30-year-old Russian man volunteers for world's first human head transplant

 In February, Medical News Today reported that an Italian surgeon is to announce updated plans to conduct the world's first human head transplant within the next 2 years. Now, a 30-year-old Russian man is set to become the first person to undergo the procedure.

The HEAVEN-GEMINI procedure - which is estimated to take 100 surgeons around 36 hours to complete - will involve spinal cord fusion.

Dr. Sergio Canavero, of the Turin Advanced Neuromodulation Group (TANG) in Italy, first spoke of his plans to carry out the first human head transplantation in July 2013 - a project named HEAVEN-GEMINI.

At the American Academy of Neurological and Orthopedic Surgeons' 39th Annual Conference in Annapolis, MD, in June, Dr. Canavero will present updated plans for the project, addressing some of the previously identified challenges that come with it.

Though researchers have seriously questioned the feasibility of Dr. Canavero's plans, it seems the first human head transplantation is a step closer to becoming a reality; Valery Spiridonov, a 30-year-old computer scientist from Vladimir, Russia, is the first person to volunteer for the procedure.

Spiridonov has Werdnig-Hoffman disease - a rare genetic muscle wasting condition, also referred to as type 1 spinal muscular atrophy(SMA). The condition is caused by the loss of motor neurons in the spinal cord and the brain region connected to the spinal cord. Individuals with the disease are unable to walk and are often unable to sit unaided.

Spiridonov was diagnosed with Werdnig-Hoffman disease at the age of 1 and told MailOnline that he volunteered for HEAVEN-GEMINI because he wants the chance of a new body before he dies.

'"I can hardly control my body now," he said. "I need help every day, every minute. I am now 30 years old, although people rarely live to more than 20 with this disease."

Donor body will be attached to recipient's head through spinal cord fusion

Dr. Canavero told CNN he has received an array of emails and letters from people asking to be considered for the procedure, many of which have been from transgender individuals seeking a new body. However, the surgeon says the first people to undergo the procedure will be those with muscle wasting conditions like Spiridonov.

The procedure - which is estimated to take 100 surgeons around 36 hours to complete - will involve spinal cord fusion (SCF). The head from a donor body will be removed using an "ultra-sharp blade" in order to limit the amount of damage the spinal cord sustains.

"The key to SCF is a sharp severance of the cords themselves," Dr. Canavero explains in a paper published earlier this year, "with its attendant minimal damage to both the axons in the white matter and the neurons in the gray laminae. This is a key point."

The spinal cord of the donor body will then be fused with the spinal cord of the recipient's head. Chemicals called polyethylene glycol or chitosan can be used to encourage SCF, according to Dr. Canavero. The muscles and blood supply will then be sutured.

The recipient will be kept in a coma for around 3-4 weeks, says Dr. Canavero, during which time the spinal cord will be subject to electrical stimulation via implanted electrodes in order to boost the new nerve connections.

The surgeon estimates that - with the help of physical therapy - the patient would be able to walk within 1 year.

Spiridonov admits he is worried about undergoing the procedure. "Am I afraid? Yes, of course I am," he toldMailOnline. "But it is not just very scary, but also very interesting."

"You have to understand that I don't really have many choices," he added. "If I don't try this chance my fate will be very sad. With every year my state is getting worse."

Spiridonov talks more about his decision to participate in HEAVEN-GEMINI in the video below:

Dr. Canavero branded 'nuts'

Dr. Canavero has previously admitted there are two major challenges with HEAVEN-GEMINI: reconnecting the severed spinal cord, and stopping the immune system from rejecting the head. But he claims that recent animal studies have shown the procedure is "feasible."

Unsurprisingly, however, researchers worldwide are highly skeptical of the proposal. Talking to CNN, Arthur Caplan, PhD, director of medical ethics and NYU Langone Medical Center in New York, NY, even called Dr. Canavero "nuts."

Caplan said the procedure needs to be conducted many more times on animals before it is applied to humans, adding that if the technique is feasible then Dr. Canavero should be trying to help paralyzed patients before attempting whole body transplants.

