• 대한임상독성학회지
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• 제10권2호
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• pp.97-102
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• 2012

Purpose: Serious acetaminophen (AAP) poisoning causes hepatotoxicity. N-acetylcysteine (NAC) is the most effective therapy for AAP poisoning and can be administered orally and intravenously (IV). Several studies have compared the efficacy of these two routes of administration and the results have been controversial. The purpose of this study was to compare the efficacy of oral and IV NAC for the prevention of hepatic toxicity in Korean patients whose serum AAP levels were higher than normal. Methods: A retrospective before/after study was performed, in which the patients presented to the emergency department with an AAP overdose from February 1995 to March 2012. A 3-day oral NAC regimen was used in the beginning, and a 20-hr intravenous regimen was then used from 2007. This study assessed the complications of an AAP overdose, such as hepatotoxicity, hepatic failure and renal failure as well as the side effects of the treatment regimen. Results: A total of 41patients was enrolled in this study. The median ALT and AST were 63 (IU/L) and 57 (IU/L) for the oral NAC treated patients, and 14 (IU/L) and 20 (IU/L) for the IV NAC treated patients (p=0.004 and p=0.001, respectively). The incidence of complications was similar in the treatment groups (p=0.399). Among the patients, 7 patients developed hepatotoxicity and were treated successfully with oral or IV NAC. Conclusion: This study suggests that IV NAC and oral NAC can prevent and successfully treat hepatic toxicity in patients whose serum AAP levels are higher than normal.

• 대한임상독성학회지
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• 제16권1호
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• pp.33-41
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• 2018

Purpose: This study was conducted to evaluate the clinical efficacy of pharmacologic treatment of amatoxin poisoning patients. Methods: Literature was accessed through PubMed, EMBASE, Cochrane library, KoreaMed, KISS and KMBASE. Studies relevant to human use of pharmacologic therapy including silymarin, penicillin and N-acetylcysteine (NAC) for amanita poisoning were included. Case reports, letters, editorials and papers with insufficient information were excluded. Comparison of clinical outcomes (especially mortality and liver transplantation rate) in each study was analyzed. Results: The final analysis included 13 retrospective studies. None of these studies showed direct comparisons of individual agents. Among 12 studies comparing silymarin vs penicillin, eight showed clinical superiority of silymarin. Among eight studies comparing silymarin with NAC, six showed clinical superiority of silymarin. Among seven studies of NAC vs penicillin, five showed clinical superiority of NAC. Conclusion: This systematic review suggested that clinical superiority of various pharmacological agents used to treat amatoxin poisoning is debatable. Nevertheless, the available evidence suggests it is reasonable to consider combinations of multiple agents for patients with amanita poisoning. Further studies are required to establish a treatment regimen for amanita poisoning.

• 한국어병학회지
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• 제32권1호
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• pp.21-28
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• 2019

It has been reported that various anti-oxidant substances stimulate non-specific immune responses in fishes. In this study it was examined whether N-acetylcysteine (NAC), a precusor for anti-oxidant glutathione (GSH) synthesis, can modulate non-specific immune function in Far Eastern catfish Silurus asotus. Immune functions were assessed using the respiratory burst activity monitored by chemiluminescence (CL) responses in isolated leucocyte. NAC stimulated CL responses with doses of 10 or 100 mg/kg, but not with 1 mg/kg after 48 hr injection. It was observed with 10 mg/kg NAC that CL activity continued to elevate from 24 hr through 96 hr post-dosing, and returned to the near preinjection level by 10 days. To understand whether NAC can also activate CL activity in vitro, NAC was directly added to isolated catfish leucocytes. It was observed, however, that NAC can not stimulate CL at reasonable concentration ranges in vitro. As NAC is a precursor for the strong anti-oxidant glutathione (GSH), a putative immune stimulator, it was assessed whether GSH can also stimulate CL responses. Observed results show that GSH activated CL both in vivo and in vitro. The data obtained collectively support the proposition that NAC indirectly stimulates non-specific immune functions in catfish by enhancing GSH biosynthesis, but not by direct action of NAC. Such effects may have beneficial significance in aquaculture for practical utilization.

