Introduction
As we move towards an era of stem cell-based treatments for neurodegenerative disorders of the CNS, particularly Parkinson’s disease, the rationale for use of dopaminergic cell-based approaches to treat this disorder needs to be considered. Allografting of fetal ventral mesencephalic tissue as a dopaminergic replacement therapy in Parkinson’s disease was first undertaken more than 20 years ago and since then many patients have had this procedure. The results from these interventions have been variable and, thus, the merits of this approach have been both questioned and championed. In this Review, we describe the rationale for use of fetal ventral mesencephalic allografts and discuss how, as our knowledge of Parkinson’s disease has changed, our understanding has altered on how best to use this repair strategy for patients. This understanding is based on a better definition of the nature and extent of problems in Parkinson’s disease but also has entailed a critical reappraisal of data from transplant trials that have already been undertaken. This reanalysis has led us to plan a clinical trial sponsored by the European Union (TRANSEURO), which will include careful selection of patients (age, stage of disease, type of Parkinson’s disease), tissue preparation (number of cells grafted, dopaminergic vsserotonergic content of the graft), tissue placement (location, tract numbers), graft support (storage media, immunotherapy after grafting), and trial design (numbers of patients, follow-up time, endpoints).The discussions and analyses that have led up to this new trial form the basis for this Review.
Aucun commentaire:
Enregistrer un commentaire