# Cell Therapy in the Treatment of Coronary Heart Disease
## 2 Non-Cardiac Origin Cells for Cardiac Cell Therapy
### Mesenchymal Stem Cells  
Another group of bone marrow stem cells consists of MSCs or fibroblast colony-forming units. MSCs are characterized by their ability to adhere to scaffolds and to differentiate into osteoblasts, adipocytes, and chondrocytes under specific in vitro conditions, and they express specific cellular markers such as CD73, CD90, and CD105, but lack CD14, CD45, CD34, and HLA-DR [23]. It should be noted that MSCs have a low level of expression for the major histocompatibility complex (MHC II) molecule, making them suitable for allogeneic transplantation [43]. It is believed that MSCs are capable of suppressing the production of inflammatory cytokines and have cytoprotective and angiogenic effects [44; 45]. As a result, MSCs offer a promising source of cell cultures for treating CHD.  
Studies of intramyocardial MSCs transplantation in laboratory animals with experimentally induced MI have shown reduced area of cardiosclerosis and increased peri infarction angiogenesis [46; 47; 48]. A recent meta-analysis, comprising 58 preclinical studies, indicated that transplantation of MSCs in animal models of acute MI and chronic CHD resulted in a decrease of around 7% in post-infarction scar size and an approximately 11% enhancement in cardiac contractile function [49].  
Intravenous administration of MSCs to patients after MI was investigated in a clinical trial in 2009 [13]. The study showed that patients who underwent treatment had a reduced risk of developing arrhythmias, and there was a relative improvement in left ventricular functional characteristics 3 months after the injections. The POSEIDON clinical trial, which investigated the use of MSCs in patients who had undergone coronary artery bypass grafting for ischemic cardiomyopathy, yielded comparable results [14]. In the C-CURE clinical trial, researchers treated MSCs with a cytokine cocktail intended to induce cardiogenic differentiation, resulting in the development of cardiopoietic stem cells. Patients with ischemic cardiomyopathy who received transendocardial injection of these cells in the left ventricle displayed a relative increase in cardiac contractile function as compared to the control group [50]. The PROMETHEUS clinical trial demonstrated a reduction in the area of cardiosclerosis and improved cardiac contractile function in patients who underwent intramyocardial transplantation of autologous MSCs [51]. Similar results were found in other clinical studies that used transendocardial injections of MSCs, which also led to a relative reduction in the area of cardiosclerosis in the heart [52; 53; 54]. In certain clinical studies, no discernible distinctions were discovered between patients receiving MSCs and those in the control group [55; 56; 57].  
While bone marrow is the primary source of MSCs, they can also be extracted from almost any organ [58]. Particular emphasis has been placed on cells derived from adipose tissue, and animal studies have demonstrated an increase in cardiac contractile function and the promotion of angiogenesis following the administration of MSCs derived from adipose tissue [30; 59].