Pentoxifylline with metformin treatment improves biochemical parameters in patients with nonalcoholic steatohepatitis

BackgroundThe progression of the nonalcoholic fatty liver disease to nonalcoholic steatohepatitis (NASH) is multifactorial, and there is still a lack of approved medications for its treatment. The study aimed to evaluate the impact of combined treatment with Pentoxifylline and Metformin on biochemical parameters in patients with Nash. Setting: Outpatient hepatology clinic.MethodsA prospective trial was conducted. The first cohort included patients with biopsy-proven Nash, while the second cohort consisted of patients with biopsy-confirmed NAFLD. Blood tests were checked at baseline and every three months. Pentoxifylline at a dosage of 400 mg t.i.d. and Metformin at the dosage of 500 mg t.i.d. were introduced for six months in Nash group. The impact of the treatment was assessed based on biochemical results after combined treatment with low-cost medications.ResultsAll 33 Nash patients completed 24 weeks of treatment. We observed significant improvement (p<0.05) of median values after treatment for the following parameters: serum uric acid levels decreased by 51.0 mmol/L, calcium decreased for 0.27 mmoL/L, magnesium showed an increase of 0.11 mmoL/L. Insulin resistance improved as a reduction of HOMA - IR by 1.3 was detected. A significant decrease of median in liver enzymes, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyltransferase by 24.0 U/L, 9.1 U/L, 10.8 U/L respectively, was noted.ConclusionsPentoxifylline and Metformin may provide possible treatment option in Nash. Some new potential benefit of the therapy in improving liver function whilst decreasing cardiovascular risk was perceived.     

Microbial transformation of hydroxy metabolites of 1-oxohexyl derivatives of theobromine by Cunninghamella echinulata NRRL 1384

Aim:  The biotransformation of pentoxifylline (PTX), propentofylline (PPT) and their racemic hydroxy metabolites ((±)-OHPTX and (±)-OHPPT) by using the fungus Cunninghamella echinulata NRRL 1384.
Methods and Results:  A fungus Cunninghamella echinulata NRRL 1384 was used to catalyse the ( S )-selective oxidation of the racemic hydroxy metabolites: (±)-OHPTX and (±)-OHPPT and for reduction of PTX and PPT. The first oxidation step appears to be selective and relatively fast while the second reduction step is slower and more selective with PTX. Modifications involving supplementing the bioconversion with glucose give yields and enantiomeric excess (ee) values similar to those obtained without glucose.
Conclusions:  The bioconversion of (±)-OHPTX gave an ( R )-enantiomer (LSF-lisofylline) with a higher enantiopurity (maximum approximately 93% ee) compared to the bioconversion of (±)-OHPPT, when the maximum ee value for ( R )-OHPPT was recorded at 83%.
Significance and Impact of the Study:  The conversion of (±)-OHPTX and (±)-OHPPT using Cunninghamella echinulata can be recognized as a process, which may be recommended as an alternative to the methods used to obtain ( R )-OHPTX and ( R )-OHPPT.     

The relative efficacy of aminoguanidine and pentoxifylline in modulating endotoxin-induced cardiac stress

This study investigates the effect of aminoguanidine (AG), a selective inducible nitric oxide synthase (iNOS) inhibitor, and pentoxifylline (PTX), a tumour necrosis factor–alpha (TNF‐α) inhibitor, on lipopolysaccharide (LPS)‐induced cardiac stress. Rats were divided into four groups: group I served as a control, group II (LPS) received a single intraperitoneal injection of LPS (10 mg·kg^–1), group III (LPS+AG) and group IV (LPS+PTX) were injected with either AG (100 mg·kg^–1) or PTX (150 mg·kg^–1) intraperitoneally 10 days prior to LPS administration. Normalization of cardiac levels of nitrite/nitrate (NO_X), malondialdehyde (MDA), glutathione (GSH), heme oxygenase‐1 (HO‐1), glutathione peroxidase (GPx) and Na⁺, K⁺‐ATPase activities was evident in the AG group. Both AG and PTX decreased the elevated serum TNF‐α levels, the activities of lactate dehydrogenase (LDH), creatine kinase (CK) and cardiac myeloperoxidase (MPO). The levels of adenosine triphosphate (ATP), adenosine diphosphate (ADP) and phosphocreatine (PCr) were enhanced following AG and PTX pretreatments. Calcium (Ca²⁺) levels were altered, and the histopathological observations supported the described results. Conclusively, the study highlights the cardioprotective potential of AG and PTX with superior results from AG. These findings reveal the relative contribution of nitric oxide and TNF‐α to oxidative stress and energy failure during endotoxemia. Copyright © 2011 John Wiley & Sons, Ltd.     

