Cryonics, November 1984
HISTOLOGICAL STUDY OF A TEMPORARILY CRYOPRESERVED HUMAN
The case history of the present subject, referred to as P3 elsewhere
(1), has been previously described [Postmortem
Examination of Three Cryonic Suspension Patients]. Essentially, the patient
was cryopreserved a significant time after clinical death and was stored for
several years in liquid nitrogen until it became necessary to terminate cryopreservation
of most of the patient's body. After thawing of the non-cephalic portion of
the body, tissue samples were taken and were preserved in either Karnovsky's
fixative (1) or in buffered formalin fixative (1) and processed some time later
for standard light microscopic observation. The results represent the first
direct information ever obtained concerning the effects of cryopreservation,
as carried out under real working conditions, on the cellular and noncellular
structural integrity of the human body. Although the conclusions which can be
drawn from this single case are limited in several ways as will be described
in the discussion which will follow, the results are such as to provide considerable
encouragement for those individuals who now are or who someday will be considering
cryopreservation as a personal alternative to death.
MATERIALS AND METHODS
Removal of Cryoprotectant from Tissue Samples. All tissues were fixed
as described elsewhere (1) on January 4, 1984. The tissues were then stored
at room temperature until March 19, 1984. On this date the tissue samples were
decanted, blotted, and weighed and the volume of fixative used to store each
tissue sample to this point in time was similarly measured. The results are
shown in Table 1. In all cases, the volume of fixative used was more than 10
times the weight of the tissue sample. At this time, the liver samples were
floating on their respective fixatives and appeared radically abnormal in color
(greenish white). The fixatives for these samples were also quite turbid, in
contrast to the transparent appearance of the fixatives bathing the remaining
samples.
Table 1: Sample Preparation for Histological Observation
| 1° fixative* |
K
|
F
|
K
|
F
|
K
|
F
|
K
|
F
|
K
|
F
|
| Tissue type** |
Kid.
|
Kid.
|
LV
|
LV
|
Lung
|
Lung
|
Liver
|
Liver
|
SC
|
SC
|
| Wt. of tissue**** |
0.57
|
1.24
|
0.275
|
0.50
|
0.56
|
0.33
|
0.38
|
0.55
|
0.59
|
0.42
|
| ml 1° fixative |
9.4
|
14.8
|
8.1
|
8.6
|
8.3
|
7.5
|
8.2
|
13.2
|
6.9
|
6.2
|
| For first dilution (a): |
|
|
|
|
|
|
|
|
|
|
| VPFR (ml) |
0
|
5
|
0
|
0
|
0
|
0
|
0
|
3
|
0
|
0
|
| VDA (ml) |
9.9
|
10.8
|
8.3
|
9
|
8.7
|
7.8
|
8.5
|
10.6
|
7.4
|
6.5
|
| FVAFD (ml) |
19.3
|
20.6
|
16.6
|
17.6
|
17.0
|
15.3
|
16.7
|
20.8
|
14.3
|
12.7
|
|
For second dilution, one-half of the FVAFD was replaced with fresh
diluent.
For final dilution and details of osmication, see text.
* 1° = primary; K = Karnovsky's fixative; F = formalin fixative.
**Kid. = kidney; LV = left ventricle of the heart; SC = spinal cord
and spinal nerves.
***Weight of tissue samples after blotting, given in grams.
(a)VPFR = volume of 1° fixative removed; VDA = volume of diluent
added;
FVAFD = fixative volume after first dilution.
|
It was assumed that each tissue sample was impregnated with roughly 3 molar
glycerol, which should be washed out gradually to avoid any significant possibility
of osmotic distortion of the tissue. The first dilution employed was intended
to reduce glycerol concentration to one half of the initial value. However,
this initial value was not known with certainty, nor was it certain that all
tissues contained the same initial concentration of glycerol. Consequently,
it was decided to dilute all samples by precisely the same factor rather than
diluting them to precisely the same final concentration. Millonig's buffered
formaldehyde fixative (MBFF, modified from the original formula; composition
given in Table 2) was therefore added to the original fixatives in measured
volumes, taking into account both the volume of original fixative present and
the approximate volume of tissue water/glycerol present (assumed to be 80% of
tissue weight). In cases for which the test tubes could not accept the required
volume of MBFF, a measured volume of original fixative was discarded and the
amount of MBFF needed was corrected and added. The exact details are given in
Table 1. After the first dilution step, the samples were stored near 0°C
and inverted several times on March 22 to ensure thorough mixing. The second
dilution step was carried out on March 27. This time the dilution was performed
by discarding one-half of the volume of fixative present in each tube and replacing
it with MBFF. The third and final dilution step took place on March 30. This
dilution was made by decanting the tissues and transferring them to the cryoprotectant-free
solutions described in the next section.
