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Umar Z, Tang JW, Marshall BJ, Tay ACY, Wang L. Rapid diagnosis and precision treatment of Helicobacter pylori infection in clinical settings. Crit Rev Microbiol 2024:1-30. [PMID: 38910506 DOI: 10.1080/1040841x.2024.2364194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/25/2024] [Indexed: 06/25/2024]
Abstract
Helicobacter pylori is a gram-negative bacterium that colonizes the stomach of approximately half of the worldwide population, with higher prevalence in densely populated areas like Asia, the Caribbean, Latin America, and Africa. H. pylori infections range from asymptomatic cases to potentially fatal diseases, including peptic ulcers, chronic gastritis, and stomach adenocarcinoma. The management of these conditions has become more difficult due to the rising prevalence of drug-resistant H. pylori infections, which ultimately lead to gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma. In 1994, the International Agency for Research on Cancer (IARC) categorized H. pylori as a Group I carcinogen, contributing to approximately 780,000 cancer cases annually. Antibiotic resistance against drugs used to treat H. pylori infections ranges between 15% and 50% worldwide, with Asian countries having exceptionally high rates. This review systematically examines the impacts of H. pylori infection, the increasing prevalence of antibiotic resistance, and the urgent need for accurate diagnosis and precision treatment. The present status of precision treatment strategies and prospective approaches for eradicating infections caused by antibiotic-resistant H. pylori will also be evaluated.
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Affiliation(s)
- Zeeshan Umar
- Marshall Laboratory of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, China
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jia-Wei Tang
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Western Australia, China
| | - Barry J Marshall
- Marshall Laboratory of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, China
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Western Australia, China
- Marshall International Digestive Diseases Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
- Marshall Medical Research Center, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Alfred Chin Yen Tay
- Marshall Laboratory of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong Province, China
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Western Australia, China
- Marshall International Digestive Diseases Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
- Marshall Medical Research Center, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Liang Wang
- Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
- Division of Microbiology and Immunology, School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia, China
- Center for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, China
- School of Agriculture and Food Sustainability, University of Queensland, Brisbane, Queensland, Australia
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Han S, Deng Z, Cheung K, Lyu T, Chan P, Li Y, Ni L, Luo X, Li K. Vonoprazan-based triple and dual therapy versus bismuth-based quadruple therapy for Helicobacter pylori infection in China: a three-arm, randomised clinical trial protocol. BMC Gastroenterol 2023; 23:231. [PMID: 37420205 DOI: 10.1186/s12876-023-02872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Helicobacter pylori infection and associated diseases are a growing global public health issue. H. pylori infection is the major cause of gastric cancer, over 90% of duodenal ulcers, and over 70% of gastric ulcers. The infection rate of H. pylori is approximately 50%, and approximately 50% of new cases of gastric cancer worldwide occur in China. Bismuth (BI)-based quadruple therapy is recommended as the first-line treatment for H. pylori in China. Vonoprazan (VPZ), a new potassium-competitive acid blocker that can inhibit gastric acid secretion more effectively than proton pump inhibitors (PPIs), has been combined with antibiotics to effectively eradicate H. pylori. In this study, we compared the efficacy and safety of two VPZ-based therapies with that of BI-based therapy for H. pylori treatment. METHODS A three-armed randomised controlled trial (RCT) is being conducted in Shenzhen, with 327 participants recruited from the Gastroenterology Clinic of the University of Hong Kong-Shenzhen Hospital. Patients were diagnosed with H. pylori infection based on a positive 13C-urea breath test (UBT). Patients are kept naïve to their treatment and are randomly assigned in a 1:1:1 ratio to either VPZ-based triple, VPZ-based dual, or BI-based quadruple therapy for 14 days. All groups are subjected to follow-up evaluations of safety, adverse drug reactions, and clinical variables in the first, second, and fourth weeks after treatment. Successful eradication is confirmed by a negative 13C-UBT six weeks after treatment. If initial treatment fails, (1) those patients are turned to another regimen, or (2) a drug resistance test is conducted, after which an individualised treatment regimen shall be prescribed according to antimicrobial susceptibility testing. The resulting data will be evaluated using intention-treat and a per-protocol analysis. DISCUSSION This study is the a RCT aims to evaluate the efficacy and safety of 14-day VPZ-based triple and dual therapies in comparison with BI-based quadruple therapy. The outcomes of this study may allow treatment recommendations and update drug instructions in China. TRIAL REGISTRATION Chinese Clinical Trial Registry (No. ChiCTR2200056375). Registered on February 4, 2022, https://www.chictr.org.cn/showproj.aspx?proj=141314.
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Affiliation(s)
- ShaoWei Han
- Shantou University Medical College, Shantou, China
- Department of Pharmacy, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - ZiJie Deng
- Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - KaShing Cheung
- Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Tao Lyu
- Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - PuiLing Chan
- Department of Pharmacy, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ying Li
- Department of Pharmacy, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Li Ni
- Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - XiaPeng Luo
- Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kuan Li
- Department of Pharmacy, Shenzhen People's Hospital, Second Clinical Medical College, Jinan University, First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.
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3
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Mestrovic A, Perkovic N, Tonkic A, Sundov Z, Kumric M, Bozic J. Personalized Approach in Eradication of Helicobacter pylori Infection. Antibiotics (Basel) 2022; 12:antibiotics12010007. [PMID: 36671208 PMCID: PMC9854992 DOI: 10.3390/antibiotics12010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
The increase in antibiotic resistance to Helicobacter pylori (H. pylori) is associated with a decrease in the effectiveness of eradication therapy. Although some success has been achieved by adjusting therapeutic regimens according to local data on resistance to certain antibiotics, a new approach is needed to ensure a better therapeutic response. Tailored therapy, based on sensitivity tests to antibiotics, is increasingly proving to be a superior therapeutic option, even as a first-line therapy. Moreover, the recently published Maastricht VI guidelines emphasize utilizing a susceptibility-guided strategy in respect to antibiotic stewardship as the first choice for eradication therapy. In addition, polymerase chain reaction (PCR) technology is becoming a standard tool in the diagnosis of H. pylori infections through non-invasive testing, which further optimizes the eradication process. We provide a review regarding the current position of the individualized approach in eradication therapy and its future prospects. Based on novel understandings, the personalized approach is an effective strategy to increase the successful eradication of H. pylori infections.
