What are the treatment options for a brain-dead organ donor?
A brain-dead organ donor needs the same intensity of care with the focus of treatment directed toward organ perfusion and improved quality of grafts. Intensive care with the use of invasive lines is mandatory for improved quality of care and titration of inotropes and fluids.
Which medications are used in the treatment of traumatic brain injury (TBI)?
Methylprednisolone 15 mg/kg immediately after diagnosis of brain death and 24thhourly thereafter. Insulin 10 U in 50% dextrose followed by an infusion to maintain blood glucose between 80 and 150 mg. Thyroxine (T4) 20 mcg bolus followed by infusions of 10 mcg/h.
Is stem cell transplantation a good choice for nervous system treatment?
Stem cell transplantation seems to be a promising therapeutic choice because of the potential to exert multiple reparative actions within the central nervous system (CNS), including cell replacement and paracrine effects. Different potential stem cell sources are available for therapeutic purposes.
What happens to the brain during a head transplant?
With a head transplant, loss of blood flow to the brain is an even larger problem. Lack of oxygen can damage the brain and leave a person with severe mental deficiencies. Cooling both the head and body before and during surgery could allow the cells to survive longer without oxygen.
Can brain tissue be transplanted?
Brain cell transplant can be autologous (using your own cells) or may use donor fetal cells. The use of fetal cells is somewhat controversial because these cells are typically obtained using aborted fetal material—and many people are opposed to using these types of cells.
Can brain stem be transplanted?
By exploiting a feature of the immune system, researchers open the door for stem cell transplants to repair the brain. Summary: In experiments in mice, researchers say they have developed a way to successfully transplant certain protective brain cells without the need for lifelong anti-rejection drugs.
Can transplanting healthy tissue into the brain help treat disease or actually improve memory?
We find that neural stem cells transplanted into the brain after neuronal ablation survive, migrate, differentiate and, most significantly, improve memory. These results show that stem cells may have therapeutic value in diseases and conditions that result in memory loss.
How does stem cell therapy work for brain injury?
Recent studies have found that exogenous stem cells can migrate to damaged brain tissue, then participate in the repair of damaged brain tissue by further differentiation to replace damaged cells, while releasing anti-inflammatory factors and growth factors, thereby significantly improving neurological function.
Can a cerebellum transplant?
Interestingly, transplantation of small fragments of the developing cerebellum in experimental models of Purkinje cell degeneration has shown that fetal cerebellar neuronal progenitors have a remarkable capacity to leave the transplant, colonize the deprived cerebellar cortex, mature as Purkinje neurons, and connect ...
Do stem cell transplants work?
Stem cell transplants are used to treat conditions in which the bone marrow is damaged and is no longer able to produce healthy blood cells. Transplants can also be carried out to replace blood cells that are damaged or destroyed as a result of intensive cancer treatment.
How do you repair damaged brain cells?
No, you cannot heal a damaged brain. Medical treatments can just help to stop further damage and limit the functional loss from the damage. The healing process of the brain is not the same as the skin. When the skin gets damaged, such as due to minor skin wounds, it usually heals wells without leaving scars.
What is stem treatment?
Stem cell therapy, also known as regenerative medicine, promotes the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. It is the next chapter in organ transplantation and uses cells instead of donor organs, which are limited in supply.
How is Alzheimer's treated with stem cells?
Stem cell therapy is a unique approach to treating Alzheimer's Disease. It involves the systemic introduction of Mesenchymal Stem Cells into the body via IV. When introduced in large quantities, these stem cells can find inflammation within the body and repair it.
How are stem cells used for brain disease treatment?
Neural stem cells (NSCs) offer the potential to replace lost tissue after nervous system injury. Thus, stem cells can promote host neural repair in part by secreting growth factors, and their regeneration-promoting activities can be modified by gene delivery.
Can stem cells repair traumatic brain injury?
However, to date, there are no therapies that completely resolve the brain damage suffered following the trauma. Stem cells, due to their capacity to differentiate into neuronal cells and through releasing neurotrophic factors, seem to be a valid strategy to use in the treatment of traumatic brain injury.
