Helicobacter pylori (H. pylori) is a prevalent bacterial infection that colonizes the
gastric mucosa, affecting approximately 50% of the global population. Classified by the
WHO as a class 1 carcinogen in 1994 and further supported by extensive evidence, H.
pylori is recognized as a leading cause of ulcers and a significant risk factor for the
development of gastric cancer. Despite a slight decline in the prevalence of H. pylori
infection in developed countries, the absolute number of infected individuals in the U.S.
remains alarmingly high at approximately 36% of the U.S. population. Gastric cancer,
associated with H. pylori infection, continues to be a major health concern worldwide,
accounting for over 1.1 million new cases and approximately 770,000 deaths each year. The
causal link between H. pylori infection and nearly 90% of gastric cancer cases
underscores the critical importance of effective eradication strategies.
Current treatments for H. pylori infection, which typically consist of triple or
quadruple therapy combining two or three antibiotics with proton pump inhibitors (PPIs),
are successful in approximately 80% of cases. This leaves a significant proportion of
cases unresolved. In addition, the emergence of multidrug-resistant H. pylori strains,
particularly those resistant to clarithromycin and quinolones, challenges these
conventional approaches. The broader issue of increasing antibiotic resistance, leads to
a reliance on back-up antibiotics for cases where standard treatments fail. A sharp
decline of eradication rates during the last decade, underscores the need for alternative
therapeutic strategies. A recent study estimated the total cost of H. pylori treatment
failure to be over $5.3 billion in the U.S., primarily due to hospitalizations,
medications, and outpatient visits for complications such as peptic ulcer disease and
non-cardia gastric cancer. Research into treatments beyond antibiotics is needed to
address the growing risk of resistance and to ensure sustainable, effective solutions for
H. pylori infection.
The field of plasma medicine, particularly through the use of Argon Plasma Coagulation
(APC), offers promising new avenues for addressing this challenge. APC, a technology with
over 30 years of clinical safety and efficacy, has been utilized for bleeding management,
ablation of cancerous tissues, and precise treatments in sensitive areas. More recently,
it has shown good efficacy in the treatment of cervical intraepithelial lesions (CIN) at
lower power levels with no visible macroscopic thermal effect. Recent advancements in
plasma medicine have highlighted the antibacterial properties of physical plasma. It has
demonstrated remarkable efficacy in wound healing by effectively eradicating bacterial
infections, including those resistant to antibiotics. The effect of non-thermal plasma
treatment is based on the high energy and voltage of the plasma, which generates reactive
oxygen and nitrogen species (RONS), an electric field that can cause electroporative
effects, and UV light emitted in the plasma.
These effects are present when plasma is applied directly to the site of action, but also
when a liquid medium such as sodium chloride solution is used as a buffer substance. This
concept of indirect plasma treatment is often referred to as Plasma Activated Liquid
(PAL). In proprietary preclinical studies, PAL generated with APC probes using forced APC
Effect 8 has been shown to achieve a 5-log reduction in H. pylori (SK225) after 15
minutes incubation. In a multidrug resistant E. coli 4MRGN stain (VC8874), a 6-log
reduction was achieved after 15 minutes incubation.
This demonstrates that PAL harnesses the antimicrobial properties of plasma in a
non-thermal, liquid-based approach. This innovative approach allows the effects of plasma
to be applied to large surface areas, such as the gastric mucosa, offering a potentially
effective treatment for H. pylori infection without the drawbacks associated with
antibiotic resistance. The established safety record of APC and the common use of liquids
as irrigation or injection solutions in endoscopy provide a solid foundation for its
potential applications in the treatment of H. pylori infection.