Hemophilia B is an X chromosome-linked recessive bleeding disorder. To develop a somatic gene therapy for this disease, we have examined whether mouse skeletal myoblasts can serve as efficient vehicles for systemic delivery of recombinant factor IX. When mouse myoblasts (C2C12) transduced with a Moloney murine leukemia virus-based vector containing the bacterial f-galactosidase gene were i 'ected into mouse skeletal muscles, they fused with the existing and regenerating myofibers and continued to express P-galactosidase. C2C12 myoblasts that were infected with recombinant retroviruses containing a human factor Ia cDNA secreted biologically active human factor IX into the culture medium at a rate of 2.6 zg per 10' cells per day. Myotubes derived from these cells in culture continued to express human factor IX (0.68 itg/day from myotubes derived from 10' C2C12 cells).After injection of the transduced C2C12 myoblasts into skeletal muscles of mice, the systemic level of recombinant human factor IX was found to be as high as -1 ,ug/ml of serum. These results provide the rationale for using skeletal myoblasts as an efficient gene delivery vehicle in the somatic gene therapy for hemophilia B.Factor IX is a plasma glycoprotein that plays a pivotal role in the middle phase of the blood coagulation cascade (1). It is normally synthesized in liver and secreted into the circulation. A deficiency of biologically active factor IX in circulation results in an X chromosome-linked recessive bleeding disorder, hemophilia B (Christmas disease). The current treatment for this disease by plasma protein replacement therapy is effective but complicated by serious side effects, such as possible exposure of patients to blood-borne pathogenic viruses, including hepatitis and human immunodeficiency viruses. Somatic cell gene therapy may provide an alternative safe treatment for this disorder (2). In such an approach, the normal factor IX gene is transferred into target somatic cells that can stably produce active factor IX and transport it into the circulation. The somatic cells used must be able to efficiently carry out various post-translational modifications, such as y-carboxylation, required for the biological activity of factor IX (1). Genetically modified skin fibroblasts implanted in mice as in dermis or subcutaneous implants can produce and secrete recombinant factor IX into the circulation (3, 4). This approach, however, has suffered from poor stability of expression (5) and inefficient transportation of recombinant proteins into the circulation (4).Skeletal myoblasts have several unique properties that make them attractive for use in somatic gene therapy. Proliferating myoblasts are readily isolated and cultured in large numbers (6, 7). More importantly, these cells can fuse with existing muscle fibers when injected into muscle tissues (8).In this report, we demonstrate the expression of the recombinant genes for human factor IX and f3-galactosidase by injecting genetically modified myoblasts into mouse skeletal muscles....