Direct brain infusion of glial cell line-derived neurotrophic factor in Parkinson disease.
Glial cell line-derived neurotrophic factor (GDNF) is a potent neurotrophic factor with restorative effects in a wide variety of rodent and primate models of Parkinson disease, but penetration into brain tissue from either the blood or the cerebro-spinal fluid is limited. Here we delivered GDNF directly into the putamen of five Parkinson patients in a phase 1 safety trial. One catheter needed to be repositioned and there were changes in the magnetic resonance images that disappeared after lowering the concentration of GDNF. After one year, there were no serious clinical side effects, a 39% improvement in the off-medication motor sub-score of the Unified Parkinson's Disease Rating Scale (UPDRS) and a 61% improvement in the activities of daily living sub-score. Medication-induced dyskinesias were reduced by 64% and were not observed off medication during chronic GDNF delivery. Positron emission tomography (PET) scans of [(18)F]dopamine uptake showed a significant 28% increase in putamen dopamine storage after 18 months, suggesting a direct effect of GDNF on dopamine function. This study warrants careful examination of GDNF as a treatment for Parkinson disease.
Gill
Steven S
SS
Frenchay Hospital, Institute of Neurosciences, Bristol, UK. steven.gill@north-bristol.swest.nhs.uk
Patel
Nikunj K
NK
Hotton
Gary R
GR
O'Sullivan
Karen
K
McCarter
Renée
R
Bunnage
Martin
M
Brooks
David J
DJ
Svendsen
Clive N
CN
Heywood
Peter
P
D004295:Dihydroxyphenylalanine / Q000378:metabolism; D005462:Fluorine Radioisotopes; D051100:Glial Cell Line-Derived Neurotrophic Factor; D006801:Humans; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000008:administration & dosage*; D010300:Parkinson Disease / Q000188:drug therapy*; D010865:Pilot Projects; D011699:Putamen / Q000187:drug effects*; D012107:Research Design; D014055:Tomography, Emission-Computed
D005462:Fluorine Radioisotopes; C495039:GDNF protein, human; D051100:Glial Cell Line-Derived Neurotrophic Factor; D009414:Nerve Growth Factors; D004295:Dihydroxyphenylalanine