Zeitschrift für Orthomolekulare Medizin 2020; 18(03): 6-12
DOI: 10.1055/a-1255-2489
Wissen

N-Acetyl-Cystein – Nur ein Mukolytikum?

Uwe Gröber

Zusammenfassung

Durch die Spaltung von Disulfidbrücken wirkt N-Acetyl-Cystein (NAC) mukolytisch bei Atemwegs-/Lungenerkrankungen und greift die Hülle von SARS-CoV-2 an, wodurch die Infektiosität des neuen Coronavirus abgeschwächt wird. Als Gluthation-Prodrug hat die Substanz zentrale Bedeutung für Immunfunktion, Regulation der Stickstoffbilanz und Erhalt immunkompetenter Zellmasse. In einer Studie konnte eine Verbesserung der Überlebenszeitprognose von AIDS-Patienten unter NAC-Therapie belegt werden. Kardioprotektive Wirkung zeigt N-Acetyl-Cystein bei endothelialer Dysfunktion und Homocyst(e)inämie. Zudem konnte die Gabe von NAC in einer Studie kontrastmittelinduzierte Nierenschäden reduzieren.



Publication History

Article published online:
14 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Sun T, Liu J, Zhao DW. Efficacy of N-Acetylcysteine in Idiopathic Pulmonary Fibrosis: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95 (19) : e3629
  • 2 Meyer A, Buhl R, Kampf S, Magnussen H. Intravenous N-acetylcysteine and lung glutathione of patients with pulmonary fibrosis and normals. Am J Respir Crit Care Medicine 1995; 152: 1055-1060
  • 3 Grandjean EM, Berthet P, Ruffmann R, Leuenberger P. Efficacy of long-term N-acetylcysteine in chronic bronchopulmonary disease: a meta-analysis of published double-blind, placebo-controlled clinical trials. Clin Ther 2000; 22 (02) : 209-221
  • 4 Poole P, Sathananthan K, Fortescue R. Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2019; 5 (05) : CD001287
  • 5 Täglicher Lagebericht des RKI zur Coronavirus-Krankheit-2019 (COVID-19), Aktualisierter Stand für Deutschland: 9.9.2020;. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-08-05-de.pdf?__blob=publicationFile
  • 6 World Health Organization. Coronavirus disease (COVID-19) situation dashboard. 2020 https://covid19.who.int/
  • 7 Täglicher Lagebericht des RKI zur Coronavirus-Krankheit-2019 (COVID-19), Aktualisierter Stand für Deutschland: 30.03.2020;. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-03-30-de.pdf?__blob=publicationFile
  • 8 Schoeman D, Fielding BC. Coronavirus envelope protein: current knowledge. Virol J 3019 (16) : 69
  • 9 Lu R, Zhao X, Li J. et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395 (10224): 565-574
  • 10 Thal D. Coronaviren – Gefahr für Tier und Mensch. Nationale Forschungsplattform für Zoonosen, 20. März 2020;. https://www.zoonosen.net/coronaviren-gefahr-fuer-tier-und-mensch . Stand: 24.08.2020
  • 11 Aldini G, Altomare A, Baron G. et al. N-Acetylcysteine as an antioxidant and disulphide breaking agent: the reasons why. Free Radic Res 2018; 7: 751-762
  • 12 Biswas SK, Rahman I. Environmental toxicity, redox signaling and lung inflammation: the role of glutathione. Mol Aspects Med 2009; 30 (1–2): 60-76
  • 13 Polonikov A. Endogenous Deficiency of Glutathione as the Most Likely Cause of Serious Manifestations and Death in COVID-19 Patients. ACS Infect Dis 2020; 6 (07) : 1558-1562
  • 14 Poe FL, Corn J. N-Acetylcysteine: A potential therapeutic agent for SARS-CoV-2. Med Hypotheses 2020; 143: 109862
  • 15 Horowitz RI, Freeman PR, Bruzzese J. Efficacy of glutathione therapy in relieving dyspnea associated with COVID-19 pneumonia: A report of 2 cases. Respir Med Case Rep 2020; 30: 101063