Table 2: Composition of MB, MBFF, and Phosphate Buffer
A. MB (Millonig's buffer, modified)
Dissolve 1.42 grams of Na2HPO4 (MW 141.96; final concentration, 99.83 mM),
0.33 grams of NaH2PO4.H2O (MW 137.99; final concentration, 24.17 mM), and
0.082 grams of sodium chloride (MW 58.44; final concentration, 14 mM) in
distilled water and bring to 100 ml with distilled water. The resulting
solution has an osmolality of about 294 and a pH of about 7.35. |
B. MBFF
1. Make 100 ml of double-strength MB.
2. "Dissolve" 7.4 grams of paraformaldehyde powder in distilled water, bring
to 100 ml with additional distilled water. Heat to 60-70°C. Add 2N NaOH
dropwise until solution mostly clears. Cool to room temperature. Carry out
step 2 in a hood using mask and gloves to avoid inhalation of powder.
3. Add 100 ml of double-strength MB to the 100 ml of 7.4% formaldehyde.
Set pH to 7.4 Add concentrated CaCl2 dropwise, with stirring, until a precipitate
forms. Filter the solution, label it "3.7% MBFF," and refrigerate. Osmolality:
about 1640 mOsm. |
C. Phosphate buffer
Dissolve 1.65 grams of Na2HPO4 (final concentration, 116.2 mM) and 0.33
grams of NaH2PO4.H2O (final concentration, 24.2 mM) in water, bring to 100
ml. pH = 7.4, osmolality = 304. |
Osmication and Further Processing. At the time of complete cryoprotectant
washout, all tissues were separated into two additional categories, tissues
to be osmicated and tissues to be processed further without osmication. Tissues
not designated for osmication were decanted and placed into the 10 ml of MBFF
containing no glycerol. The remaining tissues were decanted and placed into
10 ml of MB containing neither glycerol nor fixative. The latter solution was
replaced the next day with 4 ml of fresh MB. The osmolality of the first Millonig's
rinse was 334 mOsm as measured at this time (March 31). Tissues designated for
osmication were transferred to 9 ml aliquots of 0.5% OsO4 in isotonic sodium
phosphate buffer (formula given in Table 2) on April 2. At this time, the osmolality
of the second Millonig's rinse was found to be 309 mOsm. The tissues were allowed
to remain in osmium until April 8th, at which time they were rinsed with 2 ml
of phosphate buffer and allowed to soak overnight in 7 ml of fresh phosphate
buffer. On 4/9/84 the buffer was replaced with 4 ml of MBFF and sent to American
Histolabs, Inc. (Rockville, MD) for parafin embedding, sectioning, mounting,
and staining.
RESULTS
All tissues were examined both with and without osmium postfixation. However,
in all cases except for that of the spinal nerves and spinal cord, the non-osmicated
tissues were deemed to be the most revealing. Consequently, only osmicated tissue
sections will be presented here except for the special case of spinal nerves
and spinal cord. All tissues were also examined after primary fixation in either
Karnovsky's or formalin (giving 20 experimental groups examined in all: 5 tissues
times two fixatives times two categories for osmication or non-osmication).
However, the histological results with Karnovsky's appeared to be identical
to those obtained with formalin. Consequently, no attempt will be made below
to systematically present results based on any one of these two primary fixatives.
Except as noted below (for heart and spinal nerves), the original magnification
was the same for all photomicrographs and was 100X before photographic enlargement.
1. LIVER. As noted above, the gross appearance of P3's liver was extremely
abnormal. The histological results bear this out. The liver consisted primarily
of cavities not unlike those produced by ice as seen in freeze-substituted samples.
These cavities are displayed in Figure 1. It is believe that these cavities
are not, however, tell-tale signs of former ice crystals but instead are necrotic
areas caused by the premortal pathology of P3. If this interpretation is correct,
then these cavities reveal little about the histological consequences of freezing.
Much more revealing, in this case, is the presence within the liver of "islands"
of apparently well-preserved structure. Such an "island" of preserved cellular
structure is shown in Figure 2. The nature of the cellular structures represented
within these "oases" is not clear. What does seem clear, however, is that the
degree of structural preservation is superb. The impression obtained from these
areas is one of ultrastructural level/molecular level preservation, although
the several processes of photographic reproduction involved in creating the
image displayed in Figure 2 create a less compelling degree of clarity and "crispness"
than is apparent to the naked eye during direct observation through the microscope.
The degree of preservation observed is all the more impressive considering the
insults suffered by P3 in addition to freezing and thawing.

