# Exploring Medicinal Plants for Anti-Helicobacter Pylori Activity Abstract -Helicobacter pylori is a class 1 carcinogen that requires targeted therapeutic strategy. A number of drugs including proton pump inhibitors, antibiotics and antiprotozoals are available for the treatment of Helicobacter pylori infections like chronic gastric irritation, gastro duodenal ulcers and low grade gastric mucosa associated lymphoid tissue lymphoma. Clinical evaluation of these drugs has shown the incidence of relapses, side effects and drug interactions. Multi drug resistance to Helicobacter pylori has been the main reason for treatment failure. This has been the rationale for the development of new anti-Helicobacter pylori drugs and search for novel molecules has been extended to medicinal herbs that offer better protection, decreased relapse and undevelopment of resistance towards bacteria. The present article reviews the medicinal herbs from global perspective for their anti-Helicobacter pylori activity and active compounds from the plants responsible for this activity. We have highlighted some of the important plants and their active constituents reported for their anti-Helicobacter pylori activity. Ancient system of medicine (Ayurvedic and Unani) supported by modern science is necessary to isolate, characterize and standardize the active constituents from herbal sources for anti-Helicobacter pylori activity. Health Organization has categorized H. pylori as a class 1 carcinogen. 5 Eradication of the organism has been shown to result in ulcer healing, prevention of peptic ulcer reoccurrence and may also reduce the prevalence of gastric cancer in high-risk populations. 6 Many clinical trails involving patients with gastric and duodenal ulcers show that curing the infection is associated with a significant reduction in ulcer reoccurrence rates. [7][8] Since 1984 physicians prescribing triple therapy to treat H. pylori infections which includes three options. First option includes the combination of proton pump inhibitor (PPI), clarithromycin and ampicillin. Second option includes PPI, clarithromycin and metronidazole. Third option includes bismuth subsalicylate, metronidazole and tetracycline, but the cure rate from standard triple therapy has been low as 50%. 9-10 However, eradication by the triple therapy is not always successful and acquisition by H. pylori resistance to antibiotics could present a serious problem that may reduce treatment efficiency. 11 Quadruple therapy, where three antibiotics are taken alongside the PPI, has also been used in cases where triple therapy has not been successful. But the success rate was only 67%. 12 Many strains of H. pylori are now developing resistance to commonly used antibiotics. H. pylory acquires resistance by mutations to all the antibiotics used in the treatment regimens. The mechanism of resistance involves point mutations which are transmitted vertically, however transformation may be possible if two strains are present simultaneously in the stomach. Drug efflux proteins also can contribute to natural insensitivity to antibiotics and to emerging antibiotic resistance. Efflux pump gene hef A of H. pylori play an important role in multidrug resistance. Global resistance of H. pylori to metronidazole, clarithromycin, amoxicillin and tetracycline was also reported. One person may have more than one strain of H. pylori. Here the antibiotics may kill one strain, but not the other. [13][14] Furthermore, undesirable side effects of the drugs and the significant cost of combination therapy require the # Global Journal of Medical Research Volume XII Issue IV Version I elicobacter pylori (H. pylori), a Gram -negative 1984 by Marshall et al, is one of the most common chronic bacterial pathogens in humans. 1 Approximately 50% of people in the world are infected with it, and its prevalence is significantly higher in developing countries than in developed countries. 2 Once a person is infected, the organism can live in the stomach indefinitely and may not cause clinical illness. It is still not clear how H.pylori are transmitted or why some people infected with bacteria become sick and others do not. 3 H. pylori infection is an important etiologic impetus usually leading to chronic gastritis, gastroduodenal ulcer and low grade gastric mucosa associated lymphoid tissue lymphoma. Epidemiological data shows that a high H. pylori infection rate is related to the high incidence of gastric cancer and gastric adenocarcinoma. 4 World H spiral bacterium which was first detected in I. # Introduction II. Current Treatment Regimens As phytomedicine has proved to be an untapped treasure for the discovery of lead compounds to cure gastrointestinal disorders. Hence several studies have been aimed to evaluate the anti-helicobacter pylori activity of medicinal herbs. 15 To the best of our knowledge, there is no extensive global view on exploring medicinal plants for anti-helicobacter pylori activity. List of medicinal herbs with anti-Helicobacter pylori activity including their source and active extracts are given in table 1. The insolubility of non-polar extracts makes it very difficult for the investigators to be used in an aqueous medium during the study of anti-Helicobacter pylori activity. 26 Water or alcohol (methanol/ethanol) are used mainly for a large number of crude extract preparations. 27 The type of solvent used may have an effect on the nature of the compounds extracted and the resulting bioactivity of the extract. 