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Four years after California residents captured worldwide attention by voting to spend $3 billion on stem cell research, many of the anticipated new therapies are at least 10 years away and numerous hurdles must be overcome.

Yet the optimism remains.

As research kicks into high gear, scientists point to areas that hold great promise, including:

• Using stem cells to deliver missing enzymes or absorb toxins to help keep dying cells alive. This approach may be useful for people with Parkinson's or Alzheimer's diseases.

• Transplanting stem cells to repair damage caused by macular degeneration.

• Treating diabetics with insulin-producing cells the body will not reject.

• Using stem cells to repair heart damage or spinal cord injuries.

• Attacking cancer at its root by eliminating what some believe are cancer stem cells.

In many cases, however, before scientists can begin clinical trials, they face major stumbling blocks.

No one knows, for example, how to ensure that transplanted stem cells won't eventually form cancerous tumors. Or how to guarantee that a stem cell meant to form heart muscle won't begin...