The Role of N-Acetyl Sistein in Pulmonary Tuberculosis
Pulmonary Tuberculosis is a chronic infection that caused by Mycobacterium tuberculosis (M.tb) infection and it is still the major health problem worldwide. Mycobacterium tuberculosis infection can induce oxidative stress. Some studies has proved that active TB patients have an association with excessive oxidative stress which causes glutathione (GSH) level decrease and free radicals increase. Glutathione (GSH) facilitates the control of M.TB intracellular bacterial growth in macrophages and has direct antimicrobial activity. N-acetylcysteine (NAC) is thiol, a precursor of L-cysteine and glutathione synthesis (GSH) that has been used for decades as a mucolytic agent in the treatment of respiratory diseases. Some studies report beneficial role of NAC as immunomodulator, besides NAC also has anti-inflammatory and antimicrobial effect in TB management.
Organization WH. Tuberculosis. In: Organization WH, (Ed.). 2017.
Organization WH. Global Tuberculosis Report 2019. World Health Organization, 2018.
Training TDRA. Report of the Expert Consultation on Immunotherapeutic Interventions for Tuberculosis. Tropical Disease Research and Training, 2007.
Pahari S, Kaur G, Aqdas M, et al. Bolstering Immunity through Pattern Recognition Receptors: A Unique Approach to Control Tuberculosis. Front Immunol. 2017; 8: 906-.
Amaral EP, Conceicao EL, Costa DL, et al. N-Acetyl-Cysteine Exhibits Potent Anti-Mycobacterial Activity in Addition to Its Known Anti-Oxidative Functions. BMC Microbiology. 2016; 16: 251.
Santus P, Corsico A, Solidoro P, Braido F, Di Marco F and Scichilone N. Oxidative Stress and Respiratory System: Pharmacological and Clinical Reappraisal of N-Acetylcysteine. Copd. 2014; 11: 705-17.
Zafarullah M, Li WQ, Sylvester J and Ahmad M. Molecular Mechanisms of N-Acetylcysteine Actions. Cellular and Molecular Life Sciences : CMLS. 2003; 60: 6-20.
Indonesia PDP. Pedoman Diagnosis Dan Penatalaksanaan Tuberkulosis di Indonesia. Jakarta: Persatuan Dokter Paru Indonesia, 2014.
Venketaraman V, Millman A, Salman M, et al. Glutathione Levels and Immune Responses in Tuberculosis Patients. Microbial Pathogenesis. 2008; 44: 255-61.
Societies IUOI. Immunity to TB. International Union of Immunological Societies, 2017.
Raviglione M and O'Brien R. Tuberculosis. In: Fauci AS, Braunwald E, Kasper DL, et al., (Eds.). Harrison’s Principles of Internal Medicine. 17th Ed. New York: McGraw-Hill, 2008, P. 1006-20.
Kidd P. Th1/Th2 Balance: The Hypothesis, Its Limitations, and Implications for Health and Disease. Alternative Medicine Review : A Journal of Clinical Therapeutic. 2003; 8: 223-46.
Barnes PF, Modlin RL and Ellner JJ. T-Cell Responses and Cytokines In: Bloom BR, (Ed.). Tuberculosis : Pathogenesis, Protection, and Control. Washington DC: ASM Press, 1994, P. 417-36.
Orme IM and Cooper AM. Cytokine/Chemokine Cascades in Immunity to Tuberculosis. Immunology Today. 1999; 20: 307-12.
Guerra C, Morris D, Sipin A, et al. Glutathione and Adaptive Immune Responses against Mycobacterium Tuberculosis Infection in Healthy and HIV Infected Individuals. Plos One. 2011; 6: E28378.
Oberley-Deegan RE, Rebits BW, Weaver MR, et al. An Oxidative Environment Promotes Growth of Mycobacterium Abscessus. Free Radical Biology & Medicine. 2010; 49: 1666-73.
Samuni Y, Goldstein S, Dean OM and Berk M. The Chemistry and Biological Activities of N-Acetylcysteine. Biochimica et Biophysica Acta. 2013; 1830: 4117-29.
Hui DS and Lee N. Adjunctive Therapies and Immunomodulating Agents for Severe Influenza. Influenza and Other Respiratory Viruses. 2013; 7 Suppl 3: 52-9.
Immunology AAOAA. Immunomodulators Definition. 2017.
Vora AC. Role of Immunomodulator in Management MDR-TB. In: Singal R, (Ed.). Medicine Update: 2007 The Association of Physicians Of India. New York: Jaypee Brothers Medical Publishers, 2007, P. 775-8.
Khameneh B, Fazly Bazzaz BS, Amani A, Rostami J and Vahdati-Mashhadian N. Combination of Anti-Tuberculosis Drugs with Vitamin C or NAC against Different Staphylococcus Aureus and Mycobacterium Tuberculosis Strains. Microb Pathog. 2016; 93: 83-7.
Cumming BM, Lamprecht DA, Wells RM, Saini V, Mazorodze JH and Steyn AJC. The Physiology and Genetics Of Oxidative Stress in Mycobacteria. Microbiology Spectrum. 2014; 2.
Allen M, Bailey C, Cahatol I, et al. Mechanisms of Control of Mycobacterium Tuberculosis by NK Cells: Role of Glutathione. Front Immunol. 2015; 6: 508-.
Natural Killer Cells, Glutathione, Cytokines, and Innate Immunity against Mycobacterium Tuberculosis. Journal of Interferon & Cytokine Research. 2008; 28: 153-65.
Glutathione Supplementation Improves Macrophage Functions In HIV. Journal of Interferon & Cytokine Research. 2013; 33: 270-9.
Atkuri KR, Mantovani JJ, Herzenberg LA and Herzenberg LA. N-Acetylcysteine--A Safe Antidote for Cysteine/Glutathione Deficiency. Current Opinion in Pharmacology. 2007; 7: 355-9.
Prochnicki T, Mangan MS and Latz E. Recent Insights into the Molecular Mechanisms of the NLRP3 Inflammasome Activation. F1000Res. 2016; 5.
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