Ionic mechanisms mediating the differential effects of methohexital and thiopental on action potential duration in guinea pig and rabbit isolated ventricular myocytes

BACKGROUND: The stress response to injury concept has been proposed as a mechanism of chronic rejection. This hypothesis has been tested with a rat cardiac allograft model in recipients pretreated with donor bone marrow (BM) cells. Chronic rejection is manifested in this BM group by obliterative arteriopathy and the epicardium and endocardium contains lymphocytic infiltrates resembling Quilty lesions. Pretreatment with a liver allograft (the orthotopic liver transplant OLTx] group) is associated with an absence of chronic rejection in the transplanted heart. METHODS AND RESULTS:. Stress responses in the allograft were assessed by determining heat shock protein (hsp) expression by immunohistology of graft tissues and immunoblot analysis of stromal tissue lysates with monoclonal antibodies (mAb) to mammalian hsp60, the inducible hsp72, the constitutively expressed hsc73, and the grp78 C-terminal sequence KSEKDEL (grp78seq). Immunostaining showed clusters of grp78seq-positive cells in the inflammatory infiltrates of obliterated blood vessels and Quilty lesions in the BM group of cardiac allografts. Such grp78seq-positive cells were not seen in the OLTx group of heart allografts nor in syngrafts. Neither group showed significantly different graft myocyte staining of grp78 or hsp72, whereas hsp60 and hsc73 showed higher expression in the BM group and, to a lesser extent, the OLTx group. The increased expression of hsc73 was seen especially in the obliterated arteries and in myocytes nearby cellular infiltrates. Immunoblot analysis of graft stromal tissue lysates showed additional bands with mAb to hsp60 and hsc73 for the OLTx and especially the BM group. No significant bands were seen for hsp72 and grp78. Lymphocytes isolated from chronically rejecting allografts reacted with irradiated autologous spleen cells in the presence of mycobacterial hsp65 and interleukin-2. Culturing of graft-infiltrating cells with mycobacterial hsp71 and interleukin-2 yielded lymphocyte clones without alloreactivity, but with strong proliferative responsiveness to self-antigen-presenting cells and, only in the presence of mycobacterial hsp71 or murine grp78. This T-cell reactivity seemed to require intact hsp molecules because treatment of hsp71 with proteolytic enzymes, polymyxin, or ATP abrogated this induction of the stimulatory effect of self-antigen-presenting cells. These T cells are similar to the hsp-dependent, autoreactive lymphocytes cloned from acutely rejecting rat allografts. CONCLUSIONS: These findings support the concept that the pathogenesis of chronic rejection involves a stress response and the participation of graft-infiltrating autoreactive T cells that operate under hsp-dependent mechanisms.