerning the use of solid-phase microextraction (SPME) followed by gas chromatography–quadrupole mass spectrometry (GC–qMS) analysis. SPME–GC–qMS was then used to detect the acids released into a vapour phase upon incubation of a H. pylori reference strain J99 or a clinical specimen with the amides. These experiments have demonstrated that the administration of less than 9 mg of propionamide and/or butyramide to H. pylori cultures, in loads recognized to cause infection (10⁶–10⁹ cells), resulted in the formation of detectable and/or quantifiable amounts of propionic and/or butyric acids after 30 min incubation. As such, propionic and butyric acids can be used as biomarkers for H. pylori upon incubation with the corresponding amides. SPME–GC–qMS was also used to verify the hepatic stability of the acids. These experiments were conducted in mouse liver cells and revealed no signs of metabolization that could compromise their bioavailability in future in vivo assays. Moreover, SPME–GC–qMS permitted the detection of both acids in amounts as low as 0.8 μg in systems mimicking exhaled breath, demonstrating the sensitivity of the method for these compounds.     

Thermo‐sensitive surface molecularly imprinted magnetic microspheres based on bio‐macromolecules and their specific recognition of bovine serum albumin

Bovine serum albumin imprinted magnetic microspheres, with functional monomers of modified chitosan, N‐isopropylacrylamide and sulfobetaine methacrylate, were successfully prepared and characterized in detail. Computational analyses showed that during the preparation process, modified chitosan can effortlessly form multiple non‐covalent bonds with protein molecules. Temperature‐sensitive N‐isopropylacrylamide improves the elution efficiency by abating the mass transfer resistance. Meanwhile, the zwitterionic sulfobetaine methacrylate strongly interacts with H₂O molecules, remarkably reducing the non‐specific adsorption. The specific bovine serum albumin adsorption performances of the prepared imprinted material were then determined. The adsorption amount reached 86.87 mg/g and the imprinting factor was 6.49. These excellent specific adsorption properties are attributed to the synergetic effects of the different monomers. The fabricated imprinted material not only exhibits great prospects as a biosensor or separation material for protein molecules, but also provides a collaborative strategy for preparing multi‐functional imprinted materials.     

Effect of the Oral Intake of Probiotic Pediococcus acidilactici BA28 on Helicobacter pylori Causing Peptic Ulcer in C57BL/6 Mice Models

Probiotic lactic acid bacteria are being proposed to cure peptic ulcers by reducing colonization of Helicobacter pylori within the stomach mucosa and by eradicating already established infection. In lieu of that, in vitro inhibitory activity of pediocin-producing probiotic Pediococcus acidilactici BA28 was evaluated against H. pylori by growth inhibition assays. Further, chronic gastritis was first induced in two groups of C57BL/6 mice by orogastric inoculation with H. pylori with polyethylene catheter, and probiotic P. acidilactici BA28 was orally administered to study the eradication and cure of peptic ulcer disease. H. pylori and P. acidilactici BA28 were detected in gastric biopsy and fecal samples of mice, respectively. A probiotic treatment with P. acidilactici BA28, which is able to eliminate H. pylori infection and could reverse peptic ulcer disease, is being suggested as a co-adjustment with conventional antibiotic treatment. The study provided an evidence of controlling peptic ulcer disease, by diet modulation.     

Monodisperse superparamagnetic pH‐sensitive single‐layer chitosan hollow microspheres with controllable structure

Facile strategy was developed for the fabrication of the monodisperse superparamagnetic pH‐sensitive single‐layer chitosan (CS) hollow microspheres with controllable structure. The carboxyl group‐functionalized polystyrene microspheres prepared by soap‐free emulsion polymerization were used as the templates. After the Fe₃O₄ nanoparticles were in situ formed onto the surface of the templates, the single‐layer CS was self‐assembled and cross‐linked with glutaraldehyde subsequently. Then, the magnetic single‐layer CS hollow microspheres were obtained after the templates were removed. It was found that the feeding ratio of the monomer acrylic acid in the soap‐free emulsion polymerization had played an important role on the particle size and surface carboxyl group content of the templates, which determined the particle size and shell thickness of the magnetic single‐layer CS hollow microspheres in the proposed strategy. © 2010 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem, 2010     

Squalenyl Hydrogen Sulfate Nanoparticles for Simultaneous Delivery of Tobramycin and an Alkylquinolone Quorum Sensing Inhibitor Enable the Eradication of P. aeruginosa Biofilm Infections

