Significant Changes of Peripheral Perfusion and Plasma Adrenomedullin Levels in N-Acetylcysteine Long Term Treatment of Patients with Sclerodermic Raynaud's Phenomenon
- 1 October 2005
- journal article
- clinical trial
- Published by SAGE Publications in International Journal of Immunopathology and Pharmacology
- Vol. 18 (4), 761-770
- https://doi.org/10.1177/039463200501800420
Abstract
The unclear pathogenesis of scleroderma vascular lesions makes treatment of Raynaud's phenomenon (RP) in Systemic Sclerosis (SSc) patients very difficult and a new effective treatment is requested. Recently, a powerful antioxidant agent, the N-acetylcysteine (NAC) has been shown to decrease the frequency and severity of RP in SSc patients. Subsequently, using functional infrared imaging, we showed that a single 1-hour NAC infusion in these patients caused a significant increase of skin temperature. The aim of this study was to demonstrate the efficacy of long term therapy with NAC in an open, clinical trial evaluating clinical, instrumental and laboratory parameters. Patients started the treatment receiving for two years, from October to May, intravenous NAC infusions of 15 mg/kg per hour each, for 5 consecutive hours, every two weeks. Before and after each infusion, patients underwent both Laser Doppler perfusion Imaging (LDPI) for the evaluation of the digital perfusion and a blood test to ascertain the plasma adrenomedullin (AM) levels. The NAC infusion increased global hands perfusion and induced a significant decreasing of plasma AM concentrations. Side effects were negligible, easy to control and reversible. Reduction of frequency and severity of RP attacks was recorded. In conclusion, NAC seems to act as an effective vasodilatator in the treatment of RP secondary to SSc and, in addition, it induced significant changes in plasma levels of AM, a potent vasodilator endothelial-derived peptide.Keywords
This publication has 28 references indexed in Scilit:
- Acute effects ofN-acetylcysteine on skeletal muscle microcirculation following closed soft tissue trauma in ratsJournal of Orthopaedic Research, 2005
- N-acetylcysteine restores nitric oxide–mediated effects in the fetoplacental circulation of preeclamptic patientsAmerican Journal of Obstetrics and Gynecology, 2004
- Effect of N-acetyl-l-cysteine on peroxynitrite and superoxide anion production of lung alveolar macrophages in systemic sclerosisNitric Oxide, 2002
- Raynaud's Phenomenon: Infrared Functional Imaging Applied to Diagnosis and Drugs EffectsInternational Journal of Immunopathology and Pharmacology, 2002
- A review of the biological properties and clinical implications of adrenomedullin and proadrenomedullin N-terminal 20 peptide (PAMP), hypotensive and vasodilating peptidesPeptides, 2001
- Laser Doppler Imaging—A New Technique for Quantifying Microcirculatory Flow in Patients with Primary Raynaud's Phenomenon and Systemic SclerosisMicrovascular Research, 1999
- Circulating levels of adrenomedullin in patients with Addison's disease before and after corticosteroid treatmentClinical Endocrinology, 1998
- Raynaud's phenomenonThe Lancet, 1995
- Interleukin-1, Tumor Necrosis Factor and Lipopolysaccharide Additively Stimulate Production of Adrenomedullin in Vascular Smooth Muscle CellsBiochemical and Biophysical Research Communications, 1995
- Adrenomedullin: A Novel Hypotensive Peptide Isolated from Human PheochromocytomaBiochemical and Biophysical Research Communications, 1993