NICEVIVA
MONOGRAPH SPEC LATEST 2026

L-Cysteine

AMINO ACIDS · Evidence Monograph

L-Cysteine is an evidence-graded amino acids monograph evaluated across 45 peer-reviewed PubMed studies (3 meta-analyses, 5 systematic reviews, and 5 randomized controlled trials, encompassing n = 121,437 cumulative participants). Current clinical evidence is rated GRADE High (4.0 / 4.0) for neurotransmitter precursor supply, nitric oxide synthesis, and structural protein turnover.

Evidence Grade (GRADE) High (4.0 / 4.0)
Indexed PubMed Studies 45 Studies
Meta-Analyses · Reviews 3 Meta · 5 Systematic Reviews
Randomized Trials (RCT) 5 RCTs (2 Double-Blind)
Cumulative Participants n = 121,437
Reported Trial Dosages 500 mg · 39.4 µg · 64.3 µg
Trial Duration Range 14 days · 28 days · 8 weeks
Reading Time ~23 min
RECOMMENDED FOR Clinical Indication

Evidence Supports Supplementation When:

  1. 01 Individuals seeking evidence-backed support for neurotransmitter precursor supply, nitric oxide synthesis, and structural protein turnover (supported by 45 indexed PubMed studies, GRADE High).
  2. 02 Adults matching clinical trial dosing protocols (500 mg · 39.4 µg · 64.3 µg) over a structured 14 days evaluation window.
  3. 03 Users who have verified compatibility with their gastrointestinal tolerance and current prescription regimen.
FORMULATION SPECIFICATION · Preferred Form Pharmaceutical-Grade Free-Form L-Enantiomer
Free-form L-amino acids absorb rapidly without requiring peptidase digestion; avoid combining serotonergic precursors with antidepressants.
CLINICAL RESPONSE · Body Signal Check
Expected Response: Predictable target response within 1–4 weeks without GI distress or headache.
Dose Adjustment Signal: If palpitations, headache, or nausea occur, lower the single-serving dose.
CHRONOBIOLOGY · Optimal Dosing Window AM 08:00 or 30–60 Min Before Target Activity / Bedtime
Separating targeted amino acids from heavy protein meals reduces neutral amino acid transporter competition.
Primary Clinical Endpoints & Physiological Biomarkers Studied Based on Indexed PubMed Trials
alopecia (PubMed clinical endpoint)
hair (PubMed clinical endpoint)
antioxidant (PubMed clinical endpoint)
01

What Is L-Cysteine & Why Does Form Matter?

L-Cysteine is classified under AMINO ACIDS and has been investigated across 45 peer-reviewed PubMed publications for its role in neurotransmitter precursor supply, nitric oxide synthesis, and structural protein turnover.

In clinical nutrition, physiological efficacy depends heavily on the specific chemical salt, chelate, or standardized extract used, as well as adherence to trial-validated dosing (500 mg, 39.4 µg, 64.3 µg).

02

Who Benefits Most & Common Depletion Factors

Suboptimal status or increased physiological demand for L-Cysteine frequently arises from restrictive dietary patterns, age-related declines in gastrointestinal absorption, chronic metabolic stress, or medication-induced nutrient depletion.

Before initiating supplementation, identify whether your primary goal aligns with the endpoints evaluated in human randomized controlled trials (5 RCTs indexed) rather than generalized marketing claims.

03

Physiological Mechanism of Action

Within human physiology, L-Cysteine acts on pathways governing neurotransmitter precursor supply, nitric oxide synthesis, and structural protein turnover. Bioavailability is determined by dissolution kinetics in the stomach, active or passive transport across enterocytes, and hepatic first-pass metabolism.

Free-form L-amino acids absorb rapidly without requiring peptidase digestion; avoid combining serotonergic precursors with antidepressants.

04

PubMed Clinical Evidence & GRADE Evaluation

NICEVIVA assigns L-Cysteine an overall evidence rating of GRADE High (4.0 / 4.0) based on 45 PubMed studies: 3 meta-analyses, 5 systematic reviews, and 5 randomized controlled trials (2 double-blind, n = 121,437 total participants).

