bAlthough anti-human immunodeficiency virus type 1 (HIV-1) therapies have become more sophisticated and more effective, drug resistance continues to be a major problem. Zidovudine (azidothymidine; AZT) was the first nucleoside reverse transcriptase (RT) inhibitor (NRTI) approved for the treatment of HIV-1 infections and is still being used, particularly in the developing world. This drug targets the conversion of single-stranded RNA to double-stranded DNA by HIV-1 RT. However, resistance to the drug quickly appeared both in viruses replicating in cells in culture and in patients undergoing AZT monotherapy. The primary resistance pathway selects for mutations of T215 that change the threonine to either a tyrosine or a phenylalanine (T215Y/ F); this resistance pathway involves an ATP-dependent excision mechanism. The pseudo-sugar ring of AZT lacks a 3= OH; RT incorporates AZT monophosphate (AZTMP), which blocks the end of the viral DNA primer. AZT-resistant forms of HIV-1 RT use ATP in an excision reaction to unblock the 3= end of the primer strand, allowing its extension by RT. The T215Y AZT resistance mutation is often accompanied by two other mutations, M41L and L210W. In this study, the roles of these mutations, in combination with T215Y, were examined to determine whether they affect polymerization and excision by HIV-1 RT. The M41L mutation appears to help restore the DNA polymerization activity of RT containing the T215Y mutation and also enhances AZTMP excision. The L210W mutation plays a similar role, but it enhances excision by RTs that carry the T215Y mutation when ATP is present at a low concentration.
Generally speaking, most mutations in HIV-1 reverse transcriptase (RT) have a negative impact on the enzyme; the primary mutations that cause zidovudine (AZT) resistance are not exceptions. In some cases, secondary mutations are selected in viruses that are replicating in patients because these mutations help to compensate for the deleterious effects of primary resistance mutations. In other cases, the most important effect of a secondary mutation is to cause a further decrease in the susceptibility of the virus to the inhibitor. In this report, we have analyzed the effects of the secondary mutations M41L and L210W, in the presence of the primary mutation T215Y, on both ATP-dependent AZTMP excision and polymerase activities of HIV-1 RT to determine whether these secondary mutations enhance the excision of AZTMP by RT and/or act as compensatory mutations that partially restore the reduced polymerase activity of the T215Y mutant.During the replication of HIV-1, the single-stranded RNA genome is converted into double-stranded DNA by HIV-1 RT. This conversion requires both enzymatic activities of RT: a DNA polymerase that can copy either an RNA or a DNA template and an RNase H that cleaves RNA if, and only if, it is part of an RNA/DNA duplex. Like many DNA polymerases, RT requires both a template and a primer; nucleotides are added sequentially to the 3= end of the primer strand by the polymerase activity of...