ABSTRACT
Helicobacter pylori is a spiral-shaped, gram-negative bacterium that lives within the human stomach and is responsible for persistent gastritis, peptic ulcers, and gastric cancers, along with adenocarcinoma and MALT lymphoma. Over the years, the increasing incidence of multi-drug resistant (MDR) nature of H. pylori has made treatment difficult, lowering the success of traditional antibiotic treatment options. The bacterium’s unique potential to escape the host immune system facilitates it to survive within the harsh acidic environment of the stomach and establish long-term inflammation. It modifies its surface antigens to avoid recognition by using Pathogen Recognition Receptors (PRRs) and manipulates host’s innate and adaptive immune responses. Virulence factors, including VacA, CagA, and γ-glutamyl transpeptidase, suppress T-cell activation, inhibit Th1 and Th17 immune responses, and enhance regulatory T-cell (Treg) development, which together make contributions to persistent infection and long-term persistence. Increasing resistance to generally used antibiotics like clarithromycin, metronidazole, and levofloxacin, etc. have significantly reduced treatment efficiency, depending on alternative therapeutic strategies. Recent research have highlighted the promising value of immunotherapy in controlling MDR H. pylori as therapeutic vaccines, monoclonal antibodies in against to bacterial virulence elements, cytokine-based modulation, and immune checkpoint inhibitors to restore host immunity and overcome bacterial persistence. Other modern approaches, which include IgY antibody immunotherapy extracted from egg yolks, bovine immunoglobulin, vonoprazan-primarily based triple therapy, and bismuth-containing regimens etc. have additionally proven significant outcomes. Understanding how H. pylori escapes immune detection and develops multi-drug resistance is essential for developing new innovative, efficient solutions. Combining rational antibiotic use with proper immunotherapeutic and preventive strategies ought to appreciably enhance treatment success. Such these integrated method will efficiently encounter MDR H. pylori infections and stopping their progression to lifestyle disrupting gastric sicknesses and life-threatening cancer.
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