The accuracy of breast MRI radiomic methodologies in predicting pathological complete response to neoadjuvant chemotherapy: A systematic review and network meta-analysis.

BACKGROUND: Achieving pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) improves survival outcomes for breast cancer patients. Currently, conventional histopathological biomarkers predicting such responses are inconsistent. Studies investigating radiomic texture analysis from breast magnetic resonance imaging (MRI) to predict pCR have varied radiomic protocols introducing heterogeneity between results. Thus, the efficacy of radiomic profiles compared to conventional strategies to predict pCR are inconclusive. PURPOSE: Comparing the predictive accuracy of different breast MRI radiomic protocols to identify the optimal strategy in predicting pCR to NAC. MATERIAL AND METHODS: A systematic review and network meta-analysis was performed according to PRISMA guidelines. Four databases were searched up to October 4th, 2021. Nine predictive strategies were compared, including conventional biomarker parameters, MRI radiomic analysis conducted before, during, or after NAC, combination strategies and nomographic methodology. RESULTS: 14 studies included radiomic data from 2,722 breast cancers, of which 994 were used in validation cohorts. All MRI derived radiomic features improved predictive accuracy when compared to biomarkers, except for pre-NAC MRI radiomics (odds ratio [OR]: 0.00; 95 % CI: -0.07-0.08). During-NAC and post-NAC MRI improved predictive accuracy compared to Pre-NAC MRI (OR: 0.14, 95 % CI: 0.02-0.26) and (OR: 0.26, 95 % CI: 0.07-0.45) respectively. Combining multiple MRIs did not improve predictive performance compared to Mid- or Post-NAC MRIs individually. CONCLUSION: Radiomic analysis of breast MRIs improve identification of patients likely to achieve a pCR to NAC. Post-NAC MRI are the most accurate imaging method to extrapolate radiomic data to predict pCR.

Optimal reconstructive strategies in the setting of post-mastectomy radiotherapy - A systematic review and network meta-analysis.

BACKGROUND: A third of breast cancer patients require mastectomy. In some high-risk cases postmastectomy radiotherapy (PMRT) is indicated, threatening reconstructive complications. Several PMRT and reconstruction combinations are used. Autologous flap (AF) reconstruction may be immediate (AF→PMRT), delayed-immediate with tissue expander (TE [TE→PMRT→AF]) or delayed (PMRT→AF). Implant-based breast reconstruction (IBBR) includes immediate TE followed by PMRT and conversion to permanent implant (PI [TE→PMRT→PI]), delayed TE insertion (PMRT→TE→PI), and prosthetic implant conversion prior to PMRT (TE→PI→PMRT). AIM: Perform a network metanalysis (NMA) assessing optimal sequencing of PMRT and reconstructive type. METHODS: A systematic review and NMA was performed according to PRISMA-NMA guidelines. NMA was conducted using R packages netmeta and Shiny. RESULTS: 16 studies from 4182 identified, involving 2322 reconstructions over three decades, met predefined inclusion criteria. Studies demonstrated moderate heterogeneity. Multiple comparisons combining direct and indirect evidence established AF-PMRT as the optimal approach to avoid reconstructive failure, compared with IBBR strategies (versus PMRT→TE→PI; OR [odds ratio] 0.10, CrI [95% credible interval] 0.02 to 0.55; versus TE→PMRT→PI; OR 0.13, CrI 0.02 to 0.75; versus TE→PI→PMRT OR 0.24, CrI 0.05 to 1.05). PMRT→AF best avoided infection, demonstrating significant improvement versus PMRT→TE→PI alone (OR 0.12, CrI 0.02 to 0.88). Subgroup analysis of IBBR found TE→PI→PMRT reduced failure rates (OR 0.35, CrI 0.15-0.81) compared to other IBBR strategies but increased capsular contracture. CONCLUSION: Immediate AF reconstruction is associated with reduced failure in the setting of PMRT. However, optimal reconstructive strategy depends on patient, surgeon and institutional factors. If IBBR is chosen, complication rates decrease if performed prior to PMRT. PROSPERO REGISTRATION: CRD 42020157077.

Purinergic receptors: photoaffinity analog of adenosine triphosphate is a specific adenosine triphosphate antagonist.

