“…10,11 Numerous in vitro and in vivo studies have demonstrated that P. acnes has cytotoxic and broad antigenic properties that enable it to incite both humoral and cell-mediated immune responses. [12][13][14][15][16][17][18][19][20][21][22][23][24] Vowels et al 15 have demonstrated that a soluble factor released by P. acnes can induce peripheral blood mononuclear cells to secrete interleukin-1b, interleukin-8, and tumor necrosis factor alpha, which, in turn, have been shown to result in the chemoattraction of neutrophils, basophils, and T cells and the stimulation of other inflammatory mediators such as the leukotrienes and prostaglandins. 16 Recent sequencing of the P. acnes genome has also revealed numerous genes involved in host tissue degradation and immunogenicity.…”