Since the start of the Covid-19 pandemic, we have been constantly bombarded with immune-boosting supplements – each claiming to be more effective than the other.
By now, most of us know that there really isn’t a magic potion for SARS-CoV2.
Each of us has a unique immune response to SARS-CoV2 depending on the state of our immune system. While it is undeniable that vitamin C, D or zinc play a vital role in maintaining a healthy immune system and that the deficiency of these micronutrients can lead to a poor prognosis against viral infection, their precise role in modulation of our immune responses against SARS-CoV2 infection is still largely inconclusive.
Considering all of this, why another supplement that claims to be helpful against SARS-CoV2 infections? Let’s do a fact check to understand how NAC really works.
N-Acetylcysteine (NAC) is a supplement form of cysteine - a non-essential amino acid found in foods high in protein, such as chicken, turkey, yogurt, cheese, eggs, sunflower seeds, and legumes. It is a precursor of glutathione (an important antioxidant for detoxification and reduction of inflammation); a direct scavenger of reactive oxygen species (free radicals that damage cells and cause aging), and it prevents blood clots by reducing platelet aggregation and inhibiting clotting factors. Clinically, NAC is used as a mucolytic drug for chronic respiratory diseases and to treat the toxicity of paracetamol.
Needless to say, it has gained a lot of attention from the scientific community lately, as a preventative agent against COVID-19 due to its anti-inflammatory, anticoagulant and anti-oxidant properties, with no side effects or security concerns. .
How does it work against SARS-CoV2 infections? Infection begins with the binding of SARS-CoV2 to the ACE2 receptor – resulting in decreased activity of ACE2, which in turn tilts the balance between the constrictor (angiotensin II) and the dilator (angiotensin 1- 7) blood vessels in the lungs. The increased level of angiotensin II causes the blood vessels to narrow, leading to an increase in the concentration of free radicals (superoxide) and cell damage in the lungs. The inner wall (endothelial cells) of the blood vessels then sends signals to the clotting factor, also known as von Willebrand factor (vWF) to repair the damage causing the blood cells to aggregate via disulfide bonds to form a blood clot. This clot, in turn, blocks blood flow through the vessels, causing the oxygen levels in the tissues to decrease (hypoxia).
The rationale for using NAC is that it can intervene at several levels in the infection process. First, NAC supplementation not only increases the concentration of glutathione in the blood, but also uses its own antioxidant properties to reduce cell damage. Second – due to its ability to break disulfide bonds, NAC disrupts platelet aggregation and also breaks the bond between blood cells and clotting factor, maintaining the smooth flow of blood and oxygen in this area.
A recent publication from the American Chemical Society on Infectious Diseases suggested that glutathione deficiency could be the cause of severe manifestations and even death in patients with Covid-19. Another article published in Frontier of Cell and Developmental Biology provided evidence to demonstrate how the Indian vegetarian diet can cause cysteine and glutathione deficiency, which makes us more susceptible to severe forms of Covid-19 symptoms.
Several articles published at the end of 2020, including that of the journal Therapeutics and Clinical Risk Management, offer a detailed strategy for using NAC to fight Covid-19 and suggest oral administration of NAC (600 mg / day ) as a preventive measure against SARS-CoV2 infection. A patent was also recently filed in the United States for the use of NAC and active compounds in cinnamon for the treatment of Covid-19.
Currently, 11 clinical trials (phase 2 and phase 3 trials) propose and test the use of NAC for the prevention and treatment of SARS-CoV2 infection. While we still await the results of clinical trials, more and more evidence is gathering to support the use of NAC to reduce the inflammatory effects of Covid-19 infection.
Dr Saher Mehdi is the Founder and Chief Scientist of wellOwise, the Indian start-up specializing in precision health for chronic diseases.
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