Arylazido aminopropionyl adenosine triphosphate (ANAPP3), a photoaffinity label, antagonized specifically adenine nucleotide-induced contractions of the guinea pig vas deferens. Irradiation of tissues with visible light in the presence of ANAPP3 resulted in an irreversible antagonism, which was prevented when adenosine triphosphate was present. In the absence of light, the antagonism was reversible and may have resulted from an autoinhibition phenomenon. Responses to acetylcholine, histamine, norepinephrine, and potassium chloride were not affected by ANAPP3.

Health-related quality of life measured by the UW-QoL--reference values from a general dental practice.

The objective of this study was to obtain age and sex-specific reference values for the University of Washington head and neck cancer questionnaire version 4 (UW-QoLv4) and to compare this with patients with oral and oropharyngeal cancer. Cross-sectional reference data was collected from 372 patients in six local general dental practices, 349 of whom presented for routine appointments. Quota sampling was used to collect data for similar numbers of patients by gender by four age bands (40-49, 50-59, 60-69, 70-79 yr). The longitudinal sample consisted of 450 consecutive patients undergoing primary surgery for previously untreated oral and oropharyngeal squamous cell carcinoma presenting to the Regional Maxillofacial Unit Liverpool, between the years 1995 and 2002. At baseline the key differences were anxiety, pain, swallowing, chewing, and mood. At 1yr there were big differences in all domains with deterioration in the oral cancer group. The difference was least notable in pain, shoulder, mood and anxiety. Reference data from a non-cancer population is very important when considering UW-QoL domains as an outcome parameter in clinical trials and also when discussing health-related quality of life outcomes with patients and their families.

(+/-)-trans-2-(Aminomethyl)cyclobutanecarboxylic acid hydrochloride: a rigid analogue of gamma-aminobutyric acid.

The (+/-) title compound was prepared to evaluate prior observations that certain gamma-aminobutyric acid (gamma Abu) congeners in the transoid disposition demonstrate gamma Abu receptor binding activity. It was prepared by a multistep sequence from (+/-)-methyl trans-2-(hydroxymethyl)cyclobutanecarboxylate. In a sodium-independent binding assay, the specific binding of (+/-)-1 to synaptic membranes from rat brain tissue was 1/14 500 that of gamma Abu.

N-Isopropyl derivatives of dopamine and 5,6-dihydroxy-2-aminotetralin.

Secondary and tertiary amino homologs of the title compounds have been prepared, bearing an N-isopropyl group. In peripheral evaluation, certain members of the series exhibited beta-adrenergic agonist effects of lower activity than isoproterenol. N-Methyl-N-isopropyl-5,6-dihydroxytetralin exhibited marked properties consistent with its being an alpha agonist, and it is concluded that introduction of considerable bulk about the nitrogen of a catecholamine does not a priori destroy alpha-agonist effects. The compounds qualitatively paralleled the effects of dopamine in assays based upon direct intrastriatal administration in rats, although they were less potent than dopamine.

[(Arylcarbonyl)oxy]propanolamines. 1. Novel beta-blockers with ultrashort duration of action.

Novel [(arylcarbonyl)oxy]propanolamines were synthesized and investigated as potential ultrashort-acting beta-adrenergic receptor blockers. Many of these analogues exhibited good potency and short duration. The N-ureidoalkyl analogue 85 (ACC-9089) has a potency equal to propranolol and a duration of action of about 21 min in the dog. It has been selected as a candidate for further clinical study. Structure-activity relationships and structure-duration relationships for these new beta-blockers are also discussed.

Metabolism of 4-chlorobiphenyl by guinea pig adrenocortical and hepatic microsomes.

Studies were carried out to determine if 4-chlorobiphenyl (4-CB) was a substrate for adrenal monooxygenases and to compare its interactions with adrenal and hepatic microsomal enzymes. Addition of 4-CB to guinea pig adrenal microsomes produced a typical type I spectral change, indicative of binding to cytochrome(s) P-450 and similar to that seen in hepatic microsomal preparations. The activities of several adrenal and hepatic microsomal monooxygenases were decreased by 4-CB in vitro. High pressure liquid chromatographic analyses revealed that both adrenal and hepatic microsomes, in the presence of NADPH, converted 4-CB to a major metabolite which eluted with a retention time identical to that of 4-chloro-4'-biphenylol (4'-OH-4-CB). The identity of 4'-OH-4-CB was confirmed by mass spectrometry. The maximal rate of 4-CB metabolism was greater in adrenal, compared with liver microsomes, but 4-CB had a higher affinity for hepatic than for adrenal enzymes. The rate of adrenal 4-CB metabolism was four to five times greater in microsomes derived from the inner cortical zone (zona reticularis) than those from the outer zones (zona fasciculata and zona glomerulosa). Hepatic microsomes also converted 4-CB to a minor metabolite whose production was blocked by epoxide hydrolase inhibitors, suggesting it might be a diol. 4-CB metabolism was not demonstrable in adrenal mitochondrial preparations. The results indicate that chlorinated biphenyls can serve as substrates for adrenal microsomal monooxygenases, suggesting that local activation may contribute to their adrenocortical toxicity.

