Novel Idea: Virulence-Based Therapy Against Helicobacter pylori Infection (Smart Therapy)

INTRODUCTION Helicobacter pylori (H. pylori) is a Gramnegative, spiral, and microaerophilic bacterium, which can usually persist lifelong in gastric mucosa if not treated efficiently. H. pylori infection plays an undeniable role in the development of different gastroduodenal diseases, while its eradication cures ulcer disease and also prevents occurrence of gastric cancer (1–3). At the beginning, as usual, it was thought that antibacterial therapy could easily eliminate the infection in human gastric mucosa. As such, during the last 30 years that we have known about H. pylori, there have been numerous therapeutic regimens suggested (e.g., sequential, triple/dual, quadruple, DANCE, hybrid, salvage, and empirical) (4–8). Therefore, many studies have been conducted to identify the most effective and least harmful therapeutic regimen, although, a unique therapeutic regimen to cure H. pylori infection in all reported colonized individuals is still lacking (8, 9). However, high rates of resistance have been reported to all primary/secondary lines and even to the newly introduced alternative drugs described for H. pylori treatment (10). In 2014, due to the skyrocketing rates of antibiotics resistance, a new scope toward the antibiotic therapy against this mysterious bacterium seems necessary. It has been indicated that virulence factors are the ability of a bacterium to induce certain disease in attributed hosts (1, 11, 12). Accordingly, virulence factors in H. pylori (e.g., cagA, dupA, homB, and vacA) have essential and definite roles in pathogenesis of different gastroduodenal disorders such as chronic gastritis, gastric cancer, and peptic ulcers (13–15). Certain H. pylori strains (specific PCR positive for cagA, dupA, homB, and vacA) harboring virulence determinants are capable to survive longer and induce more severe diseases. Surprisingly, among the currently described studies, no therapeutic regimen according to H. pylori virulence pattern (virutype) has yet been suggested.