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Vol. 31, Issue 1, 21-27, January 2003
Department of Biomedical Sciences, University of Rhode Island, Kingston, Rhode Island (M.X., D.Y., B.X., B.Y.); and Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois (M.W.)
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Abstract |
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Antitumor prodrug irinotecan is used for a variety of malignancies such as colorectal cancer. It is hydrolyzed to the metabolite, 7-ethyl-10-hydroxycamptothecin (SN-38), which exerts its antineoplastic effect. Several human and rodent carboxylesterases are shown to hydrolyze irinotecan, but the overall activity varies from enzyme to enzyme. This report describes a novel mouse liver and kidney carboxylesterase (M-LK) that is highly active toward this prodrug. Northern analyses demonstrated that M-LK was abundantly expressed in the liver and kidney and slightly in the intestine and lung. Lysates from M-LK transfected cells exhibited a markedly higher activity on irinotecan hydrolysis than lysates from the cells transfected with mouse triacylglycerol hydrolase (TGH) (6.9 versus 1.3 pmol/mg/min). Based on the immunostaining intensity with purified rat hydrolase A, M-LK had a specific activity of 173 pmol/mg/min, which ranked it as one of the most efficient esterases known to hydrolyze irinotecan. A chimeric carboxylesterase and its wild-type enzyme (e.g., M-LKn and M-LK), sharing three quarters of the entire sequence from the N-terminus, exhibited the same substrate preference toward irinotecan and two other substrates, suggesting that the N-terminal sequence determines substrate selectivity. M-LK transfected cells manifested more severe cytotoxicity than TGH transfected cells upon being exposed to irinotecan. Topoisomerase I inhibitors such as irinotecan represent a promising class of anticancer drugs. Identification of M-LK as an efficient carboxylesterase to activate irinotecan provides additional sequence information to locate residues involved in irinotecan hydrolysis and thus facilitates the design of new analogs.
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Introduction |
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Carboxylesterases
represent a large class of hydrolytic enzymes that play important roles
in the metabolism of endogenous lipids, pharmacological determination
of therapeutic agents and detoxication of organophosphorus
insecticides (Satoh et al., 2002
). In addition to hydrolyzing
numerous carboxylic acid esters, amides, and thioesters, some
carboxylesterases have been shown to catalyze transesterification
reaction, which accounts for the conversion of cocaine (a methyl ester)
to a longer lasting metabolite, ethylcocaine (the corresponding ethyl
ester) (Randall, 1992
; Xu et al., 1994
). Carboxylesterase activity is
widely distributed in mammalian tissues, with the highest levels
present in liver microsomes. High abundance of carboxylesterases in the
liver is linked to certain cellular structural roles, particularly in
directing protein trafficking. For example, egasyn, a liver microsomal
carboxylesterase, binds to
-glucuronidase (normally targeted to the
lysosome), resulting in the sequestration of this enzyme in the
endoplasmic reticulum (Zhen et al., 1995
; Islam et al., 1999
). The
microsomal
-glucuronidase has been shown to hydrolyze glucuronidated
hormones (e.g., steroids), an effective mechanism that recycles
physiologically important molecules (Zhen et al., 1995
; Zhu et al.,
1996
; Islam et al., 1999
).
Hydrolysis by carboxylesterases is increasingly used as a basis for
drug design, particularly on pro-drugs containing functional groups
such as carboxylic acid ester (Buchwald and Bodor, 2000
, 2002
; Senter
et al., 2001
). Introduction of ester linkages generally improves
bioavailability of therapeutic agents or targets them to specific
tissues or cell types based on hydrolytic activation (Buchwald and
Bodor, 2000
, 2002
). Irinotecan (CPT-11;
7-ethyl-10-[4-(1-piperidino)-1-piperidino] carbonyloxycamptothecin),
for example, is an ester derivative of antineoplastic camptothecin
linking to a bipiperidino carbonyl moiety (Masuda et al., 1996
;
Humerickhouse et al., 2000
). Such a modification not only
improves significantly the polarity of the molecule but also decreases
toxicity associated with the parent compound. However, irinotecan
itself has little antitumor activity, but its hydrolytic metabolite
(SN-38) is a potent inhibitor of topoisomerase I. Therefore, hydrolytic
biotransformation plays a determinant role in the overall antitumor
activity of irinotecan. Experimentally forced expression of human and
rabbit carboxylesterases increases the sensitivity of xenografted
tumors or tumor cell lines to irinotecan (Danks et al., 1999
;
Humerickhouse et al., 2000
; Wu et al., 2002
). More importantly, the
increased sensitivity is proportionally correlated with the catalytic
velocity of a carboxylesterase toward irinotecan. Carboxylesterases
HCE-21 and rCE,
from human and rabbit, respectively, are found to effectively catalyze
irinotecan hydrolysis (Senter et al., 2001
).
