Appraising Ex Vivo Culture and Molecular Cell State Against Defined Graft Endpoints in Human Myogenic Cell Transplantation

Ex vivo expansion is needed to produce human myogenic cell products, but culture can alter the molecular states that govern engraftment and regeneration. This critical narrative review reappraised 28 primary reports of tissue-derived human myogenic cells, yielding 39 question-specific records. We separated production yield, administered dose, donor persistence, human fiber contribution, later regenerative activity, and recipient function. In documented adult donor sources, transient p38 mitogen-activated protein kinase inhibition and extracellular matrix culture increased histological graft output at matched final doses. SETD7 inhibition increased cell production and postgraft reporter signal, although the administered human dose was unreported. Brief Notch-ligand exposure changed myogenic markers without a detected gain in human fiber output. Population selection, senolytic removal, delivery geometry, and recipient support also altered selected outcomes. Expanded preparations retained later graft activity in some studies, but durable adult-source functional recovery remained insufficiently tested. The evidence supports a product-level framework that links molecular state to defined graft endpoints while evaluating dose, spatial delivery, host context, and indication-specific function separately.