The Interaction of Exercise, Stress, and Inflammation on Growth

  • Ashley Peckett
  • Brian W. Timmons
  • Michael C. Riddell


The body’s main stress axis, the hypothalamic-pituitary–adrenal (HPA) axis, has profound effects on growth and immune function that can impact health well into adulthood. In the short term, elevations in cortisol, the main stress hormone in humans, promote a catabolic state to allow for short-term defense against stressors that may be psychological or physiological in nature. In the long term, however, elevations in glucocorticoids from either endogenous or exogenous sources promote reductions in bone mass, bone density, stature, muscle mass, and an increase in central adipose gain in children and adolescents. These deleterious effects can also set the stage for numerous chronic diseases. Exercise is a potent activator of the HPA axis in humans and in rodents, yet regular exercise is not associated with chronic elevations in circulating GCs or the detrimental effects of elevated GCs, likely because of several adaptations to the HPA axis. In some cases of excessive exercise and overtraining, the detrimental effects of chronic elevations in GC levels that impact normal growth can be observed. The cellular, molecular, and physiological interactions of exercise, stress, and immune function in the context of normal and abnormal growth are highlighted in this chapter.


Glucocorticoid Receptor Regular Exercise Growth Hormone Release Urinary Free Cortisol Level Stressed Mother 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Adrenocorticotropic hormone


