Hand-foot-and-mouth disease (HFMD), caused by enterovirus, is a threat to public health worldwide. To date, enterovirus 71 (EV71) has been one of the major causative agents of HFMD in the Pacific-Asia region, and outbreaks with EV71 cause millions of infections. However, no drug is currently available for clinical therapeutics. In our previous works, we developed a set of protease inhibitors (PIs) targeting the EV71 3C protease (3C pro ). Among these are NK-1.8k and NK-1.9k, which have various active groups and high potencies and selectivities. In the study described here, we determined the structures of the PI NK-1.8k in complex with wild-type (WT) and drug-resistant EV71 3C pro . Comparison of these structures with the structure of unliganded EV71 3C pro and its complex with AG7088 indicated that the mutation of N69 to a serine residue destabilized the S2 pocket. Thus, the mutation influenced the cleavage activity of EV71 3C pro and the inhibitory activity of NK-1.8k in an in vitro protease assay and highlighted that site 69 is an additional key site for PI design. More information for the optimization of the P1= to P4 groups of PIs was also obtained from these structures. Together with the results of our previous works, these in-depth results elucidate the inhibitory mechanism of PIs and shed light to develop PIs for the clinical treatment of infections caused by EV71 and other enteroviruses.KEYWORDS EV71, protease, inhibitor, crystal structure, mechanism H and-foot-and-mouth disease (HFMD) is a common viral illness among infants and young children that causes fever, sore throat, blisters, pharyngitis, mouth ulcers, and a rash on the hands and feet (1, 2). Enterovirus 71 (EV71) has been the main causative agent of HFMD in recent years. Unfortunately, no drugs for the treatment of this disease are available. EV71 is classified as a member of Enterovirus species A within the genus Enterovirus of the Picornaviridae family (3). In the virus replication cycle, the 7.4-kb positive-sense, single-stranded RNA genome of EV71 is translated into a polyprotein which is subdivided into three primary precursors, P1, P2, and P3. Four structural proteins, VP1 to VP4, derived from the P1 portion, form the capsid of the mature virion (4), and the P2 and P3 regions are cleaved by viral proteases, forming seven individual nonstructural proteins, 2A, 2B, 2C, 3A, 3B, 3C, and 3D (5, 6). The correct replication of EV71 is dependent on the effective cleavage of the viral polyprotein by viral 2A protease (2A pro ) and 3C protease (3C pro ) (7). Of these two proteases, 3C pro not only takes major responsibility for polyprotein cleavage, with the exception that 2A pro is responsible for the cleavage of VP1/2A and 3C/3D, but also plays multiple roles in various biological processes (8).EV71 3C pro is a classical cysteine protease. Cysteine proteases are a large family containing many members functioning in various physiological processes (9). The