Showing posts with label N-Acetylcysteine. Show all posts
Showing posts with label N-Acetylcysteine. Show all posts

Saturday, 2 May 2015

Sustained Release NAC for Autism and Schizophrenia

“Pharmacokinetics” of a typical drug

Today’s post is about what should be the optimal anti-oxidant therapy for autism, schizophrenia, COPD and any other disease in which oxidative stress is present.  You will have to be able to swallow pills, to fully benefit.

NAC seems to be the most potent, safe, anti-oxidant, the only drawbacks are:-

·        Short half-life

·        Can taste/smell bad

In autism, NAC is normally given three times a day, but often it is not practical to give a drug at precise intervals throughout the day.

This is a common problem with many drugs and has been solved long ago – with the sustained release pill.

If you find that four hours after giving NAC there is an increase in irritability, anxiety or stimming, it may be that oxidative stress has already returned.  It may be that other factors have triggered a higher load of oxidative stress.  The way to be sure is just to give a small extra dose of NAC and wait 15 minutes.  If everything returns to normal, you found the problem.

Since you cannot always be present with an extra half dose of NAC, the answer is the sustained release form of NAC.

Since we have seen that oxidative stress triggers all kinds of secondary dysfunctions, the sustained release form of NAC might also help minimize them, since you could have 24 hour protection.  Oxidative stress does not go away while you sleep.

For example, I recall the Polish researcher at Harvard who suggested that oxidative stress might cause central hypothyroidism in autism (low levels of T3 in the brain).

Your body produces the pro-hormone T4 in the thyroid which then circulates throughout the body.  Special enzymes, produced locally, then convert the T4 into the active hormone called T3.  The researcher found that in the autistic brain this enzyme was reduced by oxidative stress.

Many “alternative” doctors, mainly in the US, do prescribe extra T3 hormone to people with autism and indeed other conditions.  Some older ladies across the world are buying T3 hormone, online from Mexico, since their doctor will not prescribe it.  They say it makes them feel better.

As your endocrinologist will tell you, hormones are controlled by so-called feedback loops.  So if you start adding extra T3 hormone, your thyroid will start producing less T4.  Then you need even more supplemental T3.

I did do a little experiment with a small dose of T3, to see if a short term increase in T3 affects “my” kind of autism.  It most definitely does; as does a short term spike in potassium levels.  These are useful diagnostic tests, rather than therapies.

This would suggest that minimizing oxidative stress 24 hours a day, may not just be possible, but also highly beneficial.

OTC Sustained Release NAC  (NAC SR)

There actually is an inexpensive Sustained Release NAC , available OTC (without prescription).


The problem with currently-available granulated and effervescent tablet compositions is that they release N-acetyl cysteine very rapidly. Thus, the effervescent compositions as well as the granulate compositions currently available on the market achieve a maximum blood plasma level within 1 hr from administration. One matrix tablet formulation does show a maximum blood plasma level at 2-2.5 hrs after administration, although its recipe indicates that granulation was required. The problem with granulation of acetyl cysteine is that if any dissolves, the dissolved material starts to decompose into impurities.
In accordance with the present invention, this problem of overly-rapid release is obviated by providing the N-acetyl cysteine in the form of a tablet or other article made with the rheology modifying acrylic or methacrylic acid-based polymers, or analogues, described in commonly-assigned application Ser. No. 09/559,687, filed Apr. 27, 2000. Tablets made in this manner exhibit controlled release characteristics, thereby allowing the N-acetyl cysteine active ingredient to be released over a longer period of time.

The rheology modifying polymers used in the present invention provide controlled release of the N-acetyl cysteine and other biologically active compounds contained in the inventive tablet, if any, so that when placed in water or body fluid, the polymer swells to form a viscous gel which retards diffusion of the active material.

The advanced bilayer Sustain™ tablets combine 1/3 Quick Release and 2/3 Sustained Release formats to both immediately raise and to maintain blood levels over a longer period of time.* NAC Sustain®  releases in the small intestine over a 8 hour period, compared to the 1.5 hour biological half-life of NAC in the bloodstream.*

NAC in published research

Much currently available data is from very early studies on NAC that indicated that the half-life was about 5 hours, but subsequent studies suggested it is very much shorter, perhaps just 90 minutes.

The following study is quite old, but compares the behaviour of different NAC formulations in 10 volunteers.

