Long-term clinical outcome of fetal cell transplantation for Parkinson disease: two case reports.
OBJECTIVE
Recent advances in stem cell technologies have rekindled an interest in the use of cell replacement strategies for patients with Parkinson disease. This study reports the very long-term clinical outcomes of fetal cell transplantation in 2 patients with Parkinson disease. Such long-term follow-up data can usefully inform on the potential efficacy of this approach, as well as the design of trials for its further evaluation.


METHODS
Two patients received intrastriatal grafts of human fetal ventral mesencephalic tissue, rich in dopaminergic neuroblasts, as restorative treatment for their Parkinson disease. To evaluate the very long-term efficacy of the grafts, clinical assessments were performed 18 and 15 years posttransplantation. Motor improvements gained gradually over the first postoperative years were sustained up to 18 years posttransplantation, while both patients have discontinued, and remained free of any, pharmacological dopaminergic therapy.


CONCLUSIONS
The results from these 2 cases indicate that dopaminergic cell transplantation can offer very long-term symptomatic relief in patients with Parkinson disease and provide proof-of-concept support for future clinical trials using fetal or stem cell therapies.
Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
Zinovia
Z
Kefalopoulou
Department of Medicine, Hammersmith Hospital, Imperial College London, London, England.
Marios
M
Politis
Department of Medicine, Hammersmith Hospital, Imperial College London, London, England.
Paola
P
Piccini
Reta Lila Weston Laboratories and Department of Molecular Neuroscience, UCL Institute of Neurology, London, England.
Niccolo
N
Mencacci
Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
Kailash
K
Bhatia
Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
Marjan
M
Jahanshahi
Division of Neurology, Department of Clinical Sciences, University Hospital, Lund, Sweden.
Håkan
H
Widner
Division of Neurology, Department of Clinical Sciences, University Hospital, Lund, Sweden5Division of Neurosurgery, Department of Clinical Sciences, University Hospital, Lund, Sweden.
Stig
S
Rehncrona
Neuronal Survival Unit, Wallenberg Neuroscience Center, Lund University, Lund, Sweden.
Patrik
P
Brundin
Neuronal Survival Unit, Wallenberg Neuroscience Center, Lund University, Lund, Sweden7Neurobiology Unit, Wallenberg Neuroscience Center, Lund University, Lund, Sweden.
Anders
A
Björklund
Division of Neurology, Department of Clinical Sciences, University Hospital, Lund, Sweden.
Olle
O
Lindvall
Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
Patricia
P
Limousin
Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
Niall
N
Quinn
Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
Thomas
T
Foltynie
D003342:Corpus Striatum / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery*; D059290:Dopaminergic Neurons / Q000637:transplantation; D016332:Fetal Tissue Transplantation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008636:Mesencephalon / Q000166:cytology / Q000637:transplantation; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D049268:Positron-Emission Tomography; D013997:Time Factors; D016896:Treatment Outcome
D007980:Levodopa