Elimination of pulmonary Pseudomonas aeruginosa (PA) infections is challenging to accomplish with antibiotic therapies, mainly due to resistance mechanisms. Quorum sensing inhibitors (QSIs) interfering with biofilm formation can thus complement antibiotics. For simultaneous and improved delivery of both active agents to the infection sites, self‐assembling nanoparticles of a newly synthesized squalenyl hydrogen sulfate (SqNPs) were prepared. These nanocarriers allowed for remarkably high loading capacities of hydrophilic antibiotic tobramycin (Tob) and a novel lipophilic QSI at 30 % and circa 10 %, respectively. The drug‐loaded SqNPs showed improved biofilm penetration and enhanced efficacy in relevant biological barriers (mucin/human tracheal mucus, biofilm), leading to complete eradication of PA biofilms at circa 16‐fold lower Tob concentration than Tob alone. This study offers a viable therapy optimization and invigorates the research and development of QSIs for clinical use.     

Application of matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry for the study of Helicobacter pylori

The characteristics of matrix‐assisted laser desorption/ionization time‐of‐flight (MALDI‐TOF) mass spectrometry based investigation of extremely variable bacteria such as Helicobacter pylori were studied. H. pylori possesses a very high natural variability. Accurate tools for species identification and epidemiological characterization could help the scientific community to better understand the transmission pathways and virulence mechanisms of these bacteria. Seventeen clinical as well as two laboratory strains of H. pylori were analyzed by the MALDI Biotyper method for rapid species identification. Mass spectra collected were found containing 7–13 significant peaks per sample, and only six protein signals were identical for more than half of the strains. Four of them could be assigned to ribosomal proteins RL32, RL33, RL34, and RL36. The reproducible peak with m/z 6948 was identified as a histidine‐rich metal‐binding polypeptide by tandem mass spectrometry (MS/MS). In spite of the evident protein heterogeneity of H. pylori the mass spectra collected for a particular strain under several cultivations were highly reproducible. Moreover, all clinical strains were perfectly identified as H. pylori species through comparative analysis using the MALDI Biotyper software (Bruker Daltonics, Germany) by pattern matching against a database containing mass spectra from different microbial strains (n = 3287) including H. pylori 26695 and J99. The results of this study allow the conclusion that the MALDI‐TOF direct bacterial profiling is suited for H. pylori identification and could be supported by mass spectra fragmentation of the observed polypeptide if necessary. Copyright © 2010 John Wiley & Sons, Ltd.     

Effect of molecular weight and degree of deacetylation on controlled release of isoniazid from chitosan microspheres

Glutaraldehyde cross‐linked chitosan microspheres for controlled release of isoniazid were prepared using chitosan of different molecular weights (MWs) and degrees of deacetylation (DDAs). Chitosan microspheres were characterized for their size, hydrophobocity, degree of swelling and loading of isoniazid. Hydrophobicity of chitosan microspheres increased on increasing the degree of cross‐linking and MW of chitosan. Chitosan microspheres with high degree of deacetylation (DDA) (75 wt%), high MW chitosan (2227 kg mol^?1), and with 12 wt% concentration of glutaraldehyde showed optimum loading and release of isoniazid. The isoniazid from chitosan microspheres was released in two steps, i.e. burst (%R_B) and controlled (%R_C) steps. The microspheres with low MW chitosan (260 kg mol^?1) and low DDA (48 wt%) showed prominent burst release of isoniazid, but microspheres with high MW chitosan (2227 kg mol^?1) and high DDA (75 wt%) have released more isoniazid in a controlled manner (60 wt%) at 37°C in a solution of pH 5.0 ± 0.1. The burst step of drug release (%R_B) has followed first order kinetics, whereas controlled step of drug release (%R_C) followed zero order kinetics. The burst step of drug release was Fickian and controlled step was non‐Fickian in nature. The diffusion constant (D) for isoniazid release was influenced by the properties of chitosan and degree of cross‐linking. Copyright © 2007 John Wiley & Sons, Ltd.     

