CURING COMA
A patient lies in a deep coma, and all hope seems lost, but maybe not quite. US scientists claim to be able to revive parts of the brain with a cocktail of stem cells and lasers, eventually reviving comatose patients.
Have we found a way to end the endless sleep? And could familiar drugs be repurposed to help patients recover from brain damage?
It is a small miracle that Asbjørn has left home to live in his own flat. Six years ago, when he was 16 and went to high school, he suffered an acute hypoglycaemic event related to his diabetes, and sank into a comalike condition, because his blood sugar level was out of control, increasing the pressure on his brain. For six months, the young man was in a vegetative condition, the level of consciousness right before a coma. He almost never moved, and did not react to sound nor light, and as there were no signs of improvement, doctors estimated that the condition would become permanent.
But today, Asbjørn can walk about his flat on his own, and he eats and drinks and loves to have his family come visit. Though he still needs other people’s help and finds it difficult to speak, he is a shining example of the advances that doctors have made in their efforts to make patients in a coma-like condition wake up to a life worth living.
And now, doctors aim to go one step further. In a hospital in India, scientists from the American Bioquark company are preparing clinical testing that will be the first step towards waking up braindead patients. Right now, scientists are looking for 20 test subjects, who have been declared braindead following a traumatic accident.
HELP FROM SCIENCE ILLUSTRATED
A person is braindead when all brain functions appear to have have stopped. The condition is much more far-reaching than a coma, minimal consciousness, and a vegetative condition,
in which the brain still demonstrates a little activity. Several doctors have managed to save patients from the three coma-like conditions by means of medication.
One of them is Esteban Fridman from Cornell University in New York, who woke Asbjørn from his vegetative condition. The doctor used drugs that increase the quantity of dopamine in the brain and which are used to treat Parkinson’s disease. Dopamine is a neurotransmitter, which nerve cells use to communicate. Cooperating with a Danish doctor, Fridman prescribed the drug Madopar. The treatment worked, and after only two weeks, Asbjørn woke up.
Only in some cases, doctors are able to cure the damage by restoring the brain’s chemical neurotransmitter balance. If the injury is too severe, doctors must also replace the missing nerve cells.
DOCTORS AIM TO CREATE NERVE CELLS
Bioquark CEO Ira Pastor and his staff of scientists aim to do both to resuscitate braindead patients. The team intends to introduce brand new nerve cells to the brain and make the existing nerve paths grow, filling the hole left by the damage. Though it sounds impossible, there is scientific evidence that a brain can restore itself.
Like humans can regenerate damaged tissue caused by a wound, zebrafish and other primitive animals can restore parts of their brains. The small fish have brain pockets of stem cells that can divide and develop into other cell types, i.e. a kind of universal spare parts. In 2011, German scientists showed that the stem cells can be converted into nerve cells, which can form part of networks with other nerve cells and send signals, restoring a functional brain.
Scientists have never observed anything like this in mammals, but in 2014, the experiment inspired another German team of scientists to try to help an injured mouse brain restore itself. And they could. The scientists only needed to feed the brain a little protein, known as a peptide, by the name of Sox2. A transcription factor determines the genes that are to be active and so controls what the cell does. Sox2 could reprogramme existing brain cells – glial cells, which are a type of assistant cells that support and nourish nerve cells. Thanks to
the protein, the supporting cells are rehabilitated to be fully functional nerve cells.
CELLS NEED A LEADER
The Bioquark scientists roughly aim to copy the method, taking stem cells from braindead patients’ own blood or fat deposits and injecting them into the brain stem, where they develop into nerve cells. The brain stem is the lower part of the brain and controls very basic life processes such as breathing and heartbeats. If the scientists can restore the activity in the brain stem, it can keep the rest of the body alive. But the stem cells need a “leader” to tell them what to do. The leader is going to be proteins, that the scientists generate from human egg cells.
And the proteins are not only intended to lead the stem cells, Ira Pastor explains. “The proteins from the egg cell must both reprogramme the stem cells and affect the existing cells to clean up the injured area, break down the dead tissue, and produce a healthy environment, in which the new nerve cells can thrive.”
Just like muscles must be exercised to function optimally, it is beneficial for nerve cells to be activated, and send nerve signals. The Bioquark scientists do this by aiming a laser beam at them, and in several experiments, this has made nerves grow faster than they usually do. Moreover, Iranian scientists in 2015 showed that the highenergy beams could also stimulate stem
cells to develop into nerve cells. Hence, Ira Pastor aims to radiate the 20 braindead test subjects with stem cells and proteins for a few minutes a day.
APPROVAL CAUSED OUTCRY
In April 2016, when US health authorities approved Bioquark’s application to begin the ambitious experiments, there was an outcry throughout the world.
Some found it unethical to try to make the difference between life and death. Others worried about the possibility that hospitals could be forced to keep braindead patients artificially alive for years, if there was even the slightest hope of bringing them back to life.
However, Ira Pastor urges everybody to calm down, stressing that there is still a long way to go before braindead people can be revived. “Initially, we will only look for very early signs of nerve cell generation in the patients’ brain stems – that is very different from resurrection,” he says.
PROLONGED DEATH ENSURES TIME
Although Asbjørn was nowhere near being braindead, he and others in the same situation could also benefit from the ambitious clinical testing.
Several parts of Asbjørn’s brain were damaged by the high pressure inside his skull, and he needs a walker to be able to move about and has difficulties speaking. However, persistent rehabilitation therapy could improve his condition, as the activity in the nerve cells of the brain – when he tries to speak or walk –
stimulates them to grow new branches and connections and produce new networks. And treatment with stem cells, proteins, and laser beams could boost the process.
When it comes to patients who are in a coma- like condition, the best available treatment is medication such as Madopar or Amantadin, according to Esteban Fridman. “I have had about 140 patients, and some wake up completely without suffering permament injury. Patients such as Asbjørn develop permanent handicaps, and some do not react to the treatment,” the doctor says, stressing that there are few cures that work for everybody.
Esteban Fridman will not deny that Ira Pastor’s ambitious plans of bringing the dead back to life could be realized in the long term. He mentions doctor Sam Parnia from the Stony Brook University in New York, an expert on reviving people following cardiac arrest. According to Parnia, death is not sudden, rather it is a process that could go on for several hours.
If death is a lengthy process, it will benefit Ira Pastor’s research, as it prolongs the time in which the stem cell, protein, and laser resuscitation experiments are possible.