Group B coxsackieviruses are associated with chronic inflammatory diseases of the pancreas, heart, and central nervous system. Chronic pancreatitis, which can develop from acute pancreatitis, is considered a premalignant disorder because it is a major risk factor for pancreatic cancer. To explore the genetic events underlying the progression of acute to chronic disease, a comparative analysis of global gene expression during coxsackievirus B4-induced acute and chronic pancreatitis was undertaken. A key feature of acute pancreatitis that resolved was tissue regeneration, which was accompanied by increased expression of genes involved in cell growth, inhibition of apoptosis, and embryogenesis and by increased division of acinar cells. Acute pancreatitis that progressed to chronic pancreatitis was characterized by lack of tissue repair, and the expression map highlighted genes involved in apoptosis, acinoductular metaplasia, remodeling of the extracellular matrix, and fibrosis. Furthermore, immune responses appeared skewed toward development of alternatively activated (M2) macrophages and T helper 2 (Th2) cells during disease that resolved and toward classically activated (M1) macrophages and Th1 cells during disease that progressed. Our hypothesis is that growth and differentiation signals coupled with the M2/Th2 milieu favor acinar cell proliferation, while diminished growth signals and the M1/Th1 milieu favor apoptosis of acinar cells and remodeling/proliferation of the extracellular matrix, resulting in fibrosis.The group B coxsackieviruses are associated with chronic inflammatory diseases of the pancreas (insulin-dependent diabetes mellitus and idiopathic chronic pancreatitis), heart (dilated cardiomyopathy), and central nervous system (12). Efforts to elucidate the mechanisms by which these viruses cause disease have focused on identifying the molecular determinants of viral virulence and understanding the immune response to infection. The molecular determinants of viral virulence for the group B coxsackieviruses are distinct, suggesting that these viruses induce disease via diverse mechanisms. For coxsackievirus B3 (CVB3), determinants of attenuation and virulence have been identified in the 5Ј untranslated region (42) and in VP2 (21). For CVB4, Thr-129 of VP1 is a major determinant of virulence (11). The precise mechanism by which the viral molecular determinants cause tissue injury is not clear. During coxsackievirus B infection, both virus-induced cytopathology and immunopathological mechanisms have been implicated in mediating tissue injury (12, 36).Our mouse model uses two serologically indistinguishable variants of the CVB4 serotype that cause acute and chronic pancreatitis reminiscent of clinical disease. The CVB4-P variant induces a transient, acute disease which shares pathological features (edema and inflammation) (34) with acute, interstitial pancreatitis in humans (9). The CVB4-V variant induces a severe, acute disease which progresses to chronic pancreatitis. CVB4-V-induced chronic pancreatitis ...