Effects of N-acetylcysteine on myocardial ischemia–reperfusion injury in bypass surgery

Abstract

Myocardial ischemia-reperfusion injury may complicate coronary artery bypass grafting (CABG) operations. N-Acetylcysteine (NAC) had antioxidant and microcirculatory effects, and inhibits neutrophil aggregation. The aim of this study was to determine the effects of NAC in limiting myocardial ischemia-reperfusion injury in CABG operations. Twenty patients undergoing elective coronary bypass operation with cardiopulmonary bypass were enrolled and randomly assigned to two groups: a control group operated with a routine CABG protocol, and one where NAC was administered intravenously during the operation (NAC group). Blood samples from coronary sinus for tumor necrosis factor-alpha assay, myocardial biopsy specimens for chemiluminescent luminol, and lucigenin measurements of reactive oxygen species were taken. The luminol (specific for (*)OH, H(2)O(2), and HOCl(-) radicals) and lucigenin (specific for O(2) (*-)) levels and the difference ratios after reperfusion were significantly lower in the NAC group. Tumor necrosis factor-alpha levels increased in the control group but, in contrast, a significant decrease was detected in the NAC group (P < 0.01). Creatine kinase-MB levels at 6 and 12 hours were significantly lower in the NAC group (P = 0.02). N-Acetylcysteine has potential effects to limit ischemia reperfusion injury during CABG operations. We believe that its effects on clinical outcome may be more apparent in patients prone to ischemia-reperfusion injury.

Tissue damage in rat ovaries subjected to torsion and detorsion: effects of l-carnitine and N-acetyl cysteine

“…L-Carnitine has been shown to be valuable also in the recovery of gastric mucosa, liver, neuron and kidney tissues, which were subjected to ischemia and reperfusion in different studies [11][12][13][14]. NAC has also been studied on ischemia-reperfusion injuries of tissues like testis, myocard, and kidney and was shown to be effective in the treatment of those injuries [15][16][17][18][19]. Although tissue damage diminishes by long period of reperfusion, our results show that, treatment with both Lcarnitine and NAC accelerates tissue recovery.…”

“…Later, as a precursor of glutathione and as a well-known thiol containing antioxidant, NAC was discovered as a scavenger of FORs [17,18]. NAC easily penetrates cell membranes and unlike cysteine, the rate-limiting amino acid in glutathione synthesis, has a very low toxicity [16].…”

N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency

“…14 In clinical studies, N-acetylcysteine reduced free-radical activation and systemic inflammation during cardiopulmonary bypass (CPB). 15,16 It also preserved renal function in animal models of ischemic kidney-injury. 17,18 N-acetylcysteine has already been studied extensively for preventing contrast-induced nephropathy.…”

The Role of Preconditioning and N-Acetylcysteine on Oxidative Stress Resulting From Tourniquet-Induced Ischemia-Reperfusion in Arthroscopic Knee Surgery

“…These include caffeic acid phenethyl ester, ketamine, propofol, melatonin, ice application, vitamins E and C, and hyperbaric oxygen. [12][13][14][15] Although there are many studies on IR injury in skeletal muscle in animal models, few studies have investigated the effect of ischemic preconditioning (IPC) 16 and N-acetylcysteine (NAC) 17 on IR injury in human skeletal muscle.…”