The Role of N-Acetylcysteine as Adjuvant Therapy on TGF-β and II-6-Mediated Immune Response and Subsequent Fibrosis in Covid-19 Patients Predicted by Crp and D-Dimer Levels

Background:Despite vast amount of completed and ongoing researches, the role of immune system in COVID-19 remains unclear. Widespread lung damage as the result of the disease also often causes pulmonary fibrosis as a sequela. Antioxidant property of N-Acetylcysteine (NAC) has prompted its use as adjuvant therapy in COVID-19, both in immune system regulation and prevention of pulmonary fibrosis. We analyze the role of high dose NAC (>1200 mg/day) in COVID-19 immune response, mediated by major pro-inflammatory COVID-19 cytokines IL-6 and TGF-β, and in preventing subsequent pulmonary fibrosis, predicted by CRP and D-dimer, known parameters of lung damage in COVID-19. Premature increase of TGF-β may play a major role in immune system dysregulation in COVID-19. MethodThis is a non-equivalent experimental study in confirmed COVID patients admitted in our hospital between June 2020 to July 2021. Patients were randomly divided unto NAC and control group, and IL-6, TGF-β, CRP and D-dimer levels were measured at admission and after 7 days of administration of NAC. ResultCompared to control group, there are significant decreases of IL-6, CRP, and D-dimer levels (p=.001, .000, and 0.001, respectively) after NAC administration. TGF-β level increases in both control and NAC group, although not significantly. ConclusionNAC is a beneficial adjunctive therapy in alleviating immune response in COVID-19 as it lowers IL-6 level. NAC also lowers both CRP and D-dimer levels, which suggests that NAC may prevent post COVID-19 pulmonary fibrosis by mitigating lung damage caused by the disease.