The skin is an important target for gene transfer because of its easy accessibility. Using plasmid DNA expressing rat erythropoietin (pCAGGS-Epo) Because of its ready accessibility for direct manipulation and clinical monitoring, the skin is an attractive tissue for gene transfer. Direct in vivo plasmid DNA transfer to the skin via injection 1,2 and topical administration 3 have been reported. Intradermally injected plasmid DNA rapidly traverses the dermo-epidermal junction and is taken up and expressed by keratinocytes in the epidermis. 4 Active transgene expression in the epidermis is lost by 3 days after injection, 1 a time period that is too short for clinical applications. Moreover, skin takes up and expresses DNA less efficiently than does muscle. 5 Consequently, skin-targeted transfer of plasmid DNA has focused on two principal therapeutic uses: genetic immunization 6,7 and the expression of biological response modifiers to treat skin disease. 4 Gene gun 8,9 and jet injection 10 techniques have been developed for effective skin-targeted gene transfer. A gene gun technique has been used to successfully deliver naked DNA into the epidermis. 11 Klinman et al 11 also reported that, compared with muscle, skin is a suitable site for the short-term (3 weeks) production of erythropoietin (Epo), due to the rapid turnover of skin cells. Skin-targeted gene transfer by in vivo electroporation has been shown to be effective for introducing plasmid DNA, including the SV40 T antigen gene, into newborn mouse skin, 12 and the lacZ gene has been transferred into the hairless mouse with skin-depth targeting. 13 However, there are no reports on the systemic delivery of therapeutic proteins by skin-targeted gene transfer using electroporation. We demonstrate here that skin-targeted transfer of the Epo gene using electroporation with plate-and-fork-type electrodes produced physiologically significant levels of Epo in the systemic circulation for 7 weeks, and increased erythropoiesis in normal rats for 11 weeks.We tested three types of electrodes for skin-targeted gene transfer (Figure 1). To optimize the voltage of the electric pulses used for in vivo electroporation, we compared the serum Epo levels of rats subjected to electroporation at various voltages that did not cause macroscopic skin damage: 50 V, 24 V and 12 V, for the needletype electrodes, and 24 V, 18 V and 12 V, for the disktype and plate-and-fork-type electrodes. Pre-and postinjection serum Epo levels were measured on day Ϫ7 before and day 7 after intradermal injection with 800 g of either pCAGGS-Epo or pCAGGS. Only electroporation with the plate-and-fork-type electrodes at low voltages significantly increased the serum Epo levels (Figure 2). This result demonstrates that the type of electrode used is of critical importance in skin-targeted Epo gene transfer using in vivo electroporation. The difference in effectiveness of electrode types is probably explained by differences in the direction of the current to the skin. With the needle-type electrodes, the curre...