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Year : 2009  |  Volume : 41  |  Issue : 5  |  Page : 213--217

The effects of pentoxifylline on skeletal muscle contractility and neuromuscular transmission during hypoxia

Fatma Simsek-Duran1, Mert Ertunc2, Rustu Onur2,  
1 Department of Physiology, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey
2 Department of Pharmacology, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey

Correspondence Address:
Fatma Simsek-Duran
Department of Physiology, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara


Objectives : The objective of this study was to investigate the effects of pentoxifylline (PTX), a drug that is mainly used for indications related to tissue hypoxia, on hypoxia-induced inhibition of skeletal muscle contractility and neuromuscular transmission in mice. We hypothesized that chronic PTX treatment alters skeletal muscle contractility and hypoxia-induced dysfunction. Materials and Methods : Mice were treated with 50 mg/kg PTX or saline intraperitoneally for a week. Following ether anesthesia, diaphragm muscles were removed; isometric muscle contractions and action potentials were recorded. Time to reach neuromuscular blockade and the rate of recovery of muscle contractility were assessed during hypoxia and re-oxygenation. Results : The PTX group displayed 90% greater twitch amplitudes (P < 0.01). Hypoxia depressed twitch contractions and caused neuromuscular blockade in both groups. However, neuromuscular blockade occurred earlier in PTX-treated animals (P < 0.05). Muscle contractures developed during hypoxia were more pronounced in the PTX group (P < 0.05). Re-oxygenation reduced contracture and indirect muscle contractions resumed. The rate of recovery of contractions was faster (P < 0.05) and the amplitude of contractions was greater (P < 0.01) in the PTX group. PTX treatment increased amplitude (P < 0.05) and shortened action potential (P < 0.05) without altering resting membrane potential, excitation threshold, and neurotransmitter release. Conclusion : Chronic PTX treatment increases diaphragm contractility, but amplifies hypoxia-induced contractile dysfunction in mice. These results may implicate important clinical consequences for clinical usage of PTX in hypoxia-related conditions.

How to cite this article:
Simsek-Duran F, Ertunc M, Onur R. The effects of pentoxifylline on skeletal muscle contractility and neuromuscular transmission during hypoxia.Indian J Pharmacol 2009;41:213-217

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Simsek-Duran F, Ertunc M, Onur R. The effects of pentoxifylline on skeletal muscle contractility and neuromuscular transmission during hypoxia. Indian J Pharmacol [serial online] 2009 [cited 2021 Sep 20 ];41:213-217
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Hypoxia inhibits skeletal muscle contractility and causes neuromuscular blockade. Intracellular mechanisms of hypoxia-induced damage in skeletal muscle have not been fully elucidated. Impaired calcium (Ca 2+) buffering and decreased adenosine-5'-triphosphate (ATP) production in myocytes are known to participate in hypoxia-induced impairment of muscle function. [1]

Pentoxifylline (PTX), a xanthine-derived phosphodiesterase (PDE) inhibitor, is known to increase intracellular cyclic-adenosine monophosphate (cAMP) levels. [2] An increase in cAMP levels in muscle fibers results in the activation of protein kinase A (PKA) and facilitates synaptic transmission in the mammalian neuromuscular junction (NMJ). [3] Recent data showed that PTX administration decreases plasma levels of pro-inflammatory cytokines, such as tumor necrosis factor alpha(TNF-α), interleukin (IL)-1 β, IL-10, [4] and down-regulates their production. [5] Recently, cytokines have been shown to impair contractile response in the skeletal muscle probably by affecting the nitrergic pathway or nitric oxide (NO) production. [6],[7]

PTX exerts beneficial effects on the treatment of peripheral circulatory insufficiency. A recent study has demonstrated that PTX attenuates ischemia reperfusion injury in the skeletal muscle and other tissues by decreasing neutrophil adhesion to endothelial cells, reactive oxygen species production, and platelet activation. [8] However, the effects of PTX treatment on muscle contractility and on hypoxia-induced contractile dysfunction have not been studied. This study was designed to evaluate the effects of chronic PTX treatment on the contractile properties of the skeletal muscle and hypoxia-induced contractile impairment. We hypothesized that chronic PTX treatment alters skeletal muscle contractility and hypoxia-induced dysfunction.

