Abstract
In this review, our recent advances in the development of nucleoside di- and nucleoside triphosphate prodrugs is summarized. Previously, we had developed a successful membrane-permeable pronucleotide system for the intracellular delivery of nucleoside monophosphates as well, the so-called cycloSal-approach. In contrast to that work in which the delivery is initiated by a chemically driven hydrolysis reaction, for the di- and triphosphate delivery, an enzymatic trigger mechanism involving (carboxy)esterases had to be used. The other features of the new pronucleotide approaches are: (i) lipophilic modification was restricted to the terminal phosphate group leaving charges at the internal phosphate moieties and (ii) appropriate lipophilicity is introduced by long aliphatic residues within the bipartite prodrug moiety. The conceptional design of the di- and triphosphate prodrug systems will be described and the chemical synthesis, the hydrolysis properties, a structure–activity relationship and antiviral activity data will be discussed as well. The advantage of these new approaches is that all phosphorylation steps from the nucleoside analogue into the bioactive nucleoside triphosphate form can be bypassed in the case of the triphosphate prodrugs. Moreover, enzymatic processes like the deamination of nucleosides or nucleoside monophosphates which lead to catabolic clearance of the potential antivirally active compound can be avoided by the delivery of the higher phosphorylated nucleotides.
Introduction
Since many decades, nucleoside analogues are used in anticancer and antiviral chemotherapy, and they represent the backbone to combat several viral infections nowadays.1–4 However, nucleoside analogue drugs have to be anabolized in cells by virus-encoded or, in most cases, by host cell kinases to undergo stepwise addition of phosphate groups to yield the active nucleoside triphosphate analogue.5,6 Owing to the substrate specificity of the kinases, the activation of nucleoside analogues often proceeds insufficiently. Furthermore, the clinical efficacy is hampered by limitations such as low biological half-lives due to catabolic transformation, variable bioavailability after oral administration, or the development of resistant virus strains.7,8 Within the stepwise kinase-catalyzed phosphorylation process, often the first phosphorylation step catalyzed by salvage pathway enzyme thymidine kinase (TK) has been identified as the limiting step, e.g. for the anti-HIV drug 3′-deoxy-2′,3′-didehydrothymidine (d4T, Metabolism of thymine-bearing pyrimidine nucleosides and the different pronucleotide approaches for the three phosphorylated metabolites of nucleoside analogues. General structures and designed delivery mechanisms of cycloSal- 

To bypass the second phosphorylation step, we developed symmetric and non-symmetric nucleoside diphosphate prodrugs, the so-called DiPPro-approach
It was demonstrated with d4T
Thereby, we discovered a unique way to deliver the nucleoside di- or the finally bioactive triphosphate of nucleosides into cells. In contrast to the common applications of nucleoside analogues today, with the approach to directly deliver the nucleoside triphosphate, we are entirely independent of the intracellular phosphorylation process.
As we are involved since many years in the development of nucleotide prodrugs (e.g. the cycloSal-nucleoside monophosphate prodrug technology), many of our previous results were very helpful when we started working on the di- or triphosphate prodrug idea.
The major problem in the development of nucleoside analogue di- and triphosphates in contrast to the monophosphate prodrug compounds is the presence of the phosphate anhydride bonds in the di- or triphosphate moieties. In order to neutralize the charges present in these phosphorylated compounds to get a lipophilic derivative, a phosphate triester derivative has to be prepared in the case of the monophosphate prodrugs. This was achieved in the phosphoramidate or in the cycloSal-approaches. Starting from these compounds, the delivery mechanism involves enzymatic or chemical steps which finally led to phosphate ester bond cleavages. However, in order to prepare a “neutralized” nucleoside di- or triphosphate derivative, not only the phosphate ester bonds are present but also the phosphate anhydride bonds linking the two or three phosphate moieties, respectively. Chemically such anhydride bonds are quite unstable which makes a selective cleavage of the phosphate ester bonds almost impossible. Indeed, we tried to prepare fully masked nucleoside diphosphates first but rapidly encountered the problem of quick hydrolysis of the anhydride moieties. Therefore, we decided to abandon the concept to use fully neutralized derivatives but to use partially charged compounds instead. The advantage for that was that the charges stabilize the anhydride bonds by two effects: (a) the negative charge prevents a nucleophilic reaction at the phosphate groups due to electrostatic repulsion and (b) the negative charges convert the phosphate moieties into bad leaving groups. Both effects led to a significant stabilisation of the di- or triphosphate moieties. Actually, nature “uses” the same principle in the nucleoside triphosphates such as ATP; in their charged form, these compounds are only kinetically stable but as soon as they are complexed by cations like magnesium (Mg2+), the charges are neutralized and the reactivity of these compounds increases drastically.
Nucleoside diphosphate prodrugs based on the cycloSal-concept
Initially, we tried to transfer our cycloSal-technology (compound

