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[Animal toxicity studies of probucol (author's transl)].

The oral LD50 of probucol in rats and mice was found to be higher than 5 000 mg/kg. Subacute toxicity studies failed to show any toxic effect in rats and monkeys which received 3 000 and 200 mg/kg/24 h respectively for 90 days. Chronic toxicity studies were carried out in rats during 2 years and in monkeys during 8 years. Daily oral doses of up to 800 mg/kg in rats and 500 mg/kg in monkeys had no demonstrable toxic effects; in particular, there were no differences on electron microscopy between liver sections of monkeys treated for 8 years and those of untreated monkeys. In dogs, probucol proved non toxic when given for 14 days. However, during more prolonged administration (90 days) sudden death occurred in some animals, which was unrelated to dosage or to duration of treatment. Additional studies showed that probucol sensitizes dog myocardium to epinephrine, thereby inducing ventricular fibrillation. This effect was not observed in other animal species and is considered as specific to dogs. A special study was performed in monkeys, which received high doses of probucol (equivalent to 4-15 times the human dose) associated with an atherogenic diet containing 100 times more cholesterol than their normal diet and large quantities of fats. Some monkeys fainted and died; ECG tracings revealed no other abnormality than an increase in the length of QTc. Cardiac toxicity cannot be extrapolated from animal to man, since heart monitoring failed to show any abnormality in patients treated with probucol. No mutagenic or carcinogenic effects were observed in rats, and teratological and reproduction studies carried out in rats and rabbits gave negative results.

Animals↗

The protective effect of probucol on adriamycin nephrosis in the rat.

Recent research has indicated the role of reactive oxygen species (ROS) in experimental nephritis. We examined the role of ROS and the effect of probucol, an anti-hyperlipidemic drug with antioxidant activity, on adriamycin (ADR)-induced nephrosis in the rat. Fourteen days after single intravenous injection of ADR (7.5 mg/kg b.w.), a nephrotic state was observed. Compared with the normal control values, the total kidney glutathione content was lower on day 5, but significantly higher on day 14 in the ADR-injected rats. Feeding ADR-injected rats with food containing 1% probucol was effective in reducing urinary protein excretion. Serum lipid peroxide level and kidney total glutathione content, both of which increased on day 14 in the ADR-injected rats, were also decreased significantly by concomitant probucol treatment. During long-term observation period of 18 weeks, probucol treatment relieved both urinary protein excretion and the progression of renal impairment. These protective effects of probucol suggest a role of ROS in the induction and progression of ADR nephrosis.

Animals↗

Combined treatment of probucol with diltiazem regresses atherosclerosis induced by 196 cholesterol diet in rabbit aorta.

To clarify whether probucol, an antioxidant, or diltiazem, a Ca2+ antagonist, favorably affect the regression of established atherosclerosis, rabbits were fed a 1% cholesterol diet for 10 weeks, then a standard diet for an additional 25 weeks (regression period). During the regression period, rabbits were grouped into a saline (S) group (n=8, 1 ml saline/d), a probucol (P) group (n=8, 1000 mg/d probucol), or a probucol and diltiazem (P+D) group (n=8, probucol 1000 mg/d in diet and diltiazem 30 mg/d). We measured cholesterol in serum, lipoprotein fractions, and serum triglyceride or phospholipid concentration and found no significant differences among the three groups at 10, 15, or 35 weeks. After 10 weeks of the atherogenic diet, the ratio of macroscopic atherosclerotic lesions in aortic intima rose to 36.6 + or - 5.6%. After the regression period, the S group developed more atherosclerotic lesions (48.6 + or - 6.4%). The P+D and P groups, however, had decreased scores of 24.3 + or - 5.5% (p<0.05 vs. S) and 32.3 + or - 5.6%, respectively. Moreover, these decreased scores were well correlated with the decrease in aortic tissue lipid compositions, but not the parameters for extracellular matrices. We concluded that P+D or P therapy might be effective in regressing established atherosclerosis by removing lipid contents but not extracellular matrices.

Animals↗

Effect of probucol on mRNA expression of glomerular antioxidant enzymes in rat with subtotal nephrectomy.

