The exceptional in vitro potency of the hepatitis C virus (HCV) NS5A inhibitor BMS-790052 has translated into an in vivo effect in proof-of-concept clinical trials. Although the 50% effective concentration (EC 50 ) of the initial lead, the thiazolidinone BMS-824, was ϳ10 nM in the replicon assay, it underwent transformation to other inhibitory species after incubation in cell culture medium. The biological profile of BMS-824, including the EC 50 , the drug concentration required to reduce cell growth by 50% (CC 50 ), and the resistance profile, however, remained unchanged, triggering an investigation to identify the biologically active species. Highperformance liquid chromatography (HPLC) biogram fractionation of a sample of BMS-824 incubated in medium revealed that the most active fractions could readily be separated from the parental compound and retained the biological profile of BMS-824. From mass spectral and nuclear magnetic resonance data, the active species was determined to be a dimer of BMS-824 derived from an intermolecular radical-mediated reaction of the parent compound. Based upon an analysis of the structural elements of the dimer deemed necessary for anti-HCV activity, the stilbene derivative BMS-346 was synthesized. This compound exhibited excellent anti-HCV activity and showed a resistance profile similar to that of BMS-824, with changes in compound sensitivity mapped to the N terminus of NS5A. The N terminus of NS5A has been crystallized as a dimer, complementing the symmetry of BMS-346 and allowing a potential mode of inhibition of NS5A to be discussed. Identification of the stable, active pharmacophore associated with these NS5A inhibitors provided the foundation for the design of more potent inhibitors with broad genotype inhibition. This culminated in the identification of BMS-790052, a compound that preserves the symmetry discovered with BMS-346.Hepatitis C virus (HCV) is the major causative agent of non-A, non-B hepatitis worldwide, which affects more than 3% of the world's population. Of those infected with HCV, ϳ70% proceed to a chronic state which can lead to severe liver diseases, including fibrosis, cirrhosis, or hepatocellular carcinoma (1, 7). There is currently no vaccine against HCV and no generally effective therapy for all HCV genotypes. The current optimal therapy is pegylated alpha interferon in combination with ribavirin, a regimen associated with significant side effects and limited efficacy in the most prevalent patient population, consisting of genotype 1 (4). Therefore, there is an urgent need for the development of more effective, HCV-specific antiviral therapies with fewer side effects.In the search for more efficacious, safer HCV therapies, the most actively pursued antiviral targets have been the NS3 protease and NS5B RNA-dependent RNA polymerase, both essential enzymes for the replication of HCV (2,11,12). Exciting progress has been demonstrated in clinical trials with multiple HCV NS3 serine protease inhibitors, as well as with both nucleoside and nonnucleoside po...