The findings in mice imply that humans might also possess similar characteristics. This increases the possibility and brings hopes of having a baby even at older ages along with treatments in the future, just like in the miraculous story of Prophet Abraham and Sarah as narrated both in the Qur’an (ad-Dhariyat 51:24-30) and the Bible (Genesis 21:7), showing us one aspect of the possibility and ultimate limits of knowledge and technology that humans can attain one day so that these miracles can become true, though to some extent, with the advancement of medicine.

Bone borne eggs

An interesting study showed an unexpected source of oocytes in the bone. Study by Tilly’s group at the Harvard Medical School in 2004 showed that cells in the bone marrow of mice could be a source of oocytes that are developing in the ovaries [1, 2]. Their first observation was the expression of genes related to egg cells in the bone marrow samples of mice. To test the possibility of bone marrow cells as a source of new oocytes, they chemically generated infertile mice. Treating mice with two chemotherapy drugs called cyclophosphamide and busulfan causes infertility. Once they treated the mice with these drugs, the mice had extensive damage in their ovaries along with an end in new oocyte production in their follicles. Ovarian follicles are spherical aggregations in the ovaries which periodically produce oocytes. Remarkably, when they transplanted bone marrow from female donors, they found a number of oocyte containing follicles (about several hundred). Interestingly, the appearance of those oocytes were rapid and thought to be due to circulating oocytes originating from the bone marrow and developing as they travel through the blood stream. Although they don’t have the evidence that those cells could be fertilized, findings could lead to fundamental changes in the current understanding of the female reproductive system.

Tilly and colleagues also report that bone marrow and blood transplants could also induce the development of oocytes in a genetically infertile mice model (which has a mutation in ATM gene) [3]. This mutant mice lack follicles and developing oocytes and are unable to produce mature germ cells (egg producing cells). Their study shows that bone marrow or blood transplant from healthy donors induces production of oocytes in this mice model. They conclude from those studies that bone marrow could be a source of germ cells to the ovaries throughout adult life. Their findings are somewhat supported by the clinical studies on cancer patients who were expected to be infertile but they could have babies after bone marrow transplant.

Another study on the circulating cells for female fertility used parabiotic (the union of two mice through an exchange of blood) mice model. This study by Eggan and colleagues tested the capacity of circulating bone marrow cells to generate ovulated oocytes and could not show any contribution of bone marrow cells to ovulated oocytes [4]. Blood or bone borne oocytes are highly debatable but bone marrow cells, at least, might have a role in enhancing women’s fertility. This might lead to the treatment of infertility. In addition, it might bring new opportunities for those dreaming of having a baby even at a late stage, but requires much additional research to be realized.

Lab & bone borne sperms

Sperm formation is known to continue throughout adulthood. It involves various steps of cellular differentiations. Maturation of sperms in the body takes more than a month in most mammals. Trials to mimic this complex process in petri dishes failed to demonstrate the production of normal, fertile sperms.

Scientists had dreamed of growing sperms in petri dishes for years. Recently, researchers in Japan developed a technique that allowed production of fertile mammalian sperms in a petri dish [5]. Attempts to make such mature sperms usually failed due to meiosis, a specific type of cell division that halves the number of chromosomes. Meiosis is very essential step for sperm cells to get ready to fuse with an egg. Ogawa and colleagues demonstrated that meiosis of sperm cells lay in a simple change to standard petri conditions. They tried various petri conditions but they ended up with a special serum free medium that is commonly used for growth of embryonic stem cells. Several weeks later, they observed formation of mature sperm cells and even half of them had flagella, a tail-like structure that sperm cells use to swim. Injection of those sperms into egg was also able to produce offspring. In addition, when they used frozen testis tissues of newborn mice, they could grow sperms as well. This discovery in reproductive biology is likely to be beneficial not only for people having infertility problems associated with sperm maturation but also children that undergo cancer therapy which destroys fertility. It is known that chemotherapy impairs fertility. Adults could freeze their sperm before such treatment, but young boys can’t. This new discovery offers such patients hope. In addition, this finding opens new avenues for protection of endangered animals that might die before reaching sexual maturity. It is a matter of time for the same technique to be applied to humans and other species.

