Dyskinesias and Neural Grafting in Parkinson's Disease

Abstract

In the past 20 years, intracerebral transplantation of embryonic ventral mesencephalic (VM) tissue has been looked upon as a particularly promising approach for the treatment of Parkinson’s disease (PD). Among the many possible treatment options for the future, transplantation bore the promise of a truly curative approach: endogeneous, degenerating dopamine (DA) neurons would be substituted for by healthy DA-producing cells, restoring the damaged nigrostriatal circuit once and for all (Nikkhah and Brandis, 1995; Barker, 2000; Fricker-Gates et al., 2001). Hopes were fostered by the encouraging results produced by intrastriatal VM transplants both in animal models of PD (Bjorklund, 1992; Bjorklund and Stenevi, 1979; Herman and Abrous, 1994; Perlow et al., 1979) and in early openlabel clinical trials (Lindvall, 1994; Lindvall and Hagell, 2000 and Chapter 5). The latter showed that embryonic VM tissue can engraft in the parkinsonian striatum and provide a local source of DA storage and release. In a majority of transplanted patients the grafts were found to ameliorate many of the symptoms of PD and to reduce the need for L-DOPA pharmacotherapy (Lindvall and Hagell, 2000). In addition to their immediate implications for PD, these results also suggested that neural cell replacement could develop into a radically new treatment approach for a wide range of neurological disorders (Gage et al., 1988; Lindvall and Bjorklund, 1992; Aichner et al., 2002; Turner and Shetty, 2003; Grisolia, 2002; Peschansky and Dunnett, 2002; Studer et al., 1998). This early enthusiasm was dampened by alarming reports from the first NIH-sponsored clinical