# Molecular Mechanisms of Biofilm Formation in Helicobacter pylori
## 7 Discussion: Alternative Solution Against the Biofilm and Resistance  
The biofilm formation mechanisms mentioned above could be the potential target for biofilm prevention and _H. pylori_ eradication. The biofilm has reportedly inhibited and decreased the function of commonly used antibiotics. The battle against _H. pylori_ infections has spurred innovative research on novel treatment modalities. Therefore, exploration of some alternative compounds is required. For instance, extracts from _Rubus ideas_ have been noted for their bioactive compounds that may inhibit _H. pylori_ proliferation, with studies indicating that polyphenols from these plants can exert cytotoxic effects on cancer cells, suggesting a broader therapeutic potential [103]. Additionally, probiotics such as _Lactobacillus plantarum_ and _Lactobacillus salivarius_ have effectively reduced _H. pylori_ adhesion and inflammation by competitively excluding pathogens [104; 105]. Moreover, compounds like curcumin, found in turmeric, and eugenol, derived from clove oil, have also been investigated for their ability to combat _H. pylori_. Curcumin exhibits anti-inflammatory properties, potentially weakening the biofilm structure and making it more susceptible to other treatments [106]. Another compound reported was Quinone Derivatives (Porphyromon and Phillygenin), which can generate reactive oxygen species (ROS). ROS can disrupt the biofilm matrix and lead to dispersal [107]. In addition to discovering new alternative drugs from natural resources, improving the specificity and effectiveness of the drug delivery system is also necessary. _H. pylori_ colonizes a particular area in the gastric pit and is frequently washed with the acid. Therefore, a drug delivered and activated in the target can reduce unnecessary side effects to other healthy tissue. Nanotechnology has played a significant role, and researchers have explored various approaches. The most recent study utilized mucus-penetrating nanoplatforms as ultrasound-induced free radical initiators to specifically target _H. pylori_[108]. Another study showcased the efficacy of rubropunctatin-silver composite nanoliposomes and resveratrol-loaded chitosan nanoparticles in eradicating _H. pylori_ both in vitro and in vivo [109; 110]. Furthermore, exploring biofilm disruption using nanostructured lipid carriers and fullerenol nanoparticles has opened new avenues for eradicating _H. pylori_ infections [111]. A study investigating nanoparticles targeting quorum sensing also showed a potential strategy to combat biofilms [112]. Moreover, developing gastric acid-responsive ROS nanogenerators and residence time-extended nanoparticles has offered innovative strategies for treating _H. pylori_ infections without disrupting the intestinal flora [113; 114]. The barrier of mucus formed by biofilms can also hinder drug deliveries, as discussed in the previous section. Developing multifunctional vesicles and copper-bearing metal-organic frameworks with mucus-penetrating capabilities has shown promise in effectively clearing mucosal colonized _H. pylori_[115]. Additionally, using blue light-emitting diodes and antimicrobial peptides has successfully targeted biofilm and multidrug-resistant strains of _H. pylori_[116]. In the quest for effective treatments, the synergy between natural compounds like Armeniaspirol A and synthetic agents has shown potential in combating drug-resistant strains of _H. pylori_[117]. Utilizing antimicrobial peptides, chitosan-albumin-based nano-antimicrobials, and electrolyzed superoxidized solutions has provided new avenues for addressing biofilm-related infections. The research landscape continues to evolve with studies focusing on the genetic determinants of biofilm formation, the role of bacterial cellulose chemisorbed with anti-metabolites, and the impact of phyto anti-biofilm elicitors on _H. pylori_[118]. To eradicate biofilms and _H.