Tumour necrosis factor receptor-associated periodic syndrome (TRAPS) : Identification of novel TNFRSF1A mutations and intracellular signalling defects

The systemic autoinflammatory disorders are a group of rare diseases characterized by periodically recurring episodes of acute inflammation and a rise in serum acute phase proteins, but with no signs of autoimmunity. At present eight hereditary syndromes are categorized as autoinflammatory, although the definition has also occasionally been extended to other inflammatory disorders, such as Crohn s disease. One of the autoinflammatory disorders is the autosomally dominantly inherited tumour necrosis factor receptor-associated periodic syndrome (TRAPS), which is caused by mutations in the gene encoding the tumour necrosis factor type 1 receptor (TNFRSF1A). In patients of Nordic descent, cases of TRAPS and of three other hereditary fevers, hyperimmunoglobulinemia D with periodic fever syndrome (HIDS), chronic infantile neurologic, cutaneous and articular syndrome (CINCA) and familial cold autoinflammatory syndrome (FCAS), have been reported, TRAPS being the most common of the four. Clinical characteristics of TRAPS are recurrent attacks of high spiking fever, associated with inflammation of serosal membranes and joints, myalgia, migratory rash and conjunctivitis or periorbital cellulitis. Systemic AA amyloidosis may occur as a sequel of the systemic inflammation. The aim of this study was to investigate the genetic background of hereditary periodically occurring fever syndromes in Finnish patients, to explore the reliability of determining serum concentrations of soluble TNFRSF1A and metalloproteinase-induced TNFRSF1A shedding as helpful tools in differential diagnostics, as well as to study intracellular NF-κB signalling in an attempt to widen the knowledge of the pathomechanisms underlying TRAPS. Genomic sequencing revealed two novel TNFRSF1A mutations, F112I and C73R, in two Finnish families. F112I was the first TNFRSF1A mutation to be reported in the third extracellular cysteine-rich domain of the gene and C73R was the third novel mutation to be reported in a Finnish family, with only one other TNFRSF1A mutation having been reported in the Nordic countries. We also presented a differential diagnostic problem in a TRAPS patient, emphasizing for the clinician the importance of differential diagnostic vigiliance in dealing with rare hereditary disorders. The underlying genetic disease of the patient both served as a misleading factor, which possibly postponed arrival at the correct diagnosis, but may also have predisposed to the pathologic condition, which led to a critical state of the patient. Using a method of flow cytometric analysis modified for the use on fresh whole blood, we studied intracellular signalling pathways in three Finnish TRAPS families with the F112I, C73R and the previously reported C88Y mutations. Evaluation of TNF-induced phosphorylation of NF-κB and p38, revealed low phosphorylation profiles in nine out of ten TRAPS patients in comparison to healthy control subjects. This study shows that TRAPS is a diagnostic possibility in patients of Nordic descent, with symptoms of periodically recurring fever and inflammation of the serosa and joints. In particular in the case of a family history of febrile episodes, the possibility of TRAPS should be considered, if an etiology of autoimmune or infectious nature is excluded. The discovery of three different mutations in a population as small as the Finnish, reinforces the notion that the extracellular domain of TNFRSF1A is prone to be mutated at the entire stretch of its cysteine-rich domains and not only at a limited number of sites, suggesting the absence of a founder effect in TRAPS. This study also demonstrates the challenges of clinical work in differentiating the symptoms of rare genetic disorders from those of other pathologic conditions and presents the possibility of an autoinflammatory disorder as being the underlying cause of severe clinical complications. Furthermore, functional studies of fresh blood leukocytes show that TRAPS is often associated with a low NF-κB and p38 phosphorylation profile, although low phosphorylation levels are not a requirement for the development of TRAPS. The aberrant signalling would suggest that the hyperinflammatory phenotype of TRAPS is the result of compensatory NF-κB-mediated regulatory mechanisms triggered by a deficiency of the innate immune response.

Gonadotropin regulation of rat ovarian lysosomes: Existence of a hormone specific dual control mechanism

Gonadotropic hormones PMSG (15 IU/rat), FSH (3 mgrg/rat), LH (9 mgrg/rat) and hCG (3 mgrg/rat) were shown to decrease the free cytosolic lysosomal enzymes during the acute phase of hormone action in rat ovaries. When isolated cells from such rats were analyzed for the cathepsin-D activity, the granulosa cells of the ovary showed a reduction in the free as well as in the total lysosomal enzyme activities in response to FSH/PMSG; the stromal and thecal compartment of the ovary showed a reduction only in the free activity in response to hCG/PMSG. The results suggest the presence of two distinct, target cell specific, mechanisms by which the lysosmal activity of the ovary is regulated by gonadotropins.

