Introdução: Apneia do sono é uma doença respiratória crônica com alta prevalência que causa múltiplas interrupções respiratórias, levando à hipóxia intermitente (HI). A HI culmina com a geração de radicais livres, estresse oxidativo, inflamação e esteatose hepática. A Melatonina (MEL) e N-acetilcisteína (NAC), são potentes antioxidantes, capazes de inibir esses radicais livres e o estresse oxidativo. Objetivos: Investigar o mecanismo de inflamação em um modelo de hipóxia intermitente que simule a apneia do sono, avaliando-se o fígado e o pulmão, as respostas aos tratamentos com MEL e NAC frente às alterações oxidativas e inflamatórias no fígado de camundongos. Métodos: Utilizamos 120 camundongos machos, adultos, divididos em três experimentos: avaliação do modelo experimental (n=36), avaliação inflamatória molecular em fígado e pulmão (n=12) e avaliação molecular em camundongos com uso de antioxidantes (n=72). Para a hipóxia intermitente foi utilizado o sistema de câmaras que mantêm os roedores em um equipamento que simula a apneia do sono, durante oito horas diárias. No primeiro experimento avaliaram-se as alterações hepáticas em dois momentos, com 21 dias de exposição e 35 dias de exposição à HI. Nos demais experimentos foram utilizados o mesmo sistema durante 35 dias de exposição. No terceiro experimento, a partir do 21° dia iniciaram-se a administração intraperitoneal dos antioxidantes (MEL-200uL/Kg) e NAC-10mg/Kg). Resultados: Foi verificado que o tempo de 21 dias de exposição, não foi encontrado alterações nos fígados dos camundongos. Nos animais expostos durante 35 dias à HI, contatou-se a presença de estresse oxidativo, com aumento de dano oxidativo a lipídios e ao DNA e a redução das defesas antioxidantes, e aumento significativo de metabólitos de óxido nítrico (NO), além da presença de lesão tecidual na histologia hepática. Nos pulmões e nos fígados dos camundongos submetidos à HI, contatou-se a presença de estresse oxidativo, e aumento de expressão de fatores de transcrição: hipóxia induzível (HIF-1α), nuclear (NF-κB) e necrose tumoral (TNF-α), como mediadores inflamatórios, bem como elevação da expressão da óxido nítrico sintase induzível (iNOS) e fator de crescimento vascular endotelial (VEGF), como mediadores de resposta vascular, e Caspase 3 clivada, como enzima responsável pela apoptose. Nos animais que foram tratados com MEL e NAC, houve redução significativa, nos fígados, de todas proteínas que apresentaram-se elevadas expressões do grupo exposto sem tratamento, assemelhando-se aos controles. Conclusão: Sugerimos que o tempo necessário de hipóxia intermitente, que simule a apneia do sono, para lesão hepática e estresse oxidativo seja de 35 dias, nesse tempo de exposição sabemos que tanto o pulmão quanto o fígado possuem estresse oxidativo, inflamação e apoptose, e que o uso de Melatonina e N-acetilcisteína foram capazes de proteger os fígados dessas agressões. / Introduction: Sleep apnea is a chronic respiratory disease with high prevalence causing multiple interruptions in breathing, leading to intermittent hypoxia (IH). The IH culminates with the generation of free radicals, oxidative stress, inflammation and hepatic steatosis. Melatonin (MEL) and N-acetylcysteine (NAC) are potent antioxidants, capable of inhibiting these free radicals and oxidative stress. Objectives: To investigate the mechanism of inflammation in a model of intermittent hypoxia that simulates sleep apnea, evaluating the liver and lung, responses to treatment with MEL and NAC front of oxidative and inflammatory changes in the liver of mice. Methods: We used 120 male mice, adults, divided into three experiments: evaluation of the experimental model (n = 36), inflammatory molecular assessment in liver and lung (n = 12) and molecular evaluation in mice with antioxidants (n = 72) . For intermittent hypoxia was used to maintain camera system rodents in a device that simulates sleep apnea during eight hours. The first experiment evaluated the hepatic changes in two stages, with 21 days of exposure and 35 days of exposure to IH. In other experiments we used the same system for 35 days of exposure. In the third experiment, from day 21 began intraperitoneally administration of antioxidants (MEL-200uL/Kg and NAC-10mg/Kg). Results: It was found that the time of exposure of 21 days, no changes were found in the livers of mice. In animals exposed for 35 days to IH, contacted the presence of oxidative stress, with increased oxidative damage to lipids and DNA and reduction of antioxidant defenses, and a significant increase of metabolites of nitric oxide (NO), and the presence of tissue injury in liver histology. In the lungs and livers of mice subjected to IH, contacted the presence of oxidative stress, and increased expression of transcription factors: hypoxia inducible (HIF-1α), nuclear (NF-κB) and tumor necrosis factor (TNF-α), such as inflammatory mediators and increase the expression of inducible nitric oxide synthase (iNOS) and vascular endothelial growth factor (VEGF), vascular response mediators, and cleaved Caspase 3 as enzyme responsible for apoptosis. In animals treated with NAC and MEL, a significant reduction in the livers of all proteins that were elevated expression of the exposed untreated, similarly to controls. Conclusion: We suggest that the time required for intermittent hypoxia, simulating sleep apnea, to liver damage and oxidative stress is 35 days exposure at this time we know that both the lungs and the liver have oxidative stress, inflammation and apoptosis, and the use of Melatonin and N-acetylcysteine were able to protect the livers of these aggressions.

