The search for human oval cells or bi-potential stem cells in the human liver is the subject of intensive investigation. Fetal hepatocytes (hepatoblasts) have some proliferative and bipotential capacity, but access to sufficient numbers of cells remains limiting. Candidate stem cells in the adult normal and diseased human liver have been identified using markers such as OV6, CD34, c-kit and NCAM. Lack of stem cell marker specificity however, remains a problem and further, more specific markers are required. The molecular signaling molecules and transcription factors that control proliferation and cell differentiation pathways into hepatocyte or biliary phenotype are beginning to emerge. However, whether any of the current liver stem cell approaches will be converted into effective clinical cell transplantation or gene therapy treatments has yet to be proven.