Figure 1. Pathological area of P3's liver, showing numerous cavities reminiscent
of ice crystal spaces. Scale bar = 40 microns. H&E (hematoxylin and eosin
stain), Karnovsky's.
|

Figure 2. "Island" of well-preserved cellular structure in the liver.
H&E, Karnovsky's primary fixative. Scale bar = 40 microns.
|
2. LUNG. The histological structure of P3's lung was far less affected by pathology
than was the liver, and consequently appears much more normal. Two views of
P3's lung are shown in Figure 3. The lung has the typical thin-walled alveolar
compartmentation pattern of normal lung (2) (A). Intact red blood cells (circled)
restrained normally within apparently intact capillaries can be seen occasionally
and in some lung areas (not shown) were abundant. It was also possible to observe
apparently normal smooth muscle (Fig. 3B, bracketed by arrowheads), whose characteristically
thin nuclei give the typical zebra-stripe look of smooth muscle. Note the crisp,
intact appearance of cell nuclei in all areas of the lung (arrows). Much of
the alveolar structure appeared flattened, suggesting atelectasis, but this
of change would be more likely to result from the patient's known (1) pre-mortal
pathology than from freezing and thawing.

Figure 3A. Lung. For discussion, see text. Giemsa, Karnovsky's. Magnification
as in Fig. 2 (M=F2).
|

Figure 3B. Lung, showing normal smooth muscle (arrowheads). Giemsa, Karnovsky's.
M=F2.
|
3. KIDNEY. The kidney presented a variety of different and striking appearances.
Figure 4 shows one type of appearance in which the renal tubular cells appear
to be torn. Note, however, the intact-appearing cell nuclei in these structures
(circled). The characteristic peritubular basement membrane (arrows) appears
to be intact. The glomerulus (large structure just to the right of center) presents
a surprisingly and impressively normal appearance and displays an intact's Bowman's
capsule. Figure 5 shows a similar area in which the tubules are shown in longitudinal
section. Not only do the cells appear to be literally torn apart, but they are
separated from the basement membrane. Note also the presence of an extensive
amount of unidentified ground substance (G) filling the normally empty interstitial
space. The presence of this material presumably reflects pre- and/or postmortal
pathology rather than any change produced by freezing and thawing. Figure 6
shows an apparently intact arteriole surrounded by torn tubules. The second
type of renal appearance is shown in Figure 7. Here the tubules do not appear
to be torn and thus appear more nearly normal, but their overall appearance
and the presence of material in the tubular lumina suggest that they are necrotic.
The cell nuclei and the tubular basement membranes, however, appear intact,
as does the glomerulus. Again, ground substance fills the interstitial space.
Finally, the third appearance of the kidney is shown in Figure 8. This region,
from the renal medulla, shows strikingly normal and intact appearing tubules
and ducts, although there is an equally striking contraction of most tubules
with separation from their surrounding basement membranes.

Figure 4. Kidney. For discussion, see text. PAS (periodic acid/shiff stain),
Karnovsky's. M=F2.
|

Figure 5. Kidney. For discussion, see text. PAS, Karnovsky's. M=F2.
|

Figure 6. Renal arteriole. Fundamentally intact structure is apparent.
PAS, Karnovsky's used as primary fixative. M=F2.
|

Figure 7. Kidney. For discussion, see text. PAS, Karnovsky's. M=F2.
|

Figure 8. Renal medulla. For discussion, see text. H&E, formalin. Magnification
as in Fig. 1 (M=F1).
|
4. HEART. The appearance of the left ventricle is shown in Figure 9. The muscular
bundles shown represent cardiac muscle cells arranged end-to-nd and appear to
be intact, though they are separated by large extracellular spaces not normally
encountered in heart. At the magnification shown in Fig. 9A, and, indeed, at
the resolution normally available with the light microscope, the cardiac mitochondria
cannot be seen. Muscular cross-striations are also difficult to discern at this
magnification, but, as indicated at higher magnification in Fig. 9B (see arrows),
they can be seen frequently. These characteristic striations attest to the surprisingly
good histological preservation of the tissue and the apparent absence of thaw-rigor.
The muscle fibers shown in Figure 9 also appear normal when viewed in transverse
section (Figure 10A). Normal blood vessels were also observed in the left ventricle
(Figure 10B). In some areas, apparent separation of myoblasts along the intercalated
discs was observed, but this was not a constant finding and probably represents
tearing artifacts produced by osmication (not shown).

