The colonization of the spleen by NBH cells correlates with postn

The colonization of the spleen by NBH cells correlates with postnatal deposition of microbial products that likely originate from mucosal surfaces, including lipopolysaccharide [[30]]. Compared with circulating neutrophils, NBH cells are more activated as they express increased amounts of B-cell-stimulating molecules such as BAFF, APRIL, CD40L, and IL-21, as well as increased levels of immunostimulatory cytokines such as IL-12 and TNF [[30]]. However, this activation is counterbalanced by an increased expression of immune regulatory molecules, including protease find more inhibitors and T-cell suppressor factors such as arginase and iNOS [[30]].

Consistent with this phenotype, NBH cells induce IgM secretion, as well as IgG and IgA CSR, by stimulating MZ B cells learn more via BAFF, APRIL, IL-21, and possibly CD40L, at least in humans [[30]]. On the other hand, NBH cells express T-cell-suppressive factors such as arginase and iNOS and suppress T-cell proliferation in a contact-independent manner [[30]]. By exerting this dual B-cell helper/ T-cell suppressor function, NBH cells may maximize extrafollicular B-cell responses to TI antigens while minimizing follicular

B-cell responses to TD antigens and inflammation. Accordingly, NBH cells are excluded from splenic follicles under homeostatic conditions, but then infiltrate follicles under inflammatory conditions, perhaps to activate T cells (Fig. 2; [[30]]). Remarkably, NBH cells can induce SHM through a mechanism that could involve exposure of microbial TI antigens such as TLR ligands to MZ B cells [[30]]. This possibility is consistent with studies suggesting that MZ B cells activate the SHM machinery through a TI pathway activated by TLR ligation [[27, 96-100]]. Additional evidence indicates that MZ B cells also undergo SHM through a typical TD pathway, which may reflect the ability of MZ B cells to deposit antigen

in the follicle and activate T cells [[41, 101]]. In mice, MZ B cells express unmutated Ig genes under steady-state conditions, but other B-cell subsets have been shown to induce SHM via a TI pathway involving Buspirone HCl TLR signaling [[100, 102, 103]]. The mechanism by which NBH cells activate MZ B cells likely involves mucosal colonization by bacteria [[30]]. Discrete amounts of microbial products such as lipopolysaccharide undergo peri-MZ deposition soon after birth [[30]]. The resulting activation of TLR4 on sinusoidal endothelial cells would then cause the release of neutrophil-attracting chemokines, such as CXCL8, as well as perifollicular accumulation and activation of NBH cells, some of which form postapoptotic DNA-containing cellular projections similar to neutrophil traps (NETs) [[30]].

Several major questions

Several major questions GSK2126458 arise from the current study of Catucci et al. [11]. Although WASp-deficiency related defects in both NK-cell and DC lineages contribute to an impaired control of tumor and metastases in the B16 melanoma cell model, what remains unclear is to what extent this phenotype is due to (i) the inability of DCs to form an efficient IS with NK cells in the SLOs or at the tumor site; (ii) decreased NK-cell migration, possibly in response to DC chemotactic activity; (iii) impairment of a functional lytic IS between NK cells and tumor cells; and (iv) decreased

DC migration from tumor sites to and within SLOs. These different scenarios are depicted in Fig. 1. It will be interesting to see whether the impaired crosstalk between NK cells and DCs detected in Was−/− mice can also be observed in other tumor models. Moreover, it will be important to establish

whether and how the reduced capacity of Was−/− DCs to prime CD4+ and CD8+ T cells RG-7388 manufacturer [33] and the T-cell intrinsic defect to form an IS [7] might contribute to a reduced immunosurveillance in Was−/− mice and WAS patients. The authors are supported by the Deutsche Forschungsgemeinschaft (DFG) SFB 633 and SFB 650 (to C.R.) and the EU-FP7 Marie Curie Intraeuropean Fellowship (to M.B.). The authors declare no financial or commercial conflict of interest. “
“The discovery of Helicobacter pylori sparked a revolution in the understanding and management of peptic ulcer disease and gastric cancer. Other Helicobacter species are recognized as important pathogenic agents in colitic diseases of rodents and primates, in particular Helicobacter bilis, Helicobacter fennelliae, Helicobacter

