Regeneration in humans

In humans with non-injured tissues, the tissue naturally regenerates over time; by default, new available cells replace expended cells. For example, the body regenerates a full bone within ten years, while non-injured skin tissue is regenerated within two weeks. and via observation. There are many more historical and nuanced understandings about regeneration processes. In full thickness wounds that are under 2mm, regeneration generally occurs before scarring. In 2008, in full thickness wounds over 3mm, it was found that a wound needed inserted in order to induce full tissue regeneration. Whereas 3rd degree burns heal slowly by scarring, in 2016 it was known that full thickness fractional photothermolysis holes heal without scarring. Up to 40% of full thickness skin can be removed without scarring in an area, in a fractional pattern via coring of tissue. Some human organs and tissues regenerate rather than simply scar, as a result of injury. These include the liver, fingertips, and endometrium. More information is now known regarding the passive replacement of tissues in the human body, as well as the mechanics of stem cells. Advances in research have enabled the induced regeneration of many more tissues and organs than previously thought possible. The aim for these techniques is to use these techniques in the near future for the purpose of regenerating any tissue type in the human body. ==Regeneration techniques==

By 2016, regeneration had been operationalised and induced by four main techniques: regeneration by instrument; Macrophages are differentiated from circulating monocytes. Various tissues that have been regenerated by in vitro 3D printing include: • The first organ ever induced and made in the lab was the bladder, which was created in 1999. • In April 2019, researchers 3D printed a human heart. Some examples of bioinks used in extrusion based printing include some alginates, hyaluronic acid, and gellan gum. • Inkjet Inkjet printing is similar to extrusion-based printing in that layers of materials are placed upon one another and can be hardened using various methods. Ink jet based printing differs however, in that the material is sprayed in droplets to selective locations to form layers, rather than placed as a stream of material. Inkjet printers can often contain multiple types of inks at once and can rapidly switch between them. Manufactured Vascularized Organs Heart In 2024, researchers were able to 3D print a human heart with a biphasic bioink containing pluripotent stem cells (PSC). The technique they proposed and tested would first print the external features of the organ before then printing the internal features such as internal vasculature inside the previously printed structure. Both sets of printing were performed by extruding the bioink filament into layered structures set in a microgel medium. This technique was called the "SPIRIT" technique and allowed for the printing of a full-sized heart at significantly faster speeds than previous methods. Liver In 2022, researchers proposed a new method for printing vascularized human liver tissue. This new method consisted of using a 3D printer capable of holding seven different bioinks, with the ability to switch rapidly between these different bioinks to print different structures and shapes in the liver tissue. Due to the overall complexity of the organ, they were unable to print an entire liver but were still able to successfully print pieces of densely vascularized liver tissue. In 1976, the regenerative response was shown to work in a non-diabetic after a 3 x 3 cm lipoatrophic arm scar was treated with pure monocomponent porcine soluble insulin. Types of Stem Cells The Stem Cells can be basically split into two categories based on where they come from: • Embryonic: These start in the early embryo stage and are called "pluripotent," which just is a way of saying they have the potential to turn into basically any type of cell in your body. • Adult: These are found in your own body in places like bone marrow or fat.and are a bit more limited compared to embryonic ones, but they are really important for your body’s day-to-day maintenance and fixing small injuries. Clinical Applications Stem cell therapy is already being tested in labs and clinics. A few areas that are making progress include: • Tissue Repair: Trying to rebuild tissues like skin, bone, and cartilage after an injury. • Immune system: Some therapies are looking at how stem cells can basically "comunicate" to the immune system. They can tell it to relax or decrease the inmune or defensive response, which helps reduce inflammation or helps the body accept new tissue without attacking it. • Disease endurance modification: This uses iPSCs (Induced pluripotent stem cells). Basically, scientists