Some definitions:-

A biological half-life or elimination half-life is the time it takes for a substance (drug, radioactive nuclide, or other) to lose one-half of its pharmacologic, physiologic, or radiological activity. In a medical context, the half-life may also describe the time that it takes for the concentration in blood plasma of a substance to reach one-half of its steady-state value (the "plasma half-life").
The relationship between the biological and plasma half-lives of a substance can be complex, due to factors including accumulation in tissues, active metabolites, and receptor interactions

Mean Residence Time

For the medical field, residence time often refers to the amount of time that a drug spends in the body. This is dependent on an individual’s body size, the rate at which the Drug will move through and react within the person’s body, and the amount of the Drug administered. The Mean Residence Time (MRT) in Drug deviates from the previous equations as it is based on a statistical derivation. This still runs off a steady-state volume assumption but then uses the area under a distribution curve to find the average drug dose clearance time. The distribution is determined by numerical data derived from either urinary or plasma data collected. Each drug will have a different residence time based on its chemical composition and technique of administration. Some of these drug molecules will remain in the system for a very short time while others may remain for a lifetime. Since individual molecules are hard to trace, groups of molecules are tracked and the distribution of these is plotted to find a mean residence time.


This post may have been more useful for adult readers, with Asperger’s, who are self-treating.  Many people with Schizophrenia also self-treat with NAC, but they probably do not read autism blogs.

For those unable (yet) to swallow, pills you can have the option of breaking the effervescent tablets in half (or even quarters) to try and maintain a more stable level of NAC.  We sometimes do this, half a 600 mg tablet at school at 11 am,  when needed.  It only seems to be really needed in the pollen allergy season, which seems to trigger more oxidative stress as well as histamine and IL-6.  It works.

One reader of this blog is doing something similar with Bumetanide, he/she is giving it in three daily doses.  Bumetanide also has a short half-life, as does Verapamil.  There is no sustained release form of Bumetanide, but there is for Verapamil.

A final point raised is whether the benefit from NAC comes from it being a precursor to Glutathione (GSH), the body' own master antioxidant, or whether it is actually NAC's own free radical scavenging properties that really matter. It would appear to be the latter, based on the short half life of NAC and the short term beneficial effect.  This would imply that just normalizing GSH is not enough. Studies have shown that normalizing the reduced levels of GSH levels found in autism is readily achievable.

Friday, 22 August 2014

NAC for Long Term Use in Autism

One of the post popular subjects on this blog is the use of NAC (N-acetyl cysteine) for autism. There are numerous earlier posts explaining how and why it works.

Just look up NAC in the index by subject; there are 19 posts, for those with plenty of time. (the labels function just gives the recent posts)

NAC was shown in a clinical trial at Stanford to be an effective treatment for autism.  You might have expected that this would be quickly followed by further research, but since NAC is widely available as a cheap supplement, there is not much financial incentive for further research.  Without that research, mainstream doctors will never prescribe it.

Beginner's guide to NAC 

Highly respected researchers have shown that in many types of autism, oxidative stress is present and considered that NAC might be an effective therapy.

In the past, some DAN-type doctors have used NAC, but the Stanford trial was the first mainstream trial for autism.

For oxidative stress in asthma and in particularly severe types, like COPD, NAC has long been used.  Oxidative stress stops asthma drugs from working, which is why NAC is used.

In autism, as in asthma, it appears that oxidative stress is a long term condition.  NAC controls oxidative stress, but it does not cure it.

Just as asthma research has shown that smoking triggers irreversible oxidative stress, the same appears to be true for autism.  NAC will rebuild the level of body’s own antioxidant, GSH, but as soon as you stop taking the NAC, oxidative stress reappears.  Many years after people quit smoking, the asthma research showed that oxidative stress remains, and so the asthma drugs do not work.

Will NAC be effective?

In cases of classic autism, NAC has been effective for almost everyone who has given me feedback.

The effect is usually noticed as being a reduction/elimination of stereotypy/stimming and obsessive compulsive behavior.  Other people have seen a reduction in aggression and even in sleeping problems.  The reduction in stereotypy makes way for good behaviours, like increased speech and better mood.

Some types of autism are not associated with oxidative stress; anecdotally, it seems to be some regressive types of autism.

When effective, NAC should change behaviour within a couple of days.  Equally, when you stop taking it, the same behaviours should return with a day or two.  This is a good way to check that you are not just imagining the effect.

NAC has “stopped working”

After a period of months you may find, as I did, that NAC has “stopped working”.  If this happens, most likely it is not that NAC has stopped working, but rather that something else has started working and is making the autism worse.  You need to identify what has happened, treat it, and then NAC will appear to start working again.
Possible reasons for NAC appearing to stop working include:-

·        Effect of an allergy (pollen or food)
·        Flare-up in an existing auto-immune disease
·        New auto-immune condition

For example, if the person has a history of GI problems and these get worse just as NAC “stops working”, you would know what to do.