  • 16 Memorial Sloan Kettering Cancer Center. Phase II Study of N-acetylcysteine in Severe or Critically Ill Patients With Refractory COVID-19 Infection (May 5, 2020);. https://clinicaltrials.gov/ct2/show/NCT04374461
  • 17 Dröge W, Eck HP, Mihm S. HIV-induced cysteine deficiency and T-cell dysfunction – a rationale for treatment with N-acetylcysteine. Immunol Today 1992; 13 (06) : 211-214
  • 18 Dröge W. Cysteine and glutathione deficiency in AIDS patients: a rationale for the treatment with N-acetyl-cysteine. Pharmacology 1993; 46 (02) : 61-65
  • 19 Dröge W, Holm E. Role of cysteine and glutathione in HIV infection and other diseases associated with muscle wasting and immunological dysfunction. FASEB J 1997; 11 (13) : 1077-1089
  • 20 Morris D, Ly J, Chi PT. et al. Glutathione synthesis is compromised in erythrocytes from individuals with HIV. Front Pharmacol 2014; 5: 73
  • 21 Breitkreutz R, Pittack N, Nebe CT. et al. Improvement of immune functions in HIV infection by sulfur supplementation: two randomized trials. J Mol Med 2000; 78 (01) : 55-62
  • 22 Atkuri KR, Montovani JJ, Herzenberg LA, Herzenberg LA. N-acetylcysteine – a safe antidote for cysteine/glutathione deficiency. Curr Opin Pharmacol 2007; 7 (04) : 355-359
  • 23 De Rosa SC, Zaretsky MD, Dubs JG. et al. N-acetylcysteine replenishes glutathione in HIV-infection. Clin Invest 2000; 30 (10) : 915-929
  • 24 Palamara AT, Perno CF, Aquaro S. et al. Glutathione inhibits HIV replication by acting at late stages of the virus life cycle. AIDS Res Hum Retroviruses 1996; 12 (16) : 1537-1541
  • 25 Aquilano K, Baldelli S, Ciriolo MR. Glutathione: New roles in redox signaling for an old antioxidant. Front Pharmacol 2014; 5: 196
  • 26 Herzenberg LA, De Rosa SC, Dubs JG. et al. Glutathione deficiency is associated with impaired survival in HIV disease. Proc Natl Acad Sci USA , 1997; 94: 1967-1972
  • 27 Andrews NP, Prasad A, Quyyumi AA. N-acetylcysteine improves coronary and peripheral vascular function. J Am Coll Cardiol 2001; 37 (01) : 117-123
  • 28 Khan SY, Awad EM, Oswald A. et al. Premature senescence of endothelial cells upon chronic exposure to TNFα can be prevented by N-acetyl cysteine and plumericin. Sci Rep 2017; 7: 39501
  • 29 Wiklund O, Fager G, Andersson A. et al. N-acetylcysteine treatment lowers plasma homocysteine but not serum lipoprotein(a) levels. Atherosclerosis 1996; 119 (01) : 99-106
  • 30 Ventura P, Panini R, Pasini MC. et al. N-Acetyl-cysteine reduces homocysteine plasma levels after single intravenous administration by increasing thiols urinary excretion. Pharmacol Res 1999; 40 (04) : 345-350
  • 31 Hildebrandt W, Sauer R, Bonaterra G. et al. Oral N-acetylcysteine reduces plasma homocysteine concentrations regardless of lipid or smoking status. Am J Clin Nutr 2015; 102 (05) : 1014-1024
  • 32 Tepel M, van der Giet M. et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000; 343 (03) : 180-184
  • 33 Marenza G, Assanelli E, Marana I. et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med 2006; 354 (26) : 2773-2782
  • 34 Leitlinie der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAKI), der GPA, des AeDA und der SGAI. Leitlinie zum Vorgehen bei Verdacht auf Unverträglichkeit gegenüber oral aufgenommenem Histamin. Allergo J Int 2017; (26) : 72-79