Oxidative stress and viral Infections: rationale, experiences, and perspectives on N-acetylcysteine

This article explores current evi-dence on the role of oxidative stress in viral in-fections, and on the use of antioxidant drugs as adjunctive treatment.MEDLINE/PubMed was searched for appropri-ate keywords, and preclinical and clinical studies with reviews were retrieved and examined by au-thors.Old and current evidence shows that GSH con-tent reduction is the main mechanism of redox imbalance in viral-infected cells. Clinical studies found that GSH levels are depleted in patients with viral infections such as HIV and SARS-CoV. Viral infections activate inflammation through different pathways, and several of these mechanisms are related to oxidative stress. NAC is a precursor of GSH, and many of its intracellular effects are me-diated by GSH replenishment, but it also activates some anti-inflammatory mechanisms. NAC has an excellent safety profile and better oral and topical bioavailability than GSH. These characteristics make NAC a suitable option as a repurposed drug.Adjunctive antioxidant treatment may improve the outcomes of antiviral therapies. Current evi-dence supports the rationale for this practice and some clinical experience showed encouraging results.