Phiwayinkosi V Dludla1, Stephanie C Dias2, Nnini Obonye2, Rabia Johnson2,3, Johan Louw2,4, Bongani B Nkambule5. 1. Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Francie van Zijl Drive, P.O. Box 19070, Tygerberg, 7505, South Africa. pdludla@mrc.ac.za. 2. Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Francie van Zijl Drive, P.O. Box 19070, Tygerberg, 7505, South Africa. 3. Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, Tygerberg, 7505, South Africa. 4. Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, Richards Bay, South Africa. 5. School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa.
Abstract
INTRODUCTION: Heart failure is the leading cause of death in patients with diabetes. No treatment currently exists to specifically protect these patients at risk of developing cardiovascular complications. Accelerated oxidative stress-induced tissue damage due to persistent hyperglycemia is one of the major factors implicated in deteriorated cardiac function within a diabetic state. N-acetyl cysteine (NAC), through its enhanced capacity to endogenously synthesize glutathione, a potent antioxidant, has displayed abundant health-promoting properties and has a favorable safety profile. OBJECTIVE: An increasing number of experimental studies have reported on the strong ameliorative properties of NAC. We systematically reviewed the data on the cardioprotective potential of this compound to provide an informative summary. METHODS: Two independent reviewers systematically searched major databases, including PubMed, Cochrane Library, Google scholar, and Embase for available studies reporting on the ameliorative effects of NAC as a monotherapy or in combination with other therapies against diabetes-associated cardiovascular complications. We used the ARRIVE and JBI appraisal guidelines to assess the quality of individual studies included in the review. A meta-analysis could not be performed because the included studies were heterogeneous and data from randomized clinical trials were unavailable. RESULTS: Most studies support the ameliorative potential of NAC against a number of diabetes-associated complications, including oxidative stress. We discuss future prospects, such as identification of additional molecular mechanisms implicated in diabetes-induced cardiac damage, and highlight limitations, such as insufficient studies reporting on the comparative effect of NAC with common glucose-lowering therapies. Information on the comparative analysis of NAC, in terms of dose selection, administration mode, and its effect on different cardiovascular-related markers is important for translation into clinical studies. CONCLUSIONS: NAC exhibits strong potential for the protection of the diabetic heart at risk of myocardial infarction through inhibition of oxidative stress. The effect of NAC in preventing both ischemia and non-ischemic-associated cardiac damage is also of interest. Consistency in dose selection in most studies reported remains important in dose translation for clinical relevance.
INTRODUCTION:Heart failure is the leading cause of death in patients with diabetes. No treatment currently exists to specifically protect these patients at risk of developing cardiovascular complications. Accelerated oxidative stress-induced tissue damage due to persistent hyperglycemia is one of the major factors implicated in deteriorated cardiac function within a diabetic state. N-acetyl cysteine (NAC), through its enhanced capacity to endogenously synthesize glutathione, a potent antioxidant, has displayed abundant health-promoting properties and has a favorable safety profile. OBJECTIVE: An increasing number of experimental studies have reported on the strong ameliorative properties of NAC. We systematically reviewed the data on the cardioprotective potential of this compound to provide an informative summary. METHODS: Two independent reviewers systematically searched major databases, including PubMed, Cochrane Library, Google scholar, and Embase for available studies reporting on the ameliorative effects of NAC as a monotherapy or in combination with other therapies against diabetes-associated cardiovascular complications. We used the ARRIVE and JBI appraisal guidelines to assess the quality of individual studies included in the review. A meta-analysis could not be performed because the included studies were heterogeneous and data from randomized clinical trials were unavailable. RESULTS: Most studies support the ameliorative potential of NAC against a number of diabetes-associated complications, including oxidative stress. We discuss future prospects, such as identification of additional molecular mechanisms implicated in diabetes-induced cardiac damage, and highlight limitations, such as insufficient studies reporting on the comparative effect of NAC with common glucose-lowering therapies. Information on the comparative analysis of NAC, in terms of dose selection, administration mode, and its effect on different cardiovascular-related markers is important for translation into clinical studies. CONCLUSIONS:NAC exhibits strong potential for the protection of the diabetic heart at risk of myocardial infarction through inhibition of oxidative stress. The effect of NAC in preventing both ischemia and non-ischemic-associated cardiac damage is also of interest. Consistency in dose selection in most studies reported remains important in dose translation for clinical relevance.
Authors: Fjodor Melnikov; Dianne Botta; Collin C White; Stefanie C Schmuck; Matthew Winfough; Christopher M Schaupp; Evan P Gallagher; Bryan W Brooks; Edward Spencer Williams; Philip Coish; Paul T Anastas; Adelina Voutchkova-Kostal; Jakub Kostal; Terrance J Kavanagh Journal: Chem Res Toxicol Date: 2019-01-07 Impact factor: 3.739
Authors: Marco Raffaele; Ignazio Barbagallo; Maria Licari; Giuseppe Carota; Giuseppe Sferrazzo; Mariarita Spampinato; Valeria Sorrenti; Luca Vanella Journal: Evid Based Complement Alternat Med Date: 2018-10-17 Impact factor: 2.629