Efficient a priori identification of drug resistant mutations using Dead-End Elimination and MM-PBSA.

Active site mutations that disrupt drug binding are an important mechanism of drug resistance. Computational methods capable of predicting resistance a priori are poised to become extremely useful tools in the fields of drug discovery and treatment design. In this paper, we describe an approach to predicting drug resistance on the basis of Dead-End Elimination and MM-PBSA that requires no prior knowledge of resistance. Our method utilizes a two-pass search to identify mutations that impair drug binding while maintaining affinity for the native substrate. We use our method to probe resistance in four drug-target systems: isoniazid-enoyl-ACP reductase (tuberculosis), ritonavir-HIV protease (HIV), methotrexate-dihydrofolate reductase (breast cancer and leukemia), and gleevec-ABL kinase (leukemia). We validate our model using clinically known resistance mutations for all four test systems. In all cases, the model correctly predicts the majority of known resistance mutations.