In this study, we report the tissue distribution, immunochemical cross-reactivity, and enzymatic characterization of a novel mouse liver and kidney carboxylesterase (M-LK). This carboxylesterase has a restricted tissue distribution and is highly active toward irinotecan. The N-terminal three quarter sequence appears to be responsible for such a high efficient hydrolysis. Along with HCE-2 and rCE, M-LK is the third member of carboxylesterases that are known to effectively activate irinotecan.
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Materials and Methods |
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Chemicals and Supplies. TRI REAGENT RNA extraction solution, para-nitrophenylacetate and para-nitrophenylbutyrate were from Sigma-Aldrich (St. Louis, MO); kit for primer extension labeling, nitro blue tetrazolium, and 5-bromo-4-chloro-3-indolyl-phosphate were from Promega (Madison, WI). The goat anti-rabbit-IgG conjugated with alkaline phosphatase was from Pierce Chemical (Rockford, IL). Cell culture media, mouse liver cDNA library, LipofectAMINE, and Plus Reagent were purchased from Invitrogen (Carlsbad, CA). CD-1 mice (7-8 week old) were purchased from Charles River Laboratories, Inc. (Wilmington, MA). Irinotecan and SN-38 were kindly supplied by Pharmacia & UPJohn Diagnostics (Kalamazoo, MI). Unless otherwise indicated, all other reagents were purchased from Fisher Scientific Co. (Pittsburgh, PA).
Plasmid Constructs.
The cDNAs encoding M-LK and triacylglycerol hydrolase (TGH) were
isolated by screening a mouse liver cDNA library as described previously (Hu and Yan, 1999
). The library was constructed with the
SPORT mammalian expression vector (Invitrogen). The cDNAs shared a
HindIII site at the location encoding amino acids 434 and
435. This endonuclease site enabled the sequence encoding the
C-terminal residues of both enzymes to be switched with each other (108 and 112 residues for M-LK and TGH, respectively). As a result, M-LK and
its chimeric enzyme M-LKn shared the N-terminal 434 residues but
differed on the C-terminal 108 residues. The same was true with TGH and
its chimeric enzyme TGHn. The resultant chimeric constructs were
subjected to sequencing analyses.
Transfection. Human embryonic kidney cells (293T) were plated at a density of 60% in Dulbecco's modified Eagle's medium supplemented with 10% fetal calf serum. After reaching 80% confluence, cells were transfected by LipofectAMINE and Plus Reagent. A plasmid construct or the empty vector (4 µg/100 mm dish) was initially mixed with 20 µl of Plus Reagent diluted in 750 µl of serum-free medium for 15 min and then mixed with 30 µl of LipofectAMINE Reagent diluted in 5 ml of serum-free medium for 15 min. The final transfection complexes were added to a monolayer of 293T cells. After a 3-h incubation, the media were replaced by normal culture media and incubated for 48 h in a 37°C humidified incubator with 5.0% CO2. Cells were rinsed and harvested in 1.5 ml of phosphate-buffered saline. The cell suspension was sonicated by a Branson Sonifier (Branson Ultrasonics Corp., Danbury, CT), and cell debris was removed by centrifugation at 12000g for min at 4°C. The supernatant was assayed for hydrolytic activity toward irinotecan, para-nitrophenylacetate, and para-nitrophenylbutyrate.
Enzymatic Assays.
Hydrolysis of para-nitrophenylacetate and
para-nitrophenylbutyrate was spectrophotometrically
determined as described previously (Xie et al., 2002
). Irinotecan
hydrolysis was determined with HPLC analysis. The reactions (in a total
volume of 500 µl) were performed in potassium phosphate buffer (20 mM, pH 7.4) containing cell lysates (330 µg) and irinotecan (10 µM). The incubation was performed at 37°C for 40 min and stopped by
adding 4 volumes of ice-cold methanol. To the reaction mixtures,
internal standard (200 µl of campothecin at 1 µg/ml) was added.
