Inhalational anthrax is initiated by the entry of Bacillus anthracis spores into the lung. A critical early event in the establishment of an infection is the dissemination of spores from the lung. Using in vitro cell culture assays, we previously demonstrated that B. anthracis spores are capable of entering into epithelial cells of the lung and crossing a barrier of lung epithelial cells without apparent disruption of the barrier integrity, suggesting a novel portal for spores to disseminate from the lung. However, in vivo evidence for spore uptake by epithelial cells has been lacking. Here, using a mouse model, we present evidence that B. anthracis spores are taken up by lung epithelial cells in vivo soon after spores are delivered into the lung. Immunofluorescence staining of thin sections of lungs from spore-challenged BALB/c mice revealed that spores were associated with the epithelial surfaces in the airway and the alveoli at 2 and 4 h postinoculation. Confocal analysis further indicated that some of the associated spores were surrounded by F-actin, demonstrating intracellular localization. These observations were further confirmed and substantiated by a quantitative method that first isolated lung cells from spore-challenged mice and then stained these cells with antibodies specific for epithelial cells and spores. The results showed that substantial amounts of spores were taken up by lung epithelial cells in vivo. These data, combined with those in our previous reports, provided powerful evidence that the lung epithelia were directly targeted by B. anthracis spores at early stages of infection.Anthrax is caused by the entry of Bacillus anthracis spores into the host via the lung, the gastrointestinal tract, or cuts or abrasions on the skin. Among the three forms of anthrax, the inhalational form has the highest fatality rate, approximately 50% even with antibiotic treatment. The initial stage of the infection does not display any distinctive symptoms. As the organism spreads and multiplies in the body, the disease rapidly progresses, resulting in damage to vital organs and eventually death.Recent inhalational anthrax animal studies suggested that the infection of the lung is most likely secondary, i.e., that after entering into the respiratory system, spores disseminate into the circulation, germinate to become vegetative bacilli, and then infect the lung via the blood (14,15,23). Therefore, a crucial step in the establishment of anthrax via the pulmonary route is for the spores to breach the respiratory mucosal barrier. To date, a clear understanding of how this breach is achieved remains to be established.Three routes have been proposed: alveolar macrophages (17, 18), dendritic cells (DCs) (6,8), and epithelial cells (31, 32). The macrophage and DC routes are similar in the sense that both macrophages and DCs act as a "Trojan horse," taking up spores from the airway and alveolar space and carrying them to lymph nodes, where spores are released into the circulation via an unknown mechanism. However, stud...