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Published on: March 7, 2025
Exosome-Based Detection of Helicobacter pylori Infection and Clarithromycin Resistance in Children
Minghui Song1, Jingqing Zeng2, Zhanyong Yao1
1Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Salivary exosomes offer a sensitive, non-invasive method for diagnosing H. pylori infection in children. This approach also shows strong agreement with invasive tests for detecting antibiotic resistance, aiding treatment decisions.
Area of Science:
- Pediatric infectious diseases
- Molecular diagnostics
- Exosome biology
Background:
- High prevalence of Helicobacter pylori (H. pylori) infection in children.
- Limitations of invasive diagnostic methods like gastroscopy in pediatric patients.
- Need for reliable non-invasive H. pylori detection alternatives.
Purpose of the Study:
- Evaluate diagnostic value of salivary and urinary exosomes for H. pylori detection in children.
- Assess exosome-based detection of clarithromycin resistance.
- Compare non-invasive exosome tests with standard invasive methods.
Main Methods:
- Collection of saliva and urine samples from pediatric patients.
- Exosomal DNA extraction and quantitative PCR (qPCR) for H. pylori DNA and resistance genes.
- Calculation of sensitivity and specificity against gastroscopy reference standard.
Main Results:
- Salivary exosomes detected H. pylori with 93.67% sensitivity and 80.11% specificity.
- Urinary exosomes showed higher specificity (90.56%) but lower sensitivity (62.96%).
- Salivary exosome testing demonstrated 91.15% concordance with gastric tissue for clarithromycin resistance detection.
Conclusions:
- Salivary exosome analysis is a sensitive, well-tolerated, non-invasive method for pediatric H. pylori diagnosis.
- This method shows substantial agreement with invasive techniques for identifying clarithromycin resistance.
- Exosome-based diagnostics offer a promising tool for guiding pediatric H. pylori eradication therapy.
Background:
The prevalence of Helicobacter pylori (H. pylori) infection in children is high. Current diagnostic methods, particularly invasive techniques like gastroscopy, pose challenges for pediatric populations, highlighting the need for reliable non-invasive alternatives.
Aims:
This study aimed to evaluate the diagnostic value of salivary and urinary exosomes for detecting H. pylori infection and clarithromycin resistance in children.
Methods:
Saliva and urine samples were collected from children prior to elective gastroscopy. Exosomal DNA was extracted and subjected to qPCR for the detection of H. pylori DNA and clarithromycin resistance. The sensitivity and specificity of the salivary and urinary exosome tests were calculated against the reference standard, and their performance in detecting resistance was compared with tissue-based results.
Results:
Among 500 enrolled children, the H. pylori infection rate was 31.6%. Analysis of 500 salivary and 80 urine samples showed that salivary exosomes detected H. pylori with a sensitivity of 93.67% and specificity of 80.11%. Urinary exosomes offered higher specificity (90.56%) but lower sensitivity (62.96%). In the subset of 113 infected children tested for resistance, salivary exosome testing identified clarithromycin resistance in 17.70% of cases, showing a 91.15% concordance with gastric tissue testing (15.93%). The agreement between the two methods was substantial.
Conclusion:
Salivary exosome-based detection represents a highly sensitive and well-tolerated non-invasive method for diagnosing H. pylori infection in children. It also demonstrates substantial agreement with invasive methods in identifying clarithromycin resistance, offering a promising tool to guide precise eradication therapy in the pediatric population.
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