A resposta febril é um processo dependente de inflamação, desencadeado pela produção de citocinas pró-inflamatórias a partir de fagócitos ativados. Estes mediadores podem ser liberados na corrente sangüínea ou ainda estimular nervos sensoriais e, desta forma, transmitir o sinal inflamatório até o centro termo controlador cerebral e, assim, elevar a temperatura corporal. A Nacetilcisteina (NAC) é um antioxidante e um precursor de glutationa que modula a sinalização intracelular durante a inflamação, resultando na diminuição da síntese e liberação de moléculas pró - inflamatórias incluindo as citocinas e a prostaglandina E2. Embora a resposta febril dependa de um processo inflamatório estabelecido, e a atividade antiinflamatória da NAC já seja bastante conhecida, ainda pouco se sabe sobre a ação desta pequena molécula em infecções fúngicas e processos como a febre. Desse modo, nesse trabalho, privilegiou-se a investigação dos efeitos da NAC sobre a febre, a resposta inflamatória local (cavidade peritoneal) e sobre a sinalização inflamatória no centro termorregulatório (hipotálamo) induzidas por suspensão de Saccharomyces cerevisae, na dose de 135 mg/kg, i.p. A administração sistêmica da NAC (500 mg/kg, s.c.) preveniu, mas não reverteu a febre induzida pela levedura. Ademais, verificou-se que a NAC produziu um efeito de diminuição da migração leucocitária, do extravasamento plasmático, da liberação de interleucina (IL)-1β e do fator de necrose tumoral (TNF)-α no lavado peritoneal, e, por fim, diminuiu a liberação de IL-1β no tecido hipotalâmico, ressaltando-se a ação do Saccharomyces cerevisae como indutor de todas as respostas referidas. A administração sistêmica de NAC também aumentou o conteúdo de grupos tióis não protéicos presentes no lavado peritoneal e no hipotálamo, ao mesmo tempo em que reverteu a oxidação dos grupos SH no local da inflamação. A administração central de NAC (50 μg, i.t., 120 min depois da admnistração do Saccharomyces cerevisae) também preveniu a febre induzida pelo fermento de padeiro, sem, contudo, alterar a migração leucocitária para a cavidade peritoneal. Finalmente, a administração sistêmica da NAC não alterou a resposta febril provocada por prostaglandina E2(PGE2; 300 ng, i.t.). Logo, estes resultados sugerem, não só um papel anti-inflamatório para a NAC em peritonites causadas por fungos, mas também, uma atividade antipirética que envolve a inibição da liberação da IL-1β no hipotálamo, provavelmente antes da produção de PGE2. / Febrile response is an inflammation-dependent process that started with the production of pyrogenic cytokines by activated mononuclear phagocytes. These mediators are released into bloodstream or stimulate local sensory nerves and transmit the inflammatory signal to the preopticanterior hypothalamic area, the brain thermoregulatory center. N-acetylcysteine (NAC) is an antioxidant and a glutathione precursor that modulates intracellular signaling in inflammatory response resulting in a decreased synthesis and release of pro-inflammatory molecules, including cytokines and prostaglandin E2. However, it is poorly known whether NAC interferes with other inflammation-dependent processes, such as fever. Therefore, in this study we investigated the effects of NAC on fever, local inflammatory response (peritoneal cavity) and inflammatory signalization in thermoregulatory center (hipothalamus) induced by intraperitoneal administration of baker yeast (Saccharomyces cerevisae suspension, 135 mg/kg, i.p.). Systemic administration of NAC (500 mg/kg, s.c.) prevented, but did not revert established fever induced by baker yeast. In addition, NAC decreased leukocyte migration, plasma protein extravasation and decreased tumor necrosis factor (TNF)-α, interleukin (IL)-1β release induced by baker yeast in peritoneal lavage and IL-1 release in hypothalamus. NAC also increased nonprotein thiol content in peritoneal lavage and hypothalamus, and prevented baker yeast-induced decrease of nonprotein thiol content in same samples. The central administration of NAC (50 μg, i.t., 120 min after baker yeast) also prevented baker yeast-induced fever, but did not alter leukocyte migration to peritoneal cavity. In addition, the systemic administration of NAC did not alter the febrile response elicited by prostaglandin E2 (PGE2 300 ng, i.t.). These results suggest an anti-inflammatory role for NAC on yeast-induced peritonitis and that its antipyretic effect may be due to inhibition of inflammatory IL-1β production in hypothalamus.

