Adrenal medullary autograft in human brain for Parkinson's disease

Long-Term Viability of Isolated Bovine Adrenal Medullary Chromaffin Cells following Intrastriatal Transplantation

Adrenal medullary grafts generally exhibit poor viability when grafted into the striatum. Previous work in our laboratory demonstrated that chromaffin cells can survive well for up to 2 mo following grafting into the intact rat striatum after cells are isolated from the nonchromaffin supporting cells (fibroblasts and endothelial cells) of the adrenal medulla. The aim of the present study was to assess the long-term viability of isolated bovine chromaffin cells following grafting into the intact rat striatum. The viability of grafted bovine adrenal medullary chromaffin cells was compared in rats receiving either (a) perfused adrenal medulla; (b) isolated chromaffin cells; or (c) isolated chromaffin cells that were subsequently recombined with their nonchromaffin supporting cells. One year postimplantation, all graft types which included fibroblasts and endothelial cells were infiltrated with macrophages and demonstrated an abundance of cellular debris. No viable chromaffin cells were observed. In contrast, healthy tyrosine hydroxylase (TH) and dopamine beta hydroxylase (DβH) immunoreactive chromaffin cells survived for 1 yr posttransplantation when grafted in isolation from the nonchromaffin constituents of the adrenal medulla. Good xenograft survival was achieved in this group despite the fact that these rats were only immunosuppressed for 1 mo postimplantation. Grafted cells demonstrated morphological characteristics of chromaffin cells in situ and these implants were not accompanied by macrophage infiltration. These data demonstrate that long-term survival of chromaffin cells can be achieved following intrastriatal implantation and the viability of grafted chromaffin cells is dependent upon the removal of the nonchromaffin supporting cells.

Neuropathological study 16 years after autologous adrenal medullary transplantation in a Parkinson's disease patient

To date, there is no clinicopathological correlation of adrenal medullary transplant cases in patients with survival beyond a few years. Postmortem examination of a brain from a patient with Parkinson's disease (PD), 16 years after autologous adrenal medullary transplant, was performed using tyrosine hydroxylase (TH) and chromogranin A. The patient experienced a four-year initial improvement in motor function followed by resumption of the progressive nature of her disease that continued until her death. She expired 16 years following grafting. At autopsy, TH stain of the brain revealed severe loss of TH-immunoreactivity in the substantia nigra and Lewy bodies, confirming the diagnosis of PD. The transplant site was identified by the presence of scarring and there was complete absence of any TH staining cells at the site of the transplant. There were few surviving cells staining with chromogranin A. The absence of TH-staining cells in the transplant 16 years after surgery provides further evidence that adrenal medullary transplants do not survive in the long term.

Adrenal medullary "ribbon" grafts in non-human primates: transplant method

A novel stereotaxic method permits the transplantation of autologous adrenal medullary tissue into the brain parenchyma in longtailed macaques. Long, narrow "ribbons" of intact medullary tissue are drawn into a 19 gauge needle by suction and deposited in the caudate, putamen or substantia nigra without collapsing their linear conformation. Methods of dissection, preparation of medullary ribbons, stereotaxic insertion, and chronic intracerebroventricular treatment are described in detail. The ribbon method consistently yields a large amount of viable adrenal tissue after the 4-8 week survival times tested. Although further development is necessary before this method can be applied in humans, the results suggest that autologous adrenal tissue may be viable when transplanted in human parkinsonian patients according to these methods.

Unfavorable outcome of adrenal medullary transplant for Parkinson's disease

A 45-year-old woman with moderately severe parkinsonism underwent adrenal medullary autograft to the brain. The operation was performed in Mexico City. There were multiple post-operative complications, including worsening of the parkinsonism with almost complete loss of ability to communicate. Death from bronchopneumonia occurred 13 months after surgery. At autopsy the surgical tract was found to extend through the corpus callosum and into the thalamus on the opposite side. Residual necrotic adrenal tissue was found as a small round well-defined mass in the ventricle loosely attached to the left fornix. This case emphasizes the obvious risks of this still experimental procedure and the difficulties in obtaining a surviving and functional adrenal medullary graft.

Putative chromaffin cell survival and enhanced host-derived TH-fiber innervation following a functional adrenal medulla autograft for Parkinson's disease

We report heretofore undescribed clinical and histological features of a patient with idiopathic Parkinson's disease who showed marked and persistent motoric benefit from an adrenal medulla autograft for 18 months following grafting. The patient returned to the preoperative level of disability prior to his death 30 months after implantation, the longest survival to date for an adrenal transplant. The graft site was primarily necrotic and large numbers of macrophages were still present at the time of death. A few tyrosine hydroxylase-immunoreactive cells were found within the graft, providing the first evidence that adrenal medullary cells may be viable and produce catecholamines following human transplantation. A dense network of tyrosine hydroxylase-immunoreactive terminals and processes was also seen ventral to the implant site and on both of its lateral borders. This response may represent sprouting by residual host dopaminergic neurons mediated by the vigorous response to injury displayed by the host striatum. The relative paucity of surviving chromaffin cells, however, provides further evidence that adrenal medulla grafts survive poorly following intracerebral implantation, and factors other than dopamine replacement may be responsible for most of the functional effects observed following chromaffin cell transplantation.

Extensive survival of chromaffin cells in adrenal medulla "ribbon" grafts in the monkey neostriatum

Experimental neurosurgical implantation of adrenal medulla tissue has been performed as a treatment for Parkinson's disease at several medical centers around the world, and similar techniques have been applied in a small number of nonhuman primates. None of these efforts to date has resulted in histological evidence of significant graft survival, and behavioral improvement in patients has been modest at best. The present series of experiments, however, has led to a novel and effective technique for stereotaxic implantation of long, narrow "ribbons" of autologous adrenal tissue in the monkey caudate and putamen nuclei. The survival and enzymatic activity of large portions of intact grafted ribbons have been demonstrated by tyrosine hydroxylase immunohistochemistry. Efforts based on other grafting techniques resulted in poor or mediocre survival, reminiscent of previously published results. Successful grafts, on the contrary, were morphologically similar to intact adrenal medulla tissue, except that neuronal processes were observed emanating from some of the transplanted cells. The success of the present technique, which minimally distorts or traumatizes adrenal and brain tissue, may be due primarily to the rapid establishment of a blood supply by anastomosis with host vessels. In most monkeys, nerve growth factor was also administered to the lateral ventricle for the duration of the graft, but excellent results were also achieved in the monkey that did not receive such treatment. We conclude that adrenal grafts made by the present technique can survive and function in primates.

Adrenal to caudate transplantation--postmortem study

A patient with Parkinson's disease who had undergone bilateral adrenal to caudate implantation by stereotactic technique came to autopsy. The implantation was shown to have produced minimal trauma and to have been well placed. Minimal surviving adrenal medullary tissue remained in the implanted coil, and no outgrowth of tissue into the striatum occurred.

Autotransplantation of superior cervical ganglion to the caudate nucleus in three patients with Parkinson's disease (preliminary report)

Striatal cervical ganglionic implants have been utilized for the first time for treatment of three patients suffering from Parkinson's disease. Tissue grafts from the superior cervical ganglion have been dissected and immediately transplanted into the head of the caudate nucleus. The grafted tissue placed in a cavity of the caudate nucleus remains in contact with the cerebrospinal fluid in the lateral ventricle. Three and six months after surgery, none of the patients has had any major complications and their lower score of Unified Parkinsonism Rating Scale (UPRS) points was associated with an improvement of the signs of Parkinson's disease. Present data have provided some optimism that grafting of superior cervical ganglion is a feasible approach in Parkinson's disease.