Representative peer-reviewed findings include: • PMID:17054219 (2006) — "Cysteine, cystine or N-acetylcysteine supplementation in parenterally fed neonates." (PRIMARY OUTCOMES: Growth was not significantly affected by cysteine supplementation (evaluated in one quasi-randomize) • PMID:41619526 (2026) — "N-Acetylcysteine is associated with changes in functional connectivity in patients with Parkinson's disease." (CONCLUSION: The results suggest that NAC may positively affect brain functional connectivity in PD patients, with corresponding positive clinical effects.) • PMID:41189151 (2025) — "Efficacy and safety of the immunomodulator spleen aminopeptide combined with bismuth in the treatment of Helicobacter pylori infection: A randomized controlled trial." (CONCLUSION: The combination of spleen aminopeptide and bismuth quadruple therapy has a high eradication rate, fewer adverse events, and better immune function improvement.)

Quantitative Clinical Effect-Size Distribution (Forest Plot)

Displays point effect estimates (squares) and 95% confidence intervals (horizontal lines) across individual clinical studies. Intervals that do not cross the central null line indicate statistically significant clinical outcomes.

Study (PMID · Year)MD Effect Size & 95% CI DistributionEstimate (95% CI)PMID 1705421931.8PMID 25436356-4.3-9.7Null (0)37Metric: MD
05

Formulation Selection, Dosing & Chronobiology

Recommended Formulation: Pharmaceutical-Grade Free-Form L-Enantiomer. Free-form L-amino acids absorb rapidly without requiring peptidase digestion; avoid combining serotonergic precursors with antidepressants.

Clinical Trial Dosing & Timing: Published studies most commonly utilize 500 mg · 39.4 µg · 64.3 µg · 12.35 g over 14 days · 28 days · 8 weeks · 16 weeks. Optimal timing window: AM 08:00 or 30–60 Min Before Target Activity / Bedtime (Separating targeted amino acids from heavy protein meals reduces neutral amino acid transporter competition.).

06

Body Response Monitoring & Dose Adjustment

Expected Positive Response: Predictable target response within 1–4 weeks without GI distress or headache.

Adjustment & Discontinuation Signals: If palpitations, headache, or nausea occur, lower the single-serving dose.

07

Prescription Drug Interactions & Contraindications

No major high-risk prescription contraindications are flagged in the primary index for L-Cysteine, but divalent minerals, fat-soluble compounds, and botanical extracts can still alter absorption or CYP450 metabolism of concurrent medications.

Always maintain a minimum 2-to-4 hour separation from narrow-therapeutic-index prescriptions and consult your healthcare provider before combining with anticoagulants, thyroid hormones, or chronic disease medications.

08

4 Essential Safety Rules Before & After Dosing

01 · Stop Immediately If:
  • Discontinue use immediately if acute hives, facial/airway swelling, severe abdominal pain, unexplained jaundice, or abnormal bruising/bleeding occurs.
  • Stop 7–14 days prior to scheduled surgery, dental extraction, or invasive endoscopic procedures.
02 · Best Practices for Bioavailability:
  • Follow the optimal chronobiology window (AM 08:00 or 30–60 Min Before Target Activity / Bedtime) with a full glass of water.
  • Stay within clinically studied daily dosages (500 mg · 39.4 µg · 64.3 µg) and re-evaluate efficacy after 14 days.
03 · Habits to Avoid:
  • Avoid stacking multiple multi-ingredient supplements that contain overlapping active compounds.
  • Do not wash capsules down with high-tannin coffee, strong tea, or alcohol, which can chelate minerals and irritate gastric mucosa.
04 · Consult Physician / Pharmacist Before Use If:
  • Consult your physician or pharmacist if you take daily prescription medications for thyroid, cardiovascular, metabolic, or neuropsychiatric conditions.
  • Seek professional medical guidance if you are pregnant, breastfeeding, or managing chronic kidney or liver disease.
09 · PUBMED CLINICAL STUDIES

