Pentoxifylline reverses oxidative mitochondrial defect in claudicating skeletal muscle

Objective. Previous morphologic studies and phosphorus nuclear magnetic resonance spectroscopy (³¹P MRS) have suggested a primary mitochondrial defect in claudicating skeletal muscle. We hypothesized that pentoxifylline may alleviate this defect. Methods. The response of calf muscle bioenergetics to pentoxifylline was evaluated in 10 male, nondiabetic claudicants with ³¹P MRS and standard treadmill testing before and after 12 weeks of pentoxifylline therapy. Phosphocreatine (PCr) and adenosino-diphosphate (ADP) recovery rate constants, two very sensitive measures of oxidative mitochondrial function, were measured. Results. Seven of the 10 subjects had abnormal baseline PCr (<0.015 s^-1) and ADP (<0.024 s^-1) recovery rate constants. These 7 had significant improvement in mitochondrial function with pentoxifylline; their PCr recovery rate constants increased from 0.009 ± 0.002 to 0.013 ± 0.002 s^-1 (P = 0.013) and their ADP recovery rate constants increased from 0.015 ± 0.002 to 0.022 ± 0.002 s^-1 (P = 0.004). The remaining 3 patients had normal baseline constants and demonstrated no improvement after pentoxifylline therapy. Baseline PCr and ADP recovery rate constants inversely correlated with their corresponding percentage of improvement after pentoxifylline (P < 0.05). In addition the percentage of improvement in the PCr and ADP recovery rate constants correlated with the percentage of improvement in initial claudication distance and maximum walking capacity (P < 0.05). Conclusions. Pentoxifylline improves the mitochondriopathy of claudicating muscle, producing the most improvement in limbs with the worse baseline mitochondrial function. These results point to a potential new mode of action for pentoxifylline in the treatment of claudication and identify a subgroup of patients with the best potential for improvement with treatment.