Mechanism of Action & Clinical Use of N-Acetylcystein (NAC) in Lung & Airway Diseases

Authors

  • Pitha Maykania Poty Universitas Lampung
  • Syazili Mustofa University of Lampung
  • Evi Kurniawaty University of Lampung
  • Tri Umiana Soleha University of Lampung

DOI:

https://doi.org/10.53089/medula.v14i5.1083

Keywords:

NAC, N-acetylcsteine, Lung Disease, Oxidative Stress

Abstract

Lung disease is one of the leading causes of illness and death worldwide. Lung disease can be caused by inflammation of the tissues due to oxidative stress. Oxidative stress plays a role in the pathogenesis of lung disease, both acute and chronic. Oxidative stress in the lungs occurs when antioxidant capacity is depleted due to external exposures, such as changes in oxygen pressure due to pollutants, and internal exposures, such as systemic disease and activation of inflammatory cells in response to exposure. Oxidative stress is an imbalance in the production of oxidants and antioxidants in the body's metabolism. In lung disease, oxidative stress increases in endogenous metabolism so exogenous antioxidants in the form of N-acetylcysteine ​​(NAC) are needed. NAC is a glutathione precursor that can replenish total thiols (cysteine, cysteinylglycine, glutathione, and homocysteine). The mechanism of action of NAC is by interacting with ROS so that it can increase antioxidant capacity again. Oxidative stress can deplete antioxidants, NAC will release Thiol groups directly thereby neutralizing oxidants such as N and NO2. Clinically, NAC has been proven to be useful as a treatment for lung diseases such as COVID-19, asthma, bronchiectasis, COPD, and TB at high doses, namely 1200 mg/day.

Author Biographies

Pitha Maykania Poty, Universitas Lampung

 

 

Syazili Mustofa, University of Lampung

Bagian Biokimia Biologi Molekular dan Fisiologi, Fakultas Kedokteran, Universitas Lampung

Evi Kurniawaty, University of Lampung

Bagian Biokimia Biologi Molekular dan Fisiologi, Fakultas Kedokteran, Universitas Lampung

Tri Umiana Soleha, University of Lampung

Bagian Mikrobiologi, Fakultas Kedokteran, Universitas Lampung

References

Labaki WW and Han MK. Chronic respiratory diseases: a global view. The Lancet. Respiratory medicine. 2020;8(6):531-533.

Pizzino G, et al. Oxidative Stress: Harms and Benefits for Human Health. Oxidative medicine and cellular longevity. 2017;, 8416763.

Bezerra FS, et al. Oxidative Stress and Inflammation in Acute and Chronic Lung Injuries. Antioxidants (Basel, Switzerland). 2023;12(3):548.

Hecker L. Mechanisms and consequences of oxidative stress in lung disease: therapeutic implications for an aging populace. American journal of physiology. Lung cellular and molecular physiology. 2018; 314(4): 642–653.

Rogers LK & Cismowski MJ. Oxidative Stress in the Lung - The Essential Paradox. Current opinion in toxicology. 2018; 7:37–43.

Sanguinetti CM. N-acetylcysteine in COPD: why, how, and when?. Multidisciplinary respiratory medicine. 2016; 11(8.).

Schwalfenberg GK. N-acetylcysteine: A review of clinical usefulness (an Old Drug With New Tricks). Journal Nutrition and Metabolism. 2021.

Santus P, et al. Oxidative stress and respiratory system: pharmacological and clinical reappraisal of N-acetylcysteine. COPD. 2014;11(6):705-17.

Michaeloudes C, et al. Molecular mechanisms of oxidative stress in asthma. Molecular Aspects of Medicine. 2022;85.

Mustofa S. Dampak Polusi Udara terhadap Asma. Jurnal Kedokteran Universitas Lampung. 2018;2(2):162-173.

Liu K, Hua S, Song L. PM2.5 Exposure and Asthma Development: The Key Role of Oxidative Stress. Oxidative Medicine and Cellular Longevity. 2022; 12.

Amaral EP, Vinhaes CL, Oliveira de Souza, D, Nogueira B, Akrami KM & Andrade B. B. The Interplay Between Systemic Inflammation, Oxidative Stress, and Tissue Remodeling in Tuberculosis. Antioxidants & redox signaling. 2021; 34(6):471–485.

