Determining the mechanism of N-acetylcysteine in the prevention of early remodeling, role of oxidative stress

Background: Ischemia following acute myocardial infarction provoked an increase in the level of main pro-fibrotic and inflammatory cytokine including transforming growth factor ß (TGF-ß) and tumor necrosis factor a (TNF-a) . NAC is hypothesized to have numerous therapeutic benefits in the management of cardiovascular diseases including post AMI cardiac remodeling. However, to the best of our knowledge, this is the first study evaluated NAC effect on TNF-a and TGF-ß levels in human subjects with AMI.
Method: Following confirmation of STEMI, 88patients randomly administered NAC effervescent tablet 600 mg (Fluimucil®, Zambon, Swiss) or placebo twice daily for three days. For quantification of TGF-ß and TNF-a serum levels after 24 and 72 hours of NAC or placebo administration, peripheral venous blood (10 ml) samples were collected at these time points.
Results: The comparison of biomarkers’ levels measured after 24 and 72 (hours between NAC and placebo groups did not show any statistically significant difference. The comparisons between levels of TGF-ß and TNF-a after 24 and 72 hours within NAC or placebo groups revealed that there was not any significant difference except for TGF-ß levels in placebo group that increased significantly with time past (p=0.042).
Conclusion: The administration of NAC could prevent TGF-ß levels from increasing after 72 hours as compared with those received placebo. As TGF-ß had strong correlations with the ejection fraction as the marker of LV systolic function its late antagonism seems to be important.