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The no-NAC group sustained perfusions for an average of 96 (range 87102) h, universally developing methaemoglobinaemia (2%) observed after an average of 45 h, with subsequent steep rise

This can result from chronic oxidative stress, heavy metal toxicity (especially iron overload), persistent infections, nutrient insufficiencies (sulfur amino acids, glycine, glutamate, selenium, B-vitamins), liver dysfunction, metabolic stress, and genetic polymorphisms in key enzymes like glutamate-cysteine ligase (GCL) or glutathione S-transferases (GSTs)

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This review summarizes the molecular structure and regulation of the Nrf2/Keap1 pathway, including basal and stress-induced activation, post-translational modifications, and cross-talk with PI3K/Akt, MAPK, and NF-B signaling