Hydrolysis pathways of cycloSal-NDP-prodrugs
For the synthesis of those compounds, we formed the pyrophosphate moiety starting from a corresponding nucleoside monophosphate synthesized by the Sowa and Ouchi method,
30
and these were then coupled with a P(V)-reagent (phosphorochloridate chemistry) bearing the cycloSal-moiety. It was important that the nucleoside monophosphate has to be in the corresponding di(nBu4N)+-salt form – although these are very hygroscopic – in order to achieve an efficient coupling reaction with the P(V)-reagent. Because 3-methyl-cycloSal-nucleotides had proven to be the best suitable monophosphate pronucleotides in our previous work, we used this substitution pattern in the cycloSal-moiety here as well. For the synthesis, the nucleoside monophosphate salt was dissolved in DMF/pyridine and cycloSal-phosphorochloridate was added at −60 °C. After the starting nucleotide was completely consumed, the reaction products were purified on RP-18 columns eluting with gradients of water/methanol. Due to the extensive purification required, the yields of compounds
In order to test the formation of the diphosphate, hydrolysis studies were performed in aqueous buffer solution (25 mM phosphate buffer (PBS) at pH 7.3) followed either by HPLC analysis or by
31
P-NMR spectroscopy. To our surprise, starting from the 3-methyl-substituted compound
Bis(acyloxybenzyl)-nucleoside diphosphates 10: The symmetric DiPPro-compounds
Taking the results summarized above into account, we next developed a lipophilic masking strategy for nucleoside diphosphates as shown in compound

General structure and designed hydrolysis pathway of DiPPro-compounds
The main difference is that the delivery mechanism is not chemically driven but is now initiated by an enzymatic reaction within the masking group so that the phosphate anhydride group is not “touched” in the initial triggering cleavage reaction. We concentrated our work on using esterases/lipases for the trigger due to the high intracellular concentration of these enzymes. The approach was developed by first introducing two identical acceptor-substituted benzyl esters to the β-phosphate of the nucleoside diphosphate (Scheme 4) and we kept the initial idea of using the remaining charge at the α-phosphate moiety to markedly stabilize the pyrophosphate group. Upon enzymatic hydrolysis of the phenolic acyl-ester in the benzyl residue, an “Umpolung” reaction occurred, which converted the acyl ester into a strong hydroxyl donor-substituent in the aromatic ring of the benzyl masking group. Subsequently, a spontaneous cleavage of the benzyl-C-O-bond to phosphate group occurred leading to the formation of the mono-masked acyloxybenzyl-NDP intermediate
For the synthesis, again the pyrophosphate moiety was formed starting from nucleoside monophosphates, which in contrast to the synthesis of cycloSal-nucleoside diphosphates were coupled with a reactive P(III)-reagent that already comprised the bis(acyloxybenzyl) groups. In this reaction, first a P(III)–P(V) intermediate was formed which is then oxidized to yield the pyrophosphate.24,25,27 As above, for the preparation of DiPPro-compounds

