Effects Of Adjunctive N-Acetyl Cysteine (Nac) In Tuberculosis Patients In Mbeya Region, Tanzania
| dc.contributor.author | Mapamba, Daniel | |
| dc.date.accessioned | 2025-10-21T12:02:50Z | |
| dc.date.issued | 2025-07 | |
| dc.description | SDG-1: No Poverty SDG-3: Good Health and Well-being SDG-9: Industry, Innovation, and Infrastructure SDG-10: Reduced Inequalities | |
| dc.description.abstract | Half of the global health burden of tuberculosis (TB) is due to post-TB disability and mortality occurring despite microbiologic cure. Sustained TB infection elicits an immune response against Mycobacterium tuberculosis and overproduces TNF-α and reactive oxygen species (ROS), which help to kill or contain the pathogen. However, they cause lung injuries. Adjunctive, host-directed therapies have been proposed to address these concerns. One such candidate, N-acetylcysteine (NAC), has been in clinical use since the 1970s to prevent fatal hepatic necrosis following acetaminophen poisoning. The usefulness of NAC in replenishing glutathione (GSH) and treating various diseases, including COVID-19, has been studied. The present study investigated the effect of NAC in TB treatment, focusing on the levels of glutathione, TNF-α, IL-10, hemoglobin, and its antibacterial activity. A prospective, open label, randomized controlled trial enrolled 140 adult TB patients from health facilities in the Mbeya region, who had confirmed pulmonary TB by Gene Expert, with a cycle threshold (Ct) value ≤27 and were Rifampicin-sensitive, and had chest X-rays showing moderate or far advanced lung disease. Participants were randomized to receive standard anti-TB (2HRZE/4HR) with or without NAC 600 mg BID on days 1–112. Whole blood samples were collected for measurement of hemoglobin, bactericidal activity, glutathione, TNF-α, and IL-10 expression by the ELISA method from Calorimetric Arbor Assays and R&D Systems, and sputum samples were used to assess M. tuberculosis burden. NAC treatment rapidly increased total glutathione (P<0.0001), but levels did not reach those of healthy volunteers (P<0.001). NAC reduced TNF-α expression levels (P = 0.011) without affecting IL-10 and accelerated hemoglobin recovery in participants with low values at baseline. The NAC did not affect the killing of MTB in ex vivo whole blood culture but slowed the clearance of MTB from sputum (P = 0.003). In summary, oral NAC restored GSH and resolved anemic TB patients more rapidly; it also reduced TNF-α without affecting IL-10 and antimycobacterial host defenses or treatment activity. The decline in GSH after stopping NAC may indicate sustained inflammation and oxidative stress despite apparently successful TB treatment. The reduction of the markers of oxidative stress and inflammation by NAC may account for its effects on the recovery of lung function in TB. Thus, before its use is approved, more research on various dosages and extended follow-up in various group demographics is warranted. | |
| dc.identifier.uri | https://dspace.nm-aist.ac.tz/handle/123456789/3400 | |
| dc.language.iso | en | |
| dc.publisher | NM-AIST | |
| dc.title | Effects Of Adjunctive N-Acetyl Cysteine (Nac) In Tuberculosis Patients In Mbeya Region, Tanzania | |
| dc.type | Thesis |