Helicobacter pylori eradication with either quadruple regimen with lactoferrin or levofloxacin-based triple therapy: A multicentre study

Zullo, Angelo; Francesco, De; Scaccianoce, Giuseppe; Manes, Gianpiero; Efrati, C.; Hassan, Cesare; Maconi, Giovanni; Piglionica, D; Cannaviello, C.; Panella, C.; Morini, Sergio; Ierardi, Enzo

doi:10.1016/j.dld.2007.05.021

Cited by 31 publications

(22 citation statements)

References 35 publications

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“…The previously reported inability of H. pylori to use bovine Lf led to a number of clinical trials in which Lf was used as a treatment adjuvant with the hope of starving H. pylori for iron. Our finding that H. pylori is able to utilize bovine holo-Lf may explain some of the disappointing results of clinical trials employing Lf as a treatment adjuvant (40,41). A study comparing treatment of H. pylori-infected mice with bovine Lf and treatment of H. pylori-infected mice with human Lf concluded that neither protein reduced the bacterial load, and both groups of mice had higher levels of inflammation (based on myeloperoxidase levels) than controls (19).…”

Section: Discussionmentioning

confidence: 94%

“…Cost and unacceptable drug side effects are also barriers to eradication of H. pylori infections, which makes development of new treatment methods a high priority. Based on the reported inability of H. pylori to utilize bovine Lf, this protein is being tested as a treatment adjuvant (11,34,41). Specific drugs are also being developed to inhibit heme utilization and other mechanisms of iron uptake by pathogens (7,32).…”

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confidence: 99%

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Unique Host Iron Utilization Mechanisms of Helicobacter pylori Revealed with Iron-Deficient Chemically Defined Media

et al. 2010

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Helicobacter pylori chronically infects the gastric mucosa, where it can be found free in mucus, attached to cells, and intracellularly. H. pylori requires iron for growth, but the sources of iron used in vivo are unclear. In previous studies, the inability to culture H. pylori without serum made it difficult to determine which host iron sources might be used by H. pylori. Using iron-deficient, chemically defined medium, we determined that H. pylori can bind and extract iron from hemoglobin, transferrin, and lactoferrin. H. pylori can use both bovine and human versions of both lactoferrin and transferrin, contrary to previous reports. Unlike other pathogens, H. pylori preferentially binds the iron-free forms of transferrin and lactoferrin, which limits its ability to extract iron from normal serum, which is not iron saturated. This novel strategy may have evolved to permit limited growth in host tissue during persistent colonization while excessive injury or iron depletion is prevented.

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Section: Discussionmentioning

confidence: 94%

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confidence: 99%

Unique Host Iron Utilization Mechanisms of Helicobacter pylori Revealed with Iron-Deficient Chemically Defined Media

et al. 2010

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“…LF and LFcin have been used in combination with antibiotics to treat E. coli including the resistant strains, Helicobacter pylori and hepatitis C infection (Sanchez and Watts 1999;Vorland et al 1999;Chen et al 2004b;Kaito et al 2007;Zullo et al 2007), and in these studies, adding LF/LFcin has produced positive results. This combination therapy is proposed to be an important strategy for treating E. coli infections, especially those due to resistant strains and those with a fulminant course.…”

Section: Combination Therapy With Antibiotics For E Coli Infection Amentioning

confidence: 92%

“…A few studies of bovine LF supplementation have been conducted to determine its effects on fecal flora, hepatitis C, Helicobacter pylori and anemia (Kaito et al 2007;Nappi et al 2009;Zullo et al 2007). No evident adverse effect has been reported related to the clinical use of bovine LF.…”

