BILATERAL FETAL NIGRAL TRANSPLANTATION INTO THE POSTCOMMISSURAL PUTAMEN IN PARKINSONS-DISEASE
BILATERAL FETAL NIGRAL TRANSPLANTATION INTO THE POSTCOMMISSURAL PUTAMEN IN PARKINSONS-DISEASE
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DOI：
10.1002/ana.410380307
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发表时间：
1995-09-01
影响因子：
11.2
通讯作者：
GAUGER, LI
中科院分区：
文献类型：
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作者：
FREEMAN, TB;OLANOW, CW;GAUGER, LI
我们对4例帕金森病（PD）患者进行了胎儿黑质移植。固体移植物植入双侧连合后壳核，每侧使用3至4个供体，年龄为61/2至9周。移植物沉积物在三维空间中间隔不超过5 mm。使用环孢菌素共6个月。在基线和术后1、3和6个月时对患者进行评价。在基线和术后6个月通过正电子发射断层扫描评估纹状体18-氟多巴摄取。所有患者均耐受良好。1例患者出现临床上无症状的沿针道沿着浅表皮质出血，另1例患者出现一过性术后意识模糊和幻觉。所有患者均获得了具有临床意义的获益。在“关闭”状态下，检测到显著改善（P < 0.05）的总ADRS评分，“关闭"状态下的Schwab-England残疾评分，”关闭"时间百分比和运动障碍的“开启”时间百分比。纹状体增大。在每例患者中均观察到双侧氟多巴摄取，右侧平均增加53%（P = 0.01），左侧平均增加33%（P = 0.08）。我们的研究表明，胎儿组织移植后，晚期PD患者的临床特征和纹状体氟多巴摄取明显和一致的改善，这些患者的病情术前未通过药物治疗得到改善。这些初步结果是令人鼓舞的，并支持进一步的研究，以评估移植策略作为治疗PD。
We performed fetal nigral tansplantations in 4 Parkinson's disease (PD) patients. Solid grafts were bilaterally implanted into the postcommissural putamen using 3 to 4 donors per side aged 61/2 to 9 weeks postconception. Transplant deposits were separated by no more than 5 mm in three dimensions. Cyclosporine was employed for a total of 6 months. Patients were evaluated at baseline and at 1, 3, and 6 months postoperatively. Striatal 18-fluorodopa uptake was assessed by positron emission tomography at baseline and at 6 months postoperatively. The procedure was well tolerated in all patients. One patient had a clinically asymptomatic superficial cortical hemorrhage along the needle tract and a second had transient postoperative confusion and hallucinations. All patients experienced clinically meaningful benefit. Significant improvement (P < 0.05) was detected in total UPDRS score during the ''off'' state, Schwab-England disability score during the ''off'' state, percent ''off'' time, and percent ''on'' time with dyskinesia. Increased striatal. fluorodopa uptake was observed bilaterally in each patient, with mean increases of 53% on the right (P = 0.01) and 33% on the left (P = 0.08). Our study demonstrated clear and consistent improvement in clinical features and striatal fluorodopa uptake following fetal tissue transplantation in patients with advanced PD whose condition was not improved preoperatively by drug manipulation These preliminary results are encouraging and support further studies to evaluate grafting strategies as a therapy for PD.