hepaticus and Helicobacter trogontum. Helicobacter bilis and H. hepaticus are now routinely used to initiate rodent models of inflammatory bowel disease (IBD), particularly in immunocompromised hosts. Molecular evidence exists linking various non-pylori Helicobacter spp. with human IBD; however, attempts to culture organisms in this disease cohort have proved unsuccessful to date. Attributing causation has therefore proved elusive. Seven enterohepatic, non-pylori Helicobacter Dynein organisms have been successfully cultured from humans, namely Helicobacter canadensis, Helicobacter canis, Helicobacter cinaedi, H. fennelliae, Helicobacter pullorum, Helicobacter winghamensis and Helicobacter sp. flexispira taxon 8 (now classified as H. bilis). Of these, H. cinaedi and H. fennelliae are the closest to fulfilling Koch’s postulates as causative agents in homosexual proctitis. The possibility that novel Helicobacter organisms have a role in the initiation of human IBD warrants further consideration and targeted investigations.

Alteration of the structural integrity of TLR signalling componen

Alteration of the structural integrity of TLR signalling components is often associated with profound clinical outcome and susceptibility to various infections or autoimmune disorders. During conditions of floral translocation, peripheral TLR-9 signalling is a crucial mediator of polymicrobial sepsis. Moreover, in other conditions in which bacterial translocation occurs [for example, during irradiation and human immunodefiency virus (HIV) infection] peripheral Y27632 TLR-4 signals enhance the activation status of both CD4+ and CD8+ T cells [10]. However, under most circumstances

the tissues of the GI tract are exposed constantly to TLR ligands harboured by the commensal gut flora. Mice deficient this website in TLR-9 display increased frequencies of Tregs within intestinal effector sites and reduced levels of constitutive interleukin (IL)-17- and interferon (IFN)-γ-producing effector T cells [9]. Complementing this, lamina propria dendritic cells (DCs) lacking exposure to gut flora DNA, induce Treg conversion in vitro. Furthermore, Tregversus effector T cell disequilibrium in TLR-9−/− mice restricts immune responses to oral infection with the pathogen Encephalitozoon cuniculi.

Impaired intestinal immune responses were recapitulated in mice treated with antibiotics and were reversible after reconstitution with gut flora DNA [9]. Thus, signals derived from the gut flora act as adjuvants of immune responses for priming intestinal responses against

oral pathogens via modulation of the equilibrium between Treg and effector T cells. Intestinal epithelial cell (IEC) expression of TLRs has also 4-Aminobutyrate aminotransferase proved to be important in maintaining the homeostatic host–microbiome relationship, and to involve unexpected subtleties. For example, TLR-9 is expressed on both the apical (luminal-facing) and basolateral surfaces of the epithelial cell layer, but only basolateral ligation triggers an inflammatory signal, while apical binding is inhibitory [11]. The capacity of IECs to control immune responsiveness extends to the production of thymic stromal lymphopoietin (TSLP) and IL-25, influencing the Th phenotype balance in a manner which can make or break effective immunity [12]. The structure and composition of the gut flora reflect natural selection at both the microbial and host levels, and show perturbations in GI dysfunction. For example, modified gut floral composition is found in inflammatory bowel disease (IBD) patients [13]. Furthermore, the presence of certain bacteria can aggravate small intestinal immunopathology following oral infection.

This implies that thymically derived natural Treg cells may also

This implies that thymically derived natural Treg cells may also play a role in controlling the overall size of the GC response, or upon systemic TGF-β neutralization, other factors or cytokines may partially compensate leading to nominal induction of iTreg cells. The potential role of IL-10 was also examined by repeated administration of a blocking anti-IL-10R mAb. Mice were injected i.p. on day 0 with 1 mg of anti-IL-10R (1B1.3a) mAb or control rat IgG. Starting GDC-0068 chemical structure in the second week, 500 μg of anti-IL-10R mAb

or rat IgG was injected twice weekly and continued until the mice were killed. The SRBC were given i.p. on day 0. Similar to anti-TGF-β-treated mice, blockade of the IL-10R resulted in an inability to control the balance of IgM+ to switched GC B cells in the spleen. Although not evident at days 8 and 12, this imbalance became marked at days 18 and 24 and reflected a significant increase in both the frequency and PI3K inhibitor total number of IgM− GC B cells (Fig. 9b). Examination of the frequency and number of total B220+ PNAhi B cells showed little difference between anti-IL-10R mAb and control-treated mice, except at day 24 (Fig. 9a). This is again similar to the result observed after TGF-β neutralization, and may likewise reflect the activity of natural Treg cells or the ability of other cytokines to partially compensate.