NAC dosage

From what people tell me, in a three year old children 600mg once per day is effective.

In older children higher doses, going up to 2,400 mg or 3,000 mg are being used. 

There will come a point where increasing NAC will have no further behavioural effect and then there will be more likelihood of side effects.

You can experiment to find the lowest effective dose.  It is logical to split larger doses over the day, to maximize effectiveness and minimize any side effects.

In my son (33kg/73 lbs) I give 1,200mg at breakfast, 600mg at lunch and 600mg in the evening.  I started about 20 months ago.

Quality of NAC

There is both cheap NAC in gelatin capsules and foil-packed NAC.  Over time NAC will react with the air and lose its potency; as this happens a smell of rotten eggs is produced.  The foil-packed NAC is called Fluimucil in Europe and PharmaNAC in the US.

Side effects

Almost everything has side effects of some kind, but in the doses used for autism, NAC does not seem to cause anything troubling to occur.  

NAC will also reduce homocysteine, which is linked to various heart problems in adults.  As an antioxidant, NAC will also help remove any metals that should not be present. NAC has also been shown to improve outcomes in some types of cancer.

Friday, 25 July 2014

Carnosine for Autism – an Alternative to N-Acetylcysteine (NAC)? or is it Complementary?

Several people have mentioned to me a supplement called L-Carnosine, so I thought it was worthy of its own post.

The first thing to note is lots of supplements have very similar names and indeed two entirely different substances are abbreviated to NAC.

·        Carnosine
·        Carnitine
·        L-Carnosine
·        L-Carnitine
·        N-Acetylcysteine    (abbreviated to “NAC”)
·        N-Acetylcarnosine  (also abbreviated to “NAC”)

In this blog, and in most literature on autism, NAC refers to N-Acetylcysteine.

This post is about Carnosine and L-Carnosine, but there is also research on the use of Carnitine and L-Carnitine regarding autism and Retts syndrome.  So double check what is on the label, if you do indeed order some.

Vladimir Gulevich, Carnosine (and Carnitine)

Vladimir Gulevich  received the degree of doctor of medicine in 1896 from the department of medicine of Moscow State University. From 1900, he rejoined the Moscow State University where he was rector for a brief period of time in 1919. He was a full member of the USSR Academy of Sciences since 1929.

Gulevich discovered both Carnosine and Carnitine in his work in Moscow.  Even today his university is a centre of research for both these substances.

Carnitine and carnosine are composed of the root word carn, meaning flesh, alluding to its prevalence in animal protein. A vegetarian (especially vegan) diet is deficient in adequate carnosine, compared to levels found in a standard diet.

Researchers in Britain, South Korea, Russia and other countries have shown that carnosine has a number of antioxidant properties that may be beneficial.

Carnosine has been proven to scavenge reactive oxygen species (ROS) as well as alpha-beta unsaturated aldehydes formed from peroxidation of cell membrane fatty acids during oxidative stress.

Carnosine can chelate divalent metal ions.  DAN Doctors probably do not know what divalent means, but in Hg2+ the “2” means divalent and Hg means mercury.

Carnosine was found to inhibit diabetic nephropathy.

Carnosine-containing products are also used in topical preparations to reduce wrinkles on the skin.

Some studies have detected beneficial effects of N-acetylcarnosine in preventing and treating cataracts of the eyes.

Carnosine and Autism

Small studies, including this one by Michael Chez, have shown the benefit of L-carnosine in autism.  By the way, Chez seems to be one of the handful of genuinely knowledgeable autism clinicians anywhere on the planet.


L-Carnosine, a dipeptide, can enhance frontal lobe function or be neuroprotective. It can also correlate with gamma-aminobutyric acid (GABA)-homocarnosine interaction, with possible anticonvulsive effects. We investigated 31 children with autistic spectrum disorders in an 8-week, double-blinded study to determine if 800 mg L-carnosine daily would result in observable changes versus placebo. Outcome measures were the Childhood Autism Rating Scale, the Gilliam Autism Rating Scale, the Expressive and Receptive One-Word Picture Vocabulary tests, and Clinical Global Impressions of Change. Children on placebo did not show statistically significant changes. After 8 weeks on L-carnosine, children showed statistically significant improvements on the Gilliam Autism Rating Scale (total score and the Behavior, Socialization, and Communication subscales) and the Receptive One-Word Picture Vocabulary test (all P < .05). Improved trends were noted on other outcome measures. Although the mechanism of action of L-carnosine is not well understood, it may enhance neurologic function, perhaps in the enterorhinal or temporal cortex.