Synthesis of the DiPPro-nucleoside diphosphates
Next, a series of hydrolysis studies were performed in order to investigate the delivery of the nucleoside diphosphates. First, in chemical hydrolysis, studies were conducted in PBS (25 mmol, pH 7.3). These studies proved that the stability of the compounds was generally high (above 100 h) and was dependent on the length of the alkyl moiety covalently linked to the 4-hydroxybenzyl alcohol used as the masking group – the more lipophilic the acyl residue to higher the chemical stability. In addition to the intermediate mono-masked nucleoside diphosphate always (with the exception of the diacetoxybenzyl-NDPs), some amounts of the nucleoside monophosphate were detected as well. In general, the cleavage of the second masking group present in the intermediate always proceeded much slower than the first step, which is evidenced by the accumulation of intermediates
In addition to the stability in PBS, the cleavage of prodrugs
In summary, a remarkable acceleration for the cleavage of the masking group took place in CEM cell extracts. For example, more than 95% of d4TDP was released within a few minutes from the prodrug bearing two acetoxybenzyl moieties. As in the chemical hydrolysis, the corresponding intermediate was hydrolyzed markedly slower than the parent prodrug (t1/2 ∼4 h vs. ∼10 min). Compared to the chemical half-lives, the cleavage of the first acyloxybenzyl-group was 500-fold faster and the second cleavage was 3000-fold faster in the cell extracts. The strong acceleration and the formation of d4TDP clearly point to an enzymatically catalyzed cleavage of the prodrug.
Finally, d4TDP-containing DiPPro-compounds were tested for their anti-HIV activity in wild-type CEM/0 and mutant TK-deficient CEM/TK− cell cultures. It should be mentioned that TMPK-deficient cells are non-existent because TMPK is essential for providing thymidine triphosphate necessary for DNA synthesis. Antiviral activity in TK-deficient cells is a proof that the d4TDP prodrug entered the cell by diffusion. As expected, the parent d4T used as a reference compound was only very poorly phosphorylated in this cell line. Most of the tested compounds proved to be equipotent or slightly less potent compared to the parent d4T against HIV-1 and HIV-2 in wild-type CEM/0 cells. In contrast to the wild-type CEM cells, the compounds bearing short acyl groups lost activity in the mutant TK-deficient CEM/TK− cell line. The loss in antiviral activity is a result of their low lipophilicity combined with a quick extracellular hydrolysis of some of these compounds in RPMI-1640/FCS incubation media used for this cell assay. The undesired extracellular cleavage of the masking groups led to nucleoside diphosphates. These nucleotides will then be dephosphorylated to give finally the parent nucleoside analogue. This explains the almost identical activity of the prodrugs and parent nucleoside in the wild-type CEM cells. However, antiviral activity in the TK-deficient cells is an indication that the NDP-prodrug entered the cell and released the nucleoside diphosphate. All compounds bearing acyl residues R ≥ C6H13 have shown very potent anti-HIV activities in CEM/TK− cells and thus proving their ability to pass through cellular membranes and the subsequent release of the phosphorylated d4T metabolites. As an example, the DiPPro-d4TDP bearing two decanoyl groups in the mask showed the strong potential of the DiPPro-concept because it was found to be 1570-fold more antivirally active in TK-deficient CEM cells and showed also a strong increase in antiviral activity in HIV-infected wild-type CEM/0 cells as compared to the parent d4T. Notably, none of the prodrugs showed significant cytotoxicity. Thus, the DiPPro-system is, to our knowledge, the most effective bio-reversible protection of nucleoside diphosphates reported so far.
Non-symmetric DiPPro-nucleoside diphosphate prodrugs
From the results summarized above, one can conclude that the DiPPro-approach is principally suited for the delivery of nucleoside diphosphates. However, an unfavorable aspect of the symmetric aliphatic DiPPro-compounds

Possible hydrolysis pathways of DiPPro-compounds
These observations led to the development of a second generation of DiPPro-compounds. Here, non-symmetric DiPPro-nucleotides
As described above, we expected that the short chain masking group would be cleaved chemically faster to form an intermediate
However, in cell extracts and in contrast to the chemical hydrolysis, the prodrugs were now selectively converted into nucleoside diphosphates within only 2 to 7 hours in CEM cell extracts (Figure 1).

