Short- and long-term survival and function of unilateral intrastriatal dopaminergic grafts in Parkinson's disease
Short- and long-term survival and function of unilateral intrastriatal dopaminergic grafts in Parkinson's disease
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DOI：
10.1002/ana.410420115
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发表时间：
1997-07-01
影响因子：
11.2
通讯作者：
Lindvall, O
中科院分区：
文献类型：
--
作者：
Wenning, GK;Odin, P;Lindvall, O
6例帕金森病患者将4 ~ 7例供体的人胚胎中脑组织单侧移植到壳核或壳核加尾状核内，随访10 ~ 72个月。8 - 12个月后，正电子发射断层扫描显示移植的壳核中6-L-[F-18]-氟多巴摄取增加68%，移植的尾状核无变化，未移植的纹状体区域略有减少。有治疗有价值的改善4例，但只有温和的变化，在其他2例，他们都发展为非典型特征。患者4从32个月开始没有左旋多巴，并且在72个月时移植的壳核中具有正常的氟多巴摄取。总体而言，左旋多巴剂量平均减少了10%和20%，“关闭”时间减少了34%和44%，“关闭”阶段统一帕金森病评定量表运动评分减少了18%和26%，在手术后的第一年和第二年，对单次左旋多巴剂量的反应持续时间分别增加了45%和58%。僵硬和运动功能减退改善双侧，但主要是对侧的植入物。未观察到运动障碍的一致变化。我们的结论是胚胎中脑组织移植导致多巴胺能神经元的高度可重复的生存，诱导临床上有价值的改善，在大多数收件人。
Six patients with Parkinson's disease were followed for 10 to 72 months after human embryonic mesencephalic tissue from four to seven donors was grafted unilaterally into the putamen 14 patients) or putamen plus caudate (2 patients). After 8 to 12 months, positron emission tomography showed a 68% increase of 6-L-[F-18]-fluorodopa uptake in the grafted putamen, no change in the grafted caudate, and minor decreases in nongrafted striatal regions. There was therapeutically valuable improvement in 4 patients, but only modest changes in the other 2, both of whom developed atypical features. Patient 4 was without L-dopa from 32 months and had normal fluorodopa uptake in the grafted putamen at 72 months. Overall, the L-dopa dose was reduced by a mean of 10 and 20%, ''off'' time was reduced by 34 and 44%, and the ''off'' phase Unified Parkinson's Disease Rating Scale motor score by 18 and 26%, and the duration of the response to a single L-dopa dose increased by 45 and 58% during the first and second years after surgery, respectively. Rigidity and hypokinesia improved bilaterally, but mainly contralateral to the implant. No consistent changes in dyskinesias were observed. We conclude that transplantation of embryonic mesencephalic tissue leads to highly reproducible survival of dopaminergic neurons, inducing clinically valuable improvements in most recipients.