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Intravenous glutathione prevents renal oxidative stress after coronary angiography more effectively than oral N-acetylcysteine

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Abstract

This study proposes the intravenous administration of glutathione (GSH) as a novel strategy to prevent contrast medium-induced renal oxidative stress. Renal oxidative stress is a critical cause of contrast-induced nephropathy (CIN). Recent reports have described that N-acetylcysteine (NAC) may prevent CIN by scavenging reactive oxygen species in the kidney. Twenty-one patients with reduced renal function who underwent coronary angiography (CAG) were equally assigned to the control, NAC and GSH (100 mg/min for 30 min before CAG) groups. CIN occurred in two patients, one in the control and the other in the NAC group. In the control group, the urinary lipid hydroperoxides (LOOHs) increased to 299.5 ± 94.4% of the baseline at 2 h after CAG (mean ± SE, p < 0.01). The increase in LOOHs was completely abolished in the GSH group (5.5 ± 8.8%, p = ns), but not in the NAC group (196.8 ± 81.3%, p < 0.05). In the control group, the serum GSH level fell by 9.4 ± 2.3% at 2 h after CAG (p < 0.01). The decrease was prevented in the GSH group (−1.8 ± 8.5%, p = ns), but not in the NAC group (−10.0 ± 3.3%, p < 0.05). The renal damage by contrast medium-induced oxidative stress occurs soon after CAG, and intravenous GSH is more effective in preventing the oxidative stress than oral NAC. This advantage may make GSH a potentially more effective therapeutic strategy against CIN.

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Authors and Affiliations

  1. Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan

    Takeji Saitoh, Hiroshi Satoh, Mamoru Nobuhara, Masashi Machii, Takamitsu Tanaka, Hayato Ohtani, Masao Saotome, Tsuyoshi Urushida, Hideki Katoh & Hideharu Hayashi

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  1. Takeji Saitoh
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Correspondence to Hiroshi Satoh.

Appendix

Appendix

The molecular weights of NAC (C5H9NO3S) and GSH (C10H17N3O6S) are 163.2 and 307.4, respectively. The bioavailability of NAC has been shown to be 3.4–19.8%, implying that approximately 90% of NAC degenerates to cysteine, which can be synthesized to GSH in the liver [35, 36]. Since the total amount of NAC administered during this study was 2,820 mg (1,410 mg a day for 2 days), it is equivalent to 4,780 mg of GSH (2,820 mg/163.2 × 307.4 × 0.9).

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Saitoh, T., Satoh, H., Nobuhara, M. et al. Intravenous glutathione prevents renal oxidative stress after coronary angiography more effectively than oral N-acetylcysteine. Heart Vessels 26, 465–472 (2011). https://doi.org/10.1007/s00380-010-0078-0

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