Figure 9A. Left ventricle. Myofibrils are intact but separated. H&E, formalin
primary fixative. M=F2.
|

Figure 9B. Higher magnification taken from the center of Fig. 9A. Note
the evidently normal and plentiful muscle cross-striations. H&E, formalin.
|

Figure 10A (left) and 10B(right). A shows cross-section of myofibrils,
displaying normal shape and density. B shows a cardiac blood vessel with
fundamentally preserved structure. H&E, formalin. M=F1 for both A and
B.
|
5. SPINAL NERVES. Figure 11 displays the appearance of one of P3's spinal nerves
as shown in transverse section close to its point of origin from the spinal
cord. The overall structure of the nerve in general and of the myelin sheaths
in particular appears strikingly and impressively well- preserve. Unfortunately,
many details visible in color are obscured in this black-and-white print and
by photographic reproduction. Within the myelin sheaths (dark circular areas)
shrunken but apparently intact axons can be seen, with obviously distinct boundaries
(shown more clearly in the inset). It should be kept in mind that the observed
shrinkage of these axons could represent a fixation artifact rather than an
effect of glycerolization or of freezing and thawing. Similarly impressive preservation
of another spinal nerve is shown in Figure 12. It is important to point out
that these nerves are entirely representative of all such structures observed
and were not selected on the basis of unusually good preservation.

Figure 11. Spinal nerve. M=F2. Inset (higher magnification) shows more
detail. Osmium plus H&E (O+H&E), Karnovsky's.
|

Figure 12. Second spinal nerve, showing both cross-sectional and longitudinal
views of the myelinated neurons. Myelin and axons are intact. O+H&E, Karnovsky's.
M=F2.
|
6. SPINAL CORD. P3's spinal cord manifested evidence of a severe undiagnosed
degenerative condition primarily confined to the center of the cord. A section
through this region is shown in Figure 13. As shown in Figure 13A, the central
area of cord appeared to consist primarily of cavities and connective structures.
However, in most cases of osmium did not penetrate to the center of the cord,
and in the absence of osmium it is very difficult to see myelin. Figure 13B
shows a central area of cord in which osmium did penetrate. Here we do in fact
see myelin and some small myelinated fibers, but the structure of the cord is
clearly degenerated. In Figure 13C, from a non-osmicated region of the center
of the cord, two apparently intact, apparently nervous tissue cells can be seen.
Their nature is unidentified.

Figure 13. Spinal cord. A (left): cavities in center of cord. B (center):
osmicated area in center of cord, showing a few surviving axons of small
diameter. C (right): two very well-preserved neurons in center of cord.
A and C: H&E; B: osmium + H&E. Karnovsky's for A-C. M=F1 for A-C.
|
As one proceeds from the center of the spinal cord to the periphery, one encounters
a transitional zone between the clearly degenerated regions deep within the
cord to strikingly well preserved regions near the cord surface. This transition
zone is shown in Figure 14. Figure 15 shows an area between the transition zone
and the outer edge of the cord. This region manifests excellent histological
preservation, with intact myelin sheaths and intact myelinated axons, although
considerable areas of non-nervous ground substance, presumably related to P3's
nervous pathology, are also present. Finally, Figure 16 shows the outer edge
of the spinal cord, with typically excellent histological preservation and two
apparently normal cord blood vessels which are free of blood cells (indicating
that the cord in fact perfused with glycerol).

Figure 14. Spinal cord: transition zone from central to outer areas. Note
apparently intact central blood vessel (V). Osmium + H&E, Karnovsky's.
M=F2.
|

Figure 15. Body of the peripheral part of the spinal cord. O + H&E, Karnovsky's.
M=F1.
|