A Hipertensão Portal (HP) é uma síndrome clínica associada ao desenvolvimento de circulação hiperdinâmica e varizes gastroesofágicas. O objetivo deste estudo foi avaliar a ação antioxidante da N-Acetilcisteína (NAC) em ratos com hipertensão portal. MATERIAIS E MÉTODOS: A HP foi induzida por meio do modelo experimental de ligadura parcial da veia porta (LPVP) e os animais divididos em quatro grupos experimentais (n=6): Sham-operated (SO), SO + NAC, LPVP e LPVP + NAC. A NAC (10 mg/kg ip.) foi administrada diariamente durante 7 dias, iniciados no 8º dia após a cirurgia. Foi mensurada a pressão portal na veia mesentérica, e o dano hepático foi avaliado através das enzimas AST, ALT e FA. Para avaliação do dano oxidativo no estômago, foi feita a avaliação da lipoperoxidação através da técnica das substâncias que reagem ao ácido tiobarbitúrico (TBARS) e avaliadas as atividades das enzimas antioxidantes SOD e GPx. Também foram avaliados os níveis de metabólitos do óxido nítrico (nitritos e nitratos), e, para avaliação dos aspectos histológicos, mensuramos os calibres dos vasos na submucosa gástrica, bem como analisamos lâminas coradas com hematoxilina-eosina. RESULTADOS: Os animais do grupo LPVP apresentaram um aumento significativo nos valores de pressão portal, TBARS e metabólitos do óxido nítrico quando comparados ao grupo SO. Esses valores foram acompanhados por uma diminuição das enzimas antioxidantes SOD e GPx. Na análise histológica, notaram-se vasos dilatados e presença de edema na mucosa gástrica dos animais do grupo LPVP. O tratamento com a NAC foi capaz de diminuir os valores da pressão portal, TBARS e metabólitos do óxido nítrico quando comparados ao grupo LPVP. Além disso, foi observado um aumento na atividade das enzimas antioxidantes superóxido dismutase (SOD) e glutationa peroxidase (GPx). Na avaliação da histologia do estômago, a NAC atenuou o edema e vasodilatação nos animais do grupo LPVP +NAC. Não houve diferença estatística significativa entre os valores das enzimas hepáticas. CONCLUSÕES: Sugerimos que a administração da N-acetilcisteína em ratos com hipertensão portal é eficaz na redução ao dano gástrico infligido pelo modelo experimental de ligadura parcial da veia porta. / Portal Hypertension (PH) is a clinical syndrome associated with the development of a hyperdynamic circulation and gastroesophageal varices. The aim of this study was to evaluate the antioxidant effect of N-Acetylcysteine (NAC) on portal hypertensive rats. MATERIAL/METHODS: PH was induced by partial portal vein ligature (PPVL), and the animals were divided into four experimental groups (n = 6): Sham-operated (SO), SO + NAC, PPVL and PPVL + NAC. NAC (10 mg / kg ip.) was administered for 7 days daily, beginning on the 8th day after surgery. Portal pressure was measured in mesenteric vein and liver damage was assessed by the enzymes AST, ALT and FA. To assess oxidative damage in the stomach, the technique of substances that react to thiobarbituric acid (TBARS) was performed and the activities of antioxidant enzymes dismutase (SOD) and glutathione peroxidase (GPx) was evaluated. The nitric oxide metabolites levels (nitrites and nitrates) were also evaluated and histological evaluation was made by measuring the vessels sizes in the gastric submucosa and blades stained with hematoxylin-eosin were analyzed. RESULTS: PPVL animals showed a significant increase in portal pressure, TBARS and nitric oxide metabolites values when compared to the SO group. These values were accompanied by a decrease of antioxidant enzymes SOD and GPx. In histological analysis, dilated vessels and edema in gastric mucosa of PPVL group were noted. Treatment with NAC was able to decrease portal pressure, TBARS and nitric oxide metabolites values when compared to PPVL. Furthermore, an increase in antioxidant enzymes SOD and GPx activity was observed. In the assessment of stomach histology, NAC attenuated the vasodilation and edema in PPVL + NAC group. There was no statistically significant difference between the values of liver enzymes. CONCLUSIONS: We suggest that N-acetylcysteine administration in rats with portal hypertension is effective in reducing gastric damage inflicted by the experimental model of partial portal vein ligation.