And talking to New Scientist earlier this year, Harry Goldsmith, a clinical professor of neurosurgery at the University of California-Davis, said the project is so "overwhelming" that it is the chances of it going ahead are unlikely.

"I don't believe it will ever work," he added, "there are too many problems with the procedure. Trying to keep someone healthy in a coma for 4 weeks - it's not going to happen."

Spiridonov says he is well aware of the risks, though he is still willing to take a chance on Dr. Canavero.

"He's a very experienced neurosurgeon and has conducted many serious operations. Of course he has never done anything like this and we have to think carefully through all the possible risks," he told MailOnline, but adds that "if you want something to be done, you need to participate in it."

Though it not been confirmed when the procedure will be performed, Spiridonov says it could be as early as next year.

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How far away is a cure for blindness?

Losing one of your senses is a frightening prospect for most people, but for many people, it is an unfortunate reality. Millions of people in the US face the prospect of irreversible changes to their ability to see the world around them.

Worldwide, there are an estimated 39 million people living with blindness. Around 82% are aged 50 and above.

As you read this passage, the fact that you have the ability to see and read might not even cross your mind. There are a lot of people who are not as fortunate. According to the World Health Organization (WHO), 285 million people are estimated to be visually impaired worldwide. Of these, 39 million are blind and 246 million have low vision.

A recent poll conducted by Research!America and the Alliance for Eye and Vision Research (AEVR) found that Americans regarded the loss of vision as potentially having the biggest impact on everyday life, ranking it alongside cancer, Alzheimer's disease and HIV as one of the top four "worst things that could happen to you."

Unfortunately, losing eyesight is a common problem, be it due to the process of aging or the development of a specific condition. The good news is that 80% of visual impairment can be prevented or cured, but what of the remaining 20%?

In this Spotlight article, we take a brief look at retinal degeneration disorders - a group of related conditions that are presently without a cure. What treatments are currently being developed? And can researchers envision a future where sight can be restored to all patients?

Curable and incurable disorders

Most frequently, visual impairment is caused by uncorrected refractive errors (43%) or cataracts (33%). Refractive errors include myopia (short-sightedness), hyperopia (far-sightedness) and astigmatism, whereby the cornea or lens does not have a perfectly curved shape.

When visual impairment is caused by these problems, often treatment is readily available. Refractive errors can be corrected with glasses, contact lenses or refractive surgery. Cataracts - the clouding of the lens - are commonly treated with a surgical procedure that is among the most frequently carried out in the US.

While 80% of visual impairment can be prevented or cured, there remains 20% of cases for which there is currently no way of curing. A range of conditions exists where those who develop them are faced with a gradual loss of vision until their impairment is so severe that they are effectively blind.

Retinal degeneration disorders have no cure. These diseases break down the retina, the layer of tissue found at the back of the eye containing cells that detect light entering the organ.

There are a number of these degenerative diseases, including retinitis pigmentosa, macular degeneration and Usher syndrome. In particular, age-related macular degeneration is the leading cause of blindness in the developed world.

Medical News Today asked Dr. Raymond Iezzi, an ophthalmology consultant with the Mayo Clinic, what the biggest obstacles were to finding a cure for retinal degeneration disorders. He told us that scientists and clinicians face many challenges in developing treatments as there are several hundred biochemical abnormalities underlying theses disorders.

"Further," he added, "while there are several patterns of retinal degeneration, each is treated differently depending on the cells affected as well as the stage and severity of their degeneration."

When retinal degeneration conditions were first diagnosed, they were all labeled as retinitis pigmentosa. As knowledge in this area has improved, scientists have become aware that there is a variety of different related conditions, each affecting different areas of the retina with their own specific mechanisms.

In patients whose vision is still good, therapeutic approaches can be directed at neuroprotection or gene therapy.

"By protecting cells within the retina from death associated with the underlying biochemical disorder, we may preserve sight among large populations of patients," explained Dr. Iezzi. "A robust neuroprotection strategy would prevent cell death and vision loss, regardless of the underlying biochemical abnormality."

