by Deb Wesloh
N-acetylcysteine (NAC) supplement has shown to have Antioxidant and Anti-inflammatory Properties
Polycythemia vera, essential thrombocythemia and myelofibrosis make up a class of blood cancers called myeloproliferative neoplasms or MPNs. MPNs are characterized by the over-production of red or white blood cells or platelets in the bone marrow.
MPNs increase the risk of thrombotic events like stroke, heart attack and blood clots. They also have the potential to progress into even more serious cancers like acute myeloid leukemia. In addition, MPN can cause significant symptom burden. Some of these symptoms include pruritus (itching), bone pain, fatigue, headaches, dizziness, an enlarged spleen and night sweats.
Chronic inflammation has been identified as a possible MPN catalyst. Chronic inflammation may cause issues in the stem cells resulting in continuous elevated levels of reactive oxygen species (ROS), sometimes referred to as free radicals, in the bone marrow. High levels of ROS can potentially lead to mutations due to the tenacious inflammation-induced damage to DNA in cells.(1)
Elevated ROS levels have been associated with a number of disorders including some inflammatory diseases and malignancies. It is thought that high ROS levels play a major role in development and disease progression in MPN. It becomes a vicious cycle as ROS can cause cell damage, including proteins and DNA. Cell damage increases inflammation and increases ROS levels.
Targeting ROS levels may be a key role to preventing gene instability and the progression of MPNs. An article published in 2015 mentions an approach using old agents with anticancer properties together with novel JAK1/2 inhibitors may open a new era for patients with MPNs, the outlook not only being “minimal residual disease” and potential cure but also a marked improvement in inflammation-mediated comorbidities.(2)
Some diets and supplements, have demonstrated antioxidant and anti-inflammatory properties such as decreased inflammation and reactive oxygen species.(3)
MPN patients have increased inflammation that contribute to the high symptom burden. In order to see if there was a relationship between diets and supplement use in regards to symptom burden in the MPN population, a survey was conducted in 2017. The Mayo Clinic Research Center hosted this Internet-based survey which was promoted on a number of MPN-focused websites and communities. The survey included data on demographics, MPN characteristics, nutritional habits, supplement use, and the MPN patient’s symptom burden. The survey showed that symptom burden was significantly lower among patients using amino acid supplements and N-acetylcysteine (NAC). This article emphasized that to date no studies have evaluated the habits, needs and preferences of these specific interventions among an MPN population have been conducted.(4)
An article in Healthline proposed nine possible benefits to using this supplement:
1. Essential for Making the Powerful Antioxidant Glutathione
2. Helps With Detoxification to Prevent or Diminish Kidney and Liver Damage
3. May Improve Psychiatric Disorders and Addictive Behavior
4. Helps Relieve Symptoms of Respiratory Conditions (see April 6th update below)
5. Boosts Brain Health by Regulating Glutamate and Replenishing Glutathione
6. May Improve Fertility in Both Men and Women
7. May Stabilize Blood Sugar By Decreasing Inflammation in Fat Cells
8. May Reduce Heart Disease Risk by Preventing Oxidative Damage
9. Ability to Boost Glutathione Levels May Improve Immune Function
Of these benefits listed above, the most relevance to MPN patients would likely be number 8. Oxidative damage to heart tissue often leads to heart disease, causing strokes, heart attacks and other serious conditions. NAC may reduce heart disease risk by reducing oxidative damage to tissues in your heart. NAC has also been shown to increase nitric oxide production, which helps veins dilate and improves blood flow. This expedites blood transit back to your heart and can lower your risk of heart attacks this supplement.(5)
Interview with an MPN Specialist
In an interview with Dr. Robyn Scherber from the Mays Cancer Clinic in San Antonio in January 2020, she was asked what are some potential advantages of an MPN patient taking NAC? She said that it could potentially help with chronic inflammation and ROS, as well as symptom burden.