OBJECTIVE: To investigate 1) the glomerular mRNA expression and protein activity of antioxidant enzymes (AOEs) including superoxide dismutase (SOD) and glutathine peroxidase (GSH-Px) and the glomerular content of lipid peroxide-malondiadehyde (MDA), 2) the effects of probucol (P), a potent antioxidant agent on these AOEs and MDA levels, in the chronic phase of subtotal nephrectomized rats. METHODS: The adult male Spregue-Dawley rats were randomly divided into three groups at the first week after subtotal renal ablation. Group 1 was sham rats (sham n = 8), group 2 underwent 5/6 nephrectomy without special therapy (5/6 Nx n = 8), and group 3 with 5/6 nephrectomy received probucol (5/6 Nxs+P n = 8) at a dose of 1% in the rat chow. At the 12th week after P was administrated, all of the rats were sacrificed to remove left kidney for the determination of glomerular level of MDA, activity of SOD, and GSH-Px, glomerular mRNA expression of AOEs by Northern blot analysis as well as a histological examination. RESULTS: In 5/6 Nx, serum cholesterol, proteinuria increased and creatinine clearance decreased progressively with age as compared with that in sham. Those abnormalities as well as glomerulosclerosis index (GI) ameliorated with the administration of probucol at the 12th week after subtotal nephrectomy [GI: sham 3.12 +/- 1.20, P < 0.01 vs 5/6 Nx 5/6 Nx 188.6 +/- 25.1; 5/6 Nx +/- P, 106.9 +/- 17.6, P < 0.05 vs 5/6 Nx]. The probucol therapy also significantly improved the decrease of glomerular Mn-SOD and GSH-Px both at mRNA level and protein activity and the increase of glomerular MDA content. CONCLUSIONS: We demonstrated a deficiency of glomerular AOEs in the chronic phase of remnant kidney, which may contribute to the progression of renal injury. The protective effects of probucol on both renal functional impairment and the development of glomerulosclerosis may be partially associated with improving surviving glomerular AOEs.

Animals↗

Effects of the antioxidants dihydrolipoic acid (DHLA) and probucol on xenobiotic-mediated methaemoglobin formation in diabetic and non-diabetic human erythrocytes in vitro(1).

The antioxidant effects of dihydrolipoic acid (DHLA) and probucol were investigated in a human erythrocytic in-vitro model of diabetic oxidative stress, where xenobiotics were used to form methaemoglobin. 4-Aminophenol mediated haemoglobin oxidation in non-diabetic erythrocytes was not affected by the presence of either DHLA or probucol. However, with diabetic cells, there were significant increases (P<0.01) in 4-aminophenol-mediated haemoglobin oxidation in the presence of DHLA. Methaemoglobin formed by nitrite in non-diabetic and diabetic cells was not altered by either DHLA or probucol except at one time point in diabetic cells. In non-diabetic as well as diabetic cells, methaemoglobin formed by MADDS-NHOH was significantly reduced at all three time points in the presence of DHLA (P<0.0001) but unaffected by probucol. In the presence of DHLA only, methaemoglobin formed by the products of rat microsomal oxidation of both 4-aminopropiophenone and benzocaine was markedly reduced for both xenobiotics in diabetic and non-diabetic cells (P<0.0001) compared with cells incubated in the absence of DHLA. There were no significant differences between total cellular thiol levels determined between diabetic and non-diabetic erythrocytes, nor did DHLA or probucol affect resting thiol levels. MADDS-NHOH caused a significant thiol depletion in diabetic cells, which was restored in the presence of DHLA. A further study is required to determine how DHLA attenuates the potent REDOX reactions that occur during hydroxylamine-mediated methaemoglobin formation.

Journal Article↗

Probucol: a new cholesterol-lowering drug effective in patients with type II hyperlipoproteinemia.