28 To estimate the value of each extract therefore, several factors, including the rate of extraction, the quantity extracted (yield), the diversity of compounds extracted, the diversity of inhibitory compounds extracted, the ease of subsequent handling of the extracts, toxicity of the solvent in the bioassays and the potential health hazards of the extractants have to be evaluated. In many research works, methanol/ethanol is used for alkaloid extraction; acetone for flavonoids and steroids; hexane, diethyl ether and chloroform for fat soluble oils, wax, lipids and esters. Dichloromethane for terpenoids, ethylacetate for esters, ethanol may be used for sterols, poly phenols, tannins and water for water soluble components like glycosides, polysaccharides, polypeptides and lectins. 29 Hundreds of plants with antimicrobial compounds have been reported. However, very few of these studies have reported the in vivo anti-Helicobacter pylori activity of these compounds. It is very important to know whether these compounds will still maintain their maximum activity in the gastric mucus niche of H. pylori. Anti-Helicobacter pylori compounds from plants and their mechanism of action are given in table 2. Curcumin, biologically active poly phenolic from Curcuma longa has recently been shown to arrest H. pylori growth. The anti-Helicobacter pylori activity of curcumin against 65 clinical isolates of H. pylori in vitro was examined. Minimum inhibitory concentration ranging from 5-50 µg/ml, showing its effectiveness against H. pylori growth in vitro irrespective of genetic makeup of strains. Curcumin showed immense therapeutic potential against H.pylori infection as it was highly effective in eradication of H.pylori from infected mice as well as restoration of H.pylori induced gastric damage. Curcuma longa extract was the most efficient in killing the seven strains of H.pylori within 15 minutes followed by chilli and ginger. [46][47][48] Mallotus phillipinesis is (Lam) Muell. Exhibited the most potent bactericidal activity against H.pylori which completely killed the bacteria at the concentration of 15.6-31.2 µg/ml. 16 There is no evidence of in vivo effectiveness of this plant. Antibacterial activity of Allium sativum L(garlic) against H.pylori is well documented (40 µg/ml) and resistance has not been reported.The synergistic action of garlic and omeprazole against H.pylori was also reported. Thiosulfinates play an important role in the antibiotic activity of garlic. Further clinical evaluation seems warranted. [49][50][51] A mixture of tannic acid and n-propyl gallate can limit the gastric mucosa deterioration induced by H.pylori infection and vac A administration, suggest that vac A inhibition plays a role in this protective activity. So, polyphenols from plant sources may contribute to limit the pathological outcomes of H.pylori infection. 52 Successive extracts of Sapindus mukorossi and Rheum emodi inhibited the growth of 30 resistant clinical isolates of H.pylori in vitro and in vivo studies and there was no acquired resistance against these herbal extracts even after ten consecutive passages. 53 The evidence summarized above tentatively suggests possible benefits from some herbal sources with anti-Helicobacter pylori activity. Herbal science, Ayurvedic knowledge supported by modern science is required to standardize the plant extracts and to isolate, characterize and standardize the active constituents from plant sources for anti-Helicobacter pylori activity. Extensive investigations and large scale well designed clinical trails are required to provide more conclusive proof to explore medicinal herbs for anti-Helicobacter pylori activity. Table1 : Medicinal herbs having anti-Helicobacter pylori activity (global perspective). # Global Journal of 4![](image-2.png "hydroxy- 4") Exploring Medicinal Plants for Anti-Helicobacter Pylori ActivityBotanical nameSourcePart usedExtractReferenceSouth Asian HerbsMallotus phillipinesisPakistancovering fruitAqueous ethanol (70%)16,17,18Curcuma amada Roxb.PakistanrhizomeMyristica fragrans Houtt.PakistanseedPsoralea corylifoliaPakistanseedGlycyrrhiza glabra LIndia,SrilankarootTerminalia chebulaPakistanfruitCurcuma longa LIndiarhizomeCuminum cyminumSrilankaseedCoccinia grandisIndialeavesEthanolTerminalia arjunaIndiabarkMethanolEast Asian HerbsRhizoma coptidisChinarhizomeAqueous19,20Radix scutellariaeChinarootRadix isatidis Asasarum sieboldiChina Korearoot rootMethanolLindera strychifoliaKorearootAngelica tenuissimaKorearootAlpinia oxyphyllaKoreafruitAmerican HerbsZingiber officinaleUSArhizomeMethanol21Rosmarinus officinalisUSArosemary leafFoeniculum vulgareUSAseedNigella sativaUSAseedAfrican HerbsTerminalia spinosaEast Africayoung branchesAqueous22Harrisonia abyssinicaEast AfricarootXimenia caffraEast AfricarootAzadirachta indicaEast Africaleaves, stem barkCombretum molleSouth Africastem barkAcetone23Sclerocarya birreaSouth Africastem barkCarica papayaNigerialeafAqueous& ethanol24Morinda lucidaNigerialeafOctimum gratissimum Phyllanthus amarusNigeria Nigerialeaf leafBrazelian HerbsBixa orellana LBrazilseedAqueous ethanol (96%)25Chamonilla recutita LBrazilinflorescenceIlex paraguariensis ABrazilgreen leavesMalva sylvestris LBrazilinflorescence & leaves 2Exploring Medicinal Plants for Anti-Helicobacter Pylori ActivityCompound nameExamplesMechanism of actionreferenceQuinonesQuinones,idebenone,duroquinone,menadione,juglone,coenzyme Q 1Flavones, flavonoidsQuercetin, catechins, myristin, rutinand flavonolsPhenolicsandCatechol, pyrogallol, curcuminpolyphenolsTanninsPolymeric phenols, hydrolysable tannins7-hydroxy-4-methylcoumarin,6,7-CoumarinsTerpenoidsandessential oilsAlkaloidsLectins and polypeptides © 2012 Global Journals Inc. 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