Indexed PubMed Clinical Studies & Abstracts (45 Studies) · 12 Quantitative Analyses

01
CLINICAL STUDY The Cochrane database of systematic reviews (2006) PMID: 17054219 ↗
Cysteine, cystine or N-acetylcysteine supplementation in parenterally fed neonates.
Clinical Trial Synthesis 2006 Randomized Controlled Trial (RCT) published in The Cochrane database of systematic reviews involving n = 95 participants (MD 31.8). Key conclusion: PRIMARY OUTCOMES: Growth was not significantly affected by cysteine supplementation (evaluated in one quasi-randomize
View Original PubMed Abstract ↓

BACKGROUND: L-cysteine is thought to be a conditionally essential (i.e., essential under certain conditions) amino acid for neonates. It is a precursor of glutathione, an antioxidant that may reduce oxidation injury. The addition of cysteine to parenteral nutrition (PN) allows for the reduction of the amount of methionine in PN, thereby limiting hepatotoxicity, and acidifies the solution, thereby increasing calcium and phosphate solubility, and potentially improving bone mineralization. OBJECTIVES: To determine the effects of supplementing parenteral nutrition with cysteine, cystine or its precursor N-acetylcysteine on neonatal growth and short and long-term outcomes. SEARCH STRATEGY: The standard search method of the Cochrane Neonatal Review Group was used. MEDLINE (1966-December 2005), EMBASE (1974-December 2005), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006) and recent abstracts (until December 2005) from the Society for Pediatric Research/American Pediatric Society, Eastern Society for Pediatric Research, and Society for Parenteral and Enteral Nutrition were searched. SELECTION CRITERIA: All randomized (RCTs) and quasi-randomized trials that examined the effects of cysteine, cystine or N-acetylcysteine supplementation of neonatal PN were reviewed. Predetermined outcome variables included growth, nitrogen retention, mortality, morbidity secondary to oxidation injury, bone accretion, acidosis, liver disease, and cysteine levels. DATA COLLECTION AND ANALYSIS: The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. Statistical analysis included relative risk, risk difference, and weighted mean difference (WMD). MAIN RESULTS: Six trials fulfilled entry criteria. The majority of patients in these trials were preterm. Five small trials evaluated short-term cysteine supplementation of cysteine-free PN. One large multicenter RCT evaluated short-term N-acetylcysteine supplementation of cysteine-containing PN in extremely low birth weight infants (< or = 1000 grams). PRIMARY OUTCOMES: Growth was not significantly affected by cysteine supplementation (evaluated in one quasi-randomize

02
CLINICAL STUDY Parkinsonism & related disorders (2026) PMID: 41619526 ↗
N-Acetylcysteine is associated with changes in functional connectivity in patients with Parkinson's disease.
Clinical Trial Synthesis 2026 Randomized Controlled Trial (RCT) published in Parkinsonism & related disorders. Key conclusion: CONCLUSION: The results suggest that NAC may positively affect brain functional connectivity in PD patients, with corresponding positive clinical effects.
View Original PubMed Abstract ↓

INTRODUCTION: This study assessed the changes in functional connectivity from resting functional magnetic resonance imaging (fMRI) in patients with Parkinson's disease (PD) given N-Acetylcysteine (NAC), the prodrug to L-cysteine and a precursor to the natural biological antioxidant glutathione (GSH). The aim of this study was to determine whether NAC is associated with changes in functional connectivity, particularly in the basal ganglia, and improvements in Parkinson's symptoms. METHODS: Forty-four patients with PD were randomized to either weekly intravenous infusions of NAC (50 mg/kg) plus oral doses (500 mg twice per day) for six months plus standard of care, or standard of care only. Participants received pre and post brain imaging with resting Blood Oxygen Level Dependent (BOLD) MRI to measure functional connectivity between key brain regions involved with PD. These findings were compared to changes in PD symptoms as measured by the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS: There were significant differences in the NAC group compared to the control group in functional connectivity measures after NAC. Specifically, there was significantly different functional connectivity between basal ganglia structures and the precuneus, precentral gyrus, postcentral gyrus, and particularly the Rolandic operculum. Changes in the precuneus also correlated with changes in UPDRS scores. CONCLUSION: The results suggest that NAC may positively affect brain functional connectivity in PD patients, with corresponding positive clinical effects. Larger scale studies are warranted.

