West Nile virus (WNV) infects neurons and leads to encephalitis, paralysis, and death in humans, animals, and birds. We investigated the mechanism by which neuronal injury occurs after WNV infection. Neurons in the anterior horn of the spinal cords of paralyzed mice exhibited a high degree of WNV infection, leukocyte infiltration, and degeneration. Because it was difficult to distinguish whether neuronal injury was caused by viral infection or by the immune system response, a novel tissue culture model for WNV infection was established in neurons derived from embryonic stem (ES) cells. Undifferentiated ES cells were relatively resistant to WNV infection. After differentiation, ES cells expressed neural antigens, acquired a neuronal phenotype, and became permissive for WNV infection. Within 48 h of exposure to an exceedingly low multiplicity of infection (5 ؋ 10 ؊4 ), 50% of ES cell-derived neurons became infected, producing nearly 10 7 PFU of infectious virus per ml, and began to die by an apoptotic mechanism. The establishment of a tractable virus infection model in ES cell-derived neurons facilitates the study of the molecular basis of neurotropism and the mechanisms of viral and immune-mediated neuronal injury after infection by WNV or other neurotropic pathogens.West Nile virus (WNV) is a neurotropic flavivirus that is transmitted by mosquitoes and causes West Nile encephalitis in humans, animals, and birds (35). Humans develop a febrile illness, with a subset of cases progressing to meningoencephalitis (56) or a paralytic or polio-like syndrome (38; T. J. John, Letter, N. Engl. J. Med. 348:564-566, 2003). WNV causes paralysis (14, 71), in part by destroying neurons in the anterior horn of the spinal cord, where motor neurons reside (19,38). Although neuronal injury may be directly caused by viral infection (11, 71), destruction has also been attributed to infiltrating leukocytes, inflammatory cytokines, and activated microglial cells (19,20,24,61).In principle, tissue culture models of viral infection in primary neurons can distinguish injury that is caused by virus from injury that is caused by the immune response. For many neurotropic viruses (e.g., poliovirus, herpes simplex virus type 1, Japanese encephalitis virus, rabies virus, and Sindbis virus), cells from neuroblastomas and primary cultures from embryonic or neonatal mice and rats have been used as models of neuronal infection (11,22,28,34,40,63). However, the existing primary culture systems have limitations, as they are difficult to establish and scale up for high-throughput applications. In addition, the cultures often contain cells of multiple neuronal cell types, and genetic manipulation is constrained in these postmitotic cells.Embryonic stem (ES) cells are totipotent continuous cell lines that can be differentiated into neural, muscle, and hematopoietic cells (1, 27, 68, 70) and manipulated genetically (10, 50). We and others have efficiently differentiated ES cells into neurons (ESNC) after retinoic acid induction or by lineage selection (1...