Grundlagen der antiinflammatorischen Wirkung von N-Acetylcystein und dessen therapeutische Einsatzmöglichkeiten

Zusammenfassung

N-Acetylcystein (NAC) ist ein Thiol und wird seit den 60er-Jahren als Sekretolytikum in der Therapie der Bronchitis eingesetzt. Durch seine Sulfhydrylgruppen kann NAC sowohl das für die zelluläre Glutathionproduktion notwendige Cystein bereitstellen, Paracetamol an sich binden und damit dessen biliäre Ausscheidung fördern als auch direkt reaktive Sauerstoffmetabolite reduzieren. Durch Hemmung pro-inflammatorischer redoxsensitiver Reaktionswege wirkt NAC antiinflammatorisch mit Beeinflussung der Apoptose, des Zellwachstums, der Transscription und der Zytokinantwort. Durch die antiinflammatorischen Eigenschaften wirkt NAC protektiv auf hepato- und nephrotoxische Stimuli sowie auf proinflammatorische Reaktionen in der Lunge, dem Herzen und in Gefäßen. Dieser positive NAC-Effekt ist bei der idiopathischen Lungenfibrose (IPF), der fibrosierenden Alveolitis und der Paracetamol-Intoxikation auch klinisch erkennbar. In dieser Übersicht wird die aktuelle Datenlage zu den verschiedenen Wirkungsweisen von NAC und die Möglichkeiten der klinischen Umsetzung zusammengefasst.

Abstract

N-acetylcyteine (NAC) is a thiol containing compound which by providing Sulfhydryl groups, can act both as a precursor or reduced glutathione and as a direct scavenger of reactive oxygen species. By regulation the redox status in cells, it can interfere with several signaling pathways that play a role in regulation apoptosis, angiogenesis, cell growth, nuclear transcription and cytokine production. In humans NAC had been proven to improve idiopathic pulmonary fibrosis (IPF), various forms of alveolitis and to avoid hepatoxic effects of paracetamol and paraquate through binding these compounds enabling biliary excretion. Overall, the anti-inflammatory action of NAC is well documented in vitro as well as in vivo. This review summarizes the biochemical effects of NAC and hints proven and likely diseases where NAC have or might have a beneficial effect.

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