days). The study suggested that the topoisomerase inhibitors have the potential to produce a normally functioning UBE3A protein. Most symptoms due to Angelman's syndrome are traditionally treated by speech therapy, physical therapy and occupational therapy. Anti-seizure medication is often prescribed as seizures are a common symptom of Angelman's syndrome. These treatments target only symptoms. This drug has been administered to cancer patients. It was well tolerated when administered to pediatric and adult patients. Mechanism of action Topotecan is a semi-synthetic derivative of camptothecin. Camptothecin is a natural product extracted from the bark of the tree Camptotheca acuminata. Topoisomerase-I is a nuclear enzyme that relieves torsional strain in DNA by opening single strand breaks. Once topoisomerase-I creates a single strand break, the DNA can rotate in front of the advancing replication fork. In physiological environments, topotecan is in equilibrium with its inactive carboxylate form. Topotecan's active lactone form intercalates between DNA bases in the topoisomerase-I cleavage complex. The binding of topotecan in the cleavage complex prevents topoisomerase-I from religating the nicked DNA strand after relieving the strain. This intercalation therefore traps the topoisomerase-I in the cleavage complex bound to the DNA. When the replication-fork collides with the trapped topoisomerase-I, DNA damage occurs. The unbroken DNA strand breaks and mammalian cells cannot efficiently repair these double strand breaks. The accumulation of trapped topoisomerase-I complexes is a known response to apoptotic stimuli. This disruption prevents DNA replication and ultimately leads to cell death. This process leads to breaks in the DNA strand resulting in apoptosis. Administration of topotecan down-regulates its target, topoisomerase-I; therefore, it is dosed to maximize efficacy and minimize related toxicity. Topotecan is often given in combination with paclitaxel as first line treatment for extensive-stage small-cell lung cancer. Side effects Myelosuppression, specifically neutropenia, leukopenia, anemia, and thrombocytopenia Diarrhea, nausea, vomiting, stomatitis, and constipation Increased susceptibility to infections Asthenia Generic versions Two generic versions have been approved in the European Union. In Nov 2010 the US FDA approved a generic version. References Sources External links NCI Drug Dictionary Definition of Topotecan Topotecan Hydrochloride Lactams Delta-lactones Pyranoindolizinoquinolines Topoisomerase inhibitors GSK plc brands Novartis brands