PT  - JOURNAL ARTICLE
AU  - B. Sztrymf
AU  - A. Rabiller
AU  - H. Nunes
AU  - L. Savale
AU  - D. Lebrec
AU  - A. Le Pape
AU  - V. de Montpreville
AU  - M. Mazmanian
AU  - M. Humbert
AU  - P. Hervé
TI  - Prevention of hepatopulmonary syndrome and hyperdynamic state by pentoxifylline in cirrhotic rats
AID  - 10.1183/09031936.04.00080404
DP  - 2004 May 01
TA  - European Respiratory Journal
PG  - 752--758
VI  - 23
IP  - 5
4099  - http://erj.ersjournals.com/content/23/5/752.short
4100  - http://erj.ersjournals.com/content/23/5/752.full
SO  - Eur Respir J2004 May 01; 23
AB  - Inhibition of tumour necrosis factor‐α (TNF‐α), 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‐α is a potent activator of macrophagic inducible nitric oxide synthase (NOS), the aim of this study was to investigate whether TNF‐α inhibition prevented hepatopulmonary syndrome and hyperdynamic circulatory state in rats with cirrhosis. TNF‐α 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‐α 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‐α on vascular nitric oxide synthase and intravascular macrophages. These results support an important role for tumour necrosis factor‐α in the genesis of hepatopulmonary syndrome. This study was supported by the French Association against Respiratory Disease and Tuberculosis and the Poix Foundation (both Paris, France).