The vacuolating cytotoxin VacA is one of the most important virulence factors of Helicobacter pylori, a bacterium causing severe gastric diseases such as ulcers and cancer. VacA forms large cytoplasmic vacuoles in cultured cells, although its effects on host cells in vivo remain to be elucidated. Three independent groups have reported that VacA induces epithelial cell apoptosis. In particular, a recent study has demonstrated unambiguously the role of VacA in inducing epithelial gastric cell apoptosis.