Ribavirin is administered in combination with interferon-␣ for treatment of hepatitis C virus (HCV) infection. Recently, we demonstrated that the antiviral activity of ribavirin can result from the ability of a viral RNA polymerase to utilize ribavirin triphosphate and to incorporate this nucleotide with reduced specificity, thereby mutagenizing the genome and decreasing the yield of infectious virus (Crotty, S., Maag, D., Arnold, J. J., Zhong, W., Lau, J. Y., Hong, Z., Andino, R., and Cameron, C. E. (2000) Nat. Med. 6, 1375-1379). In this study, we performed a quantitative analysis of a novel HCV RNA polymerase derivative that is capable of utilizing stably annealed primer-template substrates and exploited this derivative to evaluate whether lethal mutagenesis of the HCV genome is a possible mechanism for the anti-HCV activity of ribavirin. These studies demonstrate HCV RNA polymerase-catalyzed incorporation of ribavirin opposite cytidine and uridine. In addition, we demonstrate that templates containing ribavirin support CMP and UMP incorporation with equivalent efficiency. Surprisingly, templates containing ribavirin can also cause a significant block to RNA elongation. Together, these data suggest that ribavirin can exert a direct effect on HCV replication, which is mediated by the HCV RNA polymerase. We discuss the implications of this work on the development of nucleoside analogs for treatment of HCV infection.
Hepatitis C virus (HCV)1 establishes a persistent infection of the liver, which leads to the development of cirrhosis and cancer (1). Currently, at least four million Americans are carriers of HCV. The available therapies are not very effective in clearing virus. The current therapeutic regimen includes a combination of interferon-␣ (IFN-␣) and ribavirin (2). IFN-␣ increases the nonadaptive antiviral response in cells (3). Ribavirin is a broad-spectrum antiviral nucleoside that is converted to the mono-, di-, and triphosphorylated forms inside of cells (4). Until this year, it was thought that the mechanism of action of ribavirin involved a decrease in cellular GTP pools resulting from inhibition of inosine monophosphate dehydrogenase by ribavirin monophosphate (5). The mechanism of action for ribavirin has been expanded to include lethal mutagenesis of the viral genome as a result of ribavirin triphosphate utilization by the viral RNA-dependent RNA polymerase and incorporation into viral RNA (6, 7). As shown in Fig. 1, the pseudo base of ribavirin can pair equivalently with both cytosine and uracil, thus providing a molecular basis for the mutagenic potential of ribavirin. Given the need for more effective strategies to control HCV infection, a precise understanding of the mechanism of action of existing antivirals should provide direction for the development of new anti-HCV therapeutics.Full-length HCV polymerase (NS5B) contains a very hydrophobic carboxyl terminus. To increase the solubility of this enzyme, the carboxyl-terminal 21 amino acids have been removed (8). This enzyme has been referred ...