On 28 Dec 00, at 7:13, John Cottingham wrote:
> There are three centers in the US that I can recall performing fetal
> tissue transplants. They are U. of Colorado (Dr. Curt Freed), Good
> Samaritan Hospital (Dr. Jacqus) and somewhere in MA where they are
> doing the pig fetal tissue transplants. Outside of the US, there is
> Cuba, Sweden and China.
> Obviously fetal tissue transplant, pallidotomy and medications will
> not
> give you a new mid-brain. They can buy some time.
Embryonic-cell transplants (pig or human) are "not ready for prime
time". Earlier this year, Dr. Stanley Fahn, one of the major
researchers in PD, presented at a neurosurgical meeting:
-------------------------------------------------------------
Stanley Fahn, M. D., Neurological Institute of New York.
Executive Director of PD Foundation: New medical
management of PD. Pramipexole and Ropinrole (Dopamine
agonists). Can cause sleep attacks (sudden, no warning).
Catechol inhibitors Tocapone and Entacapone, extends
Dopamine effects. Can increased side-effects. Atypical
antipsychotics. Quetiapine better than Clozapine (requires
weekly blood counts!).
Clinical trial of transplants. Double-blind, fetal
transplants. Early adrenal cell transplants no good (tissue
died). Many PD studies have placebo effects, common in
PD. 40 patients; 20 <60 yo, 20 >60 yo. Half sham
operations. Had to have dyskinesias and freezing in “on”
state. 7 years history and DOPA-responsive (not atypical
PD). PET scan compatible with PD. Dementia excluded;
no cerebrrovascular disease.
Tissue planted in putamen. Inserted in Denver. Still
blinded until cart wheeled in (one with tissue, one without).
After blind broken, sham patients were allowed to have
open-label treatment. Europe uses caudate as well as
putamen. Immunosupressive used for 6 mos. Most places;
this study uses no immunosuppressives. [Lewy bodies in
substantia nigra is diagnostic of PD] One autopsy study
showed that 5% of cells survive.
Results: PET scans show that caudate continues to lose
cells, but putamen (site of transplant) shows increase.
Young patients: 3/11 sham felt better. Old patients about
same. Objective: Younger patients (real) did much better
(shams little or no improvement); older patients did not
improve (overall) sham or real. Bradykinesia scores and
rigidity improve in younger patients only. Tremor and
walking did not get better (all in “off” state). Neither
freezing. “On” scores did not change in either group. Four
patients have developed dyskinesias (from excessive
production of DOPA from transplanted cells); this worse!
Implant “took” in 2/3 cases, but not correlated in older
patients (older brain does not respond even if cells “take”).
Complications: Asymptomatic hemorrhage. SDH 2 months
later.
Long-term: In “off” cases, progressive improvement
continues; best in young patients. Slow decrease in DOPA
dosage, including older patients.
Summary:
1. Transplants survive
2. Increase dyskinesias, especially in young people
3. Need better analysis. Not ready for treatment of
patients!
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This technology has promise, but it is still not ready for use with
patients outside of a closely-controlled situation. The incidence of
increase in dyskinesias is troubling, especially in young patients.
Best,
Bob
Robert A. Fink, M. D., F.A.C.S.
Professional Corporation
2500 Milvia Street Suite 222
Berkeley, California 94704-2636 USA
Phone: 510-849-2555 FAX: 510-849-2557
WWW: <http://www.dovecom.com/rafink>
"Ex Tristitia Virtus"