Type II hyperlipoproteinemia or hyperbetalipoproteinemia (B-HLP), a condition with considerable atherogenic potential, is one of the most difficult lipid disorders requiring treatment. Since this abnormality responds minimally to dietary therapy alone, supplemental drug therapy is usually essential. Although the available bile-sequestering resins are effective in B-HLP, these substances are unpalatable and constipating. Since lifelong drug therapy is necessary as an adjunct to diet in the treatment of B-HLP, the ideal drug should be both effective and well tolerated. Probucol, a new cholesterol-lowering drug in tablet form without serious adverse effects, was evaluated in a 12-wk double-blind crossover trial in 11 patients with B-HLP whose serum cholesterol levels were in excess of 275 mg/dl. Probucol, in a dosage of 500 mg twice daily, produced a 10% or greater reduction in serum cholesterol levels in all 11 patients. Serum cholesterol was lowered (p less than 0.01) from 353 to 291 mg/dl in the entire group receiving probucol. There was no significant change (p greater than 0.1) in serum cholesterol (352 mg/dl) during placebo administration. These were no untoward drug effects during the study, and all patients maintained excellent complicance to the schedule of medication. These results indicate that probucol possesses considerable cholesterol-lowering activity and may be a promising new nontoxic therapeutic agent in type II hyperlipoproteinemia.

Cholesterol↗

Time-dependent change in the effect of probucol in subjects with elevated cholesterol.

A time-dependent change in the cholesterol-lowering effect of probucol has been evaluated in 20 subjects with elevated cholesterol. Probucol 500 mg was given once daily at 07.00 h (day trial) or 19.00 h (night trial) for 3 months according to a crossover design. Fasting blood samples were obtained during the control period and at the end of each treatment period. Serum concentrations of total and HDL-cholesterol were significantly decreased by both the treatments with probucol [total cholesterol (mmol.l-1): control 6.58; day trial 5.41; night trial 5.10; HDL-cholesterol (mmol.l-1): control 1.35; day trial 1.06; night trial 0.96]. These parameters were significantly lower in the night trial than in the day trial. The data indicate that the cholesterol-lowering effect of probucol varies with its time of administration in subjects with elevated cholesterol.

Aged↗

An overview of the biochemical pharmacology of probucol.

Probucol was effective in lowering serum total cholesterol in mice at dietary livels as low as 0.0075%. It was also effective after a single 100 mg/kg I.V. dose in mice. The incorporation of acetate-(14)C into liver lipids of rats and mice was not significantly affected by probucol, although the results, especially in mice, make it impossible to rule out such an effect. Cholesterol absorption was estimated in rats using a dual isotope technique. The observed reductions were not statistically significant. Several liver enzyme activities were determined after probucol treatment in rats, and a significant elevation (32%) was observed in only one, glutamic dehydrogenase. Serum cholesterol was lowered markedly in cholesterol-fed cynomolgus monkeys by probucol. There was no effect on the excretion of neutral steroids and the observed increase in fecal bile acids after drug treatment could not be confirmed statistically.

Animals↗

Endothelial dysfunction in streptozotocin-diabetic rats is not reversed by dietary probucol or simvastatin supplementation.

Oxidative stress and dyslipidaemia are key features of diabetes mellitus and may be involved in mediating the vascular endothelial dysfunction associated with this disease. The aim of this study was to examine the effect of dietary lipid-lowering and antioxidant agents on vascular endothelial function and oxidative stress. Diabetic male Sprague-Dawley rats (i.v. streptozotocin, 45 mg/kg) were fed for 4 weeks on a standard diet or on a diet supplemented with either the lipid-lowering antioxidant probucol (1% w/w in diet) or the 3-hydroxy 3-methylglutaryl coenzyme-A (HMG-CoA) reductase inhibitor simvastatin (0.01% w/w in diet). Responses to noradrenaline, acetylcholine, and sodium nitroprusside were assessed in small mesenteric arteries (mean internal diameter 300+/-5 microm, n = 80) mounted on a small vessel myograph. Plasma concentrations of total cholesterol and triglycerides were significantly raised in standard-fed diabetic rats and significantly reduced in probucol and simvastatin-fed diabetic rats 8-epi-prostaglandin (PG)F2alpha, an indicator of oxidative stress, was raised in liver and aorta from diabetic rats compared to controls. Probucol supplementation reduced 8-epi-PGF2alpha in aorta and liver of diabetic rats but increased 8-epi-PGF2alpha content in plasma and aorta from control animals. The abnormal relaxation to acetylcholine in arteries from the diabetic rats (pEC550 diabetic 6.763+/-0.172 vs control 7.541+/-0.175; p < 0.05) was not improved by probucol or simvastatin. These data, therefore, do not support a role for oxidative stress or dyslipidaemia in mediating the impaired ACh-induced endothelium-dependent relaxation of small mesenteric arteries from the streptozotocin-diabetic rat.

