title: Opportunities and challenges for mesenchymal stem cell-mediated heart repair.
abstract: OBJECTIVE
  Mesenchymal stem cells (or multipotent stromal cells) are emerging as a potent cell type for cardiac cell therapy. This review describes the potential of cardiac mesenchymal stem cell therapy, but also highlights some recently discovered less favorable mesenchymal stem cell characteristics.
  
  
  RESULTS
  Mesenchymal stem cells exert a beneficial effect on cardiac function upon administration to the ischemic myocardium. The mode of action does not seem to involve differentiation into cardiomyocytes and vascular cells. A robust effect on revascularization and remodeling is observed, however, most likely mediated by paracrine factors. Recently identified drawbacks associated with cardiac mesenchymal stem cell therapy include differentiation into unwanted mesenchymal cell types such as osteocytes and adipocytes, the occurrence of cytogenetic instability upon prolonged expansion, and immunization when used in an allogeneic setting.
  
  
  CONCLUSIONS
  The application of mesenchymal stem cells is a novel strategy with therapeutic potential for cardiac repair. Strategies are needed, however, to optimize their therapeutic potential while minimizing their potential clinical risks.
authors.affiliation: Department of Cardiology, and Einthoven Laboratory, Leiden University Medical Center, Leiden, The Netherlands. d.e.atsma@lumc.nl
authors.forename: Douwe E
authors.initials: DE
authors.lastname: Atsma
authors.forename: Willem E
authors.initials: WE
authors.lastname: Fibbe
authors.forename: Ton J
authors.initials: TJ
authors.lastname: Rabelink
mesh_terms: D000818:Animals; D002454:Cell Differentiation; D002471:Cell Transformation, Neoplastic; D006801:Humans; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells / Q000166:cytology / Q000276:immunology; D017202:Myocardial Ischemia / Q000473:pathology / Q000601:surgery*