Editorial: Helicobacter pylori and its mechanisms of antibiotic survival

COPYRIGHT © 2023 Krzyżek, Puca and Grande. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Editorial PUBLISHED 23 February 2023 DOI 10.3389/fcimb.2023.1164227

increased penetration of these antibiotics. In the last stage of the research, it was shown that LipoLLA had a marginal effect on the tested probiotics and did not disturb the composition of the intestinal microbiota of human volunteers. A phenomenon of a crucial importance in therapeutic failures, although still poorly verified scientifically, is heteroresistance (a mosaic resistance profile). Therefore, in the next research article of this Research Topic, Wang et al. focused on determining the prevalence and clinical significance of heteroresistance in H. pylori strains isolated from gastric biopsies. It was observed that heteroresistance to one of the antibiotics (clarithromycin or levofloxacin) was detected in approximately 14% of strains, and double heteroresistance was identified in more than 3% of isolates. Importantly, it was noticed that most of the strains with levofloxacin heteroresistance presented convergent phenotypic resistance when applying culture identification, whereas the results diverged significantly during analysis of clarithromycin heteroresistance in the same way. The authors pointed out that when using traditional clarithromycin-based treatment methods for H. pylori, there is a risk of not detecting heteroresistance to this antibiotic and a possibility of subsequent therapeutic failure.
As stated at the beginning of this Editorial, some complex physiological processes in microorganisms may also generate tolerance or resistance to antimicrobials. Therefore, the next research paper focused on the contribution of biofilm formation in the dissemination of antibiotic resistance in H. pylori (Krzyzėk et al., 2022). Our research team noticed a strong correlation between clarithromycin resistance or multidrug resistance of H. pylori strains and their enhanced biofilm production capacity. It was observed that these strains were characterized by more intensive production of eDNA and proteins, both of which constituted components of the biofilm matrix. The bacterial cells of strong biofilm producers showed an increased tendency for selfaggregation and were more densely entwined with flagella. Additionally, these strains secreted much higher amounts of membrane vesicles into the local environment. These results indicate a close interconnection between the physiological features associated with increased biofilm formation and the antibiotic resistance profile of H. pylori strains. It is also worth mentioning that in this article, for the first time, microfluidic conditions were used for comparative analysis of biofilm formation by clinical H. pylori strains.
In summary, the articles constituting this Research Topic provide a valuable addition to our understanding of mechanisms responsible for therapeutic failures of H. pylori infections. We hope that this knowledge may contribute to the development of new types of therapies targeting H. pylori and the reduction of the spread of resistant and multidrug-resistant strains of this bacterium.

Author contributions
PK wrote the initial draft of the manuscript. All authors have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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