cResistance to the 2=-F-2=-C-methylguanosine monophosphate nucleotide hepatitis C virus (HCV) inhibitors PSI-352938 and PSI-353661 was associated with a combination of amino acid changes (changes of S to G at position 15 [S15G], C223H, and V321I) within the genotype 2a nonstructural protein 5B (NS5B), an RNA-dependent RNA polymerase. To understand the role of these residues in viral replication, we examined the effects of single and multiple point mutations on replication fitness and inhibition by a series of nucleotide analog inhibitors. An acidic residue at position 15 reduced replicon fitness, consistent with its proximity to the RNA template. A change of the residue at position 223 to an acidic or large residue reduced replicon fitness, consistent with its proposed proximity to the incoming nucleoside triphosphate (NTP). A change of the residue at position 321 to a charged residue was not tolerated, consistent with its position within a hydrophobic cavity. This triple resistance mutation was specific to both genotype 2a virus and 2=-F-2=-C-methylguanosine inhibitors. A crystal structure of the NS5B S15G/C223H/V321I mutant of the JFH-1 isolate exhibited rearrangement to a conformation potentially consistent with short primer-template RNA binding, which could suggest a mechanism of resistance accomplished through a change in the NS5B conformation, which was better tolerated by genotype 2a virus than by viruses of other genotypes.
Hepatitis C virus (HCV) is a single-stranded positive-sense RNA virus and the cause of hepatitis C. Nonstructural protein 5B (NS5B) is the RNA-dependent RNA polymerase (RdRp) responsible for replication of the viral genome (1) and adopts a right-hand structure with palm, finger, and thumb domains common to nucleotide polymerases (2-4). In addition, HCV NS5B contains an extension of the finger region called the fingertips, as well as a -hairpin loop or -flap insertion into the thumb domain that protrudes deep into the active site and appears to be a hallmark of Flaviviridae RdRps (5). It has been suggested that a significant structural rearrangement of the thumb domain, including relocation of the -flap and a C-terminal-membrane-anchoring linker from the active-site cavity, must take place to accommodate a growing primer-template RNA chain (3,5,6). Indeed, such a rearrangement was observed in an elongationphase binary complex of an NS5B -flap deletion mutant with primer-template RNA (7). A crystal structure of an HCV NS5B ternary assembly is not yet available, and thus, insights into nucleoside triphosphate (NTP) binding and incorporation have been derived from biochemical studies and homology modeling.NS5B is critical for viral replication, exhibits important differences from cellular polymerases, and has become a major target for antiviral drug development. Chain-terminating nucleotide analog inhibitors are promising drugs against HCV because they target the conserved active site and exhibit pan-genotype activity and a high barrier of resistance (8). One such compound, sofosbuvir...