—Cytotoxic T lymphocytes (CTLs) that infiltrate the heart are important immune effectors implicated in heart transplant rejection, myocarditis, and other cardiomyopathies. To investigate the mechanism(s) underlying CTL damage to the myocardium through activation of the Fas receptor (Fas/CD95/Apo-1) by the Fas ligand, we explored the interaction between peritoneal exudate CTLs (PELs), derived from perforin gene–knockout (P−/−) mice, and murine ventricular myocytes. Fas expression on isolated ventricular myocytes was demonstrated immunohistochemically. Action potentials, [Ca 2+ ] i transients, and contractions of myocytes conjugated to P−/− PELs or treated with the apoptosis-inducing anti-Fas monoclonal antibody Jo2 were recorded. Action potential characteristics of nonconjugated myocytes and myocytes conjugated with P−/− PELs were, respectively, as follows: V m , −73.2±1.5 and −53.6±6.4 mV (mean±SEM); action potential amplitude, 117.9±3.9 and 74.3±21.2 mV; and action potential duration at 80% repolarization, 17±6 and 42±13 milliseconds (all P <.05). P−/− PELs also induced early and delayed afterdepolarizations as well as arrhythmogenic activity. Diastolic [Ca 2+ ] i increased during the cytocidal interaction with P−/− PELs, from a fluorescence ratio of 0.82±0.05 (n=7) to 1.98±0.09 (n=13) ( P <.05). All of the effects caused by P−/− PELs were reproduced by incubating the myocytes with Jo2. Heparin (50 μg/mL), an antagonist of inositol trisphosphate (IP 3 )–operated sarcoplasmic reticulum Ca 2+ channels, or U-73122 (2 μmol/L), a phospholipase C inhibitor, but not the inactive agonist U-73343, prevented Fas-mediated myocyte dysfunction. Additionally, intracellular application (through the patch pipette) of the active IP 3 analogue, inositol 1,4,5-trisphosphate, but not the inactive analogue, inositol 1,3,4-trisphosphate, caused electrophysiological changes resembling those resulting from P−/− PELs and Jo2, suggesting that CTL-induced Fas-based myocyte dysfunction is mediated by IP 3 . We conclude that a Fas-based perforin-independent mechanism of CTL action can account for the immunopathology seen in the allotransplanted heart, myocarditis, and dilated cardiomyopathy.

We studied possible mechanisms whereby cytotoxic T lymphocytes (CTL) damage the myocardium during the immunological rejection of the transplanted heart, by investigating the in vitro interaction between CTL and cardiac myocytes. We utilized the patch-clamp technique to record membrane currents and action potentials from concanavalin A-treated guinea-pig ventricular myocytes conjugated to mouse peritoneal exudate CTL (PEL). PEL-myocyte interaction reduced action potential duration at 50% repolarization (APD50) from 731.7 +/- 57.8 to 195.3 +/- 58.0 ms, action potential amplitude from 134.9 +/- 1.9 to 104.2 +/- 6.2 mV and resting membrane potential (Vm) from -80.9 +/- 0.5 to 72.5 +/- 1.5 mV. These changes were accompanied by generation of delayed afterdepolarizations, indicative of intracellular [Ca2+] overload. The electrophysiological alterations were associated with myocyte shortening (within 28.9 +/- 2.8 min) followed by complete cell destruction (within 43.5 +/- 4.3 min). To determine whether intracellular Ca2+ stores were involved in PEL-induced myocyte damage, the protective effects of ryanodine and caffeine were investigated. While ryanodine (10 microM) delayed the electrophysiological and morphological alterations, caffeine (5 mM) provided significant protection, suggesting that Ca2+ release from intracellular stores contributes to PEL-induced damage to the myocytes. Based on our findings, we suggest that the functional derangements seen in myocyte-lymphocyte conjugates can contribute to the overall decline in cardiac function during heart transplant rejection.