A line probe assay (INNO-LiPA DR, version 3) for the detection of hepatitis B virus mutations that confer resistance to entecavir therapy was evaluated. The INNO-LiPA DR assay is a highly sensitive assay that is easily applicable for the detection and monitoring of entecavir resistance-conferring mutations and is more sensitive than sequencing for the detection of mixed sequences.Hepatitis B virus (HBV) infection is a common cause of chronic liver disease, and the risk of disease progression is associated with elevated HBV DNA levels. With the introduction of new HBV polymerase inhibitors, such as entecavir (ETV) and tenefovir (TDF), major advances have been made in the antiviral management of chronic hepatitis B (CHB) (13). However, the widespread use of these agents had led to the increasing emergence of drug-resistant mutations in HBV.ETV is a potent deoxyguanosine analog, although it is less effective against lamivudine (LVD)-resistant HBV variants than against wild-type HBV (1). ETV resistance requires substitutions at residues T184, S202, and M250 in reverse transcriptase (rtT184, rtS202, and rtM250, respectively) in HBV isolates containing preexisting, LVD resistance-conferring substitutions (10-12).This study assesses a prototype line probe assay (LiPA), the INNO-LiPA DR (version 3) assay (LiPA Innogenetics, Ghent, Belgium), for the detection and characterization of the HBV polymerase mutations associated with ETV resistance. A practical feature of this assay is that the single-stage PCR product can be used for combined hybridization of strips from the INNOLiPA DR assay (version 3) and INNO-LiPA DR assay (version 2), the latter of which is used to detect the main variants resistant to LVD and adefovir-dipivoxil (ADV) (7), because both assays use the same set of primers. The INNO-LiPA DR assay was performed according to the manufacturer's instructions. Briefly, HBV DNA extracted from 200 l of serum with a QIAamp DNA blood kit (Qiagen, Venlo, The Netherlands) was amplified by a single round of PCR with the kit-supplied primer mix: sense primer (nucleotides 255 to 278; 5Ј-CGTGGTGGACTTCTCTC AATTTTC-3Ј) and antisense primer (nucleotides 1122 to 1099; 5Ј-AGAAAGGCCTTGTAAGTTGGCGA-3Ј), both of which included domains A to F of the HBV polymerase. The amplified product was used for reverse hybridization with specific oligonucleotide probes immobilized on nitrocellulose strips. After hybridization, the strips were incubated with streptavidin conjugate. Colored lines were interpreted for the presence of mutations in the HBV polymerase. The probes fixed in the INNO-LiPA DR assay strips cover known HBV polymerase variations associated with ETV resistance (codons rt184, rt202, and rt250). The strips contain 2 control lines and 22 HBV probe lines representing wild-type or mutant variants: for codon rt184, 1 line reactive to the normal variant (amino acid T), 3 lines reactive (indistinctly) to mutated amino acid S, C, G, or A (marked as SCGA lines), and 2 lines to mutated amino acid I, L, F, or M (marked as ILFM lines); f...