Gene therapy focuses instead on correcting the biochemical abnormalities that lead to the death of retina cells. This approach is highly specific, and Dr. Iezzi told MNT that several hundred treatments would need to be developed in order to treat the full range of retinal degenerative diseases.

Restoring and protecting vision with stem cells

The eye lends itself to experimental treatments, being easy to operate on and often protected from inflammatory responses that could disrupt therapies. Due to its accessibility, surgeons can also easily observe and track how new treatments are progressing.

Dr. Iezzi stated that at Mayo Clinic they are currently working on new methods to grow stem cells from a patient's own tissue samples; a regenerative approach that could one day lead to the restoration of sight to people that have lost it.

Macular degeneration is a major cause of partial blindness among people aged over 50.

Embryonic stem cells could be used to build new retinal pigmented epithelial cells - cells that nourish retinal visual cells and absorb light - that could be transplanted into a patient.

Doing this could slow or prevent the loss of the visual cells, and while deriving new visual cells from embryonic stem cells could lead to even more pronounced results, researchers have found it more difficult to successfully derive these cells and transplant them into the retina.

Mouse studies have previously shown that this technique can work and that transplanted cells can integrate fully with the retina, restoring vision to the animals.

There are two types of photoreceptive cells in the retina - rod cells and cone cells. While rod cells are stimulated by light over a wide range of intensities, perceiving shape, size and brightness, it is the cone cells that perceive color and fine detail.

Researchers have managed to derive rod cells from embryonic stem cells and are currently working on deriving cone cells and transplanting them into animals. If these trials prove successful, the next step could be human trials.

Without adequate neuro protection, however, newly transplanted cells may be just as vulnerable to retinal degeneration disorders as the cells they replace. This problem underlies the importance of research into gene therapy aiming to correct the biochemical abnormalities that lead to cell death.

There is a form of treatment, however, that has led to the restoration of vision in patients with advanced forms of retinal degeneration disorders. Just as prosthetics can be used to restore function to individuals that have lost limbs, so too can individuals who have lost their vision use retinal prostheses.

The miracle of retinal prosthesis

"In patients who have already lost their sight, our therapeutic goal is to restore vision," said Dr. Iezzi. "This has been successfully accomplished via the Argus II retinal prosthesis in patients with advanced retinitis pigmentosa."

Last month, MNT reported on the story of Allen Zderad, a man who was effectively blind but is now able to make out the outlines of objects and people thanks to his new retinal prosthesis.

Dr. Iezzi was the ophthalmologist that put Mr. Zderad forward for the procedure, making him the 15th man in the US to receive the life-changing device. He is now able to navigate through crowded environments - such as shopping centers - without the use of a cane.

A camera connected to a pair of glasses transmits visual information to a small chip attached to the back of the eye via a small computer worn in a belt pack. The chip can send light signals directly to the optic nerve, bypassing the damaged retina and providing the patient with visual information in the form of flashes of light.

Dr. Iezzi describes what the retinal prosthesis provides as "artificial vision," unlike any form of vision that patients will have experienced before. While this form of vision could be considered basic compared with what normal-sighted people are used to, it is a marked improvement for many without sight.

As he used his retinal prosthesis for the first time, Mr. Zderad described the artificial vision as "crude, but significant."

"While this technology restores rudimentary vision, eventually as these devices improve, we may one day be able to treat patients with advanced macular disease such as Stargardt macular dystrophy or age-related macular degeneration," Dr. Iezzi suggested.

The future prospects of such treatment are truly exciting, but it is likely to be some time before the benefits of this technological breakthrough are widely experienced. Currently, the device costs $144,000, and the WHO estimate around 90% of the world's visually impaired live in low-income settings.

Keeping your eyes healthy

Many people will be fortunate enough not to develop a retinal degeneration disorder, but that does not mean that their eyes are invulnerable to harm. A large amount of visual impairment can be prevented, but what measures can be taken to ensure that this happens?

Regular comprehensive eye exams can detect eye disorders before any vision is lost.

