NAC for Systemic Lupus Erythematosus

The National Center for Complementary and Alternative Medicine at the NIH is funding a study at Upstate Medical University (Syracuse, NY) on the use of N-acetylcysteine (NAC) for Systemic lupus erythematosus (SLE). This study was motivated by some promising related research in Europe, where NAC is much more widely used and investigated than in the US. Here’s an excerpt from the study description:

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease which often has debilitating and potentially life-threatening consequences. The cause of SLE is unknown and current therapies lack specificity and carry significant side effects. Existing data in the literature provide evidence that a natural antioxidant, glutathione, is depleted in T cells of patients with SLE which may be a key factor underlying abnormal activation and predisposition of T lymphocytes to pro-inflammatory cell death via necrosis. Administration of N-acetylcysteine (NAC), that serves as a precursor of GSH, improves the clinical outcome of murine lupus, and limits the toxicity of pro-oxidant/immunosuppressant medications commonly used in patients with SLE. NAC is widely available in health food stores and large doses (up to 8 g/day) can be safely administered to humans. In a one-year study of patients with inflammatory lung disease treated with prednisone and azathioprine, addition of NAC (1.8g/day) diminished disease severity and reduced drug toxicity in comparison to placebo. Moreover, oral NAC has been found to improve muscle fatigue which is reported to be the most disabling symptom in 53% of patients with SLE. Thus, establishing a dose ranging between 1.8-7.2 g/day that is well-tolerated and capable of raising intracellular GSH in lupus patients and determining its immunological and therapeutic impact in SLE appear to be well justified.

The project is reported on the NCCAM website: Abstracts of 2008 Funded Projects.

For more on NAC, see the NYBC entry for PharmaNAC. This form of NAC is manufactured to the quality standards of the European Pharmacopoeia, and provides a good way to get the dosages under study in this research on SLE.

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NAC (N-acetylcysteine) – Clinical Summary from Sloan Kettering Memorial Cancer Center’s Integrative Medicine website

NAC (N-acetylcysteine) has been much studied as a dietary supplement, and is more widely used in Europe than in the US, especially for conditions such as chronic bronchitis or as an antidote to acetaminophen poisoning. Its usefulness for people with HIV has been investigated (sometimes contentiously) by many reseachers in the past two decades. One way to bring the discussion up to date, while also giving the broadest overview of NAC’s applications and potential applications, is to refer to the entry found on the Sloan Kettering Memorial Cancer Center’s Integrative Medicine website–an online resource well worth consulting. (Note: references for this summary are found on the SKMCC website, which is reviewed frequently–this clinical summary, accessed 1/31/2008, was updated within the last two months.)

Clinical Summary

Endogenous antioxidant and precursor to intracellular glutathione. N-acetylcysteine (NAC) is used to prevent exacerbations of chronic bronchitis, treat drug-induced hepatotoxicity, and prevent and treat conditions of oxidative stress and reduced glutathione levels, such as HIV/AIDS, cancer, and toxicity from chemo- or radiotherapy. NAC increases plasma levels of cysteine and glutathione and has antioxidant, nucleophilic, mucolytic, and possibly chemopreventative properties. Animal models suggest anti-carcinogenic, antimetastatic, and antiangiogenic activities. Oral bioavailability is low. Studies in smokers and patients with history of adenomatous colonic polyps show an inhibition of cancer biomarker development, although NAC did not inhibit formation of secondary head and neck or lung tumors in a EUROSCAN trial. 400-1200 mg/day NAC reduces the number of acute exacerbations in patients with chronic bronchopulmonary disease, but little clinical effect on lung function is seen in patients with cystic fibrosis. NAC raises GSH and cysteine levels in HIV+ patients, but shows no effect in Lou Gehrig’s disease. Human studies evaluating the role of NAC in the prevention of chemo- or radiotherapy induced toxicities are inconclusive. Gastrointestinal side effects are most often reported.



And here’s a study, limited in its goals, but with an interesting specific finding about using NAC at the start of antiretroviral treatment in HIV:
The effect of N-acetylcysteine supplementation upon viral load, CD4, CD8, total lymphocyte count and hematocrit in individuals undergoing antiretroviral treatment
Spada C, Treitinger A, Reis M, et al. Clin Chem Lab Med 2002;40:452-455.
Individuals infected with the human immunodeficiency virus (HIV-1) present with decreased CD4, a progressive increase in viral load, compromised cell immune defense, and hematologic alterations. The aim of this study was to assess the serum viral load, CD4, CD8, lymphocyte count and hematocrit at the beginning of antiretroviral therapy in individuals who were supplemented with N-acetylcysteine (NAC). Twenty volunteers participated in this double-blind, placebo-controlled 180-day study. Ten participants received 600 mg of NAC per day (NAC group) and the other ten serving as a control group received placebo. The above mentioned parameters were determined before treatment, and after 60, 120 and 180 days. In NAC-treated patients hematocrit remained stable and an increase in CD4 cell count took place earlier than that in the control group.

Regular supplementation with NAC (N-acetylcysteine) can help control chronic bronchitis

This study, published in 2000, looked back at two decades of research and found that regular supplementation with NAC was associated with better control of chronic bronchopulmonary disease (such as chronic bronchitis). Perhaps a good study to keep in mind, since we are approaching the season in North America when respiratory tract problems can become more acute. 

Reference: Grandjean EM, Berthet P, Ruffmann R, Leuenberger P,
“Efficacy of oral long-term N-acetylcysteine in chronic bronchopulmonary disease: a meta-analysis of published double-blind, placebo-controlled clinical trials,” in Clinical Therapeutics 2000 Feb;22(2):209-21.

Additional note on NAC: it’s an antidote to acetaminophen (Tylenol is the best-known brand name in the US) and can counter liver toxicity associated with  acetaminophen use. Widely used for this purpose in Europe, where NAC and acetaminophen are frequently combined.

See NYBC’s description of

NAC 500mg


and


PharmaNAC–Effervescent NAC 900mg


PharmaNAC is certified compliant to the standards of the European Pharmacopoeia and USP; it’s a format that’s easy to take and similar to the ACC Akut effervescent NAC (Hexal) formerly imported by NYBC.