Can stem cell therapy help with TBI?
In recent years, study (Cox, 2018) have found that a variety of stem cells can treat neurological impairment after TBI, including mesenchymal stem cells (MSCs), neural stem cells (NSCs), multipotent adult progenitor cells (MAPCs), and endothelial progenitor cells (EPCs) (Table 1).
What tests are used to confirm brain death?
Patient repeatedly desaturates or becomes hypotensive during apnea testing: One should consider ancillary tests for confirming brain death (electroencephalography, cerebral angiography, transcranial Doppler and scintigraphy). In India, the laws are not clear about the use of ancillary tests.
How does brain death affect organ donation?
Brain death has specific implications for organ donation with the potential for saving several lives. Awareness on maintenance of the brain dead has increased over the last decade with the progress in the field of transplant. The diagnosis of brain death is clinical and can be confirmed by apnea testing. Ancillary tests can be considered when the apnea test cannot be completed or is inconclusive. Reflexes of spinal origin may be present and should not be confused against the diagnosis of brain death. Adequate care for the donor targeting hemodynamic indices and lung protective ventilator strategies can improve graft quality for donation. Hormone supplementation using thyroxine, antidiuretic hormone, corticosteroid and insulin has shown to improve outcomes following transplant. India still ranks low compared to the rest of the world in deceased donation. The formation of organ sharing networks supported by state governments has shown a substantial increase in the numbers of deceased donors primarily by creating awareness and ensuring protocols in caring for the donor. This review describes the steps in the establishment of brain death and the management of the organ donor. Material for the review was collected through a Medline search, and the search terms included were brain death and organ donation.
What is the purpose of electroencephalography?
Electroencephalography is widely used as an ancillary test for documentation of brain death . An isolelectric recording from 18 to 20 channels over a 30 min period is suggestive; however, electrical quiescence can occur from the use of sedative drugs and from hypothermia which must be excluded prior to interpretation.
What is the meaning of "brain death"?
Brain death is a state of cessation of cerebral function wherein the proximate cause is known and is considered irreversible . The American Association of Neurology (AAN) has defined brain death with three cardinal signs, cessation of the functions of the brain including the brainstem, coma or unresponsiveness and apnea.[1]
When is absent brain stem reflexes evaluated?
Absent brain stem reflexes (a formal evaluation of the brain stem reflexes is undertaken when the patient has had fixed dilated pupils and absent cranial nerve reflexes for more than 4 h). [9] Table 2lists the individual tests for brain stem reflexes.
Does brain death affect the rostral portion of the spine?
The increase in intracranial pressure (ICP) that accompanies brain death spares the rostral portion beyond the second cervical spine and does not compromise blood supply to this area.[11] This could be the explanation for complex motor movements at the spinal cord level even after diagnosing brain death.[1,9,14]
Is transcranial doppler a diagnostic test?
Transcranial Doppler is recommended as an ancillary test and is used in Intensive Care Units (ICU) as it is simple, easily available and noninvasive.[18] The presence of diastolic reverberation flow and little or no forward flow is diagnostic. The drawbacks include operator variability, inconsistent availability of an acoustic window, presence of a ventricular drain or concomitant surgery that could affect the interpretation.
How can genetic modification be used to drive the differentiation of transplanted cells?
The genetic modification of NSCs can also be used to drive the differentiation of transplanted cells, increasing their therapeutic effects. In a rat model of spinal cord injury, Li et al. [ 123] transplanted Wnt4-overexpressing NSCs; this shifted their differentiation towards a more neural phenotype. Modified cells showed better results in terms of injury repair and functional integration than the transplantation of unmodified ones. Besides this, they also investigated the involvement of β-catenin and MAPK/JNK pathway activation by Wnt4 in neural differentiation.
How to enhance therapeutic effect of NSCs?
