Citation: Handbook of Experimental Pharmacology. 243:329-353, 2017.Journal: Handbook of experimental pharmacology.Published: 2017ISSN: 0171-2004.Full author list: Lipinski MJ; Luger D; Epstein SE.UI/PMID: 28382469.Subject(s): Cardiomyopathies/co [Complications] | Graft Rejection/pc [Prevention & Control] | Heart Failure/et [Etiology] | *Heart Failure/th [Therapy] | Humans | Immunosuppressive Agents/tu [Therapeutic Use] | *Mesenchymal Stem Cell Transplantation/mt [Methods] | Myocardial Ischemia/co [Complications] | Transplantation, Autologous | Transplantation, HomologousInstitution(s): MedStar Heart & Vascular Institute | MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1007/164_2017_23 (Click here)Abbreviated citation: Handb. exp. pharmacol.. 243:329-353, 2017.Abstract: HF patients with signs and symptoms of worsening heart failure (HF), despite optimal medical therapy, have a poor prognosis. The pathways contributing to HF are multiple, probably accounting, in part, for current treatment approaches not being more effective. Stem cells, particularly mesenchymal stem cells (MSCs), have a broad range of activities, making them particularly interesting candidates for a new HF therapeutic. This review presents an overview of the studies examining the efficacy of stem cell studies administered to HF patients, focusing mainly on MSCs. It examines the issues surrounding autologous vs. allogenic stem cells, the results of different routes of administration, and implications deriving from the belief that for stem cells to be effective, they must engraft in the myocardium and exert local effects. Since intravenous administration of stem cells leads to sparse cardiac engraftment, stem cell delivery strategies have uniformly involved catheter-based delivery systems. This becomes problematic in a disease that will almost certainly require delivery of the therapeutic throughout the course of the disease. Importantly, it appears that a critical contributing cause of the progressive cardiac dysfunction experienced by HF patients is the existence of a persistent inflammatory response. Since MSCs exert potent anti-inflammatory effects through paracrine mechanisms, it is possible that intravenous delivery of MSCs may be therapeutically effective. If this concept is valid, it could lead to a transformational change in stem cell delivery strategies.