 Materials and Methods

Mice, weighing between 30 and 35 g, were obtained from the Hacettepe University, Department of Pharmacology Animal Breeding Unit. Animals were housed in communal cages with food and water available ad libitum, and exposed to a 12 h light/dark cycle with the room temperature maintained at 21C.

The procedures in the study were approved by Hacettepe University Animal Care and Use Ethics Committee, Ankara, Turkey, approval numbers 2001/08-3. Experiments were conducted in accordance with the Animal Care Guidelines of Hacettepe University.

Experiments were performed in two groups of mice, PTX, and control. In the PTX group, animals were treated with PTX (50 mg/ kg, i.p., n = 12) for a week and the control animals received saline (n 5 6). Animals were anesthetized with ether and phrenic nerves attached to the diaphragm muscles were removed. Ringer's solution had the following composition (in mm): NaCl, 135; KCl, 5; MgCl 2 , 1; CaCl 2 , 2; NaHCO 3 , 15; Na 2 HPO 4 , 1; and glucose, 11. Muscle preparations were placed vertically in a 50 ml organ bath at 37΀C and gassed with a mixture of 95% oxygen (O 2 ) and 5% carbon dioxide (CO 2 ). After applying 1-1.5 g resting tension, isometric muscle contractions were recorded via force displacement transducers (FT03, Grass Instruments, Quincy, MA) on a polygraph (Model 79C Grass Instruments, Quincy, MA). Phrenic nerve and diaphragm muscles were stimulated by rectangular electrical pulses via platinum electrodes connected to a stimulator (Model S88 Grass Instruments, Quincy, MA) and a stimulus isolation unit (SIU5 Grass Instruments, Quincy, MA). A pair of platinum electrodes was placed vertically to both sides of the muscle fibers for direct stimulation. The phrenic nerve was placed between two parallel platinum ring electrodes, which were placed in a polyethylene tubing of 3 mm diameter. Contraction amplitudes of muscles were normalized and expressed as g/g of wet tissue. In order to induce hypoxia, 95% nitrogen (N 2 ) + 5% carbon dioxide (CO 2 ) gas mixture was applied. Isometric muscle contractions, time to reach complete neuromuscular blockade during hypoxia, and the rate of recovery of muscle contractility upon re-oxygenation were determined. Electrophysiological experiments were made by using conventional microelectrode techniques. Muscle preparations were placed on perspex plates covered with Sylgard, the thoracic side on top and were perfused with Ringer's solution 1-2 ml/min at 22 1C. Muscle preparations were illuminated from the bottom of the organ bath and were observed by a stereomicroscope (Bausch and Lomb). Resting membrane potentials (RMPs), miniature end plate potentials (MEPP), and action potentials (APs) were recorded with borosilicate glass microelectrodes having 10-30 MΩ of input resistances filled with 3 mol/l KCl. Signals were amplified by Axoclamp 2A (Axon instruments, Foster city, CA, USA) amplifier and displayed on a digital storage oscilloscope (Hitachi VC-6524, Hitachi Denshi, Tokyo, Japan). Amplitude and frequency of MEPPs, threshold level, overshoot, amplitude, and half-rise and half-decay times of APs were evaluated and digitized by Powerlab 8/P (ADI Instruments, Pty. Ltd., Castle Hill, Australia) and Scope 3.2 and Chart 4.0 software programs were used to analyze data.

The following drugs were used: Pentoxifylline (Trental, Roche Istanbul, Turkey) and caffeine (Sigma Chemical Co., MO, and USA).

All data were expressed as mean ± SEM. Comparison of the groups was done by the Mann-Whitney U-test or two-way ANOVA followed by Bonferroni's post hoc test. Statistical significance was defined as P 2+ handling. [9],[10] In our study, PTX-treated diaphragm muscles did not display alteration of KCl and caffeine contractures, implying that PTX at this dose level did not change depolarization-contraction coupling and Ca 2+ release from the sarcoplasmic reticulum (SR).

