Viomycin is a tuberactinomycin antibiotic essential for treating multidrug-resistant tuberculosis. It inhibits bacterial protein synthesis by blocking elongation factor G (EF-G) catalyzed translocation of messenger RNA on the ribosome. Here we have clarified the molecular aspects of viomycin inhibition of the elongating ribosome using pre-steadystate kinetics. We found that the probability of ribosome inhibition by viomycin depends on competition between viomycin and EF-G for binding to the pretranslocation ribosome, and that stable viomycin binding requires an A-site bound tRNA. Once bound, viomycin stalls the ribosome in a pretranslocation state for a minimum of ∼45 s. This stalling time increases linearly with viomycin concentration. Viomycin inhibition also promotes futile cycles of GTP hydrolysis by EF-G. Finally, we have constructed a kinetic model for viomycin inhibition of EF-G catalyzed translocation, allowing for testable predictions of tuberactinomycin action in vivo and facilitating in-depth understanding of resistance development against this important class of antibiotics.protein synthesis | viomycin | ribosome | antibiotics | tuberculosis T uberculosis (TB) is a global threat to human health, and over 9 million people contracted the disease in 2013 (1). The emergence of strains of Mycobacterium tuberculosis, the causative agent of TB, resistant to several first-and second-line antitubercular drugs is a significant concern. The tuberactinomycin antibiotics are bacterial protein synthesis inhibitors, commonly used as second-line drugs against multidrug-resistant TB. Viomycin was the first drug of this class to be discovered (2, 3). It is a cyclic pentapeptide that contains several nonstandard amino acids ( Fig. 1A) and is produced by a nonribosomal peptidyl transferase (4).Viomycin affects bacterial protein synthesis by inhibiting mRNA translocation (5) and causing misreading of the genetic code (6). The present study focuses on viomycin inhibition of translocation. During translocation the mRNA moves through the ribosome by one base triplet (codon), the peptidyl transfer RNA (tRNA) moves from the ribosomal A to P site, and the deacylated tRNA moves from the P to E site. Translocation is catalyzed by elongation factor G (EF-G) in a GTP hydrolysis-dependent manner (7) and occurs via formation of tRNA hybrid states (8), relative rotation of the ribosomal subunits (9), and movement of the L1 stalk (10). Bulk FRET, chemical footprinting, and single-molecule FRET experiments have shown that viomycin stabilizes the ribosome in a pretranslocation state with tRNAs in hybrid A/P and P/E configurations, rotated ribosomal subunits, and the L1 stalk in a closed conformation interacting with the P-site tRNA (11-16); this structure has been visualized by cryo-EM (17). However, a crystal structure of the viomycin-bound ribosome (18) and one single-molecule FRET study (19) have suggested stabilization of the tRNAs in the classical state.Recent crystal (18,20) and cryo-EM (17) structures of the viomycin-bound riboso...