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Subject: Transplant of Fetal Brain Tissue Shown to Ease Parkinson's Symptoms<By David
Date: Thu, 26 Nov 92 10:44:02 EST
Message-ID: <42.1992Nov26.104402@AmeriCast.com>
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Transplant of Fetal Brain Tissue Shown to Ease Parkinson's
Symptoms<By David Brown=Washington Post Staff Writer=

The transplantation of fetal brain tissue into adults with severe
Parkinson's disease has been shown to significantly lessen symp-
toms of the disabling illness, which affects at least 500,000
people in the United States.

Although the transplants do not cure the disease, some patients
improved enough to feed and clothe themselves, run errands unas-
sisted, and make their previously unintelligible speech under-
stood, according to three reports of the procedure published to-
day.  Parkinson's is a degenerative disease in which patients
have tremors, uncontrolled limb movements and peculiar periods in
which they "freeze" and are unable to initiate new motion.

The average age at onset is 58, and symptoms can sometimes be
controlled for more than a decade with drugs. The disease, howev-
er, becomes drug-resistant as it progresses, and late in its
course it causes dementia and virtual paralysis.

The experience of 13 patients, described in The New England Jour-
nal of Medicine, is likely to intensify the pressure on
President-elect Clinton to lift the 4 1/2-year-old ban on federal
funding for fetal tissue transplantation research.

That prohibition arose from the belief that transplant experi-
ments - and in particular any promising results that might come
from them - would encourage abortion.

Enacted during the Reagan administration, the ban was maintained
by President Bush despite the recommendation in 1988 by a special
panel that it be lifted.

Congress voted to lift the ban earlier this year, but Bush vetoed
the measure, saying that it had "the potential for promoting and
legitimizing abortion." The House failed to override the veto.

Because of practical problems, as well as fears of contamination
of tissue from miscarriages, elective abortions are virtually the
only source of fetal material suitable for transplantation. Even
when fetuses are at the optimal gestational age, only one in 10
yields intact brain tissue.

Two American medical teams - one at Yale University, the other at
the University of Colorado - reporting in the journal financed
their research with private money. The third team is in Sweden.

The new research, some of which has been presented previously at
scientific meetings, represents the earliest application to human
subjects of experiments done on animals over the last decade.

"These results really indicate that we have turned the corner in
the treatment of Parkinson's disease," said Thomas N. Chase, a
specialist in the disease at the National Institutes of Health,
who was not involved in the research.

"We're at the point where the focus can shift from, 'Does this
procedure work?', because it clearly does, to, 'How do we improve
the results?', which are not in themselves striking."

Although the researchers acknowledged their results fell short of
the dramatic, several said that some changes significantly im-
proved patients' lives.

D. Eugene Redmond Jr., a member of the Yale team, said that after
the surgery one woman was able to ride the bus by herself and do
her own laundry for the first time in 10 years.  "I'm sure that
the people who saw her ride the bus would say, 'My goodness,
there is something wrong with that woman. She is not well.'
Nevertheless, it made a big impact on her," he said.

Parkinson's disease, first described in 1817, results from the
death of nerve cells in a fingernail-sized structure at the base
of the brain called the substantia nigra.

Most of the lost cells produced dopamine, one of many "neuro-
transmitters," or chemical messengers, used by nerve cells to
communicate with each other. At present, most treatments are
aimed at increasing the amount of dopamine in the brain, general-
ly by giving a drug called L-DOPA, which is made into dopamine by
the body.

In the transplant operations, surgeons dissect out a particular
brain structure (amounting to about one-tenth of the brain mass)
of a fetus between 7 to 11 weeks gestational age.

With various brain imaging techniques, the physicians then locate
the region of the patient's brain, called the striatum, that is
normally stimulated by dopamine-producing cells but, in
Parkinson's patients, is relatively depleted of those connec-
tions.

With a technique called "stereotactic" surgery - which employs
the principles of solid geometry to permit one to put a needle
into a hidden structure - the fetal cells are then injected into
the patient's striatum.

The transplant procedure exploits several useful properties of
fetal tissue, specifically the fact that the host body does not
reject it as "foreign," and - in the case of nerve cells - the
tissue's ability to mature and establish new connections with
surrounding cells.

Brain researchers, however, are not certain that improvements
seen in patients are the result of the fetal cells integrating
themselves into the enormously complex wiring of the brain. It is
possible that the relatively few transplanted cells work by mak-
ing chemical substances that bolster the native cells that sur-
round them in much greater numbers.

The techniques used by the three transplant teams differed signi-
ficantly. One put the tissue into the striatum on only one side
of the brain, whereas the others put it into both; one washed the
cells in culture medium before use, whereas another quick-froze
them; the Swedish group used tissue from as many as four fetuses
in each operation.

Much of the research from now on will focus on which techniques
produce the best results.

In general, the greatest improvements were in patients' abilities
to control muscle movements smoothly.

Many also experienced shorter "off" periods during which they are
rigid and immobile.  Although all the patients continued to re-
quire drug therapy, some cut their doses by as much as half,
lessening the side effects.

Some of the results described in the papers published this week
have been reported before. A videotape of one of the Colorado
team's patients  was shown at a congressional hearing last year.

The new research is expected to further raise the hopes of
thousands of Parkinson's disease patients. The Colorado group has
already gotten 3,000 calls this year inquiring about the surgery.

Researchers on both American teams, however, emphasized that the
procedure is still experimental and can be perfected only by do-
ing controlled trials.

"I think that patients who wait until (fetal) cell survival (in
the transplants) is improved, and the outcome is more predict-
able, will have a better result than these pioneering patients,"
said Curt R. Freed, of the Colorado group.

The report of modest success does not make the use of fetal tis-
sue less objectionable, one opponent of the research said yester-
day.

"The assumption always was that the research could prove to be
successful," said James Bopp Jr., a lawyer for the National Right
to Life Committee.

"The broader point is that there is more than just a question of
benefit. There is also the question whether the research and
therapy can be conducted ethically. One of the ethical principles
is that we don't take the life of one person to benefit another."

An accompanying editorial, signed by The New England Journal's
two top editors, called for an end to the federal ban by the in-
coming administration.

"Given the encouraging results . . . it appears that there are
indeed important benefits to be gained by continuing this work,"
it said.<02:33 11-26C9999-----

Copyright 1992, The Washington Post.  This story is from the
Washington Post's Capitol Edition On-Line and is not to be ar-
chived or redistributed.

For more information, send-email to American Cybercasting Cor-
poration (usa@AmeriCast.COM)