title: Post-mortem assessment of the short and long-term effects of the trophic factor neurturin in patients with α-synucleinopathies.
abstract: Substantial interest persists for developing neurotrophic factors to treat neurodegenerative diseases. At the same time, significant progress has been made in implementing gene therapy as a means to provide long-term expression of bioactive neurotrophic factors to targeted sites in the brain. Nonetheless, to date, no double-blind clinical trial has achieved positive results on its primary endpoint despite robust benefits achieved in animal models. A major issue with advancing the field is the paucity of information regarding the expression and effects of neurotrophic factors in human neurodegenerative brain, relative to the well-characterized responses in animal models. To help fill this information void, we examined post-mortem brain tissue from four patients with nigrostriatal degeneration who had participated in clinical trials testing gene delivery of neurturin to the putamen of patients. Each had died of unrelated causes ranging from 1.5-to-3-months (2 Parkinson's disease patients), to 4+-years (1 Parkinson's disease and 1 multiple-system atrophy-parkinsonian type patient) following gene therapy. Quantitative and immunohistochemical evaluation of neurturin, alpha-synuclein, tyrosine hydroxylase (TH) and an oligodendroglia marker (Olig 2) were performed in each brain. Comparable volumes-of-expression of neurturin were seen in the putamen in all cases (~15-22%; mean=18.5%). TH-signal in the putamen was extremely sparse in the shorter-term cases. A 6-fold increase was seen in longer-term cases, but was far less than achieved in animal models of nigrostriatal degeneration with similar or even far less NRTN exposure. Less than 1% of substantia nigra (SN) neurons stained for neurturin in the shorter-term cases. A 15-fold increase was seen in the longer-term cases, but neurturin was still only detected in ~5% of nigral cells. These data provide unique insight into the functional status of advanced, chronic nigrostriatal degeneration in human brain and the response of these neurons to neurotrophic factor stimulation. They demonstrate mild but persistent expression of gene-mediated neurturin over 4-years, with an apparent, time-related amplification of its transport and biological effects, albeit quite weak, and provide unique information to help plan and design future trials.
authors.affiliation: RTBioconsultants, Inc., San Diego, CA, USA; Ceregene, Inc, USA. Electronic address: bartus@RTBioconsultants.com.
authors.forename: R T
authors.initials: RT
authors.lastname: Bartus
authors.affiliation: Rush Presbyterian Medical Center, Chicago, IL, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Kordower
authors.affiliation: Washington University Medical School, St. Louis, MO, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Johnson
authors.affiliation: Ceregene, Inc, USA.
authors.forename: L
authors.initials: L
authors.lastname: Brown
authors.affiliation: Ceregene, Inc, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Kruegel
authors.affiliation: Rush Presbyterian Medical Center, Chicago, IL, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Chu
authors.affiliation: Isis Pharmaceuticals, Carlsbad, CA, USA; Ceregene, Inc, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Baumann
authors.affiliation: Toronto Western Hospital, Toronto, Canada.
authors.forename: A E
authors.initials: AE
authors.lastname: Lang
authors.affiliation: Mount Sinai School of Medicine, NYC, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Olanow
authors.affiliation: Ceregene, Inc, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Herzog
mesh_terms: D000368:Aged; D051792:Basic Helix-Loop-Helix Proteins; D003342:Corpus Striatum / Q000378:metabolism*; D000229:Dependovirus; D015316:Genetic Therapy; D005822:Genetic Vectors; D006801:Humans; D008875:Middle Aged; D009419:Nerve Tissue Proteins; D009434:Neural Pathways / Q000378:metabolism / Q000473:pathology / Q000821:virology; D019636:Neurodegenerative Diseases / Q000235:genetics / Q000378:metabolism* / Q000628:therapy / Q000821:virology; D009474:Neurons / Q000378:metabolism; D051101:Neurturin / Q000235:genetics / Q000378:metabolism*; D000076104:Oligodendrocyte Transcription Factor 2; D013378:Substantia Nigra / Q000378:metabolism*; D014446:Tyrosine 3-Monooxygenase / Q000378:metabolism; D051844:alpha-Synuclein / Q000378:metabolism*
chemical_list: D051792:Basic Helix-Loop-Helix Proteins; D009419:Nerve Tissue Proteins; D051101:Neurturin; D000076104:Oligodendrocyte Transcription Factor 2; D014446:Tyrosine 3-Monooxygenase; D051844:alpha-Synuclein; C495053:NRTN protein, human; C405708:OLIG2 protein, human
keywords: AAV2; AAV2 antibodies (Ab); Alpha-synuclein; Axonal transport deficiency; Gene therapy; Neurotrophic factors; Parkinson's disease; Synucleinopathies