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6.4 Summary of RCTs In the RIPENACTB trial, adjunct NAC treatment with 1,200 mg twice a day in hospitalized HIV/TB patients significantly reduced circulating lipid peroxidation (malondialdehyde (MDA) levels by approximately 40%50%) and increased antioxidant defenses, including glutathione (GSH, by approximately 30%40%), compared to baseline and the standard care group

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Notably, this performance was optimized through a controlled temperature gradient protocol (2530C for 6 h), which effectively mitigated proteotoxic stress-induced biomass loss from 45% to 12% while preserving extracellular PET hydrolase activity at 212.4 8.7 U/mg

Nature 475 , 324332 (2011)