Orientador: Elaine Minatel / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-16T07:43:42Z (GMT). No. of bitstreams: 1 Pinto_RafaeldeSenziMoraes_M.pdf: 2983578 bytes, checksum: b55e02c59ba61404fd155a3c6e731521 (MD5) Previous issue date: 2010 / Resumo: Estudos recentes demonstram o envolvimento do estresse oxidativo nas distrofinopatias. Neste trabalho, verificamos se o uso do antioxidante N-acetilcisteína (NAC) no período que antecede a mionecrose diminui a degeneração muscular em camundongos mdx, modelo experimental da distrofia muscular de Duchenne. Quinze camundongos mdx com 14 dias de vida receberam por via intraperitoneal 150mg/kg de NAC diluído em salina por 14 dias. Quinze camundongos mdx receberam salina pela mesma via e período. Os músculos tibial anterior (TA), esternomastóide (STN) e diafragma (DIA) foram utilizados para quantificar (1) fibras em degeneração muscular (fibras positivas ao azul de Evans), (2) fibras regeneradas (fibras com núcleo central), (3) áreas de Inflamação/Regeneração e Regeneração, (4) conteúdo de fator de necrose tumoral-alfa (TNF-?) e do 4-hidroxinonenal (4-HNE), através da técnica de immunoblotting. Amostras de sangue foram utilizadas para quantificar o conteúdo da enzima creatina quinase (CK). NAC promoveu diminuição significativa na porcentagem de fibras em degeneração (marcadas pelo azul de Evans) em todos os músculos analisados, redução significativa de fibras com núcleo central no músculo TA e diminuição significativa na área de Inflamação/Regeneração nos músculos STN e DIA (p<0,05; Teste t de Student). Na análise por immunoblotting, observamos diminuição significativa do TNF-? no músculo DIA e do 4-HNE nos músculos STN e DIA dos camundongos mdx tratados com NAC (p<0,05; Teste t de Student). Diminuição significativa dos níveis de CK foi observada nos animais tratados com NAC (p<0,05; Teste t de Student). Em conjunto, estes resultados demonstram que o antioxidante NAC possa ser potencialmente útil para o tratamento farmacológico da distrofia muscular / Abstract: Recent studies strongly support the involvement of oxidative stress in dystrophinopathies. In the present study, we verified whether N-acetylcysteine (NAC) treatment before the cycles of muscle degeneration-regeneration decreases muscular degeneration in mdx mice. Mdx mice at 14 days of age received intraperitoneal injection of NAC (150mg/kg diluted with saline) daily, for 14 days. Control mdx mice received saline by the same via and for the same period of time. The tibialis anterior (TA), sternomastoid (STN) and diaphragm (DIA) muscles were used for the quantification of (1) necrotic fibers (labeled with Evans blue dye), (2) regenerated fibers with central nuclei, (3) inflammation/regeneration area, (4) tumor necrosis factor-alpha (TNF-?) and 4-hydroxynonenal (4-HNE) levels (immunoblotting analysis). The blood of these animals was drawn to evaluate serum CK activity by spectrophotometry. NAC-treated muscle showed a significant decrease in the percentage of Evans blue dye-positive fibers (p<0,05; Student's t Test). The number of fibers with central nuclei decreased in the TA muscle (p<0,05; Student's t Test). The area of inflammation-regeneration decreased in the STN and DIA muscles in the NAC treated group. Immunoblots showed a significant decrease in the levels of TNF-? levels in DIA muscle and of 4-HNE levels in STN e DIA muscles in NAC-treated mice (p<0.05; Student's ttest). NAC significantly decreased the blood levels of creatine kinase in NAC-treated mice (p<0.05; Student's t-test). These results suggest that antioxidants such as NAC could have therapeutic potential for dystrophinopathies / Mestrado / Anatomia / Mestre em Biologia Celular e Estrutural

Orientador: Wilma De Grava Kempinas / Texto em português e inglês / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-24T16:12:27Z (GMT). No. of bitstreams: 1 Silva_RaquelFrenedoso_M.pdf: 3492189 bytes, checksum: 66cf94f64336b7c79f7b1cf8981d8d60 (MD5) Previous issue date: 2014 / Resumo: O trióxido de arsênio (As2O3) tem se mostrado altamente eficaz e muito utilizado no tratamento para diminuir ou eliminar a leucemia promielocítica aguda. Estudos mostram relação entre exposição a este composto e inibição da espermatogênese ou desenvolvimento do espermatozoide, uma vez que exerce efeito inibitório nos testículos. Diante da crescente utilização do As2O3 no tratamento da leucemia e da escassez de resultados sobre os seus efeitos adversos na reprodução masculina, justifica-se a realização do presente estudo, pelo qual se avaliou os efeitos imediatos e tardios do tratamento com As2O3 sobre fisiologia reprodutiva de camundongos Swiss adultos e se a co-administração de N-acetilcisteína (NAC), previne esses efeitos. Em um primeiro experimento, camundongos Swiss adultos foram tratados com veículo, 0,3 ou 3,0 mg/Kg/dia de As2O3, via subcutânea, em 25 aplicações. No final do tratamento, metade dos animais foram eutanasiados para avaliação dos efeitos pós-tratamento e a outra metade foi mantida sem a droga por período de 50 dias, até que se procedeu a eutanasia para avaliação da possível reversibilidade dos efeitos. Foram investigados: peso dos órgãos vitais, reprodutores e glândulas sexuais acessórias, quantidade e qualidade espermáticas, dosagem de testosterona e dosagem de arsênio no sangue. Os animais tratados com 3,0 mg/kg de As2O3 e eutanasiados logo após o fim do tratamento mostraram diminuição no peso da vesícula seminal, número de espermatozoides móveis e produção espermática diária. Após período de suspensão do tratamento, os animais tratados com