N -Acetylcysteine Treatment of Rotavirus-Associated Diarrhea in Children

Abstract

Rotaviruses are the leading cause of severe, acute, and dehydrating diarrhea affecting children under 5 years of age worldwide. Despite an important reduction in rotavirus-caused deaths as a consequence of the rotavirus vaccine, alternative or complementary strategies for preventing or treating rotavirus-associated diarrhea are needed mainly in the poorest countries. We describe the cases of four rotavirus-unvaccinated 12-13-month-old girls and a 5-year-old boy who developed rotavirus-associated diarrhea confirmed by enzyme-linked immunosorbent assay, Western blotting, and immunochemistry analyses. After the first day of diarrheal episodes, three of the five patients were immediately administered oral N-acetylcysteine (NAC) 60 mg/kg daily, divided into three equal doses every 8 hours. The other two patients did not receive NAC and served as controls. Administration of NAC resulted in a decreased number of diarrheal episodes, excretion of fecal rotavirus antigen, and resolution of symptoms after 2 days of treatment. Our results suggest that NAC treatment after the first diarrheal episode could be an efficient strategy for treating rotavirus-affected children and preventing the associated severe life-threatening accompanying dehydration.

Amelioration of oxidative stress using N‐acetylcysteine in canine parvoviral enteritis

“…() observed NAC inhibits the virus replication and proinflammatory cytokines and chemokine gene expression during influenza virus infection. The beneficial effects of NAC have been reported in highly pathogenic H5N1 influenza A virus infection, chronic obstructive pulmonary diseases and rotavirus‐associated diarrhea (Dekhuijzen, ; Garigliany & Desmecht, ; Guerrero, Torres, García, Guerrero, & Acosta, ). From the findings of this study, it can be concluded that antioxidants like NAC represent a potential additional treatment option that could be considered in the case of parvoviral diarrhea.…”

Inflammatory and oxidative stress in rotavirus infection

“…The use of NAC as a therapeutic tool for treatment of rotavirus disease in children was also demonstrated. Administration of NAC after the first diarrheal episode was shown to decrease the number of diarrheal episodes, excretion of fecal rotavirus antigen, and resolution of symptoms after 2 d of treatment [186] .…”

“…Advances in the understanding of the role of oxidative stress in rotavirus infection might contribute to improved treatment strategies of rotavirus-induced diarrhea. Interestingly, rotavirus infection of cultured cell lines, and in vivo conditions using animals and human patients has been shown to be inhibited by anti-oxidant therapy [184][185][186] . These findings encourage research to clarify the role of virus induced-oxidative stress as a damaging by-product of infection or a condition required for a successful viral life cycle.…”

The many faces of the anti-COVID immune response

“…N-Ac may be particularly beneficial in clinical syndromes driven by high redox stress, such as viral infections and ARDS (Lenz et al, 1999). Accordingly, N-Ac has shown modest benefit in ARDS (Suter et al, 1994;Zhang et al, 2017) as well in influenza (Lai et al, 2010), dengue (Abeysekera et al, 2012;Kumarasena et al, 2010;Senanayake et al, 2013), rotavirus (Guerrero et al, 2014), HIV (Akerlund et al, 1996;Eylar et al, 1993;Look et al, 1998), and viral hepatitis (Sotelo et al, 2009). While N-Ac is likely to have multiple benefits in patients with chronic viral infections, including protection of lung pneumocytes, hepatocytes, and colonic epithelial cells from virally driven apoptosis, it has the notable ability to reverse lymphopenia in this setting, suggesting that oxidative stress may contribute to lymphopenia during chronic viral infection.…”