Therapeutic role of N-acetyl cysteine (NAC) for the treatment and/or management of SARS-CoV-2-induced lung damage in hamster model

Oxidative stress by reactive oxygen species (ROS) has been hypothesized to be the major mediator of SARS-CoV2-induced pathogenesis. During infection, the redox homeostasis of cells is altered as a consequence of virusinduced cellular stress and inflammation. In such scenario, high levels of ROS bring about the production of pro-inflammatory molecules like IL-6, IL-1 beta, etc. that are believed to be the mediators of severe COVID-19 pathology. Based on the known antioxidant, anti-inflammatory, mucolytic and antiviral properties of NAC, it has been hypothesized that NAC will have beneficial effects in COVID-19 patients. In the current study efforts have been made to evaluate the protective effect of NAC in combination with remdesivir against SARS-CoV-2 induced lung damage in the hamster model. The SARS-CoV-2 infected animals were administered with high (500 mg/kg/ day) and low (150 mg/kg/day) doses of NAC intraperitoneally with and without remdesivir. Lung viral load, pathology score and expression of inflammatory molecules were checked by using standard techniques. The findings of this study show that high doses of NAC alone can significantly suppress the SARS-CoV-2 mediated severe lung damage (2 fold), but on the contrary, it fails to restrict viral load. Moreover, high doses of NAC with and without remdesivir significantly suppressed the expression of pro-inflammatory genes including IL-6 (4.16 fold), IL-1 beta (1.96 fold), and TNF-alpha (5.55 fold) in lung tissues. Together, results of this study may guide future preclinical and clinical attempts to evaluate the efficacy of different doses and routes of NAC administration with or without other drugs against SARS-CoV-2 infection.

Automated summary

Oxidative stress caused by ROS is the main mediator of SARS-CoV-2-induced pathology. NAC, with its antioxidant, anti-inflammatory, mucolytic, and antiviral properties, may have beneficial effects in COVID-19 patients. This study shows that high doses of NAC can suppress severe lung damage caused by SARS-CoV-2, but fail to restrict viral load. However, high doses of NAC with and without remdesivir significantly suppress the expression of pro-inflammatory genes in lung tissues.