Excerpts from "N-acetylcysteine (NAC) supplementation improves dyspnea and may normalize von Willebrand plasma levels in gynecologic patients with Post-Acute-COVID-Sequela (PASC)/Long COVID" [0]
It was a tiny study, but 3/3 returned to normal range on NAC and 0/6 not on NAC, and the data is longitudinal, with clear vWF before/after NAC supplemetation!
"plasmatic levels of vWF were collected during the COVID-19 pandemic in PASC/LC patients at the time of follow up visits as part of their blood-workup monitoring, we were also able to evaluate and compare vWF levels before and after starting NAC treatment to those detected in a control group of randomly selected gynecologic patients with PASC/LC symptoms who did not use the supplement"
They "found patients reporting regular use of NAC to subjectively demonstrate improvement in SOB, brain fog and fatigue. Of interest, although we noticed the plasmatic concentration of vWF to decrease with time in both groups of patients, only NAC supplementers were able to normalize their vWF levels after treatment (ie, 3 out of 3), whereas 0 % of the control PASC/LC gynecologic patients did so (ie, 0 out of 6) regardless to their baseline starting level of vWF or follow up time. Importantly, in our small series, subjective improvement in performance status and decrease/normalization in the levels of vWF were detected even in PASC/LC patient symptomatic for years."
Also that paper's intro is 🤩 fantastic and full of up to date references, independent of the power of their reported results.
[0] https://www.sciencedirect.com/science/article/pii/S2352578925000074
h/t https://zeroes.ca/@trendless/113924358608441600
[#]SARSCoV2 #COVID #COVID19 #CovidIsNotOver #dyspnea #breathing #review #science #LongCOVID #LC
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⚡ Lightning overview of N-acetylcysteine (NAC) for Long COVID with difficulty breathing (dyspnea) 🌩️
TLDR: NAC seems to help LC/dyspnea and is relatively safe.
WHY:
A small study found "three out of 3 (100 %) of the PASC/LC patients supplementing their diet with NAC decreased vWF values to normal levels at the time of subsequent evaluations, whereas none (0 %) of the 6 symptomatic PASC/LC control patients did so" [0]
REVIEW:
"N-acetylcysteine reduces severity and mortality in COVID-19 patients" right in the title [8]
"mortality was the most meaningful outcome of NAC therapeutic efficacy in patients with COVID-19 [...] mortality was significantly reduced in the NAC-treated group compared to the placebo group [RR, 0.65; 95% CI: 0.56 to 0.75; p-value 0.0001]" [8]
"Two grams of oral or IV GSH, a precursor to NAC therapy, has effectively reduced dyspnea in COVID-19 patients. Later on, in a large cohort study of 19,208 hospitalized COVID-19 cases, 2,071 of whom were treated with 600 mg/kg oral NAC, mortality was significantly reduced."
"mice treated with NAC presented markedly reduced CS-induced pulmonary injury and ameliorated CS-induced pulmonary fibrosis and inflammation" [2]
"After pretreatment with NAC at low, moderate, and high concentration, respectively, intracellular reactive oxygen species (ROS)" [2]
"N-acetyl cysteine is likely safe for most adults" [3]
"properties of NAC include enhancing glutathione S-transferase activity, repleting glutathione, scavenging free radicals, and stabilizing protein structures by crosslinking cysteine disulfide molecules along with its antioxidant, anti-inflammatory, and mucolytic properties" [4]
Back in 2021:
"Collectively this data supports the notion that 1200 mg of oral NAC can effectively reduce ROS production without compromising phagocytosis of SARS-Cov-2 in neutrophils" [5]
"N-acetylcysteine (NAC) is inexpensive, has very low toxicity, has been FDA approved for many years, and has the potential to improve therapeutic strategies for COVID-19. [...] Potential therapeutic benefits of NAC include, extracellularly scavenging ROS radicals, replenishing intracellular GSH, suppression of cytokine storm, and T cell protection, thus mitigating inflammation and tissue injury" [5]
"in in vivo experiments, NAC inhibited several profibrotic mechanisms in murine models" [6]
In humans, "NAC may restore defective autophagy [...] NAC may prevent and eliminate biofilms resulting from airway infections, particularly of Pseudomonas aeruginosa" [6]
"In COPD, beneficial effects of NAC have not been clearly confirmed in the clinical studies, probably due to insufficient doses, short time of observation, inactivation of NAC by oxidative stress, and/or the choice of inadequate outcome parameters" [6]
"supplementing GlyNAC (combination of glycine and N-acetylcysteine, a cysteine donor) for a relatively short period of 14 days improves/corrects GSH deficiency in OA, HIV-patients and diabetic patients, and these data suggest the possibility that similar supplementation of GlyNAC in COVID-19 patients could improve GSH deficiency" [7]
"Glutathione (GSH) is the most abundant" antioxidant, and "Compared to controls, RBC concentrations of total-GSH (tGSH) and reduced-GSH (rGSH) in COVID-19 patients were 60% lower"; "Because GlyNAC (combination of glycine and N-acetylcysteine) supplementation has been shown in clinical trials to rapidly improve GSH deficiency, OxS and oxidant damage, GlyNAC supplementation has implications for combating these defects" [7]
Safety-wise, in "Forty-one articles where NAC has been used at 600 mg and above, up to 3000 mg/day, and with a specific report on safety, were considered. [...] the safety profile was similar at both the high and standard doses with the oral formulation; gastrointestinal symptoms were reported but they were no more common than in the control group." [9]
"N-acetylcysteine improves oxidative stress and inflammatory response in patients with community acquired pneumonia" [10] is not COVID-19 specifically but if LC-driven oxidative stress is causally contributing to dyspnea then that result applies.
Trial check:
https://clinicaltrials.gov/study/NCT04545008 - stopped due to poor accrual
https://clinicaltrials.gov/study/NCT04455243 - never recruited
https://clinicaltrials.gov/study/NCT04466657 - never enrolled
https://clinicaltrials.gov/study/NCT04370288 - never ran?
https://clinicaltrials.gov/study/NCT04374461 - active, estimated completion 2025-05
https://clinicaltrials.gov/study/NCT04419025 - completed, unpublished - likely signifies a lack of result
[0] https://www.sciencedirect.com/science/article/pii/S2352578925000074
[1] https://www.sciencedirect.com/science/article/pii/S0753332225000496
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC6639458/
[3] https://medlineplus.gov/druginfo/natural/1018.html
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC8211525/
[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC7649937/
[6] https://pmc.ncbi.nlm.nih.gov/articles/PMC10526097/
[7] https://pmc.ncbi.nlm.nih.gov/articles/PMC8773164/
[8] https://pmc.ncbi.nlm.nih.gov/articles/PMC10390689/
[9] https://pmc.ncbi.nlm.nih.gov/articles/PMC7892733/
[10] https://pmc.ncbi.nlm.nih.gov/articles/PMC6250560/
Note I am NOT a doctor, this is a lay review!
[#]SARSCoV2 #COVID #COVID19 #CovidIsNotOver #dyspnea #breathing #review #science #LongCOVID #LC
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I would welcome references re: effective dosages for LC-associated dyspnea if anyone has done that research already
not a doc so my keyword selections are likely ill-chosen
@askazero
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