Enterovirus 71 (EV71) is a causative agent of hand, foot, and mouth disease and is also associated with serious neurological disorders. An attenuated EV71 strain [EV71(S1-3)] has been established in the cynomolgus monkey infection model; this strain contains the attenuation determinants derived from the type 1 poliovirus vaccine strain, Sabin 1 [PV1(Sabin)], in the 5 nontranslated region (NTR), 3D polymerase, and 3 NTR. In this study, we analyzed the effect of the attenuation determinants of PV1(Sabin) on EV71 infection in a NOD/SCID mouse infection model. We isolated a mouse-adapted EV71 strain [EV71(NOD/SCID)] that causes paralysis of the hind limbs in 3-to 4-week-old NOD/SCID mice by adaptation of the virulent EV71(Nagoya) strain in the brains of NOD/SCID mice. A single mutation at nucleotide 2876 that caused an amino acid change in capsid protein VP1 (change of the glycine at position 145 to glutamic acid) was essential for the mouse-adapted phenotype in NOD/SCID mice. Next, we introduced attenuation determinants derived from PV1(Sabin) along with the mouse adaptation mutation into the EV71(Nagoya) genome. In 4-week-old mice, the determinants in the 3D polymerase and 3 NTR, which are the major temperature-sensitive determinants, had a strong effect on attenuation. In contrast, the effect of individual determinants was weak in 3-week-old NOD/SCID mice, and all the determinants were required for substantial attenuation. These results suggest that a cooperative effect of the attenuation determinants of PV1(Sabin) is essential for attenuated neurovirulence of EV71.Enterovirus 71 (EV71) is a small nonenveloped virus with a genome of single-strand positive RNA of about 7,500 nucleotides (nt); it belongs to the genus Enterovirus of the family Picornaviridae (10, 60). EV71 is classified as Human enterovirus species A, along with some coxsackie A viruses, such as CA10 and CA16, which cause hand, foot, and mouth disease and herpangina (10, 54). However, EV71 infection is sometimes associated with severe neurological diseases, such as brain stem encephalitis and poliomyelitis-like paralysis (16,44,69). Fatal effects of an EV71 outbreak in Taiwan were mostly due to pulmonary edema and/or pulmonary hemorrhage, which may have been caused by direct destruction of the vasomotor and respiratory centers in the brain stem by EV71 infection (11,23,25,36,40,70). The case severity rate of EV71 in the outbreak was Ͻ0.3% (23). This suggests a high neuropathogenicity of EV71 similar to that of poliovirus (PV), which causes poliomyelitis in 0.1 to 1.0% of infected individuals (reviewed in reference 46). Currently, various vaccines and treatments against EV71 infection are being developed (13,15,38,39,61,64,66,72,73).Experimental infection models of EV71 have been established in the monkey and mouse (14,21,22,49,50,71). The advantage of the monkey model is that the monkeys inoculated with clinical isolates of EV71 show neurological disorders similar to those observed in human cases of EV71 infection, including tremor, ataxia, and poli...