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The epidemic of heart failure due to coronary artery disease is a leading cause of morbidity and mortality worldwide. The hallmark of this pathology is maladaptive ventricular remodelling that precipitates contractile dysfunction, and ultimately leads to the overt syndrome of congestive heart failure. The central feature in this malignant cascade is the massive loss of cardiomyocytes, followed by replacement with fibrotic scar; this ultimately leads to organ failure which is further accelerated by haemodynamic overload, inflammatory–oxidative stress, and/or impaired vascularisation. Despite continuous advances in disease management, the available medical, interventional or surgical treatments fall short of addressing the root cause of disease and are typically limited to palliative strategies mitigating disease symptomatology.
The rationale for stem cell based regenerative medicine applied to the treatment of heart diseases is based on the realisation that natural self renewing processes innate to the myocardium, while sufficient to sustain normal homeostasis, fall short of salvaging heart muscle following massive injury—as in the setting of myocardial infarction.1 Accordingly, boosting the cardiac reparative capacity through supplementation of stem cell pools has been increasingly considered as a novel therapeutic approach. Indeed, it is now recognised that extracardiac (eg, bone marrow) in addition to intracardiac progenitor cells are mobilised and home to the site of the myocardial injury to participate in the compensatory healing response.1 w1 Furthermore, there is growing evidence that such cells participate in the maturation and induction of collateral vascular growth and neovasculogenesis, and may acquire phenotypic properties of neighbouring cardiac myocytes.1 These findings, propelled by recent progress in developmental biology, offer an unprecedented opportunity to achieve repair of damaged myocardium using stem cells as new therapeutic tools. Here, we focus on the current clinical experience as well needs for successful translation of the emergent field of cell based therapy from proof-of-concept …