凝血酶对大鼠星形胶质细胞组织因子活性表达的影响及其机制

目的：观察凝血酶对大鼠星形胶质细胞组织因子活性表达的影响及其机制。方法;培养Ｗｉｓｔａｒ乳鼠星形胶质细胞,细胞用抗神经胶质纤维酸性蛋白单克隆抗体确认。细胞冻融液组织因子活性检测采用一期血浆复地。结果：与对照组比较,凝血酶使星形胶质细胞组织因子表达明显增高（Ｐ〈０．０５）。当凝血酶与三氟吡啦嗪或Ｈ７联用时,它对呈形胶质细胞表达组织因子活性的刺激作用受到抑制。与凝血酶组比较,已呵可碱十凝血酶组星形胶质     

Effect of pentoxifylline on arachidonic acid metabolism,neutral lipid synthesis and accumulation during induction of the lipocyte phenotype by retinol in murine hepatic stellate cell

In liver fibrosis, the quiescent hepatic stellate cells (HSC) are activated to proliferate and express the activated myofibroblast phenotype, losing fat droplets and the stored vitamin A, and depositing more extracellular matrix. Therapeutic strategies for liver fibrosis are focused on HSC. Pentoxifylline (PTF), an analog of the methylxanthine, prevents the biochemical and histological changes associated with animal liver fibrosis. The aim of the present study was to investigate the phenotypic change of myofibroblasts into quiescent lipocytes by PTF and/or retinol, using a permanent cell line GRX that represents murine HSC. We studied the action of both drugs on the synthesis of neutral lipids, activity of phospholipase A₂ (PLA₂), release of arachidonic acid (AA) and prostaglandins synthesis. Accumulation and synthesis of neutral lipids was dependent upon association of retinol with PTF. PTF (0.5 mg/mL) alone did not induce lipid accumulation and synthesis, but in cells induced by physiologic concentration of retinol (1–2.5 M), it increased the quantity of stored lipids. Retinol and PTF (5 M and 0.1 mg/mL, respectively) had a synergistic effect on neutral lipid synthesis and accumulation. In higher PTF concentrations (0.5 and 0.7 mg/ml), the synthesis was stimulated but accumulation decreased. Membrane-associated PLA₂ activity decreased after PTF treatment, which increased the AA release 8 fold, and significantly increased the production of PGE₂, but not of PGF₂. However, when in presence of retinol, we observed a slightly higher increase in PGE₂ and PGF₂ production. In conclusion, PTF treatment generated an excess of free AA. We propose that retinol counteracts the action of PTF on the AA release and PGs production, even though both drugs stimulated the lipocyte induction in the HSC.     

Effects of erythropoietin and pentoxifylline on the oxidant and antioxidant systems in the experimental short bowel syndrome

In this study, we investigated the effects of erythropoietin (Epo), and pentoxifylline (Ptx) on the oxidant and antioxidant systems in the experimental short bowel syndrome. Spraque-Dawley rats were divided into four groups and all animals underwent 75% small bowel resection. Group E was treated with 500 IU kg(- 1) Epo subcutaneously (s.c.), group P with 50 mg kg(- 1) day(- 1) s.c. Ptx and group E+P with 500 IU kg(- 1) s.c. Epo plus 50 mg kg(- 1) day(- 1) s.c. Ptx for a period of 28 days. In group C, which is the control group, no drug treatment was given. At the end of 28 days the experimented rats were killed and ileum samples excised for biochemical and histopathological testing. Malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels were determined in ileum homogenates. When compared to group C, the MDA and GSH-Px levels were significantly decreased (p < 0.05), but SOD activity was not changed (p > 0.05) in groups P and E+P, whereas both MDA and SOD and also GSH-Px activities were not changed significantly in group E (p > 0.05). The average villous length, crypt depth, muscular thickness and mucosal length were measured in all groups. The average crypt depth and mucosal length were statistically higher in the group P than group C (p < 0.001, p < 0.01, respectively). In addition, the crypt depth was statistically higher in both E and E+P groups as compared to group C (p < 0.001, p < 0.01, respectively). Therefore, our study indicates that Ptx may be more effective than Epo in reducing lipid peroxidation. Moreover, we considered that Ptx may give this protective effect by inhibiting the free oxygen radicals to a greater extent than developing the antioxidant capacity.     

Effects of pentoxifylline on the different steps during adhesion and transendothelial migration of flowing neutrophils.

We used a flow system to observe the stepwise adhesion and migration of neutrophils on cultured human umbilical vein endothelial cells (HUVEC) stimulated with tumour necrosis factor-alpha (TNF) for 4 h, and to evaluate the effects of pentoxifylline (PTX) at each step. When HUVEC had been stimulated with 100 U ml(-1) TNF, treatment of neutrophils with PTX did not reduce the number captured from flow but did cause nearly all adherent cells ( > 90%) to roll, whereas most untreated cells became immobilized and approximately 30% transmigrated within minutes. On washout of the PTX, many rolling cells halted and started to migrate. Treatment of the HUVEC with PTX at the same time as 100 U ml(-1) TNF did not affect the number of neutrophils adhering, but there was a significant increase in the percentage of cells rolling even though PTX was no longer present. Thus PTX reduced presentation of activating agents by HUVEC, as well as inhibiting the response by neutrophils to surface-presented activating agent(s). If HUVEC were stimulated with 10 U ml(-1) TNF with PTX, the adhesion of flowing neutrophils was greatly inhibited compared to TNF alone. Surface ELISA indicated that PTX reduced TNF-induced upregulation of E-selectin. This reduction was only sufficient to reduce capture of neutrophils at the low dose of TNF. Thus, by using a flow-based model, we have been able to separate the effects of a multipotent agent such as pentoxifylline, which acts on leucocytes and endothelial cells, at each stage of migration.