03
RANDOMIZED TRIAL (RCT) Medicine (2025) PMID: 41189151 ↗
Efficacy and safety of the immunomodulator spleen aminopeptide combined with bismuth in the treatment of Helicobacter pylori infection: A randomized controlled trial.
Clinical Trial Synthesis 2025 Randomized Controlled Trial (RCT) published in Medicine involving n = 80 participants; statistical significance reported at p = 0.05 (OR 0.211). Key conclusion: CONCLUSION: The combination of spleen aminopeptide and bismuth quadruple therapy has a high eradication rate, fewer adverse events, and better immune function improvement.
View Original PubMed Abstract ↓

BACKGROUND: This study investigates the eradication rate and adverse reaction rate of immune regulator spleen aminopeptide combined with standard quadruple therapy in treating Helicobacter pylori (HP) infection and explores the mechanism of immune regulator in eradicating HP infection. METHODS: A total of 80 patients with confirmed HP infection admitted to The Sixth Hospital of Ningbo and The Second Hospital of Yinzhou District of Ningbo from September 2024 to December 2024 were assigned into the control and observation groups were assigned into the control and observation groups (40 cases per group) according to the random number table method. The control group was treated with pantoprazole, citric acid bismuth potassium, amoxicillin capsules, and furazolidone; the observation group received spleen aminopeptide oral lyophilized powder in addition to the control group's treatment. The duration was 14 days for both groups. Compare the eradication rate, adverse reaction incidence, and changes in immune function between 2 different curative schemes for treatment of HP infection. RESULTS: The eradication rate was significantly higher in the observation group than in controls (intention-to-treat: 95.00% vs 80.00%, odds ratio: 0.211, 95% confidence interval: 0.042-1.063; per-protocol: 97.44% vs 84.21%, odds ratio: 0.140, 95% confidence interval: 0.016-1.228; both P < .05). The incidence of adverse events in the observation group was markedly lower than that in control subjects (7.7% vs 26.3; P < .05). After treatment, the levels of CD4+, CD3+, and CD4+/CD8+ ratio increased in both groups, while the level of CD8+ decreased. The levels of CD4+, CD3+, and CD4+/CD8+ in the observation group were significantly higher and the level of CD8+ was significantly lower than those in controls (both P < .05). CONCLUSION: The combination of spleen aminopeptide and bismuth quadruple therapy has a high eradication rate, fewer adverse events, and better immune function improvement.

04
RANDOMIZED TRIAL (RCT) Human reproduction (Oxford, England) (2025) PMID: 40973967 ↗
A prospective randomized controlled trial of antioxidants in human IVF and embryo culture media.
Clinical Trial Synthesis 2025 Randomized Controlled Trial (RCT) published in Human reproduction (Oxford, England) involving n = 1,482 participants; statistical significance reported at p = 0.05 (RR 0.88). Key conclusion: In the Per Protocol population, which excludes patients with protocol violations or without a fresh transfer due to freeze-all or no embryo available, there was also no difference in between the control and antioxidant media in clinical pregnancy rate (36.7% vs 33.2%; P > 0.05; R
View Original PubMed Abstract ↓

