acetylcysteine solution / Generic mfg. - LARVOL DELTA

N-acetylcysteine restores osteogenesis in human periodontal ligament stem cells by attenuating HIF-1α-driven oxidative stress and glycolytic reprogramming. (PubMed, J Dent Sci) - "Cells were treated with the antioxidant N-acetylcysteine (NAC), the glycolysis inhibitor 2-deoxy-d-glucose (2-DG), or the PI3K inhibitor LY294002. HIF-1α stabilization suppresses hPDLSC osteogenesis by inducing both oxidative stress and pathological glycolytic reprogramming. Targeted antioxidant intervention effectively mitigates these impairments, highlighting the ROS/PI3K/Akt/HIF-1α axis as a key link between redox imbalance and metabolic dysfunction, and suggesting a potential therapeutic target for periodontal regeneration."

Journal • Dental Disorders • Metabolic Disorders • Periodontitis • HIF1A • RUNX2 • SLC2A1

Trimethylamine N-oxide, a Gut Microbiota Metabolite, Promotes Diabetes-Mediated Erectile Dysfunction via a PANoptotic-Like Process Involving Pyroptosis, Apoptosis, and Necroptosis in CCSMCs. (PubMed, Andrology) - "Gut microbiota dysbiosis in T1DMED rats was associated with elevated serum TMAO, and TMAO triggered a PANoptotic-like process in CCSMCs via PI3K/Akt activation, thereby contributing to the progression of DMED."

Journal • Diabetes • Erectile Dysfunction • Gastrointestinal Disorder • Metabolic Disorders • Type 1 Diabetes Mellitus • CASP3 • CASP8 • NOS3

A Double-Edged Sphere: When Yttrium-90 Leads to Radioembolization-Induced Liver Disease (ACG 2026) - "Two months prior, he underwent two sessions of Y-90 radioembolization spaced two months apart, followed by approximately one month of fruquintinib therapy...The patient received vitamin K and N-acetylcysteine, but bilirubin did not improve...Defibrotide was considered for the overlapping REILD and VOD/SOS picture but was deferred due to limited evidence outside stem cell transplant populations and a high bleeding potential, with risks outweighing benefits...Serial changes in liver function tests reflecting progressive hepatic synthetic dysfunction following Y-90 radioembolization Figure: Graph 2. Progressive changes in hepatic biochemical markers during inpatient management"

CNS Disorders • Colorectal Cancer • Hepatic Encephalopathy • Hepatitis B • Hepatitis C • Hepatology • Infectious Disease • Liver Cancer • Liver Failure • Nephrology • Renal Disease • Solid Tumor

Epigallocatechin Gallate Modulates the Cellular Response to Doxorubicin in HeLa Cervical Cancer Cells. (PubMed, Biomolecules) - "Complementary assays evaluated membrane integrity, wound closure, apoptosis, cell-cycle distribution, intracellular DCF-associated fluorescence with or without N-acetylcysteine (NAC) pretreatment, caspase-3 immunoreactivity, and EGFR, FOXP3, CASP3, and CASP7 mRNA expression. Overall, EGCG and DOX exhibited synergistic interactions and multiple treatment-associated cellular and transcriptional responses in HeLa cells under the present in vitro conditions. These findings do not establish cancer-specific selectivity or a definitive molecular mechanism but provide a basis for validation in additional cervical cancer models and at clinically relevant exposures."

Journal • Cervical Cancer • Oncology • Solid Tumor • CASP3 • CASP7 • EGFR • FOXP3

Effects of the Supplementation of N-acetylcysteine on Redox Imbalance, Cytokine Levels, and Perinatal Outcomes in Pregnant Women with Preeclampsia: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. (PubMed, Pharmaceuticals (Basel)) - " NAC supplementation did not impact the mode of delivery between the NAC and placebo groups. As a secondary exploratory finding, a possible trend toward prolonged gestational age was observed in the NAC group; however, this result should be interpreted with caution, given the exploratory nature of the analysis, the neutrality of the primary outcome, and the limited sample size."

Journal • Gynecology • Obstetrics

Oxidative Stress as a Pathophysiological Core of Obesity: Preclinical Evidence for Antioxidant-Based Therapy Strategies. (PubMed, Pharmaceuticals (Basel)) - "This review synthesizes preclinical evidence for diverse interventions, including vitamins A, B, C, E, and D; minerals such as zinc and selenium; amino acids such as N-acetylcysteine (NAC), L-carnitine, and taurine; various antioxidant compounds; and approved drugs including metformin, exenatide, fenofibrate, and orlistat. Despite differing structures and mechanisms, these interventions converge on restoring redox balance by activating nuclear factor erythroid 2-related factor 2 (Nrf2)/AMP-activated protein kinase (AMPK), increasing glutathione, and stabilizing mitochondria. However, translation of these preclinical findings into clinical practice requires further clarification of dosing, delivery methods, and long-term safety."

