Exploring the Inner Workings of Direct Cardiac Reprogramming

Abstract

Purpose of review: Following cardiac injury, the heart has limited ability to regenerate leading to decreased efficiency and function. Cardiac reprogramming offers a promising treatment to ameliorate the damage caused by ischemia through conversion of cardiac fibroblasts to induced cardiomyocytes (iCMs). Here, we aim to highlight the recent advancements of the last 5 years by discussing the various aspects of cardiac reprogramming including characterization of the cardiac fibroblast, the endogenous environment of the heart, the molecular mechanisms during reprogramming, the epigenetic landscape, and the mechanics of delivering reprogramming factors.

Recent findings: Due to generally low efficiency of direct cardiac reprogramming, many researchers have continued to improve the efficiency of iCM induction and continued exploration of the basic science behind the technique. The field is continuing to optimize individual aspects of reprogramming that can be leveraged together to improve overall effectiveness. Over the last several years, knowledge regarding the process of direct cardiac reprogramming and the many factors that affect its efficiency has increased significantly. Individual aspects have continued to be optimized, and it will be essential going forward to synthesize this information. Cardiac reprogramming continues to advance towards clinical translatability.

Keywords: Cardiac fibrosis; Direct cardiac reprogramming; Myocardial infarction.