Adipose stromal cells


Activating transcription factor 4


Adipose triglyceride lipase


11β-Hydroxysteroid dehydrogenase


Corticotrophin-releasing hormone


Cytochrome P450


eIF4E-binding protein 1


Forkhead box O




Growth hormone


Glucocorticoid receptors




Hormone-sensitive lipase


Insulin-like growth factor-1


Luteinizing hormone


Lipoprotein lipase


Muscle atrophy Fbox


Macrophage colony-stimulating factor


Melanocortin-2 receptor


Mineralocorticoid receptors


Mammalian target of rapamycin


Muscle ring finger 1




Neuropeptide Y


Phosphoenolpyruvate carboxykinase


Phenylethanolamine N-methyltransferase


Paraventricular nucleus


Receptor activator for nuclear factor κ B ligand


Regulated in development and DNA damage responses


Socioeconomic status


Steroidogenic acute regulatory protein


S6 kinase 1


Urinary free cortisol


Ubiquitin–proteasome system


  1. Abad V, Chrousos GP, Reynolds JC, Nieman LK, Hill SC, Weinstein RS, Leong GM. Glucocorticoid excess during adolescence leads to a major persistent deficit in bone mass and an increase in central body fat. J Bone Miner Res. 2001;16:1879–85.PubMedCrossRefGoogle Scholar
  2. Abdallah BM, Beck-Nielsen H, Gaster M. Increased expression of 11beta-hydroxysteroid dehydrogenase type 1 in type 2 diabetic myotubes. Eur J Clin Invest. 2005;35:627–34.PubMedCrossRefGoogle Scholar
  3. Adams CM. Role of the transcription factor ATF4 in the anabolic actions of insulin and the anti-anabolic actions of glucocorticoids. J Biol Chem. 2007;282:16744–53.PubMedCrossRefGoogle Scholar
  4. Alberts P, Nilsson C, Selen G, Engblom LO, Edling NH, Norling S, Klingstrom G, Larsson C, Forsgren M, Ashkzari M, Nilsson CE, Fiedler M, Bergqvist E, Ohman B, Bjorkstrand E, Abrahmsen LB. Selective inhibition of 11 beta-hydroxysteroid dehydrogenase type 1 improves hepatic insulin sensitivity in hyperglycemic mice strains. Endocrinology. 2003;144:4755–62.PubMedCrossRefGoogle Scholar
  5. Anonymous. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. Arthritis Rheum. 2001;44:1496–503.CrossRefGoogle Scholar
  6. Borer KT. Exercise endocrinology 2nd ed. Champaigh, IL: Human Kinetics Publishers; 2003.Google Scholar
  7. Bujalska IJ, Kumar S, Hewison M, Stewart PM. Differentiation of adipose stromal cells: the roles of glucocorticoids and 11beta-hydroxysteroid dehydrogenase. Endocrinology. 1999;140:3188–96.PubMedCrossRefGoogle Scholar
  8. Buske-Kirschbaum A. Neuroimmunomodulation. Cortisol responses to stress in allergic children: interaction with the immune response. 2009;16:325–32.PubMedCrossRefGoogle Scholar
  9. Campbell JE Fediuc S, Hawke TJ, Riddell MC. Endurance exercise training increases adipose tissue glucocorticoid exposure: adaptations that facilitate lipolysis. Metabolism. 2009a;58:651–60.PubMedCrossRefGoogle Scholar
  10. Campbell JE, Rakhshani N, Fediuc S, Bruni S, Riddell MC. Voluntary wheel running initially increases adrenal sensitivity to adrenocorticotrophic hormone, which is attenuated with long-term training. J Appl Physiol. 2009b;106:66–72.PubMedCrossRefGoogle Scholar
  11. Campbell JE, Kiraly MA, Atkinson DJ, D’souza AM, Vranic M, Riddell MC. Regular exercise prevents the development of hyperglucocorticoidemia via adaptations in the brain and adrenal glands in male Zucker diabetic fatty rats. Am J Physiol Regul Integr Comp Physiol. 2010.Google Scholar
  12. Canalis E, Bilezikian JP, Angeli A, Giustina A. Perspectives on glucocorticoid-induced osteoporosis. Bone. 2004;34:593–8.PubMedCrossRefGoogle Scholar
  13. Chapman KE, Seckl JR. 11beta-HSD1, inflammation, metabolic disease and age-related cognitive dys function. Neurochem. Res. 2008;33:624–36.PubMedCrossRefGoogle Scholar
  14. Chrousos GP, Torpy DJ, Gold PW. Interactions between the hypothalamic-pituitary-adrenal axis and the female reproductive system: clinical implications. Ann Intern Med. 1998;129:229–40.PubMedGoogle Scholar