There are also reports suggesting the generation of male germ stem cells (sperm producing cells) from bone marrow [6, 7]. Mesenchymal stem cells, which are derived from the bone marrow, have shown to differentiate into male germ cells. Studies testing the effect of retinoic acid and testicular extracts showed to induce human bone marrow stem cells to differentiate into male germ cells as shown by male germ-cell specific marker expressions. Another approach tested the possibility that bone marrow-derived stem cells would differentiate into germ cells when transplanted into the mouse testis. Using GFP positive bone marrow cells transplantations, it has been demonstrated that bone marrow-derived stem cells can also be induced to differentiate into germ cells. Interestingly, there seems to be a connection between bones and fertility.

Bones and fertility

The Qur’an tells the story of Prophet Zachariah, peace be upon him, when he secretly prayed to God to ask for a successor. He said “My Lord! My bones have grown feeble and my head glistens with gray hair from old age…” (Maryam 19:4). His prayer was accepted and the angels came with the glad tidings of his son, John. He was surprised as to how he could have a son while his wife was barren and that he had already reached infirmity in old age. It has been said by scholars that weakness of bones here refers to weakness in engaging in sex due to old age and gray hairs as a sign of infertility. It is also worthy to mention another verse where the creation of human is described as happening from a lowly fluid that gushes forth the vertebra and rib bones: Let human, then, consider from what he has been created. He has been created from some of a lowly fluid gushing forth. It proceeds (as a result of incitement) between the (lumbar zone in the) vertebra and the ribs (At-Tariq 86:5−7). As commentator Ali Unal explains, these verses refer to both the mechanism of the ejection of the seminal fluid and where it is emitted [8], which is a relatively recent discovery in biology. Remarkably, the Qur’an mentions two major bones where this fluid is emerging. Our current knowledge in medicine do not say anything about the role of ribs in reproduction or fertility but both the Islamic and Judeo-Christian traditions mention the creation of Eve from Adam’s ribs, peace be upon him. Could this refer to the relation between bones and fertility? God knows best. Lastly, it is of importance to note that one of the symptoms of menopause is the loss of bone mass. Isn’t it amazing how mysterious events regarding bones and fertility are taking place beyond our control and knowledge?

Ali Fethi Toprak is a PhD candidate at University of Texas Southwestern Medical Center.

References

1. Johnson, J., et al., Germline stem cells and follicular renewal in the postnatal mammalian ovary. Nature, 2004. 428(6979): p. 145-50.
2. Vogel, G., Reproductive biology. Controversial study finds an unexpected source of oocytes. Science, 2005. 309(5735): p. 678-9.
3. Johnson, J., et al., Oocyte generation in adult mammalian ovaries by putative germ cells in bone marrow and peripheral blood. Cell, 2005. 122(2): p. 303-15.
4. Eggan, K., et al., Ovulated oocytes in adult mice derive from non-circulating germ cells. Nature, 2006. 441(7097): p. 1109-14.
5. Sato, T., et al., In vitro production of functional sperm in cultured neonatal mouse testes. Nature, 2011. 471(7339): p. 504-7.
6. Hua, J., et al., Derivation of male germ cell-like lineage from human fetal bone marrow stem cells. Reprod Biomed Online, 2009. 19(1): p. 99-105.
7. Lue, Y., et al., Fate of bone marrow stem cells transplanted into the testis: potential implication for men with testicular failure. Am J Pathol, 2007. 170(3): p. 899-908.
8. Unal, A., The Qur’an with Annotated Interpretation in Modern English. Vol. Qur’an 86:5−7, 51;24−30 and 19:4. 2009.

