The main finding of the study was that

The main finding of the study was that CPAP therapy for one month led to significant improvements in nmda receptor antagonist morphology, daytime sleepiness and verbal episodic memory function in the BSC+CPAP group compared with the BSC only group. These early hypertrophic morphological changes appeared to be specific to the right thalamus and linked regions. Furthermore, interesting relationships were observed between the morphological changes in the brainstem and improvements in daytime sleepiness in the BSC+CPAP group.
In this issue of , Bayes-Genis and colleagues () reported the first clinical study investigating safety and efficacy of the adipose graft transposition procedure (AGTP) in patients with chronic myocardial infarction undergoing coronary artery bypass graft (CABG) surgery. This innovative approach takes advantage of the local existing tissue to repair damaged myocardium, simplifying the surgical procedure and potentially avoiding the risks of using non-autologous cells or stem cells that have been manipulated in petri dish. Myocardial infarction (MI) is a devastating disease condition, and is one of the leading causes of morbidity and mortality in western countries. In the past decade, significant advance has been made to develop novel therapeutic approaches to regenerate infarcted myocardium, including the stem cell therapy and the most recent reprogramming approaches. Stem cell therapy currently faces the challenges of poor cell survival, limited cell–cell interaction and functional integration of engrafted cells, as well as unclear mechanisms of some beneficial effects observed in animal model. Clinical studies of using stem cell or stem cell-derived cardiomyocytes have a mixed result (). The newly emerged reprogramming approach converting endogenous fibroblasts into cardiomyocytes could potentially overcome some of these challenges (); however, this approach is currently at its fledgling stage and has been primarily tested on small rodents for effectiveness and safety. In clinic, revascularization strategies, including fibrinolysis, percutaneous coronary intervention (PCI), and CABG, have greatly improved myocardial salvage and prognosis in patients suffering from acute myocardial infarction. However, patients who miss the narrow optimal time window for reperfusion therapy or those who experience detrimental ischemia reperfusion injury during revascularization, will develop myocardial scar over time, which ultimately contributes to cardiac dysfunction, malignant arrhythmia, sudden cardiac death and other major cardiovascular events (). Unfortunately, current treatment is unable to replace the chronically formed scar to restore functionality of the damaged myocardium. In the current study, Antoni Bayes-Genis et al. conducted the first in-man trial that integrates cardiac adipose tissue derived cell therapy into tissue engineering for repairing damaged myocardium (). The innovative procedure involves dissection of a vascularized flap of autologous pericardial adipose tissue to cover the scar area. Adipose tissue, generally considered as a source of systemic inflammation and risk for cardiovascular diseases, has drawn extensive attention as an alternative source of multipotent stem cells for healing infarcted myocardium (). Cardiac adipose tissue is primarily comprised of specially deposited visceral fat cells around heart supported with local vasculature system. The same group has discovered a progenitor cell population existing in human cardiac adipose tissue that has potential to be differentiated into cardiomyocytes and endothelial cells. Introduction of these cells ameliorated physical and pathological adverse changes in murine infarcted hearts (). Importantly the results from APOLLO, ADVANCE, MyStromalCell, and PRECISE trials proved the safety of adipose tissue-derived stem cell therapy through intracoronary or intramyocardial delivery (). However, AGTP procedure using pericardial adipose tissue flap is different in several ways that makes it necessary and important to evaluate the safety. For example, the flap used in AGTP contains more heterogeneous cell types and the cardiac adipose tissue is also shown as a risk factor for atherosclerosis, atrial fibrillation, and ventricular arrhythmia (). As a step further, preclinical studies using large animals indicated that AGTP indeed exerted beneficial effects on infarct size, primarily through promoting angiogenesis in swine models of both acute and chronic myocardial infarction ().