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Revision as of 20:05, 16 February 2012 editBeetstra (talk | contribs)Edit filter managers, Administrators172,031 edits Saving copy of the {{drugbox}} taken from revid 474862755 of page Actinomycin for the Chem/Drugbox validation project (updated: 'DrugBank', 'KEGG').  Latest revision as of 04:30, 3 January 2024 edit Maxim Masiutin (talk | contribs)Extended confirmed users, IP block exemptions, Pending changes reviewers30,619 edits Add: s2cid, isbn, pmc. Added the cs1 style template to denot "vanc" because references contain "vauthors". 
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{{short description|Chemical compound}}
{{ambox | text = This page contains a copy of the infobox ({{tl|drugbox}}) taken from revid of page ] with values updated to verified values.}}
{{cs1 config|name-list-style=vanc}}{{Infobox drug
{{Drugbox
| Verifiedfields = changed | Verifiedfields = changed
| Watchedfields = changed
| verifiedrevid = 457803653
| verifiedrevid = 477241639
| IUPAC_name = 2-amino-''N,N<nowiki>'</nowiki>''- bis oxatetraazacyclohexadecin- 10-yl]- 4,6-dimethyl- 3-oxo- 3''H''-phenoxazine- 1,9-dicarboxamide
| IUPAC_name = 2-Amino-''N'',''{{prime|N}}''- bisoxatetraazacyclohexadecin-10-yl]-4,6-dimethyl-3-oxo-3''H''-phenoxazine-1,9-dicarboxamide
| image = Actinomycin D.png
| drug_name = Actinomycin D | image = Actinomycin D.png
| width =

| image2 = Actinomycin D sticks.png
<!--Clinical data--> <!--Clinical data-->
| tradename = | tradename = Cosmegen
| Drugs.com = {{drugs.com|monograph|dactinomycin}}
| MedlinePlus = a682224
| MedlinePlus = a682224
| pregnancy_category =
| pregnancy_AU = D
| legal_status =
| pregnancy_US = D
| routes_of_administration =
| legal_AU = S4

| legal_CA = Rx-only
| legal_UK = POM
| legal_US = Rx-only
| routes_of_administration = ]
<!--Pharmacokinetic data--> <!--Pharmacokinetic data-->
| bioavailability = | bioavailability =
| protein_bound = 5% | protein_bound = 5%
| metabolism = | metabolism = hepatic
| elimination_half-life = 36 hours | elimination_half-life = 36 hours
| excretion = Bile<ref>{{cite book|vauthors = Kwok KK, Vincent EC, Gibson JN|title=Pharmacology and Therapeutics for Dentistry|date=2017|publisher=Mosby|pages=530–562|doi=10.1016/B978-0-323-39307-2.00036-9}}</ref>

<!--Identifiers--> <!--Identifiers-->
| CASNo_Ref = {{cascite|correct|CAS}} | CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 50-76-0
| CAS_number_Ref = {{cascite|correct|??}}
| ATC_prefix = L01
| CAS_number = 50-76-0
| ATC_suffix = DA01
| ATC_prefix = L01
| ATC_supplemental =
| ATC_suffix = DA01
| PubChem = 2019
| ATC_supplemental =
| DrugBank_Ref = {{drugbankcite|changed|drugbank}}
| PubChem = 2019
| DrugBank = DB00970
| DrugBank_Ref = {{drugbankcite|changed|drugbank}}
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| DrugBank = <!-- blanked - oldvalue: APRD00124 -->
| ChemSpiderID = 10482167
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| NIAID_ChemDB = 009885
| ChemSpiderID = 10482167
| UNII_Ref = {{fdacite|correct|FDA}}
| NIAID_ChemDB = 009885
| UNII = 1CC1JFE158
| UNII_Ref = {{fdacite|correct|FDA}}
| KEGG_Ref = {{keggcite|changed|kegg}}
| UNII = 1CC1JFE158
| KEGG = C06770
| KEGG_Ref = {{keggcite|changed|kegg}}
| ChEBI_Ref = {{ebicite|correct|EBI}}
| KEGG = <!-- blanked - oldvalue: C06770 -->
| ChEBI = 27666
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEBI = 27666
| ChEMBL = 1554
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 1554