Figure 16. Outer edge of the spinal cord. Note the two apparently intact
blood vessels (V). Osmium + H&E, Karnovksy's. M=F2.
|
DISCUSSION AND CONCLUSIONS
In considering the meaning of the observations reported here, we will discuss
the following three general questions. 1) What can be said to have learned from
the observations reported here? 2) Are our observations consistent with, and
are they illuminated by, cryobiological findings obtained on simpler systems
(particularly whole organs)? And finally, 3) what are the implications of our
findings with respect to the repair of freezing damage in cryopreserved humans
and the feasibility of cryonics in general?
1. What have we learned from the present investigation?
Caveats. With respect to this question, it is first important to define
the limitations of this study. First, the observations were made on a single
patient only, and could theoretically be unique to this patient, making our
observations no better than "anecdotal." Second, we do not know what the tissue
levels of glycerol were in the areas subjected to investigation, so it is difficult
to estimate the amount of dehydration and ice formation each of the examined
tissues was subjected to and, therefore, the real resistance of the tissues
to these stresses. Third, this patient was subjected to devastating premortal
pathological conditions directly affecting at least two, and probably all, of
the tissues examined, and this pathology, together with the considerable postmortal
delay before cryopreservation, not only limited the availability of intact tissue
available for examination but also could, in principle, have affected the degree
of histological cryopreservation of the remaining intact tissue in either a
positive or negative direction. Fourth, this report was not written by a trained
histologist, microscopist, or pathologist, so we are not competent to present
detailed analyses of the histological results in terms of known pathological
effects or even in terms of comparison to normal tissue. Indeed, our present
study lacks any control tissues for comparison. Finally, our study does not
attempt to look at the ultrastructural or detailed biochemical integrity of
the tissues examined and therefore provides information only on a relatively
gross level of biological organization.
Results. While fully acknowledging and recognizing the above limitations,
major conclusions of considerable importance can nevertheless still be drawn
with confidence.
First, current methods of human cryopreservation are capable of preserving
a tremendous amount of cellular and non-cellular detail even in patients suffering
from extensive pathology and extensive postmortal deterioration and preserved
without the desired degree of cryoprotectant permeation into the tissues. Extensive
histological detail was observed in every tissue examined.
Secondly, not only the quantity but also the general quality of histological
cryopreservation observed is pleasantly surprising and impressive. Apparently
intact cell nuclei and blood vessels were present everywhere, seemingly ultrastructural-quality
preservation was seen in intact portions of the liver, glomerular and basement
membrane preservation and even tubular preservation in selected regions was
observed in the kidney, distinctly intact cardiac muscle fibers with apparently
normal patterns of striation were found, and the general histological organization
of the lung as well as all other tissues examined was intact. Cell membranes
and even capillaries appeared to escape gross structural injury as evidenced
by distinctly intact red cells containing clearly visible hemoglobin and the
fact that these red cells always confined to capillary lumens and were not found
in the extracellular spaces surrounding the capillaries. Few clear signs of
mechanical distortion and permanent alteration of the tissues by the presence
of ice were found, most tissues appearing not to have been frozen at all, despite
the fact that extensive freezing did in fact take place. One possible exception
to this general rule was the kidney, which exhibited apparent tearing of the
tubular cells in a pattern which to the authors' knowledge is not characteristic
of any known pathological condition. A perhaps more clear-cut exception was
the heart, which contained large and abnormal extracellular spaces which were
likely to have resulted from extracellular ice formation. On the other hand,
it is also possible that these spaces simply represent cardiac edema induced
by cryoprotectant perfusion.
Third, the histology of both central nervous system tissue (spinal cord) and
peripheral nervous system tissue (spinal nerve) appeared to be preserved better
than the histology of any other tissue. Intact nerve cell membranes and intact
myelin sheaths were observed, and there was no evidence of tissue distortion
by ice with the possible exception of what appeared to be microscopic fissures
in the tissue. However, it is likely that these fissures are artifacts produced
by the sectioning of osmicated, parafin-embedded tissue, as osmication always
seems to be associated with such features even in tissues which have not bee
frozen and thawed (data from a separate study). Rather extreme shrinkage of
the axons within their myelin sheaths was observed. Nevertheless, the degree
of preservation seen was overall, highly impressive and encouraging.
Fourth, and finally, something can be said about the biochemical state of the
tissues examined. Histological stains act by chemical reacting with specific