As Dr Chez points out, nobody is 100% certain why it is of benefit.  It could just be the anti-oxidant properties of carnosine or it could be something related to the interaction between carnosine and GABA in the brain.  GABA is an important neurotransmitter in the brain.

Other GABA related drugs show a positive effect in types of autism.  These include Baclofen, Arbaclofen, Bumetanide, Clonazepam and even Valproic acid (VPA).  The underlying mechanisms do differ, but all relate, in one way or the other, to GABA.

The Carnosine dosage used by Dr Chez was 800mg per day.

The body deploys a range of enzymes, called carnosinases, to break down carnosine.  In order to maximize the effect, and out-smart the  carnosinases, it might be wise to split the dose into two per day.

In a perfect world it might be simpler to inhibit the carnosinases and just rely on the carnosine from meat in the diet.

You cannot patent naturally occurring substances, so nobody can patent carnosine and no drug firm will therefore research it.  A carnosinase inhibitor could be patented and therefore could be made into a drug.

Carnosine and GABA

It looks like Moscow State University is still the centre of knowledge for Carnosine and Alexander A. Boldyrev recently published a book called:-

Book Description:

The main aim of this new book is to summarize the knowledge on the metabolic transformation of carnosine in excitable tissues of animals and human beings and to analyze the nature of its biological activity. At the beginning of monograph, the short history of the problem is stated. Distribution of carnosine in tissues, its appearance in ontogeny of vertebrates and correlation between carnosine content and functional activity of tissues are discussed. Chemical properties of carnosine and its natural derivatives and their ability to bind heavy metals and protons in water solution are documented. Special attention is paid to free radical quenching ability and to anti-glycating action. Biological activity of carnosine and carnosine containing compounds was tested using biological models of several levels of complexity, starting from individual enzymes and acellular mixtures and finishing to living cells and survival animals. Effects of carnosine on the whole animals under ischemic, hypoxic and other extreme conditions are described. In conclusion, the ability of carnosine to protect brain and muscular tissues from oxidative injury during exhausting exercise, extreme loading or neurodegenerative diseases is demonstrated. Based on these properties, carnosine is postulated to be a potent protector of human beings from oxidative stress.

You can preview much of the book on Google Books

We know from many autism researchers that oxidative stress is a feature of many people’s autism.  Anything that reduces this stress should have a positive effect on behaviour.

Common antioxidants used in autism include:-

·        N-Acetlycysteine (NAC)
·        Alpha Lipoic Acid (ALA)
·        All the many “chelating” substances used by DAN Doctors

Carnosine may be just an alternative anti-oxidant.

However, when you look through Boldyrev’s book, it does look possible that the chemical relationship between GABA and Carnosine many also play a role.


People currently taking Carnosine for Autism might well want to try N-Acetlycysteine (NAC) and see if they notice an additional benefit.  Conversely, the current NAC converts, like my son Monty, aged 11 with ASD, may well want to give Carnosine a try and see what happens.

One blog reader with Asperger’s finds Baclofen highly beneficial; he might as well give Carnosine a try, based on the GABA relationship.

Current research indicates 2,400 mg of NAC and 800 mg of Carnosine. 

It would be nice if one day somebody would do a controlled trial of NAC vs Carnosine vs Carnosine+NAC;  but don’t hold your breath.

Some people with diabetes are already taking ALA (Alpha lipoic acid) or Thioctacid for neuropathy, but find it also increases insulin sensitivity; this means they need less insulin.  They might well find both NAC and Carnosine will further increase insulin sensitivity.  Generally speaking it seems that low insulin sensitivity is bad and high insulin sensitivity is good; but I am no expert on diabetes.

In some counties Carnosine is not available, but you simply can buy it online on Amazon, ebay or many other sites. 

