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Viewpoint | Scientific Discovery and the Future of Medicine

Direct Reprogramming Bypassing Stem Cells for Therapeutics

Eduardo Marbán, MD, PhD1; Eugenio Cingolani, MD1
[+] Author Affiliations
1Cedars-Sinai Heart Institute, Los Angeles, California
JAMA. 2015;314(1):19-20. doi:10.1001/jama.2015.4504.
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This Viewpoint discusses advancements in direct reprogramming in the treatment of heart failure, diabetes, and hearing loss.

During fetal growth, cells differentiate into various types, such as cardiomyocytes and neurons, through an intricately orchestrated set of genetic and epigenetic instructions, with the input of developmental cues. Once cells migrate to their adult destination, they are highly differentiated. Cardiomyocytes beat away year after year; neurons make memories; hepatocytes clear toxins. The function of these cells remains unchanged until they die naturally or as a consequence of disease. Many tissues contain intrinsic progenitor cells that repopulate the key working cells of that tissue as they die; satellite cells in skeletal muscle are but one example. Yet even such progenitor cells have a limited number of possible fates. Advances in science now make it feasible, in many cases, to redirect cell fate: fibroblasts in the heart can become working cardiomyocytes, and pancreatic exocrine cells can turn into beta cells.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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