N-acetyl cysteine administration affects cerebral blood flow as measured by arterial spin labeling MRI in patients with multiple sclerosis
Shiva Shahrampour,
Justin Heholt,
Andrew Wang,
Faezeh Vedaei,
Feroze B. Mohamed,
Mahdi Alizadeh,
Ze Wang,
George Zabrecky,
Nancy Wintering,
Anthony J. Bazzan,
Thomas P. Leist,
Daniel A. Monti,
Andrew B. Newberg
Affiliations
Shiva Shahrampour
Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
Justin Heholt
Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
Andrew Wang
Charles E. Schmidt College of Medicine, Marcus Institute of Integrative Health at FAU Medicine, Florida Atlantic University, Boca Raton, FL USA
Faezeh Vedaei
Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
Feroze B. Mohamed
Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
Mahdi Alizadeh
Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
Ze Wang
Department of Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
George Zabrecky
Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, USA
Nancy Wintering
Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, USA
Anthony J. Bazzan
Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, USA
Thomas P. Leist
Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
Daniel A. Monti
Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, USA
Andrew B. Newberg
Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA; Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, USA; Corresponding author.
Background: The purpose of this study was to explore if administration of N-acetyl-cysteine (NAC) in patients with multiple sclerosis (MS) resulted in altered cerebral blood flow (CBF) based on Arterial Spin Labeling (ASL) magnetic resonance imaging (MRI). Methods: Twenty-three patients with mild to moderate MS, (17 relapsing remitting and 6 primary progressive) were randomized to either NAC plus standard of care (N = 11), or standard of care only (N = 12). The experimental group received NAC intravenously (50 mg/kg) once per week and orally (500mg 2x/day) the other six days. Patients in both groups were evaluated initially and after 2 months (of receiving the NAC or waitlist control) with ASL MRI to measure CBF. Clinical symptom questionnaires were also completed at both time points. Results: The CBF data showed significant differences in several brain regions including the pons, midbrain, left temporal and frontal lobe, left thalamus, right middle frontal lobe and right temporal/hippocampus (p < 0.001) in the MS group after treatment with NAC, when compared to the control group. Self-reported scores related to cognition and attention were also significantly improved in the NAC group as compared to the control group. Conclusions: The results of this study suggest that NAC administration alters resting CBF in MS patients, and this is associated with qualitative improvements in cognition and attention. Given these findings, large scale efficacy studies will be of value to determine the potential clinical impact of NAC over the course of illness in patients with MS, as well as the most effective dosages and differential effects across subpopulations.
