The effects of N-Acetylcysteine on serum level of inflammatory biomarkers in adults. Findings from a systematic review and meta-analysis of randomized clinical trials

Abstract

PurposeRandomized Clinical Trials (RCTs) have provided varied and conflicting findings regarding the effect of N-acetylcysteine (NAC) on inflammatory biomarkers. This study was conducted to review existing literature to determine whether NAC supplementation can affect inflammatory biomarkers in adults. MethodsBibliographic databases of Scopus, and PubMed were used for relevant papers published until October 2019. Results were reported as weighted mean differences (WMD) with 95% confidence intervals (CI) using multi-level models. Cochrane’s Q and I-squared (I2) tests were used to determine heterogeneity among studies. ResultsTwenty-four RCTs which include 1057 sample size were entered to analysis. NAC doses and intervention duration ranged from 400 to 2000 mg/d, and 1 to 80 weeks, respectively. Oral supplementation of NAC reduced serum level of C-reactive protein (CRP) [WMD: −0.61 mg/L, 95% CI: −1.18 to −0.03, P = 0.039, I2 = 79.6%], and interleukin-6 (IL-6) [WMD: −0.43 pg/mL, 95% CI: −0.69 to −0.17, P = 0.001, I2 = 89.3%]. However, the effect of oral NAC supplementation on other inflammatory biomarkers was nonsignificant. Dose-response investigation showed a non-linear association between oral NAC supplementation with CRP. ConclusionOral NAC supplementation reduced serum level of CRP and IL-6, but did not affect other inflammatory biomarkers. Nevertheless, more RCTs seems to be required to explore how NAC in different dosage and different routes of administration can affect inflammatory biomarkers.