Aim: To establish an efficient culture system to support embryonic stem (ES) cell differentiation into hepatocytes that coexpress F-VIII and F-IX. Methods: Mouse E14 ES cells were cultured in differentiation medium containing sodium butyrate (SB), basic fibroblast growth factor (bFGF), and/or bone morphogenetic protein 4 (BMP4) to induce the differentiation of endoderm cells and hepatic progenitor cells. Hepatocyte growth factor, oncostatin M, and dexamethasone were then used to induce the maturation of ES cell-derived hepatocytes. The mRNA expression levels of endoderm-specific genes and hepatocyte-specific genes, including the levels of F-VIII and F-IX, were detected by RT-PCR and real-time PCR during various stages of differentiation. Protein expression was examined by immunofluorescence and western blot. At the final stage of differentiation, flow cytometry was performed to determine the percentage of cells coexpressing F-VIII and F-IX, and ELISA was used to detect the levels of F-VIII and F-IX protein secreted into the culture medium. Results: The expression of endoderm-specific and hepatocyte-specific markers was upregulated to highest level in response to the combination of SB, bFGF, and BMP4. Treatment with the three inducers during hepatic progenitor differentiation significantly enhanced the mRNA and protein levels of F-VIII and F-IX in ES cell-derived hepatocytes. More importantly, F-VIII and F-IX were coexpressed with high efficiency at the final stage of differentiation, and they were also secreted into the culture medium. Conclusion: we have established a novel in vitro differentiation protocol for ES-derived hepatocytes that coexpress F-VIII and F-IX that may provide a foundation for stem cell replacement therapy for hemophilia.Keywords: coagulation factor VIII; coagulation factor IX; embryonic stem cells; differentiation; hemophilia; sodium butyrate Acta Pharmacologica Sinica (2010Sinica ( ) 31: 1478Sinica ( -1486 doi: 10.1038/aps.2010 published online 18 Oct 2010 Original Article # These authors contributed equally to this study. * To whom correspondence should be addressed. tocytes. However, whether these differentiated hepatocytes express F-VIII or F-IX is unknown.Bone morphogenetic proteins (BMPs) and fibroblast growth factors (FGFs) have been shown to be required for the formation of endoderm cells [16,17] . Studies have shown that at the time of liver specification, the induction of hepatic fate requires BMP4 expression in the mesoderm surrounding the foregut endoderm [18][19][20] . Derived from the cardiac mesoderm, bFGF is required for the initiation of liver bud development in the anterior definitive endoderm [21,22] . Additional studies have indicated a synergistic effect between BMPs and FGFs in inducing hepatocyte differentiation [23] . In our previous study, we developed a novel method to induce mouse ES cells to differentiate into hepatocytes by adding SB [12] . The aim of the present study was to adopt a modified approach to induce ES cells to differentiate into functional hepa...