White blood cells (leukocytes) are fewer in number and their duty is to fight against germs. How this process works is to be expounded by the immune system under a separate title. The red blood cells are my main building blocks and they are born by the dividing of the main cells in the bone marrow. After passing through a few phases, they lose their nucleus and are filled instead with hemoglobin, a magnificent substance containing iron. Hemoglobin’s most vital function is its binding oxygen and then carbon dioxide after releasing it. Hemoglobin reaches everywhere, traveling with the blood stream. When it comes to the lungs, hemoglobin dumps the carbon dioxide and replaces is with oxygen. Then it supplies this oxygen to the cells and removes the carbon dioxide, which is produced by burning organic compounds. So its short life passes with the same ceaseless cycle to continue your life. Hemoglobin molecules’ longevity is approximately 120 days. They contain no cell elements like ribosome, mitochondria, and nucleus and therefore cannot repair themselves. They simply die when they get old. Sad? Not at all! Red blood cells fulfill the duty they were created for and leave the stage for new ones. They are broken down in the liver and bone marrow and the iron they contain is absorbed. A certain part is transformed into bilirubin, giving bile its yellow color. As you see, nothing is truly wasted.

The red blood cells in circulation number around 25 trillion, and this number does not vary greatly, as the dying ones are constantly replaced. Their measuring gives doctors an idea about possible diseases. The amount depends on various factors’ reciprocal balance. A hormone (erythropoietin) secreted by the kidneys increases the rate of production of red blood cells, in response to falling levels of oxygen in the tissues. If you lose blood due to an accident or medical operation, the stem cells in the bone marrow receive an emergency alert to produce more red blood cells. On the other hand, if you get a blood transfer, stem cells are ordered to stop producing, due to the excess of red blood cells. You see, even such basic knowledge about bodily systems fills the learner with wonder.

Deficiency of red blood cells, scientifically known as anemia, should not be ignored. It results in pallor and weariness; you feel like sleeping more. In order to avoid this condition, your body needs different things such as group B vitamins (B6, B11, B12), vitamin C, amino acids, and iron. Since it is hard to pinpoint the deficient substance, doctors generally prescribe iron-rich multivitamin supplements.

Red blood cells divide into four types, which determine the blood groups A, B, 0, and AB. In addition to the blood group, another feature known as Rh (rhesus) factor is important to know particularly before a blood transfer. Transferring the wrong type of blood may result in death.

Platelets, which are scale-shaped cells and circulate with me are not independent; they are pieces which came off bigger cells. In a cubic millimeter of blood, 250 to 350 thousand of these little scales are found and their duty is of vital importance. If it weren’t for these pieces, the slightest cut could cause death because your bleeding would not stop. Clotting is a great blessing. It usually blocks the surface of a wound within five minutes, stopping the flow of blood and saving your life. Clotting is realized through particular molecules in these minute scales as a result of a complex chain of reactions using enzymes, vitamins, and salts. Every step of this chain of reactions is another stitch to fix the wound. Other blood cells pile up and stick together behind this net and they dry up. If such clotting occurred inside the blood vessels, it would make a disastrous effect by blocking the bloodstream. I also have enzymes to break down little amounts of such clotting. As you see, everything is splendidly organized.

Peter! A blood test reveals very critical medical data. As I visit every organ, I exchange certain substances with them. Therefore, detection of an unusual substance in me can be an early warning for a disease. Nowadays, it even helps an early diagnosis of cancer.

It is not so easy for me to explain the wisdom behind all of my duties and capabilities. But to give you an idea, there are specialized departments for studying just me at medical faculties and research institutions throughout the world.

It was.

Brittany’s path towards recovery had been abruptly cut short. After three months of chemotherapy, radiation, and alternative treatments that never ended, and with a bone marrow transplant on the horizon, Brittany had unexpectedly developed a massive infection that could not be controlled. She had been doing so well, and no one saw it coming. I was told that she had passed away in the early morning hours while I was still sound asleep in my warm, soft bed. My mom was on the phone when I arrived in the office. She was equally devastated not only because Brittany was my dear friend, but because she was also the niece of her best friend. It was a close inner circle. Now someone was missing from it.