Sunday, 5 May 2013

Stress, Neuroinflammation and Magnolia before bed

In earlier posts we learned about two kinds of stress:-
  • Oxidative stress is a biological stress that is measurable (GSH redox) and has been shown to be present in most autistic people.
  • Psychological stress is a feeling we experience in difficult situations and is measurable by sampling the level of the hormone cortisol in saliva.
It would appear that both types of stress are interrelated.
We have already established that oxidative stress in autism can be successfully be treated with NAC.  NAC acts both as an anti-oxidant in its own right and as a precursor chemical to form GSH, the body’s own antioxidant.  NAC is cheap and widely available.
The scientific literature regarding autism includes many references to inflammation of the brain, or neuroinflammation. It turns out that this inflammation is also measurable.  When samples of cerebrospinal fluid (CSF) are taken, elevated levels of chemicals called cytokines are found.  Certain cytokines are markers for neuroinflammation, such as TGF-ß1 and MCP-1.
In studies at Johns Hopkins, a leading teaching hospital in the US, they have tested all their autistic research subjects for neuroinflammation and they all tested positive.  It also appears that this is the result of on-going damage to the brain, not residual damage from the pre-natal or early post natal period.  Such damage was exhibited in autistic subjects of all ages.  These researchers were also able to locate the part of the brain most affected by neuroinflammation.
“Our study showed the cerebellum exhibited the most prominent neuroglial responses. The marked neuroglial activity in the cerebellum is consistent with previous observations that the cerebellum is a major focus of pathological abnormalities in microscopic and neuroimaging studies of patients with autism. Based on our observations, selective processes of neuronal degeneration and neuroglial activation appear to occur predominantly in the Purkinje cell layer (PCL) and granular cell layer (GCL) areas of the cerebellum in autistic subjects. These findings are consistent with an active and on-going postnatal process of neurodegeneration and neuroinflammation.”
There are numerous other researchers who concur with these findings; the problem is that they do not take the logical next step of finding how to reduce this inflammation.  Indeed John’s Hopkins go as far as to tell us
“At present, THERE IS NO indication for using anti-inflammatory medications in patients with autism. Immunomodulatory or anti-inflammatory medications such as steroids (e.g. prednisone or methylprednisolone), immunosupressants (e.g. Azathioprine, methotrexate, cyclophosphamide) or modulators of immune reactions (e.g. intravenous immunoglobulins, IVIG) WOULD NOT HAVE a significant effect on neuroglial activation because these drugs work mostly on adaptive immunity by reducing the production of immunoglobulins, decreasing the production of T cells and limiting the infiltration of inflammatory cells into areas of tissue injury. Our study demonstrated NO EVIDENCE at all for these types of immune reactions. There are on-going experimental studies to examine the effect of drugs that limit the activation of microglia and astrocytes, but their use in humans must await further evidence of their efficacy and safety” 
Here the researchers were experimenting with various chemical including NAC as an antioxidant.
“Activation of microglia has been implicated in the pathogenesis of a variety of neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), Creutzfeld-Jacob disease, HIV-associated dementia (HAD), stroke, and multiple sclerosis (MS) . It has been found that activated microglia accumulate at sites of injury or plaques in neurodegenerative CNS. Although activated microglia scavenge dead cells from the CNS and secrete different neurotropic factors for neuronal survival, it is believed that severe activation causes inflammatory responses leading to neuronal death and brain injury. During activation, microglia secretes various neurotoxic molecules and express different proteins and surface markers.
Although microglia populate only 2 to 3% of total brain cells in a healthy human being, the number increases up to 12 to 15% during different neurodegenerative diseases. Microglial activation is always associated with neuronal inflammation and ultimately neuronal apoptosis. Although microglial activation may not be always bad as it has an important repairing function as well, once microglia become activated in neurodegenerating microenvironment, it always goes beyond control and eventually detrimental effects override beneficial effects. Therefore, microglial activation is a hallmark of different neurodegenerative diseases and understanding underlying mechanisms for microglial activation is an important area of study. “ 
Another piece of research that looked at activated microglia in a neurological condition (this time Alzheimer’s disease) also used NAC as an antioxidant and anti-inflammatory agent.

Now, to better understand the terminology and the science, a little bit of biology would be useful.  If you wish to skip this part, you can go forward a few pages to the part where I look at practical steps that seem likely to reduce neuroinflammation.
 Here are the key words we need to understand:- 
  • Neurons
  • Neurotransmitters
  • Glial cells
  • Microglia
  • Astrocytes or astroglia
  • Cytokenes

Thanks to Wikipedia I have presented a summary.
 1.  Neurons
A neuron is a cell that processes and transmits information through electrical and chemical signals. A chemical signal occurs via a synapse a specialized connection with other cells. Neurons connect to each other to form neural networks. Neurons are the core components of the CNS (Central Nervous System), which includes the brain and spinal cord. A number of specialized types of neurons exist: sensory neurons respond to touch, sound, light and numerous other stimuli affecting cells of the sensory organs that then send signals to the spinal cord and brain. Motor neurons receive signals from the brain and spinal cord, cause muscle contractions, and affect glansa. Interneurons connect neurons to other neurons within the same region of the brain or spinal cord.