• Preventive Nutrition and Food Science
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• 제14권1호
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• pp.14-20
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• 2009

Matrix metalloproteinases (MMPs) are a group of zinc proteases that serve the function of breaking down extracellular matrix (ECM). The present study evaluated the role of N-acetylcysteine (NAC) on the increased deposition of ECM in hepatic and glomerular fibrosis caused by carbon tetrachloride ($CCl_4$). The activity of MMPs increased and the levels of tissue inhibitors of metalloproteinases 1 and 2 (TIMP-1 and TIMP-2) decreased in the liver and kidney of $CCl_4$-treated rats. Rats treated with $CCl_4$ and NAC showed increased activities of MMPs and decreased levels of TIMP-1 and TIMP-2 in the liver and kidney. Treatment with NAC resulted in the effective degradation of ECM due to an increase in the activities of MMPs and a decrease in the levels of TIMPs.

• The Korean Journal of Physiology and Pharmacology
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• 제9권3호
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• pp.159-164
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• 2005

Effects of antioxidants on the established nephropathy were investigated. The experimental nephropathy was induced in rats by intravenous injection of adriamycin (2 mg/kg). Six weeks later, when proteinuria was apparent, the rats were supplemented with N-acetylcysteine (NAC, 1 g/kg/day) in drinking water for additional 6 weeks. Glomerulosclerosis score and tubulointerstitial injury index were determined by light microscopy. Expression of transforming growth factor (TGF) ${\beta}1$ and laminin ${\beta}1$ was determined in the renal cortex by reverse transcription-polymerase chain reaction, Western blotting, immunohistochemistry, and immunogold electron microscopy. The adriamycin-induced proteinuria as well as the glomerulosclerosis and tubulointerstitial injury was ameliorated by the treatment with NAC. Adriamycin increased the expression of TGF ${\beta}1$ mRNA and protein, which was ameliorated by NAC. Although the expression of laminin ${\beta}1$ mRNA was increased, adriamycin did not significantly alter that of its protein. These results indicate that antioxidants ameliorate the established nephropathy in association with normalization of overexpressed TGF ${\beta}1$.

• International Journal of Oral Biology
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• 제33권4호
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• pp.187-195
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• 2008

Reparative dentine formation requires newly differentiated odontoblast-like cells. Therefore, identification of the molecule that stimulates the odontogenic differentiation of precursor cells in the tooth pulp will be helpful for the development of strategies to repair damaged pulp. In this study, we examined the effect of N-acetylcysteine (NAC) on the odontogenic differentiation of MDPC-23 cells, a mouse odontoblast-like cell line derived from dental papilla, and primary cultured rat dental papilla cells (RDPCs). NAC (1-30 mM) suppressed production of reactive oxygen species in MDPC-23 cells in a dose-dependent manner. Although 5 to 20 mM NAC did not alter MDPC-23 cell proliferation, 1 or 30 mM NAC significantly inhibited it. NAC enhanced mineralized nodule formation and the expression of several odontoblast differentiation-associated genes in both RDPCs and MDPC-23. This NAC stimulatory effect was significant, even at concentrations lower than 1 mM. However, NAC did not stimulate expression of bone morphogenetic protein-2, -4, or -7, which are known to enhance odontogenic differentiation. Since reactive oxygen species are also involved in the pulp toxicity of resin-based restorative materials, these results suggest that NAC may be a promising candidate for supplementation of dental restorative materials in order to enhance reparative dentine formation.

• 한국어병학회지
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• 제25권1호
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• pp.1-10
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• 2012

여러 항산화물질이 어류의 비특이적 면역능을 증강시키는 것이 알려져 있다. 본 연구에서는 glutathione의 생합성 전구체인 항산화물질 N-acetylcysteine(NAC)이 8종의 어류에서 비특이적 면역지표를 증가시키는 지를 검토하였다. NAC를 10 mg/kg의 용량으로 메기, 미꾸라지, 잉어, 붕어, 뱀장어, 가물치, 틸라피아 및 숭어에 복강내로 투여하고, 48시간 후 두신백혈구 세포의 화학발광반응 및 혈청 lysozyme 활성을 측정하였다. 붕어와 미꾸라지를 제외한 6종의 어류에서 화학발광 반응이, 틸라피아를 제외한 모든 어류에서 lysozyme 활성이 각각 증가하였다. 이 결과는 NAC가 다양한 어종에서 비특이적 면역증을 증가시키며, 이 현상은 어류양식에서의 실용화도 고려해 볼 가치가 있음을 의미한다.