RP-18-HPL-chromatograms of the hydrolysis of CH3/C9H19-DiPPro-d4TDP in CEM/0 cell extracts.
As a model system, hydrolysis studies were also performed using pig liver esterase (PLE) in PBS, pH 7.3. The non-symmetric aliphatic DiPPro-d4TDPs bearing an R1 = CH3 or C4H9 in combination with long alkyl chains as the R2 residue were incubated with PLE to further investigate the influence of the chain length on the enzymatic cleavage. All compounds were rapidly hydrolyzed and exclusively delivered the nucleoside diphosphate d4TDP within a few minutes (0.21–0.27 min).
Finally, the non-symmetric DiPPro-nucleotides were compared to DiPPro-compounds comprising identical prodrug groups. Thus, the non-symmetric and the symmetric counterparts DiPPro-AZTDP derivatives were hydrolyzed in PBS, pH 7.3, and in CEM/0 cell extracts. The hydrolysis studies in PBS led to marked differences in the ratios of NDP and NMP that were formed. In all cases, the symmetric compounds
Nucleoside triphosphate prodrugs: The TriPPPro-compounds
Despite the success of therapeutically very efficient nucleoside monophosphate prodrugs, e.g. the anti-HCV agent Sofosbuvir and the intracellular delivery of nucleoside diphosphates, the final goal of the research on pronucleotide systems has to be the selective intracellular delivery of nucleoside triphosphates of nucleoside analogues. The advantages are obvious: (a) the whole phosphorylation metabolism into the triphosphate is by-passed because the ultimately active triphosphate is delivered inside cells and (b) catabolic processes normally only take place at the nucleoside and the nucleoside monophosphate level will be prevented. Thus, e.g. deamination of adenosine or cytidine analogues can by excluded if triphosphates are delivered into cells. Despite these obvious advantages, almost no reports were known on the development of nucleoside triphosphate prodrugs. Of course, there are also challenges that have to be solved in the development of nucleoside triphosphate prodrugs: (a) the inherent lability of the triphosphate unit comprising reactive phosphate anhydride linkages, (b) the high negative charge that has to be compensated by lipophilic masking groups, (c) a possible unselective cleavage of these masking groups, and (d) the risk of low stability of the delivered triphosphate toward kinases/phosphatases leading to dephosphorylation and thus clearance of the bioactive metabolite. Therefore, it was common sense in the community that the design of nucleoside triphosphate prodrugs would be almost impossible: “Direct delivery of triphosphate or diphosphate forms of nucleoside analogs would be desirable but is impractical because of their instability during synthesis.” 33 One of the main reasons was that it seemed impossible to synthesize such compounds and get them inside cells. Since a few years, my group was working intensively on the development of such prodrug systems, and today, we succeeded with the so-called TriPPPro-approach. We have unambiguously proven that such compounds not only can be prepared but they also are taken up into cells and deliver bioactive nucleoside triphosphates.
In this context, we disclosed recently a new, robust synthesis approach for this class of compounds, biophysical properties of the TriPPPro-derivatives, a polymerase chain reaction (PCR), antiviral activity data of a variety of approved as well as so-far non-active nucleoside analogues as well as a study to demonstrate the cellular uptake of the compounds and the intracellular delivery of the triphosphate metabolite using a fluorescent nucleoside. This study demonstrated the general applicability and potential of the approach.28,29
In our work, we have used two different routes for synthesis toward the TriPPPro-derivatives
In order to achieve a more efficient conversion of the parent nucleoside to the TriPPPro-compounds

Synthesis of TriPPPro-prodrugs
Nucleoside monophosphates were synthesized according to the Sowa and Ouchi method
30
or, again, by the cycloSal-method. The cycloSal-method was used in cases of acid labile purine nucleosides, e.g. ddG. CycloSal-triesters
Synthesis of mono-masked triphosphate intermediates
In addition to the TriPPPro-compounds

Synthesis of the mono-masked-NTP compounds
Properties of the TriPPPro-derivatives
As before, the hydrolysis properties of TriPPPro-compounds
As the DiPPro-system, the TriPPPro-concept was designed to be triggered by the action of (carboxy)esterases. In studies using PLE in PBS (pH 7.3), the removal of both prodrug groups occurred much faster as compared to the chemical hydrolysis. Moreover, as long as the enzymatic cleavage occurred quickly enough to yield intermediates
To confirm the formation of the nucleoside triphosphate, two thymine-bearing TriPPPro-compounds were exposed to PLE. After complete consumption of TriPPPro-prodrugs

