Factor VIII Can Be Synthesized in Hemophilia A Mice Liver by Bone Marrow Progenitor Cell-Derived Hepatocytes and Sinusoidal Endothelial Cells

Hemophilia A (HA) is caused by mutation in factor VIII (FVIII) gene in humans; it leads to inadequate synthesis of active protein. Liver is the primary site of FVIII synthesis; however, the specific cell types responsible for its synthesis remain controversial. We propose that the severity of the bleeding disorder could be ameliorated by partial replacement of mutated liver cells by healthy cells in HA mice. The aim of this investigation was to study the cellular origin of FVIII by examining bone marrow cell therapy for treatment of HA in mice. Recipient liver was perturbed with either acetaminophen or monocrotaline to facilitate the engraftment and differentiation of lineage-depleted (Lin−) enhanced green fluorescent protein-expressing bone marrow cells. Immunohistochemical analysis of liver tissue was conducted to identify the donor-derived cells that expressed FVIII. This identification was confirmed by transmission electron microscopy and quantitative gene expression analysis. The phenotypic correction in HA mice was determined by tail-clip challenge and FVIII level in plasma by Chromogenix and activated partial thromboplastin time assays. Immunohistochemical analysis showed that von Willebrand factor and cytokeratin-18-expressing endothelial cells and hepatocytes, respectively, were obtained from BM-derived cells. Both cell types expressed FVIII light chain mRNA and protein, which was further confirmed by transmission electron microscopy. The transplanted HA mice showed FVIII activity in plasma (P<0.01) and survived tail-clip challenge (P<0.001). Thus, we conclude that BM-derived hepatocytes and endothelial cells can synthesize FVIII in liver and correct bleeding phenotype in HA mice.