Ribozymes are catalytic RNA molecules that can be designed to cleave specific RNA sequences. To investigate the potential use of synthetic stabilized ribozymes for the treatment of chronic hepatitis C virus (HCV) infection, we designed and synthesized hammerhead ribozymes targeting 15 conserved sites in the 5Ј untranslated region (UTR) of HCV RNA. This region forms an internal ribosome entry site that allows for efficient translation of the HCV polyprotein. The 15 synthetic ribozymes contained modified nucleotides and linkages that stabilize the molecules against nuclease degradation. All 15 ribozymes were tested for their ability to reduce expression in an HCV 5Ј UTR/ luciferase reporter system and for their ability to inhibit replication of an HCV-poliovirus (HCV-PV) chimera. Treatment with several ribozymes resulted in significant downregulation of HCV 5Ј UTR/luciferase reporter expression (range 40% to 80% inhibition, P F .05). Moreover, several ribozymes showed significant inhibition (G90%, Chronic infection with hepatitis C virus (HCV) can lead to cirrhosis, liver failure and/or hepatocellular carcinoma over a period of 10 to 20 years. 1,2 The Centers for Disease Control recently reported the number of chronically infected Americans to be approximately 4.5 million; thus, HCV infection is over four times as prevalent as human immunodeficiency virus infection. 3 Worldwide the prevalence of chronic HCV is similar to that found in the United States. 3 Thus, chronic HCV infection represents an important public health problem throughout the world.PTreatment of chronic HCV infection with interferon alfa leads to sustained viral clearance in only approximately 12% of patients. 4 Newer therapeutic regimes, such as the combination of interferon alfa and ribavirin, can lead to 38% to 43% of patients having a sustained virological response. 5,6 However, even with current combination regimes, approximately 60% of patients have no sustained virological benefit. Additionally, treatment with interferon alfa and ribavirin leads to significant toxicities. 5,6 Therefore, there still remains a great need for improved therapeutic modalities.HCV is a 9.5-kb, plus-strand, RNA virus that is a member of the human flavivirus family. 7,8 Although the sequence of the HCV-RNA genome is highly variable among clinical isolates, the 5Ј untranslated region (UTR) of the genome is highly conserved with respect to RNA sequence identity. 9,10 The conserved sequence/structure of the 5Ј UTR of HCV RNA contains an internal ribosome entry site (IRES) to mediate translation independent of a 5Ј-cap structure. 10,11 The HCV IRES does not require any viral protein for initiation of translation 12 and IRES elements also occur in cellular messenger RNAs. 13,14 Because the components of IRES-mediated translation are shared between cellular and HCV messenger RNAs, targeting the mechanism of HCV-IRES-mediated translation can be problematic. However, because the HCV-IRES sequence is highly conserved among viral genotypes, it is an excellent target for ribo...