acetylcysteine solution / Generic mfg. - LARVOL DELTA

Severe Pembrolizumab-Induced Liver Injury: Subacute Hepatic Necrosis (ACG 2025) - "This case highlights the presentation, diagnosis and treatment of severe subacute pembrolizumab-induced hepatitis.Case Description/ A 41-year-old female with a history of triple negative breast cancer treated with neoadjuvant therapy (doxorubicin and pembrolizumab, last infusion 2 months prior) and lumpectomy was referred to the hepatology department for severe asymptomatic hepatocellular transaminitis...N-acetylcysteine was initiated however, discontinued due to hyperemesis...Mycophenolate mofetil (MMF) was initiated after three days of steroid therapy due to inadequate biochemical response...This case demonstrates the potential severity of subacute ICI hepatotoxicity following treatment completion, educating clinicians to consider ICI hepatitis in patients presenting with transaminitis and with a history of immune checkpoint inhibitor use.Figure: Histopathology of liver biopsy. Hematoxylin-eosin staining showing portal inflammation with bridging necrosis and..."

Autoimmune Hepatitis • Breast Cancer • Cytomegalovirus Infection • Hepatitis C • Hepatology • Herpes Simplex • Immunology • Infectious Disease • Liver Failure • Solid Tumor • Triple Negative Breast Cancer

Checkpoint and Checkmate: Concurrent Immune-Mediated Hepatitis and HBV Reactivation in a Cancer Patient (ACG 2025) - "She was receiving Pembrolizumab and Lenvatinib for her RCC...She was started on treatment for hepatitis B reactivation with Tenofovir and N-Acetylcysteine (NAC)...After a multidisciplinary discussion, she was initiated on Solumedrol 1 g/kg in addition to continuing her Tenofovir. Thereafter, the patient's LFTs and INR rapidly improved, and she was transitioned to oral prednisone taper...Therefore, it is imperative to check hepatitis B serologies before immunosuppression and initiate antiviral prophylaxis when indicated. Unfortunately, our patient did not have her serologies checked before starting treatment.Figure: Figure 1, H&E image showing acute hepatitis pattern of injury with lobular disarray, inflammation, hepatocyte swelling, and many acidophil bodiesFigure: Figure 2, Hepatitis B stain image showing the positive staining for hepatitis B (brown color in the hepatocytes)"

Clinical • Genito-urinary Cancer • Hepatitis B • Hepatitis C • Hepatology • Infectious Disease • Liver Failure • Oncology • Renal Cell Carcinoma • Solid Tumor

JAK2/STAT3 Signaling Pathway Modulates Acute Methylmercury Toxicity in the Mouse Astrocyte C8-D1A Cell Line. (PubMed, Neurochem Res) - "Our data demonstrated that pharmacological inhibition of STAT3 using AG490 or C188-9 exacerbated MeHg-induced cell death and compromised antioxidant responses. Furthermore, to fully characterize the role of STAT3 in oxidative stress, we used two different antioxidants, N-acetylcysteine (NAC) and Trolox. Conversely, reactive oxygen species (ROS)-scavenging antioxidants partially ameliorated STAT3 activation, suggesting that MeHg-induced STAT3 activation is mediated, at least in part, by mechanisms independent of ROS. Our findings suggest that STAT3 contributes to neuroprotection against MeHg exposure in astrocytes and is, at least in part, regulated by the increase in ROS levels within these cells."