  15. Civitarese AE, Ravussin E. Mitochondrial energetics and insulin resistance. Endocrinology. 2008;149:950–4.PubMedCrossRefGoogle Scholar
  16. Clark BJ, Wells J, King SR, Stocco DM. The purification, cloning, and expression of a novel luteinizing hormone-induced mitochondrial protein in MA-10 mouse Leydig tumor cells. Characterization of the steroidogenic acute regulatory protein StAR. J Biol Chem. 1994;269:28314–22.PubMedGoogle Scholar
  17. Consoli A. Role of liver in pathophysiology of NIDDM. Diabetes Care. 1992;15:430–41.PubMedCrossRefGoogle Scholar
  18. Cottrell EC, Seckl JR. Prenatal stress, glucocorticoids and the programming of adult disease. Front Behav Neurosci. 2009;3:19.PubMedCrossRefGoogle Scholar
  19. Couch RM. Dissociation of cortisol and adrenal androgen secretion in poorly controlled insulin-dependent diabetes mellitus. Acta Endocrinol. (Copenh). 1992;127:115–7.Google Scholar
  20. Coutinho AE, Campbell JE, Fediuc S, Riddell MC. Effect of voluntary exercise on peripheral tissue glucocorticoid receptor content and the expression and activity of 11beta-HSD1 in the Syrian hamster. J Appl Physiol. 2006;100:1483–8.PubMedCrossRefGoogle Scholar
  21. Dardevet D, Sornet C, Savary I, Debras E, Patureau-Mirand P, Grizard J. Glucocorticoid effects on insulin- and IGF-I-regulated muscle protein metabolism during aging. J Endocrinol. 1998;156:83–9.PubMedCrossRefGoogle Scholar
  22. Deibert DC, DeFronzo RA. Epinephrine-induced insulin resistance in man. J Clin Invest. 1980;65:717–21.PubMedCrossRefGoogle Scholar
  23. Duclos M, Gouarne C, Bonnemaison D. Acute and chronic effects of exercise on tissue sensitivity to glucocorticoids. J Appl Physiol. 2003;94:869–75.PubMedGoogle Scholar
  24. Duclos M, Gouarne C, Martin C, Rocher C, Mormede P, Letellier T. Effects of corticosterone on muscle mitochondria identifying different sensitivity to glucocorticoids in Lewis and Fischer rats. Am J Physiol Endocrinol Metab. 2004;286:E159–67.PubMedCrossRefGoogle Scholar
  25. Duclos M, Guinot M, Le Bouc Y. Cortisol and GH: odd and controversial ideas. Appl Physiol Nutr Metab. 2007;32:895–903.PubMedCrossRefGoogle Scholar
  26. Eberl M, Jomaa H, Hayday AC. Integrated immune responses to infection - cross-talk between human gammadelta T cells and dendritic cells. Immunology. 2004;112:364–8.PubMedCrossRefGoogle Scholar
  27. Elias AN, Wilson AF, Pandian MR, Chune G, Utsumi A, Kayaleh R, Stone SC. Corticotropin releasing hormone and gonadotropin secretion in physically active males after acute exercise. Eur J Appl Physiol Occup Physiol. 1991;62:171–4.PubMedCrossRefGoogle Scholar
  28. Elsasser-Beile U, Dursunoglu B, Gallati H, Monting JS, von Kleist S. Comparison of cytokine production in blood cell cultures of healthy children and adults. Pediatr Allergy Immunol. 1995;6:170–4.PubMedCrossRefGoogle Scholar
  29. Emack J, Kostaki A, Walker CD, Matthews SG. Chronic maternal stress affects growth, behaviour and hypothalamo-pituitary-adrenal function in juvenile offspring. Horm Behav. 2008;54:514–20.PubMedCrossRefGoogle Scholar
  30. Epel E, Lapidus R, McEwen B, Brownell K. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology. 2001;26:37–49.PubMedCrossRefGoogle Scholar
  31. Fabbri A, Tinajero JC, Dufau ML. Corticotropin-releasing factor is produced by rat Leydig cells and has a major local antireproductive role in the testis. Endocrinology. 1990;127:1541–3.PubMedCrossRefGoogle Scholar
  32. Fain JN. Inhibition of glucose transport in fat cells and activation of lipolysis by glucocorticoids. Monogr Endocrinol. 1979;12:547–60.PubMedCrossRefGoogle Scholar
  33. Fediuc S, Campbell JE, Riddell MC. Effect of voluntary wheel running on circadian corticosterone release and on HPA axis responsiveness to restraint stress in Sprague-Dawley rats. J Appl Physiol. 2006;100:1867–75.PubMedCrossRefGoogle Scholar