Animals↗

Probucol for treatment of hyperlipidemia in persistent childhood nephrotic syndrome. Report of a prospective uncontrolled multicenter study.

In a prospective, uncontrolled multicenter study, we have evaluated the effects of probucol on hyperlipidemia, proteinuria, and glomerular filtration rate (GFR) in hyperlipidemic children with persistent nephrotic syndrome. Probucol was started for a total of 12 weeks in 8 children and for 24 weeks in 14 children. Lipoprotein profiles, serum malondialdehyde (MDA) levels, proteinuria, renal function, and electrocardiogram were monitored every 4 weeks. Side effects were recorded by questionnaire. Treatment was completed by 7 of 8 patients for 12 weeks and by 7 of 14 children for 24 weeks. After 12 weeks, the mean serum concentrations of triglycerides (-15%), total cholesterol (-25%), very low-density lipoprotein-cholesterol (-27%), low-density lipoprotein-cholesterol (-23%), and high-density lipoprotein-cholesterol (-24%), as well as apolipoprotein (apo) A-I (-19%), apo B (-21%), and MDA (-32%) were reduced. The positive effects of probucol on the lipoprotein profile persisted over 24 weeks; however, there was no significant effect on either proteinuria or GFR. In conclusion, probucol had beneficial effects on lipoproteins and lipid peroxidation, but improved neither proteinuria nor GFR. The drug was generally tolerated well, but had to be discontinued because of a prolonged QT interval in 4 of 22 patients.

Adolescent↗

Measurement of reactive oxygen species by chemiluminescence in diet-induced atherosclerosis: protective roles of vitamin E and probucol on different radical species.

We have investigated the effects of a high-cholesterol diet on the production of different reactive oxygen species in rabbit aortic rings and evaluated the protective effects of vitamin E and probucol in preventing peroxidative changes. Twenty-five male albino rabbits were divided into five groups. Control rabbits were fed a vitamin E-poor rabbit chow. Rabbits in the second group were given a vitamin E-poor diet supplemented with 2% cholesterol. Other groups received either 50 mg/kg vitamin E, 1% probucol, or both, in addition to 2% cholesterol for 4 weeks. Reactive oxygen species formation in aortic rings was measured by enhanced chemiluminescence using luminol and lucigenin. (The results were given as cpm/mg wet weight.) Further differentiation of radical species involved in luminol-enhanced chemiluminescence was performed using sodium azide and L-nitroarginine, a selective inhibitor of nitric oxide production. Our results indicated that cholesterol feeding increased lucigenin and luminol chemiluminescence, where the contribution of free radicals inhibited by sodium azide (radicals originating from endothelial cells or from phagocytes) were 53% and peroxynitrite 24%. Both vitamin E and probucol were effective as scavengers of free radicals, but the effect of vitamin E was more pronounced. In conclusion, the present study demonstrated excessive generation of reactive oxygen species within the atherosclerotic vessel. Peroxidative changes could be prevented by vitamin E and probucol treatment, but vitamin E seemed to be more efficient.

Animals↗

Probucol decreases asymmetrical dimethylarginine level by alternation of protein arginine methyltransferase I and dimethylarginine dimethylaminohydrolase activity.

HYPOTHESIS: Asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor (NOS), may play an important role in endothelium dysfunction. Probucol, a potent antioxidant drug, may improve endothelium function via reduction of NOS inhibitor level. The present study examined whether the decreased level of ADMA by probucol is related to enhancement of protein arginine methyltransferase I (PRMT I) expression and reduction of dimethylarginine dimethylaminohydrolase (DDAH) activity. METHODS: Endothelial cells were cultured and used for all these studies. ADMA concentration and DDAH activity were determined by HPLC. Expression of PRMT I and eNOS were characterized by western blot. RESULTS: Pretreatment with oxidized-low density lipoprotein (ox-LDL) (10, 30 or 100 microg/ml) or lysophosphatidylcholine (LPC) (1.0, 2.5 or 5.0 microg/ml) for 12, 24 or 48 h markedly increased the activity of lactate dehydrogenase (LDH) in cultured endothelial cell. Incubation ofendothelial cells with ox-LDL (100 microg/ml) or LPC (5.0 microg/ml) for 48 h significantly increased the expression of PRMT I, and levels of MDA and ADMA, and decreased the concentration of nitrite/nitrate, the expression of eNOS and the activity of DDAH. Probucol significantly decreased the level of ADMA, concomitantly with reduction of PRMT I expression and elevation of DDAH activity and up-regulation of eNOS expression. CONCLUSION: In summary, the present results suggest that the protective effect of probucol on endothelium is related to reduction of ADMA concentration by inhibition of PRMT I expression and enhancement of DDAH activity.

