N-Acetylcysteine to Combat COVID-19: Evidence Review

Zhongcheng Shi,^1,2 Carlos A Puyo³

¹Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA; ²Department of Pathology, Texas Children’s Hospital, Houston, TX, USA; ³Department of Anesthesia and Critical Care, Holy Family Hospital, Steward Health Care, Methuen, MA, USA

Abstract: The novel coronavirus disease (COVID-19) is caused by a virus (SARS-Cov-2) and is known for inducing multisystem organ dysfunction associated with significant morbidity and mortality. Current therapeutic strategies for COVID-19 have failed to effectively reduce mortality rate, especially for elderly patients. A newly developed vaccine against SARS-Cov-2 has been reported to induce the production of neutralizing antibodies in young volunteers. However, the vaccine has shown limited benefit in the elderly, suggesting an age-dependent immune response. As a result, exploring new applications of existing medications could potentially provide valuable treatments for COVID-19. N-acetylcysteine (NAC) has been used in clinical practice to treat critically ill septic patients, and more recently for COVID-19 patients. NAC has antioxidant, anti-inflammatory and immune-modulating characteristics that may prove beneficial in the treatment and prevention of SARS-Cov-2. This review offers a thorough analysis of NAC and discusses its potential use for treatment of COVID-19.

Conclusions

N-acetylcysteine (NAC) is inexpensive, has very low toxicity, has been FDA approved for many years, and has the potential to improve therapeutic strategies for COVID-19. NAC administered intravenously, orally, or inhaled, may suppress SARS-CoV-2 replication and may improve outcomes if used timely. Potential therapeutic benefits of NAC include, extracellularly scavenging ROS radicals, replenishing intracellular GSH, suppression of cytokine storm, and T cell protection, thus mitigating inflammation and tissue injury. NAC administration in combination with other antiviral agents may dramatically reduce hospital admission rate, mechanical ventilation and mortality.

Disclosure

The authors report no conflicts of interest for this work.

https://www.dovepress.com/n-acetylcysteine-to-combat-covid-19-an-evidence-review-peer-reviewed-fulltext-article-TCRM