Clinical relevance of point mutations in the 23S rRNA gene in Helicobacter pylori eradication

Abstract

Clarithromycin-based triple therapy is prescribed worldwide for Helicobacter pylori eradication. However, increases in the clarithromycin resistance of H pylori are thought to be responsible for eradication failure. Here, we studied whether point mutations in domain V of the 23S rRNA gene can affect H pylori eradication failure in a prospective, open-label, observational study. Of the 755 enrolled patients, 299 patients (39.6%) had positive Campylobacter-like organism (CLO) tests. DNA sequencing analysis of H pylori 23S rRNA in 295 patients revealed that 2143G was the most frequent point mutation (24.7% of patients), followed by the 2182T mutation (11.5%). The overall eradication failure rate was 20.9% (42/201) in clarithromycin-based triple therapy. Patients with the 2143G had an approximately 60% eradication failure rate, which suggested that 2143G was a high-risk genotype for eradication failure. Patients with the 2182C genotype without 2143G had an 8.7% failure rate, and patients without 2143G or 2182C had only a 4.3% failure rate. The presence of 2143G, which was associated with previous eradication history and female sex, was an independent risk factor for eradication failure. In conclusion, the 2143G point mutation in the 23S rRNA of H pylori was an independent risk factor for eradication failure in clarithromycin-based triple therapy. Personalized tailored therapy based on the genotypes of 23S rRNA can increase eradication success rates in H pylori infections.

Helicobacter pylori eradication rates with concomitant and tailored therapy based on 23S rRNA point mutation: A multicenter randomized controlled trial

“…In addition, despite the weakness of the DPO‐based multiplex PCR method detecting only two subtypes of point mutations, the presence of point mutations was identified as a unique significant predictive factor for the success of eradication therapy in both the concomitant therapy and tailored therapy groups. The results of previous studies that suggest that the A2143G point mutation is the most important subtype associated with the in vivo eradication rate can be a reasonable explanation for our result …”

Helicobacter pylori eradication according to sequencing-based 23S ribosomal RNA point mutation associated with clarithromycin resistance

“…Among the point mutations identified, 21.3% were clinically significant; among those, A2143G was the most common point mutation (19.5%). The same result was observed in previous studies 19,21,22 .…”

“…however, its clinical significance has not been determined 15,22,23 In the present study, there was a significantly lower eradication rate in the 7-day PAM treatment group of clarithromycin resistance compared with that in the 7-day PAC treatment group of negative clarithromycin resistance [ITT; 55.4% (51/92) vs. 74.3% (252/339), P = 0.001, PP; 66.2% (51/77) vs. (131/138), P = 0.004]. In this study, a 7-day PAM regimen was used to treat clarithromycin-resistant H. pylori similar to our study.…”

<p>Eradication Treatment of <em>Helicobacter pylori</em> Infection Based on Molecular Pathologic Antibiotic Resistance</p>

“…Research suggested that the 2143G point mutation in the 23S rRNA was a risk factor for eradication failure and the presence of 2143G was significantly associated with female sex. 37 Our study also shows that the primary and secondary resistance rates of H. pylori to amoxicillin are 5.5% and 11.7%, whereas these rates to tetracycline are 12.9% and 30.0%, respectively. A prospective serial study conducted in Beijing of China found that the primary resistance rates of H. pylori were 6.7% and 4.9% to amoxicillin and tetracycline.…”