Samples were dried and reconstituted with 400 µl of HPLC mobile phase
composed of acetonitrile and potassium phosphate (27:73%) containing 3 mM sodium heptane sulfonate (pH 4.0). Samples were separated on a Waters C18 column (Nova Pack; Waters Corp.,
Milford, MA) and monitored by a Hitachi L-7485 fluorescence detector
(Hitachi Instruments Inc., San Jose, CA) at
ex = 375 nm
and
em = 566 nm. The formation of the hydrolytic metabolite
SN-38 was calculated against standard curves constituted with
irinotecan and SN-38 (Wu et al., 2002
).
Cytotoxicity Assay. Cells (293T) were seeded in 24-well plates and cultured in Dulbecco's modified Eagle's medium supplemented with 10% fetal calf serum. After reaching ~70% confluence, cells were transfected with a cDNA encoding a carboxylesterase or the corresponding vector. As a control, sham transfection (without plasmid DNA) was also performed. After a 24-h incubation, the media were replaced with fresh media containing various concentrations of irinotecan. After an additional 30-h incubation, the media were collected and centrifuged at 4°C for 5 min to remove any debris. To determine the total cellular activity of lactate dehydrogenase (LDH), the same amount of medium (500 µl) was added to each well, and the cells were then subjected to freezing-thawing to completely lyse the cells. Likewise, the supernatants were prepared by centrifugation and used to assess the intracellular LDH. The activity of LDH was determined with a CytoTox 96 kit (Promega) as described by the manufacturer. The ratios of the released LDH over the intracellular LDH were calculated.
Other Assays.
Protein concentration was determined with Micro BCA Reagents (Pierce
Chemical) as described by the manufacturer. Three antibodies against
distinct carboxylesterases were described elsewhere (Morgan et al.,
1994
; Yan et al., 1995b
; Xie et al., 2002
). Northern and Western
analyses were performed as described previously (Zhu et al., 2000
).
Data are presented as mean ± S.D. of at least three separate
experiments, except where results of blots are shown in which case a
representative experiment is depicted in the figures. Comparisons
between two values were made with Student's t test at
p < 0.05.
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Results |
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Molecular Cloning of M-LK.
In an effort to isolate cDNAs encoding distinct mouse
carboxylesterases, cDNA trapping experiments were performed to screen a
mouse liver library with two oligonucleotides (TGTGACCATCTTTGGAGAGTC, TTTGGCGAGTCTGCGGGTGGC). These oligonucleotides targeted the region encoding the conserved motif GXSXG among carboxylesterases (Satoh et
al., 2002
), therefore, cDNAs encoding several distinct
carboxylesterases were isolated. One of the cDNAs encoded a novel
carboxylesterase and was identical to the cDNA recently deposited to
the GenBank (accession number BC 013479). Based on subsequent analyses
on its tissue distribution, the encoded carboxylesterase by this cDNA
was designated M-LK. Like other carboxylesterases, M-LK has several
structural features (Satoh et al., 2002
). It has an
N-terminal signal peptide (18 amino acids) commonly seen in
secretory proteins, five cysteine residues with four of them presumed
to form intramolecular disulfide bonds, and two putative
N-glycosylation sites. A catalytic triad
(Ser203, His448 and
Glu335) is located based on rat hydrolase B. In
addition, M-LK has a C-terminal HXEL consensus sequence acting as a
retention signal in the endoplasmic reticulum (Yan et al., 1995b
).
Sequence alignment analyses show that M-LK has ~70% sequence
identity with other mouse carboxylesterases except Es-M, a
carboxylesterases that is abundantly expressed in the male liver and
that has a markedly lower sequence identity (~45%) with any other
mouse carboxylesterases (Ovnic et al., 1991a
,b
; Aida et al., 1993
;
Ellinghaus et al., 1998
; Dolinsky et al., 2001
). Based on the
classification proposed by Satoh and Hosokawa (1998)
, M-LK is a member
of the CES1B subfamily.
Tissue Distribution.
We next examined the tissue distribution of M-LK by Northern analysis.
As a comparison, the tissue distribution of TGH (another mouse
carboxylesterase) was simultaneously determined (Dolinsky et al.,
2001
). TGH was chosen because Western analysis demonstrated that M-LK
and TGH were immunochemically distinct (below). As shown in Fig.