Cecchini R & Cecchini AL. SARS-CoV-2 infection pathogenesis is related to oxidative stress as a response to aggression. Medical hypotheses. 2020;143.

Mohiuddin M & Kasahara K. The emerging role of oxidative stress in complications of COVID-19 and potential therapeutic approach to diminish oxidative stress. Respiratory medicine. 2021;187.

Tenório MCDS, Graciliano NG, Moura, FA, Oliveira ACM & Goulart MOF. N-Acetylcysteine (NAC): Impacts on Human Health. Antioxidants (Basel, Switzerland). 2021;10(6):967.

Tardiolo G, Bramanti P & Mazzon E. Overview on the effects of N-acetylcysteine in neurodegenerative diseases. Molecules. 2018;23(12):3305.

Mokra D, Mokry J, Barosova R, Hanusrichterova J. Advances in the Use of N-Acetylcysteine in Chronic Respiratory Diseases. Antioxidants (Basel). 2023;12(9):1713.

Zheng JP, et al. Twice daily N-acetylcysteine 600 mg for exacerbations of chronic obstructive pulmonary disease (PANTHEON): a randomised, double-blind placebo-controlled trial. The Lancet. Respiratory medicine. 2014;2(3):187-94.

Greene SC, Noonan PK, Sanabria C,; Peacock WF. Effervescent N-Acetylcysteine Tablets versus Oral Solution N-Acetylcysteine in Fasting Healthy Adults: An Open-Label, Randomized, Single-Dose, Crossover, Relative Bioavailability Study. Curr. Ther. 2016;83:1–7.

Zhang Q, et al. N-acetylcysteine improves oxidative stress and inflammatory response in patients with community acquired pneumonia: A randomized controlled trial. Medicine. 2018. 97(45).

Aldini G, et al. N-Acetylcysteine as an antioxidant and disulphide breaking agent: the reasons why. Free radical research. 2018;52(7):751-762.

Hanum PS & Hanifa Q. Efektivitas N-asetilsistein Dosis Tingi Pada Pasien Covid-19 Parah. Keluwih: Jurnal Kesehatan dan Kedokteran. 2021; 3(1): 22-34.

Anwar ANY, Agustina R, Fadraersada J. Kajian Terapi Asma dan Tinngkat Kontrol Asma Berdasarkan Asma Control Test (ACT). Proceding of the 6th Mulawarman Pharmaceuticalas Conference. 2017, 1-6.

Lee PN, Hong J, Jang AS. N-acetylcysteine decreases airway inflammation and responsiveness in asthma by modulating claudin 18 expression. Korean J Intern Med. 2020; 35(5): 1229-1237.

Mustofa S, Hasanah FA, Puteri FD, Surya SR, Soemarwoto RAS. Penurunan Kesadaran Disebabkan Gagal Nafas Tipe II Pada Pasien Penyakit Paru Obstruktif Kronis (PPOK) Eksaserbasi Akut: Laporan Kasus. Jurnal Ilmu Kedokteran dan Kesehatan. 2023; 10(6):2194-2203.

Mustofa S, Putri NSPDL, Togihon L, Aryana WF, Sanjaya RP, Saputra TT. Laporan Kasus: Bronkiektasis Terinfeksi disertai Sindroma Obstruksi Pasca Tuberkulosis. Jurnal Majority. 2023;12(1):33-42.

Ejigu DA & Abay SM. N-acetyl Cysteine as an Adjunct in the Treatment of Tuberculosis. Tuberculosis research and treatment. 2020.

Atkuri KR, Mantovani JJ, Herzenberg LA and Herzenberg LA. N-Acetylcysteine--A Safe Antidote for Cysteine/Glutation Deficiency. Current Opinion in Pharmacology. 2007;7:355-9.

Published

2024-06-18

How to Cite

Poty, P. M., Mustofa, S., Kurniawaty, E., & Soleha, T. U. (2024). Mechanism of Action & Clinical Use of N-Acetylcystein (NAC) in Lung & Airway Diseases. Medical Profession Journal of Lampung, 14(5), 912-918. https://doi.org/10.53089/medula.v14i5.1083

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