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Affiliation(s)
- Antonio Mestrovic
- Department of Gastroenterology and Hepatology, University Hospital of Split, 21000 Split, Croatia
- Correspondence:
| | - Nikola Perkovic
- Department of Gastroenterology and Hepatology, University Hospital of Split, 21000 Split, Croatia
| | - Ante Tonkic
- Department of Gastroenterology and Hepatology, University Hospital of Split, 21000 Split, Croatia
- Department of Internal Medicine, University of Split School of Medicine, 21000 Split, Croatia
| | - Zeljko Sundov
- Department of Gastroenterology and Hepatology, University Hospital of Split, 21000 Split, Croatia
- Department of Internal Medicine, University of Split School of Medicine, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
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Svensson Grape E, Rooth V, Nero M, Willhammar T, Inge AK. Structure of the active pharmaceutical ingredient bismuth subsalicylate. Nat Commun 2022; 13:1984. [PMID: 35418171 PMCID: PMC9008038 DOI: 10.1038/s41467-022-29566-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Structure determination of pharmaceutical compounds is invaluable for drug development but remains challenging for those that form as small crystals with defects. Bismuth subsalicylate, among the most commercially significant bismuth compounds, is an active ingredient in over-the-counter medications such as Pepto-Bismol, used to treat dyspepsia and H. pylori infections. Despite its century-long history, the structure of bismuth subsalicylate is still under debate. Here we show that advanced electron microscopy techniques, namely three-dimensional electron diffraction and scanning transmission electron microscopy, can give insight into the structure of active pharmaceutical ingredients that are difficult to characterize using conventional methods due to their small size or intricate structural features. Hierarchical clustering analysis of three-dimensional electron diffraction data from ordered crystals of bismuth subsalicylate revealed a layered structure. A detailed investigation using high-resolution scanning transmission electron microscopy showed variations in the stacking of layers, the presence of which has likely hindered structure solution by other means. Together, these modern electron crystallography techniques provide a toolbox for structure determination of active pharmaceutical ingredients and drug discovery, demonstrated by this study of bismuth subsalicylate.
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Affiliation(s)
- Erik Svensson Grape
- Department of Materials and Environmental Chemistry, Stockholm University, 10691, Stockholm, Sweden
| | - Victoria Rooth
- Department of Materials and Environmental Chemistry, Stockholm University, 10691, Stockholm, Sweden
| | - Mathias Nero
- Department of Materials and Environmental Chemistry, Stockholm University, 10691, Stockholm, Sweden
| | - Tom Willhammar
- Department of Materials and Environmental Chemistry, Stockholm University, 10691, Stockholm, Sweden.
| | - A Ken Inge
- Department of Materials and Environmental Chemistry, Stockholm University, 10691, Stockholm, Sweden.
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5
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Kouitcheu Mabeku LB, Bello Epesse M, Fotsing S, Kamgang R, Tchidjo M. Stool Antigen Testing, a Reliable Noninvasive Method of Assessment of Helicobacter pylori Infection Among Patients with Gastro-duodenal Disorders in Cameroon. Dig Dis Sci 2021; 66:511-520. [PMID: 32350723 DOI: 10.1007/s10620-020-06219-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several techniques such as invasive and noninvasive are used for the diagnosis of H. pylori infection. AIM The aim of this study was to compare the results of rapid urease test, stool antigen test and serology in diagnosing H. pylori infection in Cameroon. METHODS Hundred patients (66 women and 34 men) were enrolled. Each patient gave a written consent. The study was approved by the local Ethical Committee of Medical Sciences and the institutional review board. From each patient, blood, stool and gastric biopsies samples were collected for H. pylori detection using three methods: stool antigen test, serology and rapid urease test (RUT), taken as gold standard. Statistical analysis was performed using Graph pad Prism 7. RESULTS Helicobacter pylori infection was detected in 43%, 45% and 73% of patients based on the RUT, stool antigen test and serology, respectively. The difference was statistically significant between serology and RUT (P = 0.0026), but not between stool antigens test and RUT (P = 0.288). Taken RUT as gold standard, the sensitivity, specificity, positive and negative predictive values of stool antigens test and serology were 65.11, 70.17, 62.22 and 72.72%; 88.37, 40.35, 55.77 and 82.14%, respectively. The accuracy of stool antigen test and serology was 68 and 61%, respectively. CONCLUSIONS Our finding showed that stool antigen test can be used as a noninvasive method of assessment of H. pylori infection in our setting. Serological test can be used in screening; however, further diagnostic tests need to be carried out to confirm seropositive cases.
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Affiliation(s)
- Laure Brigitte Kouitcheu Mabeku
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box 67, Dschang, Cameroon.
| | - Mohamadou Bello Epesse
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box 67, Dschang, Cameroon
| | - Stephane Fotsing
- Gastroenterology Department, Laquintinie Hospital of Douala, P. O. Box 4035, Douala, Cameroon
| | - Roland Kamgang
- Gastroenterology Department, Polyclinique de Poitiers, P. O. Box 15422, Douala, Cameroon
| | - Magloire Tchidjo
- Gastroenterology Department, Polyclinique de Poitiers, P. O. Box 15422, Douala, Cameroon
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Gudra D, Pupola D, Skenders G, Leja M, Radovica-Spalvina I, Gorskis H, Vangravs R, Fridmanis D. Lack of significant differences between gastrointestinal tract microbial population structure of Helicobacter pylori-infected subjects before and 2 years after a single eradication event. Helicobacter 2020; 25:e12748. [PMID: 32776403 DOI: 10.1111/hel.12748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND According to recent estimates 80% of Latvian population is infected with Helicobacter pylori thus their susceptibility to numerous gastric tract diseases is increased. The 1st line H. pylori eradication therapy includes treatment with clarithromycin in combination with amoxicillin or metronidazole and a proton pump inhibitor. However, potential adverse events caused by such therapies to microbiome are insufficiently studied. OBJECTIVE This study aimed to evaluate the long-term effect of H. pylori eradication on human gastrointestinal tract (GIT) microbiome. METHODS The assessment of H pylori eradication impact on GIT microbiome was done by analyzing 120 samples acquired from 60 subjects. Each individual was prescribed the following 10-day eradication regimen: Esomeprazolum 40 mg, Clarithromycinum 500 mg, and Amoxicillinum 1000 mg, BID. Samples from each individual were collected before starting H pylori eradication therapy, and 2 years after the completion of the therapy in OC-Sensor (Eiken Chemical Co.) sample collection containers and stored at -86°C. Prior to DNA extraction, the samples were lyophilized, and total DNA was extracted using FastDNA Spin Kit for Soil. 16S V3 rRNA gene sequencing was done employing Ion Torrent PGM, and the obtained raw sequences were analyzed using vsearch and R (phyloseq, cluster packages). RESULTS Alpha diversity measurements-observed OTUs, Chao1 and Shannon index did not differ significantly between the pre- and post-eradication states (two-tailed paired t test: P = .95; P = .71, P = .24, respectively). Unweighted and weighted UniFrac distances of beta diversity analysis indicated a non-specific pattern of sample clustering. Enterotype shift was observed for the majority of individuals comparing pre- and post-eradication study groups. Association analysis revealed that certain bacterial genera significantly correlated with age (eg, Dialister, Paraprevotella, Bifidobacterium), individual (eg, Thermotunica, Streptomyces, Faecalibacterium), and history of respiratory and/or allergic diseases (eg, Colinsella, Faecalibacterium). Redundancy analysis confirmed that the individual was a significant determinant of the subject's microbial community composition (ANOVA, 999 perm., P = .001) with the further lower impact of subject-specific medical history (eg, medication used as prescribed: P = .005, history of cardiovascular diseases: P = .005, history of respiratory, and/or allergic diseases: P = .015) and physiological (eg, age: P = .005, gender: P = .02) parameters. In the post-eradication study group, number of influential genera (n = 260) was increased compared to the pre-eradication study group (n = 209). CONCLUSION Modest global differences at the community level exist between individuals before and after the eradication therapy; however, the microbiome structure is more related to the subject-specific parameters rather than by the eradication therapy itself.
