Urinary tract infections (UTI) are one of the most common bacterial infections worldwide, with an estimated 15 million cases annually in the US alone.Uropathogenic Escherichia coli (UPEC) are the main causative agent of UTI and are responsible for >85% of all cases.Due to a high incidence of recurrence, UTI are becoming increasingly resistant to front-line antibiotics, necessitating the need for new strategies to combat these, and other, Gram-neg. bacterial infections.The virulence factor FimH is a lectin positioned at the tip of type 1 pili on UPEC that specifically binds highly mannosylated glycoproteins coating the bladder uroepithelium.FimH's mannose binding function mediates host-cell attachment and invasion, as well as the formation of intracellular biofilm colonies (IBCs), and thus, is critical for the establishment and maintenance of UTI.We have developed glycomimetic mannoside, small-mol., FimH antagonists that disrupt UPEC binding and colonization of the bladder as a novel therapy for preventing and treating UTI.Since this so-called "antivirulence" approach disarms rather than kills the bacteria, it circumvents the selective pressure which can lead to drug resistance.Through rational drug design and focused library synthesis, we have discovered several series of small-mol. biaryl O- and C-linked mannoside-based inhibitors of FimH, having up to 1 million-fold more potency than α-D-mannose in blocking UPEC binding and IBC formation.Lead C-mannosides have excellent PK properties, including long half-life and good oral bioavailability, as well as a safety profile amenable to once per day oral dosing.In mouse models of UTI, lead compounds showed robust efficacy at reducing bacterial burdens when dosed as low as 0.5 mg/kg.These efforts have led to the identification and selection of clin. candidate, GSK3882347, currently being evaluated in Phase 1b clin. trials as a novel, antibiotic-sparing treatment for acute UTI.