  34. Fimbel S, Abdelmalki A, Mayet MH, Sempore B, Koubi H, Pugeat M, Dechaud H, Favier RJ. Exercise training fails to prevent glucocorticoid-induced muscle alterations in young growing rats. Pflugers Arch. 1993;424:369–76.PubMedCrossRefGoogle Scholar
  35. Finch BK. Socioeconomic gradients and low birth-weight: empirical and policy considerations. Health Serv Res. 2003;38:1819–41.PubMedCrossRefGoogle Scholar
  36. Gaillard D, Wabitsch M, Pipy B, Negrel R. Control of terminal differentiation of adipose precursor cells by glucocorticoids. J Lipid Res. 1991;32:569–79.PubMedGoogle Scholar
  37. Gasparoni A, Ciardelli L, Avanzini A, Castellazzi AM, Carini R, Rondini G, Chirico G. Age-related changes in intracellular TH1/TH2 cytokine production, immunoproliferative T lymphocyte response and natural killer cell activity in newborns, children and adults. Biol Neonate. 2003;84:297–303.PubMedCrossRefGoogle Scholar
  38. Gayan-Ramirez G, Vanderhoydonc F, Verhoeven G, Decramer M. Acute treatment with corticosteroids decreases IGF-1 and IGF-2 expression in the rat diaphragm and gastrocnemius. Am J Respir Crit Care Med. 1999;159:283–9.PubMedGoogle Scholar
  39. Ghizzoni L, Mastorakos G, Vottero A, Barreca A, Furlini M, Cesarone A, Ferrari B, Chrousos GP, Bernasconi S. Corticotropin-releasing hormone CRH inhibits steroid biosynthesis by cultured human granulosa-lutein cells in a CRH and interleukin-1 receptor-mediated fashion. Endocrinology. 1997;138:4806–11.PubMedCrossRefGoogle Scholar
  40. Goedecke JH, Wake DJ, Levitt NS, Lambert EV, Collins MR, Morton NM, Andrew R, Seckl JR, Walker BR. Glucocorticoid metabolism within superficial subcutaneous rather than visceral adipose tissue is associated with features of the metabolic syndrome in South African women. Clin Endocrinol. (Oxf). 2006;65:81–7.CrossRefGoogle Scholar
  41. Gouarne C, Groussard C, Gratas-Delamarche A, Delamarche P, Duclos M. Overnight urinary cortisol and cortisone add new insights into adaptation to training. Med Sci Sports Exerc. 2005;37:1157–67.PubMedCrossRefGoogle Scholar
  42. Hebestreit H, Bar-Or O, IOC Medical Commission, International Federation of Sports Medicine. The young athlete 2008;13:498.Google Scholar
  43. Hume DA, Favot P. Is the osteopetrotic op/op mutant mouse completely deficient in expression of macrophage colony-stimulating factor? J Interferon Cytokine Res. 1995;15:279–84.PubMedCrossRefGoogle Scholar
  44. Imae M, Fu Z, Yoshida A, Noguchi T, Kato H. Nutritional and hormonal factors control the gene expression of FoxOs, the mammalian homologues of DAF-16. J Mol Endocrinol. 2003;30:253–62.PubMedCrossRefGoogle Scholar
  45. Kodl CT, Seaquist ER. Cognitive dysfunction and diabetes mellitus. Endocr Rev. 2008;29:494–511.PubMedCrossRefGoogle Scholar
  46. Leong GM, Mercado-Asis LB, Reynolds JC, Hill SC, Oldfield EH, Chrousos GP. The effect of Cushing’s disease on bone mineral density, body composition, growth, and puberty: a report of an identical adolescent twin pair. J Clin Endocrinol Metab. 1996;81:1905–11.PubMedCrossRefGoogle Scholar
  47. Liu Y, Nakagawa Y, Wang Y, Sakurai R, Tripathi PV, Lutfy K, Friedman TC. Reduction of hepatic glucocorticoid receptor and hexose-6-phosphate dehydrogenase expression ameliorates diet-induced obesity and insulin resistance in mice. Diabetes. 2005;54:32–40.PubMedCrossRefGoogle Scholar
  48. Liu Y, Nakagawa Y, Wang Y, Liu L, Du H, Wang W, Ren X, Lutfy K, Friedman TC. Increased glucocorticoid receptor and 11{beta}-hydroxysteroid dehydrogenase type 1 expression in hepatocytes may contribute to the phenotype of type 2 diabetes in db/db mice. J Mol Endocrinol. 2008;41:53–64.PubMedCrossRefGoogle Scholar
  49. Ma K, Mallidis C, Bhasin S, Mahabadi V, Artaza J, Gonzalez-Cadavid N, Arias J, Salehian B. Glucocorticoid-induced skeletal muscle atrophy is associated with upregulation of myostatin gene expression. Am J Physiol Endocrinol Metab. 2003;285:E363–71.PubMedGoogle Scholar
