N-acetylcysteine as a candidate therapeutic for recurrent aphthous and aphthous-like ulcers

Introduction: Recurrent aphthous stomatitis (RAS) is a painful ulcerative oral disease with a general population prevalence exceeding 20%. The etiology of RAS remains largely unknown, however, nutritional deficiency, autoimmunity, psychological stress, and, recently, oxidative stress have been implicated. The pain associated with RAS may be very severe and disabling, hence, treatment is centered on the control of pain and acceleration of healing. N-acetylcysteine (NAC) is a potent antioxidant with anti-inflammatory, immune-modulatory, and antimicrobial properties. It is available as a safe dietary supplement, and has been successfully used as adjuvant/treatment of inflammatory conditions including ulcerative lesions. The Hypothesis: Using NAC as a candidate for treatment and/or prevention of RAS and aphthous-like ulcers is hypothesized here. We propose to use NAC systemically or topically in the form of powder, paste, adhesive tablets, or mouthwash to treat active RAS or for prophylaxis in cases with frequent attacks. Evaluation of the Hypothesis: The current hypothesis should be tested on animal models of RAS. However, because NAC is currently approved and used for other indications, the hypothesis can also be directly evaluated in well-designed, randomized clinical trials.