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The role of cathepsin C in Papillon-Lefèvre syndrome, prepubertal periodontitis, and aggressive periodontitis.

We have previously reported that loss-of-function mutations in the cathepsin C gene (CTSC) result in Papillon-Lefèvre syndrome, an autosomal recessive condition characterized by palmoplantar keratosis and early-onset, severe periodontitis. Others have also reported CTSC mutations in patients with severe prepubertal periodontitis, but without any skin manifestations. The possible role of CTSC variants in more common types of non-mendelian, early-onset, severe periodontitis ("aggressive periodontitis") has not been investigated. In this study, we have investigated the role of CTSC in all three conditions. We demonstrate that PLS is genetically homogeneous and the mutation spectrum that includes three novel mutations (c.386T>A/p.V129E, c.935A>G/p.Q312R, and c.1235A>G/p.Y412C) in 21 PLS families (including eight from our previous study) provides an insight into structure-function relationships of CTSC. Our data also suggest that a complete loss-of-function appears to be necessary for the manifestation of the phenotype, making it unlikely that weak CTSC mutations are a cause of aggressive periodontitis. This was confirmed by analyses of the CTSC activity in 30 subjects with aggressive periodontitis and age-sex matched controls, which demonstrated that there was no significant difference between these two groups (1,728.7 +/- SD 576.8 micro moles/mg/min vs. 1,678.7 +/- SD 527.2 micro moles/mg/min, respectively, p = 0.73). CTSC mutations were detected in only one of two families with prepubertal periodontitis; these did not form a separate functional class with respect to those observed in classical PLS. The affected individuals in the other prepubertal periodontitis family not only lacked CTSC mutations, but in addition did not share the haplotypes at the CTSC locus. These data suggest that prepubertal periodontitis is a genetically heterogeneous disease that, in some families, just represents a partially penetrant PLS.

Adult↗

Antimicrobials for the treatment of aggressive periodontitis.

Aggressive periodontitis is characterized by a considerable attachment loss over a relatively short period of time. It may be the consequence of either the presence of highly aggressive pathogens or a highly susceptible host. In the first case, the use of antimicrobials should be beneficial in the treatment of those patients. However, due to the organization of the micro-organisms as a biofilm, the increasing incidence of allergies and resistance against antimicrobials and their side-effects, there is still controversy about their benefit in the treatment of periodontal disease. This paper discusses indications for the use of antimicrobials, the substances prescribed and the type of application under the conditions of aggressive periodontitis.

Actinobacillus Infections↗

Localized juvenile periodontitis or localized aggressive periodontitis.

In general, the new term "localized aggressive periodontitis" replaces what was previously known as "localized juvenile periodontitis." Similarly, "generalized aggressive periodontitis" replaces what used to be called "generalized juvenile periodontitis." Aggressive periodontitis is a specific type of periodontitis with clearly identifiable clinical and laboratory findings, making it sufficiently different from chronic periodontitis and warranting separate classification. Not all the characteristics must be present to assign a diagnosis or classify the disease. The diagnosis may be based on clinical, radiographic, and historical data, and laboratory testing may not be essential for assigning a diagnosis.

Adolescent↗

Osseointegrated implants in patients treated for generalized chronic periodontitis and generalized aggressive periodontitis: 3- and 5-year results of a prospective long-term study.

