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PubMed1991

Interaction of pentoxifylline with human erythrocytes. III. Comparison of fluidity change of erythrocyte membrane caused by S-adenosyl-L-methionine with that by pentoxifylline.

The change in fluidity by adding pentoxifylline to erythrocyte membranes was compared with that caused by S-adenosyl-L-methionine (SAM) by the method of electron spin resonance (ESR) spectroscopy. When SAM or pentoxifylline was added externally to the erythrocyte suspension (outside), the fluidity of the membrane bilayer was increased after incubation at 37 degrees C. However, the fluidity change in the inner part of the bilayer was relatively small compared to that in its outer part. These fluidity changes were dependent on the incubation time and the temperature. When the erythrocyte suspension was preincubated overnight at 4 degrees C in the presence of drugs (inside), the fluidity of the inner part of the membrane changed significantly. Nevertheless, that of the outer part of the lipid bilayer was not affected. Such an asymmetric fluidity change in the lipid bilayer was not observed by the addition of other xanthine derivatives such as caffeine, theophylline and theobromine. S-Adenosyl-L-homocysteine suppressed and MgCl2 enhanced the increase of the membrane fluidity by SAM or pentoxifylline. Furthermore, the effects of SAM and pentoxifylline on erythrocyte deformability were determined by a filtering technique method. In increasing order the additive effects of SAM and pentoxifylline on the erythrocyte filterability were SAM (outside) less than pentoxifylline (inside) less than pentoxifylline (outside) less than SAM (inside). These results suggest that pentoxifylline also affects the membrane fluidity through the enzymatic methylation of phospholipids.

Erythrocyte Membrane↗
PubMed1993

Serum levels of pentoxifylline and its metabolites in non-tumor-bearing mice after chronic oral pentoxifylline administration.

Pentoxifylline lowers blood viscosity and increases erythrocyte flexibility in patients with atherosclerosis, thus increasing tissue oxygen delivery. Since tumor neo-vessels are associated with tissue hypoxia, which contributes to failure of radiation therapy, pentoxifylline might also be useful as a radiation sensitizer. Such drugs are often evaluated in the murine model, but serum levels of pentoxifylline and its metabolites have not been determined in the mouse after chronic oral dosing. We investigated this by administering pentoxifylline via liquid diet or solid diet to young adult male CF1 mice for one to six weeks and assaying plasma for the parent drug and its metabolites. At one, three, and six weeks, plasma levels of pentoxifylline and major derivatives were consistently detectable. Mice remained healthy during this period, indicating that ingestion of large amounts of this drug is well tolerated.

Administration, Oral↗
PubMed1996

Efficacy and clinical tolerance of parenteral pentoxifylline in the treatment of critical lower limb ischemia. A placebo controlled multicenter study. Norwegian Pentoxifylline Multicenter Trial Group.

A total of 114 patients with critical lower limb ischemia from 11 hospitals were randomized to either Pentoxifylline 600 mg or placebo given intravenously twice a day. Rest pain was evaluated both by the investigator and the patient. Pain was evaluated with the patient in the supine as well as in the sitting position using a pain score scale, a pain relief scale and a visual analogue scale. All patients underwent a clinical examination, measurement of ankle systolic blood pressure and arteriography. These arteriograms were evaluated by a radiologist who did not know which treatment had been given. If no beneficial effect of the treatment was observed after one week, further medication was discontinued. Otherwise the treatment continued for two additional weeks. There was no statistically significant difference in pain-free or absolute walking distance between the two groups. Evaluating the patients with the most pronounced amelioration of rest pain in the supine position (divided by 4 to divided by 2 points), there was a beneficial effect of Pentoxifylline compared to placebo. Evaluation of the total material did not, however, show any statistical significances between the groups. From further subgroup analysis excluding patients who had only slight pain at the entrance of the study, there was a significant improvement in rest pain in favour of Pentoxifylline following seven days of treatment. In this group the pain evaluated according to this visual analogue scale had decreased 37 points (54%) compared to 14 points (25%) in the placebo group. More side effects, mainly gastrointestinal, were observed in the Pentoxifylline group. Most of these could be eliminated by increasing the infusion time. Further investigations are necessary to evaluated the place of Pentoxifylline in the treatment of patients with critical limb ischemia.

