Table 4.

Limitations of current research on OMVs and exosomes related to H. pylori infection.

Limitation	Description	References
Standardization of isolation methods	Current protocols for isolating OMVs and exosomes are not standardized, impacting reproducibility and clinical translation.	(18, 132–134)
In vitro model limitations	Most studies rely on in vitro models that do not accurately replicate the human gastrointestinal microenvironment, raising concerns about translational relevance.	(119, 135)
Understanding of biogenesis and release mechanisms	There is a lack of comprehensive understanding of how exosomes are produced and released from H. pylori-infected cells, including their specific cargo and functions.	(4, 135)
Genetic diversity in H. pylori	Significant genetic diversity among H. pylori strains affects OMV and exosome production, leading to inconsistent findings regarding their immunomodulatory effects.	(21, 117, 136)
Shape transitions of the bacterium	The shape transitions of the bacterium from spiral to curved, doughnut-shaped, and finally coccoid morphologies	(17, 19)
Specific signaling pathways and receptor interactions	The signaling pathways and receptor interactions involved in the immunomodulatory effects of OMVs and exosomes remain poorly characterized.	(37, 67, 68, 116)