A unique coronavirus severe acute respiratory syndrome-coronavirus (SARS-CoV) was revealed to be a causative agent of a lifethreatening SARS. Although this virus grows in a variety of tissues that express its receptor, the mechanism of the severe respiratory illness caused by this virus is not well understood. Here, we report a possible mechanism for the extensive damage seen in the major target organs for this disease. A recent study of the cell entry mechanism of SARS-CoV reveals that it takes an endosomal pathway. We found that proteases such as trypsin and thermolysin enabled SARS-CoV adsorbed onto the cell surface to enter cells directly from that site. This finding shows that SARS-CoV has the potential to take two distinct pathways for cell entry, depending on the presence of proteases in the environment. Moreover, the protease-mediated entry facilitated a 100-to 1,000-fold higher efficient infection than did the endosomal pathway used in the absence of proteases. These results suggest that the proteases produced in the lungs by inflammatory cells are responsible for high multiplication of SARS-CoV, which results in severe lung tissue damage. Likewise, elastase, a major protease produced in the lungs during inflammation, also enhanced SARS-CoV infection in cultured cells.cell entry Ķ protease Ķ spike protein Ķ SARS S evere acute respiratory syndrome (SARS) is caused by a SARS-associated coronavirus (SARS-CoV), a newly emergent member in a family of Coronaviridae (1-6). Unlike other human coronaviruses, SARS-CoV causes a fatal respiratory disease in humans (1-6). Coronavirus is an enveloped virus with a positive-stranded large genomic RNA with Ļ·30 kb (7). Spikes exist on the virion surface and resemble solar corona, each of which is composed of a trimer of the spike (S) protein (7,8). The S protein is a type I fusion protein of an approximate molecular weight of 180 kDa. The prototypical coronavirus mouse hepatitis virus enters into cells via the cell surface, although a variant isolated from persistent infection enters from an endosome, the low pH of which induces its fusion activity (9). However, the entry pathway of SARS-CoV appears to be distinct from that of the other coronaviruses. Simmons et al. (10) hypothesized that SARS-CoV enters cells by an endosomal pathway, and S protein is activated for fusion by trypsin-like protease in an acidic environment. This idea is based on the following two findings: (i) SARS-CoV infection can be blocked by lysosomotropic agents, and (ii) S protein expressed on cells is activated for fusion by trypsin. These results were obtained by studies using pseudotype retroviruses harboring SARS-CoV S protein on the envelope and those using S protein expressed on cells by expression vectors (10).In the present study, we show that various proteases, as well as trypsin, are effective in inducing the fusion of SARS-CoVinfected VeroE6 cells. These proteases facilitated SARS-CoV entry from the cell surface, which indicates that SARS-CoV has the potential to enter cells via two diff...