Aged↗
PubMed1993

Effects of dipyridamole, pentoxifylline or dipyridamole plus pentoxifylline on platelet reactivity in patients with ischemic cerebrovascular insufficiency.

Platelet activation and the subsequent platelet recruitment induced by activated platelets released products constitute the initial events of platelet thrombus formation. We have evaluated the recruiting activity of collagen-stimulated whole blood in patients with ischemic cerebrovascular insufficiency. This was done using an experimental approach that allows independent evaluation of platelet activation and recruitment. The effects of of treating the patients with dipyridamole (DIP) (300 mg/day), pentoxifylline (POX) (1200 mg/day) or a combination of the two drugs at the same doses was also evaluated before and after 7, 15, and 45 days of treatment. DIP decreased the recruiting activity in a time-dependent manner, while POX did not show any effect. However, the combined treatment with DIP+POX was more effective than DIP alone in reducing platelet recruitment, which was abolished after 45 days of treatment. Studies using the drugs in vitro indicated a greater inhibitory activity of the drug association than either drug individually. The effects of the drug association in vitro, even at high concentrations, was lower than those observed ex vivo after 45 days of treatment. This suggests that DIP+POX in vivo may have effects that condition a reduced platelet response.

Aged↗
PubMed1993

Pentoxifylline alone versus pentoxifylline combined with superoxide dismutase prolongs survival in a rat hemorrhagic shock model.

Pentoxifylline (PTX) and superoxide dismutase (SOD) have each proven effective in improving survival when administered during resuscitation in animal models of hemorrhagic shock. This study was conducted to determine if PTX and SOD combined would have synergistic effectiveness in the treatment of hemorrhagic shock. Sprague-Dawley rats (n = 40) were phlebotomized at 25 ml/kg for 2 min, then subjected to a 45-min ischemic period, and resuscitated with lactated Ringer's solution (LR) (50 ml/kg) over 1 h. This model resulted in 70% mortality over 72 h when resuscitation was with LR alone. Animals were randomized into groups to receive one of the following agents during resuscitation: PTX in LR, SOD in LR, a combination of PTX and SOD in LR, or LR alone. PTX or SOD alone were effective in prolonging survival. However, the combination of PTX and SOD did not prolong survival above LR control.

Animals↗
PubMed1990

Interaction of pentoxifylline with human erythrocytes. II. Effects of pentoxifylline on the erythrocyte membrane.

The effects of pentoxifylline and other hemorheologically active drugs on the human erythrocyte membrane were examined by means of electron spin resonance spectroscopy. It was observed that the fluidity in the region of the phospholipid head groups in the erythrocyte bilayer was increased by an externally added drug. In this region, membrane fluidity was dependent on the incubation time, suggesting an interaction with membrane proteins. On the other hand, the acyl chain motion in the lower portion of the chain, the hydrophobic end, was reduced in the presence of the drugs. In this case, the acyl chain motion was not time-dependent. These changes of the membrane fluidity at different depths of the membrane induced by the drugs may correlate to the erythrocyte deformability.

Erythrocyte Membrane↗
PubMed1996

Inhibition of fibroproliferation by pentoxifylline. Activity of metabolite-1 and lack of role of adenosine receptors.

We have reported previously that pentoxifylline and adenosine decrease platelet-derived growth factor- (PDGF) stimulated fibroproliferation. To determine the role of adenosine receptors in the inhibition of fibroproliferation observed with pentoxifylline, we used a non-selective adenosine receptor antagonist, 8-phenyltheophylline, and specific A1 and A2 adenosine receptor antagonists. If the A2 receptor, which is present on fibroblasts, mediates the inhibition of fibroproliferation which occurs with pentoxifylline, then pretreatment of fibroblasts with receptor antagonists prior to the addition of pentoxifylline should prevent the action of pentoxifylline. The results indicated that pretreatment of fibroblasts with 8-phenyltheophylline (100 microM) did not alter the inhibitory effect of pentoxifylline on PDGF-stimulated fibroproliferation. These results argue against a mechanism involving inhibition of adenosine reuptake as the mechanism for pentoxifylline's effect in this system. 8-Phenyltheophylline also did not alter the effect of pentoxifylline on baseline proliferation, suggesting that these effects of pentoxifylline are not mediated by adenosine receptors. Pentoxifylline is metabolized to several metabolites including 1-(5-hydroxyhexyl)-3,7-dimethylxanthine (metabolite-1). Metabolite-1 significantly reduced PDGF-stimulated fibroproliferation and was as effective as pentoxifylline. The combination of pentoxifylline and metabolite-1 had an additive effect. Metabolite-1 and pentoxifylline also reduced baseline proliferation. Preincubation of fibroblasts with 8-phenyltheophylline did not prevent the inhibitory action of metabolite-1 on PDGF-stimulated proliferation or on basal proliferation of fibroblasts, suggesting that the action of metabolite-1 on fibroproliferation was not mediated by adenosine receptors. Results using A1 and A2 adenosine receptor antagonists further suggest that the effect of pentoxifylline was not mediated by adenosine receptors.

