Background: Factors affecting innate immunity and acting as inflammatory regulators, such as the nuclear peroxisome proliferator-activated receptors (PPAR) could be crucial in the pathogenesis of necrotizing enterocolitis (NEC). We hypothesized that the PPARγ agonist pioglitazone (PIO) might be effective in preventing the development of NEC and/or reducing its severity. Methods: We studied preterm rats in which NEC was induced using the hypoxia-hypothermia model. The treatment group (TG; n = 30) received enteral PIO (10 mg/kg/d) for 72 h and the control group (CG; n = 30) did not. Animals were sacrificed 96 h after birth. NEC was diagnosed evaluating histological ileum changes, and mRNA levels of IL-4, IL-12, IL-6, IL-10, INF-γ, and TNF-α cytokines were measured. results: NEC occurrence was higher in the CG (18/30; 60%) than in the TG (5/30; 16.7%) and was more severe. Proinflammatory IL-12 and INF-γ mRNA levels were significantly lower in the TG than in the CG; conversely, the antiinflammatory IL-4 mRNA level was significantly higher in the TG than in the CG. conclusion: Our results demonstrate for the first time that PIO is effective in reducing the incidence and severity of NEC and in decreasing renal injuries in a preterm rat model. n ecrotizing enterocolitis (NEC) is the most common neonatal gastrointestinal complication in preterm infants (1). The prevalence of this disease is about 7% in infants with birth weght from 500 to 1,500 g, with a mortality of 30% in 28 to 36 wk of gestation infants and 40 % in <28-wk infants (2). Moreover, the development of NEC increases the risk of a delay in neurodevelopment, because inflammatory processes occurring in the gut can have a systemic diffusion, affecting other organs such as the brain (3), and, as recently suggested, the kidney (4). The physiopathology of NEC is not completely understood; however it is considered a multifactoral disease including intestinal immaturity, microbial colonization, and hypoxia-ischemia damage as risk factors. Recently, many studies have suggested that the intestinal mucosa and innate immune system play major roles in the pathogenesis of NEC (5). Thus, factors affecting innate immunity and regulating inflammation, such as the nuclear peroxisome proliferatoractivated receptors (PPAR), could be crucial. PPAR are a family of ligand-activated nuclear receptor transcription factors that regulates the function and expression of complex gene networks, especially involved in energy homeostasis and inflammation (6). They consist of three isoforms (α, β, γ), and PPARγ has been shown to induce anti-inflammatory responses inhibiting proinflammatory transcription factors such as nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) (7-9). Moreover, PPARγ can promote an antiinflammatory antioxidant response interacting with different enzymatic pathways such as cyclooxygenase 2 (COX-2), inducible nitric oxide synthase (iNOS), and endothelial nitric oxide synthase (eNOS) (6). For these reasons, many PPARγ agonists have been implicated in t...