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In developing and rural regions where prevalence rate exceeds 60%, persistence and waterborne transmission are often linked to poor sanitation conditions. Here we demonstrate that H. pylori not only survives but also replicates within acidified free-living amoebal phagosomes. Bacterial counts of the clinical isolate H. pylori G27 increased over 50-fold after three days in co-culture with amoebae. In contrast, a H. pylori mutant deficient in a cagPAI gene (cagE) showed little growth within amoebae, demonstrating the likely importance of a type IV secretion system in H. pylori for amoebal infection. We also demonstrate that H. pylori can be packaged by amoebae and released in extracellular vesicles. Furthermore, and for the first time, we successfully demonstrate the ability of two free-living amoebae to revert and recover viable but non-cultivable coccoid (VBNC)-H. pylori to a culturable state. Our studies provide evidence to support the hypothesis that amoebae and perhaps other free-living protozoa contribute to the replication and persistence of human-pathogenic H. pylori by providing a protected intracellular microenvironment for this pathogen to persist in natural aquatic environments and engineered water systems, thereby H. pylori potentially uses amoeba as a carrier and a vector of transmission.<\/jats:p>","DOI":"10.1093\/femsec\/fiaa182","type":"journal-article","created":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T19:15:40Z","timestamp":1599074140000},"source":"Crossref","is-referenced-by-count":19,"title":["Role of amoebae for survival and recovery of \u2018non-culturable\u2019 Helicobacter pylori cells in aquatic environments"],"prefix":"10.1093","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4532-1751","authenticated-orcid":false,"given":"Rafik","family":"Dey","sequence":"first","affiliation":[{"name":"School of Public Health, University of Alberta,11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada"},{"name":"Deparment of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta T6G 2E1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aja","family":"Rieger","sequence":"additional","affiliation":[{"name":"Deparment of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta T6G 2E1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Banting","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Alberta,11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J","family":"Ashbolt","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Alberta,11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada"},{"name":"Deparment of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta T6G 2E1, Canada"},{"name":"Provincial Laboratory for Public Health (ProvLab), Alberta Health Services, Edmonton, Canada"},{"name":"School of Environmental, Sciense and Engineering, Southern Cross University, Lismore NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,8]]},"reference":[{"key":"2020101809244705800_bib1","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1084\/jem.191.9.1451","article-title":"Modulating phagocyte activation: the pros and cons of Helicobacter pylori virulence factors","volume":"191","author":"Allen","year":"2000","journal-title":"J Exp Med"},{"key":"2020101809244705800_bib2","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1111\/j.1462-5822.2007.00906.x","article-title":"Phagocytosis and persistence of Helicobacter pylori","volume":"9","author":"Allen","year":"2007","journal-title":"Cell 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