Figure 4.

An overview of the biofilm formation process: (1) Attachment stage of biofilm formation involves reversible and irreversible processes. Reversible attachment occurs when planktonic cells adhere to surfaces via chemical interactions, aided by virulence factors like adhesins and pili, triggering biofilm formation and increasing microbial susceptibility to antimicrobials. (2) Growth (irreversible attachment) leads to microbial proliferation and colony establishment, enhancing adherence through transcriptional changes. This phase promotes substrate exchange, metabolic product distribution, and byproduct excretion. H. pylori secrete EPS, which lower biofilm cell susceptibility to host defenses and antimicrobials. (3) Development features an increasing extracellular matrix around microcolonies, driven by EPS production and quorum-sensing communication, both vital for resistance. Mature biofilms have high EPS content and interstitial spaces for nutrient, water, and planktonic cell movement. (4) Spreading occurs when detachment due to nutrient depletion prompts cells to seek new surfaces through erosion and sloughing.