1, M-LK was abundantly expressed in the
liver and kidney but only slightly in the intestine and lung. In
contrast, TGH had a broader tissue distribution. High levels of TGH
mRNA were detected not only in the liver and kidney but also in the
lung. In addition, TGH was moderately expressed in the heart and
slightly in the intestine and testis. Neither M-LK nor TGH mRNA was
detected in the brain or spleen. It was interesting to notice that a
previous study reported the absence of TGH in the lung (Dolinsky et
al., 2001
). We used two different mouse strains (CD-1 and B6C3F1) and high levels of TGH mRNA in the lung were detected in both cases. The
tissue distributions and the relative abundance in each organ established by Northern analyses were confirmed by Western analyses (data not shown).
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Immunocross-Reactivity.
M-LK shares an 85% sequence identity with rat hydrolase B whereas TGH
shares 98% with human carboxylesterase HCE-3 (Yan et al., 1994
; Mori
et al., 1999
; Dolinsky et al., 2001
). Therefore, it was hypothesized
that the antibody against purified hydrolase B cross-reacted with M-LK
whereas the antibody against a peptide from human HCE-3 cross-reacted
with TGH. To test this possibility, transient transfection experiments
were performed with cDNAs encoding M-LK, TGH, and two chimeric enzymes,
M-LKn and TGHn. The chimeric constructs were prepared by fusing the
N-terminal sequence of M-LK to the C-terminal sequence of
TGH or vice versa. Figure 2A shows the
diagrammatic presentation of M-LK, TGH, M-LKn, and TGHn.
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Hydrolysis of Irinotecan, para-Nitrophenylbutyrate and para-Nitrophenylacetate. We next examined whether the recombinant carboxylesterases were enzymatically active. Three substrates were used including irinotecan, para-nitrophenylbutyrate, and para-nitrophenylacetate. Irinotecan is a water-soluble anticancer prodrug whereas para-nitrophenylbutyrate and para-nitrophenylacetate are standard substrates that are widely used for assaying hydrolytic activity. In relation to human carboxylesterases, transfection and subsequent enzymatic assays were performed with human HCE-1. As shown in Fig. 3A, transfection with the empty vector caused little hydrolytic activity toward all substrates. In contrast, transfection with plasmid constructs encoding carboxylesterases caused a marked increase on hydrolysis. The overall hydrolytic activity, however, varied markedly from enzyme to enzyme and substrate to substrate as well. M-LK and TGH comparably hydrolyzed para-nitrophenylbutyrate whereas M-LK was markedly more active toward irinotecan (5-fold) and para-nitrophenylacetate (2-fold). Although the chimeric enzymes exhibited a similar substrate preference as the respective wild-type carboxylesterases (e.g., M-LKn and M-LK), the overall hydrolytic activity of the chimeras was lower than that of the wild-type carboxylesterases (Fig. 3A). M-LK was generally more active than human HCE-1 toward all substrates, particularly on irinotecan (6.9 versus 0.1 pmol/mg/min).
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Cytotoxicity Induced by Irinotecan.
We next examined whether expression of M-LK would sensitize cells to
irinotecan-induced toxicity. Cells were transfected with the vector,
M-LK, or TGH construct. The transfected cells were exposed to various
concentrations of irinotecan for 30 h, and the released and
intracellular LDH was determined. The ratio of the released LDH over
the intracellular LDH was calculated and the irinotecan induced
toxicity was expressed as a percentage of an increase on the ratios in
the presence over the absence of irinotecan. As shown in Fig.
4, transfection of the vector caused a
slight increase on LDH release (10-15%) upon irinotecan treatment.
Similar observation was made with sham transfection (data not shown).
In contrast, transfection with either M-LK or TGH caused a marked
increase on LDH release by as much as 80%. In any concentrations,
transfection with the M-LK construct resulted in a significantly higher
LDH release than that with TGH, particularly when lower concentrations
(e.g., 0.37 µM) were used (~3 fold difference). To determine
whether such differential sensitivities were due to the variations on
the expression levels, the supernatants from the lysed cell pellets
were analyzed for the abundance of the recombinant M-LK and TGH. As
depicted in Fig. 4, transfection with M-LK or TGH resulted in a similar
immunostaining intensity although the transfected cells, exposed to the
highest concentration of irinotecan, had slightly lower levels of the
recombinant carboxylesterases (likely due to higher toxicity).
