Aminoglycosides can bypass nonsense mutations and are the prototypic agents for translational bypass therapy (TBT). Initial results demonstrate the need for more potent drugs and an in vivo model system for quantitative assessment of TBT. Herein, we present an in vivo system for evaluating the efficacy of premature stop codon management therapies: in vivo quantitative stop codon management repli-sampling TBT efficacy assay (IQSCMaRTEA). Application of IQSCMaRTEA reveals that geneticin is much more efficacious in vivo than gentamicin. Treatment with geneticin elicits a multiday response, and residual F9 antigen can be detected after 3 weeks. These data demonstrate the utility of IQSCMaRTEA for evaluating drugs that bypass nonsense mutations. In addition, IQSCMaRTEA may be helpful for testing inhibitors of nonsensemediated decay, as stop codon management therapy will sometimes require inhibition of nonsense-mediated decay and translational bypass of the nonsense mutation. Furthermore, geneticin, its metabolites, or better tolerated analogues should be evaluated as a general treatment with multiday response for severe genetic disease caused by nonsense mutation.cancer chemotherapy ͉ oncology ͉ nonsense-mediated decay ͉ aminoglycoside ͉ hemophilia A minoglycosides can cause extensive misreading of the mRNA code in vitro (1) and bypass nonsense mutations as demonstrated in Escherichia coli (2), tetrahymena (3), wheat embryo (4), yeast (5), cultured animal cells (6) and human cells (4, 7-9). Barton-Davis et al. (10) described gentamicin-mediated translational bypass therapy (TBT) in the dystrophin gene in a mouse model for muscular dystrophy. Two other mouse models (6, 11) have been described, and clinical trials have been initiated (12,13). The clinical studies have been difficult to perform and disappointing to date, suggesting the need for a better animal model to explore the dose-response relationships of compounds that mediate TBT. No in vivo animal system was heretofore available for direct and quantitative functional assessment of TBT efficacy.We describe such an in vivo system: in vivo quantitative stop codon management repli-sampling TBT efficacy assay (IQSCMaRTEA). Three mutant human minigenes are used as models, two with nonsense mutations with and without dramatic nonsense-mediated decay (NMD) and one with a missense mutation.Hemophilia is the oldest known hereditary bleeding disorder affecting Ϸ1 in 10,000 males. There are Ϸ20,000 hemophilia patients in the United States. Each year, Ϸ400 babies are born with this disease, Ϸ80% with hemophilia A and 20% with hemophilia B (HB). Approximately 70% of hemophilia patients have severe hemophilia, including those with nonsense mutations. TBT has the potential to provide an inexpensive prophylaxis in hemophilia and greatly improve or eliminate symptoms from any severe genetic disease caused by a nonsense mutation (15% of severe inherited genetic disease). However, NMD and sequence context effects complicate the practical application of TBT (14, 15).IQSCMaRTEA allo...