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Affiliation(s)
- Dita Gudra
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Darta Pupola
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Girts Skenders
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia.,Faculty of Medicine, University of Latvia, Riga, Latvia
| | | | - Henrihs Gorskis
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Reinis Vangravs
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
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Özer Etik D, Sezer S, Suna N, Öztaş E, Kılıç ZMY. Can the treatment duration be shortened in bismuth-containing therapies for Helicobacter pylori eradication? TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:667-672. [PMID: 31258136 DOI: 10.5152/tjg.2019.18793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS The duration of Helicobacter pylori (H. pylori) eradication therapy as a range (e.g., 10-14 days) is an ignored problem. There is no any particular treatment duration described in current guidelines, and the conditions for when to use 10-day therapy vs. 14-day therapy have not been elucidated. The aim of this study is to determine an effective and reliable H. pylori treatment duration in clinical practice. There were four different treatment modalities administered to groups, and success rates were compared. MATERIALS AND METHODS Patients were eligible to participate in the study if they had a biopsy-proven H. pylori infection. Each patient was randomly assigned to one of the four treatment groups according to a predetermined sequence: 14-day or 10-day bismuth-containing quadruple therapy (BQT) groups and 14-day or 10-day moxifloxacin-bismuth-combined treatment (MBCT) groups. RESULTS A total of 216 patients (54 per group) were enrolled. Two-hundred six patients (95.3%) completed therapy. There was no significant difference in the eradication rates between those patients who received 10- and 14-days BQT regimens (p=0.67). The 14-BQT protocol had the highest eradication rate, the MBCT regimes had the highest compliance, and the 10-MBCT protocol had the poorest results for H. pylori eradication. The posttreatment questionnaire on adverse effects identified nausea/vomiting as the most common side effect (35.7%). CONCLUSION Overall, the results of our study suggest that shortening the BQT protocol duration to 10 days does not weaken the H. pylori eradication rate. Moreover, quinolone-containing therapies with the lowest eradication rate among the groups should not be offered as a salvage treatment in case of the BQT failure.
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Affiliation(s)
- Diğdem Özer Etik
- Department of Gastroenterology, Başkent University School of Medicine, Ankara, Turkey
| | - Semih Sezer
- Clinic of Gastroenterology, Ankara Yenimahalle Hospital, Ankara, Turkey
| | - Nuretdin Suna
- Department of Gastroenterology, Başkent University School of Medicine, Ankara, Turkey
| | - Erkin Öztaş
- Department of Gastroenterology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Zeki Mesut Yalın Kılıç
- Department of Gastroenterology, Health Sciences University Türkiye Yüksek İhtisas Hospital, İstanbul, Turkey
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Park JU, Cho JS, Kim JS, Kim HK, Jo YH, Rahman MAA, Lee YI. Synergistic Effect of Rubus crataegifolius and Ulmus macrocarpa Against Helicobacter pylori Clinical Isolates and Gastritis. Front Pharmacol 2020; 11:4. [PMID: 32153392 PMCID: PMC7044145 DOI: 10.3389/fphar.2020.00004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022] Open
Abstract
Helicobacter pylori is one of the most widespread infections involved in the pathogenesis of chronic gastritis, peptic ulcer, and gastric cancer. Hence, there is an urgent need to develop medications against H. pylori. This study aimed to evaluate synergistic effect of Rubus crataegifolius (RF) and Ulmus macrocarpa Hance (UL) against H. pylori. Antibacterial susceptibility of each extract either separately or in combination was studied against two H. pylori standard strains and 11 clinical isolates using agar dilution method. The effect of the extracts on H. pylori inoculated Balb/c mice model was also studied using single dosing (100 mg/kg each) approach. The MIC50 of RF and UL were more than 100 and 200 µg/ml, respectively, against the tested strains. However, simultaneous treatment with RF and UL at 75 and 50 µg/ml, respectively, showed decreased viable cell number, MIC70, and at 75 µg/ml each showed synergic effect with MIC90. On H. pylori inoculated Balb/c mice model, RF and UL separately (100 mg/kg each) showed moderate anti-H. pylori effect, while simultaneous treatment of RF and UL with same dose showed significant synergistic anti-gastric effects in stomach. The results showed a significant synergistic effect of plants extract against H. pylori infection and eventually gastric mucosal damage. Our finding could be considered a valuable support in the treatment of H. pylori induced gastritis and may contribute to the development of new and safe combined herbal product as anti-H. pylori regimens.
