Intracellular niches for extracellular bacteria: lessons from Helicobacter pylori.

Helicobacter pylori colonizes the gastric epithelium of humans and plays a causative role in peptic ulcer disease and perhaps gastric cancer. H. pylori proliferates in the mucus layer over the epithelium and is not cleared by the host immune response. Although the mucus layer is the major reservoir of H. pylori in vivo, a growing body of evidence suggests that H. pylori can persist in multiple intracellular locales. Clinical isolates of H. pylori invade epithelial monolayers at least as well as Shigella. The intracellular organisms are cytotoxic, and bacterial microcolonies form on the exposed basement membrane. Both mononuclear phagocytes and neutrophils phagocytose unopsonized H. pylori. However, the internalized organisms are not killed efficiently and our recent data suggest that H. pylori disrupts phagosome maturation. Collectively, the data support the hypothesis that intracellular H. pylori represent a reservoir of organisms that contributes to bacterial persistence, host tissue damage, and treatment failure.