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Eur Respir J 2004; 23:752-758
Copyright ©ERS Journals Ltd 2004

Prevention of hepatopulmonary syndrome and hyperdynamic state by pentoxifylline in cirrhotic rats

B. Sztrymf1, A. Rabiller1, H. Nunes1, L. Savale1, D. Lebrec2, A. Le Pape3, V. de Montpreville1, M. Mazmanian1, M. Humbert1 and P. Hervé1

1 Laboratoire de Chirurgie Expérimentale, Unité Propre de Recherche de l'Enseignement Supérieur (Equipe d'Accueil 2705), Centre Chirurgical Marie Lannelongue, Université Paris Sud, Paris, 2 Laboratoire d'Hémodynamique Splanchnique et de Biologie Vasculaire, Institut National de la Santé Et de la Recherche Médicale Unité 481, Hôpital Beaujon, Clichy, and 3 Service d'lmagerie des Rongeurs, Institut de Transgenose - Centre National de la Recherche Scientific, Orléans, France

CORRESPONDENCE: P. Hervé, Centre Chirurgical Marie Lannelongue, 133 avenue de la Résistance, France. Fax: 33 1 46303792. E-mail: pherve@ccml.com

Keywords: Experimental cirrhosis, hepatopulmonary syndrome, macrophage, nitric oxide synthase, rat, tumour necrosis factor-{alpha}

Received: July 10, 2003
Accepted December 2, 2003

This study was supported by the French Association against Respiratory Disease and Tuberculosis and the Poix Foundation (both Paris, France).

Inhibition of tumour necrosis factor-{alpha} (TNF-{alpha}), levels of which are increased in the blood of cirrhotic rats, prevents hyperdynamic circulatory state, mainly by decreasing the vascular overproduction of nitric oxide. Hepatopulmonary syndrome, which is characterised by intrapulmonary vascular dilatation and increased alveolar to arterial oxygen tension difference (PA-a,O2), is mainly related to pulmonary overproduction of NO by macrophages accumulated in lung vessels. Since TNF-{alpha} is a potent activator of macrophagic inducible nitric oxide synthase (NOS), the aim of this study was to investigate whether TNF-{alpha} inhibition prevented hepatopulmonary syndrome and hyperdynamic circulatory state in rats with cirrhosis.

TNF-{alpha} was inhibited by 5 weeks of pentoxifylline (10 mg·kg body weight–1·day–1) in rats with cirrhosis induced by common bile duct ligation.

Cardiac output, pulmonary and systemic vascular resistance, PA-a,O2 and cerebral uptake of intravenous technetium-99m-labelled albumin macroaggregates (which reflects intrapulmonary vascular dilatation) were similar in sham- and pentoxifylline-treated cirrhotic rats. Blood TNF-{alpha} concentrations and pulmonary intravascular macrophage sequestration, as assessed by morphometric analysis and radioactive colloid uptake, were decreased with pentoxifylline. Pentoxifylline also prevented increases in aorta and lung NOS activities and inducible NOS expression.

Thus pentoxifylline prevents development of hyperdynamic circulatory state and hepatopulmonary syndrome, probably by inhibiting the effects of tumour necrosis factor-{alpha} on vascular nitric oxide synthase and intravascular macrophages. These results support an important role for tumour necrosis factor-{alpha} in the genesis of hepatopulmonary syndrome.




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