Dose-Response Relationship, Drug↗
PubMed1994

Beneficial cardiopulmonary effects of pentoxifylline in experimental sepsis are lost once septic shock is established.

OBJECTIVE: To determine the effects of pretreatment and posttreatment with pentoxifylline in a porcine model of gram-negative sepsis. DESIGN: Nonrandomized controlled trial. STUDY SUBJECTS: Young Yorkshire swine. INTERVENTIONS: Six groups of ventilated swine were studied for 5 hours. Group 1 swine (control, n = 8) received saline solution only. Group 2 swine (sepsis, n = 8) received a 1-hour infusion of Pseudomonas aeruginosa. Groups 3, 4, and 5 swine received the P aeruginosa infusion and a 20 mg/kg bolus followed by a 6 mg/kg per hour infusion of pentoxifylline. Group 3 swine (n = 6) received pentoxifylline prior to the onset of sepsis; group 4 swine (n = 6) received pentoxifylline at 1 hour and group 5 swine (n = 4) at 2 hours after the onset of the P aeruginosa infusion. Group 6 swine (control pentoxifylline, n = 3) received pentoxifylline only. OUTCOME MEASURES: Hemodynamic variables, neutrophil counts and CD18 expression, tumor necrosis factor activity, and arterial blood gases were measured hourly. Bronchoalveolar lavage was performed at 0 and 5 hours to measure neutrophil and protein content. RESULTS: All variables remained unchanged in the control and control pentoxifylline groups. Both pretreatment and posttreatment with pentoxifylline significantly attenuated lung injury and improved arterial PaO2. The cardiac index was significantly improved by administration of pentoxifylline in groups 3 and 4. Administration of pentoxifylline to group 5 animals in established septic shock caused uncontrolled, fatal systemic hypotension in two of the four animals. Plasma tumor necrosis factor activity, blood polymorphonuclear leukocyte counts, and CD18 expression were unaffected by the administration of pentoxifylline. CONCLUSIONS: Pentoxifylline protects against pulmonary and systemic hemodynamic derangements in fulminant sepsis and protects against pulmonary dysfunction. Pentoxifylline has a "therapeutic window" when given in established sepsis; if administration is delayed until overt septic shock occurs, it may then have deleterious effects.

Animals↗
PubMed1993

Effects of pentoxifylline on sperm motility and hyperactivation in normozoospermic and normokinetic semen.

OBJECTIVE: To determine the effects of in vitro incubation with pentoxifylline on sperm motion characteristics of spermatozoa from normozoospermic, normokinetic specimens. DESIGN: Prospective, controlled experiment. SETTING: Andrology laboratory, university-based fertility center. PARTICIPANTS: Healthy, untreated male partners of couples attending the fertility center. INTERVENTION: Each specimen was washed, pelleted by centrifugation, then resuspended in human tubal fluid medium (HTF). Two portions were incubated at 37 degrees C, one with pentoxifylline (final concentration = 1 mg/mL = 3.6 mM) and the other without pentoxifylline (control). After 1 hour, the pentoxifylline-treated portion was divided: one half was washed to remove pentoxifylline, then further incubated in HTF; the other half remained incubated in HTF with pentoxifylline. MAIN OUTCOME MEASURES: Motility, hyperactivation, amplitude of lateral head displacement (ALH), curvilinear velocity (VCL), straight line velocity (VSL), linearity (LIN), beat-cross frequency. RESULTS: Incubation with pentoxifylline did not increase motility, VSL, LIN, or beat-cross frequency but did significantly increase HA, VCL, and ALH at 1, 2, and 4 hours, compared with control. Incubation in control medium without pentoxifylline did not significantly increase any of the parameters measured. After 24 hours of incubation with or without pentoxifylline, all parameters measured were significantly decreased, with the exception of LIN. CONCLUSIONS: Pentoxifylline does not increase percentage motility of washed spermatozoa in capacitation medium. Enhancement of sperm HA by pentoxifylline in capacitation medium occurs with normozoospermic, normokinetic semen specimens. This effect persists for up to 4 hours when pentoxifylline is removed from the medium after 1 hour of incubation.

