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Barker RA, Björklund A. Restorative cell and gene therapies for Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:211-226. [PMID: 36803812 DOI: 10.1016/b978-0-323-85555-6.00012-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
One of the core pathological features of Parkinson's disease (PD) is the loss of the dopaminergic nigrostriatal pathway which lies at the heart of many of the motor features of this condition as well as some of the cognitive problems. The importance of this pathological event is evident through the clinical benefits that are seen when patients with PD are treated with dopaminergic agents, at least in early-stage disease. However, these agents create problems of their own through stimulation of more intact dopaminergic networks within the central nervous system causing major neuropsychiatric problems including dopamine dysregulation. In addition, over time the nonphysiological stimulation of striatal dopamine receptors by l-dopa containing drugs leads to the genesis of l-dopa-induced dyskinesias that can become very disabling in many cases. As such, there has been much interest in trying to better reconstitute the dopaminergic nigrostriatal pathway using either factors to regrow it, cells to replace it, or gene therapies to restore dopamine transmission in the striatum. In this chapter, we lay out the rationale, history and current status of these different therapies as well as highlighting where the field is heading and what new interventions might come to clinic in the coming years.
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Affiliation(s)
- Roger A Barker
- Department of Clinical Neuroscience, Cambridge Centre for Brain Repair, Cambridge, United Kingdom.
| | - Anders Björklund
- Developmental and Regenerative Neurobiology, Department of Experimental Medical Science, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
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Mechanistic Insight from Preclinical Models of Parkinson's Disease Could Help Redirect Clinical Trial Efforts in GDNF Therapy. Int J Mol Sci 2021; 22:ijms222111702. [PMID: 34769132 PMCID: PMC8583859 DOI: 10.3390/ijms222111702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Parkinson’s disease (PD) is characterized by four pathognomonic hallmarks: (1) motor and non-motor deficits; (2) neuroinflammation and oxidative stress; (3) pathological aggregates of the α-synuclein (α-syn) protein; (4) neurodegeneration of the nigrostriatal system. Recent evidence sustains that the aggregation of pathological α-syn occurs in the early stages of the disease, becoming the first trigger of neuroinflammation and subsequent neurodegeneration. Thus, a therapeutic line aims at striking back α-synucleinopathy and neuroinflammation to impede neurodegeneration. Another therapeutic line is restoring the compromised dopaminergic system using neurotrophic factors, particularly the glial cell-derived neurotrophic factor (GDNF). Preclinical studies with GDNF have provided encouraging results but often lack evaluation of anti-α-syn and anti-inflammatory effects. In contrast, clinical trials have yielded imprecise results and have reported the emergence of severe side effects. Here, we analyze the discrepancy between preclinical and clinical outcomes, review the mechanisms of the aggregation of pathological α-syn, including neuroinflammation, and evaluate the neurorestorative properties of GDNF, emphasizing its anti-α-syn and anti-inflammatory effects in preclinical and clinical trials.
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Lungu C, Cedarbaum JM, Dawson TM, Dorsey ER, Faraco C, Federoff HJ, Fiske B, Fox R, Goldfine AM, Kieburtz K, Macklin EA, Matthews H, Rafaloff G, Saunders-Pullman R, Schor NF, Schwarzschild MA, Sieber BA, Simuni T, Surmeier DJ, Tamiz A, Werner MH, Wright CB, Wyse R. Seeking progress in disease modification in Parkinson disease. Parkinsonism Relat Disord 2021; 90:134-141. [PMID: 34561166 DOI: 10.1016/j.parkreldis.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Disease modification in Parkinson disease (PD) has remained an elusive goal, in spite of large investments over several decades. Following a large meeting of experts, this review article discusses the state of the science, possible reasons for past PD trials' failures to demonstrate disease-modifying benefit, and potential solutions. METHODS The National Institute of Neurological Disorders and Stroke (NINDS) convened a meeting including leaders in the field and representatives of key stakeholder groups to discuss drug therapy with the goal of disease modification in PD. RESULTS Important lessons can be learned from previous attempts, as well as from other fields. The selection process for therapeutic targets and agents differs among various organizations committed to therapeutic development. The areas identified as critical to target in future research include the development of relevant biomarkers, refinements of the targeted patient populations, considerations of novel trial designs, and improving collaborations between all stakeholders. CONCLUSIONS We identify potential barriers to progress in disease modification for Parkinson's and propose a set of research priorities that may improve the likelihood of success.