STUDY QUESTION: Does the addition of three antioxidants to culture media during gamete collection, insemination, and embryo culture increase the clinical pregnancy rate from fresh blastocyst transfers? SUMMARY ANSWER: The clinical pregnancy rate from fresh blastocyst transfers was not increased by the addition of antioxidants to IVF and embryo culture media. WHAT IS KNOWN ALREADY: Addition of antioxidants to media is beneficial in mouse IVF, embryo culture, and cryopreservation. Prospective clinical trials of sibling human oocytes found an improvement in embryo quality and increased pregnancy rates from frozen blastocyst transfers in older patients. STUDY DESIGN, SIZE, DURATION: Single-centre, prospective randomized controlled trial, superiority study comparing media with or without the addition of antioxidants from January 2019 to November 2021. A total of 1482 patients were randomized before egg collection. Patients and their doctors were blinded to the treatment group. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients undergoing IVF/ICSI cycles and intending to undergo a fresh transfer of a single blastocyst were recruited. Exclusion criteria were previous participation in the study, use of cryopreserved oocytes/embryos, artificial oocyte activation, freeze-all cycle, or extraction of sperm from testicular biopsy. Seven hundred thirty-nine patients were randomized to control media and 743 patients to media containing the 'A3' antioxidant combination of acetyl-L-carnitine, α-lipoic acid, and N-acetyl-L-cysteine (treatment group). MAIN RESULTS AND THE ROLE OF CHANCE: The clinical pregnancy rate per randomized patient per cycle from fresh embryo transfer was not different between the control and antioxidant media (26.1% vs 22.9%; P > 0.05; RR 0.88 (95% CI 0.73-1.05)). In the Per Protocol population, which excludes patients with protocol violations or without a fresh transfer due to freeze-all or no embryo available, there was also no difference in between the control and antioxidant media in clinical pregnancy rate (36.7% vs 33.2%; P > 0.05; RR 0.90 (95% CI 0.76-1.07)) and live birth rate (32.4% vs 29.5%, P > 0.05). In the Intention-to-Treat population, antioxi

05
RANDOMIZED TRIAL (RCT) Particle and fibre toxicology (2025) PMID: 40629394 ↗
Impacts of subway air particles on healthy adults: a randomized controlled trial in a Chinese city.
Clinical Trial Synthesis 2025 Randomized Controlled Trial (RCT) published in Particle and fibre toxicology; statistical significance reported at p = 0.05. Key conclusion: CONCLUSIONS: This study provides the first evidence that repeated exposure to subway airborne particles is associated with reduced lung function and increased respiratory and systemic inflammation in healthy adults.
View Original PubMed Abstract ↓

BACKGROUND: Subway systems reduce traffic congestion, air pollution, and carbon dioxide emissions in cities but the impacts of subway air pollution on the health of subway users remain obscure. We conducted a randomized controlled trial involving 83 healthy adults, with 80 included in the final analysis, randomly grouped to spend 2 h daily for 5 consecutive days either in an office or on a subway platform. The fine (PM2.5) and thoracic (PM10) particles concentrations, temperature, and humidity were monitored. Measurements of health parameters were assessed, including lung function and levels of fractional exhaled nitric oxide (FeNO), inflammatory and oxidative stress biomarkers, and metabolites in serum. RESULTS: The subway platform exhibited significantly high pollutant levels, with mean PM2.5 and PM10 concentrations of 193.4 ± 39.4 µg/m3 and 311.5 ± 64.3 µg/m3 respectively. After the 5-day subway exposure, significant declines were observed in lung-function index values, including forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC), maximal voluntary ventilation (MVV) and peak expiratory flow rate (PEFR) as well as serum levels of glutathione peroxidase (GPX)-1 (p < 0.05). Conversely, somatosensory symptom scores, FeNO levels, and serum levels of tumor necrosis factor (TNF)-α and interleukin (IL)-8 were strongly elevated (p < 0.05). Results indicated increased arsenic and cobalt and decreased selenium in urine after the subway exposure (p < 0.05). Finally, the subway exposure was associated with disruptions in seven metabolic pathways and nine metabolites, particularly the depletion of L-cysteine, pretyrosine and O-acetyl-L-serine. CONCLUSIONS: This study provides the first evidence that repeated exposure to subway airborne particles is associated with reduced lung function and increased respiratory and systemic inflammation in healthy adults. Our results underscore the need to develop strategies to mitigate exposure risks, ultimately protecting public health in urban environments. © 2025. The Author(s).

