The regeneration of complex structures in adult salamanders depends on mechanisms that offer pointers for regenerative medicine. These include the plasticity of differentiated cells and the retention in regenerative cells of local cues such as positional identity. Limb regeneration proceeds by the local formation of a blastema, a growth zone of mesenchymal stem cells on the stump. The blastema can regenerate autonomously as a self-organizing system over variable linear dimensions. Here we consider the prospects for limb regeneration in mammals from this viewpoint.T he goal of regenerative medicine is to restore cells, tissues, and structures that are lost or damaged after disease, injury, or aging. The current approaches are influenced by our understanding of embryonic development, of tissue turnover and replacement in adult animals (1-3), and by tissue engineering and stem cell biology (4). The regeneration of organs and appendages after injury occurs in diverse animal groups and provides another important viewpoint, in addition to the demonstration that complex adult tissues can be rebuilt. The lessons of biological regeneration have not been extensively assimilated, in part because this attribute appears remote and exceptional from a mammalian perspective. This Review is concerned principally with lessons from regeneration in salamanders, the species of adult vertebrates that possesses the most extensive abilities (5, 6). We identify three properties of regeneration in salamandersautonomy, scaling, and plasticity-and discuss some of the cellular and molecular mechanisms underlying them. It may be desirable to implement these properties in the context of mammalian regeneration.Regenerative medicine currently uses three approaches ( Fig. 1) (4): the implantation of stem cells to build new structures, the implantation of cells pre-primed to develop in a given direction, and the stimulation of endogenous cells to replace missing structures. Each of the different aspects identified in the first two examples-the generation of an appropriate cohort of regenerative cells, their regulated division and differentiation, and the restoration of the appropriate part of the structure-must be evoked from endogenous cells in the third approach. These processes operate in adult animals that regenerate, and in addition, the regenerative response must be initiated by signals responsive to tissue injury or removal. One candidate signal in salamanders is the local activation of thrombin, a regulator of hemostasis and other aspects of the response to injury, as well as an activator of S phase (the phase of chromosome replication) reentry in differentiated cells (7-9).A salamander can regenerate its limbs and tail, upper and lower jaws, ocular tissues such as the lens and retina, the intestine, and small sections of the heart (10-13). The various contexts for regeneration do not present an equivalent degree of difficulty. To restore the intricate and discontinuous pattern of the vertebrate limb is a different proposition from replac...