take a normal adult cell, like from your skin and "reprogram" it back to a similar embryonic state. This lets them grow these cells in a lab to see how a disease actually happens. It’s a much safer way to test new drugs before trying them on a real person. . Challenges and Future • Prove Safety: In order to proceed, there has to be further testing on groing capabilities of the cell and the response to the transplant of this cells into the human body, making sure it wont cause further complications like tumors. • Standardize Methods: Right now, there isn't really an standardize procedure or order for growing and storing these cells. Researchers need to come up with consistent rules so ''''Standardize Methods: Researchers need to create clear, reliable rules for how to grow, store, and transplant these cells so that the results are consistent for every patient. Research Scientists found leprosy-causing bacteria viably regenerate and rejuvenate the liver in its armadillos hosts, which may enable novel human therapies based on knowledge or components gained from naturally evolved organisms or capabilities. ==Naturally regenerating appendages and organs==

Heart Cardiomyocyte necrosis activates an inflammatory response that serves to clear the injured myocardium from dead cells, and stimulates repair, but may also extend injury. Research suggests that the cell types involved in the process play an important role. Namely monocyte-derived macrophages tend to induce inflammation while inhibiting cardiac regeneration, while tissue resident macrophages may help restoration of tissue structure and function. Endometrium The endometrium after the process of breakdown via the menstruation cycle, re-epithelializes swiftly and regenerates. Though tissues with a non-interrupted morphology, like non-injured soft tissue, completely regenerate consistently; the endometrium is the only human tissue that completely regenerates consistently after a disruption and interruption of the morphology. All other adult tissues, upon rapid shedding or injury, can scar. Fingers In May 1932, L. H. McKim published a report describing the regeneration of an adult digit-tip following amputation. A house surgeon in the Montreal General Hospital underwent amputation of the distal phalanx to stop the spread of an infection. In less than one month following surgery, x-ray analysis showed the regrowth of bone while macroscopic observation showed the regrowth of nail and skin. This is one of the earliest recorded examples of adult human digit-tip regeneration. Studies in the 1970s showed that children up to the age of 10 or so who lose fingertips in accidents can regrow the tip of the digit within a month provided their wounds are not sealed up with flaps of skin – the de facto treatment in such emergencies. They normally will not have a fingerprint, and if there is any piece of the finger nail left it will grow back as well, usually in a square shape rather than round. In August 2005, Lee Spievack, then in his early sixties, accidentally sliced off the tip of his right middle finger just above the first phalanx. His brother, Dr. Alan Spievack, was researching regeneration and provided him with powdered extracellular matrix, developed by Dr. Stephen Badylak of the McGowan Institute of Regenerative Medicine. Mr. Spievack covered the wound with the powder, and the tip of his finger re-grew in four weeks. The news was released in 2007. Ben Goldacre has described this as "the missing finger that never was", claiming that fingertips regrow and quoted Simon Kay, professor of hand surgery at the University of Leeds, who from the picture provided by Goldacre described the case as seemingly "an ordinary fingertip injury with quite unremarkable healing" A similar story was reported by CNN. A woman named Deepa Kulkarni lost the tip of her little finger and was initially told by doctors that nothing could be done. Her personal research and consultation with several specialists including Badylak eventually resulted in her undergoing regenerative therapy and regaining her fingertip. Kidney Regenerative capacity of the kidney has been recently explored. The basic functional and structural unit of the kidney is nephron, which is mainly composed of four components: the glomerulus, tubules, the collecting duct and peritubular capillaries. The regenerative capacity of the mammalian kidney is limited compared to that of lower vertebrates. In the mammalian kidney, the regeneration of the tubular component following an acute injury is well known. Recently regeneration of the glomerulus has also been documented. Following an acute injury, the proximal tubule is damaged more, and the injured epithelial cells slough off the basement membrane of the nephron. The surviving epithelial