Journal • Preclinical • Review • Genetic Disorders • Inflammation • Metabolic Disorders • Obesity • AMPK • CAT

Development and Evaluation of a Novel Inhalable Liposomal Powder Co-Encapsulating ASSNAC and Pirfenidone via Spray Freeze-Drying for Targeted Pulmonary Fibrosis Therapy. (PubMed, Pharmaceuticals (Basel)) - "S-Allylmercapto-N-acetylcysteine (ASSNAC) has been demonstrated to possess significant anti-inflammatory and antioxidant properties. Pulmonary administration avoids oral pirfenidone-induced liver and stomach toxicity. Collectively, the ASSNAC + PFD co-encapsulated liposomal dry powder produced by SFD represents a safe and efficacious therapeutic strategy for PF."

Journal • Fibrosis • Hematological Disorders • Immunology • Pulmonary Disease • Respiratory Diseases • TGFB1

The Oxidative-Mitochondrial-Inflammatory Axis in Retinitis Pigmentosa: Extracellular mtDNA as Biomarker and Therapeutic Read-Out. (PubMed, Antioxidants (Basel)) - "In this review we appraise oxidative biomarkers in RP, propose extracellular mtDNA as a candidate biomarker of disease activity, and examine antioxidant and redox-modulating therapies-from N-acetylcysteine and elamipretide trials to DAMP-sensor inhibition-across experimental and clinical models. Finally, we propose extracellular mtDNA as a candidate pharmacodynamic endpoint and outline a path toward its validation."

Biomarker • Journal • Review • Genetic Disorders • Inflammation • Inherited Retinal Dystrophy • Metabolic Disorders • Ocular Inflammation • Ophthalmology • Retinal Disorders • Retinitis Pigmentosa • NLRP3 • STING • TLR9

N-Acetylcysteine as a Bacterial Antibiofilm Adjuvant: Mechanisms, Synergistic Combinations and Clinical Translation. (PubMed, Life (Basel)) - "The main limitations (pH dependence, instability, low oral bioavailability) are critically evaluated, and approaches to overcoming them using nanoparticles, hydrogels, and combinations with propolis or chitosan are proposed. The review is intended for researchers in antimicrobial chemotherapy and developers of new drug delivery systems."

Journal • Review • Cystic Fibrosis • Genetic Disorders • Immunology • Infectious Disease • Inflammation • Nephrology • Otorhinolaryngology • Pulmonary Disease • Respiratory Diseases • Sinusitis

N-Acetylcysteine Attenuates Amikacin-Induced Biochemical, Inflammatory, and Histopathological Alterations in Mice. (PubMed, Biology (Basel)) - "Importantly, the histopathological assays on renal and cerebral cortex showed NAC caused improvements, with well-shaped tissues, attenuating the cortical histopathological alterations observed in animals treated with amikacin. These findings suggest that NAC may have the potential to attenuate certain biochemical, inflammatory, and histopathological alterations associated with high-dose amikacin exposure."

Journal • Preclinical • Inflammation • CCL11 • CXCL10 • IL18 • IL22 • IL6

Modulation of Caffeine-Induced Behavioral Alterations by N-Acetylcysteine in a Pharmacological Challenge Model. (PubMed, Pharmaceuticals (Basel)) - " Acute caffeine exposure produces behavioral alterations and changes in antioxidant enzyme activity in adult zebrafish. NAC partially attenuates these effects, particularly hyperlocomotion, anxiety-like behavior, and aggression-like responses, while showing more limited effects on caffeine-induced social alterations."

Journal • Mood Disorders • Psychiatry

Superior Gastric Mucosal Visualization With Papain Premedication Before Upper Gastrointestinal Endoscopy: A Randomized Study (ACG 2026) - "Our aim is to evaluate the efficacy and safety of papain as premedication for upper gastrointestinal endoscopy compared with N-acetylcysteine (NAC) plus simethicone and simethicone alone... Buffered papain plus simethicone achieved significantly better mucosal visibility compared with NAC plus simethicone and simethicone alone (TMV: 4.7±1.5 vs 5.7±1.7 vs 5.9±2.1; p=0.001). Patients receiving papain required less water irrigation during endoscopy (0.5±0.9 vs 1.1±1.3 vs 1.5±1.7; p=0.005) and had shorter examination duration (0.6±0.9 vs 1.2±1.11 vs 1.1±1.23; p=0.025). In 71% of patients in the papain group, no additional mucosal washing was necessary."