Metabolic activation of hydralazine by rat liver microsomes.

There is evidence to suggest that the oxidative metabolism of hydralazine (HP), an antihypertensive drug, may represent a toxic pathway which could account for some of the adverse effects of the drug. Experiments were done to determine whether the hepatic oxidative metabolism of HP is associated with the formation of reactive metabolites. In the presence of NADPH, HP was metabolized by rat liver microsomes to three major oxidation products, phthalazine, phthalazinone (PZ), and a dimer compound. Under similar incubation conditions, radioactivity derived from [14C]HP was covalently bound to microsomal protein. Metabolite formation and covalent binding increased following pretreatment of rats with phenobarbital. In contrast, pretreatment with 3-methylcholanthrene or with the monooxygenase inhibitor, piperonyl butoxide, slightly decreased both metabolite formation and covalent binding. Electron spin resonance (ESR) analyses indicated that nitrogen-centered radicals were formed when rat liver microsomes were incubated with HP under conditions similar to those required for covalent binding and for the production of the oxidative metabolites. In addition, reduced glutathione (GSH) caused concentration-dependent decreases in the production of phthalazine, PZ, and the dimer, in the covalent binding of HP to microsomal protein, and in the formation of nitrogen-centered radicals. The results of these investigations indicate that the oxidative metabolism of HP by rat liver microsomes is highly correlated with the formation of nitrogen-centered radicals and the production of metabolites that become covalently bound to microsomal protein. These observations support the hypothesis that the oxidation of HP generates reactive metabolites which may contribute to the toxicity of the drug.

Adrenal mitochondrial metabolism of spironolactone. Absence of metabolic activation.

Previous investigations have established that spironolactone (SL) administration to guinea pigs decreases adrenal mitochondrial and microsomal cytochrome P-450 content, and that the latter requires microsomal activation of the drug. Studies were carried out to determine if adrenal mitochondrial metabolism (activation) of SL was similarly involved in the effects of the drug on mitochondrial cytochrome P-450 destruction. Incubation of guinea pig adrenal mitochondria with SL in the absence of NADPH resulted in the formation of 7 alpha-thio-SL as the only metabolite. In the presence of an NADPH-generating system, an unknown polar metabolite was also produced. The mass spectrum of the unknown compound suggested that it was a hydroxylated derivative of SL. Incubation of mitochondrial preparations with 7 alpha-thio-SL also resulted in the formation of a polar metabolite, but the latter had a different HPLC retention time than that of the SL metabolite. Formation of the polar SL metabolite was prevented by metyrapone, an 11 beta-hydroxylase inhibitor, and was greatest in mitochondria from the adrenal zone having the highest 11 beta-hydroxylase activity. Steroid substrates for 11 beta-hydroxylation inhibited the production of the SL metabolite. Mitochondrial incubations with SL or with 7 alpha-thio-SL in the presence or absence of an NADPH-generating system did not affect cytochrome P-450 concentrations. The results indicate that, unlike the microsomal effects of SL, local activation of SL is not responsible for the destruction of adrenal mitochondrial cytochromes P-450. The major adrenal mitochondrial metabolites of SL appear to be 11 beta-hydroxy-SL and 7 alpha-thio-SL.

Long-term effects of BIBN-99, a selective muscarinic M2 receptor antagonist, on improving spatial memory performance in aged cognitively impaired rats.

