title: Carotid body autotransplantation in Parkinson disease: a clinical and positron emission tomography study.
abstract: BACKGROUND
  Carotid body (CB) glomus cells are highly dopaminergic and express the glial cell line derived neurotrophic factor. The intrastriatal grafting of CB cell aggregates exerts neurotrophic actions on nigrostriatal neurons in animal models of Parkinson disease (PD).
  
  
  OBJECTIVE
  We conducted a phase I-II clinical study to assess the feasibility, long term safety, clinical and neurochemical effects of intrastriatal CB autotransplantation in patients with PD.
  
  
  METHODS
  Thirteen patients with advanced PD underwent bilateral stereotactic implantation of CB cell aggregates into the striatum. They were assessed before surgery and up to 1-3 years after surgery according to CAPIT (Core Assessment Programme for Intracerebral Transplantation) and CAPSIT-PD (Core Assessment Programme for Surgical Interventional Therapies in Parkinson's Disease) protocols. The primary outcome measure was the change in video blinded Unified Parkinson's Disease Rating Scale III score in the off-medication state. Seven patients had 18F-dopa positron emission tomography scans before and 1 year after transplantation.
  
  
  RESULTS
  Clinical amelioration in the primary outcome measure was observed in 10 of 12 blindly analysed patients, which was maximal at 6-12 months after transplantation (5-74%). Overall, mean improvement at 6 months was 23%. In the long term (3 years), 3 of 6 patients still maintained improvement (15-48%). None of the patients developed off-period dyskinesias. The main predictive factors for motor improvement were the histological integrity of the CB and a milder disease severity. We observed a non-significant 5% increase in mean putaminal 18F-dopa uptake but there was an inverse relationship between clinical amelioration and annual decline in putaminal 18F-dopa uptake (r = -0.829; p = 0.042).
  
  
  CONCLUSIONS
  CB autotransplantation may induce clinical effects in patients with advanced PD which seem partly related to the biological properties of the implanted glomus cells.
authors.affiliation: Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Mínguez-Castellanos
authors.forename: Francisco
authors.initials: F
authors.lastname: Escamilla-Sevilla
authors.forename: Gary R
authors.initials: GR
authors.lastname: Hotton
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Toledo-Aral
authors.forename: Angel
authors.initials: A
authors.lastname: Ortega-Moreno
authors.forename: Simón
authors.initials: S
authors.lastname: Méndez-Ferrer
authors.forename: José M
authors.initials: JM
authors.lastname: Martín-Linares
authors.forename: Majed J
authors.initials: MJ
authors.lastname: Katati
authors.forename: Pablo
authors.initials: P
authors.lastname: Mir
authors.forename: Javier
authors.initials: J
authors.lastname: Villadiego
authors.forename: Miguel
authors.initials: M
authors.lastname: Meersmans
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-García
authors.forename: David J
authors.initials: DJ
authors.lastname: Brooks
authors.forename: Ventura
authors.initials: V
authors.lastname: Arjona
authors.forename: José
authors.initials: J
authors.lastname: López-Barneo
mesh_terms: D000328:Adult; D002344:Carotid Body / Q000166:cytology*; D017690:Cell Transplantation; D003342:Corpus Striatum; D004298:Dopamine / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D049268:Positron-Emission Tomography; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D004298:Dopamine