BACKGROUND: The successful use of osseointegrated implants in periodontally healthy patients has been documented in numerous longitudinal studies in recent years. However, the extent to which these positive results apply to periodontally diseased patients remains unclear. The aim of the present prospective longitudinal study of partially edentulous patients treated for generalized chronic periodontitis and generalized aggressive periodontitis was a clinical, microbiological, and radiographic comparison of teeth and implants and assessment of the implant success rate. METHODS: Five partially edentulous patients treated for generalized aggressive periodontitis (GAgP) and 5 treated for generalized chronic periodontitis (GCP) were enrolled in this study. The GAgP patients received 36 implants, and the GCP patients 12 implants. The teeth were examined 2 to 4 weeks before extraction of the non-retainable teeth (baseline), and 3 weeks after insertion of the final abutments (second examination). All further examinations were performed during a 3-month recall schedule over a 5-year period for the GAgP patients and over a 3-year period for the GCP patients. At each session clinical parameters were recorded at teeth and implants and the composition of the subgingival microflora was determined by dark-field microscopy and DNA analysis. Intraoral radiographs of the teeth and implants were taken for control purposes at baseline; after insertion of the superstructure; and 1, 3, and 5 years later. RESULTS: The clinical findings indicated healthy periodontal and peri-implant conditions in both patient groups throughout the study. However, an increased probing depth and an attachment loss were recorded in the GAgP patients after the third year (P<0.001). The distribution of the microorganisms revealed no significant differences between the patient groups or between implants and teeth. Moderate bone loss at teeth and implants was registered in both groups. The success rates recorded were 100% in the GCP patients and 88.8% (maxilla: 85.7%; mandible: 93.3%) in the GAgP patients. CONCLUSIONS: The 3-year and 5-year follow-ups show that osseointegrated implants may be successful in oral rehabilitation of partially edentulous patients treated for generalized aggressive periodontitis and generalized chronic periodontitis. However, as no significant differences were recorded between conditions at teeth and at implants, progression of the disease cannot be ruled out.

Adult↗

[Quantitative analysis of periodontal pathogens in aggressive periodontitis patients in a Japanese population].

The aim of the present study was to clarify the relationship between the relative/absolute numbers of periodontal bacteria and different types of periodontitis. Fifteen patients with localized aggressive periodontitis (LAgP), 25 patients with generalized aggressive periodontitis (GAgP) and 28 patients with chronic periodontitis (CP) were included in this study. Saliva and subgingival plaque samples were collected from all subjects for microbiological analysis. The prevalence and proportions of Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis and Treponema denticola were determined by conventional PCR and real-time PCR. The prevalence of A. actinomycetemcomitans in saliva was significantly higher in LAgP patients (46.7%) and GAgP patients (40.0%) than that in CP patients (14.3%). The mean proportion of A. actinomycetemcomitans in LAgP patients (4.42%) was significantly higher than that in GAgP patients (0.59%) and CP patients (0.37%) in saliva. In subgingival plaque, LAgP patients showed a significantly higher mean proportion of T. forsythensis (19.8%) than CP patients (7.45%). In conclusion, A. actinomycetemcomitans was the more predominant periodontopathic bacteria in LAgP than in GAgP and CP. The increased proportion of T. forsythensis might relate to LAgP, in addition to A. actinomycetemcomitans. These results indicate that real-time PCR analysis is useful for the evaluation of the bacterial profiles in different types of periodontitis.

Adult↗

Distribution of periodontal pathogens in Korean aggressive periodontitis.

BACKGROUND: Microbial associations in aggressive periodontitis versus different ethnic origins are substantially unknown. We undertook this study to determine the prevalence of seven putative periodontopathogens in Korean patients and to evaluate microbial differences in localized and generalized aggressive periodontitis patients. METHODS: Thirty-nine aggressive periodontitis patients between 20 and 35 years old (24 males and 15 females; mean age 29.6 years) were selected according to clinical criteria. The patients were subclassified into 17 localized and 22 generalized aggressive periodontitis patients. In each of the 39 individuals, subgingival plaque samples were collected from four diseased teeth (> or = 6 mm probing depth, 156 sites) and one healthy site (< or = 3 mm probing depth, 39 sites). Polymerase chain reaction (PCR) of the 16S ribosomal RNA gene fragments (about 530 bp) of plaque bacteria and their subsequent detection by dot-blot hybridization using specific oligonucleotide probes were performed to determine the presence of seven periodontopathogens. RESULTS: The prevalences were 75% for Actinobacillus actinomycetemcomitans, 94.2% for Tannerella forsythensis (formerly Bacteroides forsythus), 99.4% for Fusobacterium sp., 85.9% for Micromonas micros (formerly Peptostreptococcus micros), 96.8% for Porphyromonas gingivalis, 78.8% for Prevotella intermedia, and 96.8% for Treponema sp. The prevalences of these bacteria were significantly higher in diseased sites than in healthy sites. Logistic regression analysis showed that P. intermedia was more significantly associated with generalized aggressive periodontitis than the localized form, with an odds ratio of 3.28 (95% confidence interval 1.26-8.56, P = 0.015). CONCLUSIONS: Our results demonstrate that the seven periodontal pathogens analyzed are strongly associated with Korean aggressive periodontitis. In particular, P. intermedia are more significantly associated with generalized aggressive periodontitis, a more severe and progressive form, than with localized aggressive periodontitis.