Aged Long-Evans rats were screened for spatial memory deficits using the Morris water maze task. Rats found to have impaired performance on the task (aged-impaired, AI) were then treated with a selective muscarinic M2 receptor antagonist, 5,11-dihydro-8-chloro-11-[[4-[3-[(2,2-dimethyl-1-oxopentyl)ethylamino]propyl]-1-piperidinyl]acetyl]-6H-pyrido[2,3-b][1,4]benzodiazepin-6-one (BIBN-99; 0.5 mg/kg, s.c.), for 3 successive days while receiving additional water maze training. BIBN-99 significantly improved performance in the task during the 3 days of drug treatment. Treatment was then ceased for the remainder of the study and rats were tested again in the water maze on days 10, 17, and 24. Compared to vehicle-treated rats, enhanced performance was observed in the AI rats that had previously been treated with BIBN-99. These results indicate that BIBN-99 enhances spatial learning in AI animals and that enhanced (or long-term) memory persists in the absence of the drug. In a second experiment, a 2-month delay was imposed in between the original water maze screening and the drug treatment regime. Again, BIBN-99 significantly improved performance in AI rats. This latter study suggests that reference memory does not decay, even in an AI animal that had displayed poor learning following original water maze screening. Together, these studies help provide further insight into possible mechanism(s) of reference memory and its potential clinical usefulness.

Further comparison of contractions of the smooth muscle of the guinea-pig isolated vas deferens induced by ATP and related analogs.

Some structural requirements which are important for the contractile activity of adenine nucleotides at P2-purinergic receptors in the guinea-pig isolated vas deferens were examined. The consequences of deletions, substitutions and isosteric rearrangements in 1-N, C-2, C-8, N-9 and N6 of adenine, in the ribose hydroxyls, and in the polyphosphate chain were examined. Several kinds of effects on activity were observed, including potentiation of responses, losses in activity, modifications of response duration, and transitions from biphasic concentration-response curves, which are characteristic of ATP, to monophasic curves. Generally, deletions and substitutions to adenine reduced activity. Ribose modifications were better-tolerated. The presence of 5'-phosphate or phosphorothioate moieties was required for maximum activity. A comparison of the present results with previous reports indicates that certain modifications to ATP result in similar effects in both the vas deferens and urinary bladder, which are opposite those which occur in the taenia coli.

Comparison of photoaffinity labeling of P2-purinergic receptors of isolated guinea-pig vas deferens by arylazido aminopropionyl ATP and by arylazido aminobutyryl ATP.

Two chemically related arylazido photoaffinity analogs of ATP (arylazido aminopropionyl ATP (ANAPP3) and arylazido aminobutyryl ATP (ANABP3)), which have been reported in the literature to differ in their ability to inhibit myosin ATPase, were compared for their ability to antagonize contractile responses of the isolated guinea-pig vas deferens to ATP. During photolysis in organ chambers the photoconversion (delta A260/delta t) of ANAPP3 occurred with greater than first order kinetics or was multiexponential and t1/2 = 7.5 min, while delta A260/delta t for ANABP3 was first order and t1/2 = 2.25 min. After photolysis of these compounds in the presence of the guinea-pig vas deferens, using irradiation periods which caused 80% consumption of the compounds, ANABP3 was 2-3 times more potent than ANAPP3 in antagonizing contractions to ATP, which are mediated by P2-purinergic receptors. A comparison of concentration-response curves obtained for nonphotolyzed ANAPP3 and ANABP3 used as agonists suggested that the greater antagonism produced by photolyzed ANABP3 is not attributable to a greater potency. The results suggest that the longer 3'-hydroxyl-arylazide bridge length of ANABP3 places the arylnitrene intermediate in a position at or near the P2-receptor which is more favorable for covalent insertion.

Comparison of the effects of apamin, a Ca2+-dependent K+ channel blocker, and arylazido aminopropionyl ATP (ANAPP3), a P2-purinergic receptor antagonist, in the guinea-pig vas deferens.

Apamin, which blocks Ca2+-dependent increases in K+ permeability, antagonizes ATP-induced relaxation of several smooth muscles. The ATP photoaffinity label arylazido aminopropionyl ATP (ANAPP3), following its photolysis in the presence of the guinea-pig vas deferens, antagonizes contractile responses to ATP. This study was conducted to determine whether apamin antagonizes ATP-induced responses in the guinea-pig vas deferens, and also to evaluate whether ANAPP3 antagonizes responses to ATP by interfering with Ca2+-dependent K+ permeability changes. Apamin (10(-6) M) potentiated ATP-induced contractions. This potentiation was nonspecific in that responses to norepinephrine, histamine and acetylcholine also were enhanced; responses to KCl were unaffected. To evaluate the possible interactions between the two agents at the same cellular site, the effect of apamin was examined in ANAPP3-treated tissues. In such tissues apamin did not potentiate the residual responses to ATP; however, apamin was nevertheless able to potentiate responses of ANAPP3-treated tissues to norepinephrine, histamine and acetylcholine, and responses to KCl remained unaffected. These studies provide additional support for the view that ANAPP3 antagonizes ATP-induced responses of the guinea-pig vas deferens by blocking P2-purinergic receptors. The antagonism by ANAPP3 is not attributable to a blockade of Ca2+-dependent K+ permeability changes.