Analysis of Variance↗
PubMed1996

Acute haemodynamic responses and inhibition of tumour necrosis factor-alpha by pentoxifylline in rats with cirrhosis.

1. Although pentoxifylline has been shown to reduce portal hypertension, the mechanism for this is unclear. Since pentoxifylline decreases tumour necrosis factor-alpha production and since this cytokine may induce vasodilatation per se, a pentoxifylline-induced decrease in tumour necrosis factor-alpha production may limit arterial vasodilatation and decrease portal pressure. The aim of the present study was to examine the effects of pentoxifylline administration on plasma tumour necrosis factor-alpha concentration and haemodynamics in normal and cirrhotic rats. 2. In both groups, systemic and splanchnic haemodynamics and plasma tumour necrosis factor-alpha concentrations were measured before and 120 min after the administration of saline or pentoxifylline (20 mg/kg intravenous bolus). 3. In cirrhotic rats, pentoxifylline significantly decreased portal pressure (24 +/- 13%) and tributary blood flow (33 +/- 30%). On the other hand, pentoxifylline significantly increased vascular resistance in portal and hepatic arterial territories. Systemic haemodynamics were not altered. In normal rats, pentoxifylline significantly decreased portal pressure but induced no other significant changes in splanchnic or systemic haemodynamics. In cirrhotic rats, plasma tumour necrosis factor-alpha concentrations were significantly reduced after pentoxifylline administration but not after saline administration. No significant correlations were found between pentoxifylline-induced changes in tumour necrosis factor-alpha levels and changes in splanchnic haemodynamics. In normal rats, plasma tumour necrosis factor-alpha concentrations significantly decreased after pentoxifylline or saline administration. 4. This study shows that in rats with cirrhosis, pentoxifylline induces a decrease in both portal pressure and plasma tumour necrosis factor-alpha concentrations. These reductions were not correlated however.

Animals↗
PubMed1994

Effects of pentoxifylline on cerebral blood flow, metabolism, and evoked response after total cerebral ischemia in dogs.

OBJECTIVE: To test the hypothesis that pentoxifylline improves recovery of cerebral electrical activity and metabolic function after a transient cerebral global ischemia by improving cerebral blood flow during the reperfusion period. DESIGN: Randomized, controlled, prospective study. SETTING: University research laboratory. SUBJECTS: Forty male beagle dogs. INTERVENTIONS: Six control dogs received pentoxifylline (40 mg/kg bolus followed by infusion at 0.2 mg/kg/hr) without ischemia. Thirteen dogs received Ringer's lactate solution with 12 mins of cerebral global ischemia (by aortic occlusion). Nine dogs received pentoxifylline before ischemic insult. Six dogs received pentoxifylline on reperfusion, and six dogs received pentoxifylline 30 mins after reperfusion. MEASUREMENTS AND MAIN RESULTS: Total and regional cerebral blood flow, cerebral oxygen consumption, and somatosensory evoked potentials were measured during 180 mins of reperfusion. Pentoxifylline did not affect cerebral blood flow, oxygen consumption, or somatosensory evoked potentials without ischemia. Pretreatment with pentoxifylline resulted in attenuated postischemic hyperemia at 10 mins of reperfusion (94 +/- 15 vs. 133 +/- 11 [SEM] mL/min/100 g; p < .05), but there was no difference in total cerebral blood flow or oxygen consumption during later points of reperfusion. Pentoxifylline treatment during reperfusion resulted in no recovery of cerebral blood flow or oxygen consumption. All ischemic groups demonstrated a rapid ablation of somatosensory evoked potential amplitude and there were no differences in the decrement of the amplitude on ischemia. At 180 mins of reperfusion, somatosensory evoked potentials recovered to the following percentages of the baseline control values: 28 +/- 4% in dogs treated with Ringer's lactate solution; 58 +/- 4% in the pentoxifylline pretreated group (p < .05); 40 +/- 5% in dogs receiving pentoxifylline at reperfusion (p > .05); and 53 +/- 8% in dogs receiving pentoxifylline at 30 mins of reperfusion (p < .05). CONCLUSIONS: Pentoxifylline treatment improves recovery of cerebral electrical function after complete transient cerebral global ischemia by a mechanism that does not involve improvement in cerebral blood flow or global oxygen consumption.