Amidohydrolases↗

Effects of probucol on lipid metabolism and secretion in long-term cultures of adult rat hepatocytes.

To study the effects of probucol on hepatic lipid metabolism, we used adult rat hepatocytes cultured on a feeder layer of 3T3 cells lethally treated with mitomycin C. These cultures synthesize and secrete for at least 2 weeks various lipids from [14C]acetate and [14C]oleate precursors. Treatment with 20 micrograms/ml of probucol for 7 and 14 days decreased the secretion of various radiolabeled lipid species to the culture medium and produced an intracytoplasmic accumulation of triacylglycerol droplets. The lipids whose secretion was most decreased were free and esterified cholesterol (50-70% reduction). Secretion of triacylglycerols and phospholipids was also reduced but to a lower extent. Intracytoplasmic triacylglycerols accumulated and the activity of glycerol phosphate dehydrogenase, a marker enzyme of glycerolipid synthesis, also increased (35-56%). The total incorporation of both radioactive precursors into free and esterified cholesterol and phospholipids was reduced 20-60%. Our data show that 2-week treatment of 3T3-hepatocyte cultures with pharmacological concentrations of probucol reduces significantly lipid secretion and suggest that at least part of the in vivo hypolipidemic effect of probucol could be attributed to a decrease in the secretion of lipids (i.e., lipoproteins) by hepatocytes.

Animals↗

Thyronines and probucol inhibition of human capillary endothelial cell-induced low density lipoprotein oxidation.

Oxidized lipoproteins have been implicated as important factors in the pathogenicity of atherosclerosis. Thus, antioxidants play a significant role in inhibiting a critical step in atheroma progression. Previously, we demonstrated that thyronine analogs inhibit Cu(2+)-induced low density lipoprotein (LDL) oxidation. In the present study, we examined the effect of thyronine analogs on endothelial cell (EC)-induced LDL oxidation. LDL was incubated with or without EC in the presence or absence of various concentrations of thyronine, vitamin C, or probucol at 37 degrees in a humidified atmosphere (95% air, 5% CO2). Thyronine analogs, probucol, and vitamin C inhibited EC-induced LDL oxidation in a concentration-dependent manner. The concentration of each agent (microM) producing 50% inhibition (IC50) of EC-induced LDL oxidation for thiobarbituric acid reactive substances (TBARS) and electrophoretic mobility, respectively, was as follows: 0.294 and 0.417 for levothyroxine (L-T4); 0.200 and 0.299 for L-triiodothyronine (L-T3); 0.125 and 0.264 for dextro-thyroxine (D-T4); 0.203 and 0.304 for reversed triiodothyronine (rT3); 1.02 and 1.44 for probucol; and 13.6 and 14.9 for vitamin C. Thyroid binding globulin (TBG) inhibited EC-induced LDL oxidation; further, thyronines bound to TBG exhibited more antioxidant activity than unbound thyronines. Pretreatment of EC with any of the thyronines decreased the ability of EC to oxidize LDL. Also, our results showed that a synergistic interaction exists between vitamin C and T4 in the inhibition of EC-induced LDL oxidation. The T4 and TBG concentrations that inhibited LDL oxidation were in the physiological range. We conclude that T4, like the pharmacological agent probucol, reduces oxidative modification of LDL and thus may act as a natural inhibitor of atherogenesis.

Anticholesteremic Agents↗

Effects of clofibrate, phthalates and probucol on ubiquinone levels.