Hydrodynamic instability and shear layer effect on the response of an acoustically excited laminar premixed flame

Combustion instabilities can cause serious problems which limit the operating envelope of low-emission lean premixed combustion systems. Predicting the onset of combustion instability requires a description of the unsteady heat release driving the instability, i.e., the heat release response transfer function of the system. This study focuses on the analysis of fully coupled two-way interactions between a disturbance field and a laminar premixed flame that incorporates gas expansion effects by solving the conservation equations of a compressible fluid. Results of the minimum and maximum flame front deflections are presented to underline the impact of the hydrodynamic instability on the flame and the shear layer effect on the initial flame front wrinkling which is increased at decreasing gas expansion. These phenomena influence the magnitude of the burning area and burning area rate response of the flame at lower frequency excitation more drastically than reduced-order model (ROM) predictions even for low temperature ratios. It is shown that the general trend of the flame response magnitudes can be well captured at higher frequency excitation, where stretch effects are dominant. The phase response is influenced by the DL mechanism, which cannot be captured by the ROM, and by the resulting discrepancy in the flame pocket formation and annihilation process at the flame tip. (C) 2014 The Combustion Institute. Published by Elsevier Inc. All rights reserved,

Estudo imunológico e histopatológico da infecção experimental por Schistosoma mansoni em camundongos geneticamente selecionados para tolerância oral

A esquistossomose acomete 207 milhões de pessoas, com mais de 200 mil mortes anuais. Seu principal agente etiológico é o helminto Schistosoma e o principal modelo experimental, o camundongo. Linhagens de camundongos selecionadas geneticamente para susceptibilidade (TS) e resistência (TR) a tolerância imunológica constituem bons modelos para o estudo da resposta imunológica específica e inespecífica nas infecções. O objetivo deste trabalho foi caracterizar a infecção experimental por S. mansoni nestes camundongos, evidenciando a imunopatologia por diversos parâmetros na fase aguda da infecção. TR e TS não diferiram quanto a penetração de cercárias, recuperação de vermes adultos, fecundidade/produtividade de ovos das fêmeas de S. mansoni, mas predominaram ovos mortos em TS. Quanto maior o número de casais, maior a probabilidade de troca de casais e regressão sexual da fêmea, além de pequena redução da produtividade de ovos. Análise ultraestrutural dos parasitos machos recuperados de TS apresentaram tubérculos edemaciados, espinhos encurtados e em menor densidade que os parasitos dos TR. O tegumento dos parasitos recuperados de TS apresentou-se desorganizado, intensamente vacuolizado e com tendência a se desprender da superfície e espinhos internalizados e células vitelínicas desorganizadas. TS desenvolveram granulomas hepáticos grandes, com fibras radiais e predomínio do estágio exsudativo-produtivo com características de fase produtiva (EP/P), enquanto camundongos TR desenvolveram granulomas menores, com fibras concêntricas e predomínio de granulomas exsudativo-produtivos. TS desenvolveu hepatomegalia mais acentuada na fase aguda da infecção e exacerbada esplenomegalia na fase crônica. A aspartato aminotransferase mais elevada nos TR foi coerente com a acentuada histólise nos granulomas iniciais dos TR. É possível que a histólise menor em TS tenha contribuído para sua intensa hepatomegalia na fase aguda. Leucócitos totais séricos aumentaram em TS, nas fases aguda e crônica, mas não em TR. TS apresentaram anemia durante a fase crônica da infecção, possivelmente devido ao desvio na hematopoiese medular para a produção de leucócitos ou apoptose das hemácias. A mieloperoxidase neutrofílica hepática e no íleo foi maior em TS e a peroxidase de eosinófilos foi mais elevada no íleo do TS. Ambas as linhagens produziram IFN-γ, mas os níveis funcionais de IFN-γ foram diferentes nas duas linhagens em cultura de células. É possível que a imunopatologia hepática grave na linhagem TS possa estar relacionada aos altos títulos IFN-γ. TS produziu IL-10 em maior quantidade, entretanto esta citocina não foi capaz de regular o crescimento exacerbado dos granulomas hepáticos. Altos títulos de IL-4 na linhagem TS também são coerentes com a exacerbação dos granulomas, pois, como a IL-13, a IL-4 induz síntese de colágeno e está relacionada ao desenvolvimento da fibrose no granuloma esquistossomótico. Observamos redução do percentual relativo de células T CD4+ hepáticas de animais infectados em ambas as linhagens e redução percentual nas subpopulações de linfócitos B na medula óssea (precursores, linfócitos B imaturos, maduros e plasmócitos) mais acentuada em TS que em TR, possivelmente devido a extensa mobilização de B imaturos induzida pela inflamação ou desvio da hematopoiese para síntese de granulócitos em TS. Quantitativamente, TR não alterou suas subpopulações de linfócitos B. TS e TR são bons modelos para estudo da resposta imunológica na infecção esquistossomótica experimental. Novos estudos são necessários para confirmar nossas propostas e compreender os mecanismos envolvidos na diferença da resposta imunológica dessas linhagens na relação schistosoma-hospedeiro.