Regulatory effects of PTX on cytokine expression may contribute to increased skeletal muscle contractility. PTX decreases the expression of TNF-α in various tissues, including the skeletal muscle. [5] PTX also inhibits cellular TNF-α synthesis and attenuates toxic effects of TNF-α. [4],[11] It is shown that cytokines, predominantly TNF-α have a prominent role in skeletal muscle contractile dysfunction in these cytokine-related pathologies. [12] In a recent study, Alloatti et al. showed that TNF-α reduced contractility and shifted the force-frequency relationship to the right in guinea pig extensor digitorum longus muscle. They also found that the TNF-αinduced effect is mediated by NO production, which is induced by a platelet-activating factor. [13] In another study, TNF-α induced reduction of contractile force in cardiac myocytes was found to be dependent on excessive NO production. [6] NO production impairs contractile response in the skeletal muscle by acting on intracellular Ca 2+ transients, SR Ca 2+ ATP-ase expression, and/ or Ca 2+ release channel. [14] We found that muscles obtained from PTX-treated mice had greater twitch amplitudes in normoxic conditions, however, in the hypoxic state; the contractility of PTX-treated muscles was lower than that of controls. This may be related to the diverse effects of PTX on basal and hypoxia-induced local expression of cytokines, specifically, to TNF-α and IL-6 which have recently been shown to induce various effects on skeletal muscle protein metabolism, proliferation, NO production, and contractility. [15] We also found that in the re-oxygenation period, amplitudes of direct and indirect twitch contractions of PTX-treated muscles were greater, indicating a more efficient recovery process. Greater contractile responses obtained in our study in PTX-treated muscles may be explained in part, by NOS inhibition and/or decreased NO production.

Detrimental effects of hypoxia on contractility were increased in muscles obtained from PTX-treated animals. This is evidenced by the findings that hypoxia-induced twitch amplitude inhibition and contracture were greater in PTX-treated muscles. Also recovery upon re-oxygenation was delayed in these muscles. These effects may be due to increased Ca 2+ influx after PDE inhibition by PTX treatment. Excessive amounts of cytosolic Ca 2+ is deleterious, and it has been shown that elevated Ca 2+ induces disruption of the excitation-contraction (E-C) coupling. [16] Increased intracellular Ca 2+ concentration activates proteases and phospholipases, which contribute to the damage in the mitochondria and SR. [17],[18],[19] Damage of these organelles eventually causes progression of the deterioration by further increasing intracellular Ca 2+ levels. Hypoxia is one of the triggering events initiating this vicious cycle by decreased ATP content to maintain intracellular Ca 2+ balance. [20]

Our data showed that chronic PTX treatment did not alter RMP of diaphragm muscle and spontaneous neurotransmitter release at the neuromuscular junction. However, PTX treatment significantly increased muscle AP amplitudes and shortened their time course. The reduction in time course was found to be more prominent in the rising phase, implying increased Na+ channel activity. PDE inhibitors are reported to alter electrical activity of cardiac and skeletal muscles. Toborinone, a PDE inhibitor by increasing cAMP concentration increased contractility and prolonged AP duration in cardiac myocytes by blocking the delayed rectifier currents. [21] We observed an increase in skeletal muscle contractility concomitant with reduction in AP duration. This difference in AP duration may be due to different types of muscles and drugs used. Recently, Gonzalez-Serratos et al. showed that a different PDE inhibitor, LASSBio-294, did not alter RMP and APs in frog sartorius muscles; however it improved contractility and reduced muscle fatigue. [22]


Chronic PTX treatment increases skeletal muscle contractility without altering spontaneous acetylcholine release, but does not improve hypoxia-induced skeletal muscle dysfunction. These results may implicate important clinical consequences for PTX, a drug that is mainly used for indications related to tissue hypoxia.


