Cardiac stem cells (CSCs) are the most promising and effective candidates for the therapy of cardiac regenerative diseases; however, they have marked limitations. For instance, the implantation of CSCs is hampered by factors such as their sustainability and long‑term durability. Gene modification appears to be the most effective method of optimizing CSCs and gene therapy trials have demonstrated that efficient gene transfer is key to achieving therapeutic efficacy. However, the transduction ability of adenovirus (Ad) is limited. Previous studies have reported that low expression of coxsackie and adenovirus receptor (CAR) in target cells decreases the transduction efficiency. A promising method for improving Ad‑mediated gene transfer is to increase CAR expression in target cells. The present study investigated the effect of the Raf‑mitogen‑associated protein kinase (MAPK) kinase (MEK)‑extracellular signal‑associated protein kinase (ERK) signaling pathway on the expression of CAR on CSCs, as this pathway decreases cell‑cell adhesion via cell surface molecules. The results demonstrated that interference with the Raf‑MEK‑ERK signaling pathway by knockdown of ERK1/2 upregulated the expression of CAR. The entry of the Ad into the cells was increased following inhibition of ERK1/2. Moreover, following knockdown of CAR, the entry of Ad into cells was decreased. However, knockdown of c‑Jun N‑terminal kinase and p38 as other components of the MAPK pathway did not affect CAR expression. Therefore, CAR expression in CSCs may be mediated via the Raf‑MEK‑ERK signaling pathway. Upregulation of CAR by knockdown of ERK1/2 may significantly improve Ad‑mediated genetic modification of CSCs in the treatment of cardiovascular diseases.

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