Rats were exposed through their diet to clofibrate, di(2-ethylhexyl)phthalate or probucol for 6 weeks and the levels of ubiquinone (UQ), cholesterol and dolichol were monitored in liver, muscle, heart, brain and blood. The levels of UQ-9 and -10 were increased by clofibrate and, in particular by phthalate administration. With the latter agent this increase in liver was fourfold, in muscle was twofold and levels in the heart and blood increased by 20%, whereas there was no change in the brain. Probucol led to a moderate decrease in the level of UQ in liver, muscle and blood, but not in heart or brain. The extent of reduction of UQ was not modified by any of the treatments employed. Probucol did not have any effect on tissue or blood cholesterol levels, whereas clofibrate or phthalate elicited a variable response, including both increases and decreases depending on the tissue analyzed. Phthalate treatment increased the dolichol content to some extent in all tissues and in blood, but the level of this lipid was not modified upon clofibrate or probucol treatment. These results demonstrate that tissue and blood levels of UQ can be increased by exposure to appropriate chemical agents without elevating the concentration of cholesterol.

Animals↗

Probucol in hypercholesterolemia. A double blind study.

The effect of Probucol on serum lipids, lipoproteins and the apoproteins A1, A2 and B was studied in 27 patients with primary hypercholesterolemia. After 3 months of dietary treatment and a 6 week placebo period the patients received 4 X 250 mg of Probucol or placebo per day for 4 months in a double blind design. Total and LDL-cholesterol were significantly reduced with Probucol (13% and 16% respectively) in addition to the diet. Apo B showed a 12% decrease. The HDL cholesterol concentration as well as the serum triglycerides and triglyceride-rich lipoproteins were not significantly altered. Both apo A1 and apo A2 were markedly reduced under Probucol treatment. In general the subjective and objective tolerance of the drug was good.

Adult↗

Metabolic studies with probucol in hypercholesterolaemia.

Probucol (1 g/day) was administered for 6 months to 16 hypercholesterolaemic patients previously stabilized on diet alone. Total plasma cholesterol fell by 16%, LDL cholesterol by 14% and HDL cholesterol by 41%. The ratio of total cholesterol to HDL cholesterol increased by 40%. Total plasma triglycerides showed a slight upward trend. The extent of the fall in HDL cholesterol was directly proportional to the pre-treatment HDL cholesterol concentration. In 2 patients studied, treatment with Probucol produced a sustained increase in the excretion of endogenous faecal steroids, due to increased faecal bile acids. In 3 patients studied, Probucol increased the degree of cholesterol saturation in gall bladder bile. The Lithogenic Index approximated to pathological levels in 1 patient whose bile was previously relatively saturated with cholesterol. Probucol also appeared to cause a modest reduction in the degree of platelet activation in vivo, with reduced platelet prostaglandin synthesis and reduced release of platelet peptides.

Adult↗

A comparison of cholestyramine and probucol in the treatment of familial hypercholesterolaemia.

Twelve patients with familial hypercholesterolaemia (FH) who had not achieved satisfactory cholesterol levels on dietary advice alone were treated with cholestyramine for 6 months and probucol for 6 months in a randomised cross-over study to compare the relative effectiveness of the two drugs. Over the 6-month period, mean total cholesterol fell by 16.4% on cholestyramine and 12.7% on probucol. Cholestyramine produced a 17.4% fall in low density lipoprotein (LDL) cholesterol, no significant changes in very low density lipoprotein (VLDL) cholesterol or high density lipoprotein (HDL) cholesterol, a 21.4% increase in HDL cholesterol subfraction HDL2 and a 24.1% increase in the HDL/LDL cholesterol ratio. Triglyceride levels rose by 29.6% but remained within the normal range. Probucol produced a 11.7% fall in LDL cholesterol, a 9.9% fall in VLDL cholesterol, a 10% fall in total HDL cholesterol, a 37% fall in HDL cholesterol subfraction HDL2 and no change in the HDL/LDL cholesterol ratio. Triglyceride levels fell by 14%. The mean corrected QT interval increased from 0.418 to 0.434 s (P less than 0.01) on probucol but did not change significantly on cholestyramine (from 0.405 to 0.41 s). The two drugs have different metabolic effects on FH. Cholestyramine has a more marked effect on LDL cholesterol, favourably influences the HDL/LDL cholesterol ratio and is therefore considered to be the drug of choice.

Cholesterol↗