Evidence for a contribution by purines to the neurogenic response of the guinea-pig urinary bladder.

In order to determine if ATP contributes as an excitatory transmitter in the guinea-pig bladder, experiments were conducted with ANAPP3, a photoaffinity analogue of ATP, which is an antagonist of adenine nucleotides in several other smooth muscles. With or without photoactivation with visible light, ANAPP3 antagonized contractile responses of in vitro strips of bladder to exogenous ATP. The antagonism was specific in that responses to acetylcholine and KCl were not affected by ANAPP3. Responses of strips of bladder to transmural electrical stimulation were not antagonized by ANAPP3 and were relatively insensitive to atropine. However, combined treatment with ANAPP3 and atropine produced a marked antagonism of the neurogenic response. In experiments with bladders obtained from animals pretreated with 6-hydroxydopamine, the ANAPP3-sensitive component of the neurogenic response was absent. These results suggest that acetylcholine, released from cholinergic nerves, and a purine, released from 6-hydroxy-dopamine-sensitive nerves, are both involved in motor transmission in this tissue.

Interaction of [3H]arylazido aminopropionyl ATP ([3H]ANAPP3) with P2-purinergic receptors in the smooth muscle of the isolated guinea-pig vas deferens.

Following its photolysis in the presence of the isolated guinea-pig vas deferens, the ATP photoaffinity label ANAPP3 produces a specific antagonism of adenine nucleotide-induced contractile responses which are mediated by P2-purinergic receptors. To characterize the site of covalent photoincorporation of ANAPP3, intact vasa deferentia were treated with [3H]ANAPP3 and samples of homogenate, cytosol and a crude membrane fraction were analyzed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Photolysis of [3H]ANAPP3 (10(-5) M; 3.0 mu Ci/ml) resulted in the incorporation of radioactivity into cellular components with apparent molecular weights of 54-66 and 43-57 kilodaltons. The photoincorporation of [3H]ANAPP3 was associated with the crude membrane fraction and not the cytosol, was reduced in the presence of ATP in an ATP-concentration-dependent manner, was lessened following pretreatment of the tissues with photolyzed nonradiolabeled ANAPP3, and was unaffected by the nucleoside transport inhibitor, dipyridamole. In tension studies on the same tissues the presence of ATP resulted in a concentration-dependent reduction in the initial contractile response to [3H]ANAPP3 the response to 3H was antagonized in tissues which had been pretreated with nonradiolabeled ANAPP3, and dipyridamole had no effect on the contractile response to [3H]ANAPP3. According to several criteria these findings indicate that the antagonism by photolyzed ANAPP3 of adenine nucleotide-induced responses is a direct result of the covalent insertion at or near the recognition site of cell-surface P2-purinergic receptors.

Contribution by purines to the neurogenic response of the vas deferens of the guinea pig.

The specific purine-receptor antagonist, arylazido aminopropionyl ATP (ANAPP3), was used to determine if purines released from nerves of the guinea-pig was deferens contribute to the neurogenic response. ANAPP3, which is a photoaffinity label, antagonized contractile responses of the in vitro vas deferens to transmural stimulation, reversibly in the presence of the compound and irreversibly after its photoactivation in the presence of the tissues. The antagonism by ANAPP3 was augmented by depletion of norepinephrine produced by reserpine pretreatment. Responses of untreated tissues were only slightly antagonized by the alpha-adrenoceptor blocker prazosin. However, neurogenic responses were markedly reduced in the combined presence of ANAPP3 and prazosin. ANAPP3 did not affect the release of tritium from tissues prelabeled with [3H]norepinephrine. The initial phasic component of the neurogenic response was preferentially antagonized by ANAPP3 whereas the secondary more tonic component of the response was preferentially antagonized by prazosin and reserpine pretreatment. Small, residual responses remaining after chemical sympathectomy produced by 6-hydroxydopamine pretreatment were potentiated, rather than inhibited, by ANAPP3 and were, unlike untreated tissues, sensitive to atropine. These and previous findings indicate that ATP or a related purine, originating from adrenergic neurons, acts as a co-transmitter with norepinephrine in this tissue.