<!--Chemical data--> <!--Chemical data-->
| C=62 | H=86 | N=12 | O=16 | C = 62
| H = 86
| molecular_weight = 1255.42 g/mol
| N = 12
| InChI = 1/C62H86N12O16/c1-27(2)42-59(84)73-23-17-19-36(73)57(82)69(13)25-38(75)71(15)48(29(5)6)61(86)88-33(11)44(55(80)65-42)67-53(78)35-22-21-31(9)51-46(35)64-47-40(41(63)50(77)32(10)52(47)90-51)54(79)68-45-34(12)89-62(87)49(30(7)8)72(16)39(76)26-70(14)58(83)37-20-18-24-74(37)60(85)43(28(3)4)66-56(45)81/h21-22,27-30,33-34,36-37,42-45,48-49H,17-20,23-26,63H2,1-16H3,(H,65,80)(H,66,81)(H,67,78)(H,68,79)/t33-,34-,36+,37+,42-,43-,44+,45+,48+,49+/m1/s1
| O = 16
| InChIKey = RJURFGZVJUQBHK-IIXSONLDBN
| smiles = Cc1c2oc3c(C)ccc(C(O)=N4C(O)=N(C(C)C)C(=O)N5CCC5C(=O)N(C)CC(=O)N(C)(C(C)C)C(=O)O4C)c3nc-2c(C(O)=N2C(O)=N(C(C)C)C(=O)N3CCC3C(=O)N(C)CC(=O)N(C)(C(C)C)C(=O)O2C)c(N)c1=O
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C62H86N12O16/c1-27(2)42-59(84)73-23-17-19-36(73)57(82)69(13)25-38(75)71(15)48(29(5)6)61(86)88-33(11)44(55(80)65-42)67-53(78)35-22-21-31(9)51-46(35)64-47-40(41(63)50(77)32(10)52(47)90-51)54(79)68-45-34(12)89-62(87)49(30(7)8)72(16)39(76)26-70(14)58(83)37-20-18-24-74(37)60(85)43(28(3)4)66-56(45)81/h21-22,27-30,33-34,36-37,42-45,48-49H,17-20,23-26,63H2,1-16H3,(H,65,80)(H,66,81)(H,67,78)(H,68,79)/t33-,34-,36+,37+,42-,43-,44+,45+,48+,49+/m1/s1
| StdInChI = 1S/C62H86N12O16/c1-27(2)42-59(84)73-23-17-19-36(73)57(82)69(13)25-38(75)71(15)48(29(5)6)61(86)88-33(11)44(55(80)65-42)67-53(78)35-22-21-31(9)51-46(35)64-47-40(41(63)50(77)32(10)52(47)90-51)54(79)68-45-34(12)89-62(87)49(30(7)8)72(16)39(76)26-70(14)58(83)37-20-18-24-74(37)60(85)43(28(3)4)66-56(45)81/h21-22,27-30,33-34,36-37,42-45,48-49H,17-20,23-26,63H2,1-16H3,(H,65,80)(H,66,81)(H,67,78)(H,68,79)/t33-,34-,36+,37+,42-,43-,44+,45+,48+,49+/m1/s1
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = RJURFGZVJUQBHK-IIXSONLDSA-N
| StdInChIKey = RJURFGZVJUQBHK-IIXSONLDSA-N
| synonyms = <small>2-Amino- 4,6-dimethyl- 3-oxo- 3H-phenoxazine- 1,9-dicarboxylic acid bis- </small>
| synonyms = Actinomycin D<br/><small>2-Amino- 4,6-dimethyl- 3-oxo- 3H-phenoxazine- 1,9-dicarboxylic acid bis- </small>
}} }}

<!-- Definition and medical uses -->
'''Dactinomycin''', also known as '''actinomycin D''', is a ] used to treat a number of types of ].<ref name=AHFS2016/> This includes ], ], ], ], ], and certain types of ].<ref name=AHFS2016/> It is given by ].<ref name=AHFS2016/>

