Chain terminating nucleotide analog

Nucleoside reverse transcriptase inhibitor (NRTI)/nucleotide reverse transcriptase inhibitor (NtRI) A modified version of a naturally-occurring nucleoside or nucleotide that prevents human immunodeficiency virus (HIV) replication by interfering with the function of the viral reverse transcriptase enzyme. The nucleoside/nucleotide analog causes early termination of the proviral DNA chain. For activity, an NRTI requires three phosphorylation steps once inside the cell, whereas an NtRI has a phosphate group attached and needs only two phosphorylation steps inside the cell for activity. 

Mechanism of Action A nucleotide analog that inhibits HIV reverse transcriptase by being incorporated into viral DNA, resulting in DNA chain termination. Therapeutic Effect Slows HIV replication and reduces HIV RNA levels (viral load). Pharmacokinetics Bioavailability in fasted patients is approximately 25%. High-fat meals increase the bioavailability. Protein binding 0J%-12% Excreted in urine. Removed by hemodialysis. Half-life Unknown. 

Tenofovir is an acyclic nucleoside phosphonate (ie, nucleotide) analog of adenosine (Figure 49-2). Like the nucleoside analogs, tenofovir competitively inhibits HIV reverse transcriptase and causes chain termination after incorporation into DNA. However, only two rather than three intracellular phosphorylations are required for active inhibition of DNA synthesis. 

Although initially and abortively developed for treatment of HIV infection, adefovir dipivoxil gained approval, at lower and less toxic doses, for treatment of HBV infection. Adefovir dipivoxil is the diester prodrug of adefovir, an acyclic phosphonated adenine nucleotide analog (Rgure 49-2). It is phosphorylated by cellular kinases to the active diphosphate metabolite and then competitively inhibits HBV DNA polymerase to result in chain termination after incorporation into the viral DNA. Adefovir is active in vitro... 

D. The nucleoside/nucleotide analogs like azidothymidine (AZT) and didanosine are incorporated into the DNA synthesized by HIV reverse transcriptase. Because they do not have a 3 -hydroxyl group, they cannot form a bond with the next nucleotide and the chain is terminated. Host cell DNA synthesis is not affected because of the nuclear DNA repair mechanisms. 

Adefovir is an antiviral agent that inhibits hepatitis B virus (HBV) DNA polymerase (reverse transcriptase) by competing with the natural substrate deoxyadenosine triphosphate and by causing DNA chain termination after its incorporation into viral DNA. Adefovir is indicated in the treatment of chronic hepatitis B in adults with evidence of active viral replication and evidence of persistent elevations in serum aminotransferases or histologically active disease. Adefovir dipivoxil (9-[2-[bis[(pivaloyloxy)methoxy] phosphinyl]methoxyl]ethyl]adenine, bis-POM PMEA) is a diester prodrug of adefovir, an acyclic phosphonate nucleotide analog of adenosine monophosphate. 

Fludarabine phosphate, a fluorinated deamination-resistant nucleotide analog of the antiviral agent vidarabine (9-P-D-arabinofuranosyl-adenine), is active in CLL and low-grade lymphomas. After rapid extracellular dephosphorylation to the nucleoside fludarabine, it is rephosphorylated intracellularly by deoxycytidine kinase to the active triphosphate derivative. This antimetabolite inhibits DNA polymerase, DNA primase DNA ligase, and ribonucleotide reductase, and is incorporated into DNA and RNA. The triphosphate nucleotide is an effective chain terminator when incorporated into DNA, and the incorporation of fludarabine into RNA inhibits RNA function, RNA processing, and mRNA translation. 

Nucleotides will be added to the primer by base pairing with the restriction fragment. Synthesis will stop if the 2, 3 -dideoxy analog of dATP is added instead of dATP, because the 2, 3 -dideoxy analog does not have a 3 -OH to which additional nucleotides can be added. Therefore, three different chain-terminated fragments will be obtained from the DNA restriction fragment shown here. 

Mechanisms Formerly called azidothymidine (AZT), zidovudine is a nucleoside requiring phosphorylation by host cell kinases to form a nucleotide analog that both inhibits reverse transcriptase of HIV-1 and HIV-2 and causes chain termination in viral DNA. Resistance—common in patients with advanced HIV infection—is due to mutations at several sites on the pol gene which encodes for several proteins, including reverse transcriptase. 

Telbivudine (3), a synthetic thymidine nucleoside analog, is the unmodified L-enantiomer of the naturally occurring D-thymidine. It prevents HBV DNA synthesis by acting as an HBV polymerase inhibitor. Within hepatocytes, telbivudine (3) is phosphorylated by host cell kinase to telbivudine-5 -triphosphate which, once incorporated into HBV DNA, causes DNA chain termination, thus inhibiting HBV replication. In this sense, telbivudine (3), like most nucleotide antiviral drugs, is a prodrug. Clinical trials have shown telbivudine (3) to be significantly more effective than lamivudine (2) or adefovir dipivoxil (4) and less likely to cause resistance. ... 

Many other nucleotide analogs, notably those of dTTP, have been developed as potential RTase inhibitors having pharmacological value. For example, 3 -azido-3 -deoxythymidine 5 -triphosphate (NjdTTP) is incorporated by AMV RTase (and HIV-1 RTase as well) into the T sites of DNA and terminates chain elongation in a dose-dependent manner (48). The N3dTTP, which is converted from 3 -azido-3 -deoxythymidine (AZT) by cellular kinases, is believed to be the active metabolite producing the potent inhibitory effect of AZT on HIV-1 replication. 

Section 28 14 The nucleotide sequence of DNA can be determined by a technique m which a short section of single stranded DNA is allowed to produce its complement m the presence of dideoxy analogs of ATP TTP GTP and CTP DNA formation terminates when a dideoxy analog is incorporated into the growing polynucleotide chain A mixture of polynucleotides dif fermg from one another by an incremental nucleoside is produced and analyzed by electrophoresis From the observed sequence of the comple mentary chain the sequence of the original DNA is deduced... 

An analogous series of reactions is used to produce depyrimidinated DNA fragments. Hydrazine is used in these reactions, since both cytosine and thymine react with hydrazine. The bases are cleaved to yield urea and a pyrazole ring. The deoxyribose moiety is left as a hydrazone. Piperidine, which reacts with the hydrazone, is used to cleave the nucleotide chain. Cytosines react specifically with hydrazine in 5 mol/ L NaCl, but no specific reaction exists for thymines. Consequently, one aliquot yields labeled oligonu-cleotides 3 -terminated at cytosines, whereas a second aliquot contains nucleotides cleaved in the absence of NaCI at both cytosine and thymine residues. 

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