The Effects of N-acetylcysteine on Performance and Redox Homeostasis

N-acetylcysteine Supplementation in Individuals With Low Glutathione Levels: the Effects on Physical Performance and Redox Homeostasis

The main objective of the present study was to investigate whether N-acetylcysteine supplementation in individuals with low glutathione levels would confer ergogenic effects by replenishing glutathione levels and by reducing oxidative stress. Towards this aim, investigators sought to exploit the large inter-individual variability in redox biomarker levels. More specifically, investigators screened 100 male participants for glutathione baseline levels in blood and formed three stratified groups according to this value (i.e., low, moderate and high; 12 individuals per group). After by-passing the regression to the mean artefact by performing a second glutathione measurement in the three aforementioned groups, investigators assessed both aerobic and anaerobic physical performance in order to acquire a more comprehensive view about the ergogenic effectiveness of the antioxidant treatment. This was accomplished by implementing three different whole-body physical performance tests (i.e., VO2max test, time trial and Wingate), as opposed to most in vivo studies that either applied isolated body-part exercise tests (e.g., by isokinetic dynamometry) or performed a single exercise test (e.g., time-to-fatigue test). It was hypothesised, that data of the present investigation will bridge the chasm between the scientific (i.e., chronic antioxidant supplementation blunts exercise performance and adaptations) and the community-based (i.e., free radicals should anyway be counteracted by "protective" exogenous antioxidants) truths about the role of antioxidants as ergogenic aids. It was also hypothesised that the results will show that low glutathione levels are linked to decreased aerobic and anaerobic physical performance accompanied by increased levels of oxidative stress and that N-acetylcysteine supplementation will restore both performance and redox homeostasis. Based on the findings of the present investigation, the widespread routine practice of consuming antioxidants during exercise training could be changed and the consumption of antioxidants would be restricted only for those who are deficient in glutathione.

Study Overview

• Status: Completed
• Conditions: Glutathione Metabolism Anemias
• Intervention / Treatment: Drug: Lactose; Drug: N-acetylcysteine

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Phase 2

Contacts and Locations

Study Locations

• Cyprus
  • Nicosia, Cyprus, 1516
    • European University Cyprus
• Greece
  • Athens, Greece, 17237
    • National and Kapodistrian University of Athens
  • Thessaloniki, Greece, 54124
    • Aristotle University of Thessaloniki

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 29 years (ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• Healthy male subjects who participated recreationally in physical activities less than 3 times per week.

Exclusion Criteria:

• Subjects were excluded from the study, if they reported any musculoskeletal injury that would limit their ability to perform the exercise sessions. Participants were asked to recall whether they had participated in regular resistance or aerobic training or in unaccustomed exercise during the period before the study entry. Individuals who reported such activities were precluded from the study. Smoking and consumption of antioxidant supplements the days prior to the study were additional exclusion criteria.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: SCREENING
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
PLACEBO_COMPARATOR: Lactose; The placebo group received orally two lactose tablets per day for 30 days. Each individual received the capsules pre-packed in daily doses labeled with the day of consumption.	Drug: Lactose; The placebo group received orally two lactose tablets per day. The participants were instructed to receive the capsules every twelve hours. Each individual received the capsules pre-packed in daily doses labeled with the day of consumption. The supplementation period was 30-day for placebo.
EXPERIMENTAL: N-acetylcysteine; The antioxidant group received orally two N-acetylcysteine tablets (each tablet contained 600 mg of NAC; Lamberts Health Care Ltd, Kent, United Kingdom). The participants were instructed to receive the capsules every twelve hours in order to achieve high concentration of N-acetylcysteine throughout the 24 h. Each individual received the capsules pre-packed in daily doses labeled with the day of consumption.	Drug: N-acetylcysteine; The antioxidant group received orally two N-acetylcysteine tablets (each tablet contained 600 mg of NAC; Lamberts Health Care Ltd, Kent, United Kingdom). The participants were instructed to receive the capsules every twelve hours in order to achieve high concentration of N-acetylcysteine throughout the 24 h. Each individual received the capsules pre-packed in daily doses labeled with the day of consumption. The supplementation period was 30-day for N-acetylcysteine.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measurement of maximal oxygen consumption (ml/kg/min)	Maximal oxygen consumption was assessed (using incremental cycling test to volitional exhaustion) on cycle ergometers (Monark, Vansbro, Sweden). Briefly, after a 5-min warm-up period at 100W, workload increased by 50W every 2.5 minutes until heart rate reached 160 bpm. Then, workload increased by 25W every 2.5 minutes until exhaustion. Respiratory gas variables were measured using a metabolic cart (Quark b2, Cosmed, Italy), which was calibrated before each test using standard gases of known concentration. Maximal oxygen consumption along with time trial and wingate test were used for assessing both aerobic and anaerobic physical performance in order to acquire a more comprehensive view about the ergogenic effectiveness of the antioxidant treatment.	64 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measurement of glutathione levels (μmol/g Hb)	Erythrocyte GSH was determined spectrophotometrically. 20 μL of erythrocyte lysate treated with 5% TCA mixed with 660 μL of67 mMsodium potassium phosphate (pH 8.0) and 330 μL of 1mM 5,5- dithiobis-2 nitrobenzoate. The samples were incubated in the dark at room temperature for 45 min, and the absorbance was read at 412 nm. The measurement of glutathione was used for assessing the efficacy of NAC supplementation to restore glutathione levels in the low-glutathione group as well as the effects of NAC supplementation in the medium and high glutathione groups.	64 days