2.  Neurotransmitters - interaction between neurons
A neuron affects other neurons by releasing a neurotransmitter that binds to chemical receptors. The effect upon the postsynaptic neuron is determined not by the presynaptic neuron or by the neurotransmitter, but by the type of receptor that is activated. A neurotransmitter can be thought of as a key, and a receptor as a lock: the same type of key can here be used to open many different types of locks. Receptors can be classified broadly as excitatory (causing an increase in firing rate), inhibitory (causing a decrease in firing rate), or modulatory (causing long-lasting effects not directly related to firing rate).
The two most common neurotransmitters in the brain, and GABA, have actions that are largely consistent. Glutamate acts on several different types of receptors, and have effects that are excitatory at ionotropic receptors and a modulatory effect at metabotropic receptors. Similarly GABA acts on several different types of receptors, but all of them have effects (in adult animals, at least) that are inhibitory. Because of this consistency, it is common for neuroscientists to simplify the terminology by referring to cells that release glutamate as "excitatory neurons," and cells that release GABA as "inhibitory neurons." Since over 90% of the neurons in the brain release either glutamate or GABA, these labels encompass the great majority of neurons.

GABA is very important in autism and we will return to it in greater depth when we will look at the three types of GABA receptors.

3.   Glial cells
Glial cells are non-neuronal cells that maintain homeostasis and provide support and protection for neurons in the brain, and for neurons in other parts of the nervous system such as in the autonomic nervous system.
Four main functions of glial cells have been identified:
  1. To surround neurons and hold them in place,
  2. To supply nutrients and oxygen to neurons,
  3. To insulate one neuron from another,
  4. To destroy pathogens and remove dead neurons.
Glial cells do modulate neurotransmission, although the mechanisms are not yet well understood.

Some glial cells function primarily as the physical support for neurons. Others regulate the internal environment of the brain, especially the fluid surrounding neurons and their synapses, and nutrify neurons. During early embryogenesis glial cells direct the migration of neurons and produce molecules that modify the growth of axons and dendrites. Recent research indicates that glial cells of the hippocampus and cerebellum participate in synaptic transmission, regulate the clearance of neurotransmitters from the synaptic cleft, and release gliotransmitters such as ATP, which modulate synaptic function.
Glial cells were not believed to have chemical synapses or to release transmitters. They were considered to be the passive bystanders of neural transmission. However, recent studies have shown this to be untrue. For example, astrocytes are crucial in clearance of neurotransmitters from within the synaptic cleft, which provides distinction between arrivals of action potentials and prevents toxic build-up of certain neurotransmitters such as glutamate (excitotoxicity). It is also thought that glia play a role in many neurological diseases, including Alzheimer’s disease. Furthermore, at least in vitro, astrocytes can release gliotransmitter glutamate in response to certain stimulation.
Glia have a role in the regulation of repair of neurons after injury. In the CNA (Central Nervous System), glia suppress repair. Glial cells known as astrocytes enlarge and proliferate to form a scar and produce inhibitory molecules that inhibit regrowth of a damaged or severed axon. In the PNS (Peripheral Nervous System), glial cells known as Schwann cells promote repair. After axonal injury, Schwann cells regress to an earlier developmental state to encourage regrowth of the axon. This difference between PNS and PNS raises hopes for the regeneration of nervous tissue in the CNS. For example a spinal cord may be able to be repaired following injury or severance.

