The hepatitis C virus (HCV) serine protease is necessary for viral replication and represents a valid target for developing new therapies for HCV infection. Potent and selective inhibitors of this enzyme have been identified and shown to inhibit HCV replication in tissue culture. The optimization of these inhibitors for clinical development would greatly benefit from in vitro systems for the identification and the study of resistant variants. We report the use HCV subgenomic replicons to isolate and characterize mutants resistant to a protease inhibitor. Taking advantage of the replicons' ability to transduce resistance to neomycin, we selected replicons with decreased sensitivity to the inhibitor by culturing the host cells in the presence of the inhibitor and neomycin. The selected replicons replicated to the same extent as those in parental cells. Sequence analysis followed by transfection of replicons containing isolated mutations revealed that resistance was mediated by amino acid substitutions in the protease. These results were confirmed by in vitro experiments with mutant enzymes and by modeling the inhibitor in the three-dimensional structure of the protease.Despite the introduction of blood-screening tests ϳ10 years ago, hepatitis C virus (HCV) is still the major cause of bloodborne chronic hepatitis, with nearly 200 million infected people worldwide. HCV infection often evolves into a chronic disease, which can lead to liver dysfunction and hepatocellular carcinoma. Current therapeutic regimens based on alpha interferon (IFN-␣) and the nucleoside analog ribavirin are only partially effective and are limited by the adverse effects of both agents (50). Given the high prevalence of this disease, developing new treatments is a major public health objective. Similarly to human immunodeficiency virus (HIV) research, most efforts to develop antiviral agents for HCV have focused on the inhibition of key viral enzymes, serine protease, helicase, and polymerase (2).The most extensively studied HCV target has been the NS3-4A serine protease, a heterodimeric enzyme comprising the N-terminal domain of the NS3 protein (amino acids 1 to 180) and the small hydrophobic NS4A protein (3). This protease cleaves the viral polyprotein at four junctions (NS3/ NS4A, NS5A/NS5B, NS4A/NS4B, and NS4B/NS5A), and its activity is necessary for viral replication (24). Although the NS3 protease domain possesses enzymatic activity, the 54-amino-acid NS4A protein is required for cleavage at the NS3/ NS4A and NS4B/NS5A sites and increases cleavage efficiency at the NS4A/NS4B and NS5A/NS5B junctions (4, 14, 28, 47). X-ray crystallography (20, 35, 51) and nuclear magnetic resonance (NMR) spectroscopy (1, 36) have shown that the NS3-4A structure is similar to that of other chymotrypsin-like serine proteases, with two domains, both composed of a -barrel and two short ␣-helices. The catalytic triad comprises histidine 57, aspartate 81, and serine 139 and is located between the two domains. The central region of NS4A is an integral part of t...