Abstract The nucleotide stress response (NSR) is defined as activation of nucleoside salvage pathways to rescue cells from the detrimental consequences caused by a deficiency of or increased demand for nucleotides. Thymidylate depletion due to loss of function of the enzyme, thymidylate synthase (TS) or exposure to TS inhibitors disrupts the balance in nucleotide pools and damages DNA leading to stress-induced cell death. In order to replete nucleotide pools, cells activate nucleoside (ENT 1) transporters to increase the influx of extracellular nucleosides. TS catalyzes the de-novo synthesis of thymidylate for DNA replication. The enzyme in humans undergoes conformational switching between active and inactive forms. We are testing the hypothesis that stabilization of the inactive conformation will not induce the resistance mechanisms that are observed after exposure to active site-targeted TS inhibitors. To identify lead compounds that bind to the inactive conformation, a NSR assay has been developed, which measures a stress response to TMP depletion. TS inhibitors that bind to either the active or inactive conformations will induce TMP stress which is measured as induction of uptake of a fluorescent probe, N2, N3-etheno-6-thiomethylpurine riboside (ETMPR). In order to differentiate TS inhibitors that are selective for active and inactive conformations, we conducted an experiment on paired isogenic cell lines that express either wild-type hTS (undergoes conformational switching) or a mutant hTS (R163K - stabilized in the active conformation). Cells exposed to the potent active site TS inhibitor, raltitrexed (RTX) exhibited a similar level of uptake of ETMPR. When cells are exposed to glutarate (inactive site inhibitor predicted by structure-based drug design), fluorescent nucleoside uptake was preferentially induced in cells expressing wild-type hTS, consistent with the prediction that glutarate is an inactive site targeted drug. Protein turnover studies revealed that glutarate decreases TS expression, which is opposite to the effect of active TS inhibitors, which stabilize TS to degradation. Collectively, the data indicate that the NSR assay will be useful in identifying lead inactive site-targeted drugs and that these drugs will not stabilize TS, a mechanism thought to cause resistance to active state TS inhibitors. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5508.