Petruk K C, Wilson A F, Schindel D R, Witt N J, McLean D R, McFarland P A, Johnston R G, McPhee M S, Martin W R, Calne D B
University of Alberta, Canada.
Prog Brain Res. 1990;82:671-6. doi: 10.1016/s0079-6123(08)62658-8.
Treatment of refractory PD with autologous adrenal medullary implants utilizing two-stage surgery warrants further investigation. This transplantation technique is associated with prolonged transplant area BBB disruption which may require a change in medical treatment strategies including the withdrawal of peripheral dopa decarboxylase inhibitors and possible intravenous or intraventricular dopamine therapy. Of 5 patients receiving adrenal medullary transplants, 3 have demonstrated varying degrees of clinical improvement which has persisted for the duration of the study. The positive correlation between clinical outcome and caudate function (i.e., 6-fluorodopa PET scans) suggests a positive influence of the transplantation procedure on the diseased striatum. Whether or not the grafted tissue remains viable for an extended period is currently being investigated utilizing 6-FDG-PET studies. Because of the presence of persistent BBB disruption, we surmise that at least viability of implanted fenestrated adrenal medullary capillaries exists. We conclude that this prolonged leakage is the result of the implanted tissue rather than the cavitation procedure as prolonged BBB disruption was not witnessed in a control group of patients with post-traumatic cerebral contusions or in Parkinson's patients subjected to thalamotomies. Whether two-stage surgery results in increased graft viability, and host neuronal sprouting, leading to prolonged clinical improvement and slowing the progression of PD awaits continued longitudinal (greater than 24 months) studies.
采用两阶段手术进行自体肾上腺髓质植入治疗难治性帕金森病值得进一步研究。这种移植技术与移植区域血脑屏障的长期破坏有关，这可能需要改变治疗策略，包括停用外周多巴脱羧酶抑制剂以及可能采用静脉或脑室内多巴胺治疗。在5例接受肾上腺髓质移植的患者中，3例已表现出不同程度的临床改善，且在研究期间持续存在。临床结果与尾状核功能（即6-氟多巴PET扫描）之间的正相关表明移植手术对患病纹状体有积极影响。目前正在利用6-FDG-PET研究来调查移植组织是否能长期存活。由于血脑屏障持续破坏，我们推测至少植入的有窗孔的肾上腺髓质毛细血管是存活的。我们得出结论，这种长期渗漏是植入组织的结果，而非空洞形成手术所致，因为在创伤后脑挫伤患者的对照组或接受丘脑切开术的帕金森病患者中未观察到血脑屏障的长期破坏。两阶段手术是否会提高移植组织的存活率以及宿主神经元的发芽，从而导致临床改善持续时间延长并减缓帕金森病的进展，有待继续进行纵向（超过24个月）研究。
