Modes of action of NAC
The mechanisms of paracetamol-induced hepatic damage are now understood to be more complex than just cysteine depletion, and a series of other targets in the process of liver injury have been suggested for therapy, particularly for mitochondrial injury, the response and process of necrotic hepatocyte death including cell signalling processes, tumour suppressor proteins that modify the cell cycle (p53) and nuclear factor erythroid 2-related factor 2 (Nrf2) and as a hydrogen sulfide precursor.18–21 Furthermore NAC might exert therapeutic effects in other organs rather than just as a sulfhydryl donor22,23. If relevant to the liver in human acute paracetamol induced liver failure these mechanisms would help to explain benefit of NAC in later stages of paracetamol-induced hepatic failure.24,25