<!-- Side effects and mechanism -->
Most people develop side effects.<ref name=AHFS2016/> Common side effects include ], vomiting, mouth ulcers, hair loss, ], infections, and muscle pains.<ref name=AHFS2016/> Other serious side effects include future cancers, ], and ] if extravasation occurs.<ref name=AHFS2016/> Use in ] may harm the baby.<ref name=AHFS2016/> Dactinomycin is in the ] family of medications.<ref name=BNF69>{{cite book|title=British national formulary : BNF 69|date=2015|publisher=British Medical Association|isbn=9780857111562|page=582|edition=69}}</ref> It is believed to work by blocking the creation of ].<ref name=AHFS2016/>

<!-- History and culture -->
Dactinomycin was approved for medical use in the United States in 1964.<ref name=AHFS2016>{{cite web|title=Dactinomycin|url=https://www.drugs.com/monograph/dactinomycin.html|publisher=The American Society of Health-System Pharmacists|access-date=8 December 2016|url-status=live|archive-url=https://web.archive.org/web/20170911072431/https://www.drugs.com/monograph/dactinomycin.html|archive-date=11 September 2017}}</ref> It is on the 2023 ].<ref name="WHO23rd">{{cite book |title=The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) |vauthors=((World Health Organization)) |publisher=World Health Organization |year=2023 |location=Geneva |hdl=10665/371090 |id=WHO/MHP/HPS/EML/2023.02 |author-link=World Health Organization |hdl-access=free}}</ref>

== Medical use ==
Actinomycin is a clear, yellowish liquid administered intravenously and most commonly used in treatment of a variety of cancers, including:
*]<ref>{{cite journal | vauthors = Turan T, Karacay O, Tulunay G, Boran N, Koc S, Bozok S, Kose MF | title = Results with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) chemotherapy in gestational trophoblastic neoplasia | journal = International Journal of Gynecological Cancer | volume = 16 | issue = 3 | pages = 1432–1438 | year = 2006 | pmid = 16803542 | doi = 10.1111/j.1525-1438.2006.00606.x | s2cid = 32560653 }}</ref>
*]<ref>{{cite journal | vauthors = D'Angio GJ, Evans A, Breslow N, Beckwith B, Bishop H, Farewell V, Goodwin W, Leape L, Palmer N, Sinks L, Sutow W, Tefft M, Wolff J | display-authors = 6 | title = The treatment of Wilms' tumor: results of the Second National Wilms' Tumor Study | journal = Cancer | volume = 47 | issue = 9 | pages = 2302–2311 | date = May 1981 | pmid = 6164480 | doi = 10.1002/1097-0142(19810501)47:9<2302::aid-cncr2820470933>3.0.co;2-k | doi-access = free }}</ref>
*]<ref>{{cite journal | vauthors = Khatua S, Nair CN, Ghosh K | title = Immune-mediated thrombocytopenia following dactinomycin therapy in a child with alveolar rhabdomyosarcoma: the unresolved issues | journal = Journal of Pediatric Hematology/Oncology | volume = 26 | issue = 11 | pages = 777–779 | date = November 2004 | pmid = 15543019 | doi = 10.1097/00043426-200411000-00020 }}</ref>
*]<ref>{{cite journal | vauthors = Jaffe N, Paed D, Traggis D, Salian S, Cassady JR | title = Improved outlook for Ewing's sarcoma with combination chemotherapy (vincristine, actinomycin D and cyclophosphamide) and radiation therapy | journal = Cancer | volume = 38 | issue = 5 | pages = 1925–1930 | date = November 1976 | pmid = 991106 | doi = 10.1002/1097-0142(197611)38:5<1925::AID-CNCR2820380510>3.0.CO;2-J | doi-access = free }}</ref>
*Malignant ]<ref>{{cite journal | vauthors = Uberti EM, Fajardo M, Ferreira SV, Pereira MV, Seger RC, Moreira MA, Torres MD, de Nápoli G, Schmid H | display-authors = 6 | title = Reproductive outcome after discharge of patients with high-risk hydatidiform mole with or without use of one bolus dose of actinomycin D, as prophylactic chemotherapy, during the uterine evacuation of molar pregnancy | journal = Gynecologic Oncology | volume = 115 | issue = 3 | pages = 476–481 | date = December 2009 | pmid = 19818481 | doi = 10.1016/j.ygyno.2009.09.012 }}</ref>
Sometimes it will be combined with other drugs in ], like the VAC regimen (with ] and ]) for treating rhabdomyosarcoma and Ewing's sarcoma.<ref>{{Cite journal |display-authors=6 |vauthors=Arndt CA, Stoner JA, Hawkins DS, Rodeberg DA, Hayes-Jordan AA, Paidas CN, Parham DM, Teot LA, Wharam MD, Breneman JC, Donaldson SS, Anderson JR, Meyer WH |date=2009 |title=Vincristine, Actinomycin, and Cyclophosphamide Compared With Vincristine, Actinomycin, and Cyclophosphamide Alternating With Vincristine, Topotecan, and Cyclophosphamide for Intermediate-Risk Rhabdomyosarcoma: Children's Oncology Group Study D9803 |journal=] |volume=27 |issue=31 |pages=5182–5188 |doi=10.1200/JCO.2009.22.3768 |pmid=19770373|doi-access=free |pmc=2773476 }}</ref>

