• Jessica Deree, Joilson Martins, Tercio de Campos, James G Putnam, William H Loomis, Paul Wolf, and Raul Coimbra.
• Division of Trauma and Surgical Critical Care, Department of Surgery, University of California San Diego School of Medicine, San Diego, California, USA.
• J. Surg. Res. 2007 Nov 1;143(1):99-108.

BackgroundEvidence exists that resuscitation with Ringer's lactate (RL) contributes to postshock inflammation and lung injury. We hypothesized that the anti-inflammatory agent pentoxifylline (PTX) attenuates postresuscitative lung injury through modulation of transcription factors after hemorrhagic shock.MethodsMale Sprague Dawley rats underwent a 1 h period of hypotension and resuscitation with RL (32 mL/kg) or RL + PTX (25 mg/kg). Lung sections were graded for histological injury and myeloperoxidase content. Cytokine-induced neutrophil chemoattractant concentration was determined by enzyme immunoassay. Matrix metalloproteinase-2 and -9 (MMP) activity was evaluated by zymography. Heme oxygenase-1, nuclear factor kappa B (NF-kappaB) p65 nuclear translocation, and cytoplasmic I-kappaB phosphorylation were assessed by Western blot. NF-kappaB and cAMP response element binding protein (CREB) DNA binding were determined by light shift chemiluminescent electrophoretic mobility shift assay.ResultsRL resuscitation led to statistically significant increases in all parameters of lung injury when compared with the negative control. The addition of PTX significantly decreased histology lung injury, myeloperoxidase content, cytokine-induced neutrophil chemoattractant by 48% (P < 0.05), heme oxygenase-1 expression by 50% (P < 0.05), MMP-2 activity by 70% (P < 0.05), MMP-9 activity by 44% (P < 0.05), cytoplasmic I-kappaB phosphorylation by 66% (P < 0.01), nuclear NF-kappaB p65 phosphorylation by 51% (P < 0.05), and NF-kappaB DNA binding by 42% (P < 0.05). In contrast, PTX increased CREB DNA binding by 69% when compared with RL alone (P < 0.04).ConclusionsThe addition of PTX to conventional RL infusion after shock significantly reduced histological lung injury and pulmonary neutrophil activity when compared to treatment with RL alone. The administration of PTX was also associated with diminished NF-kappaB and enhanced CREB activation. Therefore, the administration of PTX may serve as a novel therapeutic adjunct after hemorrhagic shock.

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