4.  Microglia
Microglia are a type of glial cell that are the resident macrophages of the brain and spinal cord, and thus act as the first and main form of active immune defense in the CNS. Macrophages are highly specialized in removal of dying or dead cells and cellular debris. This role is important in chronic inflammation, as the early stages of inflammation are dominated by neutrophil granulocytes, which are ingested by macrophages if they come of age.
Microglia constitute 20% of the total glial cell population within the brain.] Microglia (and astrocytes) are distributed in large non-overlapping regions throughout the brain and spinal cord.  Microglia are constantly scavenging the CNS for plaques, damaged neurons and infectious agents. The brain and spinal cord are considered "immune privileged" organs in that they are separated from the rest of the body by a series of endothelial cells known as the blood brain barrier (BBB), which prevents most infections from reaching the vulnerable nervous tissue. In the case where infectious agents are directly introduced to the brain or cross the blood–brain barrier, microglial cells must react quickly to decrease inflammation and destroy the infectious agents before they damage the sensitive neural tissue. Due to the unavailability of antibodies from the rest of the body (few antibodies are small enough to cross the blood brain barrier), microglia must be able to recognize foreign bodies, swallow them, and act as antigen presenting cells activating T-cells. Since this process must be done quickly to prevent potentially fatal damage, microglia are extremely sensitive to even small pathological changes in the CNS. They achieve this sensitivity in part by having unique potassium channels that respond to even small changes in extracellular potassium.
5.  Astrocytes or astroglia,
Astrocytes or astroglia are characteristic star-shaped glial cells in the brain and spinal cord. They are the most abundant cell of the human brain. They perform many functions, including biochemical support of endothelial cells that form the blood-brain barrier, provision of nutrients to the nervous tissue, maintenance of extracellular ion balance, and a role in the repair and scarring process of the brain and spinal cord following traumatic injuries.
Research since the mid-1990s has shown that astrocytes propagate intercellular Ca2+- waves over long distances in response to stimulation, and, similar to neurons, release transmitters (called gliotransmitters) in a Ca2+-dependent manner. Data suggest that astrocytes also signal to neurons through Ca2+-dependent release of glutamate. Such discoveries have made astrocytes an important area of research within the field of neuroscience..
Previously in medical science, the neuronal network was considered the only important one, and astrocytes were looked upon as gap fillers. More recently, the function of astrocytes has been reconsidered, and are now thought to play a number of active roles in the brain, including the secretion or absorption of neural transmitters and maintenance of the blood–brain barrier.  Following on this idea the concept of a "tripartite synapse" has been proposed, referring to the tight relationship occurring at synapses among a presynaptic element, a postsynaptic element and a glial element.
  • Structural: They are involved in the physical structuring of the brain. Astrocytes get their name because they are "star-shaped". They are the most abundant glial cells in the brain that are closely associated with neuronal synapses. They regulate the transmission of electrical impulses within the brain.
  • Glycogen fuel reserve buffer: Astrocytes contain glycogen and are capable of glycogenesis. The astrocytes next to neurons in the frontal cortex and hippocampus store and release glycogen. Thus, Astrocytes can fuel neurons with glucose during periods of high rate of glucose consumption and glucose shortage. Recent research suggests there may be a connection between this activity and exercise.
  • Metabolic support: They provide neurons with nutrients such as lactate.
  •  Blood-brain barrier: The astrocyte end-feet encircling endothelial cells were thought to aid in the maintenance of the blood–brain barrier, but recent research indicates that they do not play a substantial role; instead, it is the tight junctions and basal lamina of the cerebral endothelial cells that play the most substantial role in maintaining the barrier. However, it has recently been shown that astrocyte activity is linked to blood flow in the brain, and that this is what is actually being measured in fMRI.
  • Transmitter uptake and release: Astrocytes express plasma membrane transporters such as glutamate transporters for several neurotransmitters, including glutamate, ATP, and GABA. More recently, astrocytes were shown to release glutamate or ATP in a vesicular, Ca2+-dependent manner.
  •  Regulation of ion concentration in the extracellular space Astrocytes express potassium channels at a high density. When neurons are active, they release potassium, increasing the local extracellular concentration. Because astrocytes are highly permeable to potassium, they rapidly clear the excess accumulation in the extracellular space. If this function is interfered with, the extracellular concentration of potassium will rise, leading to neuronal depolarization by the Goldman equation. Abnormal accumulation of extracellular potassium is well known to result in epileptic neuronal activity.
  • Vasomodulation: Astrocytes may serve as intermediaries in neuronal regulation of blood flow.
  • Nervous system repair: Upon injury to nerve cells within the central nervous system, astrocytes fill up the space to form a glial scar, repairing the area and replacing the CNS cells that cannot regenerate.
  • Long-term potentiation: Scientists continue to argue back and forth as to whether or not astrocytes integrate learning and memory in the hippocampus. It is known that glial cells are included in neuronal synapses, but many of the LTP studies are performed on slices, so scientists disagree on whether or not astrocytes have a direct role of modulating synaptic plasticity.
6.  Cytokines
Cytokines are small signaling molecules used for cell signaling.  The term cytokine encompasses a large and diverse family of regulators produced throughout the body by cells of diverse embryological origin.
The term cytokine has been used to refer to the immunomodulating agents, such as interleukins and interferons. Biochemists disagree as to which molecules should be termed cytokines and which hormones. As we learn more about each, anatomic and structural distinctions between the two are fading. Classic protein hormones circulate in nanomolar (10-9M) concentrations that usually vary by less than one order of magnitude. In contrast, some cytokines (such as IL-6) circulate in picomolar (10-12M) concentrations that can increase up to 1,000-fold during trauma or infection. The widespread distribution of cellular sources for cytokines may be a feature that differentiates them from hormones. Virtually all nucleated cells, but especially endo/epithelial cells and resident macrophages (many near the interface with the external environment) are potent producers of IL-1, IL-6, and TNF-a. In contrast, classic hormones, such as insulin, are secreted from discrete glands (e.g., the pancreas).  As of 2008, the current terminology refers to cytokines as immunomodulating agents. However, more research is needed in this area of defining cytokines and hormones.
Part of the difficulty with distinguishing cytokines from hormones is that some of the immunomodulating effects of cytokines are systemic rather than local. Further, as molecules, cytokines are not limited to their immunomodulatory role. For instance, cytokines are also involved in several developmental processes during embyrogenesis.