a mesma dose continuaram apresentando redução nos mesmos parâmetros. Em um segundo experimento, foi avaliada a contratilidade do ducto epididimário isolado tanto frente ao tratamento in vivo dos animais (tratados com o veículo ou com a dose de 3,0 mg/kg/dia de As2O3) quanto ao tratamento in vitro do tecido. Essa análise revelou que a contração máxima do ducto epididimário estava significativamente aumentada nos animais tratados com As2O3 in vivo. E em uma terceira etapa os animais foram divididos em Controle, As2O3 (3,0 mg/Kg/dia), NAC na água de beber (40mM) e As2O3 + NAC, tratados por 5 semanas. Após o final do tratamento, os animais foram avaliados quanto aos parâmetros que se apresentaram prejudicados com o tratamento anterior, descrito na etapa um. Quando a NAC foi oferecida aos animais, houve uma melhora significativa nos parâmetros espermáticos antes prejudicados pela administração da droga, i.e., o peso de vesícula seminal, número de espermatozoides móveis e produção espermática diária do grupo As2O3 + NAC foram similares ao grupo controle. Podemos concluir que o As2O3 exerce efeitos tóxicos sobre o sistema genital de camundongos machos, e que esses efeitos podem ser persistentes mesmo após o término do tratamento. Os resultados mostraram, também, que a administração de um antioxidante pode prevenir os efeitos deletérios dessa droga sobre os parâmetros avaliados / Abstract: Arsenic trioxide (As2O3), a trivalent arsenic form has proven highly effective and widely used in the treatment to reduce or eliminate acute promyelocytic leukemia. Studies show a relationship between exposure to this compound and inhibition of spermatogenesis and sperm development since it exerts an inhibitory effect on the testis. Given the growing use of As2O3 on treatment of leukemia and the lack of results about the side effects on male reproduction, it is justified to carry out this study, which evaluated the immediate and late effects of treatment with As2O3 on the structure and reproductive physiology of adult Swiss mice and whether the co-administration of N-acetylcysteine (NAC) prevents these effects. In a first experiment, adult Swiss mice were treated with vehicle, 0.3 or 3.0 mg/Kg/day of As2O3, subcutaneously in 25 applications. At the end of treatment, half of the animals were euthanized for evaluation of the post- treatment effects and the other half was maintained without the drug for 50 days until the euthanasia to evaluate the potential reversibility of the effects. It was evaluated: the vital, reproductive and accessories organ weights, analyzes of sperm quantity and quality, testosterone and arsenic measurements in blood. Animals treated with 3.0 mg/Kg of As2O3 and euthanized immediately after the end of treatment showed a decrease of seminal vesicle weight, in number of motile spermatozoa and daily sperm production. After suspension of treatment, animals treated with this same dose continued to show reduction in these same parameters. In a second experiment, the contractility of the epididymal duct was evaluated both in vivo treatment of animals (treated with vehicle or a 3.0 mg/Kg/day of As2O3) and in vitro treatment of the tissues. This analysis revealed that the maximum contraction of the epididymal duct was significantly increased in in vivo treated animals. And in a third step animals were divided into Control, As2O3 (3.0 mg/Kg/day) NAC in tap water (40 mM) and As2O3 + NAC, treated for 5 weeks. After the end of treatment, animals were assessed for previously impaired parameters described in step one. When NAC was given to the animals, there was a significant improvement in sperm parameters before harmed by the drug administration, i.e. seminal vesicle weight, number of motile sperm and daily sperm production in As2O3 + NAC group were similar to the control group. We conclude that As2O3 exerts toxic effects on the male mice genital system, and that these effects may be persistent even after the end of treatment. Also, the results showed that administration of an antioxidant can prevent the deleterious effects of this drug on the parameters evaluated / Mestrado / Biologia Celular / Mestra em Biologia Celular e Estrutural

Na infecção pelo HIV o equilíbrio entre antioxidantes e pró-oxidantes e a produção de citocinas encontram-se alterados, causando estresse oxidativo crônico. Presume-se que o estresse oxidativo crônico e a ativação do sistema imunológico favorecem a replicação do vírus através da ativação do NF-kB e a apoptose de células mononucleares do sangue periférico. O objetivo deste estudo foi avaliar o efeito da suplementação, durante 180 dias, com 600mg/dia de N-acetilcisteína (NAC), sobre a carga viral, os níveis de sub-populações de linfócitos, a viabilidade de linfócitos e sobre os níveis séricos de citocinas, proteínas, lipídeos, &#946;2 microglobulina e outros marcadores da ativação do sistema imunológico em pacientes assintomáticos, submetidos ao primeiro tratamento anti-retroviral. Participaram deste estudo, duplo cego controlado por placebo, que teve a duração de 180 dias, 30 indivíduos que iniciaram a terapia anti-retroviral. O grupo estudo foi constituído por 14 indivíduos que além do tratamento anti-retroviral foram suplementados com NAC, enquanto o grupo controle foi constituído por 16 indivíduos que além do tratamento anti-retroviral receberam placebo. Os marcadores avaliados foram determinados no dia anterior ao início do tratamento a que foram submetidos e após 60, 120 e 180 dias. Verificou-se aumento significante dos linfócitos CD4+, da relação CD4/CD8, de linfócitos