Abstract
Background
Pentoxifylline (PTX), a methylxanthine derivate with immunomodulating properties, has been used as adjunctive treatment in severe neonatal sepsis. The aim of the study was to investigate the anti-inflammatory effects of PTX on Lipopolysaccharides (LPS)-stimulated monocytes of preterm neonates in vitro compared with monocytes of term infants and adult controls.
Methods
Whole cord blood samples and control adult blood samples were incubated with LPS and PTX. The expression of surface markers, phagocytosis, cytokine secretion, and Toll-like receptor (TLR)4 signaling of monocytes were assessed by flow cytometry. Changes of TLR4-messenger RNA (mRNA) levels were confirmed by reverse-transcriptase PCR.
Results
The expression of CD14, CD11b, CD64, CD71, and CD80 was downregulated by PTX in a dose-dependent manner; the greatest effect was observed on CD14 and CD11b in preterm infants. PTX markedly downregulated LPS-induced tumor necrosis factor-α, interleukin (IL)-1β, and IL-6 levels in all age groups. Early IL-10 production was significantly downregulated by PTX in term and preterm neonates, while remaining unchanged in adults. Moreover, PTX downregulated TLR4 expression of monocytes on cellular and mRNA level, decreased signaling, and suppressed phagocytosis.
Conclusion
PTX downregulated TLR4 expression and signaling, thereby leading to strong anti-inflammatory properties in monocytes. Age-dependent differences were identified for CD14 and CD11b expression and IL-10 production.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Stoll BJ, Hansen NI, Higgins RD et al, Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002–2003. Pediatr Infect Dis J 2005;24:635–9.
Chalmers IM, Janossy G, Contreras M, Navarrete C . Intracellular cytokine profile of cord and adult blood lymphocytes. Blood 1998;92:11–8.
Sadeghi K, Berger A, Langgartner M et al, Immaturity of infection control in preterm and term newborns is associated with impaired toll-like receptor signaling. J Infect Dis 2007;195:296–302.
Schüller SS, Sadeghi K, Wisgrill L et al, Preterm neonates display altered plasmacytoid dendritic cell function and morphology. J Leukoc Biol 2013;93:781–8.
Levy O . Innate immunity of the newborn: basic mechanisms and clinical correlates. Nat Rev Immunol 2007;7:379–90.
Krakauer T, Oppenheim JJ . IL-1 and tumor necrosis factor-alpha each up-regulate both the expression of IFN-gamma receptors and enhance IFN-gamma-induced HLA-DR expression on human monocytes and a human monocytic cell line (THP-1). J Immunol 1993;150:1205–11.
Wisgrill L, Groschopf A, Herndl E et al, Reduced TNF-α response in preterm neonates is associated with impaired nonclassic monocyte function. J Leukoc Biol 2016;100:607–12.
Förster-Waldl E, Sadeghi K, Tamandl D et al, Monocyte toll-like receptor 4 expression and LPS-induced cytokine production increase during gestational aging. Pediatr Res 2005;58:121–4.
Lakhani SA, Bogue CW . Toll-like receptor signaling in sepsis. Curr Opin Pediatr 2003;15:278–82.
Shimaoka M, Park EJ . Advances in understanding sepsis. Eur J Anaesthesiol Suppl 2008;42:146–53.
Pammi M, Haque KN . Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates. Cochrane Database Syst Rev 2015;3:CD004205.
Shabaan AE, Nasef N, Shouman B, Nour I, Mesbah A, Abdel-Hady H . Pentoxifylline therapy for late-onset sepsis in preterm infants: a randomized controlled trial. Pediatr Infect Dis J 2015;34:e143–8.
Zabel P, Schade FU, Schlaak M . Inhibition of endogenous TNF formation by pentoxifylline. Immunobiology 1993;187:447–63.
D’Hellencourt CL, Diaw L, Cornillet P, Guenounou M . Differential regulation of TNF alpha, IL-1 beta, IL-6, IL-8, TNF beta, and IL-10 by pentoxifylline. Int J Immunopharmacol 1996;18:739–48.
Neuner P, Klosner G, Pourmojib M, Knobler R, Schwarz T . Pentoxifylline in vivo and in vitro down-regulates the expression of the intercellular adhesion molecule-1 in monocytes. Immunology 1997;90:435–9.
Wang W, Tam WF, Hughes CC, Rath S, Sen R . c-Rel is a target of pentoxifylline-mediated inhibition of T lymphocyte activation. Immunity 1997;6:165–74.
Szymura‐Oleksiak J, Bury J, Lauterbach R, Pawłowski M . Serum Concentrations of pentoxifylline and its metabolites in premature infants with sepsis when administered by continuous intravenous infusion. Pharm Pharmacol Commun 1997;3:367–71.
