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GS-9191 is a novel double prodrug of the nucleotide analog 9-(2-phosphonylmethoxyethyl)guanine (PMEG), developed as a topical small molecule agent for the treatment of human papillomavirus (HPV)-induced lesions, such as genital warts. After application to the skin, it is metabolized in epithelial cells to cPrPMEDAP and then deaminated to PMEG. The active metabolite, PMEG diphosphate, potently inhibits DNA polymerase alpha and beta, leading to inhibition of DNA synthesis and cell cycle arrest in S phase followed by apoptosis. Preclinical studies demonstrated marked potency against HPV-positive cell lines and efficacy in animal models of papillomavirus infection[1][6][4]. Clinical development reached Phase I for genital warts[3][7].
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