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Administration of adult stem cells for cardiac repair after myocardial infarction (MI) is a revolutionary new strategy that could become clinically feasible in the near term, appears to be safe and relatively cost-effective, and offers tremendous potential to improve prognosis.1 Using diverse cell populations and strategies, several relatively small clinical studies have reported encouraging outcomes, with improvement in various measures of myocardial perfusion and left ventricular (LV) function.2 However, negative data have also emerged, generating controversy regarding the overall efficacy of cell therapy.2This controversy persists even after the recent publication of the three largest randomized studies to date of cell therapy for cardiac repair.3–5 In the largest of these trials, the multicentre REPAIR-AMI study,3 204 patients received an intracoronary infusion of autologous mononuclear bone marrow cells (BMCs) or placebo (medium) at 3–7 days after a reperfused acute MI. After 4 months, the absolute improvement in global LV ejection fraction (EF) was greater in patients treated with BMCs compared with control patients. After 1 year, BMC treatment was associated with a significant reduction in the combined endpoints of death, recurrent MI, and revascularization and death, recurrent MI, and re-hospitalization for heart failure.3,6 An improvement in LV function and clinical outcome after BMC treatment was also noted in the TOPCARE-CHD trial among patients with an old MI.4 However, no benefit was reported in the other trial of acute MI (the ASTAMI trial),5 in which 100 patients with reperfused acute anterior MI received either intracoronary infusion of BMCs or no intervention at a median of 6 days after MI. After 6 months, there was no difference in LVEF, infarct size, … *Corresponding author. Tel: +1 502 8521837; fax: +1 502 852 6474. E-mail address : rbolli{at}louisville.edu

Bone marrow for cardiac repair: the importance of characterizing the phenotype and function of injected cells