Chemical Synthesis and Immunological Evaluation of Helicobacter pylori Serotype O6 Tridecasaccharide O‐Antigen Containing a dd‐Heptoglycan

The development of glycoconjugate vaccines against Helicobacter pylori is challenging. An exact epitope of the H. pylori lipo‐polysaccharide (LPS) O‐antigens that contain Lewis determinant oligosaccharides and unique dd ‐heptoglycans has not yet been identified. Reported here is the first total synthesis of H. pylori serotype O6 tridecasaccharide O‐antigen containing a terminal Le^y tetrasaccharide, a unique α‐(1→3)‐, α‐(1→6)‐, and α‐(1→2)‐linked heptoglycan, and a β‐d ‐galactose connector, by an [(2×1)+(3+8)] assembly sequence. Seven oligosaccharides covering different portions of the entire O‐antigen were prepared for immunological investigations with a particular focus on elucidation of the roles of the dd ‐heptoglycan and Le^y tetrasaccharide. Glycan microarray analysis of sera from rabbits immunized with isolated serotype O6 LPS revealed a humoral immune response to the α‐(1→3)‐linked heptoglycan, a key motif for designing glycoconjugate vaccines for H. pylori serotype O6.     

Novel Carboxymethyl Chitosan Microspheres for Controlled Delivery of Chelerythrine

Novel carboxymethyl chitosan (O-CMCS) microspheres containing an anti-tumor drug chelerythrine (CHE) have been successfully prepared by an emulsion crosslinking method using glutaraldehyde. The optimized microsphere formulation was characterized for particle size, shape, morphology, crystallinity and in vitro drug release. Results for mean particle size, drug loading content, entrapment efficiency and in vitro drug release of chelerythrine loaded microspheres were found to be 12.18 μm, 4.08%, 54.78% and 35.30% at pH 7.4 in 20 h, respectively. The optimized microspheres had an imperfect crystalline lattice and a spherical, rough morphology and the CHE release from O-CMCS microspheres followed the Higuchi matrix model. All these results suggested that O-CMCS microspheres are a promising carrier system for controlled drug delivery.     

Polymer Structure‐Guided Self‐Assisted Preparation of Poly(ester‐thioether)‐Based Hollow Porous Microspheres and Hierarchically Interconnected Microcages for Drug Release

Porous polymer microspheres (PPMs) have been widely applied in various biomedical fields. Herein, the self‐assisted preparation of poly(ester‐thioether)‐based porous microspheres and hierarchical microcages, whose pore sizes can be controlled by varying the polymer structures, is reported. Poly(ester‐thioether)s with alkyl side chains (carbon atom numbers were 2, 4, and 8) can generate hollow porous microspheres; the longer alkyl chain length, the larger pore size of microspheres. The allyl‐modified poly(ester‐thioether) (PHBDT‐g‐C₃) can form highly open, hierarchically interconnected microcages. A formation mechanism of these PPMs is proposed; the hydrophobic side chains‐mediated stabilization of oil droplets dictate the droplet aggregation and following solvent evaporation, which is the key to the formation of PPMs. The hierarchically interconnected microcages of PHBDT‐g‐C₃ are due to the partially crosslinking of polymers. Pore sizes of PPMs can be further tuned by a simple mixing strategy of poly(ester‐thioether)s with different pore‐forming abilities. The potential application of these PPMs as H₂O₂‐responsive vehicles for delivery of hydrophobic (Nile Red) and hydrophilic (doxorubicin hydrochloride) cargos is also investigated. The microspheres with larger pore sizes show faster in vitro drug release. The poly(ester‐thioether)‐based polymer microspheres can open a new avenue for the design of PPMs and provide a H₂O₂‐responsive drug delivery platform.     

Squalenyl Hydrogen Sulfate Nanoparticles for Simultaneous Delivery of Tobramycin and an Alkylquinolone Quorum Sensing Inhibitor Enable the Eradication of P. aeruginosa Biofilm Infections

Elimination of pulmonary Pseudomonas aeruginosa (PA) infections is challenging to accomplish with antibiotic therapies, mainly due to resistance mechanisms. Quorum sensing inhibitors (QSIs) interfering with biofilm formation can thus complement antibiotics. For simultaneous and improved delivery of both active agents to the infection sites, self-assembling nanoparticles of a newly synthesized squalenyl hydrogen sulfate (SqNPs) were prepared. These nanocarriers allowed for remarkably high loading capacities of hydrophilic antibiotic tobramycin (Tob) and a novel lipophilic QSI at 30 % and circa 10 %, respectively. The drug-loaded SqNPs showed improved biofilm penetration and enhanced efficacy in relevant biological barriers (mucin/human tracheal mucus, biofilm), leading to complete eradication of PA biofilms at circa 16-fold lower Tob concentration than Tob alone. This study offers a viable therapy optimization and invigorates the research and development of QSIs for clinical use.     

