“…In some systems, the cells that survive severe stress are not resistant, but are actually sensitized to subsequent stress, so that the two hits of severe stress are synergistic in their toxic effects in these populations (Boger et al 2010;Carvey et al 2006;Gao and Hong 2011;Manning-Bog and Langston 2007;Sulzer 2007;Unnithan et al 2012Unnithan et al , 2013Weidong et al 2009;Zhu et al 2001Zhu et al , 2007. In short, one might expect the direction of the stress response, i.e., whether it will elicit pro-survival or pro-death responses, to depend on cell type, heat shock protein expression, antioxidant defenses, dose and duration of the injury, previous exposures to other stressors, brain region, animal age, nutrient intake, physical activity levels, disease stage, and numerous other endogenous and environmental variables (Leak 2014).…”