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This review highlights selected examples of polyketide diversification via control of monomer selection, oxidation state, stereochemistry, and cyclization. We conclude with a perspective on the present and future of polyketide structure diversification and hope that the examples presented here will encourage medicinal chemists to embrace polyketide synthetic biology as a means to revitalize polyketide drug discovery. This journal is © The Royal Society of Chemistry 2019.The 5,6,7,8-tetrahydroimidazo[1,2-a]pyrazine derivative BIM-46174