Animals↗
PubMed1995

Pentoxifylline prevents a decrease in arterial oxygen tension in oleic acid-induced lung injury.

OBJECTIVES: a) To determine whether pentoxifylline has a preventive effect on the decrease in PaO2 that is caused by oleic acid, and whether pentoxifylline facilitates normalization of PaO2 from the decreased state. b) To examine whether pentoxifylline can attenuate an increase in pulmonary vascular permeability that is induced by oleic acid. DESIGN: Prospective trial. SETTING: University laboratory. SUBJECTS: a) A total of 48 guinea pigs (700 to 1100 g) for blood gas analysis. b) A total of 28 guinea pigs (390 to 670 g) for measurement of pulmonary vascular permeability. INTERVENTIONS: a) For blood gas analysis, the guinea pigs were mechanically ventilated. Oleic acid (15 microL/kg) was injected into the guinea pigs to decrease PaO2. Pentoxifylline (5 or 20 mg/kg) was administered 40 or 3 mins before oleic acid injection or 13 mins after oleic acid injection. b) For measurement of pulmonary vascular permeability, the guinea pigs were anesthetized with pentobarbital and catheterized via the external jugular vein for drug administration. Pentoxifylline (20 mg/kg) plus Evans blue (30 mg/kg) or theophylline (20 mg/kg) plus Evans blue (30 mg/kg) were administered at 40- and 1-min intervals before oleic acid (15 microL/kg) injection, respectively. Perfusion with saline was performed through the aorta 90 mins after the oleic acid injection. The airways were removed and separated into the trachea, the main bronchus, the proximal bronchus, and the distal bronchus. Evans blue was extracted from the airways with formamide for 18 hrs and measured. MEASUREMENTS AND MAIN RESULTS: a) We measured PaO2, PaCO2, and pH, and recorded airway pressure and systemic blood pressure at 15, 10, and 5 mins before oleic acid injection and at 6, 10, 15, 35, 55, and 75 mins after oleic acid injection. Compared with the control groups, a decrease in PaO2 by oleic acid was significantly prevented when pentoxifylline (5 or 20 mg/kg) was administered 40 mins before oleic acid injection. However, a decrease in PaO2 by oleic acid was not significantly reduced when pentoxifylline was administered 3 mins before oleic acid injection. Pentoxifylline administered 13 mins after oleic acid injection did not affect the recovering course of PaO2 significantly. b) An increase in pulmonary vascular permeability by oleic acid was significantly attenuated by both pentoxifylline and theophylline. The effect of theophylline was significantly stronger than the effect of pentoxifylline in the main bronchi. The effect of theophylline was not significantly different from the effect of pentoxifylline in other areas. CONCLUSION: Pentoxifylline is a noteworthy drug that could be a candidate as a therapy to help prevent hypoxemia in lung injuries that share a common mechanism with oleic acid-induced lung injury.

Airway Resistance↗
PubMed1994

Pentoxifylline inhibits tumor necrosis factor-alpha-mediated cytotoxicity and cytostasis in L929 murine fibrosarcoma cells.