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Affiliation(s)
- Jung Uoon Park
- Industrial Bioresource Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea
| | | | - Jong Seok Kim
- College of Medicine, Myunggok Medical Research Institute, Konyang University, Daejeon, South Korea
| | - Hyun Kyu Kim
- R & D, Kolmar BNH Co., Ltd., Sejong, South Korea
| | - Young Hee Jo
- R & D, Kolmar BNH Co., Ltd., Sejong, South Korea
| | | | - Young Ik Lee
- Industrial Bioresource Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, South Korea.,Lee's Biotech Co., KRIBB, Daejeon, South Korea
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Lee YI, Kim JS, Cho JS, Kim HK, Hussain A. Standardized Combined Plant Extract, RUG-com, Reduces Bacterial Levels and Suppresses Acute and Chronic Inflammation in Balb/c Mice Infected with CagA + Helicobacter pylori.. Prev Nutr Food Sci 2020; 24:426-433. [PMID: 31915638 PMCID: PMC6941731 DOI: 10.3746/pnf.2019.24.4.426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/23/2019] [Indexed: 01/20/2023] Open
Abstract
Helicobacter pylori are etiological agents in the development of gastritis, gastroduodenal ulcers, gastric cancer, and mucosa-associated lymphoid tumors. Our previous investigations demonstrated that standardized combined plants extracts (Rubus crataegifolius and Ulmus macrocarpa) inhibit the growth of H. pylori in in vitro experiments. Also, we demonstrated that Gardenia jasminoides is effective in preventing gastritis and gastric ulcers in animal experiments. In the present work, we tested the standardized combined three plant extract (RUG-com) on the mouse model of H. pylori infectious disease to examine the effects of RUG-com on both the prevention and curing on the stomachs of infected mice. After the final administrations, biopsy samples of gastric mucus were assayed for bacterial numbers, biochemical analysis, inflammatory scores, and histology. Treatment with standardized plants extracts, single or combined, reduced the H. pylori load compared with the control. Treatment also significantly (P<0.05) reduced both acute and chronic mucosal and subacute inflammation, and epithelial cell degeneration and erosion induced by H. pylori infection. Further investigations demonstrated that H. pylori-induced inflammation was decreased by RUG-com extracts via down regulating cyclooxygenase-2 and inducible nitric oxide synthase pro-inflammatory gene expression. Our results suggest that RUG-com is useful to prevent H. pylori infection, H. pylori-induced inflammation and associated gastric damage.
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Affiliation(s)
| | - Jong Seok Kim
- Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon 35365, Korea
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10
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Liou TC, Liao PH, Lin YC, Chu CH, Shih SC. Intraluminal therapy for Helicobacter pylori infection. J Gastroenterol Hepatol 2019; 34:1337-1343. [PMID: 30734357 DOI: 10.1111/jgh.14627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Several strategies have been proposed to increase the eradication rate of Helicobacter pylori. However, the widespread increasing resistance rates to current multiple-dose oral antibiotic therapies call for alternative therapeutic approaches. We aim to develop a novel intraluminal therapy for H. pylori infection (ILTHPI). METHODS From April 2017 to December 2017, 100 H. pylori-infected treatment-naïve patients with upper abdominal pain or discomfort underwent endoscopic examinations and concomitant ILTHPI, which comprised the control of intragastric pH, the irrigation of gastric mucosal surface with a mucolytic agent, and the application of single-dose medicaments containing antibiotic powders. The safety profiles while conducting ILTHPI and adverse events after ILTHPI were evaluated. The success of eradication was assessed based on the result of the 13 C-urea breath test 6 weeks after ILTHPI. In addition, a patient with successful ILTHPI was reconfirmed by a negative H. pylori stool antigen test four to 6 months after ILTHPI to exclude short-term recurrence. RESULTS All the 100 enrolled patients completed the ILTHPI with good safety profiles and mild adverse events (6%). Five patients dropped out, and 51 of 95 patients (53.7%) achieved successful eradication immediately after endoscopic examinations. All 51 patients revealed negative stool H. pylori antigen tests four to 6 months after successful ILTHPI. No short-term recurrence was observed. CONCLUSIONS We have developed a novel therapeutic approach. With the ILTHPI, H. pylori can be eradicated immediately by administrating a single-dose regimen while conducting an endoscopic examination. CLINICAL TRIALS NUMBER NCT03124420.
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Affiliation(s)
- Tai-Cherng Liou
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Po-Hao Liao
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yu-Chun Lin
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Cheng-Hsin Chu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Shou-Chuan Shih
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Efficacy and Safety of Vonoprazan-Based versus Proton Pump Inhibitor-Based Triple Therapy for Helicobacter pylori Eradication: A Meta-Analysis of Randomized Clinical Trials. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9781212. [PMID: 31211144 PMCID: PMC6532346 DOI: 10.1155/2019/9781212] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/28/2019] [Accepted: 04/17/2019] [Indexed: 01/06/2023]
Abstract
Aims To compare the efficacy and safety of vonoprazan-based versus proton pump inhibitor (PPI)-based triple therapy in the eradication of Helicobacter pylori. Methods We performed a systematic search in PubMed, Embase, and the Cochrane Library databases for relevant randomized controlled trials up to March 2019. Studies were included if they compared the efficacy and safety of H. pylori eradication of vonoprazan-based and PPI-based triple therapy. Results Three studies with 897 patients were evaluated in this meta-analysis. The H. pylori eradication rate of vonoprazan-based triple therapy was higher than that of PPI-based triple therapy as first-line regimens (intention-to-treat analysis: pooled eradication rates, 91.4% vs 74.8%; odds ratio [OR], 3.68; 95% confidence interval (CI): [1.87–7.26]; P<0.05). The incidence of adverse events in vonoprazan-based triple therapy was lower than that in PPI-based triple therapy (pooled incidence, 32.7% vs 40.5%; OR, 0.71; 95%CI: [0.53–0.95]; P<0.05). Conclusions Efficacy of vonoprazan-based triple therapy is superior to that of PPI-based triple therapy for first-line H. pylori eradication. Additionally, vonoprazan-based triple therapy is better tolerated than PPI-based triple therapy.
