R egenerative stem cell therapy to promote cardiac repair has been a target of interest in the past 10 years to prevent heart failure after an acute myocardial infarction (AMI). 1,2 Various different stem cells have been investigated for their ability to repair the heart.3 Mesenchymal stem cells (MSCs) seem to be a potent candidate to date. The mechanism of action of MSC is primarily based on the release of paracrine factors to the myocardium. 4 However, retention and survival of stem cells in the myocardium after intracoronary infusion remains an issue in cell-based therapy, because only a limited number of surviving stem cells remain in the myocardium, thereby limiting the potential benefit of the therapy. [5][6][7] CellBeads, which consist of alginate-encapsulated MSCs (eMSCs; BTG International Germany GmbH, Alzenau, Germany), were developed to improve survival of cells in the myocardium, thereby elongating the release of cardioprotective proteins into the infarcted myocardium. These eMSCs secrete endogenous paracrine factors that include vascular endothelial growth factor, monocyte chemotactic protein-1, interleukin (IL)-6, IL-8, glial-derived neurotrophic factor, and neurotrophin-3 and are genetically modified to produce glucagon-like peptide-1 (GLP-1) fusion protein, which comprises 2 GLP-1 molecules bound by an intervening peptide, extending its half-life in vivo. [8][9][10][11][12] Among its beneficial effectsBackground-Engraftment and survival of stem cells in the infarcted myocardium remain problematic in cell-based therapy for cardiovascular disease. To overcome these issues, encapsulated mesenchymal stem cells (eMSCs) were developed that were transfected to produce glucagon-like peptide-1, an incretin hormone with known cardioprotective effects, alongside MSC endogenous paracrine factors. This study was designed to investigate the efficacy of different doses of intracoronary infusion of eMSC in a porcine model of acute myocardial infarction (AMI). Methods and Results-One hundred pigs were subjected to a moderate AMI (posterolateral AMI; n=50) or a severe AMI (anterior AMI; n=50), whereupon surviving animals (n=36 moderate, n=33 severe) were randomized to receive either intracoronary infusion of 3 incremental doses of eMSC or Ringers' lactate control. Cardiac function was assessed using invasive hemodynamics, echocardiography, and histological analysis. A trend was observed in the moderate AMI model, whereas in the severe AMI model, left ventricular ejection fraction improved by +9.3% (P=0.004) in the best responding eMSC group, because of a preservation of left ventricular end-systolic volume. Arteriolar density increased 3-fold in the infarct area (8.4±0.9/mm 2 in controls versus 22.2±2.6/mm 2 in eMSC group; P<0.001). Although not statistically significant, capillary density was 30% higher in the border zone (908.1±99.7/mm 2 in control versus 1209.0±64.6/mm 2 in eMSC group; P=ns). Conclusions-eMSCs enable sustained local delivery of cardioprotective proteins to the heart, thereby enhancing angio...