Coxsackievirus B3 (CVB3) infections can cause myocarditis in humans and are implicated in the pathogenesis of dilated cardiomyopathy. The natural genetic determinants of cardiovirulence for CVB3 have not been identified, although using strains engineered in the laboratory, cardiovirulence determinants have been identified in the CVB3 5 nontranslated region (5NTR) and capsid. The myocarditic phenotypes of two CVB3 clinical isolates were determined using an established murine model of inflammatory heart disease. The 5NTRs and capsid proteins of the noncardiovirulent CVB3/CO strain and cardiovirulent CVB3/AS strain were examined to determine their influence on the cardiovirulence phenotype. Six intratypic chimeric viruses were constructed in which 5NTR and capsid sequences of the infectious cDNA copy of the cardiovirulent CVB3/20 genome were replaced by homologous sequences from CVB3/CO or CVB3/AS. Chimeric strains were tested for cardiovirulence by inoculation of C3H/HeJ mice. Sections of hearts removed at 10 days postinoculation were examined for evidence of myocarditis by light microscopy and assayed for the presence of virus. Replacement of the CVB3/ 20 capsid coding region by that from the homologous region of CVB3/CO resulted in no change in the cardiovirulent CVB3/20 phenotype, with virus recoverable from the heart at 10 days postinoculation. However, recombinant virus containing the CVB3/CO 5NTR alone or the 5NTR and capsid sequences together were not myocarditic, and infectious virus was not recovered from the myocardium. Chimeric viruses containing the CVB3/ AS 5NTR alone, capsid sequence alone, or both together preserved the myocarditic phenotype. These data support the 5NTR as the primary site in the determination of the natural cardiovirulence phenotype of CVB3.Coxsackievirus B3 (CVB3), one of six CVB serotypes, is a member of the genus Enterovirus within the family Picornaviridae. The genome of CVB3, like that of other enteroviruses, is a single-stranded, messenger sense, polyadenylated RNA molecule 7,400 nucleotides (nt) in length. The single open reading frame, flanked 5Ј and 3Ј by nontranslated regions (NTRs), is subdivided into three regions, P1 to P3 (51), that encode a polyprotein of 2,185 amino acids (aa). The P1 region encodes the viral capsid proteins VP1 (281 aa), VP2 (263 aa), VP3 (238 aa), and VP4 (69 aa). The P2 and P3 regions encode the nonstructural viral proteins important for processing of the polyprotein, replication, and translation. The near atomic structure of the CVB3 virion has been solved (31), demonstrating a structure similar to that of poliovirus type 1 (18) and rhinovirus (38).Coxsackie B viruses have been identified as a major cause of human viral myocarditis. They are also thought to play a significant role in the development of dilated cardiomyopathy (reviewed in reference 1). In general, neonates and children suffer more severe clinical syndromes due to CVB. In one study, of 41 infants who succumbed to CVB infection, approximately 95% demonstrated clinical or histologic...