It is also used as a ] in adjunct to ],<ref>{{Cite book |title=Abeloff's Clinical Oncology |vauthors=Matthews NH, Moustafa F, Kaskas NM, Robinson-Bostom L, Pappas-Taffer L |publisher=Elsevier |year=2020 |pages=621–648 |chapter=41 - Dermatologic Toxicities of Anticancer Therapy |doi=10.1016/B978-0-323-47674-4.00041-4|isbn=9780323476744 |s2cid=198317393 }}</ref> since it can increase the ] of ] by inhibiting repair of sublethal radiation damage and delay the onset of the ] that occurs following irradiation.<ref>{{cite journal | vauthors = Hagemann RF, Concannon JP | title = Mechanism of intestinal radiosensitization by actinomycin D | journal = The British Journal of Radiology | volume = 46 | issue = 544 | pages = 302–308 | date = April 1973 | pmid = 4720744 | doi = 10.1259/0007-1285-46-544-302 }}</ref>

== Side effects ==
Common ] includes ], ], ], ], ] and ]. Actinomycin is a ], if ] occurs.

==Mechanism==
In ], actinomycin D is shown to have the ability to inhibit ]. Actinomycin D does this by binding ] at the transcription initiation complex and preventing elongation of ] chain by ].<ref>{{cite journal | vauthors = Sobell HM | title = Actinomycin and DNA transcription | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 82 | issue = 16 | pages = 5328–5331 | date = August 1985 | pmid = 2410919 | pmc = 390561 | doi = 10.1073/pnas.82.16.5328 | doi-access = free | bibcode = 1985PNAS...82.5328S }}</ref>

== History ==
Actinomycin D was the first ] shown to have anti-] activity.<ref name="gen">{{cite journal| vauthors = Hollstein U |title=Actinomycin. Chemistry and mechanism of action|doi=10.1021/cr60292a002|journal=Chemical Reviews|volume=74|issue=6|pages=625–652|year=1974}}</ref> It was first isolated by ] and his co-worker ] in 1940,<ref>{{cite journal | vauthors = Waksman SA, Woodruff HB |s2cid=84774334|title=Bacteriostatic and bacteriocidal substances produced by soil actinomycetes|journal=Proceedings of the Society for Experimental Biology and Medicine |volume=45 |pages=609–614 |year=1940 |doi=10.3181/00379727-45-11768 }}</ref> using fermentation products from '']''.<ref>{{Cite book |title=LiverTox: Clinical and Research Information on Drug-Induced Liver Injury |publisher=National Institute of Diabetes and Digestive and Kidney Diseases |year=2012 |chapter=Dactinomycin |pmid=31644085}}</ref> It was approved by the U.S. ] (FDA) on December 10, 1964,<ref>{{Cite web |title=Drugs@FDA: Dactinomycin |url=https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&varApplNo=050682 |access-date=2023-10-15 |website=FDA}}</ref> and launched by ] under the trade name Cosmegen.