Another possible method for enhancing the therapeutic effect of NSCs is modulating the expression of selected growth factors ( Figure 3 ). For example, the genetic modification of NSCs to overexpress IGF-1 [ 50 ], a growth factor involved in in vivo neurogenesis and synaptogenesis, has been attempted. Upon transplantation into the hippocampal area of a murine AD model, IGF-1-overexpressing human cortical-derived NSCs exhibited long-term persistence in targeted brain areas, even though no data regarding the impact on disease progression were reported.
Is NSC transplantation beneficial?
Remarkably, studies performed into several animal models of different neurodegenerative diseases reported encouraging evidence of a functional benefit after NSC transplantation [ 7, 8, 9, 10, 11, 12, 13 ], representing preliminary steps for future clinical translation of this strategy. In this review, we will consider key features of NSCs and related engraftment processes from the perspective of cell therapy approaches for neurodegenerative diseases ( Figure 1 ).
Is NSC a therapeutic strategy?
Neural stem cell (NSC) transplantation has been studied as a potential therapeut ic approach and appears to exert a beneficial effect against neurodegeneration via different mechanisms, such as the production of neurotrophic factors, decreased neuroinflammation, enhanced neuronal plasticity and cell replacement. Thus, NSC transplantation may represent an effective therapeutic strategy. To exploit NSCs’ potential, some of their essential biological characteristics must be thoroughly investigated, including the specific markers for NSC subpopulations, to allow profiling and selection. Another key feature is their secretome, which is responsible for the regulation of intercellular communication, neuroprotection, and immunomodulation. In addition, NSCs must properly migrate into the central nervous system (CNS) and integrate into host neuronal circuits, enhancing neuroplasticity. Understanding and modulating these aspects can allow us to further exploit the therapeutic potential of NSCs. Recent progress in gene editing and cellular engineering techniques has opened up the possibility of modifying NSCs to express select candidate molecules to further enhance their therapeutic effects. This review summarizes current knowledge regarding these aspects, promoting the development of stem cell therapies that could be applied safely and effectively in clinical settings.
Can NSCs be transplanted?
Our group previously demonstrated that the transplantation of NSCs derived from human iPSCs can have a positive therapeutic effect in the context of SMARD1 [ 10 ]. After transplantation, NSCs properly engrafted and differentiated in the spinal cord of SMARD1 animals, protecting their endogenous MNs and improving phenotypes. Wild-type iPSC-derived NSCs co-cultured with SMARD1 iPSC-derived MNs ameliorated the pathological phenotype of MNs by producing neurotrophins, including GDNF, BDNF, and NT3, as demonstrated by ELISA on culture medium [ 10 ]. Similar results were obtained with ALS MNs and were associated with the same neurotrophins [ 9, 64, 65 ].
What is a transplant?
A transplant is an organ, tissue or a group of cells removed from one person (the donor) and transplanted into another person (the recipient) or moved from one site to another in the same person. A skin graft is a common example of a transplant from one part of a person’s body to another part.
Why is transplantation a complex area of medicine?
Transplantation is a complex area of medicine because when organs or tissues are transplanted from one person to another, the recipient’s immune system can reject and destroy the donor organ or tissue, and medication is needed to supress this immune response.The treatments used vary depending on the tissue or organ being transplanted, the level of compatibility between the donor and the recipient, and other factors.
What is a transplant between species called?
Transplants from other species. A transplant between species is called a xenotransplant and the process is called xenotransplantation. Heart valves from cows and pigs have been used for many years to replace faulty heart valves in people.
What is it called when you transplant a part of your body to another part?
A transplant from one part of your body to another part is called an autograft and the process is called autotransplantation. Some examples of autografts include: skin graft – uses healthy skin to help heal a wound or burn on another part of the body.
What is a skin graft?
A skin graft is a common example of a transplant from one part of a person’s body to another part. A transplant between two people can cause a rejection process where the immune system of the recipient or host attacks the foreign donor organ or tissue and destroys it. To reduce the risk of rejection of the donated organ, ...
What is the process of allotransplantation?
Allotransplantation can create a rejection process where the immune system of the recipient attacks the foreign donor organ or tissue and destroys it. The recipient may need to take immunosuppressive medication for the rest of their life to reduce the risk of rejection of the donated organ.
