Myocardial healing using cardiac fat.

Chronic diseases, including myocardial scar healing and heart failure remission, impose huge social and economic burdens, and novel approaches are needed. Several therapeutic modalities are currently being evaluated, including cell therapy, stem cell conditioning, and cardiac tissue engineering. Areas covered: This review discusses the restoration of cardiac function after myocardial infarction using a vascularized flap of autologous cardiac adipose tissue over an akinetic scar. It addresses the risks and benefits of using cardiac adipose progenitors and the adipose graft transposition procedure (AGTP) to ameliorate cardiac dysfunction in preclinical and clinical trials. Expert commentary: The focus is shifting from first-generation studies that used ex vivo expanded and manipulated progenitors to newer second-generation approaches, including AGTP, which are inexpensive and do not raise ethical issues. AGTP safety has been validated, and the ongoing AGTP-2 trial to determine AGTP efficacy and outcome is currently recruiting patients (NCT02798276). This reparative strategy is safe, avoids the risks associated with ex vivo manipulation, and the preclinical and clinical trials performed to date show cardiac function recovery and reduced necrosis. Confirmation of these data in the AGTP-2 trial could pave the way for the clinical use of this novel modality.