Anti-Helicobacter pylori activities were determined by agar dilution, confocal laser scanning microscopy, and cell proliferation assays following treatment with various grape extracts. Muscadine grape skin possessed the strongest activity, followed by grape synergy (skin and seed) and seed, suggesting that higher phenolic levels do not necessarily determine overall anti-H. pylori efficacy.Helicobacter pylori is considered the etiological agent of peptic ulcers and gastritis and is associated with mucosa-associated lymphoid tissue lymphoma and gastric cancer (4). Although treatment is usually effective, it can result in side effects, such as antibiotic resistance development (14) and relapse due to low compliance (2). Therefore, alternative methods should be explored to treat H. pylori infection.Studies have reported many natural plant extracts with anti-H. pylori activity, including garlic, broccoli, cranberries, and green tea (5,12,16,26). Grapes (Vitis vinifera), well known for their high levels of antioxidants and polyphenols, have also shown promise as novel antimicrobial agents. A few studies have already reported the anti-H. pylori activities of grape seed and wine, including an active chemical constituent (e.g., resveratrol, a stilbene from red wine) (13). However, no effort has been made to evaluate the grape skin or different grape types (e.g., table and muscadine grapes). For example, muscadines (Vitis rotundifolia) contain significantly higher levels of phenolics than commercial table grapes in addition to possessing some unique forms of these compounds (23). However, little is currently known about the antibacterial properties these fruits possess, making them prime candidates for study. In addition, it is believed that the high complexity of bioactive compounds present in these products and their broad range of activity over a number of microorganisms may make it difficult for microbes to acquire resistance during treatment (26).The objectives of this study were to investigate the effects of various grape extracts against H. pylori and to determine any correlations between anti-H. pylori activity and extract phenolic content.Five H. pylori strains (G2-1, 26695, WV 99, NB2-1, and 1324P-1) were obtained from Douglas Berg (Washington University, St. Louis, MO), and five clinical H. pylori isolates (D5251, D5131, D5178, D5136, and D5135) were obtained from Ben Gold (Emory University and Centers for Disease Control and Prevention, Atlanta, GA). H. pylori P1pDH80, a green fluorescent protein (GFP)-labeled strain, was provided by Rainer Haas (Max von Pettenkofer Institut fur Hygiene und Medizinische Mikrobiologie, Munchen, Germany). H. pylori SS1, a mouse-adapted strain, was provided by Kathryn Eaton (Department of Veterinary Biosciences, Ohio State University, Columbus, OH). For the entire study, bacteria were grown on brain heart infusion agar (Difco Laboratories, Detroit, MI) (pH 7.4 Ϯ 0.2) supplemented with 10% horse serum (HS) (Sigma Chemical Co., St. Louis, MO) at 37°C for 72 h under microaerophilic ...