ABSTRACT:P-glycoprotein (P-gp)-mediated efflux at the blood-brain barrier has been implicated in limiting the brain distribution of many anti-HIV1 drugs, primarily protease inhibitors, resulting in suboptimal concentrations in this important sanctuary site. The objective of this study was to characterize the interaction of abacavir with P-gp and determine whether P-gp is an important mechanism in limiting abacavir delivery to the central nervous system (CNS). In vitro and in vivo techniques were employed to characterize this interaction. Abacavir stimulated P-gp ATPase activity at high concentrations. The cellular accumulation of abacavir was significantly decreased by ϳ70% in Madin-Darby canine kidney II (MDCKII)-MDR1 monolayers compared with wild-type cells and was completely restored by the P-gp inhibitors ((R)-4-((1aR,6R,10bS)-1,2-difluoro-1,1a,6,10b-tetrahydrodibenzo(a,e)cyclopropa(c)cycloheptan-6-yl)-␣-((5-quinoloyloxy)methyl)-1-piperazineethanol, trihydrochloride) (LY335979) and N-[4-[2-(6,7-dimethoxy-3,4-dihydro-1H-isoquinolin-2-yl)ethyl]phenyl]-5-methoxy-9-oxo-10H-acridine-4-carboxamide (GF120918). Directional flux experiments indicated that abacavir had greater permeability in the basolateral-to-apical direction (1.58E-05 cm/s) than in the apical-to-basolateral direction (3.44E-06 cm/s) in MDR1-transfected monolayers. The directionality in net flux was abolished by both LY335979 and GF120918. In vivo brain distribution studies showed that the AUC plasma in mdr1a(؊/؊) CF-1 mutant mice was ϳ2-fold greater than the AUC plasma in the wild type, whereas the AUC brain in the mutant was 20-fold higher than that in the wild type. Therefore, the CNS drug targeting index, defined as the ratio of AUC brain-to-plasma for mutant over wild type, was greater than 10. These data are the first in vitro and in vivo evidence that a nucleoside reverse transcriptase inhibitor is a P-gp substrate. The remarkable increase in abacavir brain distribution in P-gp-deficient mutant mice over wild-type mice suggests that P-gp may play a significant role in restricting the abacavir distribution to the CNS.Abacavir, a carbocyclic nucleoside and a guanosine analog, is a member of the nucleoside reverse transcriptase (NRTI) family of anti-HIV1 agents. Abacavir is metabolized intracellularly to its active form, carbovir triphosphate (Daluge et al., 1997). Abacavir is used in combination with other NRTIs as well as protease inhibitors in active retroviral therapy (ART) (Josephson et al., 2007).HIV1 can infect the CNS at a very early stage of the disease and can lead to the development of AIDS-dementia complex (Ances and Ellis, 2007). The CNS has been cited as a reservoir for the HIV1 virus due to incomplete suppression of the viral replication (Kerza-Kwiatecki and Amini, 1999). Suboptimal concentrations of anti-HIV1 drugs in the CNS can not only lead to incomplete eradication of the virus but also provide ideal conditions for the selection of more virulent mutants (Lipniacki, 2003). Recent reports have highlighted the compartmentalizati...