title: Pentoxifylline promotes replication of human cytomegalovirus in vivo and in vitro.
abstract: OKT3 monoclonal antibody (MoAb) therapy is well established in the prevention and therapy of acute rejection in transplant patients. Unfortunately, this therapy is associated with several short-term (cytokine release syndrome) and long-term (infections, EBV-related lymphoma) side effects. Recently, we were able to demonstrate an association between the TNF alpha release following the first OKT3 MoAb infusions and the appearance of human cytomegalovirus (HCMV) reactivation several days later. In order to prevent this TNF alpha associated HCMV reactivation patients were additionally treated with pentoxifylline (PTX), a methylxanthine derivative that has been shown to suppress TNF alpha induction. Although the TNF alpha peak plasma level following OKT3 MoAb treatment was markedly reduced, the incidence of HCMV reactivation and HCMV disease was not influenced. In transient transfection experiments using HCMV immediate early enhancer/promoter CAT reporter gene constructs PTX enhanced the promoter activity independently from TNF alpha in premonocytic cells. Furthermore, PTX acted synergistically with TNF alpha. In virus-infected human embryonal lung fibroblasts HCMV replication was triggered in the presence of both PTX and TNF alpha, while either substance alone had only marginal effects. The stimulatory effect of PTX on the immediate early (IE) enhancer/promoter was mediated via CREB/ ATF, a eukaryotic transcription factor that binds to the 19 bp sequence motif in the enhancer region, while TNF alpha stimulation was mediated by activation of the transcription factor NF-kappaB and its binding to the 18 bp sequence motif in the enhancer. These data suggest a potential side effect of cAMP-elevating drugs such as PTX.
authors.affiliation: Institute of Medical Virology, Medical Clinic V-Nephrology, Medical Faculty (Charite), Humboldt Universitat zu Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Staak
authors.forename: S
authors.initials: S
authors.lastname: Prosch
authors.forename: J
authors.initials: J
authors.lastname: Stein
authors.forename: C
authors.initials: C
authors.lastname: Priemer
authors.forename: R
authors.initials: R
authors.lastname: Ewert
authors.forename: W D
authors.initials: WD
authors.lastname: Docke
authors.forename: D H
authors.initials: DH
authors.lastname: Kruger
authors.forename: H D
authors.initials: HD
authors.lastname: Volk
authors.forename: P
authors.initials: P
authors.lastname: Reinke
mesh_terms: D000208:Acute Disease; D000956:Antigens, Viral / Q000097:blood; D002478:Cells, Cultured; D015500:Chloramphenicol O-Acetyltransferase / Q000096:biosynthesis / Q000235:genetics; D003587:Cytomegalovirus / Q000187:drug effects* / Q000235:genetics / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000821:virology; D004742:Enhancer Elements, Genetic; D005347:Fibroblasts / Q000821:virology; D005786:Gene Expression Regulation / Q000187:drug effects; D017781:Genes, Immediate-Early; D017930:Genes, Reporter; D005814:Genes, Viral; D006084:Graft Rejection / Q000188:drug therapy; D018922:HL-60 Cells; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D015850:Interleukin-6 / Q000096:biosynthesis / Q000235:genetics; D016030:Kidney Transplantation; D016853:Muromonab-CD3 / Q000494:pharmacology / Q000627:therapeutic use; D016328:NF-kappa B / Q000502:physiology; D010431:Pentoxifylline / Q000494:pharmacology*; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology; D010750:Phosphoproteins / Q000096:biosynthesis / Q000235:genetics; D011183:Postoperative Complications / Q000276:immunology / Q000821:virology; D011401:Promoter Regions, Genetic; D011993:Recombinant Fusion Proteins / Q000096:biosynthesis / Q000235:genetics; D014158:Transcription, Genetic; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis / Q000235:genetics; D014763:Viral Matrix Proteins / Q000096:biosynthesis / Q000235:genetics; D014766:Viremia / Q000821:virology; D014775:Virus Activation / Q000187:drug effects*; D014779:Virus Replication / Q000187:drug effects*
chemical_list: D000956:Antigens, Viral; D007166:Immunosuppressive Agents; D015850:Interleukin-6; D016853:Muromonab-CD3; D016328:NF-kappa B; D010726:Phosphodiesterase Inhibitors; D010750:Phosphoproteins; D011993:Recombinant Fusion Proteins; D014409:Tumor Necrosis Factor-alpha; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D015500:Chloramphenicol O-Acetyltransferase; D010431:Pentoxifylline