Hydrophilic Microspheres Containing αα-tert Butoxy-ωω-vinylbenzyl-polyglycidol for Immunodiagnostics: Synthesis,Properties and Biomedical Applications

Summary: Synthesis, characteristics and medical diagnostic application of core-shell poly(styrene/α-tert-butoxy-ω-(vinylbenzyl)polyglycidol) (P(S/PGL)) microspheres are described. The particles were prepared by soap-free emulsion polymerization of styrene and α-tert-butoxy-ω-(vinylbenzyl)polyglycidol macromonomer (PGL) initiated with potassium persulfate. The polymerization in water yielded microspheres with diameters in the range from 220 to 650 nm, depending on concentration of the macromonomer. Polydispersity was usually below 1.06. The fraction of PGL in interfacial layer of microspheres ranged from 0 to 42 mol.% (estimated by XPS). Microspheres suspended in NaCl solutions manifested fully reversible swelling-deswelling properties of their interfacial layer with characteristic transition temperature (T_t) slightly dependent on NaCl concentration. The adsorption of human serum albumin on the surface of P(S/PGL) microspheres was highly reduced when the PGL surface fraction exceeded 40 mol.%. P(S/PGL) microspheres with immobilized antigens Helicobacter pylori were used for detection of antibodies against. The test was based on monitoring differences in electrophoretic mobility of P(S/PGL) microspheres covalently bound H. pylori antigens and antibodies against H. pylori in blood serum.     

Freezing the Dynamic Gap for Selectivity: Motion‐Based Design of Inhibitors of the Shikimate Kinase Enzyme

Shikimate kinase (SK), the fifth enzyme of the aromatic amino acid biosynthesis, is a recognized target for antibiotic drug discovery. The potential of the distinct dynamic apolar gap, which isolates the natural substrate from the solvent environment for catalysis, and the motion of Mycobacterium tuberculosis and Helicobacter pylori SK enzymes, which was observed by molecular dynamics simulations, was explored for inhibition selectivity. The results of the biochemical and computational studies reveal that the incorporation of bulky groups at position C5 of 5‐aminoshikimic acid and the natural substrate enhances the selectivity for the H. pylori enzyme due to key motion differences in the shikimic acid binding domain (mainly helix α5). These studies show that the less‐exploited motion‐based design approach not only is an alternative strategy for the development of competitive inhibitors, but could also be a way to achieve selectivity against a particular enzyme among its homologues.     

Continuous Detection of pH‐responsive Drug Delivery System in Cells in situ by Confocal Laser Scanning Microscopy

Mesoporous silica nanoparticles (MSN) were coated by pH‐responsive polymer chitosan‐poly (methacrylic acid) (CS‐PMAA). This nano drug delivery system showed good application prospects and the polymer‐coated microspheres were promising site‐specific anticancer drug delivery carriers in biomedical field. A continuous detection of pH‐responsive drug delivery system in cells in situ, utilizing MSN/CS‐PMAA composite microspheres, was proposed. Two kinds of different cell lines, tumor cell line (Hela) and normal somatic cells (293T), were used to investigate the behaviours of the drug loaded system in the cells. Conclusions could be drawn from the fluorescent images obtained by confocal laser scanning microscopy (CLSM), modified drug‐loaded microspheres (MSN/CS‐PMAA) were ingested into cells more easily, the uptake of DOX@FITC‐MSN/CS‐PMAA by HeLa/293T cells were performed at pH 7.4/pH 6.8, DOX was released during the ingestion process, fluorescence intensity decreased with time because of efflux transport and photo‐bleaching. Fluoresence detection by flow cytometry was performed as comparison. The continuous fluorescent observation in situ could be widely used in the pH‐responsive releasing process of drug delivery system in the cells.     

Vitamin A and vitamin E interaction behavior on chitosan microspheres

Chitosan is a biodegradable natural polymer with great potential for pharmaceutical applications due to its biocompatibility, high charge density, and non-toxicity. In this study, chitosan microspheres were successfully prepared by an adapted method of coagulation/dispersion. The degree of deacetylation of chitosan powder was obtained by NMR ¹H and FTIR techniques. Chitosan powder and chitosan microspheres were characterized by BET surface area and scanning electron microscopy (SEM). The interactions among the chitosan microspheres and the vitamins A and E were characterized by FTIR. In order to evaluate the ability of interaction of vitamin A and vitamin E with the chitosan microspheres, the thermodynamic parameters were followed by calorimetric titration. Different experimental approaches were applied, such as adsorption isotherms, kinetics and thermodynamics studies. The obtained results showed that the interactions of chitosan microspheres with the vitamins were spontaneous, enthalpically and entropically favorable, indicating that the chitosan microspheres can be used with success in the controlled release of these vitamins.