What is the purpose of liver transplant?
Transplants – such as a liver transplant – can save lives. They can also restore function to improve quality of life. For example, transplanting the clear tissue that covers the eye (cornea) is not necessary for life, but can restore sight.
What is a stem cell transplant?
A blood stem cell transplant is used most often to treat patients with: A blood stem cell transplant can also be a treatment option for patients with: Click here for a more detailed list of diseases treated by a stem cell transplant. Click here for historical data on outcomes after transplant for a particular disease.
What is the treatment for aplastic anemia?
severe aplastic anemia. A blood stem cell transplant can also be a treatment option for patients with: a genetic or inherited disorder, such as sickle cell disease or thalassemia. an immune deficiency disease, such as Wiskott Aldrich Syndrome or SCIDS. a solid tumor, such as neuroblastoma.
What are the issues with head transplants?
Head transplants also raise issues of who the new body belongs to, especially in terms of its sperm or eggs.
What are the risks of organ transplant?
One of the most common risks of organ transplants is tissue rejection. With a head transplant, though, it would be the head that would be seen as “foreign” by the new body’s immune system.
What are the tissues that surgeons need to join?
Surgeons will need to join many tissues of the head and new body, including muscles, skin, ligaments, bones, blood vessels, and most importantly, the nerves of the spinal cord.
Why would a man need to take immunosuppressive medications for the rest of his life?
But he would need to take powerful immunosuppressive medications for the rest of his life to limit the chance that the new body’s immune system would attack the tissues of his head.
Is reanimating the dead a scientific impossibility?
While reanimating the dead remains a scientific impossibility, scientists are pushing the boundaries of modern medicine closer and closer to Shelley’s vision. As they do, the public’s uneasiness about the ethical limits of medicine has been stoked.
Can a head transplant cause brain damage?
With a head transplant, loss of blood flow to the brain is an even larger problem. Lack of oxygen can damage the brain and leave a person with severe mental deficiencies.
Does public angst about head transplants subside?
Public angst about head transplants may subside after a few successful surgeries, the way it has with face transplants.
What is the most common protozoal brain infection in organ transplanted patients?
Toxoplasmosis, caused by Toxoplasma gondii, is the most common protozoal brain infection in organ transplanted patients. The liver is a frequent site of cyst carriage, confirming that transplantation of an organ from a seropositive donor to seronegative recipient brings high risk for acquired toxoplasmosis ( 05 ).
What is the most commonly performed transplant?
Kidney transplantation is the most frequently performed transplantation. Liver, heart, and lung transplantation are also now routinely performed at many centers. Hematopoietic stem cell transplantation helps in restoring hematopoietic function in patients with severe hematological and immune disorders. A variety of neurologic complications is ...
What is the most common neurologic complication in acute stages?
Even in adults, metabolic encephalopathy with altered consciousness is the most common neurologic complication in acute stages ( 23; 34 ). Heart transplantation. Neurologic complications in orthotopic heart transplantation adversely affects the prognosis in the posttransplant period.
What are the most common opportunistic brain infections?
Immunosuppression following organ transplantation increases the risk for opportunistic central nervous system infection and is associated with high mortality. Virus and fungal infections are the most frequent opportunistic brain infections in the organ-transplanted population.
What are the complications of organ transplant?
Organ transplant recipients are at risk of having opportunistic infections and other neurologic complications for several years after transplant. COVID-19 has a severe course in organ transplant recipients.
What are the effects of immunosuppressive drugs on transplant recipients?
A large number (30% to 60%) of transplant recipients experience devastating neurologic complications following solid-organ transplantation and hematopoietic stem cell transplantation. Seizures and encephalopathy are seen early in the posttransplant period.
Which drugs are associated with neurologic complications?
Corticosteroids, anti-inflammatory drugs (azathioprine and mycophenolate), calcineurin inhibitors (cyclosporine and tacrolimus), and mechanistic target of rapamycin (TOR) inhibitors (sirolimus and everolimus) are all associated with a variety of neurologic complications. Epidemiology.