Adult↗

Clinical, genetic and microbiological findings in a Brazilian family with aggressive periodontitis.

BACKGROUND/AIM: Aggressive periodontitis comprises a group of rapidly progressive forms of periodontitis. Besides bacteria, a high level of subject susceptibility must be involved in the expression of disease. In the present study, we report the clinical, microbiological and genetic profile of a 14-individual family with aggressive periodontitis. METHOD: PCR was utilized to detect pathogenic bacteria of affected sites. DNA was obtained from epithelial cells through a mouthwash with 3% glucose and scrapping of the oral mucosa. RFLP-PCR was used to analyze cytokine genetic polymorphisms. RESULTS: Localized aggressive periodontitis was diagnosed for an 18-year-old systemically healthy non-smoking proband, with siblings displaying aggressive periodontitis. Bacteroides forsythus and Treponema denticola were the most frequent pathogens. The proband presented Actinobacillus actinomycetemcomitans and detectable levels of Porphyromonas gingivalis, Bacteroides forsythus and Treponema denticola. Allele 2 of IL-1alpha (-889) polymorphism was found in all individuals as well as allele 1 of the IL-1beta (+3953) gene. Alleles 1 and 2 (50 % each) of IL-1beta (-511), allele 1 of TNF-alpha (-308) and allele 2 (in homo or heterozygosity) of IL-RN (intron 2) gene were present. CONCLUSION: The results show that the present microbiological and genetic parameters were not relevant for the prediction of periodontitis susceptibility in this family.

Adolescent↗

[A 35-year-old man with aggressive periodontitis].

BACKGROUND: Aggressive and necrotic periodontal diseases may occasionally be associated with undiagnosed systemic diseases and immune deficiencies. We present a 35-year-old man with an undiagnosed hypo-gammaglobulinaemia and severe aggressive periodontitis. MATERIAL AND METHODS: Gingival biopsies and peripheral blood were collected for immunohistochemical and cell culture studies from the patient with aggressive periodontitis, 3 patients with chronic periodontitis and 3 controls. Mast cells and neutrophils were visualised and counted on histological sections. Freshly isolated monocytes were challenged with lipopolysaccharides and supernatants assayed for interleukin (IL)-1beta, IL-8, IL-10, IL-12 and tumour necrosis factor. Analysis of peripheral blood for any hidden systemic diseases was carried out, including blood cell counts and measurement of immunoglobulin levels in serum. RESULTS: The patient had depressed levels of immunoglobulin in serum (IgG: 3.2 g/l, IgA: 0.6 g/l and IgM: 0.4 g/l ) and was diagnosed with common variable immunodeficiency. The inflamed gingiva revealed significantly increased numbers of mast cells and neutrophils. Signs of mast cell degranulation were observed in the aggressive periodontitis patient only, and monocytes secreted significantly more IL-1beta, IL-8, IL-12 and tumour necrosis factor, but less IL-10. INTERPRETATION: Low antibody production concurrent with an obviously increased activity of the innate immune defense with massive release of pro-inflammatory cytokines may partly cause the severe destruction of periodontal tissue as seen in this patient.

Adult↗

Expressions of selected adhesion molecules on peripheral blood leukocytes in patients with aggressive periodontitis.

INTRODUCTION: Aggressive forms of periodontitis lead to rapid bone destruction resulting in extensive losses in children's and young adults' dentition. Adhesion molecule deficiency syndrome and abnormalities in the expression of various adhesion molecules on peripheral blood leukocytes can be observed in prepubertal and aggressive periodontitis (AP) patients. The aim of the study was thus to assess the expression of selected cell adhesion molecules (CAMs; CD11a, CD11b, CD11c, CD54, and CD62L) on monocytes, neutrophils, and lymphocytes of the peripheral blood in patients with AP. MATERIAL/METHODS: The study involved 16 patients with AP and a control group of 13 generally healthy subjects with healthy periodontium. CAM expressions were determined by flow cytometry and presented as mean fluorescence intensity (MFI) and percentage of cells showing expression of the assessed adhesion molecules. RESULTS: Neutrophil CAM expressions in AP patients were comparable with those of the control group. MFI of CD62L on monocytes in AP patients was significantly lower than that of the controls. Lymphocytes showed increased CD11b expression compared with the control group. The percentage of leukocytes showing CAM expression in both groups was similar. Only the percentage of lymphocytes with CD11b in AP patients was significantly higher than in healthy controls. CONCLUSIONS: Because of the evident lack of differences between patients and controls and the great amount of individual dispersion of the results, the above CAMs on peripheral blood leukocytes in generally healthy patients with AP do not seem to be characteristic markers of this disease.

