A novel class of nonnucleoside hepatitis C virus (HCV) polymerase inhibitors characterized by a dihydropyrone core was identified by high-throughput screening. Crystallographic studies of these compounds in complex with the polymerase identified an allosteric binding site close to the junction of the thumb and finger domains, approximately 30 Ă
away from the catalytic center. AG-021541, a representative compound from this series, displayed measurable in vitro antiviral activity against the HCV genotype 1b subgenomic replicon with a mean 50% effective concentration of 2.9 M. To identify mutations conferring in vitro resistance to AG-021541, resistance selection was carried out using HCV replicon cells either by serial passages in increasing concentrations of AG-021541 or by direct colony formation at fixed concentrations of the compound. We identified several amino acid substitutions in the AG-021541-binding region of the polymerase, including M423(T/V/I), M426T, I482(S/T), and V494A, with M423T as the predominant change observed. These mutants conferred various levels of resistance to AG-021541 and structurally related compounds but remained sensitive to interferon and HCV polymerase inhibitors known to interact with the active site or other allosteric sites of the protein. In addition, dihydropyrone polymerase inhibitors retained activity against replicons that contain signature resistance changes to other polymerase inhibitors, including S282T, C316N, M414T, and P495(S/L), indicating their potential to be used in combination therapies with these polymerase inhibitors. AG-021541-resistant replicon cell lines provide a valuable tool for mechanism-of-action studies of dihydropyrone polymerase inhibitors. The clinical relevance of in vitro resistance to HCV polymerase inhibitors remains to be investigated.Hepatitis C virus (HCV) has emerged as one of most important etiological factors for blood-transmitted chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (34, 38). The infection becomes persistent in about 85% of infected individuals, despite the presence of a strong humoral and cellular immune response (3). Currently, about 4.5 million individuals in the United States and more than 170 million worldwide are infected with HCV, which represents an important public health problem. A combination of pegylated forms of alpha interferon (IFN-âŁ) and ribavirin is the only therapy available against HCV, but the success rate observed in individuals infected with genotype 1, which is the most prevalent genotype in the United States and worldwide, is only about 40% to 50% (7,8,25). In addition, IFN-⣠therapy is associated with significant side effects including fatigue, headache, myalgia, fever, nausea, and insomnia in more than 30% of patients. Ribavirin also causes hemolytic anemia in 10% to 20% of patients (22,36). Consequently, there remains a significant unmet medical need for more effective and safer HCV therapy.The HCV genome is a single-stranded, positive-sense RNA of approximately 9.6 kb (5). The genom...