97 to log101.46 copies/ml,

respectively, reflecting the more efficient delivery of TAF to target cells and tissues. Clearly the lower dose of TAF (25 mg) relative to TDF (300 mg) will give TAF a marked advantage when considering combination pill therapy. Understanding how marked a difference a prodrug can make from the TAF example, Adrian went on to describe how a prodrug approach transformed a new nucleotide project in which intrinsic properties of the pharmacologically-active nucleotide analog were optimized. Their starting point was GS-2128 (D4APi), which had good activity against both wild-type and resistant HIV strains but was an active inhibitor of mitochondrial polymerase-gamma. On comparing the known structures of HIV RT and mitochondrial Ibrutinib polymerase-gamma, differences in the 2′-binding pocket were noted. This led to GS-9148 in which 2′-F was added to GS-2128 (Fig. 8). Compared to TFV, GS-9148 was about 3-fold less active against wild-type HIV but maintained better activity against resistant strains (K65R and multiple thymidine analog resistance mutations). Most importantly, it was inactive (IC50>300 μM) against

mitochondrial polymerase gamma. More than 50 prodrugs were synthesized and evaluated in metabolism studies and in dogs (intravenous and oral administration). Alectinib Then the enantiomers were tested separately in dogs. This led to the selection of GS-9131. Whereas TFV is efficiently utilised by renal uptake transporters, GS-9148 was poorly taken into the kidney. No adverse renal findings were observed with the prodrug (GS-9131) in 28-day studies in rats, dogs and monkeys at the highest doses tested (300 mg, 20 mg and 30 mg/kg daily, respectively). In summary, this work has given examples of the prodrug approach being used successfully both to increase selectivity (by loading on-target tissues vs off-target

tissues) and to increase activity (via by-passing metabolic constraints). Adrian presented cases in which a prodrug strategy was able to fulfil the full potential of a selective, active triphosphate analog and enable its further progression as a clinical candidate. The keynote speakers were David Margolis and Myron Cohen (Fig. 9). David Margolis, heptaminol University of North Carolina, NC, USA In HIV-infected patients, there is a long-lasting reservoir of HIV in the form of integrated viral DNA in resting CD4+ memory cells of the host immune system. Therefore, even if it were possible to eliminate 100% of viral replication, a reservoir of HIV would remain. There may be reservoirs in other long-lived cells. To date, there is only one known HIV patient who has been cured of his infection, the “Berlin Patient”. He was treated for cancer by chemotherapy followed by a bone-marrow transplant. Being CCR5 +/−, the chemotherapy had a greater chance to remove all the CCR5+ve cells. The bone marrow donor was CCR5−ve.