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The emerging field of regenerative medicine may one day revolutionize the treatment of heart disease and neurodegenerative disorders, solve the organ donor shortage problem, and completely restore damaged muscles, tendons and other tissues. The extra help allows the body to regrow tissues of the type or in the amount that it normally could not do by itself. Unique among the human body's larger organs, the liver has a remarkable ability to recover from injury. If the discovery can translate to human applications, it will enhance efforts aimed at finding ways to use large numbers of a person’s own cells to restore damaged brain function, partially because the technique produces cells in far greater amounts than the body can on its own. UPDATE - I cover the internet and news reactions to this article and added technical information. UPDATE I consider this proposed procedure in the context of organ donation and xenotransplantation. HEAVEN capitalizes on a minimally traumatic cut of the spinal cord using an ultra-sharp blade (very different from what occurs in the setting of clinical spinal cord injury, where gross, extensive damage and scarring is observed) followed within minutes by chemofusion (GEMINI). Two surgeons in the field figured that a combination of the chemicals might enhance the regrowth even more. The indications for HEAVEN would be far-reaching (including non-brain cancer), but, given the dearth of donors, a select group of gravely ill individuals would be the target. What follows is a possible scenario in order to give the reader a feel for the whole endeavor.
Donor is a brain dead patient, matched for height and build, immunotype and screened for absence of active systemic and brain disorders. The procedure is conducted in a specially designed operating suite that would be large enough to accommodate equipment for two surgeries conducted simultaneously by two separate surgical teams.
Before PH, barbiturate or propofol loading is carried out in R to obtain burst suppression pattern.
Under the operating microscope, the cords in both subjects are clean-cut simultaneously as the last step before separation.
Once R's head is separated, it is transferred onto D's body to the tubes that would connect it to D's circulation, whose head had been removed. The vascular anastomosis for the cephalosomatic preparation is easily accomplished by employing bicarotid-carotid and bijugular-jugular silastic loop cannulae. Trachea, esophagus, the vagi, and the phrenic nerves are reconnected, these latter with a similar approach to the cord. There have been many studies on spinal cord repair, but many have the repair performed after waiting for one week. In 2000, there was immediate recovery from spinal cord injury through molecular repair of nerve membranes with polyethylene glycol. A brief application of the hydrophilic polymer polyethylene glycol (PEG) swiftly repairs nerve membrane damage associated with severe spinal cord injury in adult guinea pigs. The early-stage neural stem cells grew new axonal connections across the injury and re-established significant mobility, something that hasn't been done before, Tuszynski said.
The stem cells improved mobility on a 21-point scale, from 1.5 after spinal cords were severed to 7 after the treatment. Rats with spinal cord injuries and severe paralysis are now walking (and running) thanks to researchers at EPFL. In 1959, China announced that it had succeeded in transplanting the head of one dog to the body of another twice. On March 14, 1970, a group of scientists from Case Western Reserve University School of Medicine in Cleveland, Ohio, led by Robert J. Improvement in the locomotor function in the micelle-treated group was evident by a more rapid increase of BBB scores in the first 14 days and continuation of improvement over the following two weeks. Already such self-healing treatments have somewhat rejuvenated a few patients' ailing hearts and helped surgeons repair injured muscles.