Finally, to ensure that anti-IL-10R mAb treatment did not directly modulate responding B cells, the GC population was tested for expression of IL-10R. As shown in the Supplementary material, Fig. S3, no expression above background was detected. A large number of studies have documented the role of Treg cells in controlling antibody responses.16–46 Using either in vivo disruption (anti-GITR mAb) or depletion (anti-CD25 mAb) protocols, investigators have shown that loss of Treg-cell activity results in enhanced humoral

responses to experimental antigens,16–22 pathogens23,24 and auto-antigens.17,25–29 In all of these reports, antibody levels directed against the specific Oxymatrine antigen or infectious agent were significantly elevated, including IgG,16–27,29 IgA18,25 and even IgE.19,26 Additional studies examined whether adoptive transfer of polyclonal21,30–32,35,37–40 or TCR transgenic33,34,36,41 Treg cells could dampen antibody responses to defined allo-antigens or auto-antigens. In all cases, the transfer of Treg cells significantly lowered or even eliminated serum antibodies directed against these antigens. As GCs serve as the basis for T-cell-driven humoral responses, the current study examined the behaviour of primary splenic GC reactions induced to a number of antigens in mice treated with an anti-GITR mAb (Figs 1–4). After disruption of Treg-cell activity, total SRBC-induced GC B-cell numbers were increased at all time-points examined (days 8–24). A higher proportion of IgM− switched B cells within the GC compartment largely accounted for this increase.

Our recent studies demonstrated high avidity binding of RTLs to m

Our recent studies demonstrated high avidity binding of RTLs to macrophages, dendritic cells and B cells, and such RTL “armed” myeloid cells (but not B cells) could tolerize T cells specific for the RTL-bound peptide 43. The current study clearly demonstrates that two-domain MHC-II complexes embodied by RTLs are distinct from the corresponding four-domain complexes, and these two-domain structures deliver

Tipifarnib manufacturer tolerogenic rather than activating signals through the cognate TCR. We believe that the RTL-armed APCs are tolerogenic through two possible mechanisms: (i) that the RTLs present on the APC surface can still ligate the TCR of cognate T cells suboptimally as partial agonists; and (ii) the RTLs induce inhibitory cell surface co-inhibitory molecules (e.g. PD-1 or PD-L1/2) and/or secreted inhibitory cytokines (e.g. IL-10) Selleckchem Cabozantinib that inhibit T-cell activation in concert with RTL ligation of the TCR, with or without prior processing and re-presentation of RTL-derived antigenic peptide and MHC determinants. Our TCRL Fabs

will be used to further elucidate the in vivo therapeutic pathways of RTL1000 in the humanized DR2-Tg EAE model. RTL342m idiotype-specific TCRLs can be used to both inhibit RTL binding to APC and block RTL association with the TCR, as would be predicted for Fab 2E4. A similar approach can shed light on the functionality of the novel native two-domain structures and address whether they constitute Ag-specific tolerogens that resemble RTLs regulatory pathways. By using our conformational sensitive Fabs we will test our hypothesis that natural RTL-like structures are degradation products of soluble four-domain MHC-II molecules that have undergone

partial enzymatic cleavage. In addition, we are in the process of isolating TCRL Fabs specific for the native DR2–MOG-35-55 complex. Such Fabs will enable us to monitor possible processing and re-presentation of RTL peptides by APCs. In recent years, with the advantage of fluorochrome-labeled MHC-II multimers, there is increased knowledge about specific CD4+ T cells in various inflammatory autoimmune conditions 14, 44–47. T1D patients and at-risk subjects were found to have a significantly higher prevalence of GAD-555-567-specific CD4+ T cells than control Olopatadine subjects 48. Our novel TCRL to four- versus two-domain MHC-II–peptide complexes have the potential to selectively recognize APCs presenting disease-inducing or regulatory determinants, respectively, to islet cell-responsive CD4+ T cells during T1D. Similarly, Fabs to four- versus two-domain DR2–MOG-35-55 determinants may be invaluable in localizing and quantifying encephalitogenic versus tolerogenic APC in subjects with MS. RTL1000 and RTL340 constructs were modified for a biotinylated version. In these constructs, a Bir-A tag for biotinylation was introduced to the N-terminus using a 20-aa flexible linker.

