Thread by @BostonTox

7 Reasons Why @challiance is Giving N-acetylcysteine (#NAC) to #COVID19 + Patients with Early Respiratory Symptoms

NACinCOVID.net
#NACinCOVID
@MLaiB

1. #NAC is a powerful antioxidant...
NAC=N-acetyl derivative of amino acid L-cysteine, precursor of the body’s primary intracellular antioxidant glutathione (GSH). (Behold the reducing power of thiol -SH groups!)

... antioxidant #NAC scavenges reactive O2 species (ROS) that signal pro-inflammatory molecules that can incite #CytokineStorm

... hope is to prevent body's immune response from overshooting and progressing to cytokine storm and #ARDS

2. #NAC improves oxygenation without ROS generation...

- it increases O2 delivery to extrahepatic organs
- it increases ATP production

... more O2 and ATP *WITHOUT* more ROS generation is a good idea in hypoxic patients on supplemental O2 b/c:
More O2 -->
More Reactive O2 Species (ROS) -->
More signaling of more inflammatory molecules -->
#CytokineStorm -->
#ARDS 😬

3. #NAC suppresses #CytokineStorm-inciting molecules and cells

- it scavenges free radicals (see #1)

- it suppresses macrophages, neutrophils, leukocyte endothelial cell adhesion, and cytokines that lead to and damage lung cells in Acute Lung Injury (ALI) and #ARDS

4. #NAC inhibits pro-inflammatory molecules

- NAC inhibits production of pro-inflammatory molecules (IL6, TNF-alpha, CCL5, CXCL8, CXCL10) in lung epithelial cells (Liu et al, Horowitz et al, Sun et al)

#COVID19

5. #NAC has antiviral activity (Ciriolo et al, Fraternale et al)

vs. influenza A (Casanova et al, Geiler et al)
vs. H1N1 subtype (De Flora et al)
vs. HIV (Kalebic T, Kinter A, Poli G, Anderson ME, Meister A, and Fauci AS #DrFauci #AnthonyFauci)

#COVID19 is caused by a virus

6. #NAC has anticoagulant/antithrombotic activity (Jang et al, Martinez de Lizarrondo et al, Niemi et al, Wang et al)

With concerns that SARS-COV-2 produces a hypercoagulable state in #COVID19 (Bikdeli et al), NAC's anticoagulant/thrombotic properties may be beneficial

7. #NAC works favorably in other pulmonary disease processes
- COPD (Santus et al)
- ALI (Kao et al)
- Silicosis (Sun et al)
- Glutathione(GSH) has successfully reduced dyspnea in NYC pts dx'd with #COVID19 (Horowitz et al April 2020). What makes GSH? #NAC.