Apparently the hydrolytic metabolite has direct cytotoxic effect
although topoisomerase inhibitors are generally considered as
anti-proliferative agents (Wu et al., 2002
). As expected, no
immuno-reactive protein was detected in the vector-transfected cells.
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Discussion |
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This report describes the tissue distribution, immunochemical
cross-reactivity, and substrate preference of a novel mouse carboxylesterase M-LK. Rapid hydrolysis of irinotecan by M-LK ranks
this carboxylesterase as one of the most efficient esterases known to
hydrolyze this prodrug. Several mammalian carboxylesterases are found
to catalyze irinotecan hydrolysis, but the overall activity differs
markedly from enzyme to enzyme (Humerickhouse et al., 2000
; Senter et
al., 2001
; Wadkins et al., 2001
). Human HCE-2, for example, is 26-fold
more active than human HCE-1 (92 versus 3.5 pmol/mg/min). A rCE is even
more active than HCE-2 and is 40 or 130 times as active as HCE-1
depending on the laboratories in which the enzymatic assays were
performed (Senter et al., 2001
; Wadkins et al., 2001
). Based on the
immunostaining intensity against various amounts of purified rat
hydrolase A (Fig. 3), we estimate that M-LK and HCE-1 have a specific
activity of 173 and 2.5 pmol/mg/min, respectively. Such estimation
ranks M-LK as one of the most efficient esterases known to hydrolyze
irinotecan, although purified M-LK is required to precisely determine
its specific activity. Similarly, TGH is estimated to have a specific
activity of 33 pmol/mg/min, which is 13 times as active as HCE-1. Mouse
TGH shares a 98% sequence identity with human HCE-3 (Mori et al.,
1999
; Dolinsky et al., 2001
), and presumably both have a similar
activity toward irinotecan. Therefore, HCE-3 likely contributes
significantly to the hydrolytic activation of irinotecan.
The substrate preference shared by the chimeric and its respective
wild-type carboxylesterase (e.g., M-LKn and M-LK) suggests that the
N-terminal sequence contains residues involved in
enzyme-substrate interactions as observed with its counterpart in
acetyl- and butyrylcholinesterases (Oakeshott et al., 1999
).
Carboxylesterases and cholinesterases both belong to a superfamily of
/
fold proteins; they share a moderate sequence identity
(~30%); and they use two-step serine hydrolase mechanism and are
highly sensitive to serine enzyme inhibitors (Sussman et al., 1991
;
Ordentlich et al., 1993
; Oakeshott et al., 1999
; Satoh et al., 2002
).
X-ray crystallographic studies with acetylcholinesterase, and recently
with rCE, reveal that the catalytic triad is located at the base of a
deep catalytic gorge (Sussman et al., 1991
). Amino acid residues lining
the inner surface or the rim of the gorge form several functional
subsites. Site-directed mutagenesis studies demonstrate that the
nonconserved residues in the subsites (e.g., the acyl pocket) are
largely responsible for the difference between acetyl- and
butyrylcholinesterases on the substrate preference and inhibitor
reactivity (Ordentlich et al., 1993
; Oakeshott et al., 1999
; Satoh et
al., 2002
). Therefore, it is conceivable that carboxylesterases, like
cholinesterases, contain functional subsites that play determinant
roles in substrate selectivity. Several lines of evidence support this
notion. X-ray crystallographic study demonstrates that rCE and
acetylcholinesterase are similar on the secondary structural elements
within the catalytic domain although they show significant deviation on
other regions (e.g., the 
domain) (Sussman et al., 1991
;
Bencharit et al., 2002
). In this report, the chimeric enzymes share
with the respective wild-type carboxylesterases the
N-terminal sequence (a region harboring all the subsites)
and exhibit the same selectivity toward irinotecan,
para-nitrophenylacetate, and
para-nitrophenylbutyrate (Fig. 3A). Conversely, M-LK and TGH
differ on 14 of 25 residues composing the subsites (the hydrophobic
subsite, the acyl pocket, and the peripheral anionic subsite) and
exhibit different substrate preference toward these substrates (Fig.