RT primer extension assay using the HIV polymerase RT: (a) Study with the hydrolysis product of TriPPPro-d4TTP; (b) study with the hydrolysis product of TriPPPro-TTP; lanes (1) only the hydrolysis product, (2) hydrolysis product + dCTP, (3) hydrolysis product + dCTP/dGTP, (4) hydrolysis product + dCTP/dGTP/dATP, (5) all four commercial dNTPs, and (6) primer.
In a second proof-of-principle experiment, the PLE hydrolysis products were used in a PCR assay using FIREPol DNA polymerase. In case of the hydrolysate of TriPPPro-d4TTP, no amplification of the DNA probe occurred. In contrast, formed TTP from its corresponding prodrug TriPPPro-TTP mixed with the three other 2′-deoxynucleoside triphosphates led to an amplification of the DNA sample. 29
The incubation of TriPPPro-compounds with human CD4+ T-lymphocyte cell extracts led to a marked acceleration of the triphosphate formation. The half-lives of prodrugs
The effectiveness of the TriPPPro-compounds
Surprisingly, the TriPPPro-compounds of 2′,3′-dideoxy-2′,3′-didehydrouridine (d4U) and 2′,3′-dideoxyuridine (ddU) showed no marked antiviral activity. Incubations of ddUTP in cell extracts showed an extremely fast dephosphorylation (t1/2 < 1 min) of the triphosphate to yield ddUDP and later ddUMP. Therefore, we speculate that in some cases, the formed triphosphates (although released from TriPPPro-compounds as proven by hydrolysis in PLE) were not retained in sufficient concentrations in cells to exhibit antiviral activity. This means, that the uridine analogues d4U and ddU seem to be inappropriate for antiviral therapy, although the triphosphates itself were found to be very potent inhibitors when tested in a biochemical assay using isolated RT. In contrast, other nucleoside analogues were converted into potent inhibitors against HIV by application of the TriPPPro-approach. Interestingly, 2′,3′-dideoxyinosine (ddI) triphosphate and abacavir (ABC) triphosphate released from the corresponding TriPPPro-compounds are to be considered as novel metabolites that are usually not formed from the corresponding parent nucleoside analogues ddI and ABC. Indeed, the eventual triphosphate metabolite intracellularly formed from ddI is 2′,3′-dideoxyadenosine triphosphate (ddATP) (but not ddITP, due to prior metabolic amination of ddIMP to ddAMP) and from ABC is carbovir-TP (not ABCTP due to prior deamination of ABCMP to carbovir-MP).40,41 Thus, the TriPPPro-technology also enables to deliver and discover novel antivirally active compounds that otherwise cannot be formed by the parent (or any other) nucleoside analogue.
Finally, in a first study investigating the cell uptake of TriPPPro-compounds
Summary and conclusion
In conclusion, our continuous work on the design of nucleotide prodrugs led finally to the development of a first example of a successful nucleoside di- and also a triphosphate prodrug system. The key for this development was that the reactive phosphate anhydride linkage(s) in the DiPPro- or TriPPPro-compounds were stabilized by the presence of negative charges. All attempts to mask all of the phosphate oxygen atoms led to completely uncharged di- or triphosphate moieties which were extremely reactive and proved to be unsuitable to be used in the pronucleotide sense. However, by keeping the charges, the lipophilicity needed for the uptake into cells has to be provided by the two lipophilic masking groups attached to the terminal phosphate group. The second key was not using a chemical triggering process for the delivery of the nucleotide any longer as in the cycloSal-compounds but to use an enzyme-catalyzed cleavage in the masking group without involving the phosphate groups. This avoided almost all possible side reactions associated with the phosphate esters or phosphate anhydride bonds. All this finally led to the successful formation of the bioactive di- or triphosphate inside the cell after cell uptake. The results summarized here clearly proved that the DiPPro- and the TriPPPro-approach allowed the intracellular delivery of nucleoside analogue di- or -triphosphates and the latter approach was used to convert inactive nucleoside analogues into powerful antivirally active metabolites. Thus, the TriPPPro-strategy offers high potential to be used in antiviral and antitumor therapies. In principle, the approach can be used for all those nucleoside analogues that lack efficient conversion into the triphosphate or which are not phosphorylated at all at one of the three individual phosphorylation steps. Also compounds that are quickly cleared due to catabolic processes may be rescued by this approach. In addition, this approach might be also suitable to address chemical biology questions by delivering triphosphorylated nucleotide probes into living cells.
Nevertheless, there are still some remaining tasks to be solved. One major issue are the surprising differences in stability of nucleoside analogue triphosphates. For example, it has been shown that the triphosphate of the Sofosbuvir nucleoside (a uracil nucleoside analogue) showed an extremely high intracellular stability of about 35 h, which was also made responsible for the significant and persistent anti-HCV effect of this triphosphate to inhibit NS5B-polymerase. In contrast, its cytosine analogue showed a half-life of just 5 h under the same experimental conditions. 42 As mentioned above, we have shown that ddUTP or d4UTP (also uracil nucleoside analogues) were extremely quickly dephosphorylated in CEM cell extracts. Thus, if these compounds are not efficiently rephosphorylated and so restoring the triphosphate pool, the compounds are useless as antiviral agents.
Another important issue in the development of such charged, lipophilic triphosphate derivatives is still the membrane passage. So far, we just performed the cell assay summarized above. However, we have neither data on the uptake mechanism nor data on the quantity of compound which is taken up by cells. So, which portion of the added compound is actually responsible for the antiviral activity observed?
Another issue can be the dependence of the masking groups of the compounds to be initially cleaved by enzymes. Is the differentiation between the blood stability and the intracellular stability sufficient to allow a successful application of these compounds in vivo? Maybe it is possible to introduce a different trigger for the masking group which might be more efficient?
Work along this line is currently underway in our laboratories.
Footnotes
Acknowledgements
I would like to acknowledge all the contributions made by my hard-working coworkers. The list of names would be too long to name all of them here but they are all coauthors of our original papers published during the last decade. Without their enthusiasm and creativity, these projects would never had reached this level.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work was supported continuously by Universität Hamburg and Deutsche Forschungsgemeinschaft (DFG; Me1161/3–1; -4–1; -9–1; -13–1 and 14–1).
