Prolonged treatment with N-acetylcysteine andL-arginine restores gonadal function in patients with PCO syndrome

Conclusions: This preliminary, open study shows that prolonged, oral treatment with combined administration of NAC and ARG determines a clear increase in the number of menstrual cycles, likely ovulatory, in patients with PCOS. These data therefore support the hypothesis that the treatment acts by increasing NO availability counteracting exaggerated free radicals that connote the PCOS. These finding have to be verified in a more prolonged, double blind, placebo controlled study in PCOS patients.

Introduction:
Nitric oxide (NO) plays a wide spectrum of biological actions including a positive role in oocyte maturation and ovulation. Free radicals have been shown elevated in PCOS and therefore would be responsible for quenching NO that, in turn, would play a role in determining oligo or
amenorrhea connoting PCOS. We recently demonstrated that the combined administration of N-acetylcysteine (NAC) and arginine (ARG) is able to exert an antioxidant action leading to an increase in NO availability in patients with type 2 diabetes mellitus, another
condition characterized by insulin-resistance and endothelial dysfunction.

Aim: Aim of the study was to evaluate the effects of a prolonged treatment with NAC and ARG in patients with PCOS, focusing on their ovarian function as well as on some metabolic parameters.

Materials
and methods: Eight patients with PCOS displaying oligo-amenorrhea from at least 1 year underwent a combined treatment with NAC (1200 mg/die) plus ARG (1600 mg/die) for 6 months. Menstrual function, glucose and insulin levels, and in turn HOMA index, were monitored.

Results:
Menstrual function was restored as indicated by the number of uterine bleedings under treatment (3.00, 0.18–5.83 vs 0.00, 0.00–0.83; P<0.02). Also, a well-defined biphasic pattern in the basal body temperature in 21 out of a total of 24 cycles under treatment suggested ovulatory cycles. The HOMA index decreased under treatment (2.12, 1.46 4.42 vs 3.48, 1.62 5.95; P<0.05).

Conclusions: This preliminary, open study shows that prolonged, oral treatment with combined administration of NAC and ARG determines a clear increase in the number of menstrual cycles, likely ovulatory, in patients with PCOS. These data therefore support the hypothesis that the treatment acts by increasing NO availability counteracting exaggerated free radicals that connote the PCOS. These finding have to be verified in a more prolonged, double blind, placebo controlled study in PCOS patients.

Endocrine Abstracts (2009) 20 P657

Andi Masha, Chiara Manieri, Stefano Dinatale, Guido Albino Bruno, Ezio Ghigo & Valentino Martina

Division of Endocrinology, Department of Internal Medicine, University of Turin, Turin, Italy.