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12
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Liou JM, Chen PY, Kuo YT, Wu MS. Toward population specific and personalized treatment of Helicobacter pylori infection. J Biomed Sci 2018; 25:70. [PMID: 30285834 PMCID: PMC6167866 DOI: 10.1186/s12929-018-0471-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/03/2018] [Indexed: 02/06/2023] Open
Abstract
In the face of rising prevalence of antibiotic resistance, susceptibility testing to provide personalized treatment is recommended prior to eradication therapy for Helicobacter pylori (H. pylori). Yet, population specific treatment according to the local prevalence of antibiotic resistance may be an alternative if susceptibility testing is not available. In this article, we reviewed the global prevalence of primary antibiotic resistance and the efficacies of commonly used regimens in antibiotic susceptible and resistance strains. We then constructed a model to predict the efficacies of these regimens and proposed an algorithm to choose the optimal first-line and rescue therapies according to the prevalence of antibiotic resistance. Clarithromycin-based therapy (triple, sequential, concomitant, and hybrid therapies) for 14 days remains the treatment of choice in regions with low clarithromycin resistance (≤15%) and bismuth quadruple therapy may be an alternative therapy. In regions with high clarithromycin resistance (> 15%), bismuth quadruple therapy is the treatment of choice and non-bismuth quadruple therapy may be an alternative. Either levofloxacin-based therapy or bismuth quadruple therapy may be used as second-line rescue therapy for patients fail after clarithromycin-based therapies, whereas levofloxacin-based therapy may be used for patients fail after bismuth quadruple therapy. Susceptibility testing or genotypic resistance should be determined after two or more eradication failures. However, empirical therapy according to prior medication history to avoid the empirical reuse of levofloxacin and clarithromycin may be an acceptable alternative after consideration of cost, patient preference, and accessibility. Rifabutin-based therapy for 14 days may serve as the fourth-line therapy. New antibiotics specific for H. pylori are highly anticipated.
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Affiliation(s)
- Jyh-Ming Liou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Internal Medicine, College of Medicine, National Taiwan University, No. 7, Chung-Shan S. Road, Taipei, Taiwan.
| | - Po-Yueh Chen
- Division of Gastroenterology and Hepatology, Department of Internal medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yu-Ting Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, No. 7, Chung-Shan S. Road, Taipei, Taiwan
| | - Ming-Shiang Wu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Internal Medicine, College of Medicine, National Taiwan University, No. 7, Chung-Shan S. Road, Taipei, Taiwan.
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13
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Microarray-Based Detection and Clinical Evaluation for Helicobacter pylori Resistance to Clarithromycin or Levofloxacin and the Genotype of CYP2C19 in 1083 Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2684836. [PMID: 30276203 PMCID: PMC6151853 DOI: 10.1155/2018/2684836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/24/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
Background. Helicobacter pylori (H. pylori) is one of the most frequent and persistent bacterial infections that affect nearly half of the world's population. Antibiotic resistance is a constantly evolving process and local surveillance of antibiotic resistance is warranted to guide clinicians in their choice of therapy. The aim of this study was to establish a microarray-based detection to identify H. pylori infection, clarithromycin and levofloxacin susceptibility, and CYP2C19 genetic polymorphism and guide to potential choice of proton pump inhibitor (PPI), antibiotic administration for tailored H. pylori eradication therapy. Methods. By analyzing the sequence of human genomic CYP2C19⁎2 and CYP2C19⁎3 and mutations within the 23S rRNA and gyrA gene regions conferring clarithromycin and levofloxacin resistance, respectively, we developed a microarray for individual therapy detection of H. pylori infection. Plasmids were established as positive or limit of detection (LOD) reference materials. The specificity and sensitivity of the microarray had been performed. And a total of 1083 gastric biopsy samples were tested and the Kappa value had been calculated between the array and Sanger sequencing. We also analyzed the resistance to clarithromycin and levofloxacin in China, as well as the CYP2C19 polymorphisms. Results. The LOD of detecting H. pylori was 103 CFU/mL and human genome DNA was 2 ng/μL. The detection results of 1083 gastric biopsy samples showed that 691 (63.80%) were H. pylori positive, of which 266 (38.49%) were resistant to clarithromycin, 192 (27.79%) were resistant to levofloxacin, and 61 (8.83%) were resistant to both of them. For the type of CYP2C19 polymorphism, 412 (38.04%) were homozygous fast type (HomEM), 574 (53%) were heterozygous EM (HetEM), and 97 (8.96%) were poor metabolizer (PM). Conclusions. The proposed microarray-based detection has high specificity, sensitivity, and reproducibility for detecting the resistance of clarithromycin or levofloxacin as well as CYP2C19 polymorphism, which may help to improve the clinical eradication rate of H. pylori.
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Talebi Bezmin Abadi A. Diagnosis of Helicobacter pylori Using Invasive and Noninvasive Approaches. J Pathog 2018; 2018:9064952. [PMID: 29951318 PMCID: PMC5987299 DOI: 10.1155/2018/9064952] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/12/2018] [Indexed: 01/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) as gram-negative and spiral microorganism is responsible for colonization in the gastric microniche for more than 50% of world population. Recent studies have shown a critical role of H. pylori in the development of peptic ulcers, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric cancer. Over the past decade, there has been a sharp interest to use noninvasive tests in diagnosis of the H. pylori infection. During the years after discovery by Marshall and Warren, it has been frequently declared that the rapid urease test (RUT) is one of the cheapest and rapid diagnostic approaches used in detecting the infection. Although the specificity and sensitivity are durable for this test, clinical experiences had shown that the ideal results are only achieved only if we take biopsies from both corpus and antrum at the same time. Given the diagnosis of the H. pylori in clinical samples, gastroenterologists are facing a long list of various molecular and nonmolecular tests. We need more in-depth researches and investigations to correctly generalize rapid and accurate molecular tests determining both bacterial identity and antibiotic resistance profile.
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Affiliation(s)
- Amin Talebi Bezmin Abadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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15
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Roberts-Thomson IC, Lung T. Cost-effective options for the prevention and management of gastrointestinal and liver disease in the Asia-Pacific region. J Gastroenterol Hepatol 2018; 33:121-127. [PMID: 28833619 DOI: 10.1111/jgh.13925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/08/2017] [Accepted: 08/14/2017] [Indexed: 12/14/2022]
Abstract
The Asia-Pacific region contains more than half of the world's population and is markedly heterogeneous in relation to income levels and the provision of public and private health services. For low-income countries, the major health priorities are child and maternal health. In contrast, priorities for high-income countries include vascular disease, cancer, diabetes, dementia, and mental health disorders as well as chronic inflammatory disorders such as hepatitis B and hepatitis C. Cost-effectiveness analyses are methods for assessing the gains in health relative to the costs of different health interventions. Methods for measuring health outcomes include years of life saved (or lost), quality-adjusted life years, and disability-adjusted life years. The incremental cost-effectiveness ratio measures the cost (usually in US dollars) per life year saved, quality-adjusted life year gained, or disability-adjusted life year averted of one intervention relative to another. In low-income countries, approximately 50% of infant deaths (< 5 years) are caused by gastroenteritis, the major pathogen being rotavirus infection. Rotavirus vaccines appear to be cost-effective but, thus far, have not been widely adopted. In contrast, infant vaccination for hepatitis B is promoted in most countries with a striking reduction in the prevalence of infection in vaccinated individuals. Cost-effectiveness analyses have also been applied to newer and more expensive drugs for hepatitis B and C and to government-sponsored programs for the early detection of hepatocellular, gastric, and colorectal cancer. Most of these studies reveal that newer drugs and surveillance programs for cancer are only marginally cost-effective in the setting of a high-income country.
