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N-acetylcysteine
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'''N-acetylcysteine''' (also known as NAC, acetylcysteine, N-acetyl-L-cysteine) is a supplement and drug used to increase levels of [[glutathione]] ([[GSH]]), the most common natural antioxidant in the body.<ref>[https://examine.com/supplements/n-acetylcysteine/ Examine: N-acetylcysteine]</ref><ref name="examine-gluthathione" /> ==Purpose== For this reason, NAC itself is sometimes referred to as an [[antioxidant]]. NAC is a pro-drug for cysteine, which is the rate-limiting ingredient in the biosynthesis of glutathione. It is thought that NAC is better than cysteine at increasing GSH in the brain since most cysteine will be consumed by the liver during first-pass metabolism, and NAC may bypass first-pass metabolism. Since orally consumed GSH will be broken down in the stomach, NAC is a more efficient means of enhancing GSH in cells.<ref name="examine-gluthathione">[https://examine.com/supplements/glutathione/ Examine:Glutathione]</ref> ==Sources== ==Evidence== NAC was originally approved as a medicine to breakdown excess mucus in the lungs.{{citation needed | date = 2021}} ==ME/CFS== In a presentation to the 2016 [[International IACFS/ME Research and Clinical Conference|IACFS/ME conference]] Dr [[Dikoma Shungu]] of Cornell University gave a presentation on a trial of NAC in [[ME/CFS]] patients.<ref name="IACFSME2016">{{Cite web|url= http://iacfsme.org/ME-CFS-Primer-Education/News/IACFSME-2016-Program.aspx|url-status=dead|archive-url=https://www.healthrising.org/forums/threads/nac-for-neuroinflammation-in-me-cfs-and-fibromyalgia.5046/post-26022|archive-date=2016-11-21 | title = N-Acetylcysteine Alleviates Cortical Glutathione Deficit and Improves Symptoms in CFS: An In Vivo Validation Study using Proton Magnetic Resonance Spectroscopy | first = N. | last= Weiduschat | first2 = X. | last2 = Mao | first3 = D. | last3 = Vub | first4 = M. | last4 = Blate | first5 = G. | last5 = Kang | first6 = H.S. | last6 = Mangat | first7 = A. | last7 = Artis | first8 = S. | last8 = Banerjee | first9 = G. | last9 = Lange | first10 = C. | last10 = Henchcliff | first11 = B.H. | last11 = Natelson | first12 = D.C. | last12 = Shungu|work=IACFS/ME Syllabus | date = 2016 | page=35}}</ref> Previously his team had found a 36% deficit of the tissue anti-oxidant occipital cortex [[glutathione]] (GSH) in the cortical areas of the brains of ME/CFS patients.<ref>[https://www.ncbi.nlm.nih.gov/pubmed/22281935 Increased ventricular lactate in chronic fatigue syndrome. III. Relationships to cortical glutathione and clinical symptoms implicate oxidative stress in disorder pathophysiology. Shungu et al]</ref> The trial supplemented patients (meeting the [[Fukuda criteria|CDC criteria]] for CFS) with 1800mg daily of GSH precursor n-acetylcysteine for 4 weeks and looked at levels of cortical GSH. The study found that cortical GSH had increased in patients and that CFS symptoms (as assessed with the [[Centers for Disease Control and Prevention|CDC]] CFS symptom inventory) were significantly reduced.<ref name="IACFSME2016" /> In 2020, a double-blind placebo controlled clinical trial of NAC was registered, and is due to take place at Cornell University in conjunction with [[National Institute of Neurological Disorders and Stroke|NINDS]], to measure the effects of 900mg and 3600mg of NAC compared to a placebo in ME/CFS patients.<ref name="NCT04542161">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04542161 | title = Assessment of N-Acetylcysteine as Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | last = | first = | authorlink = | date = |website=clinicaltrials.gov|language=en|archive-url=|archive-date=|url-status=|access-date=2020-09-11}}</ref> The trial will take part in two different locations, with the principle investigator is [[Dikoma Shungu]].<ref name="NCT04542161" /> The trial aims to measure the effect of NAC on patients with ME/CFS who have low GSH levels.<ref name="NCT04542161" /> ==Clinical use== NAC is clinically used as a mucolytic agent and antidote in case of paracetamol overdose.{{citation needed | date = 2021}} [[AXA1125]], also known as [[LIVRQNac]], is an experimental drug, is in clinical trials for a number of different illnesses.{{citation needed | date = 2021}} ==Costs and availability== N-acetylcysteine is available as a dietary supplement without a prescription. ==Risks and safety== ==Learn more== *[https://examine.com/supplements/glutathione/ Examine: Glutathione] *[https://examine.com/supplements/n-acetylcysteine/ Examine: N-acetylcysteine] *[http://www.healthrising.org/blog/2013/03/10/your-brain-on-view-big-nih-chronic-fatigue-syndrome-grant/ Health Rising: Brain on Fire (October 2013)] *[https://www.healthrising.org/forums/threads/nac-for-neuroinflammation-in-me-cfs-and-fibromyalgia.5046/post-26022 N-Acetylcysteine Alleviates Cortical Glutathione Deficit and Improves Symptoms in CFS: An In Vivo Validation Study using Proton Magnetic Resonance Spectroscopy: Dikoma Shungu et al (IACFS/ME Syllabus 2016)] ==See also== *[[AXA1125]] *[[Glutathione]] *[[Oxidative and nitrosative pathway]] *[[Neuroinflammation]] *[[Center for Enervating NeuroImmune Disease]] *[[Dikoma Shungu]] *[[Martin Pall]] *[[Nitric oxide hypothesis]] == References == {{Reflist}} [[Category:Potential treatments]] [[Category:Supplements]] [[Category:Antioxidants|Antioxidants]]
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