1Brotto MA, Andreatta-van Leyen S, Nosek CM, Brotto LS, Nosek TM. Hypoxia and fatigue-induced modification of function and proteins in intact and skinned murine diaphragm muscle. Pflugers Arch 2000;440:727-34.
2Stellin GP, Waxman K. Current and potential therapeutic effects of pentoxifylline. Compr Ther 1989;15:11-3.
3Losavio A, Muchnik S. Facilitation of spontaneous acetylcholine release induced by activation of cAMP in rat neuromuscular junctions. Life Sci 2000;66:2543-56.
4Van Furth AM, Verhard-Seijmonsbergen EM, Van Furth R, Langermans JA. Effect of lisofylline and pentoxifylline on the bacterial-stimulated production of TNF-alpha, IL-1 beta IL-10 by human leucocytes. Immunology 1997;91:193-6.
5Park E, Schuller-Levis G, Park SY, Jia JH, Levis WR. Pentoxifylline downregulates nitric oxide and tumor necrosis factor-alpha induced by mycobacterial lipoarabinomannan in a macrophage cell line. Int J Lepr Other Mycobact Dis 2001;69:225-33.
6Finkel MS, Oddis CV, Jacob TD, Watkins SC, Hattler BG, Simmons RL. Negative inotropic effects of cytokines on the heart mediated by nitric oxide. Science 1992;257:387-9.
7Ralevic V. Hypoxic vasodilatation: Is an adenosine-prostaglandins- NO signalling cascade involved J Physiol 2002;544:2.
8Kishi M, Tanaka H, Seiyama A, Takaoka M, Matsuoka T, Yoshioka T, et al. Pentoxifylline attenuates reperfusion injury in skeletal muscle after partial ischemia. Am J Physiol 1998;274: H1435-42.
9Ferrier GR, Howlett SE. Differential effects of phosphodiesterase-sensitive and-resistant analogs of cAMP on initiation of contraction in cardiac ventricular myocytes. J Pharmacol Exp Ther 2003;306:166-78.
10Muniz J, Huerta M, Duenas J, Trujillo X, Elizalde A. Caffeine and theophylline contractures in tonic skeletal muscle fibers of the frog. Jpn J Physiol 1992;42:711-20.
11Costelli P, Bossola M, Muscaritoli M, Grieco G, Bonelli G, Bellantone R, et al. Anticytokine treatment prevents the increase in the activity of ATP-ubiquitin- and Ca(21)-dependent proteolytic systems in the muscle of tumour-bearing rats. Cytokine 2002;19:1-5.
12Reid MB, Li YP. Cytokines and oxidative signalling in skeletal muscle. Acta Physiol Scand 2001;171:225-32.
13Alloatti G, Penna C, Mariano F, Camussi G. Role of NO and PAF in the impairment of skeletal muscle contractility induced by TNF-alpha. Am J Physiol Regul Integr Comp Physiol 2000;279: R2156-63.
14Stamler JS, Meissner G. Physiology of nitric oxide in skeletal muscle. Physiol Rev 2001;81:209-37.
15Helge JW, Stallknecht B, Pedersen BK, Galbo H, Kiens B, Richter EA. The effect of graded exercise on IL-6 release and glucose uptake in human skeletal muscle. J Physiol 2003;546:299-305.
16Verburg E, Dutka TL, Lamb GD. Long-lasting muscle fatigue: Partial disruption of excitation-contraction coupling by elevated cytosolic Ca 21concentration during contractions. Am J Physiol Cell Physiol 2006;290: C1199-208.
17Bossenmeyer-Pourie C, Koziel V, Daval JL. CPP32/CASPASE-3-like proteases in hypoxia-induced apoptosis in developing brain neurons. Brain Res Mol Brain Res 1999;71:225-37.
18Petry C, Huwiler A, Eberhardt W, Kaszkin M, Pfeilschifter J. Hypoxia increases group IIA phospholipase A(2) expression under inflammatory conditions in rat renal mesangial cells. J Am Soc Nephrol 2005;16:2897-905.
19Edelstein CL. Calcium-mediated proximal tubular injury-what is the role of cysteine proteases Nephrol Dial Transplant 2000;15:141-4.
20Bannister NJ, Publicover SJ. Interacting effects of Ca 21 and hypoxia in the induction of sarcolemmal damage in mouse diaphragm in vitro. Acta neuropathologica 1995;90:411-4.
21MacGowan GA. Clinical overview of the novel inotropic agent toborinone. Expert Opin Investig Drugs 2000;9:1109-17.
22Gonzalez-Serratos H, Chang R, Pereira EF, Castro NG, Aracava Y, Melo PA, et al. A novel thienylhydrazone, (2-thienylidene)3,4-methylenedioxybenzoylhydrazine, increases inotropism and decreases fatigue of skeletal muscle. J Pharmacol Exp Ther 2001;299:558-66.