As I reflect on that horrific day over four years later, I have finally come to peace with Brittany’s tragic and untimely death, though I doubt I will truly ever understand it. Yet I have realized that we have no choice other than to come to terms with death because it is an integral part of the life process. However, I do not consider Brittany to be truly gone. I believe she lives on in so many ways, and I think that we as a society are just on the threshold of understanding life beyond death and the spiritual continuance and connection that lives on in the day to day lives of everyone who knew the deceased.

In the most simplistic terms, I see Brittany in the spirits, faces, and actions of every person’s life she ever touched. I see her in her mother and how she compassionately and gently treats other people; I see her in her sister and her never ending kindness and understanding; I see her in her aunt and her eternal optimism; I see her in the many friends she had who worked so hard to keep her memory alive within a very large high school environment; and I see her in myself when I try to embrace her passion, patience, and inner peace. She lives on in all of us and always will. I have come to believe that a person’s spirit and soul are truly separate from their earthly body; I’ll never see her smiling face again other than in pictures, but I still see her every day.

During Brittany’s brief but valiant battle with cancer, she embodied so many traits to which the rest of us can only hope to aspire. She exemplified a true sense of inner grace that I had never witnessed before in any other person. Throughout her illness, she never showed any outward signs of fear, although undoubtedly she was terribly frightened. She never complained although she must have often been in excruciating pain. She was always positive and optimistic and tried to keep a smile on her face, even though I know it must have been an incredible challenge. I knew she was struggling, but she didn’t want anyone to know. She never wanted to burden anyone, even though she was facing the biggest battle anyone can ultimately face. Brittany did not have the benefit of growing old and wise, yet her spirit is endless and inspirational. At only fifteen years old, she never even had the opportunity to graduate from high school, go to college, fall in love, raise children, and live a long life.

She was only in the 9th grade, a mere freshman in high school. So what does this say about a teenager who is selfless enough to not want to impose any pain on anyone around her when she was clearly suffering? I often wonder if she thought that she might die, even though she always said that she was going to be okay, and even proclaimed that she planned to run laps around the hospital once she was finally released. Certainly, she thought of others more than herself during this very difficult time. I sometimes wish I had talked to her about death just to know more about her thoughts on the subject; I just don’t think that she ever considered death to be an option, but I’ll never know for sure.

Yet even today I continue to feel Brittany around me, just as I see her in the all people’s lives that she forever touched. She has obviously left her earthly body, but that does not mean she is not present in the lives of those who loved and continue to love her. She had such an incredibly strong spirit and it was not in any way defined by the body that she so briefly resided in; her spirit remains while it has also moved on to its next destination, no doubt to find a higher purpose. She will never truly be gone, nor will the people who knew her and loved her ever let go of what she represented and the joy she brought to their lives.

What ultimately defines a person’s spiritual being both in life and in the afterlife? Is the earthly body and spirit a completely different entity from the heavenly spirit or does it represent an ongoing continuum? Does a person’s spirit die just as the body dies? I contend that it does not because the spirit is never something you can reach out and touch. It is real, but it is not palpable, even in life. You can’t see it, touch it, taste it, hear it, or physically feel it, yet you can sense it. A person’s spirit forever defines their goodness or lack thereof in some circumstances, their impact on other people’s lives, and the innate individual qualities that make that soul unique.

A person’s spirit is not finite by any means, but rather it is all encompassing. It is the inherent essence of the soul of an individual, whether living or deceased. Could anyone truly claim that the spirit of Martin Luther King Jr. is dead and gone after his inspirational, albeit abbreviated life and his infamous words, “I have a Dream”? Conversely, doesn’t the spirit of Adolph Hitler similarly still exist in the families that continue to mourn the atrocities endured by the victims of the Holocaust? A spirit is not limited by life or by death, by good or by evil, nor by a moment in time or by eternity.

