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It does take a brain scientist Neuropathologist provides teens with up-close look at human tissue transplants By Linda Bicksler STAFF WRITER As more than 150 students scrutinized the process, Jeffrey Kordower of Chicago's Rush-Presbyterian Hospital held up thick, pork-chop-style slabs of the human brain, gesturing toward grayish and whitish areas to review parts and their functions. He pointed to various brain sections: the caudate nucleus, the basal ganglion, the substantia nigra. Frequently, Kordower explained what the areas would look like if the patient had a disease. "Not only is the brain made up of brain and glutea, but spaces," he told students. "Spinal fluid flows on the outside, and in the brain as well. If you jarred your head, it wouldn't be the brain banging against the skull, causing damage. There would be something to protect it." Teens from advanced science and psychology classes at Naperville Central and Naperville North high schools watched intently, absorbed in the recent demonstration that also included monkey and rat brains. Later, the students had questions. This close to the leading edge of brain research, the issues can be controversial. These future medics, researchers and psychologists came to the presentation knowing brain research is linked to methods for treating disease that have been hotly disputed by experts — cloning, fetal cell transplants and stem cell transplants, to name a few. Kordower, as director of the Research Center of Brain Repair at Rush-Presbyterian, heads a team that performs transplants using the brain cells of aborted fetuses. A student's experience with these topics should go beyond forming an opinion, said Len Hopkins, teacher of an advanced-placement psychology course at Central. He thinks teens should understand how the processes work. "All the research they've looked at has been researched by someone else," Hopkins said. "I want them to be critical of that research." Hopkins' ultimate goal: to verify the methods used by real scientists. Though District 203 teachers already identified sections of the human brain using a plastic model, some details are visible only on live specimens, Hopkins said. The in-class model, for example, showed the brain's central fissure as "just another set of squiggly lines," Hopkins said. But on Kordower's sample brain tissue, students saw the wide, darkened band that crosses the brain. "When (Kordower) said 'What does the temporal lobe do?' and they said 'Memory' — bingo. That clinched the learning for them," Hopkins said. "The connection was there." Halfway through the presentation, Kordower moved from physiology of the brain to groundbreaking research. His team has tried a number of methods to improve the symptoms of people who have diseases that are caused by a reduced amount of the chemical dopamine in their brains. The initial treatment for Parkinson's disease, Kordower said, is a pill. But the pill solves the problem for only about five to seven years. Eventually, "the window of opportunity shrinks and shrinks," he said. The symptoms return, with increasingly harsh side effects. Via videotape, students witnessed the effect of planting electrical transmitter devices into the brains of Parkinson's patients. Recently approved by the Food and Drug Administration, this new procedure costs $20,000 and lasts for eight to 10 years. The before and after pictures, caught on film, are striking. Before surgery, an elderly man held his arms outward. Both arms wavered, and his right arm trembled violently. But when doctors turned on a stimulator that was implanted in his brain, the shaking in his left arm decreased and his right arm showed no movement at all. "You can still see the tremor in the left side," Kordower said. "But do you see how still the tremor in the right side is?" In case after case, the electrode produced faster reflexes, less rigidity and the ability to walk without assistance. Thirty to 40 percent of patients "get a really good benefit," Kordower said. "In some cases, it's more dramatic than we showed you." A more controversial method used by Kordower's assistants is transplanting the brain cells of aborted fetuses into the brains of patients. The use of fetal tissue, Hopkins said, began in the 1980s, a time when such experimentation was banned in the United States. An odd coincidence occurred, however, when a Swedish scientist and a California scientist met on a bus and decided to combine their research. Fetal tissue from Sweden was implanted into the brains of young Californians who developed, by taking a bad strain of heroin, symptoms identical to those caused by Parkinson's disease. That strain, when duplicated, became known as MPTP. The implantation worked, almost entirely removing the Parkinson's symptoms. Unlike other methods, "Every time you do a fetal cell graft, it works," Kordower said. "This is where we get interesting, when we discuss these issues," Hopkins said. "I asked the kids 'Do you have a problem with this?' Some of the kids do. Some of the kids don't. Is there an ethical issue? Then it needs to be discussed." Saying he recognizes people's views on abortion differ, Kordower defended the use of fetal tissue for research. But he advocates some limits. Ethical constraints mean a fetus should never be obtained by sale. Nor should an embryo be grown so that it can be used as a cadaver in research, he said. In fact, Kordower said, transplants using fetal tissue are rare. So far, just 25 Parkinson's patients have had fetal transplants, though a million and a half fetuses are aborted in the United States each year, he said. Ethical and moral issues aside, another problem with fetal transplants is the number required for each procedure. Eight fetuses are needed to treat the brain of one patient. And fetuses are hard to obtain from clinics, Kordower said. Moreover, the number of Parkinson's patients exceed the available fetuses. But Kordower said he sees the wave of the future not in fetal, but stem cell transplants, which often rely on genes from an adult's bone marrow. The strange discovery of the drug MPTP enabled scientists to conduct a new kind of research. When MPTP is inoculated into monkeys, they develop Parkinson's disease. The ability to experiment on primates with Parkinson's has led scientists, two decades later, to what Kordower said may be the forefront of a cure. Using stem cell research, scientists have located GDNF, a substance that prevents a brain from losing its dopamine, a natural chemical which acts as a stimulator. "I've never seen anything as potent as this," Kordower said. "I think it's safe and effective. Of all the cures we have thought about or looked at occurring, I think this is the closest." When asked what parts of Kardower's presentation stood out, students' answers varied. "I was surprised to find out that Parkinson's patients sometimes overdo the medication that they take to mask the effects (of the disease) — and how determined they are to overcome it," student Patrick Strauf said. "I didn't realize it took that many fetuses to help one patient," said Amy Butz, a junior. No matter their stance on the issues, the students praised the process. "In class, the teacher went through the slab, and said, 'This is what the cerebellum looks like — it's like a little flower,'" junior Jenny Dierdorf said. "Today, you saw — 'Oh, it really does look like that.' It's amazing to see it firsthand." "To this point, all we've seen are models and sketches," junior Dan Rickert said. "It's a whole new world when you get to see the real thing." 03/02/01 http://www.copleynewspapers.com/sunpub/naper/city/brain0302.htm ..........................