An individual can lose a big chunk of it in an accident or during surgery, but as long as at least a quarter of the organ remains intact and generally free of scars, it can grow back to its full size and function. Scientists are learning how to mix a hodgepodge of sugar molecules, proteins and fibers to create an environment in which the stem cells can develop into replacement tissue. The surgery is performed under conditions of deep hypothermia for maximal protection of the neural tissue. Two chemicals, chondroitinase and FGF, show strong signs of doing exactly that--in rats, at least. The surgeons, from Case Western Reserve University and the Cleveland Clinic, began by entirely severing the spinal cords of 15 rats to ensure no independent, natural regrowth.
This would include for instance people with some kinds of muscular dystrophies, which prove eventually lethal and a source of major suffering. If timing allows, an autotransfusion protocol with D's blood can be enacted for reinfusion after anastomosis. Some slack must be allowed for, thus allowing further severance in order to fashion a strain-free fusion and side-step the natural retraction of the two segments away from the transection plane.
The two cord stumps are accosted, length-adjusted and fused within 1-2 minutes: The proximal and distal cord segments must not be accosted too tightly to avoid further damage and not too loose to stop fusion. In both R and D, after appropriate laminectomies, a durotomy, both on the axial and posterior sagittal planes, would follow, exposing the cords.
Subsequently, the vessel tubes would be removed one by one, and the surgeons would sew the arteries and veins of the transplanted head together with those of the new body. Appropriate physiotherapy will be instituted during follow-up until maximal recovery is achieved. It would be far easier to repair if the repair is done right away and separation and reattachment is done in a careful surgical way. A 2 min application of PEG to a standardized compression injury to the cord immediately reversed the loss of nerve impulse conduction through the injury in all treated animals while nerve impulse conduction remained absent in all sham-treated guinea pigs. Published in the June 1, 2012 issue of Science, the results show that a severed section of the spinal cord can make a comeback when its own innate intelligence and regenerative capacity is awakened.
White, a neurosurgeon and a professor of neurological surgery who was inspired by the work of Vladimir Demikhov, performed a highly controversial operation to transplant the head of one monkey onto another's body.
The damage was a crushing of the spinal cord, so the transplant procedure would have better results because it would be a careful separation of the spinal cord under cold conditions with immediate application of the protectant chemicals. A key approach for repairing injured spinal cord is to seal the damaged membranes at an early stage. As the following stories show, investigators have made strides in replacing damaged heart tissue and rebuilding muscle.
Agents exist that can reconstitute the membranes of a cut axon and animal data have accrued since 1999 that restoration of axonal function is possible. Moreover, and equally important, the motoneuronal pools contained in the cord grey matter remain largely untouched and can be engaged by spinal cord stimulation, a technique that has recently shown itself capable of restoring at least some motor control in spinal injured subjects. Independently, over the past three decades, each chemical has shown some promise in restoring simple but crucial rat motor processes, like breathing, even with entirely severed spinal cords. That shut off the rats' bladder control (a nervous system process that is especially important in rats, since they urinate often and to mark their territory).
R lies supine during induction of PH, then is placed in the standard neurosurgical sitting position, whereas D is kept upright throughout. Besides the axial incisions, three other cuts are envisioned, both for later spinal stabilization and access to the carotids, trachea and esophagus (R's thyroid gland is left in situ): Two along the anterior margin of the sternocleidomastoids plus one standard midline cervical incision.
White matter is particularly resistant to many of the factors associated with secondary injury processes in the central nervous system (CNS) such as oxygen and glucose deprivation and this is a safeguard to local manipulation. Importantly, during head transference, the main vessels are tip-clamped to avoid air embolism and a later no-reflow phenomenon in small vessels.


Physiological recovery was associated with a significant recovery of a quantifiable spinal cord dependent behavior in only PEG-treated animals. The procedure was a success to some extent, with the animal being able to smell, taste, hear, and see the world around it. White, however, these head transplants involved grafting one rat's head onto the body of another rat that kept its head. Here, we show that axonal membranes injured by compression can be effectively repaired using self-assembled monomethoxy poly(ethylene glycol)-poly(D,L-lactic acid) di-block copolymer micelles. From a clinical perspective, an animal with a BBB score equal to or less than 11 lacks hindlimb and forelimb coordination, whereas a score of 12 to 13 corresponds to occasional to frequent forelimb and hindlimb coordination. A salamander can regrow its tail, but a person cannot regain an amputated leg or renew sections of the brain lost to Alzheimer's disease.
One such molecule is poly-ethylene glycol (PEG), a widely used molecule with many applications from industrial manufacturing to medicine, including as an excipient in many pharmaceutical products. The researchers then injected the two growth-stimulating chemicals into both sides of the severance, and reinforced the gap in the cord with steel wiring and surgical thread. The application of PEG could be delayed for approximately 8 h without adversely affecting physiological and behavioral recovery which continued to improve for up to 1 month after PEG treatment. The operation involved cauterizing arteries and veins carefully while the head was being severed to prevent hypovolemia.
Injured spinal tissue incubated with micelles (60 nm diameter) showed rapid restoration of compound action potential and reduced calcium influx into axons for micelle concentrations much lower than the concentrations of polyethylene glycol, a known sealing agent for early-stage spinal cord injury. For this feat, humans need help—and that is the promise of an emerging field of research called regenerative medicine. Some of these advances could emerge from the lab as treatments in a few years, or they may take decades, or they may ultimately fail. In particular, a custom-made turning stand acting as a crane is used for shifting R's head onto D's neck.
A few loose sutures are applied around the joined cord, threading the arachnoid, in order to reinforce the link. Because the nerves were left entirely intact, connecting the brain to a blood supply kept it chemically alive.
The scientists said that the key to successful head transplants was to use low temperatures. Intravenously injected micelles effectively recovered locomotor function and reduced the volume and inflammatory response of the lesion in injured rats, without any adverse effects.
R's head, previously fixed in a Mayfield three-pin fixation ring, will literally hang from the stand during transference, joined by long Velcro straps. A second IV injection of PEG or derivative may be administered within 4-6 hours of the initial injection. The animal survived for some time after the operation, even at times attempting to bite some of the staff. Our results show that copolymer micelles can interrupt the spread of primary spinal cord injury damage with minimal toxicity. A 25G temperature probe may be positioned into R's brain (deep in the white matter), but, as highlighted, a TM thermistor should do.



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