N-acetylcysteine for the treatment of COVID-19 among hospitalized patients

Авдеев, С. Н.; Gaynitdinova, V. V.; Merzhoeva, Zamira M.; Berikkhanov, Zelimkhan G.-M.

doi:10.1016/j.jinf.2021.07.003

Cited by 20 publications

(18 citation statements)

References 10 publications

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“…In a Russian case-control study, 24 consecutive patients with confirmed SARS-CoV-2 infection and radiological findings compatible with severe COVID-19 pneumonia were treated with NAC at a daily dose of 1200-1800 mg intravenously and 22 patients were included in the control group [70]. NAC therapy provided a significant improvement in oxygenation parameters and reduction in CRP, National Early Warning Score (NEWS) 2 scale, and length of hospitalization.…”

Section: Evidence For Use Of Thiols In Covid-19mentioning

confidence: 99%

Use of Thiols in the Treatment of COVID-19: Current Evidence

Cazzola

Rogliani

Salvi³

et al. 2021

Lung

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There is a possible role for oxidative stress, a state characterized by an altered balance between the production of free radicals or reactive oxygen species (ROS) and antioxidant defences, in coronavirus disease 2019 (COVID-19), the genesis of which is quite complex. Excessive oxidative stress could be responsible for the alveolar damage, thrombosis, and red blood cell dysregulation observed in COVID-19. Apparently, deficiency of glutathione (GSH), a low-molecular-weight thiol that is the most important non-enzymatic antioxidant molecule and has the potential to keep the cytokine storm in check, is a plausible explanation for the severe manifestations and death in COVID-19 patients. Thiol drugs, which are considered mucolytic, also possess potent antioxidant and anti-inflammatory properties. They exhibit antibacterial activity against a variety of medically important bacteria and may be an effective strategy against influenza virus infection. The importance of oxidative stress during COVID-19 and the various pharmacological characteristics of thiol-based drugs suggest a possible role of thiols in the treatment of COVID-19. Oral and intravenous GSH, as well as GSH precursors such as N-acetylcysteine (NAC), or drugs containing the thiol moiety (erdosteine) may represent a novel therapeutic approach to block NF-kB and address the cytokine storm syndrome and respiratory distress observed in COVID-19 pneumonia patients

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Section: Evidence For Use Of Thiols In Covid-19mentioning

confidence: 99%

Use of Thiols in the Treatment of COVID-19: Current Evidence

Cazzola

Rogliani

Salvi³

et al. 2021

Lung

View full text Add to dashboard Cite

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“…Beneficial effects of N-acetylcysteine have been demonstrated in clinical trials in various infections, including influenza and influenza-like infections, namely H1N1 influenza pneumonia or even community acquired pneumonia (De Flora et al, 1997;Zhang et al, 2018). In COVID-19, administration of N-acetylcyteine, alone or together with other types of supplementation may be beneficial in patients with different degrees of severity of SARS-CoV-2 infection, as suggested by a few small-sized, non-controlled clinical interventional studies or case reports (De Flora et al, 2020;Avdeev et al, 2021;Wong et al, 2021), although these results may not apply to patients with SARS-CoV-2-induced ARDS (de Alencar et al, 2021;Taher et al, 2021), and still need to be more robustly analysed in larger, randomised, placebo-controlled studies.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Changes in Glycolytic Pathway in SARS-COV 2 Infection and Their Importance in Understanding the Severity of COVID-19

