Nerve regeneration and reattachment

Posted by on October 25, 2017

 

One of the most common questions on people’s minds is, will the nerves work? The answer is not so simple because it is actually a three part question. First, can the nerves be regrown in the new foreskins, second can the nerves be reattached, and third, will the brain recognize the nerves?

 

The first part of this question is can the nerves be re-grown at all? The answer to that is yes and it is based on scientific evidence. In 2015 a group of European scientists regrew skin complete with not only just the skin itself but the blood vessels and yes, the nerves. Furthermore, in Anthony Atala’s work with human vaginas, rabbit penises, and now, human penises, he was able to regrow the nerves with everything else. The nerves, just like every other part of the foreskin, are represented in the extra cellular matrix (“ECM”). Thus, when the donor foreskins are decellularized, the nerve channels remain, and when the ECMs are recellularized with your cells, the nerves will be regrown. 

 

Part two of this question is will the brain recognize the reconnected nerves? The answer is almost definitely yes. The foreskin is not really distinct from the rest of the penile skin. Unlike what doctors may tell you, they are not cutting off any exact part, they are merely cutting off enough of the skin to expose the glans of the penis. Additionally, almost all men still have a small remnant of the frenulum which is part of the ridged band and uses the same sensory nerves. What this means though, is that the foreskin sensory cells send messages down the same channels as those used by the rest of the penis. Thus, even though you may not have had your foreskin since you were a day old, the brain will still recognize the new foreskin as merely an extension of what you already have. 

 

Finally, part three of the question is can the nerves be reconnected? This is the most difficult to answer. Unlike nerves of the central nervous system, nerves in the peripheral nervous system can regrow. The current gold standard of reconnecting nerves is to use direct nerve repair. Basically, this means suturing two nerve endings together. When there is a gap, doctors pursue either a nerve allograph or autograph. However, in our case, the foreskins will be grown so perfectly to fit your bodies, that there should not be a gap. Thus, direct nerve repair would be the best option under current medicine. The problem with these methods is that they are far from perfect. When the nerves are sutured together, information cannot begin to pass immediately. It is not akin to a wire that has been cut and tied together. Instead what happens is the nerve must now regrow from the point of injury forward. While timing can vary, the generally accepted rule is that nerves grow at a rate of 1mm per day. When there are hundreds of nerve branches that must all be repaired, this can take months, if not years, and even then, success is usually limited. Part of the problem with this method is that once the nerves are cut, the distal nerve begins to scar and undergo something called Wallerian Degeneration. Basically, the distal end closes in on itself to protect the neural pathways for when in the future, it hopefully reconnects with the proximate nerve ending. This becomes an issue because now the nerve regrowth must fight through this scar tissue to find its way. As said previously, this makes for a slow and arduous process that gives okay results at best.

 

Luckily, science is evolving. Dr. George Bittner and his team at the University of Texas Austin have, after two decades of work, come up with a process that has vastly improved results. The researchers completely severed the siatic nerve of rats. Instead of then using a standard direct nerve repair method, the researchers applied a calcium solution, then polyethylene glycol, and then sutured the nerves. Within just two weeks, the rats were exhibiting 80% of normal function. One should note that the siatic nerve is a mixed sensory, motor nerve meaning it is much more difficult to repair. The rats were also only given two weeks and real nerve repair can take years. Thus in our case, results should be even better. Additionally, polyethylene glycol has already been approved for use by both the FDA and EMA. Bittner and his team are now working in conjunction with WellSpan York Hospital in Pennsylvania to conduct clinical trials. Their five-year experiment has now been underway for over a year. 

 

Perhaps the most promising approach to the issue of nerve reconnection comes from stem cells. In 2010 Alison Lloyd and her team at the University College London discovered that Schwann Cells when activated by fibroblasts, help repair nerve tissue. Usually, Schwann cells act as a protector for the axons that surround the nerves. However, upon injury, Schwann cells help nerves reconnect properly by creating a tunnel between nerve endings so that the damaged axons can grow across it. It is believed by many scientists that it may be possible to use stem cells to promote Schwann cell growth and help reconnect nerves. In 2014, researchers at the University of Pittsburgh damaged the siatic nerve of mice. They then injected the damaged site with stem cells derived from human muscle tissue. The results were stunning. After just twelve weeks, the treated mice were able to achieve the same balance on both the damaged leg and undamaged leg. The control group could not even come close. After 72 weeks, the treated mice had the same muscle mass as mice which had never been injured. The control mice were still not even close. This research is truly extraordinary and in just a few years, Foregen will be able to harness its potential to fully repair the nerve connections to your new foreskin. 

 

With these amazing advancements in medical research, I am able to answer your question, that yes, the nerves will be able to regrow, reattach, and be recognized by the brain. 

 

Further Reading:

 

Allen, Michael. “Complete Human Skin Grown in Lab.” Horizon: the EU Research & Innovation Magazine, 13 Apr. 2015, horizon-magazine.eu/article/complete-human-skin-grown-lab_en.html#.

 

Gholipour, Bahar. “Lab-Grown Vaginas Implanted Successfully in 4 Teenagers.” Scientific American, 11 Apr. 2014, www.scientificamerican.com/article/lab-grown-vaginas-implanted-successfully-in-4-teenagers/.

 

D.C. Riley, G.D. Bittner, M.A. Mikesh, N.L. Cardwell, A.C. Pollins, C.L. Ghergherehchi, S.R. Bhupanapadu Sunkesula, T.N. Ha, B.T.D. Hall, A.D. Poon, M. Pyarali, R.B. Boyer, A.T. Mazal, N. Munoz, R.C. Trevino, T.Schallert,  W.P. Thayer. 2015.  Polyethylene glycol--fused allografts produce rapid behavioral recovery after ablating sciatic nerve segments. J Neurosci Res. 2015 Apr;93(4):572-83. doi: 10.1002/jnr.23514. Epub 2014 Nov 25.

 

Mitra Lavasani, Seth D. Thompson, Jonathan B. Pollett, Arvydas Usas, Aiping Lu, Donna B. Stolz, Katherine A. Clark, Bin Sun, Bruno Péault, Johnny Huard. Human muscle-derived stem/progenitor cells promote functional murine peripheral nerve regeneration. Journal of Clinical Investigation, 2014; DOI: 10.1172/JCI44071

 

Article by Joshua



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