is the leading cause of lower respiratory tract infection in children worldwide. The understanding of neonatal RSV pathogenesis depends on using an animal model that reproduces neonatal RSV disease. Previous studies from us and others demonstrated that the neonatal lamb model resembles human neonatal RSV infection. Here, we provide an extensive and detailed characterization of the histopathology, viral load, cellular infiltration, and cytokine production in lungs and tracheobronchial lymph nodes of lambs inoculated with human RSV strain A2 over the course of infection. In the lung, RSV titers were low at day 3 postinfection, increased significantly by day 6, and decreased to baseline levels at day 14. Infection in the lung was associated with an accumulation of macrophages, CD4 ϩ and CD8 ϩ T cells, and a transcriptional response of genes involved in inflammation, chemotaxis, and interferon response, characterized by increased IFN␥, IL-8, MCP-1, and PD-L1, and decreased IFN, IL-10, and TGF-. Laser capture microdissection studies determined that lung macrophage-enriched populations were the source of MCP-1 but not IL-8. Immunoreactivity to caspase 3 occurred within bronchioles and alveoli of day 6-infected lambs. In lung-draining lymph nodes, RSV induced lymphoid hyperplasia, suggesting an ability of RSV to enhance lymphocytic proliferation and differentiation pathways. This study suggests that, in lambs with moderate clinical disease, RSV enhances the activation of caspase cell death and Th1-skewed inflammatory pathways, and complements previous observations that emphasize the role of inflammation in the pathogenesis of RSV disease. lung; neonate; immune response; sheep HUMAN RESPIRATORY SYNCYTIAL VIRUS (RSV) is the leading cause of severe lower respiratory tract illnesses in premature/newborn infants and young children. The World Health Organization (WHO) estimates that in the United States alone, 70,000 to 126,000 infant hospitalizations for pneumonia or bronchiolitis are attributed to RSV every year (43). Furthermore, global annual RSV infections are estimated by the WHO at 64 million, with 160,000 deaths occurring yearly. Immunocompromised individuals (30) and the elderly (14) are also at risk for severe RSV disease, whose manifestations include rhinitis, bronchitis, otitis media, and pneumonia (31). Despite the importance of RSV as a pathogen, there is no currently licensed vaccine for RSV. Challenges encountered for the successful development of a pediatric RSV vaccine include the relatively immature immune response of infants, the potential interference of maternal antibodies with vaccinations, and previous concerns of vaccine-induced enhanced disease severity (reviewed in Ref. 40). However, some progress has been made with prophylaxis using the humanized anti-RSV monoclonal antibody palivizumab (20). Palivizumab is indicated for the prevention of serious lower respiratory tract disease caused by RSV in high-risk children (premature infants and children less than 2 years of age with chronic lung disease ...