Abstract Aristolochic acid (AA) is a potent human carcinogen and nephrotoxin found in preparations of Aristolochia plants used in Chinese Traditional Medicine. Following biotransformation to form N-sulfonyloxyaristolactam (AL-I-NOSO3), this intermediate undergoes heterolytic cleavage of the sulfate group to generate a reactive cyclic nitrenium ion, the ultimate DNA binding species. Recently, we showed that primary human hepatocytes significantly increase renal toxicity of AA in the integrated human liver-kidney “organs on-chips” model. Therefore, we propose that AA is activated in the liver by forming AL-I-NOSO3, which is transported to the kidney protected from decomposition by binding to serum albumin. We employed mass spectrometric, fluorimetric and X-crystallography based approaches to dissect mechanisms of interactions between human serum albumin (HSA), AA, N-hydroxyaristolactam and AL-I-NOSO3. First, we demonstrate that HSA stabilizes otherwise labile N-sulfonyloxyaristolactam. Quenching of the native fluorescence of HSA due to the presence of a sole molecule of tryptophane-214, allowed us to conclude that all three compounds have similar affinities to IIA drug binding pocket of HSA. Subsequently, we obtained a high-resolution X-ray structure of AA bound to HSA in domain IB (1.9°A, pdb: 6HSC). Since prior to crystallization HSA was enriched with sodium myristate and site IB in circulation is occupied by fatty acids, our results imply that the IB pocket is the primary high affinity binding site for AA and its active forms. To assess whether AL-I-NOSO3 covalently binds protein, we incubated human plasma and purified HSA with this active AA. Immunoblotting of reacted HSA using antibodies that recognize aristolactam(AL)-adducted DNA suggests irreversible covalent adduction of AL to HSA. A combined approach using mass spectrometry instruments and enzymatic digestion revealed that AL is adducted to HSA at the following sites: Trp-214, Tyr-138 and Tyr-141. The former amino acid is located in the IIA drug binding site of HSA, while the latter two can be found in our HSA/AA structure in the site IB in the vicinity to AA molecule, corroborating our X-crystallography and fluoremetric data. Based on these studies we propose that AL-I-NOSO3 has a dual mode of interactions with HSA. If AL-I-NOSO3 decomposes prior to HSA binding, aristolactam will become irreversibly trapped with HSA. This binding to HSA would serve as mechanism of detoxication of AA species. However, if AL-I-NOSO3 binds to HSA prior to decomposition, it should be protected by HSA and transported to target tissues in its intact form. Citation Format: Sergei Pomyalov, Radha Bonala, Robert Rieger, Irina Zaitseva, Charles Iden, John Haley, Robert Turesky, Francis Johnson, Thomas Rosenquist, Arthur P. Grollman, Gil Shoham, Viktoriya S. Sidorenko. Molecular mechanisms by which a bioactivated human carcinogen is transported to target tissues [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4660.