viáveis, albumina, cisteína e glutationa, bem como diminuição significante dos níveis de TNF-&#945;, IL-8, haptoglobina e &#945;1-glicoproteína ácida, &#946;2-microglobulina, IgA e IgM, nos dois grupos estudados. Os níveis séricos de IL-6, colesterol total, LDL-colesterol, VLDL-colesterol e triglicerídeos não apresentaram alteração significante ao final deste estudo. Concluindo, a suplementação com 600 mg/dia de NAC, em pacientes submetidos ao tratamento anti-retroviral, não proporcionou benefícios adicionais àqueles decorrentes deste tratamento. / In HIV infection, the balance between antioxidants and pró-oxidants and the production of citokines are disturbed leading to a chronic state of oxidative stress and immune activation. It is presumed that HIV takes advantage of the proinflammatory and prooxidative environment to replicate through the NF-kB pathway leading to the apoptosis of peripheral blood mononuc1ear cells. The aim of this work was to study the effect of oral administration of N-acetylcysteine (NAC) 600 mg per day during 180 days on viral load, viability of lymphocytes, cytokines, proteins, lipids, &#946;2-microglobulin and other immune activation markers in asymptomatic patients under their first antiretroviral therapy. This was a double-blind, placebo-controlled study with 30 individuals who started antiretroviral therapy and were followed for 180 days. These individual were divided into two subgroups: the study group consisted of 14 participants who received NAC supplementation, whereas the control group had 16 individuals who received placebo. The studied markers were determined on the day before the beginning of treatment and after 60, 120 and 180 days of treatment. A significant increase was seen for CD4+ lymphocytes, the CD4/CD8 ratio, albumin, cysteine and glutathione; also, a significant reduction was found for levels of TNF-&#945;, IL-8, &#946;2 microglobulin, IgA, IgG, IgM, haptoglobin, and acid &#945;1-glycoprotein as a consequence of antiretroviral treatment. After 180 days of treatment, the levels of total protein, globulins and HDL-cholesterol presented significant alteration on1y in the control group, while the serum levels of IL-6, total cholesterol, LDL-cholesterol, VLDL-cholesterol and triglyceride did not show significant alteration at the end of the present study. In conclusion, the supplementation of HIV-positive patients with 600 mg/day of NAC did not bring additional benefits to those resulting from antiretroviral treatment.

Outre son role majeur dans la resistance cellulaire au stress oxydant, le tripeptide glutathion (L-ƒÁ glutamyl- cysteinyl-glycine) est essentiel a la survie cellulaire. Un deficit en glutathion, associe a un stress oxydant, est un trait commun a plusieurs maladies chroniques inflammatoires et degeneratives. Dans le cadre de ces differentes pathologies, plusieurs etudes ont montre que la prise orale de N-acetylcysteine (NAC), un precurseur de glutathion, ameliorait l'etat des patients. Le stress oxydant et l'inflammation sont deux caracteristiques principales de l'insuffisance cardiaque et des dystrophies musculaires. Nous avons pose l'hypothese d'un deficit en glutathion dans ces maladies et les benefices possibles d'un traitement par le NAC. Dans le modele du rat developpant une insuffisance cardiaque post-infarctus, nous montrons qu'il existe un deficit en glutathion tissulaire. Un mois de traitement oral par le NAC, donne en curatif post-infarctus, restaure le taux de glutathion cardiaque, reduit le stress oxydant, et interrompt le cycle vicieux inflammation/mort cellulaire, TNF/TNF-R1/NSMase/ caspase-3/apoptose. Un deficit en glutathion systemique et tissulaire caracterise aussi les souris LmnaH222P/H222P de 6-7 mois developpant une cardiomyopathie dilatee, modele de la cardiomyopathie associee a la dystrophie musculaire dfEmery Dreifuss. Un mois de traitement oral par le NAC reduit chez les souris de 7 mois la dilatation ventriculaire gauche et la dysfonction contractile, limite la progression de la fibrose cardiaque et lfinflammation. Ceci est associe a une repletion en glutathion et une normalisation de l'expression des enzymes du metabolisme du glutathion, a une diminution du stress oxydant et de l'expression du TNF. Une premiere etude chez les patients de chirurgie cardiaque (n=91) nous a permis de mettre en evidence que : d'une part, il existait un deficit en glutathion auriculaire chez les patients de la classe NYHA IV compares aux patients de la classe NYHA I. D'autre part, les patients asymptomatiques (classe NYHA I) presentaient un deficit en glutathion sanguin, compares aux individus sains, aggrave chez les patients symptomatiques (classes NYHA II a IV). Le deficit en glutathion sanguin chez les patients asymptomatiques precede lfelevation du taux sanguin de TNFR1, un marqueur standard du degre de severite de l'insuffisance cardiaque. Une seconde etude, chez des patients porteurs dfune mutation de la lamine (n=28) et susceptibles de developper une cardiomyopathie dilatee d'Emery Dreifuss, montre que certains de ces patients presentent un deficit en glutathion sanguin, associe chez un seul de ces patients a un taux eleve de TNFR1. L'analyse comparee des donnees biochimiques et cliniques est en cours. Les souris DMDmdx4cv sont un modele experimental de la dystrophie musculaire de Duchenne (DMD), mais ne developpent que tardivement la maladie cardiaque. Nous observons une augmentation du taux du glutathion systemique chez les souris de plus de 10 semaines. Un traitement oral avec un inhibiteur de synthese du glutathion a faible dose, le