Summary We report the first demonstration of the biotransformation of the anti-cancer drug 5-fluorouracil (FU) into two new metabolites, a-fluoro-f-hydroxypropionic acid (FHPA) and fluoroacetate (FAC), in the isolated perfused rat liver (IPRL) and in the rat in vivo. IPRL was perfused with solutions of pure FU at two doses, 15 or 45 mg kg-' body weight, and rats were injected i.p. with 180 mg of FU kg-' body weight.Fluorine-19 NMR analysis of perfusates from IPRL and rat urine showed the presence of the normal metabolites of FU and low amounts of FHPA (0.4% or 0.1% of injected FU in perfusates from IPRL treated with 15 or 45 mg of FU kg-' body weight, respectively; 0.08% of the injected FU in rat urine) and FAC (0.1% or 0.03% of injected FU in perfusates from IPRL treated with 15 or 45 mg of FU kg-' body weight, respectively; 0.003% of the injected FU in rat urine). IPRL was also perfused with a solution of a-fluoro-i-alanine (FBAL) hydrochloride at 16.6 mg kg-' body weight dose equivalent to 15 mg of FU kg-' body weight. Low amounts of FHPA (0.2% of injected FBAL) and FAC (0.07%) were detected in perfusates, thus demonstrating that FHPA and FAC arise from FBAL catabolism. As FAC is a well-known cardiotoxic poison, and FHPA is also cardiotoxic at high doses, the cardiotoxicity of FU might stem from at least two sources. The first one, established in previous papers (Lemaire et al, 1992(Lemaire et al, , 1994, is the presence in commercial solutions of FU of degradation products of FU that are metabolized into FHPA and FAC; these are formed over time in the basic medium necessary to dissolve the drug. The second, demonstrated in the present study, is the metabolism of FU itself into the same compounds.Keywords: 5-fluorouracil; a-fluoro-J-alanine; '9F nuclear magnetic resonance; metabolism; fluoroacetate; a-fluoro-o-hydroxypropionic acid; isolated perfused rat liver; rat urine 5-Fluorouracil (FU) is widely used as an anti-tumour agent for treatment of solid tumours. Its chief side-effects are myelosuppression, diarrhoea, vomiting and mucositis. However, over the last decade, the number of reports of cardiotoxicity and neurotoxicity attributed to FU has rapidly increased, probably because of the use of higher doses in continuous perfusion (Moertel et al, 1964;Rezkalla et al, 1989;Moore et al, 1990;Gamelin et al, 1991; De Fomi et al, 1992;Robben et al, 1993;Anand, 1994). The precise biochemical mechanism underlying these two side-effects remains unclear, although several investigators have postulated, but never demonstrated experimentally, that FU might be transformed into fluoroacetate (FAC), a highly cardiotoxic and neurotoxic poison (Koenig and Patel, 1970;Okeda et al, 1990). FAC enters the Krebs cycle and is then transformed into fluorocitrate, which inhibits the enzyme aconitase. Aconitase catalyses the conversion of citrate to isocitrate via the obligatory intermediate cis-aconitate. Inhibition of aconitase leads to a build-up of citrate in animal tissues (in particular heart) and serum, and the heart product...