Administration of N-Acetylcysteine (NAC) as Adjunctive Therapy for COVID-19 Patients by Improving Oxidative Stress and Inflammation Through Assessment of MDA, IL-6, IL-1β, TNF-α, and TGF-β

Abstract

INTRODUCTION: Oxidative stress due to COVID-19 will trigger a widespread inflammatory reaction in the lungs. Malondialdehyde (MDA), Interleukin-6 (IL-6), Interleukin-1 β (IL-1β), Tumor Necrosis Factor-α (TNF-α), and Tumor Growth Factor- β (TGF-β) are pro-inflammatory cytokines which levels may rise in the presence of an inflammatory process. N-Acetylcysteine (NAC) is an antioxidant widely considered as adjunctive therapy in COVID-19. We aim to analyze the effect of NAC administration in improving oxidative stress and inflammation in COVID-19 through assessment of MDA, IL-6, IL-1β, TNF-α, and TGF-β. METHOD: This is a quasi-experimental study with pre-post design. MDA, IL-6, IL-1β, TNF-α, and TGF-β levels were measured in admission and day 8 of administration of 5000 mg/72 hours of NAC. RESULT: From 74 samples, between admission and day 8 of NAC therapy, There is a decrease of IL-6 (185.31 ± 181.30 to 97.60 ± 161.86 (p=0.003)), TNF-α (5.83 ± 3.51 to 4.37 ± 3.33 (p=0.019)), IL-1 β (4.65 ± 4.13 to 1.87 ± 0.96 (p<0.001)), and MDA levels (3000.70 ± 2017.98 to 2116.54 ± 1109.58 (p<0.001). However, TGF-β levels were increased from 5.47 ± 2.76 to 7.97 ± 3.24 (p<0.001). DISCUSSION: From our patients we get a significant decrease of pro-inflammatory cytokines (MDA, IL-6, IL-1β, and TNF-α) after administration of NAC. However, we acquired a significant increased level of TGF-β in our patients despite NAC administration which implies the chronic immune response in COVID-19 patients. CONCLUSION: There is an improvement of oxidative stress and inflammation by administration of NAC as adjunctive therapy in COVID-19 patients assessed by decrease of MDA, IL-6, IL-1β, and TNF-α levels. There is no effect of NAC as adjunctive therapy in TGF-β levels in COVID-19 patients. Keywords: NAC, COVID-19, MDA, IL-6, IL-1β, TNF-α, TGF-β