Journal • Preclinical • CNS Disorders • Inflammation

A Rare Manifestation of Immune Checkpoint Inhibitor Toxicity (ACG 2025) - "Their use has significantly increased since ipilimumab was approved in 2011 for metastatic melanoma...We present a case of immune-mediated cholangitis (IMC) induced by ICI.Case Description/ An 80-year-old female with metastatic endometrial cancer presented to the emergency department with encephalopathy due to hydrocodone-acetaminophen taken for cancer-related pain. She took a 1-week course of trimethoprim-sulfamethoxazole (TMP-SMX) and completed pembrolizumab cycle 19 3 weeks prior to presentation...N-acetylcysteine and antibiotics were prescribed on admission...There are some data to suggest ursodiol may provide added benefit. Further research is necessary to provide diagnostic and management guidance. Figure: CT with contrast demonstrating bile duct thickeningFigure: ALP trend following initiation of glucocorticoids on Day 2"

Checkpoint inhibition • CNS Disorders • Endometrial Cancer • Gastrointestinal Disorder • Hepatology • Immunology • Melanoma • Oncology • Solid Tumor

Protective effect of N-acetylcysteine in doxorubicin-induced primary ovarian failure in female rats. (PubMed, Turk J Obstet Gynecol) - "NAC preserved ovarian reserve and follicular integrity by suppressing oxidative stress, inflammation, and apoptosis induced by DOX. These findings highlight NAC as a promising protective agent against chemotherapy-induced ovarian toxicity."

Journal • Preclinical • Hematological Disorders • Infertility • Oncology • Sexual Disorders • CASP3 • PCNA • TNFA

Case Report: Probable Drug-Induced Liver Injury Due to Heart-Leaved Moonseed (ACG 2025) - "The patient received a 72-hour N-acetylcysteine protocol without clinicalimprovement. Because liver tests remained abnormal and autoimmune markers were positive,corticosteroid therapy was started: intravenous Solu-Medrol followed by an oral prednisone taper...Althoughreported cases of liver injury are rare, T. cordifolia has the potential to cause acute hepatitis, oftenpresenting with features resembling autoimmune hepatitis. Thus, careful monitoring for adverse effectsis warranted in patients using T. cordifolia.Figure: (A) Heart-Leaved Moonseed Cited from https://famepharma.com/heart-leaved-moonseed"

Case report • Clinical • Autoimmune Hepatitis • Cardiovascular • Diabetes • Dyslipidemia • Hepatology • Hypertension • Immunology • Inflammation • Liver Failure • Metabolic Disorders • Type 2 Diabetes Mellitus

Multimodal single-cell transcriptomics with patient-specific iPSC-derived airway organoids as a drug screening approach for cystic fibrosis with nonsense mutations. (PubMed, Biomed Pharmacother) - "Utilizing multimodal single-cell transcriptomics with the ASGARD framework, we found that nintedanib, N-acetylcysteine, and losartan were associated with attenuation of the TNF-α pathway in CF with nonsense mutations. This CF-3D airway organoid model recapitulates aspects of pathogenesis at the single-cell level and serves as a platform for evaluating therapeutics targeting CFTR nonsense mutations."

Journal • Cystic Fibrosis • Genetic Disorders • Immunology • Pulmonary Disease • Respiratory Diseases • CFTR • EGF • TGFB1 • TNFA

A 2-System Toxicity: Drug-Induced Liver Injury Leading to Bone Marrow Failure (ACG 2025) - "He was treated with N-acetylcysteine, resulting in gradual improvement of liver function...The patient was started on eltrombopag (150 mg daily) and continued receiving platelet transfusions...Treatment typically includes transfusions, immunosuppressive therapy, hematopoietic growth factors, and bone marrow transplantation. This case underscores the importance of recognizing supplements as potential triggers of systemic toxicity and highlights the need for further research to guide clinical management of HAAA."

Anemia • Aplastic Anemia • Bone Marrow Transplantation • Dermatology • Hepatology • Immunology • Infectious Disease • Liver Failure • Neutropenia • Pruritus • Thrombocytopenia

Transtympanic Injection of Antioxidant-Eluting Microparticles for Otoprotection From Cisplatin Toxicity in a Mouse Model. (PubMed, Otolaryngol Head Neck Surg) - "Transtympanic N-acetylcysteine microparticle injections provided functional otoprotection in cisplatin-exposed mice."

