Role of N-Acetylcisteine as Antioxidant in COVID-19
Abstract
At the end of December 2019, there was an outbreak of pneumonia of unknown etiology with symptoms of fever, dry cough, fatigue and gastrointestinal symptoms at seafood market, Huanan Market, Wuhan, Hubei, China. Initial outbreak was reported on the market in December 2019 and involved about 66% population of the workers there. Coronavirus Disease 2019 (COVID-19) is a contagious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is a new type of coronavirus that has never been previously identified in humans.
N-acetylcysteine (NAC) is a metabolite of sulfur-containing amino acid cysteine. This drug has molecular formula HSCH2CH(NHCOCH3)CO2H and a molecular weight of 163.19. In human, it can be given orally or by intravenous infusion and can also be inhaled using a nebulizer. Significant increases in blood serum glutathione reductase (GR) levels, due to an imbalance of oxidative stress, have occurred in COVID-19 patients, especially when admitted to intensive care unit (ICU). From data set of several literature, endogenous deficiency in GSH can underlie severe manifestations and deaths due to COVID-19. N-acetylcisteine (NAC) is used in a variety of conditions for recovery or protection from decreased GSH levels and has a wide margin of safety. This is useful in treating ARDS from other causes and can reduce or prevent lung damage in COVID-19 patients. NAC has been shown to have protective mechanisms against various conditions associated with COVID-19 and its comorbidities, including cardiovascular disease. NAC given intravenously has been shown to potentiate vasodilator, anti-inflammatory and anti-aggregating effects of nitroglycerin, and these beneficial interactions have translated into improved outcomes, such as in acute myocardial infarction, unstable angina, and acute pulmonary edema. NAC administration has been incorporated into a strategy aimed at maintaining endothelial function and limiting microthrombosis in severe cases of COVID-19.
Keywords:
N-acetylcisteine, COVID-19, antioxidantDownloads
References
Kementerian Kesehatan. Pedoman Pencegahan dan Pengedalian Coronavirus Disease (COVID-19) Revisi V. Pedoman Pencegah dan Pengedalian Coronavirus Dis. 2020;5:1-214. doi:10.33654/math.v4i0.299
Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: An overview.J Chinese Med Assoc. 2020; 83 (3): 217-220. doi: 10.1097 / JCMA.0000000000000270
Rahman S, Bahar T. COVID-19: The New Threat. Int J Infect. 2020; 7 (1): 1-6. doi: 10.5812 / iji.102184
Liu Y, Wang M, Luo G, et al. Experience of N-acetylcysteine airway management in the successful treatment of one case of critical condition with COVID-19: A case report.Medicine (Baltimore). Published online 2020. doi: 10.1097 / MD.0000000000022577
Jaiswal N, Bhatnagar M, Shah H. N-acetycysteine: A potential therapeutic agent in COVID-19 infection. Med Hypotheses. 2020; 144. doi: 10.1016 / j.mehy.2020.110133
Dekhuijzen PNR. Antioxidant properties of N-acetylcysteine: Their relevance in relation to chronic obstructive pulmonary disease.Eur Respir J. Published online 2004. doi: 10.1183 / 09031936.04.00016804
Ezeri?a D, Takano Y, Hanaoka K, Urano Y, Dick TP. N-Acetyl Cysteine Functions as a Fast-Acting Antioxidant by Triggering Intracellular H 2 S and Sulfane Sulfur Production.Cell Chem Biol. Published online 2018. doi: 10.1016 / j.chembiol.2018.01.011
Nasi A, McArdle S, Gaudernack G, et al. Reactive oxygen species as an initiator of toxic innate immune responses in retort to SARS-CoV-2 in an aging population, consider N-acetylcysteine as early therapeutic intervention.Toxicol Reports. Published online 2020. doi: 10.1016 / j.toxrep.2020.06.003
Dodd S, Dean O, Copolov DL, Malhi GS, Berk M. N-acetylcysteine for antioxidant therapy: Pharmacology and clinical utility. Expert Opin Biol Ther. Published online 2008. doi: 10.1517 / 14728220802517901
Rangel-Méndez JA, Moo-Puc RE. N-acetylcysteine as a potential treatment for COVID-19.Future Microbiol. Published online 2020. doi: 10.2217 / fmb-2020-0074
Shi Z, Puyo CA. N-acetylcysteine to combat COVID-19: An evidence review.Ther Clin Risk Manag. Published online 2020. doi: 10.2147 / TCRM.S273700
Poe FL, Corn J.N-Acetylcysteine: A potential therapeutic agent for SARS-CoV-2. Med Hypotheses. Published online 2020. doi: 10.1016 / j.mehy.2020.109862
Suhail S, Zajac J, Fossum C, et al. Role of Oxidative Stress on SARS-CoV (SARS) and SARS-CoV-2 (COVID-19) Infection: A Review.Protein J. Published online 2020. doi: 10.1007 / s10930-020-09935-8
Ibrahim H, Perl A, Smith D, et al. Therapeutic blockade of inflammation in severe COVID-19 infection with intravenous N-acetylcysteine.Immunol Clin. Published online 2020. doi: 10.1016 / j.clim.2020.108544
De Flora S, Balansky R, La Maestra S. Rationale for the use of N-acetylcysteine in both prevention and adjuvant therapy of COVID-19. FASEB J. 2020; 34 (10): 13185-13193. doi: 10.1096 / fj.202001807
Andreou A, Trantza S, Filippou D, Filippou D, Sipsas N, Tsiodras S. COVID-19: The potential role of copper and N-acetylcysteine (NAC) in a combination of candidate antiviral treatments against SARS-CoV-2. In Vivo (Brooklyn). Published online 2020. doi: 10.21873 / invivo.11946
Goodnough R, Canseco K. Truncated IV acetylcysteine treatment duration has potential to safely preserve resources during the COVID-19 pandemic. Clin Toxicol. Published online 2020. doi: 10.1080 / 15563650.2020.1758327
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