title: Improvement by N-acetylcysteine of acute respiratory distress syndrome through increasing intracellular glutathione, and extracellular thiol molecules and anti-oxidant power: evidence for underlying toxicological mechanisms.
abstract: In acute respiratory distress syndrome (ARDS), there is extensive overproduction of free radicals to the extent that endogenous anti-oxidants are overwhelmed, permitting oxidative cell damage. The present study examined the benefit of the anti-oxidant compound N-acetylcysteine (NAC) in the management of ARDS by measuring patient's intracellular glutathione (inside red blood cells) and extracellular (plasma) anti-oxidant defense biomarkers and outcome. Twenty-seven ARDS patients were recruited from the intensive care unit of a teaching Hospital and randomly divided into two groups. Both groups were managed similarly by regular treatments but 17 patients received NAC 150 mg/kg at the first day that followed by 50 mg/kg/day for three days and 10 patients did not receive NAC. Treatment by NAC increased extracellular total anti-oxidant power and total thiol molecules and also improved intracellular glutathione and the outcome of the patients. In conclusion, patients with ARDS are in a deficient oxidant-anti-oxidant balance that can get a significant benefit if supplemented with NAC.
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Sadegh
authors.initials: MS
authors.lastname: Soltan-Sharifi
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mojtahedzadeh
authors.forename: Atabak
authors.initials: A
authors.lastname: Najafi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Reza Khajavi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Reza Rouini
authors.forename: Mandana
authors.initials: M
authors.lastname: Moradi
authors.forename: Azadeh
authors.initials: A
authors.lastname: Mohammadirad
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdollahi
mesh_terms: D018806:APACHE; D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D005260:Female; D005978:Glutathione / Q000097:blood*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects*; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D013438:Sulfhydryl Compounds / Q000097:blood*; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D013438:Sulfhydryl Compounds; D005978:Glutathione; D000111:Acetylcysteine