A new class of hepatitis C NS3/4A inhibitors was identified by introducing a novel spirocyclic proline−P2 surrogate onto the P2−P4 macrocyclic core of . The potency profile of new analogues showed excellent pan-genotypic activity for most compounds. The potency evaluation included the most difficult genotype 3a (EC 50 values ≤10 nM) and other key genotype 1b mutants. Molecular modeling was used to design new target compounds and rationalize our results. A synthetic approach based on the Julia−Kocienski olefination and macrolactamization to assemble the P2−P4 macrocyclic core containing the novel spirocyclic proline−P2 moiety is presented as well. KEYWORDS: Hepatitis C, HCV, HCV NS3/4A, antivirals, MK-5172, H epatitis C is a liver infection caused by the hepatitis C virus (HCV). There is an estimated 130−150 million people infected around the world. 1 In the United States alone 3.2 million people are infected with the virus and the disease will progress to a chronic stage in approximately 75−85% of patients. 2 Since chronic HCV infection is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation, the disease represents a major burden for patients and health care systems worldwide. 3,4 The HCV virus was identified more than two decades ago, and its discovery triggered an enormous research effort to identify direct acting antiviral agents capable of curing the disease. The HCV virus is a (+)-strand RNA that encodes a polyprotein of approximately 3000 amino acids, which contains the necessary enzymes for viral replication. The HCV NS3/4A protease is one of those enzymes that plays an essential role in viral replication. 5,6 HCV protease inhibitors were the first direct acting antivirals approved for treatment of the disease and remain an integral component of new combination therapies aiming for all-oral regimens. 7 Our research group reported the discovery of the HCV protease inhibitor MK-5172 (grazoprevir) (1), 8 Figure 1, which has been approved by the United States Food and Drug Administration for the treatment of HCV infection in combination with the HCV 5a inhibitor MK-8742 (elbasvir). MK-5172 (grazoprevir) has proven effective in treating the HCV infection with greater than 95% sustained virologic response (SVR) in patients infected with genotype-1. 9 Due to its impressive clinical results MK-5172 received "breakthrough therapy" designation by the FDA prior to its approval. More recently, we disclosed the identification of MK-8831 (2), 10 Figure 1, which represents a new class of HCV NS3/4A inhibitors containing a unique "spirocyclic" proline as P2-surrogate. MK-8831 was advanced to clinical trials to assess its efficacy.The unique "spirocyclic" proline present in MK-8831 was designed to reduce the entropic cost of binding of inhibitors having an ether-linked biaryl group attached to the P2-proline such as grazoprevir, paritaprevir, simeprivir (a cyclopentane ring replaces the P2-proline in simeprivir), and others. An improvement in potency was expected by rigidifying th...