Tumor necrosis factor-alpha (TNF alpha) is recognized as a principal mediator of a variety of inflammatory conditions. In animal models, pentoxifylline attenuates the morbidity and mortality of bacterial sepsis, an effect which has been attributed to its ability to suppress the induction of TNF alpha. To determine whether pentoxifylline also directly inhibits the effects of TNF alpha, the ability to inhibit cytotoxicity on the TNF alpha-sensitive murine fibrosarcoma cell line, L929, was examined. Cell viability was assessed by crystal violet staining and cell proliferation was assessed by [3H]-thymidine uptake assay. TNF alpha induced dose-dependent cytotoxicity. At concentrations of TNF alpha of 1000 U/ml, viability at 3 days was approximately 35% of control. When L929 cells were co-incubated with TNF alpha (1000 U/ml) and pentoxifylline (1 mM), cell viability increased to approximately 75% of control (P = 0.001). At concentrations of TNF alpha of 10,000 U/ml, cell viability which was 11% of control with TNF alpha alone increased to 53% in the presence of pentoxifylline (P = 0.002). TNF alpha at 1000 and 10,000 U/ml concentrations decreased [3H]-thymidine uptake to approximately 5% of control values. Co-incubation with pentoxifylline significantly increased uptake to 13% of control at both TNF alpha concentrations (P = 0.002). Pentoxifylline did not affect the level of type I TNF alpha receptor--ligand cross-link product. However, in TNF alpha receptor binding assays, incubation with pentoxifylline 1 mM for 4 h was associated with an increase in the receptor affinity (control: KD = 0.42 nM vs pentoxifylline-treated: KD = 0.21 nM, P = 0.006), without significant change in number of type I TNF alpha receptors, suggesting that pentoxifylline affects post-receptor signalling events. We have observed that pentoxifylline prevents the TNF alpha-mediated activation of sn-2 arachidonic acid-specific cytosolic phospholipase A2, an important component of the signal transduction pathway of TNF alpha cytotoxicity. Because pentoxifylline does not inhibit all activities mediated by the type I TNF alpha receptor, its selective inhibition of post-receptor signalling may facilitate further study into the mechanisms underlying the diverse effects of TNF alpha.

Animals↗
PubMed1993

Effects of pentoxifylline on in vivo leukocyte function and clearance of group B streptococci from preterm rabbit lungs.

OBJECTIVES: Pentoxifylline was evaluated for its ability to enhance inactivation of group B streptococci in lungs of prematurely born rabbits. Mechanisms associated with intrapulmonary streptococcal clearance and the pharmacodynamics of pentoxifylline were also investigated. DESIGN: Randomized, controlled animal trial. SETTING: University research laboratory. SUBJECTS: A total of 123 New Zealand rabbits were delivered prematurely by cesarean section and were used for clearance studies. Twenty-three preterm pups were additionally utilized to study the pharmacodynamics of pentoxifylline. INTERVENTIONS: Preterm rabbits were infected with group B streptococcal aerosols and given intraperitoneal injections of either pentoxifylline (25, 12.5, and 12.5 mg/kg) or placebo at 0, 6, and 12 hrs after infection. MEASUREMENTS AND MAIN RESULTS: At 0, 4, and 24 hrs, the numbers of streptococci were determined in the left lung, while the right lung underwent bronchoalveolar lavage to quantify intra-alveolar leukocytes, phagocytosis of inhaled bacteria, and concentrations of lysozyme and tumor necrosis factor. In a separate experiment, blood and bronchoalveolar fluid from infected animals were analyzed for pentoxifylline content. Streptococcal proliferation was less in pentoxifylline-treated animals than in controls at 24 hrs (p < .01). Pulmonary macrophages and polymorphonuclear leukocytes recovered from bronchoalveolar lavage fluid did not differ in numbers or phagocytic activity. Pentoxifylline-treated animals had lower levels of lysozyme (p < .02) and tumor necrosis factor (p < .005) in bronchoalveolar lavage fluid compared with placebo-treated pups. Therapeutic levels of pentoxifylline were achieved in blood and bronchoalveolar lavage fluid. CONCLUSIONS: Despite lowering lysozyme and tumor necrosis factor content in epithelial lining fluid, pentoxifylline improves the inactivation of group B streptococci in preterm rabbit lungs. These findings suggest that increased group B streptococcal clearance was coincident with an anti-inflammatory effect due to pentoxifylline. We conclude pentoxifylline may be clinically useful as an adjunctive therapy for group B streptococcal pneumonia in newborns.

Animals↗
PubMed1996

Influence of long-term continuous intravenous administration of pentoxifylline on endothelial-related coagulation in critically ill patients.