  50. Makino S, Hashimoto K, Gold PW. Multiple feedback mechanisms activating corticotropin-releasing hormone system in the brain during stress. Pharmacol Biochem Behav. 2002;73:147–58.PubMedCrossRefGoogle Scholar
  51. Matzinger P. An innate sense of danger. Semin Immunol. 1998;10:399–415.PubMedCrossRefGoogle Scholar
  52. McCroskery S, Thomas M, Maxwell L, Sharma M, Kambadur R. Myostatin negatively regulates satellite cell activation and self-renewal. J Cell Biol. 2003;162:1135–47.PubMedCrossRefGoogle Scholar
  53. McEwen B, Goodman H. Handbook of physiology, volume IV: coping with the environment: neural and endocrine mechanisms. New York: Oxford University Press; 2001;IV.Google Scholar
  54. Moulias R, Meaume S, Raynaud-Simon A. Sarcopenia, hypermetabolism, and aging. Z Gerontol Geriatr. 1999;32:425–32.PubMedCrossRefGoogle Scholar
  55. Nicolaides NC, Galata Z, Kino T, Chrousos GP, Charmandari E. The human glucocorticoid receptor: molecular basis of biologic function. Steroids. 2010;75:1–12.PubMedCrossRefGoogle Scholar
  56. Park E, Chan O, Li Q, Kiraly M, Matthews SG, Vranic M, Riddell MC. Changes in basal hypothalamo-pituitary-adrenal activity during exercise training are centrally mediated. Am J Physiol Regul Integr Comp Physiol. 2005;289:R1360–71.PubMedCrossRefGoogle Scholar
  57. Penhoat A, Jaillard C, Saez JM. Corticotropin positively regulates its own receptors and cAMP response in cultured bovine adrenal cells. Proc Natl Acad Sci USA. 1989;86:4978–81.PubMedCrossRefGoogle Scholar
  58. Pereira RM, Delany AM, Canalis E. Cortisol inhibits the differentiation and apoptosis of osteoblasts in culture. Bone. 2001;28:484–90.PubMedCrossRefGoogle Scholar
  59. Piroli GG, Grillo CA, Reznikov LR, Adams S, McEwen BS, Charron MJ, Reagan LP. Corticosterone impairs insulin-stimulated translocation of GLUT4 in the rat hippocampus. Neuroendocrinology. 2007;85:71–80.PubMedCrossRefGoogle Scholar
  60. Puigserver P, Rhee J, Donovan J, Walkey CJ, Yoon JC, Oriente F, Kitamura Y, Altomonte J, Dong H, Accili D, Spiegelman BM. Insulin-regulated hepatic gluconeogenesis through FOXO1-PGC-1alpha interaction. Nature. 2003;423:550–5.PubMedCrossRefGoogle Scholar
  61. Rebuffe-Scrive M, Bronnegard M, Nilsson A, Eldh J, Gustafsson JA, Bjorntorp P. Steroid hormone receptors in human adipose tissues. J Clin Endocrinol Metab. 1990;71:1215–9.PubMedCrossRefGoogle Scholar
  62. Roberge C, Carpentier AC, Langlois MF, Baillargeon JP, Ardilouze JL, Maheux P, Gallo-Payet N. Adrenocortical dysregulation as a major player in insulin resistance and onset of obesity. Am J Physiol Endocrinol Metab. 2007;293:E1465–78.PubMedCrossRefGoogle Scholar
  63. Rubin J, Biskobing DM, Jadhav L, Fan D, Nanes MS, Perkins S, Fan X. Dexamethasone promotes expression of membrane-bound macrophage colony-stimulating factor in murine osteoblast-like cells. Endocrinology. 1998;139:1006–12.PubMedCrossRefGoogle Scholar
  64. Sakakura M, Takebe K, Nakagawa S. Inhibition of luteinizing hormone secretion induced by synthetic LRH by long-term treatment with glucocorticoids in human subjects. J Clin Endocrinol Metab. 1975;40:774–9.PubMedCrossRefGoogle Scholar
  65. Schakman O, Gilson H, Thissen JP. Mechanisms of glucocorticoid-induced myopathy. J Endocrinol. 2008;197:1–10.PubMedCrossRefGoogle Scholar
  66. Seckl JR, Morton NM, Chapman KE, Walker BR. Glucocorticoids and 11beta-hydroxysteroid dehydrogenase in adipose tissue. Recent Prog Horm Res. 2004;59:359–93.PubMedCrossRefGoogle Scholar
  67. Shearer WT, Rosenblatt HM, Gelman RS, Oyomopito R, Plaeger S, Stiehm ER, Wara DW, Douglas SD, Luzuriaga K, McFarland EJ, Yogev R, Rathore MH, Levy W, Graham BL, Spector SA, Pediatric AIDS Clinical Trials Group. Lymphocyte subsets in healthy children from birth through 18 years of age: the Pediatric AIDS Clinical Trials Group P1009 study. J Allergy Clin Immunol. 2003;112:973–80.PubMedCrossRefGoogle Scholar
