Guridi J, Herrero M T, Luquin M R, Obeso J A
Departamento de Neurocirugía, Hospital de Navarra, Pamplona.
Neurologia. 1991 May;6(5):175-83.
In rats with a lesion of the dopaminergic nigrostriatal pathway induced by 6-hydroxydopamine (6-OHDA), the histologic and functional viability of the striatal implant of fetal mesencephalic substantia nigra has been demonstrated. In the same model, the implant of adrenal medulla is also effective but less lasting. In monkeys with parkinsonism induced by MPTP there are suggestions of effectiveness of the fetal mesencephalic implant and also of other tissues such as placenta and sympathetic ganglion or sural nerve. Now the possibility of a better functional recovery by acting on the neuronal growth factors is being evaluated. In patients with Parkinson's disease, the accumulated experience indicates that 32% are improved with adrenal medulla implant, but the best candidates are those who also benefit from the available drug therapy without the risks of surgery. The implant of fetal tissue has been carried out in about 90 patients, with very variable results. In the most thoroughly investigated patients the improvement has been moderate. The future research points to the identification of the factors that control and regulate striatal reinnervation and the use of genetically determined cells. That would permit a more precise reposition of the biochemical deficiency in Parkinson's disease, without the ethical and practical problems derived from the use of fetal tissue.
在由6-羟基多巴胺（6-OHDA）诱导造成多巴胺能黑质纹状体通路损伤的大鼠中，已证实胎儿中脑黑质纹状体植入物的组织学和功能活性。在同一模型中，肾上腺髓质植入物也有效，但持续时间较短。在由MPTP诱导患帕金森病的猴子中，有证据表明胎儿中脑植入物以及其他组织（如胎盘、交感神经节或腓肠神经）有效。现在正在评估通过作用于神经元生长因子实现更好功能恢复的可能性。在帕金森病患者中，积累的经验表明，32%的患者通过肾上腺髓质植入物有所改善，但最佳候选者是那些在无手术风险的情况下也能从现有药物治疗中获益的患者。已对约90名患者进行了胎儿组织植入，结果差异很大。在研究最深入的患者中，改善程度中等。未来的研究指向控制和调节纹状体再支配的因素的识别以及基因确定细胞的使用。这将允许更精确地纠正帕金森病中的生化缺陷，而不会产生因使用胎儿组织而产生的伦理和实际问题。
