Surgical stress and the heat shock response: in vivo models of stress conditioning

All forms of surgical therapy are stressful and injurious. The majority of surgical procedures are performed electively and provide an opportunity to condition the patient before surgery to maximize outcome. We have successfully protected the spinal cord and kidneys from warm ischemia-reperfusion injury with whole-body heat shock (42.5 degrees C, 15 min, HS) and recovery (37 degrees C, 6-8 h) before acute aortic occlusion. Control rabbits experienced an 88% incidence of paralysis (7/8) after acute spinal cord ischemia, while HS-pretreated animals never became paralyzed (0/9, p < 0.001). Control pig kidneys showed partial function (4/8 survival) after 90-min warm ischemia, while HS-pretreated kidneys always functioned (8/8 survival, p < 0.04). A positive temporal association was made between the HS-associated functional protection and the enhanced expression of inducible HSP70. The induction of the heat-shock response (cellular stress response) to protect tissues from lethal acute ischemia-reperfusion injury could be employed in a wide range of medical and surgical settings.