types of functional groups in the tissues. To the extent that stained tissue
is observed to exhibit both the normal color and the normal intensity of stain
expected for control tissue, it can be concluded that it possesses the same
functional groups in the same amounts as untreated tissue. We did not find the
tissue staining in this study to be discernably different from what would be
expected for normal control tissue. Therefore, within very broad limits, we
can conclude that extensive chemical modification of human tissue is not caused
by cryopreservation of the body.
2. Relationship of current study to the cryobiological literature.
Shrinkage of axons and the spinal cord. As noted above, significant
axonal shrinkage was observed histologically. One possibility is that this represents
osmotic shrinkage of the axon due to permeation of glycerol into the space between
the sheath and the axon without further permeation into the axon itself. Osmotic
dehydration might also explain the gross shrinkage of the cord as a whole observed
macroscopically (1). Although Menz's data (3) and the data of Fahy et al. (3B)
indicate that glycerol permeation into nervous tissue requires only several
minutes to an hour at room temperature, permeation is apparently quite slow
at 15øC or below (3C). However, if osmotic dehydration by glycerol is the cause
of the observed shrinkage, it is remarkable that freezing did not alter the
semipermeability of the axonal membrane to permit glycerol entry after thawing.
The shrinkage may instead be a fixation artifact, as similar shrinkage has been
seen in control animal material fixed without previous perfusion with cryoprotectant.
In this case, shrinkage of the cord as a whole could also be fixation-related
or it could be attributed to premortal pathology. A more remote possibility
could be that freezing caused shrinkage of the axons and that the axons then
failed to regain their normal volumes upon thawing due to being injured in some
way by the freezing-thawing process. However, there is little or not precedent
for this type of behavior in the cryobiological literature.
Mechanical distortion of tissues by ice. In general, little evidence
for any mechanical injury to P3's tissues could be found in this study. Although
there is currently basic unanimity within the organ cryopreservation field that
mechanical injury from ice is a major causative factor in the failure of presently
available organ freezing procedures, the observations made here showing little
or in some cases no evidence for this type of injury are in agreement with recent
studies which point toward ways of avoiding mechanical damage. In particular,
considerable recent research associated with the MRC Medical Cryobiology Group
in Cambridge in the United Kingdom (4,5), involving both smooth muscle strips
and whole rabbit kidneys, has shown that extremely slow cooling, on the order
of the cooling rates used for the freezing of P3, causes ice to form in a pattern
which prevents or greatly reduces the disruption of extracellular architecture
of these systems which is otherwise caused by freezing at normal rates.
Even at higher rates, however, mechanical injury may not be detectable. For
example, a classical study of Meryman's, intended to evaluate the significance
of mechanical distortion of tissue by ice, found that even after extreme tissue
distortion by ice, as revealed by freeze substitution, thawed liver resumed
an essentially normal appearance (6). It has also bee reported that the entire
leg or foot of various animals can survive freezing to -15øC (or even to dry
ice temperatures, according to H.T. Meryman) without the benefit of a cryoprotective
agent (7) despite the massive distortion of tissue structure which must be inevitable
during such extreme conditions of freezing. It has been known for years that
intertidal animals such as snails, oysters, and mussels, which survive extreme
conditions of freezing for months at a time, do so despite almost unbelievable
mechanical distortion by ice (8), which is not apparent upon thawing. In a review
of organ preservation published many years ago, Robertson and Jacob called the
histological appearance of tissues after freezing and thawing "unremarkable"
(9). Slow freezing of at least 80-90% of the water in isolated canine lungs
in the absence of cryoprotection was found to be compatible with survival of
the lungs, as determined by acceptable function after transplantation in many
cases and by good histological preservation (10), in agreement with the present
results.
In our experience, the appearance of P3's cardiac muscle, which contained exaggerated
extracellular spaces presumably produced by the former presence of extracellular
ice, is virtually identical to the appearance of frozen-thawed rabbit skeletal
muscle as reported by Meryman (7). On the other hand, P3's heart muscle also
appears extremely similar to the control hearts of Lillehei et al. (11). Mechanical
distortion of the skeletal muscle of human bodies frozen without a cryoprotectant
(12) is apparently more severe than what we observed.
The apparent tearing of renal tubular cells reported seems to be without precedent.
It seems unlikely to be due to mechanical effects of ice formation. Toldeo-Pereyra,
for example, did not observe this type of injury in human kidneys frozen very
quickly to nearly the glass transition temperature (13), and tearing similarly
appears absent in kidneys frozen very slowly to dry ice temperature (5). It
is possible that this injury is a form of microscopic fracturing which takes