== Research use ==
Because actinomycin can bind DNA duplexes, it can also interfere with ], although other chemicals such as ] are better suited for use in the laboratory as inhibitors of DNA synthesis.

Actinomycin D and its ] derivative, ] (7-AAD), are used as stains in ] and ] applications. The affinity of these stains/compounds for GC-rich regions of DNA strands makes them excellent markers for DNA. 7-AAD binds to single stranded DNA; therefore it is a useful tool in determining apoptosis and distinguishing between dead cells and live ones.<ref>{{cite journal | vauthors = Toba K, Koike T, Watanabe K, Fuse I, Takahashi M, Hashimoto S, Takahashi H, Abe T, Yano T, Shibazaki Y, Itoh H, Aizawa Y | display-authors = 6 | title = Cell kinetic study of normal human bone marrow hematopoiesis and acute leukemia using 7AAD/PY | journal = European Journal of Haematology | volume = 64 | issue = 1 | pages = 10–21 | date = January 2000 | pmid = 10680701 | doi = 10.1034/j.1600-0609.2000.09005.x | s2cid = 41065740 }}</ref>

== Biosynthesis ==
Actinomycin D is composed of a central ] ] tethered to two identical cyclic peptides and was first structurally characterized by Nuclear Magnetic Resonance (NMR) analysis in 1982.<ref name="Shafer_1982">{{cite journal | vauthors = Shafer RH, Formica JV, Delfini C, Brown SC, Mirau PA | title = Biosynthesis and characterization of actinomycin D and conformational analysis by nitrogen-15 nuclear magnetic resonance | journal = Biochemistry | volume = 21 | issue = 25 | pages = 6496–6503 | date = December 1982 | pmid = 6129895 | doi = 10.1021/bi00268a027 }}</ref> The biosynthesis of Actinomycin D has been under investigation since its discovery; early fermentation feeding experiments revealed the roles of both ] and ] as precursor substrates,<ref>{{cite journal | vauthors = Sivak A, Katz E | title = Biosynthesis of the actinomycin chromophore. Influence of alpha-, 4-, 5-, and 6-methyl-DL-tryptophan on actinomycin synthesis | journal = Biochimica et Biophysica Acta | volume = 62 | issue = 1 | pages = 80–90 | date = July 1962 | pmid = 13913519 | doi = 10.1016/0006-3002(62)90493-6 }}</ref><ref name="Shafer_1982" /> and strain mutagenesis experiments demonstrated that a phenoxazinone synthase enzyme might be responsible for coupling of two moieties of ] (4-MHA) into the final phenoxazinone structure.<ref>{{cite journal | vauthors = Troost T, Katz E | title = Phenoxazinone biosynthesis: accumulation of a precursor, 4-methyl-3-hydroxyanthranilic acid, by mutants of Streptomyces parvulus | journal = Journal of General Microbiology | volume = 111 | issue = 1 | pages = 121–132 | date = March 1979 | pmid = 458423 | doi = 10.1099/00221287-111-1-121 | doi-access = free }}</ref> The 4-MHA substrate was shown to be produced from tryptophan through the action of enzymes such as ], ], ], ], and ].<ref>{{cite journal | vauthors = Jones GH | title = Actinomycin synthesis in Streptomyces antibioticus: enzymatic conversion of 3-hydroxyanthranilic acid to 4-methyl-3-hydroxyanthranilic acid | journal = Journal of Bacteriology | volume = 169 | issue = 12 | pages = 5575–5578 | date = December 1987 | pmid = 2445729 | pmc = 213988 | doi = 10.1128/jb.169.12.5575-5578.1987 }}</ref><ref name="Keller_2010">{{cite journal | vauthors = Keller U, Lang M, Crnovcic I, Pfennig F, Schauwecker F | title = The actinomycin biosynthetic gene cluster of ''Streptomyces chrysomallus'': a genetic hall of mirrors for synthesis of a molecule with mirror symmetry | journal = Journal of Bacteriology | volume = 192 | issue = 10 | pages = 2583–2595 | date = May 2010 | pmid = 20304989 | pmc = 2863554 | doi = 10.1128/JB.01526-09 }}</ref>