Lauterbach R, Pawlik D, Kowalczyk D, Ksycínski W, Helwich E, Zembala M . Effect of the immunomodulating agent, pentoxifylline, in the treatment of sepsis in prematurely delivered infants: a placebo-controlled, double-blind trial. Crit Care Med 1999;27:807–14.
Coimbra R, Melbostad H, Loomis W, Tobar M, Hoyt DB . Phosphodiesterase inhibition decreases nuclear factor-kappaB activation and shifts the cytokine response toward anti-inflammatory activity in acute endotoxemia. J Trauma 2005;59:575–82.
Marcinkiewicz J, Grabowska A, Lauterbach R, Bobek M . Differential effects of pentoxifylline, a non-specific phosphodiesterase inhibitor, on the production of IL-10, IL-12 p40 and p35 subunits by murine peritoneal macrophages. Immunopharmacology 2000;49:335–43.
Rieckmann P, Weber F, Günther A et al, Pentoxifylline, a phosphodiesterase inhibitor, induces immune deviation in patients with multiple sclerosis. J Neuroimmunol 1996;64:193–200.
Sanjabi S, Zenewicz LA, Kamanaka M, Flavell RA . Anti-inflammatory and pro-inflammatory roles of TGF-beta, IL-10, and IL-22 in immunity and autoimmunity. Curr Opin Pharmacol 2009;9:447–53.
Howard M, Muchamuel T, Andrade S, Menon S . Interleukin 10 protects mice from lethal endotoxemia. J Exp Med 1993;177:1205–8.
Howard M, O’Garra A, Ishida H, de Waal Malefyt R, de Vries J . Biological properties of interleukin 10. J Clin Immunol 1992;12:239–47.
Danikas DD, Karakantza M, Theodorou GL, Sakellaropoulos GC, Gogos CA . Prognostic value of phagocytic activity of neutrophils and monocytes in sepsis. Correlation to CD64 and CD14 antigen expression. Clin Exp Immunol 2008;154:87–97.
Falconer AE, Carr R, Edwards SW . Impaired neutrophil phagocytosis in preterm neonates: lack of correlation with expression of immunoglobulin or complement receptors. Biol Neonate 1995;68:264–9.
Lingnau M, Höflich C, Volk H-D, Sabat R, Döcke W-D . Interleukin-10 enhances the CD14-dependent phagocytosis of bacteria and apoptotic cells by human monocytes. Hum Immunol 2007;68:730–8.
Shames BD, Selzman CH, Meldrum DR et al, Interleukin-10 stabilizes inhibitory kappaB-alpha in human monocytes. Shock 1998;10:389–94.
Ward PA, Lentsch AB . Endogenous regulation of the acute inflammatory response. Mol Cell Biochem 234–235:225–8.
Levy O, Coughlin M, Cronstein BN, Roy RM, Desai A, Wessels MR . The adenosine system selectively inhibits TLR-mediated TNF-alpha production in the human newborn. J Immunol 2006;177:1956–66.
Anaya JM, Espinoza LR . Phosphodiesterase inhibitor pentoxifylline: an antiinflammatory/immunomodulatory drug potentially useful in some rheumatic diseases. J Rheumatol 1995;22:595–9.
Kreth S, Ledderose C, Luchting B, Weis F, Thiel M . Immunomodulatory properties of pentoxifylline are mediated via adenosine-dependent pathways. Shock 2010;34:10–6.
Acknowledgements
The technical support by Günther Hofbauer is gratefully appreciated. We also thank Ludwig Gortner for corrections and Daniel Agustus for reading the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
STATEMENT OF FINANCIAL SUPPORT
The study was supported by a grant of the “Verein Unser Kind”. No other external funding was provided.
Rights and permissions
About this article
Cite this article
Schüller, S., Wisgrill, L., Herndl, E. et al. Pentoxifylline modulates LPS-induced hyperinflammation in monocytes of preterm infants in vitro. Pediatr Res 82, 215–225 (2017). https://doi.org/10.1038/pr.2017.41
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/pr.2017.41
This article is cited by
-
Antioxidant, antibacterial, and barrier-protective effects of beetroot (Beta vulgaris L.) polysaccharides in a lipopolysaccharide-induced Caco-2/macrophage model of intestinal barrier dysfunction
Advances in Traditional Medicine (2026)
-
Pentoxifylline Prevents Neuroinflammation and Modifies PTEN/TrkB Signaling in an LPS-Induced Depression Model
Journal of Neuroimmune Pharmacology (2025)
-
Protocol: Pentoxifylline optimal dose finding trial in preterm neonates with suspected late onset sepsis (PTX-trial)
BMC Pediatrics (2021)
-
Immunometabolic approaches to prevent, detect, and treat neonatal sepsis
Pediatric Research (2020)
-
Intravenous pentoxifylline is well tolerated in critically ill preterm infants with sepsis or necrotizing enterocolitis
European Journal of Pediatrics (2020)