The National Eye Institute (NEI) suggest a number of simple steps that can be taken to ensure your eyes are as healthy as they can be:

• Do not smoke. Smoking has been associated with increased risks of developing cataracts, optic nerve damage and age-related macular degeneration
• Eat a balanced diet and maintain a healthy weight
• Clean your hands and contact lenses properly to reduce the risk of eye infection
• Know you family's eye health history. Many serious eye disorders such as retinitis pigmentosa are hereditary and knowing your risk of developing such conditions can improve the level of treatment available
• Have a comprehensive eye exam. The only way to be completely sure of the health of the eyes is to visit an eye care professional.

WHO state that over the past 20 years there has been significant progress in preventing and curing visual impairment in many countries around the world. In 2013, the World Health Assembly approved the 2014-19 Action Plan for the universal access to eye health. The aim of this plan is to reduce avoidable visual impairments by 25% by 2019.

While many people believe that the loss of vision is one of the health problems that could have the biggest impact on everyday life, it is encouraging to think that visual impairment is no longer as absolute a prospect as it once was.

Thanks to prosthetics, people who have lost legs can walk around unaided, with most people unaware that they have any limbs missing. It is not too hard to now envisage a future world in which people could be cured of blindness, with any hints of their previous disability remaining invisible.

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Survival 'Excellent' Following Living Donor Liver Transplantation For Acute Liver Failure

Patients in Japan who underwent living donor liver transplantation (LDLT) for acute liver failure (ALF) were classified as having excellent outcomes, with ten-year survival at 73%. The findings, published in the September issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases (AASLD), suggest that the type of liver disease or treatment plan does not affect long-term patient survival following LDLT. Donor and patient age, however, does impact long-term outcome post-transplant.

According to the AASLD, roughly 2,000 Americans develop ALF-formally called fulminant hepatitis-each year, with many of these cases caused by acetaminophen (Tylenol) overdose, drug-induced liver injury, autoimmune liver disease, or viral hepatitis. Previous studies report patient survival from ALF was less than 15% before the era of liver transplantation and significantly better at more than 65% following transplantation.

LDLT-when a portion of a healthy liver from a living donor is used for transplantation-was developed as an alternative treatment option to overcome the shortage of deceased donor organs. A 2007 study by de Villa et al. found that LDLT accounts for less than 5% of liver transplants in the U.S. and Europe compared to more than 90% in Asia excluding mainland China.

"ALF is a rare, life-threatening condition where the rapid deterioration of liver function causes changes in mental activity and disrupts the body's blood clotting capabilities," explains lead author Dr. Yasuhiko Sugawara, Associate Professor in the Graduate School of Medicine at the University of Tokyo in Japan. "Expanding knowledge of treatment options, such as LDLT, that improve patient outcome is imperative."

Using data from the Intractable Liver Disease Study Group of Japan, researchers identified 209 ALF candidates who underwent living donor liver transplantation. The authors report that in patients who underwent LDLT the cumulative one-year, five-year and ten-year survival rates following transplantation were 79%, 74%, 73%, respectively. Patient age impacted short-term and long-term mortality, while donor age only affected long-term patient mortality.

"Our study demonstrates the benefit of LDLT in a Japanese population, which has less access to deceased donor organs," concludes Dr. Sugawara. "Prospective studies are needed to determine the overall impact of LDLT in all patients with ALF."

In a related editorial also published in Liver Transplantation, Professor Chung-Mau Lo with the University of Hong Kong and Queen Mary Hospital in Hong Kong, China, notes that LDLT for ALF patients has generated debate among experts in several areas: (1) reports in Western countries of inferior outcome with LDLT in high-urgency situations; (2) likelihood of ALF patients receiving a liver in countries with developed deceased organ donation programs; and (3) concern with coercion of donors and a possible increase of donor risk when the evaluation process is rushed in such an urgent situation.

"Deceased donor liver transplantation is dictated by the availability of the organ, and high-risk marginal grafts are frequently used. LDLT allows for early transplant to avoid waitlist mortality and better timing of the operation, which can be performed at the first sign of patient deterioration," concludes Professor Lo. "LDLT for ALF has developed in Asia because there is no choice. Is it possible that it may in fact be a better choice?"

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