e , slow reversal

toward baseline) is observed Although

e., slow reversal

toward baseline) is observed. Although this “die away” is most noticeable beyond 60 minutes [71], it starts at around the 45th–50th minute [61], thus justifying heating protocols restricted to between 30 and 45 minutes. Finally, the nature of the device used to heat the skin plays a key role. Indeed, all the studies showing that maximal vasodilation was reached by heating the skin to 42°C or higher have used LDF probes and metallic heaters that were directly applied on the skin. In contrast, the heating devices used with full-field techniques are water-filled chambers which the laser beam traverses. To study the influence of the water within the chamber, we compared

MG-132 mouse the LTH plateau induced with a water-filled heating probe (SHP3, Moor Instruments, Axminster, UK) before and immediately RAD001 supplier after probe removal in 12 healthy subjects. The mean (SD) LTH plateau assessed with LSCI at the end of heating for 30 minutes at 43°C on the forearm (before probe removal) was 109.7 (18.2) PU compared to 153.9 (30.1) PU immediately after probe removal (data were averaged over three minutes; p < 0.001, Wilcoxon rank test), suggesting a 30% decrease in signal when recorded across the chamber (M Roustit, personal unpublished data). Therefore, one should be extremely careful as to the methods used when comparing data expressed as %CVCmax between different experiments. In conclusion, under routine

conditions (i.e., unanesthetized skin and inter-day sites of the probes not precisely marked), integrating LDF and full-field techniques shows better inter-day reproducibility of LTH on the forearm than single-point LDF. In all cases, data should preferentially be expressed as raw CVC or, for the initial peak, as %CVCmax. Although local heating is by far the most common thermal challenge, local cooling has also been used, particularly in the study of RP. Several cooling methods coupled to LDF have been buy Sunitinib described, such as immersion of the hand or a finger in cold water [92], flexible cold packs [17], or use of a stream of carbon dioxide [89]. Due to its relative ease of use, immersion in cold water has been extensively used, including in patients with RP [48]. However, this technique induces a systemic sympathetic activation [140], which interferes with the local microvascular response. Custom-designed metal LDF probes coupled with a Peltier element allow local cooling while recording skin blood flux [72], without inducing any effect on ipsilateral and contralateral controls [116], enabling the physiology of skin microvascular reactivity to local cooling to be studied. Local cooling of the skin induces an initial vasoconstriction followed by transient vasodilation and finally, prolonged vasoconstriction [71] (Figure 6).

While the mechanisms that control T  retortaeformis and G  strigo

While the mechanisms that control T. retortaeformis and G. strigosum abundance remain obscure, our findings support the hypothesis of a Th2-mediated antibody and eosinophil clearance of primary infections to the former species but not the latter nematode (47–50). Our recent modelling of the immune response network to T. retortaeformis, based on this study, was consistent

with a Th2-mediated antibody/eosinophil clearance and an IL-4 anti-inflammatory Galunisertib purchase protection against this nematode (Takar et al., in preparation). However, additional experiments are necessary to confirm these conclusions. In this respect, the evidence that IL-4 can induce Foxp3-expressing Treg and the potential for parasite tolerance (51) raises the question of whether the persistence of G. strigosum in the presence of high IL-4 mucosa expression

involves some tolerance mechanisms activated by the rabbit or whether this is an intrinsic property of the stomach to avoid immuno-pathology. Closely related helminth Alectinib nmr infections of other herbivores such as sheep and cattle have highlighted the less effective immune response to the abomasal parasites Teladorsagia circumcincta, Haemonchus contortus, Ostertagia ostertagi and Haemonchus placei, compared to the more efficient response against the intestinal nematodes Trichostrongylus colubriformis, Trichostrongylus vitrinus and Cooperia spp. Our study is consistent with these general findings, specifically stomach and small intestine N-acetylglucosamine-1-phosphate transferase are distinct environments with different immune properties (52) and colonized by helminths with contrasting life history traits (53,54). Based on these systems, helminths in the stomach/abomasal, such as G. strigosum,

tend to have larger body size, slower development and higher fecundity. They also appear to stimulate an immune response either that is slow to develop or has higher tolerance to infections, or can be more easily immuno-suppressed by the helminth. Helminths in the small intestine, e.g. T. retortaeformis, have the opposite of these life history features, probably as a response to a more effective immune response. The co-evolution of the host immune system and the helminth life history traits in the stomach and small intestine appear to have followed different strategies. Nevertheless, in our rabbit–nematode system, the outcome has been equally successful as these parasites cause persistent chronic infections. In conclusion, we have shown that T. retortaeformis and G. strigosum exhibited different immuno-parasitological characteristics during primary infections of naïve rabbits. These nematodes appear to elicit an unequivocal Th-2-biased immune response.