cells, however, undergo migration, dedifferentiation, proliferation, and redifferentiation to replenish the epithelial lining of the proximal tubule after injury. Recently, the presence and participation of kidney stem cells in the tubular regeneration has been shown. However, the concept of kidney stem cells is currently emerging. In addition to the surviving tubular epithelial cells and kidney stem cells, the bone marrow stem cells have also been shown to participate in regeneration of the proximal tubule, however, the mechanisms remain controversial. Studies examining the capacity of bone marrow stem cells to differentiate into renal cells are emerging. Like other organs, the kidney is also known to regenerate completely in lower vertebrates such as fish. Some of the known fish that show remarkable capacity of kidney regeneration are goldfish, skates, rays, and sharks. In these fish, the entire nephron regenerates following injury or partial removal of the kidney. Liver The human liver is particularly known for its ability to regenerate, and is capable of doing so from only one quarter of its tissue, due chiefly to the unipotency of hepatocytes. Resection of liver can induce the proliferation of the remaining hepatocytes until the lost mass is restored, where the intensity of the liver's response is directly proportional to the mass resected. For almost 80 years surgical resection of the liver in rodents has been a very useful model to the study of cell proliferation. Toes Toes damaged by gangrene and burns in older people can also regrow with the nail and toe print returning after medical treatment for gangrene. Vas deferens The vas deferens can grow back together after a vasectomy–thus resulting in vasectomy failure. This occurs due to the fact that the epithelium of the vas deferens, similar to the epithelium of some other human body parts, is capable of regenerating and creating a new tube in the event that the vas deferens is damaged and/or severed. Even when as much as five centimeters, or two inches, of the vas deferens is removed, the vas deferens can still grow back together and become reattached–thus allowing sperm to once again pass and flow through the vas deferens, restoring one's fertility. ==Induced regeneration==

There are several human tissues that have been successfully or partially induced to regenerate. Many fall under the topic of regenerative medicine, which includes the methods and research conducted with the aim of regenerating the organs and tissues of humans as a result of injury. The major strategies of regenerative medicine include dedifferentiating injury site cells, transplanting stem cells, implanting lab-grown tissues and organs, and implanting bioartificial tissues. Bladder In 1999, the bladder was the first regenerated organ to be given to seven patients; as of 2014, these regenerated bladders are still functioning inside the beneficiaries. Fat In 1949, purified insulin was shown to regenerate fat in diabetics with lipoatrophy. Scientists also identified bone morphogenetic protein (BMP) signalling as important for myofibroblasts transforming into adipocytes for the purpose of skin and fat regeneration. In addition, during a typical myocardial infarction or heart attack, an estimated one billion cardiac cells are lost. The scarring that results is then responsible for greatly increasing the risk of life-threatening abnormal heart rhythms or arrhythmias. Therefore, the ability to naturally regenerate the heart would have an enormous impact on modern healthcare. However, while several animals can regenerate heart damage (e.g. the axolotl), mammalian cardiomyocytes (heart muscle cells) cannot proliferate (multiply) and heart damage causes scarring and fibrosis. Despite the earlier belief that human cardiomyocytes are not generated later in life, a recent study has found that this is not the case. This study took advantage of the nuclear bomb testing and other radioactive sources during the Atomic Age which introduced carbon-14 into the atmosphere (essentially all of which had decayed up to that point in Earth's history) and therefore into the cells of biologically active inhabitants. They extracted DNA from the myocardium of these research subjects and found that cardiomyocytes do in fact renew at a slowing rate of 1% per year from the age of 25, to 0.45% per year at the age of 75 by comparing the presence of carbon-14 with the stable and abundant carbon-12. Further research has been conducted that supports the potential for human cardiac regeneration. Inhibition of p38 MAP kinase was found to induce mitosis in adult mammalian cardiomyocytes, while treatment with FGF1 and p38 MAP kinase inhibitors was found to regenerate the heart, reduce scarring, and improve cardiac function in rats with cardiac