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The long-term safety and efficacy of bilateral transplantation of human fetal striatal tissue in patients with mild to moderate Huntington’s disease

Authors

Barker, Roger A, Mason, Sarah L., Harrower, Timothy P., Swain, Rachel A., Ho, Aileen K., Sahakian, Barbara J., Mathur, Raj, Elneil, Sohier, Thornton, Steven, Hurrelbrink, Carrie, Armstrong, Richard J., Tyers, Pam, Smith, Emma, Carpenter, Adrian, Piccini, Paola, Tai, Yen F., Brooks, David J., Pavese, Nicola, Watts, Colin, Pickard, John D., Rosser, Anne E., Dunnett, Stephen B.

Journal

Journal Of Neurology, Neurosurgery, And Psychiatry, Volume: 84, No.: 6, Pages.: 657-665

Year of Publication

2013

Abstract

Huntington’s disease (HD) is a fatal autosomal dominant neurodegenerative disease involving progressive motor, cognitive and behavioural decline, leading to death approximately 20 years after motor onset. The disease is characterised pathologically by an early and progressive striatal neuronal cell loss and atrophy, which has provided the rationale for first clinical trials of neural repair using fetal striatal cell transplantation. Between 2000 and 2003, the ‘NEST-UK’ consortium carried out bilateral striatal transplants of human fetal striatal tissue in five HD patients. This paper describes the long-term follow up over a 3-10-year postoperative period of the patients, grafted and non-grafted, recruited to this cohort using the ‘Core assessment program for intracerebral transplantations-HD’ assessment protocol. No significant differences were found over time between the patients, grafted and non-grafted, on any subscore of the Unified Huntington’s Disease Rating Scale, nor on the Mini Mental State Examination. There was a trend towards a slowing of progression on some timed motor tasks in four of the five patients with transplants, but overall, the trial showed no significant benefit of striatal allografts in comparison with a reference cohort of patients without grafts. Importantly, no significant adverse or placebo effects were seen. Notably, the raclopride positron emission tomography (PET) signal in individuals with transplants, indicated that there was no obvious surviving striatal graft tissue. This study concludes that fetal striatal allografting in HD is safe. While no sustained functional benefit was seen, we conclude that this may relate to the small amount of tissue that was grafted in this safety study compared with other reports of more successful transplants in patients with HD.;

Bibtex Citation

@article{Barker_2013, doi = {10.1136/jnnp-2012-302441}, url = {http://dx.doi.org/10.1136/jnnp-2012-302441}, year = 2013, month = {jan}, publisher = {{BMJ}}, volume = {84}, number = {6}, pages = {657--665}, author = {R. A. Barker and S. L. Mason and T. P. Harrower and R. A. Swain and A. K. Ho and B. J. Sahakian and R. Mathur and S. Elneil and S. Thornton and C. Hurrelbrink and R. J. Armstrong and P. Tyers and E. Smith and A. Carpenter and P. Piccini and Y. F. Tai and D. J. Brooks and N. Pavese and C. Watts and J. D. Pickard and A. E. Rosser and S. B. Dunnett and S. Simpson and J. Moore and P. Morrison and T. Esmonde and N. Chada and D. Craufurd and J. Snowdon and J. Thompson and P. Harper and R. Glew and R. Harper}, title = {The long-term safety and efficacy of bilateral transplantation of human fetal striatal tissue in patients with mild to moderate Huntington{textquotesingle}s disease}, journal = {Journal of Neurology, Neurosurgery {&} Psychiatry} }

Keywords

adult, adverse effects, brain tissue transplantation, corpus striatum, embryology, female, fetal, fetal tissue transplantation, function, human, humans, huntington disease, huntingtons, male, methods, middle aged, motor, neuropsychological tests, striatal, surgery, tissue, transplantation, treatment outcome

Countries of Study

UK

Types of Dementia

Huntingtons

Types of Study

Before and After Study

Type of Outcomes

ADLs/IADLs

Type of Interventions

Non-pharmacological Treatment

Non-Pharmaceutical Interventions

Other