Therefore, the escape of T cells bearing TCRs with some degree of

Therefore, the escape of T cells bearing TCRs with some degree of affinity toward TAPAs is probable. Furthermore, differences in the presentation of certain antigens, resulting from variable gene expression [26] and instability within the peptide MHC complex [27], may also contribute to thymic escape. The clear difference in binding parameters between VA- and TAPA-specific TCRs has implications

for therapeutic approaches. NVP-AUY922 datasheet Vaccines rely on the activation of preexisting T cells to target tumors; however, since TAPA-specific T cells possess TCRs with relatively low affinities for antigen, vaccines may be largely ineffective in eliciting an effective antitumor CTL response. This may provide one explanation for the limited success of such approaches [10, 11]. A more promising strategy, for modulating the immune system to target tumors is through adoptive therapy [28], especially if this is combined with genetically engineered TCRs designed to have a “VA-TCR-like” affinity. Indeed, T cells carrying these enhanced affinity TCRs have been shown to recognize tumor antigens with high avidity [29]. click here The construction of enhanced affinity TCRs is also central to emerging

cancer therapies comprising soluble, bispecific proteins, such as the recently described ImmTACs. These molecules combine a genetically engineered, picomolar affinity, soluble TCR, with a humanized anti-CD3 antibody, capable of redirecting TCL non tumor-specific T cells [30, 31]. Similar fusions that rely on monoclonal antibody binding to redirect the CTL response have been applied with success [32]. However, the antigens targeted by antibodies are limited to those produced as integral membrane proteins; TCRs meanwhile can recognize the larger pool of intracellular-derived peptides presented in the context of the MHC. Therefore therapeutic agents exploiting enhanced affinity TCRs hold substantial promise. Immune tolerance to tumors is a critical issue to overcome in the development of effective immunotherapies against cancer. By comparing the binding

parameters of individual TCRs to their respective pHLAs, the data presented here provide an enhanced understanding of the role of TCR affinity in tumor immune evasion, informing on the most appropriate strategies for successful therapeutics. CD8+ T cells from donors were enriched from freshly prepared peripheral blood by negative selection using microbeads according to the manufacturer’s instructions (Dynal). DCs and activated B cells were generated as described in [20, 33]. Purified CD8+ cells were cultured in CTL medium: IMDM (Invitrogen), 10% human AB serum (Sera Laboratories Int.), 100 U/mL penicillin, 100 μg/mL streptomycin, 1% glutamine (Invitrogen), supplemented with IL-7 at 10 ng/mL and autologous peptide pulsed irradiated DCs were added in a 5:1 ratio (T cells: DCs).

The five most intense ions were sequentially isolated for collisi

The five most intense ions were sequentially isolated for collision-induced dissociation MS/MS fragmentation and detection in the linear ion trap. Ions with single and unrecognized charge states were excluded. Raw data were analyzed with MaxQuant software (Version 1.0.12.31) in combination with MASCOT search engine for peptide and protein identifications (Version 2.2.04, Matrix Science).

International protein index Chicken (Version 3.47) was used as a Gallus gallus sequence database. MS/MS peak lists were filtered to contain at most six peaks per 100 Da interval and searched selleck screening library against MASCOT server. The MS mass tolerance was set to 7 ppm and MS/MS mass tolerance was set to 0.8 Da. Up to three missed cleavages of trypsin were allowed. Oxidized methionine and cysteine carbamidomethylation were searched as variable modifications. The modifications corresponding to arginine and lysine labeled with heavy stable isotopes was handled as fixed modifications in the MASCOT search, if applicable, after identification of SILAC pairs by MaxQuant. The false-positive rate was set to 1% at the

