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Damage to intestinal epithelial cells and severe diarrhea can occur when SN-38G is reactivated by microbial beta-glucuronidases (BGs) in the gut, which recognize the glucuronidated drug as a carbon source
SN-38 glucuronide (SN-38-G) is the inactive metabolite of the topoisomerase I inhibitor irinotecan and is reactivated to SN-38 in the gut by bacterial beta-glucuronidases (GUS), resulting in acute, dose-limiting GI toxicity
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