place only below the glass transition temperature to relieve long-range thermal
stresses which cause other organs to fracture macroscopically but which do not
in general produce macroscopic fractures of the kidney (1). But this interpretation
is at odds with the observations of others (14,15), who did not observe cell
tearing even though they froze kidneys to below the glass transition temperature.
Perhaps this pattern was somehow produced as a result of premortal pathology,
e.g., as a result of the dense ground substance which could have prevented normal
thermal contraction of tubules, or perhaps it is an artifact of some kind. Further
research will be necessary to elucidate the cause of this unusual type of injury.
On the other hand, we found no evidence for histological injury to the renal
glomeruli. This type of injury is known to be greatly diminished or prevented
at the cooling rates experienced by P3 (5).
We also found no evidence of unravelling and disruption of myelin sheaths as
reported by Menz (3) in his study of the freezing of cutaneous nerves, which
could be a mechanical effect of freezing. This disagreement is almost certainly
because Menz's nerves were frozen abruptly in the absence of cryoprotectant
while P3's nervous system was frozen very slowly in the presence of glycerol.
Menz's study also showed that dimethyl sulfoxide may cause focal unravelling
of myelin similar to that seen in rabbit brains perfused with dimethyl sulfoxide-containing
solutions (3C). A very recent study of Jensen et al. (15B) also reported fragility
of frozen-thawed rat hippocampal grafts frozen with dimethyl sulfoxide, further
suggesting a problem with this cryoprotectant for brain. However, Menz found
no such effect of glycerol, in agreement with P3's histological picture.
It seems clear that the findings in this study are in reasonable general agreement
with, and are compatible with, other findings in cryobiology concerning mechanical
effects of ice (and the lack thereof) on tissue histology.
Thaw rigor. One possible point of disagreement, however, was our failure
to observe "thaw rigor," which is rigor mortis produced by freezing and thawing
(16). The absence of thaw rigor was inferred from the seemingly normal striation
pattern observed (1). It is not clear why we failed to observe the histological
pattern of thaw rigor. One possibility is that, in view of the long postmortem
delay preceding cryopreservation, the cardiac muscle passed through both rigor
mortis and secondary relaxation prior to cryopreservation. Love (16) has noted
that very slow freezing prevents thaw rigor by allowing for depletion of ATP
during cooling, which is therefore not available to cause rigor upon thawing.
Chemical effects of freezing. Normal histological staining and normal
histochemical reactions after the freezing and thawing of kidneys have been
reported by others (14). It is also clear that chemical changes produced by
freezing must in general be rather limited, or it would not be possible for
most cells to survive freezing or for analyses to be made of a nearly infinite
variety of biochemical constituents of cells after freezing and thawing, as
is commonly done. Our results simply confirm for cryopreserved human bodies,
in a limited way, what is already known to be true for the great majority of
other systems.
3. Implications
The feasibility of reversal of cryopreservation injury. The present
results do have an important bearing on the question of repair. The following
conclusions seem clear.
First, despite examples in which the observed degree of injury is severe, particularly
in the case of the kidney, wherein there appeared to be a physical disruption
of the tubular cells, there is never any doubt as to the identity of the tissue
being examined. Kidney is obviously kidney, lung is obviously lung, and so on.
(Due to the patient's pathology, we are unable to comment definitively on the
liver, but it is likely also to follow the same pattern, particularly in view
of Meryman's results cited above.) Furthermore, the normal biochemical nature
of these easily identifiable tissues appears to be largely unaltered. It follows
from these facts that cellular (17) or molecular (18,19) repair machines, if
they can be made at all, will have no trouble identifying their environment
and proceeding to make appropriate repairs. The observations suggest that the
amount of molecular repair required should not be large compared to the overall
molecular inventory of the tissue, and therefore that the degree of molecular
repair required should fall comfortably within the range of repair capability
thought to be possible (18,19). On the other hand, it must be acknowledged that
it is not easy to visualize how molecular machines would be able to repair large-scale
structural flaws such as those seen in the kidney (torn cells) or those seen
on a more gross level as macroscopic fractures (1).
Second, regardless of how much injury was present in a given tissue, even in
the case of the liver (in which almost no discernable cell structure at all
was present other than what was found in the small "islands"), it was always
found that cell nuclei were intact and easy to identify. It follows that the
genetic information necessary to identify a given cell and therefore to repair
a given tissue will probably be available in practically every cell in the body,
despite prolonged periods of postmortal deterioration. This conclusion is supported
by the apparent stability of the genome in the face of either freezing (20)
or postmortem deterioration (21). Even if DNA is significantly degraded within
