• 대한임상독성학회지
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• 제4권2호
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• pp.107-112
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• 2006

Purpose: In many Korean hospitals, serum acetaminophen concentrations in cases of overdose cannot be measured initially because of inadequate laboratory facilities. Under these circumstances, physicians base the administration of the antidote, N-acetylcysteine, on ingestion amounts as determined by initial history taking. We therefore examined the correlated between ingested amounts and serum acetaminophen concentrations. Methods: Medical records were reviewed retrospectively for patients who presented to the ED with acetaminophen overdose between January 2002 and March 2006. Fifty-nine patients were recruited and sixteen patients were excluded. The forty-three remaining patients were placed into either the high-risk or low-risk group based on their ingested amount (140 mg/kg), and were separately categorized into the toxic or non-toxic group based on their serum acetaminophen concentrations, according to the Rurnack-Matthew nomogram. Results: Ten patients (83.3%) among twelve in the high-risk group were found to have non-toxic serum concentrations, and just one patient (3.2%) among thirty-one in the low-risk group fell into the toxic group based on their serum concentrations. The sensitivity and specificity of risk stratification of the ingested amount as a predictor of intoxication requiring antidote therapy were 66.7% and 75.0%, respectively. Conclusion: This study suggests that the therapeutic decision for acetaminophen overdose should not be based solely on ingested amount only, but requires assessment of acetaminophen concentration.

• 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.

• 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.

• 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.

• 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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• 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.

• 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.

• Tuberculosis and Respiratory Diseases
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• 제41권5호
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• pp.475-483
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• 1994

연구배경 : N-acetylcysteine(ACE)은 임상에서는 객담용해제로 널리 쓰이고 있으나 시험관내 실험 또는 동물실험에서 ACE는 염증세포에서의 산소유리기를 감소시키고, 세포내 강력한 항산화기능을 갖고있는 glutathione(GSH)의 합성을 촉진한다고 알려졌다. 저자들은 만성폐쇄성폐질환 환자에게 통상 투여용량인 매일 600mg씩 1주일간 ACE를 투여했을때 말초혈액내 호중구의 superoxide 분비, chemotaxis 등의 기능에 변화가 오는지 또는 혈장의 GSH 농도가 증가되는지를 살펴보고 동시에 시험관내 실험으로 정상인의 호중구에 ACE를 가했을때 ACE의 농도에 따라 superoxide나 GSH의 양에 변화가 오는지를 관찰하였다. 방법 : ACE 투여 전, 후에 만성폐쇄성폐질환 환자의 말초혈액에서 호중구를 분리하여 PMA로 자극하거나 안했을때의 superoxide 분비를 분광광도계로, luminol-enhanced chemiluminescence를 luminometer로, 혈장의 GSH 농도를 분광광도계로 각각 측정하였다. 한편 정상인의 호중구를 분리하여 $10^{-2}-10^{-5}$ mole의 ACE와 혼합배양시의 superoxide, chemiluminescence 및 GSH를 각각 같은 방법으로 측정하였다. 결과 : ACE를 투여하기 전, 후의 말초혈액내 호중구의 superoxide 분비는 $1.97{\pm}1.75nM/1.4{\times}10^6\;cells/15min$, $2.75{\pm}2.14nM$이었고 PMA로 자극하였을때는 $67.52{\pm}13.41nM$, $67.99{\pm}13.54\;nM$로서 각각 유의한 차이가 없었다(p>0.05). 호중구의 chemiluminescence도 ACE 투여전, 후에 $2.64{\pm}2.29mV$, $2.91{\pm}3.58mV$이었고 PMA로 자극하였을때는 $40.76{\pm}30.09mV$, $37.33{\pm}30.03mV$로서 유의한 차이가 없었다(p>0.05). 호중구의 chemotaxis를 chemotactic index로 비교하였을때 ACE투여전, 후에 $55.71{\pm}16.34$, $59.68{\pm}11.57$이었고 혈장의 GSH는 $0.37{\pm}0.17nM/4{\times}10^5cells$, $0.39{\pm}0.18nM$로서 역시 유의한 차이가 없었다(p>0.05). 정상인의 호중구를 분리하여 $10^{-5}-10^{-2}$ mole의 ACE와 동시배양하며 PMA로 자극하였을때 superoxide는 ACE를 가하지 않은 대조군에서의 $56.54nM/1.4{\times}10^6\;cells/15min$에 비해 ACE의 $10^{-2}$ mole에서 37.0nM로서 유의하게 감소하였고 ACE의 농도에 따라 감소하는 양상을 보였다(r=-0.269, p<0.05). 호중구의 GSH 농도는 대조군의 $0.27nM/4{\times}10^5\;cells$에 비하여 ACE의 $10^{-3}$ mole에서 0.35nM, $10^{-2}$ mole 에서 1.15 nM로서 유의하게 증가하여 ACE의 농도에 따라 증가하였다(r=0.72, p<0.01). 결론 : ACE를 만성폐쇄성폐질환 환자에게 매일 600mg씩 1주일간 투여하였을때 말초혈액내 호중구의 superoxide 분비, chemotaxis에 영향을 주지 않았고 혈장의 glutathione 농도에도 변화가 없었다. 그러나 정상인의 호중구를 분리하여 ACE와 같이 배양한 실험에서 ACE는 농도에 비례하여 호중구의 superoxide 분비를 억제하였고 GSH를 증가시켰다. 이상으로 미루어 ACE는 염증세포에서의 superoxide 분비를 억제하고 GSH를 증가시킴으로서 oxidant-antioxidant 간의 불균형으로 야기되는 ARDS, 폐기종, 간질성폐질환등의 치료에 이용될수 있을것으로 생각되나 폐기종을 포함한 만성폐쇄성폐질환의 치료에 이용되기 위해서는 ACE의 혈중농도 또는 폐포세척액내의 농도를 충분히 증가시키는 방법이 강구되어야 할 것으로 사료된다.