Respiratory tract (RT) infections by members of the enterovirus (EV) genus of the Picornaviridae family are the most frequent cause for the common cold and a major factor in the exacerbation of chronic pulmonary diseases. The lack of a practical small-animal model for these infections has obstructed insight into pathogenic mechanisms of the common cold and their role in chronic RT illness and has hampered preclinical evaluation of antiviral strategies. Despite significant efforts, it has been difficult to devise rodent models that exhibit viral replication in the RT. This is due mainly to well-known intracellular host restrictions of EVs with RT tropism in rodent cells. We report the evolution of variants of the common-cold-causing coxsackievirus A21, an EV with tropism for the human intercellular adhesion molecule 1 (hICAM-1), through serial passage in the lungs of mice transgenic for the hICAM-1 gene. This process was accompanied by multiple changes in the viral genome, suggesting exquisite adaptation of hICAM-1-tropic enteroviruses to the specific growth conditions within the RT. In vivo mouse RT-adapted, variant coxsackievirus A21 exhibited replication competence in the lungs of hICAM-1 transgenic mice, providing a basis for unraveling EV-host interactions in the mouse RT.The common cold (acute nasopharyngitis) is a frequent ailment, primarily of viral etiology, recognized since antiquity. The incidence in adults and children ranges from 2 to 4 and 6 to 8 cases, respectively, per person per year. The economic impact of viral, noninfluenza respiratory tract (RT) infections has been estimated at Ďł$40 billion/year in the United States alone (16). A majority of viral infections are due to members of the enterovirus (EV) genus of the Picornaviridae family recognizing hICAM-1 as a receptor (20,39,40). These comprise 88 major-group human rhinoviruses (HRVs) and coxsackievirus A (CAV) serotypes 1, 11, 13, 15, and 17 to 24. EV RT infections cause transient, benign symptoms, such as rhinorrhea, sneezing, and sore throat, but they are major factors in the exacerbation of asthma (28, 35) and chronic obstructive pulmonary disease (COPD) (37, 38). Curiously, viral replication is modest and host cell destruction in the RT is absent (21, 44), indicating a role of host inflammatory reactions rather than overt tissue damage in pathogenesis (33, 34). The significant public health impact of EV RT infections inspired many efforts to develop animal models. Since natural susceptibility is restricted to higher primates (12), these approaches were based on adapting EVs to rodents. HRVs that use the lowdensity lipoprotein receptor (LDL-R) for host cell entry spontaneously infect mouse L fibroblasts (47) and exhibit very modest replication in wild-type (wt) BALB/c mice (46). This suggests that these viruses either use the murine LDL-R or another murine cell surface molecule for host cell attachment and entry. More targeted, recent efforts focused on supplying authentic human receptors, e.g., with mice transgenic for the hICAM-1 gene (...