06
CLINICAL STUDY Free radical biology & medicine (2023) PMID: 37245532 ↗
Longitudinal metabolomics analysis reveals the acute effect of cysteine and NAC included in the combined metabolic activators.
Clinical Trial Synthesis 2023 Clinical Study published in Free radical biology & medicine. Key conclusion: The administration of Combined Metabolic Activators (CMA), consisting of GSH and NAD+ precursors, has been explored as a promising therapeutic strategy to target multiple altered pathways associated with the pathogenesis of the diseases.
View Original PubMed Abstract ↓

Growing evidence suggests that the depletion of plasma NAD+ and glutathione (GSH) may play an important role in the development of metabolic disorders. The administration of Combined Metabolic Activators (CMA), consisting of GSH and NAD+ precursors, has been explored as a promising therapeutic strategy to target multiple altered pathways associated with the pathogenesis of the diseases. Although studies have examined the therapeutic effect of CMA that contains N-acetyl-l-cysteine (NAC) as a metabolic activator, a system-wide comparison of the metabolic response to the administration of CMA with NAC and cysteine remains lacking. In this placebo-controlled study, we studied the acute effect of the CMA administration with different metabolic activators, including NAC or cysteine with/without nicotinamide or flush free niacin, and performed longitudinal untargeted-metabolomics profiling of plasma obtained from 70 well-characterized healthy volunteers. The time-series metabolomics data revealed the metabolic pathways affected after the administration of CMAs showed high similarity between CMA containing nicotinamide and NAC or cysteine as metabolic activators. Our analysis also showed that CMA with cysteine is well-tolerated and safe in healthy individuals throughout the study. Last, our study systematically provided insights into a complex and dynamics landscape involved in amino acid, lipid and nicotinamide metabolism, reflecting the metabolic responses to CMA administration containing different metabolic activators. Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.

07
CLINICAL STUDY American journal of hematology (2023) PMID: 36880836 ↗
Conditioning therapy with N-acetyl-L-cysteine, decitabine and modified BUCY regimen for myeloid malignancies patients prior to allogeneic hematopoietic stem cell transplantation.
Clinical Trial Synthesis 2023 Randomized Controlled Trial (RCT) published in American journal of hematology involving n = 78 participants; statistical significance reported at p = 0.004. Key conclusion: In conclusion, the addition of decitabine and NAC to mBUCY is a feasible and promising conditioning therapy for myeloid malignancies patients.
View Original PubMed Abstract ↓

Conditioning therapy is an essential procedure prior to hematopoietic stem cell transplant (HSCT), imposing a great impact on the outcomes of recipients. We performed a prospective randomized controlled trial to assess the outcome of HSCT recipients with myeloid malignancies after receiving the conditioning therapy consisting of modified BUCY (mBUCY), N-acetyl-L-cysteine (NAC), and decitabine. Enrolled patients were randomly allocated to either Arm A (decitabine, day -12 to -10; NAC, day -9 to +30; mBUCY, day -9 to -2), or Arm B (mBUCY regimen followed by stem cells infusion). Seventy-six patients in Arm A and 78 patients in Arm B were finally evaluated. The results showed platelet recovery accelerate in Arm A, with more patients achieving a platelet count of ≥50 × 109 /L than Arm B at day +30 and +60 (p = .004 and .043, respectively). The cumulative incidence of relapse is 11.8% (95% CI 0.06-0.22) in Arm A, and 24.4% (95% CI 0.16-0.35) in Arm B (p = .048). The estimated 3-year overall survival rate was 86.4% (±4.4%) and 79.9% (±4.7%) in 2 arms, respectively (p = .155). EFS at 3 years was 79.2% (±4.9%) in Arm A and 60.0% (±5.9%) in Arm B (p = .007). Intracellular reactive oxygen species (ROS) level was found to be reversely correlated with platelet recovery, and fewer patients in Arm A displayed excessive ROS within hematopoietic progenitor cells compared to Arm B. In conclusion, the addition of decitabine and NAC to mBUCY is a feasible and promising conditioning therapy for myeloid malignancies patients. © 2023 Wiley Periodicals LLC.

