N-Acetyl Cysteine as an Adjunct in the Treatment of Tuberculosis

Table 1

Summary of studies on anti-TB effects of NAC against MTB.

Author	Year	Type of study	Anti-TB effect	Effect measurement	Type of immune cells	Type of MTB	Conc. of NAC	Study subjects	Remark	Reference
Venketaraman et al.	2006	Cell culture	Yes	CFU reduction, effect size not indicated	Human Øs	H37Rv	10 mM	HIV +ve and -ve		[9]
Cao et al.	2018	Cell culture	Yes	50% CFU reduction	THP-1	Erdman strain	10 mM	NA	Also showed that anti-TB drugs and NAC have synergistic effects	[10]
Venketaraman et al.	2008	Cell culture	Yes	CFU reduction, effect size not indicated	Human Øs	H37Rv	10 mM	HIV -ve	Used whole blood culture	[11]
Guerra et al.	2011	Cell culture	Yes	CFU reduction, effect size not indicated	Human NK cells	H37Rv	20 mM	HIV +ve and -ve	NK cells pretreated with NAC	[20]
Morris et al.	2013	Cell culture	Yes	CFU against control, effect size not indicated	Human Øs	H37Rv	10 mM	HIV +ve and -ve		[13]
Amaral et al.	2016	Cell culture	Yes	CFU vs. control, effect size not indicated	THP-1	H37Rv, avium, Beijing 1471, M. bovis	10 mM	HIV -ve		[14]
Guerra et al.	2011	Cell culture	Yes	CFU reduction, effect size not indicated	Human Øs	H37Rv	5, 10, 20 mM	HIV +ve and -ve		[20]
Vilchèze et al.	2017	Cell culture & 7H9	No	4-5 log CFU reduction	J774 Øs	H37Rv	5-10 mM	NA	Anti-TB effect when only combined with RIF/INH	[23]
Lamprecht et al.	2016	7H9 medium	Yes	CFU reduction, sterilized	NA	H37Rv	5 mM	NA	Combined with BDQ, Q203, and CFZ	[30]
Teskey et al.	2018	Cell culture & animal study	Yes	CFU reduction	Human PBMCs	Erdman strain	10 mM	Healthy and T2DM patients, rats		[24]
Palanisamy et al.	2011	Animal study	Yes	CFU reduction	NA	H37Rv	400 mg/kg/day for 60 days	Guinea pigs		[26]
Mahakalkar et al.	2017	Clinical trial	Yes	Sputum conversion	NA	NA	600 mg/day	Smear +ve TB patients		[28]
Khameneh et al.	2016	LJ media	No	NA	NA	H37Rv	0.04-40 mg/ml	NA	Anti-TB effect only when combined with RIF or INH	[29]

CFU: colony-forming unit; Øs: macrophages; NK cells: natural killer cells; LJ: Lowenstein Jensen; PBMC: peripheral blood mononuclear cells; T2DM: type 2 diabetes mellitus; NAC: N-acetyl cysteine; INH: isoniazid; RIF: rifampicin; BDQ: bedaquiline; CFZ: clofazimine; Q203: investigational product.