“…Following binding of VacA to the surface of eukaryotic cells, the toxin can insert into the plasma membrane to form anionselective channels (23)(24)(25)(26) and can also be internalized (20,27,28). Intracellular expression of VacA by transient tranfection with VacA-encoding plasmids results in the formation of intracellular vacuoles that are indistinguishable from those that form when VacA is added to the outside of cells (29,30), suggesting that this toxin acts intracellularly.…”