Reversing brain death: How far are we?

From gene editing to human head transplantation, medical science keeps hitting benchmarks which could only be fantasized about just a decade ago. Now, scientists have turned their attention to yet another “mission impossible”: reversing brain death.

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A controversial phase I trial will aim to restore life to 20 people who have been declared brain dead.

A controversial first ever trial has recently been approved, which aims to restore neuronal activity in humans who have been declared brain dead.

The proof-of-concept study – which forms a part of the Reanima Project – is the brainchild of two life sciences companies: Bioquark, Inc., based in the United States, and Revita Life Sciences, based in India.

Scientists, including Bioquark CEO Ira Pastor, will test a variety of techniques that previous studies have demonstrated to possess the ability to regenerate nerve tissues, and these will be combined with devices that have been shown to stimulate the central nervous system of coma patients.

Using this “combinatorial approach,” the scientists hope to change patients from a brain dead state into a coma state, effectively bringing them back to life.

Not unexpectedly, much criticism has arisen in response to this proposal.  An article published in the journal Critical Care claims that the trial on reversing brain death has “no scientific foundation” and “borders on quackery.”

Pastor’s response to such criticism couldn’t be more reassuring: “A hundred years ago they said the same things about cardiopulmonary resuscitation and organ transplantation – now look how far we’ve come.”

However, sheer optimism aside, a closer look at the science behind the project may reveal whether or not it is really feasible to bring someone back from the dead.

What is brain death?

Brain death has been defined as the irreversible loss of all functions of the brain, and it

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Brain death is defined as the complete, irreversible loss of all brain function.

occurs as a result of brain injury through trauma, stroke, or any cause of loss of blood flow or oxygen to the brain.

 

Brain death should not be confused with coma. While a person in a coma is unconscious, parts of their brain are still functioning, and there is a possibility that their condition may improve. Patients who are brain dead, however, are considered to have a complete loss of brain function, and no way has been found to reverse this – yet.

Attempting to do the impossible

The clinical trial will involve a four-step approach:

First, the spinal cords of the brain dead subjects will be injected with stem cells, cells that have the ability to differentiate into other cell types, (neurons inclusive).

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Researchers plan to use a four-step approach in reversing brain death in clinically dead subjects.

Subjects will also be injected with a substance called BQ-A – derived from ooplasms, (the cytoplasm of an egg) – which Pastor said will act as the “blue print” and “mortar” in the regenerative process.

The peptides will aid neuronal growth, while also helping to reprogram and recondition the surrounding tissue at the location where stem cells are injected. They will also help to target and destroy components of dead tissue.

Once these steps are complete, nerve stimulation techniques and laser therapy will be applied to each subject for 15 days, to promote connections between the newly formed neurons.

After the procedure, each subject will be continuously monitored in the intensive care unit. In particular, the researchers will monitor the patients’ brain activity, pulse, blood pressure, respiration changes, and oxygen saturation.

Is reversing brain death realistic?

Individually, each of the four techniques that Pastor and team plan to use in their trial have shown promise for improving brain functioning. But are such evidences enough to suggest that, when combined, these techniques can revive patients who have been declared brain dead?

“By definition, DNC [death by neurological criteria] requires irreversible cessation of all functions of the entire brain, including the brainstem. As such, the proposal that DNC could be reversible is self-contradictory,” Caplan and Lewis wrote in their article last year.

Dr. Dean Burnett, a neuroscientist at the Centre for Medical Education at Cardiff University in the United Kingdom, felt the same way when he said, “While there have been numerous demonstrations in recent years that the human brain and nervous system may not be as fixed and irreparable as is typically assumed, the idea that brain death could be easily reversed seems very far-fetched, given our current abilities and understanding of neuroscience.”

In response however, Pastor reminded us of the case of a 10-month-old boy who, after being declared clinically brain dead, began breathing 15 hours later.

Pastor strongly believes that such an achievement may not be as far away as many people believe. He noted that cancer and many other diseases are often caused by “multiple biological processes that interact in complex networks.”

“Brain death – not to simplify it by any means – by comparison has only one ultimate, quite well defined end regulatory state, making it much easier for us to develop, target, or modify our methods towards a successful outcome,” he said.

“Our main hope is that this trial will show us that the ‘gray zone’ between deep coma and irreversible coma is indeed just that – ‘gray,’ and that, with the tools of 21st century regenerative medicine, that there are possibilities to push that transition in the opposite direction to save lives, as well as begin a new chapter in the treatment of the wide range of consciousness disorders – coma, persistent vegetative state, locked-in syndrome, etc.,” said Pastor.

If this first phase of the Reanima Project is successful hopefully by this time next year, Pastor said that the team will then attempt to restore independent breathing and heartbeat to each patient. “Yielding a subject that is no longer technically dead anymore, the next step is continue on with patients through the disorders of consciousness spectrum, to an eventual state of wakefulness,” he added.

 

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