Dr. Scherber was asked about any studies that have been conducted regarding NAC use with MPN patients. She stated that at this time, no studies had been conducted at this point with humans. However, the she referenced a recent study University of California, Irvine with JAK2V617F knockin mice that she said was very encouraging.(6)
This study treated the V617F knockin mouse model of polycythemia vera with NAC to determine its antithrombotic effects in the context of MPNs. Data from the study suggests that NAC treatment extended the lifespan of JAK2V617F mice without impacting their blood counts or spleen enlargement. The exact mechanism by which NAC rescues JAK2V617F from thrombotic death requires further investigation, although the results suggest that NAC impacts the interaction between platelets and neutrophils in MPN. Given that NAC is a low-cost, widely available, safe agent, the results are encouraging the evaluation of NAC in patients with MPN for reduction of thrombotic risk. Therefore a clinic trial investigating the impact of NAC in MPN is in development.
During the interview with Dr. Scherber she was asked about this pending clinical trial. She stated that Dr. Angela Fleischman’s team is potentially looking to begin this trial but did not have the specific dates.
Despite all the positive feedback on the use of NAC with MPNs, Dr. Scherber cautioned against taking the supplement without doctor’s approval as it is yet unknown what potential side effects and drug interactions might be; especially with blood thinners. She recommended waiting until the results of the clinical trial with its controlled and monitored environment are known. 
David Wallace, Publisher Note:
Many patients are looking for anything natural (supplements, diet, exercise, etc.) to help relieve symptoms and possibly improve the course of our disease. This article in Blood Advances, N-acetylcysteine inhibits thrombosis in a murine model of myeloproliferative neoplasm makes a strong case for further investigation. Keep in mind, the study was performed in mice. Never-the-less, if you are interested in this supplement you may want to print the research report (from Blood) and have your doctor review.
If you are considering taking N-acetylcysteine NAC, be sure to consult your physician or MPN specialist. Thanks to Deb Wesloh for her investigative reporting and to Dr. Scherber for her contribution, including the two slides used in this article.
April 6th, 2020 Update:
I found this news release to be compelling, as “NAC may help provide relief to people infected with encapsulated RNA viruses such as influenza and coronavirus.” – Recent research points the way toward a practical nutraceutical strategy for coping with RNA virus infections including influenza and coronavirus
“Both influenza and coronavirus cause an inflammatory storm in the lungs and it is this inflammatory storm that leads to acute respiratory distress, organ failure, and death. Certain nutraceuticals may help to reduce the inflammation in the lungs from RNA viruses and others may also help boost type 1 interferon response to these viruses, which is the body’s primary way to help create antiviral antibodies to fight off viral infections.”
 https://www.sciencedirect.com/science/article/abs/pii/S0145212612004328; Chronic inflammation as a promoter of mutagenesis in essential thrombocythemia, polycythemia vera and myelofibrosis. A human inflammation model for cancer development? Mediators of Inflammation. Mads Emil Bjorn and Hans Carl Hasselbalch. 2015.
 Inflammation and Cancer Risk: Can Anti-Inflammatory Diets Help? Karen Collins, MS, RDN, CDN, FAND
Today’s Dietitian Vol. 20, No. 1, P. 12 https://www.todaysdietitian.com/newarchives/0118p12.shtml
 Robyn M. Scherber, Blake T. Langlais, Holly Geyer, Amylou Dueck, Heidi Kosoriek, Carol Johnston, Leslie Padrnos,Jeanne Palmer, Angela G. Fleischman, Ruben A Mesa; Nutrition and Supplement Use Characteristics in the Myeloproliferative Neoplasms: Results from the Nutrient Survey. Blood 2017; 130 (Supplement 1): 2193.
 https://www.healthline.com/nutrition/nac-benefits#section Top 9 Benefits of NAC (N-Acetyl Cysteine) Amy Goodson, MS, RD, CSSD, LD on September 26, 2018
 N-acetylcysteine inhibits thrombosis in a murine model of myeloproliferative neoplasm, Angela Fleischman, Brianna Craver, Gajalakshmi Ramanathan, Summer Hoang, Xinyue Change, Laura Mendez Luque, Stefan Brooks, Hew Yeng Lai, January 24, 2020
 Interview with Dr. Robyn Scherber, Mays Cancer Center, San Antonio, Texas. January 28, 2020. Conducted by Deborah Wesloh