Journal • Preclinical • Otorhinolaryngology

TB-MET-NAC: A Trial of 2 Disease-Modifying Drugs (Metformin and N-acetylcysteine ) to Promote TB Lung Function Recovery (clinicaltrials.gov) - P3 | N=1104 | Not yet recruiting | Sponsor: Open Source Pharma Foundation

New P3 trial • Infectious Disease • Pulmonary Disease • Respiratory Diseases • Tuberculosis

Damnacanthus giganteus extract block diffuse large b-cell lymphoma proliferation and EMT by regulating mitochondrial dysfunction and glycolysis. (PubMed, Hereditas) - "‌Our study demonstrates for the first time that DGE effectively suppresses tumor proliferation and EMT during DLBCL progression. These antitumor effects appear to be mediated through modulation of mitochondrial function and glycolysis. These findings position DGE as a promising novel therapeutic candidate for DLBCL treatment, meriting immediate clinical translation and further evaluation."

Journal • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Hematological Malignancies • Lymphoma • Metabolic Disorders • Non-Hodgkin’s Lymphoma • Oncology • Transplantation • ANXA5 • CDH2 • VIM

Rapid-Onset Liver Failure After First Risankizumab Infusion: Successful Treatment With N-Acetylcysteine (ACG 2025) - "Dobutamine and N-acetylcysteine was added, and steroids continued...While biologics like Infliximab and Adalimumab have more documented hepatic adverse events, Risankizumab's tertiary data is evolving...N-acetylcysteine has been shown to improve outcomes in non-acetaminophen acute liver failure and was used here effectively. With inpatient data, patient scored 5 on the Naranjo scale, indicating possible relation to prior Il-23 infusion.Figure: Fig 1: Trend of hepatic function testing."

Acute Kidney Injury • Atrial Fibrillation • Autoimmune Hepatitis • Cardiovascular • CNS Disorders • Congestive Heart Failure • Crohn's disease • Fibrosis • Gastroenterology • Heart Failure • Hepatology • Immune Modulation • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Ischemic stroke • Liver Failure • Metabolic Disorders • Nephrology • Renal Disease • IL23A

Acute Liver Failure From Acetaminophen Toxicity in the Setting of Concurrent Alcohol and Rifampin Use (ACG 2025) - "The acetaminophen level was 96 mcg/mL ~12 hours post-ingestion, and N-acetylcysteine (NAC) therapy initiated...After discharge, he started ethambutol and moxifloxacin for latent TB treatment. Our case emphasizes the elevated risk of severe hepatotoxicity from acetaminophen in combination with certain classes of medications...Furthermore, concurrent alcohol use can further exacerbate this potential. This case highlights the importance of understanding high-risk medication interactions in at-risk individuals using acetaminophen."

CNS Disorders • Crohn's disease • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Liver Failure • Respiratory Diseases • Tuberculosis • CYP2E1 • CYP3A4

Cardioprotective Effects of SAR Through Attenuating Cardiac-Specific Markers, Inflammatory Markers, Oxidative Stress, and Anxiety in Rats Challenged with 5-Fluorouracil. (PubMed, J Xenobiot) - "This study aimed to evaluate the cardioprotective effects of two different doses of saroglitazar (SAR) in an animal model of cardiotoxicity induced by 5-fluorouracil (5-FU). Thirty-five rats were randomly allocated into five groups: the negative control, which received distilled water; the 5-FU (150 mg/kg as I.P.) group; the N-acetylcysteine (100 mg/kg) group; and the SAR (0.5 and 5 mg/kg) groups...These findings render SAR a promising candidate to be tested in clinical trials. Further studies are warranted with other cardiotoxicants to confirm these findings."

Journal • Preclinical • Cardiovascular • Inflammation • Psychiatry • IL1B • TNFA

Efficacy of N-Acetyl Cysteine in the Treatment of Burning Mouth Syndrome-A Randomized Controlled Trial. (PubMed, Dent J (Basel)) - "N-acetylcysteine (NAC) is an antioxidant that exhibits neuroprotective properties...However, the difference between the treatment and control group was not statistically significant. NAC does not significantly improve the oral health-related quality of life, burning sensations, and discomfort in BMS subjects compared to placebo."

