We have screened 47 locked nucleic acid (LNA) antisense oligonucleotides (ASOs) targeting conserved (>95% homology) sequences in the hepatitis C virus (HCV) genome using the subgenomic HCV replicon assay and generated both antiviral (50% effective concentration [EC 50 ]) and cytotoxic (50% cytotoxic concentration [CC 50 ]) dose-response curves to allow measurement of the selectivity index (SI). This comprehensive approach has identified an LNA ASO with potent antiviral activity (EC 50 ؍ 4 nM) and low cytotoxicity (CC 50 >880 nM) targeting the 25-to 40-nucleotide region (nt) of the HCV internal ribosome entry site (IRES) containing the distal and proximal miR-122 binding sites. LNA ASOs targeting previously known accessible regions of the IRES, namely, loop III and the initiation codon in loop IV, had poor SI values. We optimized the LNA ASO sequence by performing a 1-nucleotide walk through the 25-to 40-nt region and show that the boundaries for antiviral efficacy are extremely precise. Furthermore, we have optimized the format for the LNA ASO using different gapmer and mixomer patterns and show that RNase H is required for antiviral activity. We demonstrate that RNase H-refractory ASOs targeting the 25-to 40-nt region have no antiviral effect, revealing important regulatory features of the 25-to 40-nt region and suggesting that RNase H-refractory LNA ASOs can act as potential surrogates for proviral functions of miR-122. We confirm the antisense mechanism of action using mismatched LNA ASOs. Finally, we have performed pharmacokinetic experiments to demonstrate that the LNA ASOs have a very long half-life (>5 days) and attain hepatic maximum concentrations >100 times the concentration required for in vitro antiviral activity.Hepatitis C virus (HCV) infection is a major cause of liver disease, with Ͼ170 million infected people worldwide being at risk from liver failure and hepatocarcinoma. Current standard of care (SOC) using pegylated alpha 2a interferon (IFN-␣2a)-ribavirin is failing 40 to 50% of treated HCV patients, so new therapies are urgently required. New directly acting antiviral therapies for hepatitis C are becoming available, but these will eventually fail many HCV patients due to emerging drugresistant mutations in HCV strains (6, 7). HCV genomic RNA is an attractive antiviral target because it holds genetic information for viral proteins and contains regions of highly conserved sequence required for HCV replication/translation. Many groups have identified antisense oligonucleotides (ASOs) capable of inhibiting HCV RNA replication and viral polyprotein synthesis in vitro. Clinical trials on chronically HCV-infected patients show that modified ASOs targeting HCV can result in Ͼ2-log-unit decreases in viral loads, although the mechanism driving clinical antiviral activity has yet to be fully validated as antisense (14,28,33). Moreover, locked nucleic acid (LNA) represents a new generation of ASOs with improved affinity of binding to RNA targets, increased sequence specificity, greater biostability ag...