Immunoisolated xenogenic chromaffin cell therapy for chronic pain. Initial clinical experience.
BACKGROUND
Chromaffin cells from the adrenal gland secrete a mixture of compounds that have a strong analgesic effect, especially when administered intrathecally. Many studies in animal models have shown that discordant xenogeneic cell isolates, including chromaffin cells, can survive and have biologic effects when transplanted within a semipermeable membrane capsule.


METHODS
To evaluate the clinical potential of encapsulated cell therapy, a human-scale implant containing bovine chromaffin cells was developed, characterized, and implanted in the subarachnoid space of seven patients with severe chronic pain not satisfactorily managed with conventional therapies. Patients received no pharmacologic immunosuppression. Cell devices were implanted during minimally invasive surgery, and device design allowed retrieval. All devices were recovered after implant periods of 41 to 176 days.


RESULTS
Postexplant histologic analysis, immunostaining, and secretory function all confirmed survival and biochemical function of the encapsulated cells. Reductions in morphine intake and improvement in pain ratings were observed in several patients.


CONCLUSIONS
This study represents the first successful trial of encapsulated xenogeneic cells in humans. The preliminary findings of pain reduction warrant the initiation of a randomized, double-blind phase II study to evaluate the potential efficacy of the procedure.
Buchser
E
E
Division of Surgical Research, CHUV, University of Lausanne Medical School, Switzerland.
Goddard
M
M
Heyd
B
B
Joseph
J M
JM
Favre
J
J
de Tribolet
N
N
Lysaght
M
M
Aebischer
P
P
D000328:Adult; D000368:Aged; D000818:Animals; D002417:Cattle; D019439:Chromaffin Cells / Q000637:transplantation*; D002908:Chronic Disease; D016503:Drug Delivery Systems / Q000295:instrumentation; D004343:Drug Implants; D005260:Female; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D014183:Transplantation, Heterologous
D004343:Drug Implants; D008567:Membranes, Artificial