L-Nucleoside analogs are a new class of clinically active antiviral and anticancer agents. The phosphorylation of these analogs from diphosphate to triphosphate metabolites is crucial for their biological action. We studied the role of 3-phosphoglycerate kinase, a glycolytic enzyme, in the metabolism of L-nucleoside analogs, using small interfering RNAs to down-regulate the amount of this enzyme in HelaS3 and 2.2.15 cells, chosen as models for studying the impact of the enzyme on the anticancer and antihepatitis B virus activities of these analogs. Decrease in the expression of 3-phosphoglycerate kinase led to a corresponding decrease in the formation of the triphosphate metabolites of L-nucleoside analogs (but not D-nucleoside analogs), resulting in detrimental effects on their activity. The enzyme is important for generating as well as maintaining the steady state levels of L-nucleotides in the cells, thereby playing a key role in the activity of L-nucleoside analogs against human immunodeficiency virus, hepatitis B virus, and cancer. This study also indicates a structure-based distinction in the metabolism of L-and D-nucleoside analogs, disputing the classic notion that nucleoside diphosphate kinases are responsible for the phosphorylation of all classes of nucleoside analog diphosphates.L-Nucleoside analogs are an emerging class of anticancer and antiviral agents that are being used clinically or are under advanced clinical trials (1, 2). Structurally, L-nucleoside analogs are mirror images of the natural D-nucleosides. Despite the unnatural L-configuration, these analogs are able to utilize the salvage pathway of deoxynucleoside metabolism to be phosphorylated to the active triphosphate form (3, 4). Similar to the D-nucleoside analog counterparts, L-nucleoside analog triphosphates exert their pharmacological activity through incorporation into cellular or viral DNA, leading to chain termination or inhibition of viral reverse transcriptase or DNA polymerase (5-10). In the past decade, the realization that L-nucleosides are capable of being activated in cells has led to the discovery of several antiviral pyrimidine L-deoxynucleoside analogs. The first two steps in the metabolism of L-nucleoside analogs seem to be similar to those of its D-nucleoside counterparts. The cytidine analogs, 3TC, L-OddC, L-Fd4C, and gemcitabine, are phosphorylated by cytoplasmic deoxycytidine kinase to the monophosphate metabolite, whereas L-FMAU can be phosphorylated by both deoxycytidine kinase and thymidine kinase (4, 10, 23-25). The cytidine analogs are then phosphorylated by cytidine/uridine monophosphate kinase to the respective diphosphates, and thymidine analogs are phosphorylated by thymidylate kinase (4, 26 -28). The last step of pyrimidine nucleoside analog metabolism was assumed to be carried out by nucleoside diphosphate kinase (NDPK); however, its role in the phosphorylation of L-nucleoside analog diphosphates remained doubtful (29 -31). We examined this in further detail by studying the phosphorylation of pyrimidine D...