3A, Table 1). In addition, we have
previously made similar observations with 12 human and rodent
carboxylesterases (Xie et al., 2002
). For example, hydrolase A and
HCE-3, sharing all of the 25 residues, preferably hydrolyze para-nitrophenylbutyrate over
para-nitrophenylacetate. In contrast, hydrolase A differs
from rat hydrolase E by 6 of the 25 residues (particularly in the acyl
pocket), and they exhibit opposite preference toward these two
substrates (Xie et al., 2002
; Table 1).
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Hydrolysis of irinotecan is likely further limited by its rather bulky
leaving group 4-piperidino-piperidine (4PP), which contrasts
small/linear aliphatic chains of standard substrates such as
para-nitrophenylbutyrate and
para-nitrophenylacetate. Recent X-ray crystallographic
studies with rCE reveal that this carboxylesterase has a gate, so
called "side door", for the leaving group 4PP to exit (Bencharit et
al., 2002
). Such a side door resembles "the back door" proposed for
acetylcholinesterase but is located ~180° away from the back door
(Gilson et al., 1994
; Bencharit et al., 2002
). The side door, composed
of Leu252, Ser254,
Ile387, and Leu424, likely
ensures a fast exit of the leaving group. Interestingly, these four
residues are not conserved among the carboxylesterases (M-LK, rCE, and
HCE-2) that are known to effectively hydrolyze irinotecan (Senter et
al., 2001
; Wadkins et al., 2001
; Figs. 3A and
5), suggesting that such a side door
exists only in rCE, or that M-LK and HCE-2 have a similar structure
that consists of different residues. Studies with chimeric enzymes of
rCE demonstrate that residues 121-453 are sufficient to maintain the
activity of the wild-type enzyme on irinotecan hydrolysis (Wadkins et
al., 2001
). Sequence alignment analysis of this region among rCE, M-LK, and HCE-2 reveal three amino acids (Ile/Leu253,
Ile/Val298, and Pro411)
that are relatively conserved (Fig. 5). In contrast, less active
carboxylesterases such as HCE-1 have a threonine at all three positions
(Fig. 5). Interestingly, two of the three residues are directly related
to the residues forming the side door proposed for rCE (Bencharit et
al., 2002
). The residue 253 is located between two of the
side-door-forming residues (Leu252 and
Ser254). The proline 411, although 12 residues
apart from Leu424 (one of the side-door-forming
residues), is located on the same
-helix (
-12). Proline is
usually found in the bends of folded proteins and is known to restrict
range of allowed conformation. Therefore, the proline 411 likely
ensures such a side door to be open and thus facilitates the exit of
the leaving group 4PP. Finally, the residue 298 is located on
-helix
8, which is part of the catalytic domain as shown by the X-ray
crystallographic structure (Bencharit et al., 2002
).
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In summary, we report the tissue distribution, immunochemical cross-reactivity, and enzymatic characterization of a novel mouse carboxylesterase M-LK. This carboxylesterase is highly expressed in the liver and kidney and is a third member of carboxylesterases known to efficiently hydrolyze prodrug irinotecan. Topoisomerase I inhibitors such as irinotecan represent a promising class of anticancer drugs. Identification of M-LK as an efficient carboxylesterase to activate irinotecan provides additional sequence information to locate residues involved in irinotecan hydrolysis and thus facilitates the design of new analogs. Furthermore, M-LK is likely used in viral-directed enzyme-prodrug combined therapy.
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Footnotes |
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Received August 7, 2002; accepted September 24, 2002.
This work was partially supported by a Grant ES07965 from the National Institute of Environmental Health Sciences and a New Investigator Award from the American Association of Colleges of Pharmacy.
Address correspondence to: Dr. Bingfang Yan, Department of Biomedical Sciences, University of Rhode Island, Kingston, RI 02881. E-mail: byan{at}uri.edu
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Abbreviations |
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Abbreviations used are: Irinotecan, 7-ethyl-10-[4-(1-piperidino)-1-piperidino] carbonyloxycamptothecin (CPT-11); HCE, human carboxylesterase; rCE, rabbit carboxylesterase; M-LK, mouse liver and kidney carboxylesterase; TGH, triacylglycerol hydrolase; HPLC, high performance liquid chromatography; LDH, lactate dehydrogenase; HS, anti-hydrolase S antibody; 4PP, 4-piperidino-piperidine; SN-38, 7-ethyl-10-hydroxycamptothecin.
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References |
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