Journal • Neuralgia • Pain

Evaluation of the protective effect of Benfotiamine against neurotoxic effects, depression and oxidative stress induced by noise exposure. (PubMed, Sci Rep) - "Benfotiamine also appears to be more effective than N-acetylcysteine in reducing noise exposure effects. The findings confirm that noise contributes to oxidative stress in the brain and the development of depressive-like behaviors, while also highlighting the protective effects of Benfotiamine against noise-induced damage."

Journal • CNS Disorders • Depression • Mood Disorders • Psychiatry

Naphthalene exposure inhibits osteogenic differentiation via the reactive oxygen species-ubiquitin pathway. (PubMed, Ecotoxicol Environ Saf) - "Naphthalene enhanced the intracellular reactive oxygen species level and suppressed nuclear expression of β-catenin signaling and its target molecules, including glycogen synthase kinase 3β, cyclin D1, and c-Myc, and these proteins were restored by treatment with the antioxidant N-acetylcysteine. Treatment with lithium chloride and MG132 confirmed that naphthalene-induced reactive oxygen species generation increased GSK3β activity, thereby promoting the proteasomal degradation of β-catenin and suppressing osteogenic activity in MG-63 cells...In conclusion, this study is the first to demonstrate the inhibitory effects of naphthalene on osteogenic differentiation in MG-63 cells, as validated using a 3D spheroid model. Further research on the molecular mechanisms underlying naphthalene's effects, particularly its role in the Wnt/β-catenin/GSK3β pathway, is needed."

Journal • Targeted Protein Degradation • CCND1 • MYC • SPP1

Biochemical Profiling and Protective Effects of Scutellaria litwinowii Against AlCl3-Induced Neurotoxicity in PC12 Cells. (PubMed, J Ethnopharmacol) - "This research suggests that S. litwinowii and baicalein may serve as protective agents against oxidative stress and apoptosis-related cell damage."

Journal • Alzheimer's Disease • CNS Disorders • Infectious Disease • Inflammation • Pain • BIRC5 • CTNNB1

Dihydromikanolide Inhibits ROS-Mediated NLRP3 Inflammation via Antioxidant Nrf2 Activation and Mitophagy Induction in LPS/ATP-Stimulated Macrophages. (PubMed, J Cell Mol Med) - "Interestingly, LPS/ATP-stimulated NLRP3 inflammasome and IL1β expression were inhibited by DHK, Mito-TEMPO (a mitochondrial ROS inhibitor), or N-acetylcysteine (a ROS inhibitor)...DHK alleviated LPS-induced pathological alterations of lung through inhibiting NLRP3 inflammation, enhancing antioxidant Nrf2 pathway and inducing mitophagy in LPS-stimulated BALB/c mice. Dihydromikanolide may be a potential therapeutic agent for inflammatory diseases."

IO biomarker • Journal • Inflammation • Respiratory Diseases • BCL2 • BECN1 • IL1B • NLRP3 • NQO1 • PI3K • SQSTM1 • TNFA

Mitophagy Activation by N-Acetylcysteine Protects against Mic60 Deficiency-Induced Auditory Neuropathy. (PubMed, Neurosci Bull) - "NAC treatment preserves mitochondrial integrity and rescues hearing by enhancing mitophagy. Our findings establish Mic60+/- mice as an AN animal model, highlight the role of Mic60 in the mitochondria of primary auditory neurons, and identify NAC as a potential AN treatment."

Journal • CNS Disorders • Otorhinolaryngology • Pain

From Transplant Candidate to Recovery: A Case of Severe Acetaminophen Overdose With Multisystem Involvement (ACG 2025) - "Continuous N-acetylcysteine (NAC) therapy was initiated...Abdominal ultrasound demonstrated hepatic steatosis.Figure: Figure 2. EKG showed ST elevations in inferolateral leads, likely due to myopericarditis secondary to liver injury."