OBJECTIVE: To determine the influence of pentoxifylline on endothelial-associated coagulation. DESIGN: Prospective, randomized, placebo-controlled study. SETTING: A surgical intensive care unit of a university hospital. PATIENTS: Consecutive patients (n = 60) with trauma or sepsis secondary to major (nontrauma) surgery. All patients received controlled mechanical ventilation. INTERVENTIONS: According to a randomized sequence, the patients either received pentoxifylline continuously over 5 days (1.5 mg/kg/hr iv) (trauma-pentoxifylline group [n = 15], sepsis-pentoxifylline group [n=15] or saline solution as placebo (trauma-control group [n = 15], sepsis-control group [n = 15]. MEASUREMENTS AND MAIN RESULTS: In addition to the standard coagulation screen, thrombomodulin, protein C, (free) protein S, and thrombin-antithrombin plasma concentrations were measured by enzyme-linked immunosorbent assays. Intensive care therapy, hemodynamics, and changes of Acute Physiology and Chronic Health Evaluation II score were comparable for pentoxifylline-treated and nontreated patients. An average dose of 2.5 g/day of pentoxifylline (range 2.2 to 2.9) was infused into the pentoxifylline-treated patients. At baseline, plasma thrombomodulin concentrations were higher in the septic patients than in the trauma patients. Thrombomodulin plasma concentrations increased significantly more in the control patients (trauma: from 38.9 +/- 10.5 to 59.9 +/- 10.1 ng/mL; sepsis: from 49.7 +/- 12.1 to 72.3 +/- 11.2 ng/mL) than in the pentoxifylline-treated patients (trauma: from 37.9 +/- 11.9 to 50.2 +/- 9.2 ng/mL; sepsis from 51.9 +/- 10.1 to 63.3 +/- 10.2). Starting from similar baseline values, protein C concentration increased significantly more in the sepsis-pentoxifylline patients (from 52.0 +/- 11.1% to 69.1 +/- 11.1%) than in the untreated septic patients (from 50.1 +/- 10.0% to 52.5 +/- 9.5%). There were no significant differences between the pentoxifylline-treated and nontreated groups for protein S and thrombin-antithrombin concentrations. Standard coagulation parameters (fibrinogen, activated partial thromboplastin time, antithrombin III) did not differ between these groups either. CONCLUSIONS: Continuous intravenous administration of pentoxifylline for 5 days beneficially influenced the thrombomodulin/protein C/protein S system in both the trauma and septic patients.

APACHE↗
PubMedDate not supplied

The effects of extended perioperative pentoxifylline on random skin flap survival.

PURPOSE: This study was designed to determine the effects of long-term perioperative pentoxifylline administration on random skin flap survival in an appropriate animal model. A secondary objective was to document bioavailability of pentoxifylline in the animal model by measuring blood levels of parent compound and metabolites at regular intervals and comparing these to levels measured in humans. MATERIALS AND METHODS: A randomized control study of the effects of oral pentoxifylline on the survival of "random" skin flaps was conducted at the animal care facility of an academic tertiary referral center on six randomly selected Yorkshire pigs. Oral pentoxifylline was administered daily to four pigs for 3 months, and two pigs received placebo. Pentoxifylline blood levels for each experimental animal were measured after 4, 8, and 12 weeks of daily dosing. Blood viscosity, fibrinogen, and hematocrit were measured for each of the six animals on day 1, day 30, day 60, and day 91. On day 91, 12 surgical random skin flaps were elevated on each of the six animals and immediately sewn back in the donor bed. Pentoxifylline dosing was continued for 2 weeks, and placebo was continued in control animals. On postoperative day 15, all animals were killed and all flaps were measured individually for area of viability. The outcome measure was the detection of statistically significant increase in survival area in skin flaps of those animals administered perioperative pentoxifylline. RESULTS: No significant augmentation of flap survival was noted in experimental animals when compared with those in the control group; no significant difference was noted between or within groups of experimental animals. Pentoxifylline and metabolite blood levels in all experimental animals at every interval were noted to be comparable to those documented in human studies; metabolite concentrations conformed to expected patterns as observed in humans. No significant alterations of blood viscosity, fibrinogen, or hematocrit were measured in the experimental animals when compared with those in the control group. The only animal showing mean flap survival outside the 95% confidence interval was one in the control group. CONCLUSION: No augmentation of random skin flap survival could be shown in the pig model after a 3 month regimen of daily oral pentoxifylline. Blood levels of pentoxifylline in experimental animals were compared with those documented in humans. No alteration of blood viscosity, fibrinogen, or hematocrit was noted in any of the experimental animals when compared with each other or with those in the control group.

