Figure 3.

Remaining challenges of direct reprogramming approaches before a clinical application. Before a translation of direct reprogramming approaches from bench to bedside, several challenges have to be resolved. First of all, issues like the inefficiency of the reprogramming process from fibroblasts (grey cells in front of the arrow) to induced cardiomyocytes (iCMs, red elongated shaped cells behind the arrow), the insufficient maturity of the iCMs, the delivery method, or the understanding of underlying mechanisms have to be addressed. As a next step, especially for evaluating the safety of delivery methods, large animal studies have to be performed. Further effort has to be put into the optimization of the reprogramming technology before a clinical application becomes possible.