Clinical • Cardiovascular • Hematological Disorders • Hepatology • Immunology • Inflammation • Liver Failure • Psychiatry • Renal Disease • Thrombocytopenia • Transplantation

Running into Trouble: A Case of Acute Liver Failure From Severe Rhabdomyolysis After a Marathon (ACG 2025) - "We present the case of a healthy young adult who developed acute fulminant liver failure and renal failure following marathon-associated heat stroke and rhabdomyolysis, possibly exacerbated by Adderall use.Case Description/ A 21-year-old male with a history of ADHD on Adderall presented with altered mental status during a marathon after reportedly ingesting Adderall mid-race...The patient was treated with N-acetylcysteine, hemodialysis, lactulose, and supportive ICU care...While rhabdomyolysis is typically associated with renal complications, this case underscores its potential to precipitate acute liver failure. Prompt recognition, early ICU intervention, and multidisciplinary management can lead to full recovery even in fulminant presentations.Figure: Figure 1: Pathology image showing hepatic fibrosis."

Clinical • Acute Kidney Injury • ADHD (Impulsive Aggression) • Attention Deficit Hyperactivity Disorder • Cardiovascular • CNS Disorders • Fibrosis • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Liver Failure • Nephrology • Psychiatry • Renal Disease

Drug-Induced Liver Injury From Off-Label Fenbendazole Use in Metastatic Breast Cancer: A Case Report (ACG 2025) - "Hepatology was consulted for presumed DILI and N-acetylcysteine was empirically initiated to aid with liver function recovery...However, systematic safety evaluation and patient education are urgently needed.Figure: The medication the patient was taking, image provided by her son. Fenbendazole is easily available over the counter as canine dewormer.Figure: LFTs trended over patient's hospital course."

Case report • Clinical • Metastases • Breast Cancer • CNS Disorders • Hepatic Encephalopathy • Hepatocellular Cancer • Hepatology • HER2 Breast Cancer • HER2 Positive Breast Cancer • Infectious Disease • Liver Failure • Oncology • Solid Tumor • HER-2 • PGR

Significantly Elevated Transaminases in a Patient With Norovirus Infection (ACG 2025) - "Gastroenterology was consulted, and recommended N-acetylcysteine for empiric management of the acute liver injury...To our knowledge, this is the first case report demonstrating a rise of this magnitude with regard to AST and ALT levels in a patient with norovirus infection. Although this association is rare, clinicians should consider acute liver injury as a possible extra-intestinal manifestation of norovirus infection.Figure: The trend of transaminase levels throughout hospitalization, with a notable peak in AST and ALT around day 10."

Clinical • Gastroenterology • Gastrointestinal Disorder • Hepatology • Infectious Disease • Inflammation • Liver Failure

The Perfect Storm: Aspirin-Induced Liver Injury in Epstein-Barr Virus Mononucleosis Complicated by Cold Agglutinin Hemolytic Anemia (ACG 2025) - "Due to initial diagnostic uncertainty and significant transaminase elevation, she was empirically treated with intravenous N-acetylcysteine. Repeat laboratory testing showed resolved anemia and near normal liver function tests. This complex case highlights a unique presentation of severe liver injury suspected to be triggered by aspirin in the setting of acute EBV infection complicated by cold agglutinin hemolysis. While Reye syndrome is a well-recognized clinical entity involving liver injury in children given aspirin for viral illness, this case suggests that young adults may also experience idiosyncratic liver toxicity in this setting, particularly in the immunologically active milieu of acute EBV infection.Figure: Table 1: Relevant laboratory values at specific timepoints following day of aspirin intake"

Anemia • Autoimmune Hemolytic Anemia • Epstein-Barr Virus Infections • Hematological Disorders • Hepatology • Infectious Disease • Inflammation • Liver Failure • HP