Toxicity of Antiviral Nucleoside Analogs and the Human Mitochondrial DNA Polymerase

To examine the role of the mitochondrial polymerase (Pol γ) in clinically observed toxicity of nucleoside analogs used to treat AIDS, we examined the kinetics of incorporation catalyzed by Pol γ for each Food and Drug Administration-approved analog plus 1-(2-deoxy-2-fluoro-β-d-arabinofuranosyl)-5-iodouracil (FIAU), β-L-(−)-2′,3′-dideoxy-3′-thiacytidine (−)3TC, and (R)-9-(2-phosphonylmethoxypropyl)adenine (PMPA). We used recombinant exonuclease-deficient (E200A), reconstituted human Pol γ holoenzyme in single turnover kinetic studies to measureKd (Km) andkpol (kcat) to estimate the specificity constant (kcat/Km) for each nucleoside analog triphosphate. The specificity constants vary more than 500,000-fold for the series ddC > ddA (ddI) > 2′,3′-didehydro-2′,3′-dideoxythymidine (d4T) ≫ (+)3TC ≫ (−)3TC > PMPA > azidothymidine (AZT) ≫ Carbovir (CBV). Abacavir (prodrug of CBV) and PMPA are two new drugs that are expected to be least toxic. Notably, the higher toxicities of d4T, ddC, and ddA arose from their 13–36-fold tighter binding relative to the normal dNTP even though their rates of incorporation were comparable with PMPA and AZT. We also examined the rate of exonuclease removal of each analog after incorporation. The rates varied from 0.06 to 0.0004 s−1 for the series FIAU > (+)3TC ∼ (−)3TC > CBV > AZT > PMPA ∼ d4T ≫ ddA (ddI) ≫ ddC. Removal of ddC was too slow to measure (