Several inflammatory cytokines are induced by oxidant stress. The fact that cytokines themselves trigger the release of other cytokines and also lead to increased oxidant stress makes them important in chronic inflammation, as well as other immunoresponses, such as fever and acute phase proteins of the liver (IL-1,6,12, INF-a).
Practical Steps to reduce neuroinflammation
Neuroscience is both complex and an evolving science; much remains unknown and so often there cannot be definite answers; rather judgements based on the balance of probabilities.
What is clear is that in autism we have oxidative stress and inflammation.  There also appears to be a vicious circle where the inflammation messenger itself makes that inflammation worse.  In some cases, it is the oxidative stress that triggers the inflammation; in other cases the inflammation may have other causes.
A more complex explanation relates to where the signal to the microglia came from in the first place.  Mast cells from the immune system are proposed to be the source of this signal.
For the time being let us focus on the simpler solution; that the anti-oxidant should also be the anti-inflammatory agent.  Surprise, surprise, our friend NAC is being used in numerous studies as the anti-inflammatory agent.
This is good news for Monty; it may be that NAC is not just reducing his state of oxidative stress, but gradually his neuroinflammation as well.  It certainly does seem to be doing him good.  As indicated in the research, the effect of NAC seems to be highly dose dependent.
But not to have all our eggs in one basket, it would be nice to have another anti-neuroinflammatory agent.  It seems there is one at hand, but we have to look to the East to find it.
The bark of the magnolia tree has been used in Korean, Chinese and Japanese medicine for more than a thousand years.  It seems that one compound in particular within magnolia, obovatol, has powerful properties to reduce neuroinflammation.
In another paper
and another
This is all experimental but it is clear that in theory at least, obovatol looks very interesting.
For a wider view of the medical properties of the magnolia family, there is an excellent paper from Korea that reviews the possible mechanisms. Therapeutic applications of compounds in the Magnolia family
 The proposed benefits are in the treatment of:- 
  • cancer
  • neuronal disease
  • inflammatory disease
  • cardiovascular disease 
The four active compounds are: 
  1. magnolol
  2. honokiol
  3. 4-O-methylhonokiol
  4. obovatol 
Also, anxiolytic-like effects of obovatol appeared to be mediated by the GABA benzodiazepine receptor Cl− channel opening and obovatol potentiated pentobarbital-induced sleeping time through GABA receptors/Cl− channel activation.

This data suggest that components of Magnolia could be used for treating anxiety, and its effect may be linked to GABA receptor/Cl− channel activation. 
Anti-inflammatory mechanisms of Magnolia have been reported to be associated with the suppression of NO production, the expression of iNOS, IL-1β, TNF-α and COX, the generation of prostaglandins, thromboxanes and leukotrienes, and the activation of MAPKs, AP-1 and NF-κB.
Magnolia Bark Extract
Magnolia bark extract is extensively produced in China and sold inexpensively by the supplement industry.  The individual compounds could be separated, as in the Korean research, but the extract that is sold is just a mixture of what happened to be in that batch of bark.  If you read the reviews, it seems that many people experience a reduction in cortisol allowing them to sleep better; reduced anxiety is widely reported.  It even seems to stop some people snoring, which I am certainly all in favour of.
So while it is far from the scientific basis on which you could use NAC, it would seem that Magnolia bark extract will unlikely do harm and just might do some good as an anti-neuroinflammatory agent.  In about 20 years, the research will show whether you were wasting your money, or whether you were a pioneering early-adopter.
I think I will do some primary research on this one and be a pioneer.