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Affiliation(s)
| | - Thomas Lung
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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16
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Awaad AS, Alafeefy AM, Alasmary FA, El-Meligy RM, Zain M, Alqasoumi SI. Novel essential amino acid-sulfanilamide hybrid as safe anti-ulcerogenic agent with anti- helicobacter pylori activity. Saudi Pharm J 2017; 25:967-971. [PMID: 29158702 PMCID: PMC5681326 DOI: 10.1016/j.jsps.2017.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/24/2017] [Indexed: 01/27/2023] Open
Abstract
A novel and safe essential amino acid (Leucine) incorporating sulfanilamide was synthesized, and evaluated for its anti-ulcerogenic activity and in vitro anti-Helicobacter pylori activity. The new molecule showed a dose dependent activity against absolute ethanol-induced ulcer in rats, it produced percent protection of control ulcer by 66.7 at dose 100 mg/kg. In addition it showed a potent anti-Helicobacter pylori activity in vitro against 7 clinically isolated strains. The minimum inhibitory concentration (MIC) ranged from 12.5 to 50 μg/ml. The preliminary safety studies and toxicity profile are optimistic and encouraging.
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Affiliation(s)
- Amani S. Awaad
- Pharmacognosy Department, College of Pharmacy, Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Ahmed M. Alafeefy
- Department of Chemistry, Kulliyyah of Science, International Islamic University, Malaysia
| | - Fatmah A.S. Alasmary
- Chemistry Department, College of Science, King Saud University, Riyadh 11362, Saudi Arabia
| | - Reham M. El-Meligy
- Aromatic and Medicinal Plants Department, Desert Research Center, Cairo, Egypt
| | - M.E. Zain
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - Saleh I. Alqasoumi
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Saudi Arabia
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17
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Wang F, Feng J, Chen P, Liu X, Ma M, Zhou R, Chang Y, Liu J, Li J, Zhao Q. Probiotics in Helicobacter pylori eradication therapy: Systematic review and network meta-analysis. Clin Res Hepatol Gastroenterol 2017; 41:466-475. [PMID: 28552432 DOI: 10.1016/j.clinre.2017.04.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 03/30/2017] [Accepted: 04/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several probiotics were effective in the eradication treatment for Helicobacter pylori (Hp), but their comparative efficacy was unknown. AIM To compare the efficacy of different probiotics when supplemented in Hp eradication therapy. METHODS A comprehensive search was conducted to identify all relevant studies in multiple databases and previous meta-analyses. Bayesian network meta-analysis was performed to combine direct and indirect evidence and estimate the relative effects. RESULTS One hundred and forty studies (44 English and 96 Chinese) were identified with a total of 20,215 patients, and more than 10 probiotic strategies were supplemented in Hp eradication therapy. The rates of eradication and adverse events were 84.1 and 14.4% in probiotic group, while 70.5 and 30.1% in the control group. In general, supplementary probiotics were effective in improving the efficacy of Hp eradication and decreasing the incidence of adverse events, despite of few ineffective subtypes. In triple eradication therapy, there was no significant difference among the effective probiotics, and combined probiotics did not show a better efficacy and tolerance than single use. In triple therapy of 7 days and 14 days, Lactobacillus acidopilus was a slightly better choice, while Saccharomyces boulardii was more applicable for 10-day triple therapy. CONCLUSIONS Compared to placebo, most probiotic strategies were effective when supplemented in Hp eradication therapy. In triple eradication therapy, no probiotic showed a superior efficacy to the others. Compared to single use, combined probiotics could not improve the efficacy or tolerance significantly.
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Affiliation(s)
- Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Juerong Feng
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Pengfei Chen
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China; Department of Gastroenterology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Xiaoping Liu
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Minxing Ma
- The Third Department of Medical Oncology, the Fifth People's Hospital of Qinhai Province, Xining, China
| | - Rui Zhou
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Ying Chang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Jing Liu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China.
| | - Jin Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China.
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China.
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18
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Mandaric L, Diamantini E, Stella E, Cano-Paoli K, Valle-Sistac J, Molins-Delgado D, Bellin A, Chiogna G, Majone B, Diaz-Cruz MS, Sabater S, Barcelo D, Petrovic M. Contamination sources and distribution patterns of pharmaceuticals and personal care products in Alpine rivers strongly affected by tourism. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 590-591:484-494. [PMID: 28284634 DOI: 10.1016/j.scitotenv.2017.02.185] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 06/06/2023]
Abstract
Knowledge regarding the impact of tourism on the emergence of pharmaceuticals and personal care products (PPCPs) in Alpine river waters is limited and scarce. Therefore, a study on the occurrence patterns and spatiotemporal variability of 105 PPCPs in an Alpine river basin located in the Trentino-Alto Adige region (North-Eastern Italy) has been conducted. We observed that the total concentration of analyzed PPCPs was generally higher in all sampling sites during winter than in the summer. The analysis of tourist data revealed that during both sampling campaigns the number of tourists was lower in the downstream sites in comparison with the upstream area of the basin (Val di Sole). Particularly, sampling sites located near important tourist resorts have shown the highest abundance of the PPCPs during winter, being analgesics/anti-inflammatories, antihypertensives and antibiotics the most abundant pharmaceutically active compounds (PhACs). Diclofenac showed the highest concentration amongst PhACs, reaching concentrations up to 675ngL-1 in the sampling site situated downstream of the Tonale wastewater treatment plant (WWTP). Antihypertensives were found at concentrations >300ngL-1, while antibiotics were quantified up to 196ngL-1, respectively. Amongst personal care products (PCPs), the most abundant compound was octyl-dimethyl-p-aminobenzoic acid (ODPABA) with concentrations reaching up to 748ngL-1 in the sampling site situated within the Rotaliana district. In general, concentrations and detection frequencies were higher in water than in the sediment samples. The most frequently detected PhACs in sediments from both sampling campaigns were antibiotics, while amongst PCPs in sediments, octocrylene (OC) showed the highest concentration in both sampling campaigns. As a result, this study highlights the potential impact of tourism on the water quality of the Alpine aquatic ecosystems.
