We have established an in vitro model of long-term continuous Chlamydia pneumoniae infection in HEp-2 cells. Using transmission electron microscopy, we demonstrated the presence of spontaneous abnormal chlamydial inclusions similar in appearance to the persistent chlamydial forms induced in vitro by treatment with cytokines or antibiotics or by nutrient deprivation.Chlamydia pneumoniae is a frequent cause of communityacquired pneumonia and bronchitis in adults and children. Like other chlamydial species, it can cause prolonged or chronic infections which may persist for months or years (11). These persistent infections have been implicated in the development of a number of chronic diseases, including chronic obstructive pulmonary disease, atherosclerosis, and asthma (20). However, whether persistent C. pneumoniae is a cause, a triggering cofactor, or an innocent bystander remains controversial.Persistent chlamydial infections can be established in vitro using several methods, including treatment with cytokines (2, 4, 16, 18) or antibiotics (5, 6) or by deprivation of certain nutrients (13). In all cases they have been described as having morphologically abnormal reticulate bodies (RBs), which suggests that they are somehow altered during their otherwise normal development.In the present study we describe the ultrastructural findings determined using an in vitro model of long-term continuous C. pneumoniae infection in HEp-2 cells, a respiratory epithelial cell line (14,17).Briefly, confluent HEp-2 cells were inoculated once with C. pneumoniae isolate TW-183 (ATCC VR2282) or CM-1 (ATCC VR1360) to achieve 100% infection. After 3 to 5 days, when lysis of most of the infected host cells was seen, the culture medium was replaced with fresh medium but without added cycloheximide. After 1 week of further incubation, growth of colonies of new host cells was observed. Since then, continuous C. pneumoniae cultures have been maintained for over 4 years by reseeding the infected host cells into new flasks to prevent overgrowth. No new cells or chlamydiae were added. C. pneumoniae remained viable and cultivable in this model.Two days prior to sampling, the continuously infected cells were seeded onto six-well plates. Cell monolayers were trypsinized, and infected cells were collected into 1.5-ml centrifuge tubes and fixed with 3% glutaraldehyde in 0.1 M cacodylate buffer overnight at 4°C. Samples were prepared for transmission electron microscopy by standard procedures (9). Samples were postfixed in osmium tetroxide, followed by uranyl acetate. The cells were then dehydrated in increasing concentrations of ethanol (50, 70, and 90%) and acetone (90 and 100%) and subsequently embedded in Spurr's epoxy resin. Ultrathin sections (50 to 100 nm in thickness) were prepared and collected onto 200-mesh copper grids, contrasted with 1% uranyl acetate and Reynolds lead citrate before being examined, and photographed using a JEOL 1200EX transmission electron microscope.Three types of chlamydial inclusions were observed by transmission el...