Research Progress and Prospects of Direct Cardiac Reprogramming Technology

As adult cardiomyocytes are in a state of terminal differentiation, they have no regenerative capacity. Once the heart is subjected to ischemia and hypoxia, cardiomyocytes suffer irreversible damage, and damaged and necrotic cardiomyocytes are replaced by myocardial fibroblasts, which in turn form scar tissue leading to cardiac remodeling and ultimately to heart failure. The discovery of direct cardiac reprogramming, in which myocardial fibroblasts are induced to become cardiomyocyte-like cells by specific means, holds new promise for the treatment of cardiac diseases and the regeneration of the heart. In this paper, we will provide an overview of the development of direct cardiac reprogramming, summarize the transcription factor-mediated reprogramming approach, and discuss its molecular mechanisms, including key transcription factors, signaling pathways, immune response and autophagy. At the same time, we will analyze the current challenges faced by the field and the future direction of development.