Características morfológicas de vermes adultos de Schistosoma mansoni Sambon, 1907 recuperados de camundongos alimentados com dieta hiperlípidíca na fase crônica da infecção esquistossomótica. Análise por microscopia de campo claro e confocal

Estudos em animais experimentais evidenciaram associações significativas entre esquistossomose mansoni e hipercolesterolemia. Estudos in vitro e in vivo já demonstraram que o colesterol é essencial para Schistosoma mansoni, embora este não tenha capacidade de sintetizá-lo. A captação é realizada a partir do ambiente (cultivo ou hospedeiro) através do tegumento. O colesterol está envolvido nos mecanismos de evasão do helminto contra a resposta imunológica, além de poder participar na modulação da sinalização celular e reprodução, estimulando os órgãos reprodutores dos helmintos adultos como observado na fase aguda da infecção experimental. Este trabalho tem como objetivo avaliar se o mesmo fenômeno ocorre na fase crônica. Os helmintos foram recuperados de dez camundongos submetidos à dieta hiperlipídica ou padrão (controle) foram corados pelo carmin cloridrico e montados, individualmente, em lâmina histológica com bálsamo do Canadá. A preparação foi analisada por microscopia de campo claro nos seguintes caracteres: tegumento e o sistema reprodutor nos vermes machos (lobos testiculares, vesícula seminal, lobos testiculares supranumerários e canal ginecóforo) e, nas fêmeas (ovário, oótipo, útero, ovo, glândulas vitelínicas e espermateca). Posteriormente, algumas lâminas foram separadas para visualização pela microscopia confocal dos órgãos do sistema reprodutores acima descritos. Apesar de ter sido observado uma maior quantidade de espermatozoides, uma maior quantidade de oócitos sendo liberados no grupo da dieta, não houve diferença estatística significativa (p>0,05) entre os grupos analisados. Houve um aumento na oogênese como observado na fase aguda. Dessa forma, o colesterol pode estar relacionado com a estimulação na atividade dos órgãos reprodutores dos helmintos adultos na fase crônica da infecção.

Alterações no tecido esplênico de camundongos esquistossomóticos com desnutrição calórica e protéica induzida no período de lactação

Apesar de significativos avanços obtidos no estudo da esquistossomose mansônica, as relações existentes entre esquistossomose e má-nutrição ainda não se acham completamente esclarecidas. Sendo a fase de lactação um período de vida de extrema importância para o indivíduo, alterações metabólicas na gestante podem afetar diretamente o desenvolvimento do feto sugerindo uma programação (imprinting) no metabolismo deste indivíduo em resposta adaptativa aos fatores ambientais encontrados em períodos iniciais de desenvolvimento. Este trabalho teve como objetivo avaliar as características do baço na fase aguda da infecção esquistossomótica de camundongos programados metabolicamente por restrição calórica e restrição protéica. Os baços dos animais eutanasiados na 9 semana de infecção foram submetidos a cortes histológicos (5m) e corados com hematoxilina-eosina. Foi realizada avaliação histopatológica, análise morfométrica e estereologia. A análise estatística foi realizada utilizando-se o programa Graph Pad Instat. Foi observada desorganização estrutural da polpa branca e da polpa vermelha nos grupos programados, independente da presença de infecção. Animais infectados apresentaram hiperplasia e hipertrofia da polpa branca e maior quantidade de pigmentos dispersos no tecido esplênico, bem como a presença de eosinófilos no interior de estruturas vasculares. A polpa branca dos grupos infectados tanto de restrição calórica quanto de restrição protéica apresentaram medidas morfométricas maiores quando comparados aos grupos não infectados. Os resultados estereológicos mostraram que o grupo de restrição calórica infectado apresentou menor densidade de volume de polpa vermelha, enquanto não houve diferenças significativas na densidade de volume de polpa branca. Megacariócitos foram vistos em maior quantidade nos grupos infectados, com ênfase no grupo de restrição protéica. Estes dados sugerem que a programação pela desnutrição materna na lactação e a infecção esquistossomótica provocam desorganização do tecido esplênico.

