The functional role of the hepatitis B virus (HBV) pre-S region for assembly and appearance of the virus is not completely understood. In this study, 3 natural-occurring mutants were investigated. Three mutants of the pre-S region-a point mutation in the CCAAT box (MUT1), a 6-bp deletion (MUT2) 3Ј of the CCAAT box, and a 153-bp deletion (MUT3) in the preS2 domain-were cloned alone or in combinations in replication-competent HBV plasmids and transfected in hepatoma cells. The impact on HBV assembly and appearance was studied by Northern Blot, primer extension analysis, immunofluorescence studies, enzyme-linked immunosorbent assay, and electron microscopy. An inversed ratio of pre-S/S mRNA transcripts compared with wild-type (wt) HBV was found when either MUT1 or -2 were included into the plasmid. Intracellular localization with both mutants showed retention of large S-protein in the endoplasmic reticulum and nuclear accumulation of core protein. The extracellular amount of S-protein was reduced with MUT1 and -2 or combinations in which 1 of the mutants was included. However, the extracellular appearance of viral products was comparable with wtHBV. In contrast, MUT3 showed major changes. Virion-like particles had a fried-egg, and filaments a screw-like appearance. The S-promoter mutations MUT1 and MUT2 correlated with viral retention. MUT3 leads to malformed viral particles. Therefore, different regions in the pre-S domain are essential to determine the intracellular localization and extracellular appearance of HBV, and might contribute to the prognosis of chronic HBV infection. (HEPATOLOGY 1999; 30:517-525.)The hepatitis B virus (HBV) is the smallest DNA virus known to be pathogenic for humans. The HBV is a member of the hepadnavirus family, showing a close host tropism. The genome of the HBV consists of a small circular DNA of 3.2 kb in length. Despite its small size, the HBV genome contains 4 open reading frames partly overlapping and generating at least 7 viral gene products. The 4 open reading frames are under the transcriptional control of 4 promoters (preS1, S, C, and X promoter) and 2 enhancer (enhancer I and II) elements. [1][2][3] The envelope gene of the HBV is controlled by 2 different promoters: the pre-S-and the S-promoter, which regulate transcription of a 2.4-and a 2.1-kb mRNA, respectively. The pre-S-promoter is located 5Ј of the first in frame ATG of the large (pre-S1) envelope protein. The S-promoter is found in the coding region of the pre-S gene and is a TATA-less promoter. Mainly, 2 factors control the activity of the Spromoter: Sp 1 and NF-Y. 4-7 NF-Y binds to the so-called CCAAT box and is especially important for the regulation of the S-gene controlling the ratio between the pre-S and S mRNA. 4,8 The 2 mRNAs transcribed from the S-gene code for 3 S-proteins (small, middle, and large) sharing the 226 amino acids at the C-terminus. Translation of the small S-protein starts at the third in-frame ATG of the S-gene, while the other 2 proteins start at the first and second ATG. However, some sub...