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Affiliation(s)
- Ladislav Mandaric
- Catalan Institute for Water Research (ICRA), C/Emili Grahit, 101 E, 17003 Girona, Spain
| | - Elena Diamantini
- Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano, 77, Trento I-38123, Italy
| | - Elisa Stella
- Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano, 77, Trento I-38123, Italy
| | - Karina Cano-Paoli
- Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano, 77, Trento I-38123, Italy
| | - Jennifer Valle-Sistac
- Department of Environmental Chemistry IDAEA-CSIC, C/Jordi Girona, 18-26, 08034 Barcelona, Spain
| | - Daniel Molins-Delgado
- Department of Environmental Chemistry IDAEA-CSIC, C/Jordi Girona, 18-26, 08034 Barcelona, Spain
| | - Alberto Bellin
- Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano, 77, Trento I-38123, Italy
| | - Gabriele Chiogna
- Faculty of Civil, Geo and Environmental Engineering, Technical University of Munich, Arcistrasse 21, Munich 80333, Germany; Institute of Geography, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Bruno Majone
- Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano, 77, Trento I-38123, Italy
| | - M Silvia Diaz-Cruz
- Department of Environmental Chemistry IDAEA-CSIC, C/Jordi Girona, 18-26, 08034 Barcelona, Spain
| | - Sergi Sabater
- Catalan Institute for Water Research (ICRA), C/Emili Grahit, 101 E, 17003 Girona, Spain; Institute of Aquatic Ecology, University of Girona, Campus de Montilivi, 17071 Girona, Spain
| | - Damia Barcelo
- Catalan Institute for Water Research (ICRA), C/Emili Grahit, 101 E, 17003 Girona, Spain; Department of Environmental Chemistry IDAEA-CSIC, C/Jordi Girona, 18-26, 08034 Barcelona, Spain
| | - Mira Petrovic
- Catalan Institute for Water Research (ICRA), C/Emili Grahit, 101 E, 17003 Girona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Lluis Company 25, 08010 Barcelona, Spain.
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19
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Yu LY, Sun LN, Zhang XH, Li YQ, Yu L, Yuan ZQY, Meng L, Zhang HW, Wang YQ. A Review of the Novel Application and Potential Adverse Effects of Proton Pump Inhibitors. Adv Ther 2017; 34:1070-1086. [PMID: 28429247 PMCID: PMC5427147 DOI: 10.1007/s12325-017-0532-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Indexed: 02/07/2023]
Abstract
Proton pump inhibitors (PPIs) are known as a class of pharmaceutical agents that target H+/K+-ATPase, which is located in gastric parietal cells. PPIs are widely used in the treatment of gastric acid-related diseases including peptic ulcer disease, erosive esophagitis and gastroesophageal reflux disease, and so on. These drugs present an excellent safety profile and have become one of the most commonly prescribed drugs in primary and specialty care. Except for gastric acid-related diseases, PPIs can also be used in the treatment of Helicobacter pylori infection, viral infections, respiratory system diseases, cancer and so on. Although PPIs are mainly used short term in patients with peptic ulcer disease, nowadays these drugs are increasingly used long term, and frequently for a lifetime, for instance in patients with typical or atypical symptoms of gastroesophageal reflux disease and in NSAID or aspirin users at risk of gastrotoxicity and related complications including hemorrhage, perforation and gastric outlet obstruction. Long-term use of PPIs may lead to potential adverse effects, such as osteoporotic fracture, renal damage, infection (pneumonia and clostridium difficile infection), rhabdomyolysis, nutritional deficiencies (vitamin B12, magnesium and iron), anemia and thrombocytopenia. In this article, we will review some novel uses of PPIs in other fields and summarize the underlying adverse reactions.
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20
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Arslan N, Yılmaz Ö, Demiray-Gürbüz E. Importance of antimicrobial susceptibility testing for the management of eradication in Helicobacter pylori infection. World J Gastroenterol 2017; 23:2854-2869. [PMID: 28522904 PMCID: PMC5413781 DOI: 10.3748/wjg.v23.i16.2854] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/06/2017] [Accepted: 03/30/2017] [Indexed: 02/06/2023] Open
Abstract
The management of Helicobacter pylori (H. pylori) infection treatment differs from the common treatment protocol for other infectious diseases. Because culture- or molecular-guided approaches face several practical issues, such as the invasive procedures required to obtain gastric biopsy specimens and the lack of availability of routine laboratory testing in some places, H. pylori treatment includes the administration of two or three empirically selected antibiotics combined with a proton pump inhibitor rather than evidence-based eradication treatment. The efficacy of empirical therapy is decreasing, mostly due to increasing multiple resistance. Multiresistance to levofloxacin, clarithromycin, and metronidazole, which are commonly used in empirical treatments, appears to have increased in many countries. Mutations play a primary role in the antimicrobial resistance of H. pylori, but many different mechanisms can be involved in the development of antibiotic resistance. Determining and understanding these possible mechanisms might allow the development of new methods for the detection of H. pylori and the determination of antimicrobial resistance. A treatment based on the detection of antimicrobial resistance is usually more effective than empirical treatment. Nevertheless, such an approach before treatment is still not recommended in the Maastricht guidelines due to the difficulty associated with the routine application of available culture- or molecular-based susceptibility tests, which are usually administered in cases of treatment failure. The management of first and rescue treatments requires further research due to the steadily increase in antimicrobial resistance.
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Vonoprazan-Based Regimen Is More Useful than PPI-Based One as a First-Line Helicobacter pylori Eradication: A Randomized Controlled Trial. Can J Gastroenterol Hepatol 2017; 2017:4385161. [PMID: 28349044 PMCID: PMC5350398 DOI: 10.1155/2017/4385161] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/18/2017] [Indexed: 12/18/2022] Open
Abstract
Background. A new agent, potassium-competitive acid blocker vonoprazan (VPZ) has potent acid-inhibitory effects and may offer advantages over conventional H. pylori eradication therapies. We aimed to compare the eradication rate between VPZ-based treatment and PPI-based one. Methods. This randomized controlled trial was designed to assign 141 patients with H. pylori-positive gastritis to VPZ group (VPZ 20 mg, amoxicillin 750 mg, and clarithromycin 200 or 400 mg twice daily for 7 days) or PPI group (rabeprazole 20 mg or lansoprazole 30 mg, amoxicillin 750 mg, and clarithromycin 200 or 400 mg twice daily for 7 days). Primary endpoints were eradication rates and adverse events. Results. Seventy of 72 patients in VPZ group and 63 of 69 patients in PPI group completed the treatment after 7 days. The eradication rate was significantly higher in VPZ group than PPI group by intention-to-treat analysis (95.8% versus 69.6%, P = 0.00003, 95% confidence interval [CI] 88.3-99.1% versus 57.3-80.1%) and per-protocol analysis (95.7% versus 71.4%, P = 0.0002, 95% CI 88.0-99.1% versus 58.7-82.1%). The incidence of adverse events was not different between the groups (26.3% in VPZ group versus 37.7% in PPI group, P = 0.15). Conclusion. VPZ-based regimen is more useful than that PPI-based regimen as a first-line H. pylori eradication therapy.