Clinical • Infectious Disease

Unmasking a Hidden Culprit: Acute Liver Injury Following Angiogram (ACG 2026) - "Persistent elevation prompted N-acetylcysteine (NAC) treatment with resolution of transaminases...Figure: Chart 1. Lab values over the course of 8 days"

Cardiovascular • Coronary Artery Disease • Gastroenterology • Hematological Disorders • Hepatology • Liver Failure • Peripheral Arterial Disease • Thrombosis

Hit and Run Hepatitis: Norovirus as a Potential Trigger for Seronegative Autoimmune Hepatitis (ACG 2026) - "Despite N-acetylcysteine, empiric antibiotics, and vitamin K, LFTs uptrended, and patient was transferred to liver transplant center...She was then transitioned to oral prednisone and discharged...Azithromycin induced liver injury was unlikely, as enzyme elevations occurred before its administration. Altogether, this case identifies norovirus as a potential AIH trigger and underscores the value of liver biopsy in seronegative cases."

Autoimmune Hepatitis • Hepatitis C • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Novel Coronavirus Disease • Respiratory Diseases • CD8

Kratom-Induced Drug-Induced Liver Injury (DILI), Presenting With a Mixed Hepatocellular-Cholestatic Pattern and Mimicking Acute Cholecystitis (ACG 2026) - "Patient received N-acetylcysteine with gradual improvement of liver enzymes before discharge...This case demonstrates that kratom-associated DILI can produce convincing hepatobiliary imaging abnormalities and mimic surgical biliary disease, potentially leading to invasive intervention before diagnosis is recognized. Figure: Liver biopsy Figure: Liver biopsy"

Back Pain • Cholestasis • CNS Disorders • Depression • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Leukopenia • Liver Failure • Musculoskeletal Pain • Obesity • Thrombocytopenia

Not So Slick: When Neem Oil Ingestion Acute Liver Injury from Neem Oil Ingestion (ACG 2026) - "For his eczema, patient is on pimecrolimus and reported both ingestion and topical application of Neem powder for four weeks prior to admission...Given concern for drug-induced liver injury, the patient was started on intravenous N-acetylcysteine until LFTs have improved by 50%...Given its lipophilic nature, it has a higher absorption and tissue penetration when ingested causing damage to both hepatocytes and biliary canaliculi damage showing an early rise in AST/ALT followed by rise in ALP and bilirubin and bile excretion becomes impaired. When in combination with a secondary assault such as alcohol which increases CYP-mediated toxic metabolite formation and impairs mitochondrial recovery."

Addiction (Opioid and Alcohol) • Atopic Dermatitis • Cardiovascular • Hepatology • Immunology • Liver Failure • Metabolic Disorders

Profound Hepatocellular Liver Injury in a 26-Year-Old With Concomitant Intrahepatic Cholestasis of Pregnancy (ICP): A Diagnostic Conundrum (ACG 2026) - "Course complicated by worsening LFTs (AST 203/ALT 489â AST 2,244 /ALT 2,725/ALP 175), impaired synthetic function (INR 1.5, albumin 2.7, T bilirubin 2.3) & BA elevation (99 µmol/L)...Given concerns for overlapping drug-induced liver injury (DILI) & intrahepatic cholestasis of pregnancy (ICP), ursodeoxycholic acid & N-acetylcysteine (NAC) were started...Amoxicillin-clavulanate is the most common cause of idiosyncratic DILI in the US and accounts for 11% of cases...D. Portal tracts showing no significant inflammation; favoring a non-infectious etiology"

Autoimmune Hepatitis • Cholestasis • Genetic Disorders • Gynecology • Hepatology • Immunology • Inflammation • Liver Failure • Urticaria • ABCB1

Ticked Liver: An Unusual Case of Severe Ehrlichiosis-Associated Hepatitis (ACG 2026) - "Given the severity of hepatocellular injury, intravenous N-acetylcysteine was initiated, and infectious disease specialists recommended empiric doxycycline while a comprehensive infectious work-up was pursued. This case highlights the importance of maintaining suspicion for tick-borne illness in patients presenting with acute hepatitis in endemic regions. Early recognition based on social history and concomitant cytopenia and empiric doxycycline therapy while awaiting confirmatory testing remain essential to improving outcomes in severe ehrlichiosis."

Clinical • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Endocrine Disorders • Heart Failure • Hematological Disorders • Hepatology • Infectious Disease • Inflammation • Leukopenia • Liver Failure • Thrombocytopenia

Worming Yourself to Transplant: A Case of Albendazole Induced Acute Liver Failure (ACG 2026) - "She was treated with N-acetylcysteine without improvement. Portal venule is denoted with asterisk (2A). Central vein (asterisk) with perivenular hemorrhagic necrosis and numerous surrounding necrotic hepatocytes (black arrowheads) with mixed lobular inflammation (2B).?"

