Developing dopaminergic cell therapy for Parkinson%26apos;s diseasegive up or move forward?

作者：Lindvall Olle^*

来源：Movement Disorders, 2013, 28(3): 268-273.

DOI：10.1002/mds.25378

• Parkinson%26apos
• s disease
• dopaminergic neurons
• neural grafts
• stem cells
• transplantation

Despite 3 decades of basic and clinical studies, there is still no dopaminergic cell therapy for Parkinson%26apos;s disease. Several arguments have been put forward why this approach, so far tested with transplantation of human fetal mesencephalic dopamine-rich tissue, will never be of clinical use and should be abandoned: (1) Lack of efficacy in 2 sham surgery-controlled trials; (2) occurrence of troublesome off-medication dyskinesias in a subgroup of grafted patients; (3) disease process destroys grafted neurons; and (4) non-motor symptoms will not be influenced by intrastriatal dopaminergic grafts. Here, the author argues that, based on recent scientific advancements, the development of a dopaminergic cell therapy for Parkinson%26apos;s disease should continue. Factors influencing the outcome after transplantation have now been identified, and dopaminergic neurons can be generated in large numbers from stem cells. Mechanisms of graft-induced dyskinesias are much better understood, and patients with well functioning grafts can exhibit long-term motor recovery of therapeutic value even in the presence of non-motor symptoms.

• 出版日期2013-3