Early experiments elucidated the presence of non-ribosomal peptide synthetases,<ref name="Construction and in vitro analysis">{{cite journal | vauthors = Schauwecker F, Pfennig F, Grammel N, Keller U | title = Construction and in vitro analysis of a new bi-modular polypeptide synthetase for synthesis of N-methylated acyl peptides | journal = Chemistry & Biology | volume = 7 | issue = 4 | pages = 287–297 | date = April 2000 | pmid = 10780924 | doi = 10.1016/s1074-5521(00)00103-4 | doi-access = free }}</ref><ref name="Molecular cloning of the actinomyci">{{cite journal | vauthors = Schauwecker F, Pfennig F, Schröder W, Keller U | title = Molecular cloning of the actinomycin synthetase gene cluster from ''Streptomyces chrysomallus'' and functional heterologous expression of the gene encoding actinomycin synthetase II | journal = Journal of Bacteriology | volume = 180 | issue = 9 | pages = 2468–2474 | date = May 1998 | pmid = 9573200 | doi = 10.1128/jb.180.9.2468-2474.1998 | pmc = 107190 }}</ref><ref>{{cite journal | vauthors = Stindl A, Keller U | title = The initiation of peptide formation in the biosynthesis of actinomycin | journal = The Journal of Biological Chemistry | volume = 268 | issue = 14 | pages = 10612–10620 | date = May 1993 | doi = 10.1016/S0021-9258(18)82242-6 | pmid = 7683683 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Stindl A, Keller U | title = Epimerization of the D-valine portion in the biosynthesis of actinomycin D | journal = Biochemistry | volume = 33 | issue = 31 | pages = 9358–9364 | date = August 1994 | pmid = 8049237 | doi = 10.1021/bi00197a041 }}</ref> and subsequent purification and heterologous expression experiments<ref name="Construction and in vitro analysis"/><ref name="Molecular cloning of the actinomyci"/><ref>{{cite journal | vauthors = Keller U | title = Actinomycin synthetases. Multifunctional enzymes responsible for the synthesis of the peptide chains of actinomycin | journal = The Journal of Biological Chemistry | volume = 262 | issue = 12 | pages = 5852–5856 | date = April 1987 | pmid = 3571237 | doi = 10.1016/s0021-9258(18)45652-9 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Keller U | title = Acyl pentapeptide lactone synthesis in actinomycin-producing streptomycetes by feeding with structural analogs of 4-methyl-3-hydroxyanthranilic acid | journal = The Journal of Biological Chemistry | volume = 259 | issue = 13 | pages = 8226–8231 | date = July 1984 | pmid = 6203903 | doi = 10.1016/s0021-9258(17)39717-x | doi-access = free }}</ref> showed the ''acmD'' and ''acmA'' genes to be responsible for activation of the 4-MHA, which then undergoes chain elongation through the action of the ''acmB'' and ''acmC'' genes. In total, the NRPS assembly line is composed of twenty-two modules, including two each of ] and ] domains.<ref>{{cite journal | vauthors = Pfennig F, Schauwecker F, Keller U | title = Molecular characterization of the genes of actinomycin synthetase I and of a 4-methyl-3-hydroxyanthranilic acid carrier protein involved in the assembly of the acylpeptide chain of actinomycin in Streptomyces | journal = The Journal of Biological Chemistry | volume = 274 | issue = 18 | pages = 12508–12516 | date = April 1999 | pmid = 10212227 | doi = 10.1074/jbc.274.18.12508 | doi-access = free }}</ref><ref name="Keller_2010" /> Recent sequencing of the actinomycin D gene cluster in ''Streptomyces chrysomallus'' showed that the four NRPS genes were surrounded on both sides by the two clusters of the genes involved in the well-studied ] and responsible for the production of 4-MHA from tryptophan, with nine ]s identified between the two clusters.<ref name="Keller_2010" />
]

== References ==
{{reflist|32em}}

== External links ==
* {{cite web | url = https://druginfo.nlm.nih.gov/drugportal/name/dactinomycin | publisher = U.S. National Library of Medicine | work = Drug Information Portal | title = Dactinomycin }}

{{Chemotherapeutic agents}}

{{portal bar|Medicine}}

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