Varicella-zoster virus (VZV) open reading frame 10 (ORF10) is a determinant of virulence in SCIDhu skin xenografts but not in human T cells in vivo.In this analysis of the regulation of ORF10 transcription, we have identified four ORF10-related transcripts, including a major 1.3-kb RNA spanning ORF10 only and three other read-through transcripts. Rapid-amplification-of-cDNA-ends experiments indicated that the 1.3-kb transcript of ORF10 has single initiation and termination sites. In transient expression assays, the ORF10 promoter was strongly stimulated by the major VZV transactivator, IE62. Deletion analyses revealed approximate boundaries for the full ORF10 promoter activity between ؊75 and ؊45 and between ؉5 and ؊8, relative to the ORF10 transcription start site. The recombinant virus POKA10-⌬pro, with the ORF10 promoter deletion, blocked transcription of ORF10 and also of ORF9A and ORF9 mRNAs, whereas expression of read-through ORF9A/9/10 and ORF9/10 transcripts was increased, compensating for the loss of the monocistronic mRNAs. The cellular factor USF bound specifically to its consensus site within the ORF10 promoter and was required for IE62 transactivation, whereas disrupting the predicted TATA boxes or Oct-1 binding elements had no effect. The USF binding site was disrupted in the recombinant virus, POKA10-pro⌬USF, and no ORF10 protein was produced. Both ORF10 promoter mutants reduced VZV replication in SCIDhu skin xenografts. These observations provided further evidence of the contribution of the ORF10 protein to VZV pathogenesis in skin and demonstrated that VZV depends upon the cellular transcriptional factor USF to support its virulence in human skin in vivo.Varicella-zoster virus (VZV) is an alphaherpesvirus that causes varicella, establishes latency in sensory ganglia, and may reactivate, resulting in herpes zoster (1, 42). As is characteristic of herpesviruses, VZV genes are predicted to be transcribed in an ordered and temporally controlled cascade of putative immediate-early, early, and late gene expression during lytic infection. VZV immediate-early proteins are essential for activating viral genes, early genes are required for VZV genome synthesis, and many late genes are involved in virion morphogenesis and maturation (40). Much of the control of the expression of these different classes of viral proteins is at the level of transcription. Both the kinetics and the levels of expression of transcripts that encode viral proteins are dictated by features of the promoter controlling the particular transcript (15). VZV gene expression also appears to occur in latently infected cells in sensory ganglia, but it is restricted to a subset of viral genes, which may include open reading frames (ORFs) 4, 21, 29, 62, 63, and 66 (7, 9). The differential expression of VZV genes during productive and persistent infection is likely to be related to specific cis-acting regulatory mechanisms, alternative promoter usage, and neuron-specific cellular factors. Therefore, a better understanding of the characterist...