Collaborators and Investigators

• Sponsor: Aristotle University Of Thessaloniki
• Collaborators: National and Kapodistrian University of Athens; European University Cyprus
• Investigators: Study Director: Michalis Nikolaidis, PhD, Aristotle University of Thessaloniki

Publications and helpful links

General Publications

• Margaritelis NV, Theodorou AA, Paschalis V, Veskoukis AS, Dipla K, Zafeiridis A, Panayiotou G, Vrabas IS, Kyparos A, Nikolaidis MG. Experimental verification of regression to the mean in redox biology: differential responses to exercise. Free Radic Res. 2016;50(11):1237-1244. doi: 10.1080/10715762.2016.1233330. Epub 2016 Oct 25.
• Jeukendrup A, Saris WH, Brouns F, Kester AD. A new validated endurance performance test. Med Sci Sports Exerc. 1996 Feb;28(2):266-70. doi: 10.1097/00005768-199602000-00017.
• Paschalis V, Theodorou AA, Kyparos A, Dipla K, Zafeiridis A, Panayiotou G, Vrabas IS, Nikolaidis MG. Low vitamin C values are linked with decreased physical performance and increased oxidative stress: reversal by vitamin C supplementation. Eur J Nutr. 2016 Feb;55(1):45-53. doi: 10.1007/s00394-014-0821-x. Epub 2014 Dec 20.
• Nikolaidis MG, Kyparos A, Spanou C, Paschalis V, Theodorou AA, Panayiotou G, Grivas GV, Zafeiridis A, Dipla K, Vrabas IS. Aging is not a barrier to muscle and redox adaptations: applying the repeated eccentric exercise model. Exp Gerontol. 2013 Aug;48(8):734-43. doi: 10.1016/j.exger.2013.04.009. Epub 2013 Apr 28.

Study record dates

Study Major Dates

• Study Start (ACTUAL): November 1, 2015
• Primary Completion (ACTUAL): February 15, 2016
• Study Completion (ACTUAL): September 12, 2016

Study Registration Dates

• First Submitted: April 6, 2017
• First Submitted That Met QC Criteria: April 17, 2017
• First Posted (ACTUAL): April 20, 2017

Study Record Updates

• Last Update Posted (ACTUAL): April 21, 2017
• Last Update Submitted That Met QC Criteria: April 20, 2017
• Last Verified: April 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Protective Agents; Respiratory System Agents; Antioxidants; Antidotes; Free Radical Scavengers; Expectorants; Acetylcysteine; N-monoacetylcystine
• Other Study ID Numbers: 83022/2015

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No