AniracetamvsNAC (N-Acetyl Cysteine)

Aniracetam is a positive allosteric modulator of AMPA receptors, binding to the allosteric site and slowing receptor desensitization, which prolongs excitatory postsynaptic currents and facilitates long-term potentiation. It also modulates group II metabotropic glutamate receptors (mGluR2/mGluR3), which regulate presynaptic glutamate release. Uniquely among racetams, aniracetam increases dopamine and serotonin release in the prefrontal cortex via modulation of monoamine transporter activity and vesicular release, contributing to its anxiolytic and mood-enhancing effects. It reduces GABAergic inhibition in the hippocampus through indirect modulation of GABA-A receptors, facilitating NMDA receptor activation and memory consolidation. The lipophilic phenylacetyl group enables rapid blood-brain barrier penetration.

NAC provides cysteine, the rate-limiting substrate for glutathione (GSH) synthesis via gamma-glutamylcysteine ligase (GCLC) and glutathione synthetase (GSS). GSH is the primary intracellular antioxidant, essential for GPx and GST-mediated detoxification of reactive oxygen species in neurons. NAC also modulates glutamate via the cystine-glutamate antiporter (System Xc-, composed of xCT and 4F2hc) — NAC is deacetylated to cysteine, which exchanges for glutamate; the increased extracellular cystine is reduced to cysteine intracellularly, while the exchange increases extrasynaptic glutamate, which activates inhibitory mGlu2/3 autoreceptors on presynaptic terminals, reducing excessive glutamatergic signaling and compulsive behaviors. This glutamate modulation is the basis for psychiatric applications (OCD, addiction). NAC may also directly modulate NMDA receptors via redox sites.