et al. 2021

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COVID-19 is an infectious disease caused by Coronavirus 2 (SARS-CoV-2) that may lead to a severe acute respiratory syndrome. Such syndrome is thought to be related, at least in part, to a dysregulation of the immune system which involves three main components: hyperactivity of the innate immune system; decreased production of type 1 Interferons (IFN) by SARS-CoV-2-infected cells, namely respiratory epithelial cells and macrophages; and decreased numbers of both CD4+ and particularly CD8+ T cells. Herein, we describe how excessive activation of the innate immune system and the need for viral replication in several cells of the infected organism promote significant alterations in cells’ energy metabolism (glucose metabolism), which may underlie the poor prognosis of the disease in severe situations. When activated, cells of the innate immune system reprogram their metabolism, and increase glucose uptake to ensure secretion of pro-inflammatory cytokines. Changes in glucose metabolism are also observed in pulmonary epithelial cells, contributing to dysregulation of cytokine synthesis and inflammation of the pulmonary epithelium. Controlling hyperglycolysis in critically ill patients may help to reduce the exaggerated production of pro-inflammatory cytokines and optimise the actions of the adaptive immune system. In this review, we suggest that the administration of non-toxic concentrations of 2-deoxy-D-glucose, the use of GLUT 1 inhibitors, of antioxidants such as vitamin C in high doses, as well as the administration of N-acetylcysteine in high doses, may be useful complementary therapeutic strategies for these patients, as suggested by some clinical trials and/ or reports. Overall, understanding changes in the glycolytic pathway associated with COVID-19 infection can help to find new forms of treatment for this disease.

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“…23,24 In addition, the ROS product, hydrogen peroxide, represents a superoxide capable of inducing endothelial cell injury by impairing intracellular constituents such as proteins, lipids and nucleic acids. 25 NAC is an antioxidant and can inhibit the inflammation that occurs in many pathological conditions, 26 To further assess some of potential underlying mechanisms involved, we focused on the Nrf2/HO-1 signalling pathway, which is a classic oxidative stress pathway. 28 Nrf2 is an important transcription factor against oxidative stress, such that increases in oxidative stress, enables Nrf2 binding to an antioxidant response element (ARE), such as HO-1.…”

Section: Discussionmentioning

confidence: 99%

“… 23 , 24 In addition, the ROS product, hydrogen peroxide, represents a superoxide capable of inducing endothelial cell injury by impairing intracellular constituents such as proteins, lipids and nucleic acids. 25 NAC is an antioxidant and can inhibit the inflammation that occurs in many pathological conditions, 26 but there are few studies on the effect of NAC on DMED. In the present study, we focused our attention on investigating changes within the cavernosal microenvironment of DMED mice after NAC treatment.…”

Section: Discussionmentioning

confidence: 99%

N‐acetylcysteine improves diabetic associated erectile dysfunction in streptozotocin‐induced diabetic mice by inhibiting oxidative stress

Wang

Pan

et al. 2022

J Cellular Molecular Medi

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Oxidative stress appears to play a role in the pathogenesis of diabetes mellitus erectile dysfunction (DMED). This study aimed to investigate the effect of N‐acetylcysteine (NAC) on DMED in streptozotocin‐induced diabetic mice and to explore potential mechanisms. In the present study, we show that an erectile dysfunction is present in the streptozotocin‐induced mouse model of diabetes as indicated by decreases in intracavernous pressure responses to electro‐stimulation as well as from results of the apomorphine test of erectile function. After treatment of NAC, the intracavernous pressure was increased. In these DMED mice, oxidative stress and inflammatory responses were significantly reduced within the cavernous microenvironment, while activity of antioxidant enzymes in this cavernous tissue was enhanced after NAC treatment. These changes protected mitochondrial stress damage and a significant decreased in apoptosis within the cavernous tissue of DMED mice. This appears to involve activation of the nuclear factor erythroid 2‐like‐2 (Nrf2) signalling pathway, as well as suppression of the mitogen‐activated protein kinase (MAPK) p38/ NF‐κB pathway within cavernous tissue. In conclusion, NAC can improve erectile function through inhibiting oxidative stress via activating Nrf2 pathways and reducing apoptosis in streptozotocin‐induced diabetic mice. NAC might provide a promising therapeutic strategy for individuals with DMED.

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N-acetylcysteine for the treatment of COVID-19 among hospitalized patients

Cited by 20 publications

References 10 publications

Use of Thiols in the Treatment of COVID-19: Current Evidence

Use of Thiols in the Treatment of COVID-19: Current Evidence

Changes in Glycolytic Pathway in SARS-COV 2 Infection and Their Importance in Understanding the Severity of COVID-19

N‐acetylcysteine improves diabetic associated erectile dysfunction in streptozotocin‐induced diabetic mice by inhibiting oxidative stress

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