injury. One of the most promising sources of heart regeneration is the use of stem cells. It was demonstrated in mice that there is a resident population of stem cells or cardiac progenitors in the adult heart – this population of stem cells was shown to be reprogrammed to differentiate into cardiomyocytes that replaced those lost during a heart tissue death. In humans specifically, a "cardiac mesenchymal feeder layer" was found in the myocardium that renewed the cells with progenitors that differentiated into mature cardiac cells. What these studies show is that the human heart contains stem cells that could potentially be induced into regenerating the heart when needed, rather than just being used to replace expended cells. Loss of the myocardium due to disease often leads to heart failure; therefore, it would be useful to be able to take cells from elsewhere in the heart to replenish those lost. This was achieved in 2010 when mature cardiac fibroblasts were reprogrammed directly into cardiomyocyte-like cells. This was done using three transcription factors: GATA4, Mef2c, and Tbx5. Cardiac fibroblasts make up more than half of all heart cells and are usually not able to conduct contractions (are not cardiogenic), but those reprogrammed were able to contract spontaneously. These sheets were still found to be present four weeks later. In 2021, researchers demonstrated a switchable iPSCs-reprogramming-based approach for regeneration of damaged heart without tumor-formation in mice. In April 2019, researchers 3D printed a prototype human heart the size of a rabbit's heart. Worse still, due to increasing smoking rates and the aging populations in many countries, the number of deaths as a result of COPD and other chronic lung diseases is predicted to continue increasing. Therefore, developments in the lung's capacity for regeneration is in high demand. It has been shown that bone marrow-derived cells could be the source of progenitor cells of multiple cell lineages, and a 2004 study suggested that one of these cell types was involved in lung regeneration. Therefore, a potential source of cells for lung regeneration has been found; however, due to advances in inducing stem cells and directing their differentiation, major progress in lung regeneration has consistently featured the use of patient-derived iPSCs and bioscaffolds. The extracellular matrix is the key to generating entire organs in vitro. It was found that by carefully removing the cells of an entire lung, a "footprint" is left behind that can guide cellular adhesion and differentiation if a population of lung epithelial cells and chondrocytes are added. This has serious applications in regenerative medicine, particularly as a 2012 study successfully purified a population of lung progenitor cells that were derived from embryonic stem cells. These can then be used to re-cellularise a three-dimensional lung tissue scaffold. A 2010 investigation used the ECM scaffold to produce entire lungs in vitro to be transplanted into living rats. These successfully enabled gas exchange but for short time intervals only. Cystic fibrosis is another disease of the lungs, which is highly fatal and genetically linked to a mutation in the CFTR gene. Through growing patient-specific lung epithelium in vitro, lung tissue expressing the cystic fibrosis phenotype has been achieved. This is so that modelling and drug testing of the disease pathology can be carried out with the hope of regenerative medical applications. Penis Penises have been successfully regenerated in the lab. The nerves in the spine are a tissue that requires a stem cell population to regenerate. In 2012, a Polish fireman Darek Fidyka, with paraplegia of the spinal cord, underwent a procedure, which involved extracting olfactory ensheathing cells (OECs) from Fidyka's olfactory bulbs, and injecting these stem cells, in vivo, into the site of the previous injury. Fidyka eventually gained feeling, movement and sensation in his limbs, especially on the side where the stem cells were injected; he also reported gaining sexual function. Fidyka can now drive and can now walk some distance aided by a frame. He is believed to be the first person in the world to recover sensory function from a complete severing of the spinal nerves. Thymus The thymus gland is one of the first organs to degenerate in normal healthy individuals. Researchers from the University of Edinburgh have succeeded in regenerating a living organ that closely resembles a juvenile thymus in terms of structure and gene expression profile. Vagina Between the years 2005 and 2008, four women with vaginal hypoplasia due to Müllerian agenesis were given regenerated vaginas. Up to eight years after the transplants, all organs have normal function and structure. ==See also==