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N-Acetylcysteine to Combat COVID-19: An Evidence Review, 2020, Zhongcheng Shi and Carlos Puyo

Discussion in 'Epidemics (including Covid-19, not Long Covid)' started by Arnie Pye, Apr 11, 2022.

  1. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

    Title : N-Acetylcysteine to Combat COVID-19: An Evidence Review

    Link : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649937/

    The novel coronavirus disease (COVID-19) is caused by a virus (SARS-Cov-2) and is known for inducing multisystem organ dysfunction associated with significant morbidity and mortality. Current therapeutic strategies for COVID-19 have failed to effectively reduce mortality rate, especially for elderly patients. A newly developed vaccine against SARS-Cov-2 has been reported to induce the production of neutralizing antibodies in young volunteers. However, the vaccine has shown limited benefit in the elderly, suggesting an age-dependent immune response. As a result, exploring new applications of existing medications could potentially provide valuable treatments for COVID-19. N-acetylcysteine (NAC) has been used in clinical practice to treat critically ill septic patients, and more recently for COVID-19 patients. NAC has antioxidant, anti-inflammatory and immune-modulating characteristics that may prove beneficial in the treatment and prevention of SARS-Cov-2. This review offers a thorough analysis of NAC and discusses its potential use for treatment of COVID-19.
    Hutan, oldtimer and Trish like this.
  2. InitialConditions

    InitialConditions Senior Member (Voting Rights)

    North-West England
    One of my pet hates is academic studies where the abstract does not tell you the most important result/conclusion of the study.
    oldtimer, Dolphin, Hutan and 5 others like this.
  3. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

    Anyone interested in NAC should know that it is easily sourced in the UK without prescription. However, fairly recently (since the pandemic started I think), the US pharma industry and the FDA have decided that because NAC is actually useful it should be made prescription only, presumably because they could rake in profits from it. US Amazon has removed it from sale, but other Amazon sites such as Amazon UK haven't. Apart from US Amazon I haven't read of any other US websites removing NAC from sale so it is still easily sourced, at least for now.

    Note that in the UK NAC is really quite cheap e.g. less than £10 for 100 x 600mg capsules, less than £20 for 250 x 600mg capsules.

    I've never heard of anyone suffering from side effects from NAC at standard doses, but that doesn't mean they don't happen.

    For further information on NAC : https://examine.com/supplements/n-acetylcysteine/
  4. Agapanthus

    Agapanthus Senior Member (Voting Rights)

    I have been taking around 1200 gm in 2 doses for around 10 years now. Actually I thought I had been taking half of this dose but just realised that since switching brands I increased my dose accidentally (says you can take up to 2 capsules on the one I have at 600mg each).

    At the age of nearly 70 it looks like a good plan to continue it! I am turning into one of the aged people.

    Probably irrelevant, but when I developed Covid just after meeting with my son and his wife in Dec 2020 (they didn't know they were both carrying it), I had it mildly while they had it quite severely. I actually tested negative but I feel sure that got the virus from them, as I hadn't had much contact with anyone else for some days and I was with them over a weekend and one was ill but didn't know it was Covid, and the other was carrying it as they became ill as soon as they got home.

    I gather that if you have it mildly it doesn't necessarily show a positive on the antibody test. My son was worried about me catching it, as it was before any vaccines.

    Unfortunately I do feel that even with the mild dose, that my function has gone down since I had it.
    Last edited: Apr 11, 2022
  5. Dolphin

    Dolphin Senior Member (Voting Rights)

    This was presented at a previous IACFS/ME conference:

    N-Acetylcysteine Alleviates Cortical Glutathione Deficit and Improves Symptoms in CFS: An In Vivo Validation Study using Proton Magnetic Resonance Spectroscopy

    N. Weiduschata, X. Maoa, D. Vub, M. Blateb, G. Kanga, H.S. Mangatc, A. Artisd, S. Banerjeed, G. Langeb, C. Henchcliffec, B.H. Natelsonb, D.C. Shungua
    a Departments of Radiology, c Neurology and Neuroscience, and d Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA; b Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, NY, USA;

    OBJECTIVES We previously reported a robust 36% deficit of occipital cortex glutathione (GSH) – the primary tissue antioxidant – in patients with CFS compared to healthy comparison (HC) subjects, a finding that implicated oxidative stress in the disorder. The primary objective of the present study was to assess whether supplementing CFS patients with the GSH synthetic precursor N-acetylcysteine (NAC) daily for 4 weeks would spur in situ synthesis and significant elevation of cortical GSH compared to baseline, as assessed in vivo with proton magnetic resonance spectroscopy (1H MRS).

    METHODS For this pilot clinical study, we recruited 16 medication-free patients meeting the CDC criteria for CFS and 15 HC subjects. Following baseline measurement of occipital cortex GSH with 1H MRS and administration of a battery of clinical assessments, both CFS and HC participants received a 4-week supplement of 1800mg NAC/day. After 4 weeks, identical 1H MRS scan and clinical assessments were conducted to determine the effect of NAC on cortical GSH levels and on CFS symptoms as assessed with the CDC CFS symptom inventory.

    RESULTS At baseline, controlling for age and race, cortical GSH levels were 15% lower in CFS than in HC (95%CI: -0.0005,0; p=0.04, one-tailed as the differences and direction of changes were postulated a priori). Following 4 weeks of daily NAC supplementation, cortical GSH levels rose significantly relative to baseline (95%CI: 0.0001,0.0006; p=0.004, one-tailed) in CFS patients to match those in HC, which did not differ compared to baseline (95%CI: -0.0002,0.0003; p=0.33, one-tailed). Lastly, NAC supplementation markedly improved symptoms in CFS patients, with significant decreases in CDC CFS symptom inventory total scores (95%CI: -51.5-9.6; p=0.006), case definition scores (95%CI: -28.2-2 .0; p=0.03) and “other symptoms” scores (95%CI: -24.0-7.3; p<0.001). However, GSH levels did not correlate with any clinical measure.

    CONCLUSION The results of this study have provided the very first direct evidence that NAC crosses the blood-brain barrier to spur in situ synthesis and elevation of cortical GSH. Significantly, increasing cortical GSH levels with NAC ameliorated symptoms in CFS patients. Future studies evaluating the clinical efficacy, and optimal dose and treatment duration of NAC are warranted.

    Dikoma C. Shungu, Ph.D., Professor of Physics in Radiology, Fellow of the International Society for Magnetic Resonance in Medicine (FISMRM); Chief, Laboratory for Advanced MRS Research Citigroup Biomedical Imaging Center, Weill Cornell Medicine; 516 E 72nd Street, New York, NY 10065. Email: dcs7001@med.cornell.edu. Funding source: NIH Grant # 1 R21 NR013650. There are no conflicts of interest to declare or disclose.
  6. Hutan

    Hutan Moderator Staff Member

    Aotearoa New Zealand
    Trish likes this.

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