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22
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Wang Y, Takki S, Cheung O, Xu H, Wan W, Öhrström L, Inge AK. Elucidation of the elusive structure and formula of the active pharmaceutical ingredient bismuth subgallate by continuous rotation electron diffraction. Chem Commun (Camb) 2017; 53:7018-7021. [DOI: 10.1039/c7cc03180g] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bismuth subgallate was revealed as a coordination polymer providing insight into its solubility and gas sorption properties.
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Affiliation(s)
- Yunchen Wang
- Department of Material and Environmental Chemistry
- Stockholm University
- 106 91 Stockholm
- Sweden
| | - Sofia Takki
- Department of Material and Environmental Chemistry
- Stockholm University
- 106 91 Stockholm
- Sweden
| | - Ocean Cheung
- School of Engineering and Physical Sciences
- Heriot-Watt University
- Edinburgh
- UK
| | - Hongyi Xu
- Department of Material and Environmental Chemistry
- Stockholm University
- 106 91 Stockholm
- Sweden
| | - Wei Wan
- Department of Material and Environmental Chemistry
- Stockholm University
- 106 91 Stockholm
- Sweden
| | - Lars Öhrström
- Department of Chemistry and Chemical Engineering
- Chalmers University of Technology
- 412 96 Gothenburg
- Sweden
| | - A. Ken Inge
- Department of Material and Environmental Chemistry
- Stockholm University
- 106 91 Stockholm
- Sweden
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23
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Modak JK, Liu YC, Supuran CT, Roujeinikova A. Structure-Activity Relationship for Sulfonamide Inhibition of Helicobacter pylori α-Carbonic Anhydrase. J Med Chem 2016; 59:11098-11109. [PMID: 28002963 DOI: 10.1021/acs.jmedchem.6b01333] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
α-Carbonic anhydrase of Helicobacter pylori (HpαCA) plays an important role in the acclimation of this oncobacterium to the acidic pH of the stomach. Sulfonamide inhibitors of HpαCA possess anti-H. pylori activity. The crystal structures of complexes of HpαCA with a family of acetazolamide-related sulfonamides have been determined. Analysis of the structures revealed that the mode of sulfonamide binding correlates well with their inhibitory activities. In addition, comparisons with the corresponding inhibitor complexes of human carbonic anhydrase II (HCAII) indicated that HpαCA possesses an additional, alternative binding site for sulfonamides that is not present in HCAII. Furthermore, the hydrophobic pocket in HCAII that stabilizes the apolar moiety of sulfonamide inhibitors is replaced with a more open, hydrophilic pocket in HpαCA. Thus, our analysis identified major structural features can be exploited in the design of selective and more potent inhibitors of HpαCA that may lead to novel antimicrobials.
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Affiliation(s)
- Joyanta K Modak
- Department of Microbiology, Monash University , Clayton, Victoria 3800, Australia.,Infection and Immunity Program, Monash Biomedicine Discovery Institute, Monash University , Clayton, Victoria 3800, Australia
| | - Yu C Liu
- Department of Microbiology, Monash University , Clayton, Victoria 3800, Australia
| | - Claudiu T Supuran
- Laboratorio di Chimica Bioinorganica, Polo Scientifico, Università degli Studi di Firenze , Via della Lastruccia 3, Sesto Fiorentino, Florence 50019, Italy.,Neurofarba Department, Sezione di Scienze Farmaceutiche, Università degli Studi di Firenze , Via U. Schiff 6, Sesto Fiorentino, Florence 50019, Italy
| | - Anna Roujeinikova
- Department of Microbiology, Monash University , Clayton, Victoria 3800, Australia.,Infection and Immunity Program, Monash Biomedicine Discovery Institute, Monash University , Clayton, Victoria 3800, Australia.,Department of Biochemistry and Molecular Biology, Monash University , Clayton, Victoria 3800, Australia
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The Association of Helicobacter pylori Eradication with the Occurrences of Chronic Kidney Diseases in Patients with Peptic Ulcer Diseases. PLoS One 2016; 11:e0164824. [PMID: 27764171 PMCID: PMC5072588 DOI: 10.1371/journal.pone.0164824] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 09/30/2016] [Indexed: 02/06/2023] Open
Abstract
The association of Helicobacter pylori eradication with the occurrence of renal dysfunction in patients with peptic ulcer diseases is still unclear. This study aimed to clarify the relevance of H. pylori eradication to the occurrence of chronic kidney diseases in patients with peptic ulcer diseases. Data that were available from 2000–2011 were extracted from the National Health Insurance Research Database in Taiwan, and all patients with peptic ulcer diseases (n = 208 196) were screened for eligibility. We divided randomly selected patients into an H. pylori eradication cohort (cohort A, n = 3593) and matched them by age and sex to a without H. pylori eradication cohort (cohort B, n = 3593). Subgroup analysis was further performed for H. pylori eradication within ≤ 90 days of the diagnosis date (early eradication, n = 2837) and within 91–365 days (non-early eradication, n = 756). Cox proportional hazards regression analysis was used to estimate the association of H. pylori eradication with the risk of developing chronic kidney diseases and mortality. We observed that there were more patients suffering from chronic kidney disease in cohort B than in the early eradication subgroup of cohort A (8.49% vs. 6.70%, respectively, p = 0.0075); the mortality rate was also higher in cohort B (4.76% vs. 3.70%, respectively, p = 0.0376). Old age, pulmonary disease, connective tissue disorders, and diabetes were risk factors for chronic kidney diseases but early H. pylori eradication was a protective factor against chronic kidney diseases (hazard ratio: 0.68, 95% confidence interval: 0.52–0.88, p = 0.0030), and death (hazard ratio: 0.69, 95% confidence interval: 0.49–0.96, p = 0.0297). In conclusion, our findings have important implications suggesting that early H. pylori eradication is mandatory since it is associated with a protective role against the occurrence of chronic kidney diseases.
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