Adult↗

Long-term follow-up of successful orthodontic-periodontal treatment of localized aggressive periodontitis: a case report.

This report describes a case of localized aggressive periodontitis (localized juvenile periodontitis) that was jointly treated with conventional periodontal therapy, selective extractions to eliminate localized areas of vertical bone loss, and orthodontic therapy. A 20-year follow-up is described in this report. The success of periodontal treatment in a case such as this depends on making an accurate diagnosis, providing periodontal treatment to control the disease, and providing regular periodontal maintenance during and after orthodontic treatment.

Journal Article↗

Change of antibiotic susceptibility following periodontal therapy. A pilot study in aggressive periodontal disease.

BACKGROUND: The hypothesis was tested that bacterial susceptibilities in aggressive periodontitis change upon administration of systemic antibiotics as adjuncts to periodontal therapy. METHODS: In 23 subjects (average age 38.9+/-6.7 years) with aggressive periodontitis, microbial parameters were assessed prior to and 1 year after completion of comprehensive mechanical/surgical and systemic antimicrobial therapy. Following identification of five selected pathogens with the Rapid ID 32 A system, their susceptibilities towards amoxicillin/clavulanate potassium, metronidazole, and tetracycline were examined with the E-test. Antibiotics were administered according to the test results, and the minimal inhibitory concentrations (MIC90) were reevaluated after 1 year. Statistical analysis was performed on a patient basis, with the site data used for evaluation of the MIC levels. RESULTS: Bacterial MIC levels remained constant among the three antibiotic treatment groups compared with baseline. Mean MIC90 values ranged from <0.02 to 0.11 microg/ml (amoxicillin/clavulanate potassium), <0.02 to 0.27 microg/ml (metronidazole), and <0.02 to 0.11 microg/ml (tetracycline). Observed changes in susceptibility were attributed to the elimination of single bacterial taxa in the subgingival environment after antibiotic therapy. There were no statistically significant differences in clinical parameters among the treatment groups. Single tetracycline MICs were 1.5- to 6-fold enhanced compared to amoxicillin/clavulanate potassium and metronidazole. CONCLUSION: The periodontal pathogens investigated prior to and 1 year after periodontal therapy are tested sensitive to the antimicrobial agents. In aggressive periodontitis, changes in bacterial susceptibility upon the administration of systemic antibiotics are associated with the limited number of isolates tested following therapy.

Adult↗

Aggressive periodontitis in a patient with chronic cutaneous lupus erythematosus: a case report.

Lupus erythematosus is considered to be a high risk factor for periodontitis. As an autoimmune disease of unknown origin, cutaneous lupus erythematosus (CLE) is subdivided into 3 categories: chronic (CCLE), subacute (SCLE), and acute (ACLE). While the ACLE has a high prevalence of conjunctive periodontal lesions, aggressive periodontitis in patients with CCLE has been rarely reported. This article describes the case of a patient diagnosed with aggressive periodontitis. Three months after the diagnosis of periodontitis, the patient experienced advancing hair loss (alopecia), pale fingers and toes, as well as edema in the legs and around the eyes. Skin biopsy showed follicular hyperkeratosis with perivascular mononuclear cell infiltrate. Colliquation of the basal cells, thickening of the basal lamina, and vacuolar degeneration of basal keratinocytes were also found. A lupus band test was positive, and diagnosis of CCLE was established. Three months following the treatment of lupus with antimalarial agents, the periodontal condition became stable with no further exacerbation or progression of the existing periodontitis. An 11-month postsurgical follow-up revealed stable periodontal and general medical conditions. A patient's medical history should be re-evaluated in the event of recurrence of periodontal lesions refractory to periodontal treatment. The control of systemic conditions like lupus erythematosus is essential for a good prognosis in the treatment of periodontitis as well as for the general health of the patient.