peptide level, the false discovery rate was set to 1% at the protein level and the minimum required peptide length was set to six amino acids. We thank Tomohiro Kurosaki for kindly providing antibodies to chicken SLP65, and Sandra Beer-Hammer for 14-3-3γ plasmids. We thank Uwe Plessmann and Monika Raabe for their 4-Aminobutyrate aminotransferase excellent technical assistance in MS analyses. T.O. was founded by the Institute of Mol. & Cell. Immunology and the Max Planck Institute for Biophysical Chemistry. This work was Everolimus supported by the Deutsche Forschungsgemeinschaft through FOR 521 and SFB 860, and the European Community’s Seventh Framework Program FP7/2007-2013 under grant agreement no 201549. (EURO-PADnet HEALTH-F2-2008-201549). H.B. and T.O. performed proteomic and functional analyses of Syk. M.E. conducted confocal laser scanning microscopy. H.H. contributed to interactome analyses. H.U. designed and supervised proteomic elucidation

of Syk and J.W. supervised the project and wrote the paper. Conflict of interest: The authors declare no financial or commercial conflict of interest. Detailed facts of importance to specialist readers are published as ”Supporting Information”. Such documents are peer-reviewed, but not copy-edited or typeset. They are made available as submitted by the authors. “
“Citation Kaul R, Cohen CR, Chege D, Yi TJ, Tharao W, McKinnon LR, Remis R, Anzala O, Kimani J. Biological factors that may contribute to regional and racial disparities in HIV prevalence. Am J Reprod Immunol 2011; 65: 317–324 Despite tremendous regional and subregional disparities in HIV prevalence around the world, epidemiology consistently demonstrates that black communities have been disproportionately affected by the pandemic.

Dr Segawa clarified the differences between both diseases14 and e

Dr Segawa clarified the differences between both diseases14 and encouraged me to pursue my study on EPDF. Following the Segawa Symposium, I proceeded with a clinical survey covering 43 cases of EPDF from 22 families.15–17 Sixteen of the 22 families had a positive family history, and 10 of them had parental consanguinity.

There were 10 multiplex families, 11 simplex families and one uniplex family. No patients had a history of parkinsonism in their antecedent or descendant relatives. There was no gender preponderance. We conducted a study to compare patients with diurnal fluctuation (sleep benefit) versus those without, and found the difference in terms of age at onset, initial symptom, progression of the disease, as well as incidence of dystonia, hyperreflexia, MK1775 and of dopa-induced dyskinesia (Table 1).15,16 This supports the idea that diurnal fluctuation is cardinal in characterizing EPDF, not merely seen by chance in early-onset PD. The magnitude of diurnal fluctuation PI3K inhibitor varied among families and individuals. The phenomenon was marked in earlier stages of the disease, and became less so with increasing age and was masked with the initiation of antiparkinsonian drug therapy. Most patients experienced at least slight improvement after sleep even 30–40 years after the onset. Patients treated with levodopa frequently

developed dyskinesia and motor fluctuation, which were alleviated by lowering the dose of levodopa and/or administering other drugs. Three patients developed delusions during levodopa treatment, which persisted even after

reduction of levodopa with concomitant use of neuroleptics. The clinical pentoxifylline manifestations of EPDF are relatively uniform, without any cognitive disorders or severe autonomic failures. Genetic analysis using the Weinberg’s proband method confirmed that EPDF is of autosomal recessive form.17 Pathology is an essential qualification in building disease entities. Prior to our presentation, there were only a few reports on the neuropathology of autosomal recessive parkinsonism. One patient reported by Ota et al.18 was likely the first based on the age of onset, occurrence of the disease in siblings, and consanguineous marriage. However, the authors did not refer to diurnal fluctuation, nor to presence or absence of Lewy bodies in the substantia nigra pars compacta (SNPC). Another case was reported by Mizutani et al.19 with a few Lewy bodies in the SNPC in addition to decreased neuronal melanin. However, this case later proved to be Segawa disease (Yokochi, pers. comm., 2008). In 1992 one of my EPDF patients died. The patient was a 52-year-old woman from a family with parental consanguinity and two other sisters affected from the same disease. Her disease started at the age of 20. From the initial stage, she noticed symptomatic alleviation after sleep (sleep benefit) which allowed her to do housework for 2–3 h after sleep. Subsequently diurnal fluctuation became less remarkable.