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33 NACs clinical benefits may stem from multiple mechanisms besides GSH replenishment, including ( i ) indirect antioxidant effects, ( ii ) provision of hydrogen sulfide (H 2 S) and sulfane sulfur with anti-inflammatory properties, 14,19,37,38 or ( iii ) an impact on NO regulation

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These agents pleotropic effects have translated into clinicals trials showing improvement in cardiovascular outcomes, improved quality of life and/or heart failure events in heart failure with preserved ejection fraction, resolution of steatohepatitis and improvement in liver fibrosis, prevention and treatment of type 2 diabetes, and improvement in renal function in chronic kidney disease