Molecular cloning, characterization and mRNA expression of peroxiredoxin in Zhikong scallop Chlamys farreri

Peroxiredoxin V (PRX V) is known as an atypical 2-cysteine peroxiredoxin that protects the organisms against various oxidative stresses and functions in signal transduction. The cDNA of a PRX V gene (designated as CfPRX) was cloned from scallop Chlamys farreri. The full-length sequence of CfPRX cDNA was of 2,179 bp with a 564 bp open reading frame encoding a peptide of 187 amino acids. Sequence comparison showed that CfPRX shared higher identities with PRX Vs than that with other isoforms of PRX, indicating CfPRX was a member of the PRX V family. Fluorescent real-time quantitative PCR analysis revealed the presence of CfPRX transcripts in gill filaments, adductor muscle, heart, gonad, kidney and hemocytes, and the stimulation of Listonella anguillarum significantly (P < 0.01) enhanced the mRNA expression of CfPRX in hemocyte. These results indicated that CfPRX was a constitutive and inducible acute-phase protein which was involved in the immune resistance to L. anguillarum stimulation.

Identification of a C-type lectin from the bay scallop Argopecten irradians

C-type lectins are Ca2+ dependent carbohydrate-recognition proteins that play crucial roles in the invertebrate innate immunity, such as nonself recognition, activation of proPO system, antibacterial activity, promotion of phagocytosis and nodule formation. In this study, a novel C-type lectin of bay scallops Argopecten irradians (Ai Lec) was identified using expressed sequence tag (EST) and RACE techniques. The Ai Lec cDNA encoded a polypeptide of 171 amino acids with a putative signal peptide of 21 amino acid residues and a mature protein of 150 amino acids. The deduced amino acid sequence of Ai Lec was highly similar to those of the C-type lectins from other animals and contained a typical carbohydrate-recognition domain (CRD) of 131 residues, which has four conserved disulfide-bonded cysteine residues that define the CRD and two additional cysteine residues at the amino terminus. The expression of Ai Lec transcript was dominantly detected in the hepatopancreas and slightly detected in the haemocytes of normal scallops. 6 h after Vibrio anguillarum-challenge and 8 h after Micrococcus luteus-challenge, the temporal expression of Ai Lec mRNA in hemocytes was increased by 4.4- and 3.6-folds, respectively. The results suggested that Ai Lec was a constitutive and inducible acute-phase protein and might be involved in immune response to Gram-negative and Gram-positive microbial infection in bay scallop A. irradians.

CDNA cloning and mRNA expression of the lipopolysaccharide- and beta-1,3-glucan-binding protein gene from scallop Chlamys farreri

Lipopolysaccharide and beta-1,3-glucan-binding protein (LGBP) play a crucial role in the innate immune response of invertebrates as a pattern recognition protein (PRP). The scallop LGBP gene was obtained from Chlamys farreri challenged by Vibrio anguillarum by randomly sequencing cDNA clones from a whole body cDNA library, and by fully sequencing a clone with homology to known LGBP genes. The scallop LGBP consisted of 1876 nucleotides with a canonical polyadenylation signal sequence AATAAA and a poly(A) tail, encoding a polypeptide of 440 amino acids with the estimated molecular mass of 47.16 kDa and a predicted isoelectric point of 5.095. The deduced amino acid sequence showed a high similarity to that of invertebrate recognition proteins from blue shrimp, black tiger shrimp, mosquito, freshwater crayfish, earthworms, and sea urchins, with conserved features including a potential polysaccharide-binding motif, a glucanase motif, and N-glycosylation sites. The temporal expression of LGBP genes in healthy and V. anguillarum-challenged C farreri scallop, measured by real-time semiquantitative reverse transcription polymerase chain reaction (PCR), showed that expression was up-regulated initially, followed by recovery as the stimulation cleared. Results indicated that scallop LGBP was a constitutive and inducible acute-phase protein that could play a critical role in scallop-pathogen interaction. (C) 2004 Elsevier B.V. All rights reserved.

