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Cell transplantation is the first therapy design to treat the underlying injury in heart failure "cardiomyocyte and vessel cell death" and bring us closer to the ambitious goal of myocardial regeneration.A variety of cell types have been proposed for transplantation in different stages of cardiovascular disease.However, the challenges facing cardiac stem cell therapy are multiple: What is the ideal stem cell? How many cells should be given? How should those cells be given? And which patients will most likely benefit from cell therapy? The choice of cell type depends greatly on the injury to be treated and on the routes of administration available.Stem cells can be delivered indirectly through peripheral and coronary veins (transvascular delivery) and coronary arteries (intracoronary delivery).Other option is direct delivery as intramyocardial injections via surgical, transendocardial, or transvenous approaches.Another potential delivery strategy is mobilization of stem cells from the bone marrow by means of cytokine therapy.There is a wealth of preclinical and early clinical data showing the safety, feasibility, and early efficacy of cell therapy using different administration modalities.However, stem cell delivery remains a major challenge in the development of cardiac stem cell therapy strategies.Since 2008 there are three ongoing clinical trials in Latvia: transplantation of autologous bone marrow mononuclear cells for patients with acute myocardial infarction, chronic heart failure and diabetes mellitus using intracoronary delivery or injections in branches of splenic artery during balloon angioplasty.The first interim results of these studies will be available in December 2009.