SN-38
SN-38 is the active form of the chemotherapy irinotecan, carried by sacituzumab govitecan. It is only moderately potent, so the ADC carries a lot of it.
SN-38 blocks topoisomerase I, the enzyme that relieves twisting in DNA during copying, so the copying machinery collides with trapped complexes and the DNA breaks. It is about a thousand times more potent than irinotecan itself but only nanomolar, which is why sacituzumab govitecan carries roughly eight copies per antibody and uses a linker that lets go in the tumour environment. It is pumped out by the ABCG2 transporter, one route to resistance, and people who metabolise it slowly (UGT1A1*28) get more diarrhoea and low blood counts.
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Shares Payload (ADC), Topoisomerase-I inhibitors (and ADC payloads), Antibody-drug conjugate (ADC).