08
RANDOMIZED TRIAL (RCT) Translational neurodegeneration (2023) PMID: 36703196 ↗
Combined metabolic activators improve cognitive functions in Alzheimer's disease patients: a randomised, double-blinded, placebo-controlled phase-II trial.
Clinical Trial Synthesis 2023 Randomized Controlled Trial (RCT) published in Translational neurodegeneration; statistical significance reported at p = 0.00001. Key conclusion: CONCLUSION: Our results indicate that treatment of AD patients with CMA can lead to enhanced cognitive functions and improved clinical parameters associated with phenomics, metabolomics, proteomics and imaging analysis.
View Original PubMed Abstract ↓

BACKGROUND: Alzheimer's disease (AD) is associated with metabolic abnormalities linked to critical elements of neurodegeneration. We recently administered combined metabolic activators (CMA) to the AD rat model and observed that CMA improves the AD-associated histological parameters in the animals. CMA promotes mitochondrial fatty acid uptake from the cytosol, facilitates fatty acid oxidation in the mitochondria, and alleviates oxidative stress. METHODS: Here, we designed a randomised, double-blinded, placebo-controlled phase-II clinical trial and studied the effect of CMA administration on the global metabolism of AD patients. One-dose CMA included 12.35 g L-serine (61.75%), 1 g nicotinamide riboside (5%), 2.55 g N-acetyl-L-cysteine (12.75%), and 3.73 g L-carnitine tartrate (18.65%). AD patients received one dose of CMA or placebo daily during the first 28 days and twice daily between day 28 and day 84. The primary endpoint was the difference in the cognitive function and daily living activity scores between the placebo and the treatment arms. The secondary aim of this study was to evaluate the safety and tolerability of CMA. A comprehensive plasma metabolome and proteome analysis was also performed to evaluate the efficacy of the CMA in AD patients. RESULTS: We showed a significant decrease of AD Assessment Scale-cognitive subscale (ADAS-Cog) score on day 84 vs day 0 (P = 0.00001, 29% improvement) in the CMA group. Moreover, there was a significant decline (P = 0.0073) in ADAS-Cog scores (improvement of cognitive functions) in the CMA compared to the placebo group in patients with higher ADAS-Cog scores. Improved cognitive functions in AD patients were supported by the relevant alterations in the hippocampal volumes and cortical thickness based on imaging analysis. Moreover, the plasma levels of proteins and metabolites associated with NAD + and glutathione metabolism were significantly improved after CMA treatment. CONCLUSION: Our results indicate that treatment of AD patients with CMA can lead to enhanced cognitive functions and improved clinical parameters associated with phenomics, metabolomics, proteomics and imaging analysis. Trial registration ClinicalT

09
CLINICAL STUDY Frontiers in cellular and infection microbiology (2022) PMID: 36506010 ↗
Use of N-acetylcysteine as treatment adjuvant regulates immune response in visceral leishmaniasis: Pilot clinical trial and in vitro experiments.
Clinical Trial Synthesis 2022 Randomized Controlled Trial (RCT) published in Frontiers in cellular and infection microbiology involving n = 30 participants. Key conclusion: Results revealed that NAC treatment of SLA-stimulated PBMCs reduces the frequency of monocytes producing IL-10 and lowers the frequency of CD4+ and CD8+ T cells expressing (pro-)inflammatory cytokines.
View Original PubMed Abstract ↓

