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Cell-based Therapy Shows Promise In Patients With Parkinson's Disease
ScienceDaily (Apr. 29, 2008) - A novel cell therapy using retinal pigment 
epithelial (RPE) cells attached to tiny gelatin bead microcarriers implanted 
in the brain can improve the symptoms of patients with moderate to advanced 
Parkinson's disease (PD). Rush University Medical Center neurosurgeon Dr. 
Roy A. E. Bakay and colleagues from Emory University, Atlanta found the 
therapy Spheramine was well-tolerated and patients experienced improvement 
in Parkinsonian symptoms (tremor, rigidity, slowness of movements, and 
impaired balance and coordination.)
The pilot study* was initiated at Emory University Hospital and followed six 
patients with moderate to advanced PD to investigate the safety, 
tolerability, and efficacy of the Spheramine implantation. The full patient 
group has been evaluated for four years, and several have been monitored for 
six years. Bakay and colleagues report long-term improvement or 
stabilization of symptoms, maintained for a minimum of two years after 
Spheramine implantation.  They note no Spheramine-related serious adverse 
events were reported and that the most frequent adverse event was 
postsurgical headache, which spontaneously resolved within one to two weeks.
"The results of this study are very encouraging - Spheramine is well 
tolerated through several years of follow-up and improvement in parkinsonian 
symptoms is sustained," stated Bakay.
The cellular product Spheramine consists of RPE cells attached to 
microcarriers. RPE cells produce levodopa, the precursor of dopamine. 
Dopamine is a neurotransmitter produced by nerve cells in the brain that 
progressively declines as the disease progresses.
The RPE cells, which are normally found in the back of the eye, are cultured 
under standardized conditions and attached to the microscopic beads prior to 
implantation. The microcarriers are necessary for the cells to survive in 
the brain. The implanted cells serve as a new potential source of levodopa 
to enhance dopamine production where it is most needed.
The patients were selected based on disease stage, levodopa responsiveness, 
and severity of PD symptoms while off medication.  An even distribution of 
Spheramine was surgically implanted into the more affected side of the 
brain, and patients left the hospital a few days later.
The primary efficacy measure in this trial is the motor score of the Unified 
Parkinson's Disease Rating Scale (UPDRS) when the patient has been OFF 
antiparkinsonian medication for at least 12 hours.   The researchers report 
clinical improvements were noted in both UPDRS motor scores off medication 
(44 percent improvement from baseline at 48 months) and patient-reported 
quality of life scores (23 percent improvement from baseline of total PDQ-39 
score at 48 months). Several of these patients have been monitored for 6 
years and the trial has been extended to 10 years of follow-up."
Bakay said positive results in the pilot study prompted the initiation of a 
Phase IIb, multicenter, double-blind, randomized, sham surgery-controlled 
study (STEPS) to further evaluate the safety, tolerability and efficacy of 
Spheramine.  Changes from the pilot study included implantation in both 
sides of the brain and the addition of a sham surgery group.  To date, 71 
patients have been randomized for either Spheramine or sham surgery and 
results from the will become available later this year.
Parkinson's Disease
Parkinson's disease is a progressive brain disorder that affects a person's 
motor skills which worsen as the disease advances.  Early in the disease, 
there is a loss of brain cells that produce the chemical dopamine. Normally, 
dopamine operates in a delicate balance with other neurotransmitters to help 
coordinate the millions of nerve and muscle cells involved in movement. 
Without enough dopamine, this balance is disrupted, resulting in tremor 
(trembling in the hands, arms, legs and jaw); rigidity (stiffness of the 
limbs); slowness of movement; and impaired balance and coordination - the 
hallmark symptoms of PD.
PD affects one in every 100 people over the age of 65. The latest 
epidemiology studies indicate that worldwide numbers will increase from an 
estimated 4.1 million in 2005 to 8.7 million people with PD by 2030. There 
were an estimated 19,500 PD-related deaths in the United States in 2005, an 
increase of 1,500 deaths from 2004.
It is estimated to cost $23 billion a year in direct and indirect costs and 
lost productivity. Despite therapeutic advancements, oral medications 
provide insufficient symptom control after the disease has progressed and 
new approaches are needed.
Retinal Cell Implantation Shows Promise And Improvement In Advanced 
Parkinson's Disease Patients (Apr. 18, 2002) - An innovative procedure, in 
which retinal cells are implanted in the brains of patients with advanced 
Parkinson's disease (PD), is showing promise, according to a group of Emory 
University ...  > read more
Eye Cell Implants Improve Motor Symptoms For Parkinson Patients (Jan. 10, 
2006) - A preliminary study suggests that implants of cells from the human 
retina improved motor symptoms in patients with Parkinson disease, and they 
appear to be safe and well tolerated, according to a ...  > read more
New Clinical Research Study Evaluates Novel Cell Therapy For Parkinson's 
Disease (Sep. 19, 2003) - Physicians at Rush University Medical Center are 
testing whether a novel cell therapy using retinal pigment epithelial (RPE) 
cells attached to tiny gelatin bead microcarriers implanted in the brain ... 
 > read more
Gene Therapy For Parkinson's Disease Is Safe And Some Patients Benefit, 
According To Study (Jun. 25, 2007) - Safe gene therapy may be effective 
staving off worsening Parkinson's according to the first scientific review 
of a dozen patients who have received the treatment over the last three ... 
 > read more
Promising New Parkinson's Treatment Proves Safe (Apr. 26, 2000) - An 
experimental drug that may improve Parkinson's disease symptoms when used in 
conjunction with current therapies is safe for use by Parkinson's patients, 
according to a study published by ...  > read more
Rayilyn Brown
Board Member AZNPF
Arizona Chapter National Parkinson's Foundation
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