Molecular cloning and characterization of a short type peptidoglycan recognition protein (CfPGRP-S1) cDNA from Zhikong scallop Chlamys farreri

Peptidoglycan recognition protein (PGRP) specifically binds to peptidoglycan and plays a crucial role in the innate immune responses as a pattern recognition receptor (PRR). The cDNA of a short type PGRP was cloned from scallop Chlamys farreri (named CfPGRP-SI) by homology cloning with degenerate primers, and confirmed by virtual Northern blots. The full length of CfPGRP-SI cDNA was 1073 bp in length, including a 5 ' untranslated region (UTR) of 59 bp, a 3 ' UTR of 255 bp, and an open reading frame (ORF) of 759 bp encoding a polypeptide of 252 amino acids with an estimated molecular mass of 27.88 kDa and a predicted isoelectric point of 8.69. BLAST analysis revealed that CfPGRP-S1 shared high identities with other known PGRPs. A conserved PGRP domain and three zinc-binding sites were present at its C-terminus. The temporal expression of QPGRP-S1 gene in healthy, Vibrio anguillarum-challenged and Micrococcus lysodeikticus-challenged scallops was measured by RT-PCR analysis. The expression of CfPGRP-S1 was upregulated initially in the first 12 h or 24 h either by M. lysodeikticus or V. anguillarum challenge and reached the maximum level at 24 h or 36 h, then dropped progressively, and recovered to the original level as the stimulation decreased at 72 h. There was no significant difference between V. anguillarum and M. lysodeikticus challenge. The results indicated that the CfPGRP-S1 was a constitutive and inducible acute-phase protein which was involved in the immune response against bacterial infection. (c) 2007 Elsevier Ltd. All rights reserved.

The first molluscan TCTP in Venerupis philippinarum: Molecular cloning and expression analysis

Translationally controlled tumor protein (TCTP) is one of the abundant and ubiquitously expressed proteins in metazoans In the present study, the first molluscan TCTP (denoted as VpTCTP) was identified from Venerupis philippinarum haemocytes by EST and RACE approaches The full-length cDNA of VpTCTP consisted of 1148 nucleotides with an open-reading frame of 555 bp encoding 184 amino acids The deduced amino acid sequence of VpTCTP shared high similarity with TCTPs from other species, indicating that VpTCTP should be a new member of TCTP family Several highly conserved motifs, including 5'terminal ologopyrimidine (5'TOP) starting sequence and rich AU and AUUT elements in 3'UTR, were also identified in VpTCTP The tissue and temporal expression of VpTCTP after Vi boo anguillarum challenge was recorded by quantitative real-time RT-PCR. VpTCTP transcript could be detected in all examined tissues with the highest expression level in haemocytes and the lowest in hepatopancreas Concerning the time-course expression in haemocytes, the relative expression of VpTCTP mRNA was down-regulated sharply from 6 h to 12 h post-infection. Then, the expression level was obviously up-regulated and reached 3.4-fold to that in the control group at 48 h post challenge As time progressed, the expression of VpTCTP recovered to the original level at 96 h. All these results indicated that VpTCTP was an acute-phase protein involved in the Immune response of V philippinarum (C) 2010 Elsevier Ltd. All rights reserved.

Expression of C-reactive protein in human lung epithelial cells and up-regulation by cytokines and carbon particles.

