BMI was strong positive correlated with IR and dyslipidemia, and was a strong independent predictor of CAN. In this score system, BMI was an indicator of IR and diabetes status that was the most contributors to CAN. High BP plays a crucial role in progression of CAN. Low HRV and CAN associated with HT. High-risk individuals might benefit from controlling BP to normal status. In general, DM and its duration were considered as two main risk factors for the progression of CAN. In this study, the two factors with high ORs associated with CAN. This suggests that PA-MSHA can successfully trigger TLR pathway activation and upregulation of cytokines and proinflammatory factors independent of TLR5. Followed by their transfer to HEp-2 cells monolayers seeded in DMEM. The passage from an amino acid rich medium to a relatively poor medium such as DMEM mimics the pathway of EPEC through the digestive system, alternating portions of high nutrient content in the jejunum and the lower part of the small intestine, where nutrients are less abundant. Under these conditions RelA is likely to be activated, and a temporary increase in ppGpp ensues. Accordingly, EPEC adherence genes are poorly expressed in rich media when ppGpp concentration is low and are activated upon transferring to DMEM. The bacterial growth rates observed in the present study. It has previously been shown that ppGpp enhances the expression of the LEE in enterohemorrhagic E. coli. However, there are some important differences between EPEC and EHEC regarding the expression of the adhesin genes. First, even though both pathotypes share the LEE pathogenicity island, the EAF plasmid is not present in EHEC strains and the LEE genes are thus not regulated by PerC. Second, transcription of the LEE genes in EHEC begins at the mid-exponential phase and peaks at the late exponential/early stationary phase. In contrast, in EPEC the LEE as well as the perABC and bfp operons are maximally activated at the mid-exponential-phase. Third, expression of the LEE genes as well as the adherence capacity of EHEC are higher in LB medium supplemented with bicarbonate, while EPEC neither adhere nor properly expresses the genes associated with adherence when grown in LB supplemented or not with bicarbonate. Even though the environmental conditions required for the synthesis of EPEC and EHEC adherence factors are not identical, ppGpp positively affects the adherence of both lineages. This suggests that regulation by ppGpp is conserved regardless the specific mechanisms of control of adherence employed by the different diarheogenic bacteria. ppGpp is associated with bacterial virulence in several species. In most cases ppGpp plays a positive role and is required to fully induce the virulence genes. For instance in all Proteobacteria hitherto analyzed, such as E. coli, Salmonella enterica, Yersinia pestis, Pseudomonas aeruginosa Francisella tularensis and Bordetella pertusis a positive role for ppGpp was found. This reinforces the notion that upregulation of bacterial virulence by ppGpp is an ancient evolutionary phenomenon. Chronic periodontitis is the most frequent form of periodontitis. The bacterial biofilm is required, but not sufficient, for disease initiation.