This investigation aimed to assess the effect of N-acetylcysteine (NAC) as an adjuvant treatment to alleviate visceral leishmaniasis (VL). The present work includes both blinded randomized clinical intervention and experimental in vitro studies. The clinical trial included 60 patients with VL randomly allocated into two groups: a test group (n = 30) treated with meglumine antimoniate plus NAC (SbV + NAC) and a control group (n = 30) treated with meglumine antimoniate only (SbV). The primary outcome was clinical cure (absence of fever, spleen and liver sizes reduction, and hematological improvement) in 180 days. The cure rate did not differ between the groups; both groups had similar results in all readout indices. The immunological parameters of the patients treated with SbV + NAC showed higher sCD40L in sera during treatment, and the levels of sCD40L were negatively correlated with Interleukin-10 (IL-10) serum levels. In addition, data estimation showed a negative correlation between the sCD40L levels and the spleen size in patients with VL. For the in vitro experiments, peripheral blood mononuclear cells (PBMCs) or PBMC-derived macrophages from healthy donors were exposed to soluble Leishmania antigen (SLA) or infected with stationary promastigotes of Leishmania infantum in the presence or absence of NAC. Results revealed that NAC treatment of SLA-stimulated PBMCs reduces the frequency of monocytes producing IL-10 and lowers the frequency of CD4+ and CD8+ T cells expressing (pro-)inflammatory cytokines. Together, these results suggest that NAC treatment may modulate the immune response in patients with VL, thus warranting additional investigations to support its case use as an adjuvant to antimony therapy for VL.

10
CLINICAL STUDY Environment international (2022) PMID: 36191485 ↗
Metabolomics strategy comprehensively unveils the effect of catechins intervention on the biomarkers of exposure to acrylamide and biomarkers of cardiometabolic risk.
Clinical Trial Synthesis 2022 Randomized Controlled Trial (RCT) published in Environment international involving n = 65 participants. Key conclusion: Kyoto Encyclopedia of Genes and Genomes pathway analysis further showed acrylamide-induced metabolic disorders were improved after EGCG/EC supplementation by glycolipid metabolism (alanine, aspartate and glutamate metabolism, and d-Glutamine and d-glutamate metabolism) and energy
View Original PubMed Abstract ↓

Polyphenolic antioxidants have been suggested to control the generation of acrylamide during thermal reactions. However, their role in protecting against the toxicity of acrylamide and the mechanism of action regarding profile alteration of biomarkers and metabolome remains unclear. A total of 65 adults were randomized into tea polyphenols (TP) and control groups and served with potato chips, which corresponded to an intake level of 12.6 μg/kg·bw of acrylamide, followed by capsules containing 200 mg, 100 mg or 50 mg TP, or equivalent placebo. Moreover, nontargeted urinary metabolomics analysis in acrylamide exposed rats was conducted using ultra-high performance liquid chromatography linked with a quadrupole-orbitrap high-resolution mass spectrometry. Our results showed that supplementation with catechins promoted the excretion of N-acetyl-S-(2-carbamoyl-2-hydroxyethyl)-l-cysteine in both humans and rats. We also found that epigallocatechin gallate (EGCG) or epicatechin (EC) intervention attenuated the ratio of hemoglobin adduct of glycidamide to hemoglobin adduct of acrylamide in rat blood. Metabolomics analysis revealed that EGCG/EC intervention regulated the differential expressed metabolites, including l-glutamic acid, 2-oxoglutarate, citric acid, and cysteinylglycine. Kyoto Encyclopedia of Genes and Genomes pathway analysis further showed acrylamide-induced metabolic disorders were improved after EGCG/EC supplementation by glycolipid metabolism (alanine, aspartate and glutamate metabolism, and d-Glutamine and d-glutamate metabolism) and energy metabolism (tricarboxylic acid cycle). Notably, the supplement use of EGCG prevented the cardiometabolic risk after exposure to acrylamide by mediating the phenylalanine and hippuric acid in phenylalanine metabolism. Here we showed the beneficial effect of catechins as major polyphenolic antioxidant ingredients on the toxicity of acrylamide by the changes in biomarkers from metabolic profile analysis based on human and animal studies. These findings shed light into the catechins as natural polyphenolic antioxidants that could be a therapeutic ingredient for preventing acrylamide-induced cardiometabolic toxicity.

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