Retroviral-mediated overexpression of the pro-survival gene Akt1 was first shown to enhance the survival of MSCs in an ischemic setting.23 Hypoxic pre-conditioning has also been used to improve the survival of multiple cell types after transplantation including MSCs.24, 25 Similarly, a variety of small molecules that enhance survival by blocking apoptosis have been shown to enhance MSCs engraftment and improve therapeutic efficacy.26, 27 To date and to our knowledge, no strategy has been described to specifically improve the survival of aged hMSCs in the setting of ischemic heart disease. The gene discussed is AKT1; the disease is coronary artery disorder.