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. 2023 Aug 2;29:1611300. doi: 10.3389/pore.2023.1611300

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Copyright © 2023 Cazzaniga, Zonzini, Di Pierro, Palazzi, Cardinali and Bertuccioli.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Metabolism and elimination of irinotecan (CPT11). Once injected, irinotecan is activated by some esterases (CES 1/2) into its active metabolite (SN38). After its anticancer action, it is again conjugated in the liver into an inactive compound ready to be eliminated (SN38G) mainly through the intestine and faeces. In its colonic passage, the presence of bacterial groups with enzymatic b-glucuronidase activity, reactivate the compound (SN38) again, effectively increasing its concentration and the risk of associated toxicity (e.g., mucositis).