Section: Clinical Studies Of Antimicrobial Activity Of Lactoferrinmentioning

confidence: 97%

Lactoferrin: an iron-binding antimicrobial protein against Escherichia coli infection

et al. 2011

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Escherichia coli (E. coli) are the most common aerobic gram-negative bacilli in a normal intestinal tract. They cause most of the intra-abdominal infections, wound infections associated with abdominal surgery, and septicemia. Most of these infections are of endogenous intestinal origin. Lactoferrin (LF) is an iron-binding glycoprotein found in milk and various external secretions. This protein has been found to have a number of biological functions, including antimicrobial, anti-cancer, antioxidant, and immunomodulatory effects. Partial degradation of LF by pepsin can give rise to peptides termed lactoferricin (LFcin) with more potent antimicrobial activity. LF and LFcin have been shown to inhibit the growth of a number of pathogenic bacteria (including E. coli and antibiotic-resistant strains), fungi, and even viruses in both in vitro and in vivo studies. We previously demonstrated that both recombinant porcine LF (pLF) produced from yeast and a synthetic 20-residue porcine LFcin peptide exhibit antimicrobial activity in vitro. In one of our recent studies, we performed pathogen challenges, including pathogenic E. coli, Staphylococcus aureus and Candida albicans, of the digestive tract of a transgenic milk-fed animal model. The results showed that LF has broad spectrum antimicrobial activity in the digestive tract and protects the mucosa of the small intestine from injury. Our following study also revealed that pLF as a feedstuff additive enhances avian immunity, including antibody formation and cell-mediated immunity. All of these results suggest that LF could be a novel natural protein in the treatment and prevention of infections with E. coli or antibiotic-resistant bacteria strains.

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“…In addition, in this study, the eradication rate of bismuth-containing QT for 10 days was 94.2% in Turkey where a high frequency of metronidazole and clarithromycin resistance has been observed [19,20]. Many prospective studies were recently performed, and all of these regimens seem to be highly effective in the eradication of H. pylori [11,17,18,[21][22][23][24]. Although, QT is a highly effective regimen that could be recommended as a first-line therapy, bismuth is not available in many developed countries due to its potential nephrotoxicity [25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Comparison of three different regimens against Helicobacter pylori as a first-line treatment: A randomized clinical trial

Kefeli

Başyiğit

Yeniova

et al. 2015

Bosn J of Basic Med Sci

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Treatments with bismuth-containing quadruple therapy (QT), sequential therapy (ST), or concomitant therapy (CT) have been proposed as empirical first-line regimens for Helicobacter pylori. We compared the efficacy and tolerability of 10 days bismuth-containing quadruple QT, 10 days ST, and 10 days CT with as first-line treatments for H. pylori in a randomized crossover study. The subjects were randomly divided into three groups. The first 130 patients were treated with rabeprazole, bismuth potassium citrate, metronidazole, and tetracycline for 10 days. The second 130 patients in the sequential group were treated with rabeprazole and amoxicillin for 5 days, and then rabeprazole, clarithromycin, and metronidazole for an additional 5 days. The last 130 patients in the concomitant group were treated with rabeprazole, amoxicillin, clarithromycin, and metronidazole for 10 days. H. pylori eradication was confirmed by urea breath test at 6 weeks. The primary outcome was eradication rates of first-line treatment by intention to treat and per protocol (PP) analyzes. There was no difference between the average ages and the male/female ratio of the groups. The PP analysis was performed on 121, 119, and 118 patients in the QT, ST, and CT groups, respectively. In the PP analysis, the successful eradication 94.2% (114/121), 95.0% (113/119), and 95.8% (113/118) the QT, ST, and CT groups, respectively. There was no significant difference among the three groups (p = 0.86). 10 days QT, ST, and CT are highly effective as empirical first-line therapies for H. pylori in the region with high clarithromycin resistance.

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Helicobacter pylori eradication with either quadruple regimen with lactoferrin or levofloxacin-based triple therapy: A multicentre study

Cited by 31 publications

References 35 publications

Unique Host Iron Utilization Mechanisms of Helicobacter pylori Revealed with Iron-Deficient Chemically Defined Media

Unique Host Iron Utilization Mechanisms of Helicobacter pylori Revealed with Iron-Deficient Chemically Defined Media

Lactoferrin: an iron-binding antimicrobial protein against Escherichia coli infection

Comparison of three different regimens against Helicobacter pylori as a first-line treatment: A randomized clinical trial

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