Wolfgang Miesbach: Targeting Hepatic Endothelial Cells for Lentiviral Gene Therapy in Haemophilia A
Wolfgang Miesbach, Head of Hemostasis/Hemophilia Center at Medical Clinic 2 at University Hospital Frankfurt, shared a post on LinkedIn:
“FVIII was never a hepatocyte’s job.
ESGCT 26, Floriya Antony on the hepatic endothelium as a target for lentiviral gene therapy in haemophilia A:
The liver’s natural source of FVIII is the sinusoidal endothelial cell, not the hepatocyte.
Forcing a hepatocyte to overproduce a large, awkward protein loads the endoplasmic reticulum, and sustained ER stress can turn the unfolded protein response from pro-survival to pro-apoptotic. A lentiviral vector driven by the endothelial stabilin-2 promoter puts the gene back where the biology expects it.
- Sustained FVIII activity of about 10% for up to 24 weeks in haemophilia A mice
- Lower long-term ER stress markers and less hepatic lipid accumulation than a ubiquitous promoter
- No relevant anti-FVIII antibodies, no significant liver toxicity in adult or newborn mice
- Efficacy persisted after deliberate endothelial injury; neonatal treatment promoted vascular recovery
Taken together, these preclinical findings support the hepatic endothelium as a promising target for safe and durable lentiviral gene therapy in haemophilia A.”

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