C-reactive protein (CRP) is the prototypic human acute-phase protein and is found at increased levels in the blood during episodes of inflammation. CRP was generally thought to be produced only by hepatocytes; however, several studies have shown extrahepatic synthesis of CRP. A previous study showed that PM10 and ultrafine carbon black (ufCB) were able to induce CRP expression in A549 cells. This study aims to examine the factors that lead to the production of CRP in A549 cells. A549 human lung epithelial cells were treated with cytokines (interleukin 6, tumor necrosis factor , interferon , or interleukin 1) or carbon particles (CB and ufCB) for 18 h. It was found that CRP could be expressed within the cells and that CRP was secreted from the cells particularly with tumor necrosis factor , CB and ufCB treatments. It was also found that this expression of CRP with CB and ufCB treatments was dependent on nuclear factor kappa B (NFB). The expression of CRP in A549 cells may indicate an important role for CRP expression and secretion from lung epithelial cells in response to inflammatory stimuli.

The effect of nitric oxide surface flux on the foreign body response to subcutaneous implants.

Although the release of nitric oxide (NO) from biomaterials has been shown to reduce the foreign body response (FBR), the optimal NO release kinetics and doses remain unknown. Herein, polyurethane-coated wire substrates with varying NO release properties were implanted into porcine subcutaneous tissue for 3, 7, 21 and 42 d. Histological analysis revealed that materials with short NO release durations (i.e., 24 h) were insufficient to reduce the collagen capsule thickness at 3 and 6 weeks, whereas implants with longer release durations (i.e., 3 and 14 d) and greater NO payloads significantly reduced the collagen encapsulation at both 3 and 6 weeks. The acute inflammatory response was mitigated most notably by systems with the longest duration and greatest dose of NO release, supporting the notion that these properties are most critical in circumventing the FBR for subcutaneous biomedical applications (e.g., glucose sensors).

Persistent Inflammation Subverts Thrombospondin-1–Induced Regulation of Retinal Angiogenesis and Is Driven by CCR2 Ligation

Neovascular retinal disease is a leading cause of blindness orchestrated by inflammatory responses. Although noninfectious uveoretinitis is mediated by CD4(+) T cells, in the persistent phase of disease, angiogenic responses are observed, along with degeneration of the retina. Full clinical manifestation relies on myeloid-derived cells, which are phenotypically distinct from, but potentially sharing common effector responses to age-related macular degeneration. To interrogate inflammation-mediated angiogenesis, we investigated experimental autoimmune uveoretinitis, an animal model for human uveitis. After the initial acute phase of severe inflammation, the retina sustains a persistent low-grade inflammation with tissue-infiltrating leukocytes for over 4 months. During this persistent phase, angiogenesis is observed as retinal neovascular membranes that arise from inflamed venules and postcapillary venules, increase in size as the disease progresses, and are associated with infiltrating arginase-1(+) macrophages. In the absence of thrombospondin-1, retinal neovascular membranes are markedly increased and are associated with arginase-1(-) CD68(+) macrophages, whereas deletion of the chemokine receptor CCR2 resulted in reduced retinal neovascular membranes in association with a predominant neutrophil infiltrate. CCR2 is important for macrophage recruitment to the retina in experimental autoimmune uveoretinitis and promotes chronicity in the form of a persistent angiogenesis response, which in turn is regulated by constitutive expression of angiogenic inhibitors like thrombospondin-1. This model offers a new platform to dissect the molecular and cellular pathology of inflammation-induced ocular angiogenesis.

Identification of serum stress biomarkers in pigs housed at different stocking densities

Eight Duroc × (Landrace × Large White) male pigs housed at a stocking rate of 0.50 m2/pig were subjected to a higher stocking rate of 0.25 m2/pig (higher density, HD) for two 4-day periods over 26 days. Using biochemical and proteomic techniques serum and plasma samples were examined to identify potential biomarkers for monitoring stress due to HD housing. HD housed pigs showed significant differences (P < 0.001) in total cholesterol and low density lipoprotein-associated cholesterol, as well as in concentrations of the pig-major acute phase protein (Pig-MAP) (P = 0.002). No differences were observed in serum cortisol or other acute phase proteins such as haptoglobin, C-reactive protein or apolipoprotein A–I. HD-individuals also showed an imbalance in redox homeostasis, detected as an increase in the level of oxidized proteins measured as the total plasma carbonyl protein content (P < 0.001) with a compensatory increase in the activity of the antioxidant enzyme glutathione peroxidase (P = 0.012). Comparison of the serum proteome yielded a new potential stress biomarker, identified as actin by mass spectrometry. Cluster analysis of the results indicated that individuals segregated into two groups, with different response patterns, suggesting that the stress response depended on individual susceptibility.