Correspondence: Cody V. Gibson, +1 (256) 867-5707
Keywords: Analgesia, mechanotransduction, extracellular matrix, decellularization, Meissner's corpuscles, mitosis, stem cells, foreskin restoration.
An Overview of Circumcision
Circumcision is a surgical procedure which involves the removal of an anatomical structure known as the prepuce (foreskin). This procedure is typically performed in infancy, and it is associated with many risks including hemorrhage, infection, nerve damage, and even death. Circumcision is sometimes performed with inadequate or no analgesia, and damages from the procedure are well-documented by scientific literature. Despite the risks associated with circumcision, the incidence of the procedure is still quite high in the United States. Because circumcision is often performed during infancy, consent is not obtained on behalf of the patient. Also, like many other body modifications, circumcision is irreversible at the time of this article’s publication.
Limited success has been attained with the use of restoration devices, which involve stretching the foreskin remnant to induce mitosis (cell division) through a mechanism known as mechanotransduction. Over time, this results in a foreskin analog which appears and functions very much like the original tissues. However, it is thought that restoration by this method is unable to restore the Meissner’s corpuscles (fine touch receptors), which are found in high concentrations within the foreskin. Also, this technique for restoration requires time and dedication and may not be feasible for those who have little remaining foreskin.
Foregen’s approach to foreskin regeneration differs from manual restoration methods. Rather than advocating the use of restoration devices which induce mechanotransduction pathways, Foregen is focusing on regenerative medicine. Regenerative medicine is an emerging branch of medicine which involves a multi-disciplinary approach to tissue regeneration. It encompasses both engineering and biological sciences, and there has been great success with regenerative medicine, evident by the many organs and tissues which have been grown in laboratories and successfully implanted into patients.
The benefits of regenerative medicine for foreskin regeneration are many. Because the tissues which makeup the regenerated foreskin are formed from a patient’s own stem cells, there is no chance for rejection. Also, it is predicted that complete functionality of the foreskin would be achieved as regeneration results in the development of all structures associated with the foreskin which includes nerves, blood vessels, mucous membranes, and other anatomical features.
The procedure would involve the removal of foreskins from consenting deceased males, followed by a process which strips away all cells from the donor foreskin until only the ECM (extracellular matrix) remains. The ECM is a group of molecules which are secreted by the body’s cells, and they can be thought of as a scaffolding upon which cells adhere. After the decellularization process, the patient’s stem cells would be seeded into the ECM. Stem cells are unique because they are undifferentiated which means that unlike differentiated cells, their function has yet to be assigned. After allowing the newly-seeded stem cells to regrow the various structures associated with the foreskin, the end result would be a fully-functional foreskin. The microsurgery would be performed by making an incision above and below the scar to remove it. Then the new foreskin would be attached to its corresponding remaining parts and seeded with stem cells at the incision site so no scar forms back. As the attached tissue begins the process of integration, the nerves would begin transmitting signals back to the brain, and sensation would be restored. Also, the protective function and all other functions of the foreskin would be observed. As the commercial availability of foreskin regeneration progresses, it is the goal of Foregen to look into using 3D printing technology rather than cadaver foreskins to regenerate the foreskin.
Much progress has been made by Foregen, progress which would have been impossible if not for the financial and moral support of those who graciously donate to Foregen. Thus far, Foregen employs two scientists who have successfully decellularized the foreskins of bulls—a huge development for the field of foreskin regeneration. The rationale for selecting bull foreskins for experimentation is due to the overlap in characteristics between human and bovine foreskins. Continued progression is contingent upon the support of donors. To see how you can help Foregen reach its goal of full foreskin regeneration, please click on the “Get Involved” tab at the top of this page.
. Gold, G., Young, S., O'Brien, M., & Babl, F. E. (2015, December). Complications following circumcision: Presentations to the emergency department. Retrieved August 24, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/26228029
. Collier, R. (2011, December 13). Whole again: the practice of foreskin restoration. Retrieved August 25, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/22083672
. Zöllner, A. M., Tepole, A. B., & Kuhl, E. (2012, March 21). On the biomechanics and mechanobiology of growing skin. Retrieved August 25, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278515/
. Jessop, Z. M., Al-Sabah, A., Francis, W. R., & Whitaker, I. S. (2016). Transforming healthcare through regenerative medicine. Retrieved August 25, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980802/
. Orlando, G., Soker, S., Stratta, R. J., & Atala, A. (2013, August). Will Regenerative Medicine Replace Transplantation? Retrieved August 25, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721273/
. BROWN, B. N., & BADYLAK, S. F. (2014, April). Extracellular matrix as an inductive scaffold for functional tissue reconstruction. Retrieved August 25, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203714/
. FAQs. (n.d.). Retrieved August 25, 2017, from http://www.foregen.org/faq