Adult↗

[Mechanical periodontal treatment combined with tetracycline for aggressive periodontitis].

OBJECTIVE: To evaluate the effect of mechanical periodontal treatment combined with tetracycline on periodontal attachment, distances of cementum-enamel junction (CEJ) to the bone defect bottom and to the alveolar crest, and avidity of serum IgG against Porphyromonas gingivalis (Pg) lipopolysaccharide (LPS) in patients with aggressive periodontitis. METHODS: Twenty-six patients with aggressive periodontitis were divided equally into two groups to receive mechanical periodontal treatment combined with tetracycline or exclusive mechanical periodontal treatment, with another 20 periodontally healthy subjects serving as the control group. In the two patient groups, routine clinical examination of the subjects was performed to record periodontal attachment level and distances of CEJ to the bottom of the bone defects and to the alveolar crest before and 3 and 6 months after the treatment. The avidity of serum IgG against Pg LPS was measured by ELISA with thiocyanate elution before and after periodontal treatment. RESULTS: Compared with patients with exclusive mechanical periodontal treatment, patients with combined treatments showed significant improvement in periodontal attachment level and the distance of CEJ to the bone defect bottom after the treatment (P<0.01 and P<0.05, respectively) with also significantly reduced avidity of serum IgG against Pg LPS (P<0.01). CONCLUSION: Mechanical periodontal treatment combined with tetracycline produces favorable effects in patients with aggressive periodontitis.

Adult↗

[Prevalence of putative periodontal microorganisms in Chinese patients with aggressive periodontitis].

OBJECTIVE: To evaluate the prevalence of putative periodontal microorganism in Chinese patients with aggressive periodontitis (AgP). METHODS: A total of 72 subgingival plaque samples were collected from 55 AgP patients and 17 healthy subjects. Seven putative periodontal microorganisms including Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythensis (Tf), Treponema denticola (Td), Campylobacter rectus (Cr), Prevotella intermedia (Pi) and Prevotella nigrescens (Pn) were detected by using 16S rRNA based polymerase chain reaction (PCR). RESULTS: The prevalence of Aa in AgP patients was very low (1.8%), while Pg, Tf, Td and Cr were more frequently detected in AgP patients (prevalence: 81.8%, 83.6%, 80% and 81.8%) than in healthy controls (prevalence: 17.6%, 11.8%, 5.9%, 29.4%, P < 0.01). CONCLUSIONS: The prevalence of Pg, Tf, Td and Cr were very high in aggressive periodontitis patients, and the combination of these bacteria may play an important role in AgP.

Adolescent↗

Periodontal and hematological characteristics associated with aggressive periodontitis, juvenile idiopathic arthritis, and rheumatoid arthritis.

BACKGROUND: Periodontitis shares several clinical and pathogenic characteristics with chronic arthritis, and there is some degree of coexistence. The aims of this study were to elucidate whether patients with localized aggressive periodontitis (LAgP), generalized aggressive periodontitis (GAgP), juvenile idiopathic arthritis (JIA), and rheumatoid arthritis (RA) share periodontal and hematological characteristics distinguishing them from individuals free of diseases. METHODS: The study population consisted of white adults ( or=4 mm, CAL>or=2 mm, and ABL>or=2 mm compared to controls. The percentage of sites with CAL>or=2 mm significantly correlated with the levels of IgM-RF and IgA-RF. Missing teeth in JIA and RA patients were not lost due to periodontitis. Patients with GAgP showed higher levels of leukocytes, including neutrophils, and CRP compared to controls. In part, JIA and RA patients showed similar results. CONCLUSIONS: Young adults with RA may develop periodontal destruction, and these patients require professional attention. Both differences and similarities in periodontal and hematological variables were seen in individuals with periodontitis, JIA, and RA.

Adult↗

Can presence or absence of periodontal pathogens distinguish between subjects with chronic and aggressive periodontitis? A systematic review.

