The cysteinyl leukotrienes (cys-LTs) are a family of potent lipid mediators of inflammation derived from arachidonic acid. Activation of certain cell types results in the biosynthesis and export of leukotriene (LT) C4, which then undergoes extracellular metabolism to LTD 4 and LTE4. LTE4, the most stable cys-LT, is only a weak agonist for the defined type 1 and type 2 cys-LT receptors (CysLT1R and CysLT 2R, respectively). We had recognized a greater potency for LTE4 than LTC4 or LTD4 in constricting guinea pig trachea in vitro and comparable activity in eliciting a cutaneous wheal and flare response in humans. Thus, we hypothesized that a vascular permeability response to LTE 4 in mice lacking both the CysLT1R and CysLT 2R could establish the existence of a separate LTE4 receptor. We now report that the intradermal injection of LTE4 into the ear of mice deficient in both CysLT1R and CysLT2R elicits a vascular leak that exceeds the response to intradermal injection of LTC 4 or LTD4, and that this response is inhibited by pretreatment of the mice with pertussis toxin or a Rho kinase inhibitor. LTE 4 is Ϸ64-fold more potent in the CysLT1R/CysLT2R double-deficient mice than in sufficient mice. The administration of a CysLT1R antagonist augmented the permeability response of the CysLT1R/CysLT2R doubledeficient mice to LTC4, LTD4, and LTE4. Our findings establish the existence of a third receptor, CysLTER, that responds preferentially to LTE4, the most abundant cys-LT in biologic fluids, and thus reveal a new target for therapeutic intervention.inflammation ͉ lipid mediator ͉ knockout mice T o recognize a role for the cysteinyl leukotrienes (cys-LTs) and their receptors in inflammation, we initially developed mice lacking the critical biosynthetic enzyme, leukotriene C 4 synthase (LTC 4 S), which forms leukotriene (LT) C 4 by conjugation of reduced glutathione to LTA 4 . LTA 4 is generated from arachidonic acid released from phospholipids of the outer nuclear membrane by cytosolic phospholipase A 2 ␣ during cell activation. In the presence of 5-lipoxygenase (5-LO) and the 5-LO-activating protein (FLAP), the arachidonic acid is converted sequentially to 5-hydroperoxyeicosatetraenoic acid and LTA 4 (1, 2). Both LTC 4 S and FLAP are integral proteins of the outer nuclear membrane and function as trimers (3-5) in the tightly regulated intracellular synthesis of LTC 4 . After its export via an energy-dependent step that requires multidrug resistanceassociated proteins 1 and 4, LTC 4 is metabolized by cleavage removal of glutamic acid and then glycine to provide LTD 4 and LTE 4 , respectively. In a passive cutaneous anaphylaxis model, mice lacking LTC 4 S (Ltc4s Ϫ/Ϫ ) exhibited a significant reduction in vascular leak after local sensitization of ear mast cells with specific IgE and systemic challenge with antigen (6). These findings revealed a permeability-enhancing function for cys-LTs comparable to that of the amines stored in the mast cell secretory granules. These Ltc4s Ϫ/Ϫ mice also were significantly protected agains...