# The Long and Winding Road to Cardiac Regeneration
## 2 Stem Cell Therapy
### Pluripotent Stem Cells
#### 2.2.2 Induced Pluripotent Stem Cell  
Induced pluripotent stem cell (iPSC) technology is making a major impact in the field of cardiac regeneration [142]. iPSCs are derived from adult somatic cells, such as skin cells [143], and then reprogrammed to an embryonic stem cell ESC state, where they can be used to obtain any type of tissue in the body. This technology has been used to create beating heart cells in a lab setting, providing a special opportunity to repair and replace damaged heart tissue [144]. This advancement has opened up possibilities for repairing and replacing damaged heart tissue. The potential of iPSCs in cardiac regeneration lies in their versatility. They can be easily manipulated to form different components of the heart, offering researchers a unique opportunity to study and understand the cellular context in which these cells operate [145]. This knowledge is crucial for developing effective therapies. In the field of heart disease, iPSCs have become a powerful tool. Researchers can generate cardiac cell types from patients' own cells, allowing them to study the effects of specific genetic and environmental factors [146]. This personalized approach helps in understanding disease progression and developing targeted treatments [147]. Moreover, iPSCs are used to create cell-based models of human heart diseases. These models aid in uncovering the underlying mechanisms and pathophysiology of various cardiac conditions [148]. By gaining a deeper understanding of these diseases, researchers can improve diagnosis and prognosis, and develop novel treatment strategies. iPSC technology also plays a role in engineering heart-on-chip devices. These devices allow for the testing of numerous therapeutic agents in vitro, accelerating the development of treatments [149; 150]. Additionally, iPSC-derived cardiac tissues have the potential to restore normal heart function by providing a replacement for lost cells and tissue in failing hearts [151; 152]. However, there are challenges associated with using iPSCs in cardiac research. Safety concerns arise due to the potential of iPSCs to form tumors if not properly controlled. Ensuring the safety of iPSC-based therapies is crucial before considering widespread clinical applications [153; 154]. Another challenge is immune rejection. While autologous transplantation of iPSCs bypasses immune rejection issues, generating patient-specific iPSCs of sufficient quality can be challenging. Allogeneic transplantation using iPSCs from different donors raises concerns about immune rejection and the need for immunosuppressive drugs [155; 156]. Efficiency of differentiation is also a complex process. Generating a pure population of functional cardiac cells from iPSCs is still being optimized [157], and variability in differentiation efficiency can affect the overall effectiveness of iPSC-based cardiac regeneration [158]. Furthermore, iPSC-derived cardiomyocytes often exhibit immature characteristics, limiting their functionality and integration into existing cardiac tissue [159; 160]. Achieving mature, fully functional cardiomyocytes is a critical goal for successful cardiac regeneration. To ensure effective cardiac regeneration, transplanted cells must be able to integrate and establish proper electromechanical coupling with the host tissue [56; 161; 162]. However, achieving this alignment and synchronization with existing cardiac tissue is challenging and requires further research. Additionally, ethical concerns surround the generation of iPSCs through genetic reprogramming techniques. While iPSCs avoid the ethical considerations associated with embryonic stem cells, the alteration of genetic makeup raises ethical questions [163; 164]. Addressing these challenges and limitations is essential for the successful translation of iPSC-based cardiac regeneration strategies from the laboratory to clinical applications.