Helicobacter cinaedi is an emerging opportunistic pathogen associated with infections of diverse anatomic sites. Nevertheless, the species demonstrates fastidious axenic growth; it has been described as requiring a microaerobic atmosphere, along with a strong preference for supplemental H 2 gas. In this context, we examined the hypothesis that in vitro growth of H. cinaedi could be enhanced by coculture with human epithelial cells. When inoculated (in Ham's F12 medium) over Caco-2 monolayers, the type strain (ATCC BAA-847) gained the ability to proliferate under H 2 -free aerobic conditions. Identical results were observed during coculture with several other monolayer types (LS-174T, AGS, and HeLa). Under chemically defined conditions, 40 amino acids and carboxylates were screened for their effect on the organism's atmospheric requirements. Several molecules promoted
Helicobacter cinaedi is an emerging pathogen of the class Epsilonproteobacteria. This spiral-shaped Gram-negative rod is associated with opportunistic infections of multiple anatomic sites, including the intestinal tract (1, 2), blood (3, 4), peripheral soft tissue (5, 6), and other body fluids (7-9). This behavior contrasts with related Helicobacter and Campylobacter species, which typically demonstrate a more limited tissue tropism. H. cinaedi was identified ϳ30 years ago in men who have sex with men (1) and HIV patients (10, 11), although infections have since been described in other immunocompromised groups (12, 13), as well as immunocompetent (14-17) and postsurgical patients (18).Despite abundant case reports, the ecology/epidemiology of H. cinaedi remains poorly defined and sparsely studied. Limited molecular evidence suggests that it can be found in the stools of a small percentage of healthy individuals (19). The organism has also been isolated from animal feces (including rodents, dogs, and primates), although its role as a veterinary and/or zoonotic pathogen is uncertain (20,21). An environmental reservoir has not yet been identified. The majority of recent literature on H. cinaedi (for instance, many of the current references) originates from Japan, although it is unclear whether this reflects regional prevalence or an increased awareness among Japanese investigators. Knowledge of H. cinaedi biology and tools for its genetic manipulation are likewise sparse, limited to several studies of targeted deletion mutants. These deletion mutants include strains deficient in cytolethal distending toxin (22) and alkyl hydroperoxide reductase (23), both of which demonstrate attenuated virulence in a murine colitis model.Likely contributing to this paucity of information, H. cinaedi is a challenging organism to manipulate in vitro. Strains are notable for poor, film-like growth on agar plates, a preference for biphasic culture (broth over agar), and decreased viability on subculture (24, 25). Recommended medium conditions for H. cinaedi are not