“…The PR S-groove secondary resistance mutations restore PR binding to substrates by increasing S-groove affinity for cleavage site residues P12-P5/P5′-P12′ (|P12-P5|) [22,23], and that in turn restores viral replication while maintaining PI resistance [14][15][16][17][18][19][20][21]. The HIV-1 PR S-groove model is supported by computational chemistry results [22,23], experimental results [23,25], as well as NMR results [24]. The solution NMR results by [22]) bound to 24-mer SP1-NC substrate (backbone ribbon), PR with electrostatic surface potential (blue positive, red negative), cleavage site residues P4-P4 (red) bound to active site, cleavage site residues P12-P5/P5 -P12 (|P12-P5|) bound in S-grooves (bronze); (B) PR bound to 24-mer substrate as in (A), PR as backbone ribbon (A-subunit teal, B-subunit blue), seven S-groove residues that interacted with Gag cleavage site residues |P12-P5|in a NMR study by Deshmukh et al [24] are shown in addition to D29 (carbon grey, oxygen red, nitrogen blue), SP1-NC cleavage site residues P5 N and P4 G including backbone nitrogens indicated, active site tetrahedrally coordinated water under flaps; (C) PR bound to 24-mer SP1-NC substrate as in (B), with ten native PR S-groove residues shown, Wensing and coworkers reported PI resistance mutations for each of those ten native residues [13], S-groove residues on PR A-subunit anti-parallel β-sheet (left), residues on backside of PR B-subunit S-groove anti-parallel β-sheet (right), red residue labels indicate primary PI resistance, black residue labels indicate secondary PI resistance, when residues were mutated as reported by Wensing and coworkers [13]; (D) PR bound to MA/CA cleavage site when part of a MA-CA polyprotein (1L6N.pdb as modified [23]) with backbone ribbon (MA yellow, CA bronze) as previously reported [23].…”