OBJECTIVES: The purpose of this study was to determine to what extent the presence or absence of periodontal pathogens can distinguish between subjects with chronic and aggressive periodontitis. MATERIAL AND METHODS: A systematic review of cross sectional and longitudinal studies providing microbiological data both from patients with chronic periodontitis (ChP) and aggressive periodontitis (AgP) at a subject level. Strict inclusion criteria were applied. The presence or absence of five microorganisms was selected as primary study parameters: Actinobacillus actinomycetemcomitans (AA), Porphyromonas gingivalis (PG), Prevotella intermedia (PI), Bacteroides forsythus (BF), and Campylobacter rectus (CR). RESULTS: The presence or absence of AA could be evaluated in 11 papers. In seven papers the presence or absence of PG could be analysed. Subject specific data on PI were available from six studies. Two studies could be used regarding the presence or absence of BF, and two regarding CR. Sensitivity and specificity of every microbiological test were individually calculated for each selected study, assuming that the clinical diagnosis of AgP or ChP was the true status the tests attempted to detect. AgP was considered to be the condition of interest and ChP was considered equivalent to 'non-AgP'. Receiver Operator Characteristic (ROC) diagrams were constructed using these data. ROC diagrams indicated the limited discriminatory ability of all of the test parameters to identify subjects with AgP. An additional assessment showed that the highly leukotoxic variant of AA was uniquely associated with patients suffering from aggressive periodontitis. However, in a high proportion of patients diagnosed with AgP the presence of this variant could not be detected. CONCLUSION: The presence or absence of AA, PG, PI, BF or CR could not discriminate between subjects with AgP from those with ChP.

Acute Disease↗

Periodontal status among relatives of aggressive periodontitis patients and reliability of family history report.

OBJECTIVES: To assess the periodontal status of relatives of Aggressive Periodontitis (AgP) patients, and to evaluate the reliability of the family history report as provided by the proband. MATERIAL AND METHODS: Data from 54 AgP patients were gathered along with a family history report for each of their relatives. Only 27 patients (probands) had relatives willing to be examined. This yielded a total of 61 relatives from whom the periodontal status was obtained. The family history report for each examined relative was compared with the periodontal diagnosis made at examination to assess reliability. RESULTS: Eight percentage of the examined relatives, aged between 12-76, were diagnosed with AgP, while chronic periodontitis was present in 39%, gingivitis in 38% and 15% were healthy. If the report provided by the proband was positive, the likelihood of finding any type of periodontitis in that relative was 85.7%, whereas if the report was negative the likelihood of the absence of periodontitis was 70.6%. CONCLUSION: The percentage of examined relatives who were affected with AgP (8%), although lower than percentages reported in other AgP family studies, was still higher than the prevalence of the condition in random populations. Reliability of periodontal family history was considered good and more reliable when it was positive.

Adolescent↗

Nitric oxide synthase activity in neutrophils from patients with localized aggressive periodontitis.

BACKGROUND: Localized aggressive periodontitis (LAgP) is associated with neutrophil dysfunction including defective chemotaxis and reduced calcium influx factor activity. Nitric oxide (NO) and its enzyme, nitric oxide synthase (NOS), have been suggested to be involved in chemotaxis. Some reports, however, were unable to detect either NO or NOS in human neutrophils. In this study, we focused on NOS activity in LAgP neutrophils and examined the involvement of NOS in chemotaxis of normal neutrophils and NOS activity in neutrophils from normal subjects and patients with LAgP. METHODS: Neutrophils from 10 normal subjects and 10 LAgP patients were isolated from peripheral venous blood. Membrane associated-NOS (MA-NOS) and soluble NOS (S-NOS) were extracted from cells with or without FMLP stimulation. NOS activity was measured using the radiolabeled L-arginine to L-citrulline conversion assay. RESULTS: N(omega)-nitro-L-arginine methyl ester (L-NAME), an inhibitor of NOS, significantly inhibited FMLP-induced chemotaxis (P<0.01) and dibutyryl cGMP, an activator of cGMP-dependent protein kinase, significantly attenuated the inhibition by L-NAME (P<0.01). Unstimulated and FMLP-stimulated MA-NOS activity in LAgP neutrophils was statistically significantly higher than that in normal neutrophils (P<0.05). S-NOS activity in LAgP neutrophils was higher than that in normal neutrophils. CONCLUSIONS: This study suggests that NOS is present in human neutrophils and may be involved in FMLP-induced chemotaxis in normal neutrophils. NOS activity is increased in LAgP and is negatively correlated to chemotaxis response.

8,11,14-Eicosatrienoic Acid↗