Administration, Oral↗
PubMed1995

Effect of pentoxifylline on radiation-induced lung and skin toxicity in rats.

PURPOSE: There is currently substantial clinical interest in pentoxifylline as an inhibitor of radiation-related normal tissue injury. To further assess this drug's potential toxicity-sparing effects, pentoxifylline was studied in rats using a radiation-induced lung injury model. METHODS AND MATERIALS: Adult male rats were exposed to either sham irradiation or a single fraction of 21 Gy delivered to the left hemithorax. Four study groups were defined: those that received neither radiation nor pentoxifylline, those that received pentoxifylline (500 mg/L in drinking water) but no irradiation, those that underwent irradiation without pentoxifylline, and those that received both pentoxifylline and radiation. Lung injury was measured by changes in relative left:right lung perfusion ratios derived from quantitative gamma camera imaging of 99mTechnetium-macroaggregated albumin uptake in the pulmonary circulation. Serial scans were done over a 40-week period following radiation. Skin toxicity was also assessed. After 40 weeks, the animals were killed, and lung tissue was assayed for angiotensin converting enzyme activity as a marker for endothelial cell damage. RESULTS: Both groups of radiated (with or without pentoxifylline) rats showed equivalent acute sharp decreases in left:right lung perfusion ratios compared to the nonirradiated groups, reaching a mean nadir value of 0.29 at week 4. Irradiated lung perfusion in subsequent weeks in the radiation-only group showed minimal recovery, with a plateau mean ratio of 0.37 (0.36-0.39). However, there was apparent later recovery of lung perfusion in the radiation with pentoxifylline group from weeks 14 through 40, to a mean ratio of 0.47 (0.43-0.52) (p < 0.01 compared to the radiation-only group). Angiotensin converting enzyme activity correlated closely with lung perfusion data. No effect of pentoxifylline on acute or late skin toxicity was detected. CONCLUSIONS: This study suggests that pentoxifylline does not have any measurable effect on acute lung injury following hemithoracic irradiation in rats, but does result in sparing of later lung toxicity.

Animals↗
PubMed1991

Pentoxifylline lessens the endotoxin-induced increase in albumin clearance across pulmonary artery endothelial monolayers with and without neutrophils.

Pentoxifylline, a methylxanthine with phosphodiesterase inhibitor activity, attenuates endotoxin-induced pulmonary vascular protein leak and decreases lung neutrophil accumulation in vivo. In vitro, pentoxifylline decreases neutrophil activation as measured by superoxide release and phagocytosis of latex beads. To test the hypothesis that the beneficial effect of pentoxifylline may be via a direct effect on the endothelial cells as well as via prevention of neutrophil activation, we incubated bovine pulmonary artery endothelial cell monolayers with endotoxin and pentoxifylline in the presence or absence of human neutrophils. Albumin clearance across the monolayers was used as an index of endothelial permeability. Endotoxin (1.0 micrograms/ml) increased albumin clearance in a dose- and time-dependent fashion (207.5 +/- 25%, P less than 0.05). Co-incubation with neutrophils enhanced this effect. Pentoxifylline significantly attenuated the endotoxin-induced increase in albumin clearance both with and without neutrophils, and lessened endotoxin-induced cell lysis (chromium release) and morphologic changes. Because increased endothelial cyclic adenosine monophosphate (cAMP) levels may decrease protein permeability and pentoxifylline increases cAMP in neutrophils, we measured cAMP levels in endothelial cells. Incubation with pentoxifylline failed to raise cAMP levels in endothelial cells, in contrast to incubation with aminophylline. In conclusion, pentoxifylline attenuates endotoxin-induced increase in albumin clearance across endothelial monolayers both in the presence and absence of neutrophils. These results suggest that part of the protective effect of pentoxifylline may be mediated via effects on endothelium. Furthermore, this pentoxifylline-mediated endothelial barrier effect appears to be independent of an effect on cAMP.

Albumins↗