  68. Shibli-Rahhal A, Van Beek M, Schlechte JA. Cushing’s syndrome. Clin Dermatol. 2006;24:260–5.PubMedCrossRefGoogle Scholar
  69. Sorrells SF, Caso JR, Munhoz CD, Sapolsky RM. The stressed CNS: when glucocorticoids aggravate inflammation. Neuron. 2009;64:33–9.PubMedCrossRefGoogle Scholar
  70. Strack AM, Sebastian RJ, Schwartz MW, Dallman MF. Glucocorticoids and insulin: reciprocal signals for energy balance. Am J Physiol. 1995;268:R142–9.PubMedGoogle Scholar
  71. Stranahan AM, Arumugam TV, Cutler RG, Lee K, Egan JM, Mattson MP. Diabetes impairs hippocampal function through glucocorticoid-mediated effects on new and mature neurons. Nat Neurosci. 2008;11:309–17.PubMedCrossRefGoogle Scholar
  72. Taitz LS, King JM. Growth patterns in child abuse. Acta Paediatr Scand Suppl. 1988;343:62–72.PubMedGoogle Scholar
  73. Theintz GE, Howald H, Weiss U, Sizonenko PC. Evidence for a reduction of growth potential in adolescent female gymnasts. J Pediatr. 1993;122:306–13.PubMedCrossRefGoogle Scholar
  74. Timmons BW, Raha S. A pediatric perspective on inflammation and oxidative stress in response to exercise. Appl Physiol Nutr Metab. 2008;33:411–9.PubMedCrossRefGoogle Scholar
  75. Tsatsoulis A, Fountoulakis S. The protective role of exercise on stress system dysregulation and comorbidities. Ann NY Acad Sci. 2006;1083:196–213.PubMedCrossRefGoogle Scholar
  76. Vegiopoulos A, Herzig S. Glucocorticoids, metabolism and metabolic diseases. Mol Cell Endocrinol. 2007;275:43–61.PubMedCrossRefGoogle Scholar
  77. Vestergaard H, Bratholm P, Christensen NJ. Increments in insulin sensitivity during intensive treatment are closely correlated with decrements in glucocorticoid receptor mRNA in skeletal muscle from patients with Type II diabetes. Clin Sci. (Lond.) 2001;101:533–40.CrossRefGoogle Scholar
  78. Wang H, Kubica N, Ellisen LW, Jefferson LS, Kimball SR. Dexamethasone represses signaling through the mammalian target of rapamycin in muscle cells by enhancing expression of REDD1. J Biol Chem. 2006;281:39128–34.PubMedCrossRefGoogle Scholar
  79. Watts LM, Manchem VP, Leedom TA, Rivard AL, McKay RA, Bao D, Neroladakis T, Monia BP, Bodenmiller DM, Cao JX, Zhang HY, Cox AL, Jacobs SJ, Michael MD, Sloop KW, Bhanot S. Reduction of hepatic and adipose tissue glucocorticoid receptor expression with antisense oligonucleotides improves hyperglycemia and hyperlipidemia in diabetic rodents without causing systemic glucocorticoid antagonism. Diabetes. 2005;54:1846–53.PubMedCrossRefGoogle Scholar
  80. Yao M, Denver RJ. Regulation of vertebrate corticotropin-releasing factor genes. Gen Comp Endocrinol. 2007;153:200–16.PubMedCrossRefGoogle Scholar
  81. Yumuk VD. Targeting components of the stress system as potential therapies for the metabolic syndrome: the peroxisome-proliferator-activated receptors. Ann NY Acad Sci. 2006;1083:306–18.PubMedCrossRefGoogle Scholar
  82. Zhang WJ, Tan YF, Yue JT, Vranic M, Wojtowicz JM. Impairment of hippocampal neurogenesis in streptozotocin-treated diabetic rats. Acta Neurol Scand. 2008;117:205–10.PubMedCrossRefGoogle Scholar
  83. Zhao WQ, Alkon DL. Role of insulin and insulin receptor in learning and memory. Mol Cell Endocrinol. 2001;177:125–34.PubMedCrossRefGoogle Scholar
  84. Zhou J, Cidlowski JA. The human glucocorticoid receptor: one gene, multiple proteins and diverse responses. Steroids. 2005;70:407–17.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Ashley Peckett
    • 1
  • Brian W. Timmons
    • 2
  • Michael C. Riddell
    • 1
  1. 1.Physical Activity and Chronic Disease Unit, School of Kinesiology and Health ScienceMuscle Health Research Centre, York UniversityTorontoCanada
  2. 2.Children’s Exercise & Nutrition Centre, McMaster Children’s HospitalMcMaster UniversityHamiltonCanada

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