30-60 min. of death (22,23), the resulting fragments should still provide ample
information for cellular or molecular repair devices to decipher and act upon
particularly as these fragments will all presumably be localized within the
nucleus.
Third, there was no evidence of catastrophic vascular injury in any of the
sections examined. Presumably, then, if macroscopic fracturing (1) can be prevented,
the vascular system should in principle be available as a delivery route for
both cellular and molecular repair device.
Finally, the tissue of greatest importance, central nervous system and peripheral
nervous system tissue, appears excellently preserved even under the conditions
experienced by P3. This observation together with recent studies of the cryopreservation
of brains suggests that, in some ways, repair of the brain may be even simpler
than repair of the remainder of the body. Naturally, however, much more information
on the status of the brain and of the body after cryopreservation is still urgently
required. Electron microscopic results obtained on a dog frozen using dimethyl
sulfoxide, reported by Gale (24), indicate more CNS damage than is hinted at
by the present results with P3.
Overall, this initial study shows that it is feasible to preserve histological
detail in humans by cryopreservation after death. Since damage is likely to
be more structural than chemical and since this study shows significant structural
preservation can be achieved, the results are consistent with general feasibility
of Ettinger's proposal for the rescue of contemporary people suffering from
incurable terminal diseases (25). Of course, only many, many years of decades
of additional research will be sufficient to establish or rule out the true
feasibility of this approach.
REFERENCES
1. Federowicz, M., Hixon, H., and Leaf, J.D., Postmortem examination of three
cryonic suspension patients, Cryonics, 9/84 (#50), 16-28, 1984.
2. Bloom, W., and Fawcett, D.W., A Textbook of Histology, Ninth Edition W.B.
Saunders Co., Philadelphia, 1968.
3. Menz, L.J., Structural changes and impairment of function associated with
freezing and thawing in muscle, nerve, and leucocytes. Cryobiology, 8, 1-13,
1971. 3B. Fahy, G.M., Takahashi, T., and Crane, A.M., Histological cryoprotection
of rat and rabbit brains, Cryo-Letters, 5, 33-46, 1984.
4. Taylor, M.J., and Pegg, D.E., The effect of ice formation on the function
of smooth muscle tissue stored at -21 or -60øC, Cryobiology, 20, 36-40, 1983.
5. Hunt, C.J., Studies on cellular structure and ice location in frozen organs
and tissues: the use of freeze-substitution and related techniques, Cryobiology,
21, 385-402, 1984.
6. Meryman, H.T., Ice Crystal Formation in Frozen Tissues. Lecture and Review
Series, Naval Medical Research Institute, No. 53-3, 25-48,1953.
7. Meryman, H.T., "Review of Biological Freezing," in Cryobiology (H.T. Meryman,
ed.), Academic Press, New York, 1-114, 1966, and unpublished observations.
8. Kanwisher, J., Histology and metabolism of frozen intertidal animals, Biol.
Bull., 116, 258-264, 1959.
9. Robertson, R.D., and Jacob, S.W., "The Preservation of Intact Organs," in
Advances in Surgery, vol. 3 (C.E. Welch, ed.), Year Book Medical Publishers,
Chicago, 1968.
10. Okaniwa, G., et al., Studies on the preservation of canine lung at subzero
temperatures. J. Thorac. Cardiovasc. Surg., 65, 180-186, 1973.
11. Lillehei, R.C., et al., In vitro preservation of whole organs by hypothermia
and hyperbaric oxygenation, Cryobiology, 1, 181-193, 1964.
12. Reuter, K., Dtsch. Z. ges. gerichtl. Med., 1, 330, 1922; quoted in Love
(ref below) (not checked)
13. Toledo-Pereyra, L.H., and MacKenzie, G.H., Freezing of human kidneys, initial
in vitro observations, The American Surgeon, 48, 232-236, 1982.
14. Schimmel, H., Wajcner, G., Chatelain, C., and LeGrain, M., Freezing of
whole rate and dog kidney by perfusion of liquid nitrogen through the renal
Surg. Forum, 9, 802-804, 1958.
15B. Jensen, S., Sorenson, T., Moller, A.G., and Zimmer, J., Intraocular grafts
of fresh and freeze-stored rat hippocampal tissue: a comparison of survivability
and histological and connective organization, J. Comp. Neurol., 227, 558-568,
1984.
16. Love, R.M., "The Freezing of Animal Tissue," in Cryobiology (H.T. Meryman,
ed.), Academic Press, New York, pp. 317-405, 1966.
17. Darwin, M.g., The anabolocyte: a biological approach to repairing cryoinjury,
Long Life Magazine, 1, 80-83, 1977.
18. Drexler, E., The Future of Design, to be published.
19. Drexler, E., Cell Repair Machines and Tissue Reconstruction: Some Notes
on Computational Complexity and Physical Constraints, to be published.
20. Elliott, K., and Whelan, J., eds., The Freezing of Mammalian Embryos, Elsevier/Excerpta
Medica, New York, 1977.
21. Gilbert, J.M., et al., The preparation of biologically active messenger
RNA from human postmortem brain tissue, J. Neurochem., 36, 976- 984, 1981. This
reference is actually to mRNA, not DNA. However, the hardiness of RNA suggest
hardiness of DNA. In addition, the intact mRNA could be transcribed into DNA
using reverse transcriptase (this is well- established technique).
22. Lazarus, H.M., and Hopfenbeck, A., DNA degradation during organ storage,
Experientia, 30, 1410-1411, 1974.
23. WIlliams, J.R., Little, J.B., and Shipley, W.U., Association of mammalian
cell death with a specific endonucleolytic degradation of DNA, Nature (Long.),
252, 754-755, 1974.
24. Gale, L., Alcor experiment: surviving the cold. Long Life Magazine, 2,
58-60, 1978.
25. Ettinger, R.C.W., The Prospect of Immortality, Doubleday, 1964.
|