Comparison of contractions of the smooth muscle of the guinea-pig vas deferens induced by ATP and related nucleotides.

The shape of contractile responses of the isolated guinea-pig vas deferens changes as ATP concentration is increased from 10(-7) to 10(-2) M. The ATP concentration-response curve is bimodal and reflects the change in response profile. Initially spike-like (10(-7) -3 x 10(-5) M) in nature, contractions acquire a secondary, slower tonic phase in transitional ATP concentrations (greater than or equal to 3 x 10(-5) M). At high ATP concentrations (10(-2) M) the secondary phase predominates. To determine if there are structural requirements for these complex effects, responses to ATP were compared to those elicited with analogs containing phosphate-chain, ribose and adenine modifications. In general, substitution of 5'-anhydride linkages with methylene or imido bridges prolonged responses to low concentrations but at high concentrations both potentiated and abbreviated the responses. ATP gamma S, a substrate for phosphohydrolases which incorporate phosphate but which are less able to remove thiophosphate, produced responses with a greatly prolonged tonic phase. Removal of the 2'-hydroxyl of ATP resulted in reduced potency at low concentrations while removal of the 3'-hydroxyl was without effect. Modification of both the 1 and N6 positions of adenine substantially reduced agonist activity. Responses to ATP and the beta, gamma-methylene congener were unaffected by treatment with 10(-5) M indomethacin. The results indicate that more than one simple interaction of ATP with a receptor is involved in the production of responses to ATP. Of several hypotheses discussed, we favor one which suggests that the phasic responses to low concentrations of ATP are receptor-mediated and modified by tissue enzymes, while those to high concentrations are mediated, in part, by hydrolysis per se. The hypothesis, which realizes that conformational preferences may exist as well, is proposed for the vas deferens only.

A study of the atropine-resistant component of the neurogenic response of the rabbit urinary bladder.

Rabbit bladder body was stimulated to contract by a number of agonists, of which bradykinin was the most potent, and ATP one of the least potent substances tested. The atropine-resistant component of the neurogenic response was unaffected by 2 X 10(-5) M chlorpheniramine or 10(-6) M methysergide, doses which suppressed responses to histamine or 5HT. Indomethacin 10(-5) M, or 10(-5) M capsaicin both reduced the atropine-resistant component. Following treatment with 10(-6) M atropine and 10(-5) M prazosin, 10(-4) M ANAPP3 produced a further suppression of the response, but did not antagonize the response to ATP. In the bladder body, the transmitter(s) responsible for the neurogenic response may be acetylcholine and prostaglandins and possibly ATP and substance P.

Relationship between covalent binding to microsomal protein and the destruction of adrenal cytochrome P-450 by spironolactone.

Previous investigations have demonstrated that guinea pig adrenal microsomes catalyze an NADPH-dependent activation of spironolactone (SL) resulting in the degradation of cytochrome(s) P-450 and decreases in steroidogenic enzyme activities. Studies were done to evaluate the relationship between the destruction of cytochrome P-450 and the covalent binding to microsomal protein by SL and by 7 alpha-thiospironolactone (7 alpha-thio-SL), an obligatory intermediate in the activation pathway. NADPH-dependent irreversible binding to guinea pig adrenal microsomal protein was demonstrable with 22-14C- and with 35S-labelled SL or 7 alpha-thio-SL as substrates. In the absence of NADPH, there was relatively little binding. NADPH-dependent covalent binding was not demonstrable with hepatic microsomal preparations. The amount of covalent binding to adrenal microsomes was far greater with 7 alpha-thio-SL than with SL and also greater with 35S-labelled than with 14C-labelled substrates. The latter results suggest the possibility of more than one reactive metabolite. Time-course experiments revealed a good correlation between covalent binding and P-450 destruction by SL and by 7 alpha-thio-SL. In addition, the 17 alpha-hydroxylase inhibitor, SU-10'603, and the 17 alpha-hydroxylase substrate, progesterone, prevented both the degradation of cytochrome P-450 and the NADPH-dependent covalent binding by 7 alpha-thio-SL. Reduced glutathione also decreased covalent binding but did not diminish P-450 destruction. The latter results indicate that some of the covalent binding is unrelated to the degradation of cytochrome P-450. However, all of the data are consistent with the hypothesis that 7 alpha-thio-SL is a suicide inhibitor of adrenal cytochrome P-450 and that covalent binding to protein is involved in the degradation of cytochrome P-450.