Lbuthionine sulfoximine (5 mM BSO), ramene le taux de glutathion systemique chez la souris DMDmdx4cv au taux chez la souris sauvage, mais provoque des alterations des cardiomyocytes identifiees par immunohistochimie, des micronecroses, des anomalies de capillaires et des anomalies mitochondriales observees en microscopie electronique. En conclusion, le deficit en glutathion est un evenement precoce et durable au cours de l'insuffisance cardiaque, d'origine ischemique ou genetique. Les perspectives offertes par ces resultats sont: 1) le test du glutathion sanguin pour le depistage de sujets asymptomatiques a risque; 2) l'indication de NAC aux patients cardiaques, en complement du traitement courant / The tripeptide glutathione (L-? -glutamyl-cysteinyl-glycine) does not only play a major in cellular resistance to oxidative stress, but is also essential to cell survival. A deficit in glutathione, associated with oxidative stress, is a common hallmark of several chronic inflammatory and neurodegenerative diseases. In different examples, several studies reported that oral treatment with N-acetylcysteine (NAC), a glutathione precursor, improved patient status. Oxidative stress and inflammation are two main characteristics of heart failure (HF) and muscular dystrophy. We hypothesized that glutathione deficiency occurred in these diseases and that treatment with NAC might be beneficial. In post-myocardial infarction (MI) rats, with established chronic HF, we show that cardiac tissue is depleted in glutathione. Curative 1-month oral NAC treatment replenishes cardiac tissue glutathione, reduces oxidative stress and disrupts the vicious inflammation/cell death, TNF/TNF-R1/N-SMase/ caspase-3/ apoptosis cycle. Deficit in serum and cardiac glutathione also characterize 6- to 7-month old LmnaH222P/H222P mice with dilated cardiomyopathy (DCM), a model of the cardiomyopathy associated with Emery Dreifuss muscular dystrophy (EDMD), One-month oral NAC treatment reduces left ventricular dilation and contractile dysfunction, limits the progression of cardiac fibrosis and inflammation in 7-month old LmnaH222P/H222P mice. This is associated with glutathione repletion and normalization of glutathione metabolism enzymes, and reduction of oxidative stress and TNF expression. In a first study in cardiac surgery patients (n=91) we show that: on the one hand, atrial glutathione is depleted in patients of NYHA class IV compared with asymptomatic patients of NYHA class I. On the other hand, asymptomatic patients of NYHA class display a deficiency in blood glutathione compared with healthy controls that worsens in asymptomatic patients of NYHA class II-IV. Blood glutathione deficiency in asymptomatic patients precedes elevation of blood TNFR1, a standard marker of HF severity. A second study, in patients with lamin mutation (n=28), prone to develop an Emery Dreifuss DCM, shows that a number of patients display blood glutathione deficiency, with one patient having a high blood TNFR1 level. Analysis of clinical data is underway. DMDmdx4cv mice are an experimental model of Duchenne muscular dystrophy. We observe an increase in blood glutathione in 10-week-old mice and older. Oral treatment with a low dose of L-buthionine sulfoximine (5 mM BSO), an inhibitor of glutathione synthesis, resumes blood glutathione in DMDmdx4cv mice to the control value in WT mice, but produces alterations in cardiomyocytes identified by immunohistochemistry and micronecrosis, capillary and mitochondrial abnormalities observed by electronic microscopy. In conclusion, glutathione deficiency is an early and lasting event in ischemic or genetically-linked HF. These results pave the way for two possible applications: 1) blood glutathione test for the screening of asymptomatic individuals at risk for HF; 2) NAC indication to cardiac patients in addition to current treatment

Background: There is robust preclinical literature and preliminary clinical findings supporting the use of N-Acetylcysteine (NAC) to treat substance use disorders, including tobacco use disorder (TUD). However, randomized controlled trials have yielded mixed results and NAC's efficacy for TUD has not been established. The goals of this study were to assess the efficacy of NAC in promoting early and end-of-treatment abstinence and preventing relapse among adult smokers. Methods: This randomized, double-blinded clinical trial enrolled adult, daily smokers (N = 114; ages 23–64; 51 % female; 65 % White; 29 % Black/African American; 7% Hispanic/Latinx), who were randomized 1:1 to receive NAC (n = 59) or placebo (n = 55) (1200 mg b.i.d.) for eight weeks. Participants received brief cessation counseling and incentives for abstinence during the first three days of the quit attempt. Primary outcomes: (i) carbon monoxide (CO)-confirmed abstinence during the first three days of the quit attempt. Secondary outcomes: (ii) time to relapse; (iii) biologically confirmed abstinence at Week 8. Results: No differences were found between NAC and placebo groups on measures of early abstinence (3-day quit attempt; 11 % for NAC vs. 15 % for placebo; all p > 0.11), time to relapse (p = 0.19), and end-of-treatment abstinence (7% for NAC vs. 11 % for placebo; all p > 0.40]. Conclusions: Results indicate that NAC is a well-tolerated pharmacotherapy but is unlikely to be efficacious as a monotherapy for TUD in adults. Considered in the collective context of other research, NAC may potentially be more useful in a younger population, as a combination pharmacotherapy, or in the presence of more intensive psychosocial treatment.

