The acetylation polymorphism is one of the most common genetic variations in the transformation of drugs and chemicals. More than 50% of individuals in Caucasian populations are homozygous for a recessive trait and are of the "slow acetylator" phenotype. They are less efficient than "rapid acetylators" in the metabolism of numerous drugs and environmental and industrial chemicals. The acetylation polymorphism is associated with an increased risk of drug toxicity and with an increased frequency of certain cancers. We report the identification of the primary mutations in two alleles of the gene for the N-acetyltransferase (NAT; acetyl-CoA:arylamine N-acetyltransferase, EC 2.3.1.5) isozyme NAT2 associated with slow acetylation. These alleles, Ml and M2, account for more than 90% of slow acetylator alleles in the European population we have studied. Ml and M2 were identified by restriction fragment length polymorphisms with Kpn I and Msp I and subsequently cloned and sequenced. Ml and M2 each are characterized by a combination of two different point mutations, one causing an amino acid substitution (Ile-113 -* Thr in Ml, Gin in M2), the other being silent (C 481 -+ T in Ml, C 282 T in M2). Functional expression of Ml and M2 and of chimeric gene constructs between mutant and wild-type NAT2 in COS-1 cells suggests that Ml causes a decrease of NAT2 protein in the liver by defective translation, whereas M2 produces an unstable enzyme. On the basis of the mutations described here and a rare mutant allele (M3) reported recently, we have developed a simple DNA amplification assay that allows the predictive genotyping of more than 95% of slow and rapid acetylator alleles and the identification of individuals at risk.The acetylation polymorphism is one of the most common inherited variations in the biotransformation of drugs and chemicals. Its association with drug toxicity and an increased risk to develop certain cancers has made it one of the oldest and best-studied examples of a pharmacogenetic condition (1-3). Forty to 70% of Caucasians in Europe and North America are of the "slow acetylator" phenotype and are less efficient than "rapid acetylators" in the metabolism of numerous drugs and chemicals containing primary aromatic amine or hydrazine groups. These include agents such as isoniazid, sulfamethazine (SMZ) and other sulfonamides, procainamide, hydralazine, dapsone, and caffeine, as well as several chemicals with carcinogenic potential such as benzidine, 2-aminofluorene, and f-naphthylamine, present in dyes, antioxidants, pesticides, and explosives (2-4). Highly mutagenic and carcinogenic arylamines also are generated during cooking of food (5). Slow acetylators are at higher risk to develop bladder cancer (1-4), whereas rapid acetylators are at higher risk for colorectal cancer (6).In previous studies, we have shown that slow acetylators have a quantitative decrease in their liver of a cytosolic arylamine N-acetyltransferase (NAT; acetyl-CoA:arylamine N-acetyltransferase, EC 2.3.1.5) (7). This enzyme was p...