Pathogenic strains of Helicobacter pylon cause progressive vacuolatlon and death of epithelial cells. To identify the nature of vacuoles, the distribution of markers of various membrane traffic compartments was studied. Vacuoles derive from the endocytic pathway since they include the fluid-phase marker Lucifer yellow. Early endosome markers such as rab5, trerrin, and trnsferrin receptor, as well as the lysosomal hydrolase cathepsin D, are excluded from these structures. In contrast, the vacuolar membrane is specifically stained by ity-purified antibodies against rab7, a small GTPase, localized to late endosomal compartments. The labeling of rab7 on vacuolar membranes increases as vacuolation progresses, without a concomitant increase of cellular rab7. Cell vacuolation is inhibited by the microtubule-depolymerizing agents nocodazole and colchicine. Taken together, these findins indicate that the vacuoles specifically originate from late endosomal compartments.Strong evidence indicates that toxigenic strains of Helicobacter pylori play a major role in the development of type B gastritis, peptic ulcers, and gastric adenocarcinoma (1-3). Biopsies of H. pylori-colonized stomach epithelium show cellular swelling, expansion of endosomal compartments, and extensive vacuolation (4). A vacuolar degeneration of epithelial cells, followed by cell death, is induced in vitro by H. pylori bacterial extracts (5-7). The luminal pH of these vacuoles is acidic, as deduced from the uptake of neutral red, a membrane-permeant amine that becomes protonated in the vacuolar lumen, and from the potentiating effect of ammonia (8). Two virulence factors, produced by pathogenic strains of H. pylori are thought to be mainly responsible for this cell degeneration and death: a urease and a cytotoxin (3,4,7,8). The urease hydrolyzes urea and the ammonia produced permeates membranes, as neutral red does, and accumulates as ammonium ions inside intracellular acidic compartments, thus causing their osmotic swelling (9-11). However important, this process alone cannot account for the manyfold increase in vacuole volume, because, without membrane addition, it would lead to vacuole rupture.Recently a cytotoxin has been isolated from culture supernatants of a virulent strain of H. pylori (12) and shown to cause vacuolation in vitro (12) and in vivo (13). The genes encoding this protein (vacA; H. pylori vacuolating toxin A), and a bacterial antigen (cagA) characteristic of H. pylori pathogenic strains, have been recently cloned and sequenced, and they share no similarity with any other known protein (13,14). Thus, the molecular mechanism of action of vacA and the sequence of events leading to vacuolar cell degeneration and death remain largely obscure.The inhibition of vacuole formation by bafilomycins, specific inhibitors of the vacuolar-type ATPase proton pump (V-ATPase) (15), indicates that vacuoles originate from intracellular compartments endowed with a V-ATPase, such as endosomes, lysosomes, or the trans-Golgi network (TGN) (16)(17)(18)....