What is known and objective: Amiodarone, a commonly used class III antiarrhythmic agent notable for a relatively long half-life of up to 6 months and its pronounced adverse effect profile, is used for both acute and chronic management of cardiac arrhythmias. Chronic use of amiodarone has been associated with asymptomatic hepatotoxicity; however, acute toxicity is thought to be uncommon. There are only six reported cases of acute liver failure (ALF) secondary to amiodarone. In all these cases the outcome of death during the same hospitalization resulted. We aimed to report the only case of acute liver failure secondary to amiodarone infusion in the existing literature where the patient survived. Case summary: A 79-year-old woman admitted with atrial flutter was being treated with intravenous (IV) amiodarone when she abruptly developed coagulopathy, altered mental status and liver enzyme derangement. She was diagnosed with acute liver failure (ALF) secondary to an amiodarone adverse drug reaction, with a calculated score of seven on the Naranjo adverse drug reaction probability scale. Amiodarone was immediately withheld, and N-acetylcysteine (NAC) was initiated. Clinical improvement was seen within 48 hours of holding the drug and within 24 hours of initiating NAC. On post-hospital follow-up visit she was reported to have complete recovery. What is new and conclusion: This report emphasizes the importance of monitoring liver enzymes and mental status while a patient is being administered IV amiodarone. N-acetylcysteine administration may have possibly contributed to the early and successful recovery from ALF in our patient. To date, she is the only patient in the existing literature who has been reported to survive ALF secondary to amiodarone administration.

Inledning: Jodkontrastmedel är ett läkemedel som administreras av röntgensjuksköterskan för att förbättra kontrasten mellan inre organ och vävnader samt skilja mellan normala och patologiska områden. Jodkontrastmedel gavs uppskattningsvis i 80 miljoner doser över hela världen år 2003. Av kontrastmedel kan allvarlig biverkning eller till och med ett livshotandetillstånd uppkomma som kontrastmedelsinducerad nefropati (KMN). N-Acetylcystein (NAC) har flera egenskaper, bland annat antioxidfunktioner och förbättring av njurarnas perfusion som kan vara bidragande egenskaper till att förebygga KMN. Syfte: Denna litteraturöversikt var att sammanställa om N-Acetylcystein (NAC) är ett effektivt hydreringsalternativ för att förebygga kontrastmedelsinducerad nefropati (KMN) Metod: Studien utfördes som en allmänlitteraturöversikt. Tio vetenskapliga artiklar kvalitetsgranskades, analyserades och resultatet presenterades i kategorier. Resultat: Analysen av tio artiklar resulterade i sex kategorier, om NAC har en bra hydrerande effekt mot KMN, högriskpatienternas utveckling av KMN och NAC:s effekt, kontrastmedelsdos, mätvärden kontrollerade med serumkreatinin och cystatin C, biverkningar från oral och intravenös administration av NAC samt studiernas definition på KMN. Slutsats: NAC tillsammans med hydrering har visat sig i vissa studier vara effektivt mot KMN men det är ändå oklart om det är NAC som ger den positiva effekten. NAC tillsammans med hydrering verkar inte ge några negativa effekter för patienten då NAC har få biverkningar och är ett billigt läkemedel, men röntgensjuksköterskan bör ge kontrastmedelsdos enligt uträknad GFR. / Introduction: Iodine contrast media is a drug that is administered by the radiographer to enhance the contrast between the internal organs and tissues and distinguish between normal and pathological areas. Iodine contrast media is given estimated to 80 million dosesworldwide year 2003. By contrast media, a serious side effect or even a life-threatening condition can arise like contrast induced nephropathy (CIN). N-Acetylcysteine (NAC) has acapacity of antioxidant functions and improvement of renal perfusion, which may be properties to help and prevent CIN. Purpose: This literature review was to compile if N-Acetylcysteine (NAC) is an effective hydrations alternative to prevent contrast induced nephropathy (CIN) Method: The study was conducted as a general literature review. Tenquality scientific articles were reviewed, analyzed and the results were presented in categories. Results: The analysis of the ten articles resulted in six categories, the NAC has a good dehydrating effect against KMN, high-risk patients, the development of KMN and NAC:s effect, contrast media, measurements controlled by serum creatinine and cystatin C, side effects from oral and intravenous administration of NAC and studies definition of KMN Conclusions: NAC with hydration has been shown in some studies to be effective against KMN but it is still unclear whether it is NAC that gives the positive effect. We believe that NAC along with hydration do not hurt to give to the patient when the NAC has few side effects and is an inexpensive drug, but radiographer should give contrast media according to calculated GFR.