• Tuberculosis and Respiratory Diseases
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• 제61권4호
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• pp.366-373
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• 2006

연구배경 : Paraquat는 P-450 reductase에 의해 반응성 산소유리기(ROS)를 발생시켜 세포막, 단백질, 핵산 등과 반응함으로써 세포손상을 유도하며 급성 폐 손상을 일으킨다. 최근 급성 폐 손상 및 급성 호흡곤란 증후군에 있어서 폐상피세포의 아포프토시스가 중요한 역할을 한다고 알려지기 시작하였다. 이에 반응성 산소유리기에 의한 폐 손상의 대표적 물질인 paraquat로 인한 폐상피세포의 세포죽음이 아포프토시스인지 확인하고 dexamethasone, N-acetylcysteine, 그리고 bcl-2가 paraquat로 인한 폐상피 세포죽음에 어떠한 영향을 미치는지 등을 연구하였다. 방법 : 폐상피세포주인 A549와 BEAS-2B 세포주, 그리고 bcl-2 construct를 유전자 주입한 A549 pcDNA3-bcl-2 세포주를 이용하였다. 아포프토시스는 Annexin V assay를 이용하여서 판정하였으며 세포독성 검사는 MTT assay를 이용하였다. Paraquat는 0, $1{\mu}M$, $10{\mu}M$, $100{\mu}$M, 1 mM, 10 mM의 농도로 사용하였다. Dexamethasone은 $1{\mu}M$의 농도로 paraquat 투여 12시간 전에 전처치하였고, N-acetylcysteine은 1 mM의 농도로 paraquat 투여 1시간 전에 전처치하였다. 결과 : 양 세포주 모두에서 paraquat는 농도와 시간 경과에 따라서 세포죽음을 증가시켰고, 이러한 세포죽음은 아포프토시스였다. N-acetylcysteine과 dexamethasone은 시간과 농도에 따라 약간의 차이가 있으나 전반적으로 10~30%의 방어효과가 있었다. Bcl-2를 과발현시킨 A549-bcl-2 세포주에서 A549-neo 세포주에 비해 paraquat에 의한 세포독성이 약 20~30% 정도 차단되었다. 결론 : Paraquat는 폐상피세포에서 아포프토시스를 유도하며, paraquat에 의한 아포프토시스는 마이토콘드리아 경로에 의해 일어날 것으로 추정된다.

• 대한임상독성학회지
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• 제6권1호
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• pp.1-8
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• 2008

Acetaminophen (AAP) overdose can result in potentially serious hepatotoxicity. The ingested dose and time from ingestion to presentation are important prognostic factors. Toxic dose in adult is thought to be at least 10 g or 200 mg/kg. However, early management of acute overdose should be guided by the plasma AAP concentration. The antidote for AAP poisoning is N-acetylcysteine (NAC). It provides complete protection against hepatotoxicity if given within 8 h of acute overdose. If the concentration is above the possible toxicity line as predicted by the Rumack-Matthew nomogram, either the 72-hr oral or the 20-hr intravenous NAC regimen should be administered. NAC is also effective if started late in patients with established hepatic failure. This article summarizes the current consensus of clinical assessment and management for acute AAP overdose.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권2호
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• pp.210-213
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• 2008

저자들은 버섯 중독 후 간성 뇌증을 동반한 급성 간부전으로 발현된 소아를 Penicillin GK를 사용한 약물 요법으로 완치할 수 있었다. 소아에서 급성 간부전은 사망률이 높은 위중한 질병이며, 생존을 위하여 간이식이 필요한 경우가 많다. 그러나 일부의 경우에는 본 증례와 같이 정확한 병력 청취에 의하여 특별한 치료를 시행하면 간이식을 시행하지 않고서도 환아의 생명을 구할 수 있다.