In life, Brittany was indeed unique and someone many would consider to be a refreshing and optimistic soul, and certainly she continues to be the same years after her passing. No one ever had a negative thing to say about Brittany, even in an often catty high school environment. She was never among what many would consider the “popular” crowd; rather, she hung with members of the Anime Club. She was generally happier reading a book than going to the latest movie. She was quiet and introspective, scientific and analytical, not one interested in parties, dating and high school football games. Wherever she is today, I envision her working with the angels, perhaps on mathematical and scientific innovations that may eventually benefit those of us on earth. She certainly wouldn’t be happy sitting idle. She would always need a challenge and an opportunity to use her amazing brain power. God must have needed her for a much higher purpose.

Surely her untimely death has left her family devastated and questioning why this happened, especially to such a kind and innocent young person. For those of us who knew and loved her, it obviously makes no sense, and I continue to question, but in the end, know that I will someday understand. But I know for a fact that she wouldn’t want sadness or bitterness. That’s not at all what Brittany was about. I believe that she would instead hope that we look inside of ourselves and take a harder look at what purpose we want to fulfill within our own lifetimes.

Life is inherently limited. We all know that someday it will come to an end for each and every one of us. It is very, very sad when it comes to an end prematurely; at least by our standards. But God’s standards may be infinitely different from our own, and in the end, an individual’s legacy to those left behind on this earth cannot be measured by longevity. Further, it does not matter whether a person is a John F. Kennedy, an Albert Einstein, a Mother Teresa or a small town high school student, because it is not the number of lives we are able to touch, but the spirit in which we are able to do it. As long as a life is lived with a sense of true, unabashed passion, the spirit as we know it can never be extinguished in the minds of those left behind. More importantly, for reasons yet to be understood by mere mortals, that spirit has found another place in time, another purpose to fulfill, inevitably choreographed by the most divine power.

When I graduated from high school in 2008, Brittany’s mother gave me a memorable gift. Knowing my love of music and dance, she presented me with a CD by Lee Ann Womack with the feature track being “I Hope You Dance”. The lyrics are inspirational and timeless. In part, they are as follows:

“I hope you never lose your sense of wonder,
You get your fill to eat but always keep that hunger,
May you never take one single breath for granted,
God forbid love ever leave you empty handed,
I hope you still feel small when you stand beside the ocean,
Whenever one door closes I hope one more opens,
Promise me that you’ll give faith a fighting chance,
and when you get the choice to sit it out or dance –
I hope you dance, I hope you dance.” (MCA Nashville, 2000)

Brittany’s mom, whose daughter should have been in that same procession marching in cap and gown to “Pomp and Circumstance”, receiving her well earned diploma, simply wrote the message, “April, I hope you dance!” At that moment, I once again felt Brittany’s eternal presence.

There is without a doubt a higher plan, in my opinion, for every relationship we encounter on this earth. Brittany and I will see each other again someday, and I have no doubt that she will still have that beautiful, inspirational smile on her face. Still I miss her, but I do know that she is not far away. And when we do meet again, she’ll probably just say something like, “Hey there, April, I missed you, but I told you I was just fine.”

Since that terrible day in 2005 when I found out that my best friend, who was thought to be on the road to recovery, suddenly and unexpectedly lost her battle, I have done a great deal of soul searching and introspection. Sometimes I wonder how the potential and very unselfish bone marrow donor in New Jersey felt when he heard that he matched a young high school girl thousands of miles away and could save the life of this anonymous recipient. I imagine that he must have been excited yet somewhat nervous because the bone marrow extraction from the donor is said to be somewhat uncomfortable. But then I wonder how this man felt when the statistically unlikely match failed to come to fruition. I would think that this stranger must have grieved as well, or at least this is what I want to believe.

Brittany and this unknown New Jersey resident had more than bone marrow in common. Having known and loved Brittany, I knew she was kind, loving, unselfish, and generous. Even though I never knew her potential donor, he obviously embodied the same qualities. And when I say “embodied,” I mean it in a spiritual sense. If Brittany had not suffered a massive infection, a person who had never met her was willing to undergo an invasive procedure in an attempt to save her life. That is a person’s true spirit. It is what defines us, it is who we are in life and thereafter, it is the life we live while we are here on this earth and legacy we ultimately leave behind.

April Bollig is pursuing a degree in Elementary Education at University of Colorado at Colorado Springs.