cViruses are known to use virally encoded envelope proteins for cell attachment, which is the very first step of virus infection. In the present study, we have obtained substantial evidence demonstrating that hepatitis C virus (HCV) uses the cellular protein apolipoprotein E (apoE) for its attachment to cells. An apoE-specific monoclonal antibody was able to efficiently block HCV attachment to the hepatoma cell line Huh-7.5 as well as primary human hepatocytes. After HCV bound to cells, however, antiapoE antibody was unable to inhibit virus infection. Conversely, the HCV E2-specific monoclonal antibody CBH5 did not affect HCV attachment but potently inhibited HCV entry. Similarly, small interfering RNA-mediated knockdown of the key HCV receptor/coreceptor molecules CD81, claudin-1, low-density lipoprotein receptor (LDLr), occludin, and SR-BI did not affect HCV attachment but efficiently suppressed HCV infection, suggesting their important roles in HCV infection at postattachment steps. Strikingly, removal of heparan sulfate from the cell surface by treatment with heparinase blocked HCV attachment. Likewise, substitutions of the positively charged amino acids with neutral or negatively charged residues in the receptor-binding region of apoE resulted in a reduction of apoE-mediating HCV infection. More importantly, mutations of the arginine and lysine to alanine or glutamic acid in the receptor-binding region ablated the heparin-binding activity of apoE, as determined by an in vitro heparin pulldown assay. HCV attachment could also be inhibited by a synthetic peptide derived from the apoE receptor-binding region. Collectively, these findings demonstrate that apoE mediates HCV attachment through specific interactions with cell surface heparan sulfate. H epatitis C virus (HCV) is a leading cause of liver diseases, chronically infecting an estimated 130 million to 170 million people worldwide (71, 82). HCV infection results in acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma (59), which ranks as the fifth most common cancer and the third most frequent cause of cancer death worldwide. Hepatitis C is also the most common indication for liver transplantation (15). Coinfection of HCV and HIV is very common, particularly among drug abusers (3). Thus, HCV infection poses a major global health problem. Current standard therapy with pegylated alpha interferon (peg-IFN-␣) and ribavirin is less than 50% effective against HCV genotype 1, the dominant virus accounting for up to 70% of infections (27,41,54). Although two HCV NS3 protease-specific inhibitors, telaprevir and boceprevir, have recently been approved (33), their combination with peg-IFN-␣ and ribavirin has limitations such as severe side effects, long duration of treatment, and high cost. Discovery and development of more efficacious and safer anti-HCV drugs are urgently needed.HCV is the prototype virus of the Hepacivirus genus in the Flaviviridae family (68). It is an enveloped RNA virus containing a single positive-strand RNA genome that encodes...