Clinical • Autoimmune Hepatitis • Cardiovascular • CNS Disorders • Genetic Disorders • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Hypertension • Immunology • Infectious Disease • Inflammation • Liver Failure • Metabolic Disorders • Obesity • Transplantation

Drug-Induced Liver Injury Superimposed on EBV Infection Presenting as Cholestatic Hepatitis With Hyperferritinemia: A Case Report (ACG 2026) - "Case Description/ A 25-year-old female with a history of asthma presented with a five-day history of intractable nausea, vomiting, abdominal pain, and headache, which she self-medicated with frequent doses of acetaminophen and Excedrin (acetaminophen/aspirin/caffeine)...N-acetylcysteine (NAC) was initiated on hospital day 3, resulting in a reduction of hepatic inflammation and down-trending of bilirubin and ALP...(A) AST and ALT, (B) total and direct bilirubin, and (C) ferritin levels. Figure: Table 1 - Serial Hepatic Function Tests: Complete Laboratory Data from Hospital Admission through Discharge"

Case report • Clinical • Asthma • Cardiovascular • Epstein-Barr Virus Infections • Gastroenterology • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Respiratory Diseases • Septic Shock

Polycythemia Vera Masquerading as Essential Thrombocythemia: A Case of BuddâChiari Syndrome Leading to Acute Liver Failure in a Young Woman (ACG 2026) - "Despite N-acetylcysteine (NAC) initiation per ALF protocol, she developed refractory hyperammonemia needing CRRT...Figure: Table 1. Initial Laboratory Values on Presentation"

Clinical • Cardiovascular • Essential Thrombocythemia • Genetic Disorders • Hematological Disorders • Hepatology • Liver Failure • Myeloproliferative Neoplasm • Obesity • Polycythemia Vera • Respiratory Diseases • Thrombocytosis • Thrombosis • JAK2

Reperfusion, Redox, Recovery: Exploring the Role of Systemic N-Acetylcysteine in Ischemic Hepatitis (ACG 2026) - "A total of 1,938 ICU patients met inclusion criteria, including 359 (18.5%) who received NAC. NAC-treated patients were younger (46.0 vs. 63.0 years, p< 0.001), less likely to require vasopressors (40.1% vs."

Cardiovascular • Chronic Kidney Disease • Diabetes • Hepatology • Infectious Disease • Inflammation • Ischemic stroke • Liver Failure • Metabolic Disorders • Myocardial Infarction • Renal Disease

Critical Order Omission in Liver-Related Hospital Admissions: Impact of Structured EMR Order Sets on Guideline Adherence (ACG 2026) - "Omissions of key management stepsâdiagnostic paracentesis in suspected spontaneous bacterial peritonitis (SBP), N-acetylcysteine (NAC) in acute liver failure (ALF), and albumin challenge in hepatorenal syndrome (HRS)âare associated with increased morbidity and mortality... Baseline adherence to guideline-critical orders was 43%, demonstrating substantial omission of high-priority interventions. Adherence was lowest for AH (22.9%), HRS (28.6%), and ALF (36.7%), the conditions associated with the greatest short-term mortality risk. Following EMR order set implementation, critical-order adherence increased to 70% (p< 0.001)."

Adherence • Clinical • Autoimmune Hepatitis • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Nephrology • Renal Disease

Gallstone Hepatitis Unmasked: E. coli Bacteremia Secondary to Choledocholithiasis Presenting With Transaminases Exceeding 3,000 IU/L (ACG 2026) - "Further history revealed upper respiratory symptoms, abdominal discomfort, and low-grade fever, prompting evaluation by her primary care physician and treatment with cephalexin for presumed urinary tract infection...She was initiated on N-acetylcysteine therapy given concern for impending hepatic failure...Blood cultures subsequently grew Escherichia coli and Aeromonas hydrophila/caviae, prompting initiation of ceftriaxone therapy...This case highlights the importance of maintaining biliary obstruction in the differential diagnosis of marked hepatocellular injury. Early recognition and biliary decompression with ERCP are critical, as prompt intervention can result in rapid clinical and biochemical recovery."

Autoimmune Hepatitis • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Nephrology • Septic Shock

Acute Liver Failure as the Initial Manifestation of EBV-Associated Aggressive NK-Cell Leukemia Complicated by Hemophagocytic Lymphohistiocytosis (ACG 2026) - "She was treated with N-acetylcysteine for acute liver failure and placed on continuous renal replacement therapy...She was transferred to the hematology service and treated with nivolumab, ruxolitinib, and brentuximab...Acute liver failure is an unusual presentation of the disease and generally occurs when there is a significant EBV viral load. Prompt consideration of HLH and early bone marrow evaluation are critical for establishing the diagnosis and initiating disease-directed therapy."

Acute Kidney Injury • CNS Disorders • Dyslipidemia • Epstein-Barr Virus Infections • Hematological Malignancies • Hemophagocytic lymphohistiocytosis • Hepatology • Hypertriglyceridemia • Immunology • Infectious Disease • Leukemia • Liver Failure • Nephrology • Rare Diseases • Renal Disease