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Affiliation(s)
- Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 6001 Executive Blvd, #2188, Rockville, MD, 20852, USA.
| | | | - Ted M Dawson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Ray Dorsey
- University of Rochester Medical Center, Rochester, NY, USA
| | - Carlos Faraco
- Division of Clinical Research, NINDS, NIH, Bethesda, MD, USA
| | | | - Brian Fiske
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Robert Fox
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Karl Kieburtz
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | | | | | | | | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dalton J Surmeier
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amir Tamiz
- Division of Translational Research, NINDS, NIH, Bethesda, MD, USA
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Barker RA, Björklund A, Gash DM, Whone A, Van Laar A, Kordower JH, Bankiewicz K, Kieburtz K, Saarma M, Booms S, Huttunen HJ, Kells AP, Fiandaca MS, Stoessl AJ, Eidelberg D, Federoff H, Voutilainen MH, Dexter DT, Eberling J, Brundin P, Isaacs L, Mursaleen L, Bresolin E, Carroll C, Coles A, Fiske B, Matthews H, Lungu C, Wyse RK, Stott S, Lang AE. GDNF and Parkinson's Disease: Where Next? A Summary from a Recent Workshop. JOURNAL OF PARKINSON'S DISEASE 2020; 10:875-891. [PMID: 32508331 PMCID: PMC7458523 DOI: 10.3233/jpd-202004] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
The concept of repairing the brain with growth factors has been pursued for many years in a variety of neurodegenerative diseases including primarily Parkinson's disease (PD) using glial cell line-derived neurotrophic factor (GDNF). This neurotrophic factor was discovered in 1993 and shown to have selective effects on promoting survival and regeneration of certain populations of neurons including the dopaminergic nigrostriatal pathway. These observations led to a series of clinical trials in PD patients including using infusions or gene delivery of GDNF or the related growth factor, neurturin (NRTN). Initial studies, some of which were open label, suggested that this approach could be of value in PD when the agent was injected into the putamen rather than the cerebral ventricles. In subsequent double-blind, placebo-controlled trials, the most recent reporting in 2019, treatment with GDNF did not achieve its primary end point. As a result, there has been uncertainty as to whether GDNF (and by extrapolation, related GDNF family neurotrophic factors) has merit in the future treatment of PD. To critically appraise the existing work and its future, a special workshop was held to discuss and debate this issue. This paper is a summary of that meeting with recommendations on whether there is a future for this therapeutic approach and also what any future PD trial involving GDNF and other GDNF family neurotrophic factors should consider in its design.
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Affiliation(s)
- Roger A. Barker
- Cambridge Centre for Brain Repair, Department of Clinical Neuroscience and WT-MRC Cambridge Stem Cell Institute, Cambridge, UK
| | | | - Don M. Gash
- Professor Emeritus of Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Alan Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol and Neurological and Musculoskeletal Sciences Division, North Bristol NHS Trust, Bristol, UK
| | | | - Jeffrey H. Kordower
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Krystof Bankiewicz
- Neurological Surgery, Gilbert and Kathryn Mitchell Endowed Chair, Director, Brain Health and Performance Center, The Ohio State University, Department of Neurological Surgery, Columbus, OH, USA
| | - Karl Kieburtz
- Center for Health & Technology, and the Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mart Saarma
- Institute of Biotechnology, HiLIFE, University of Helsinki, Helsinki, Finland
| | | | - Henri J. Huttunen
- Herantis Pharma Plc, Finland
- Neuroscience Center, HiLIFE, University of Helsinki, Finland
| | | | | | - A. Jon Stoessl
- Pacific Parkinson’s Research Centre & Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Howard Federoff
- School of Medicine, Susan and Henry College of Health Sciences, University of California, Irvine and CEO, Aspen Neuroscience, San Diego, CA, USA
| | | | | | - Jamie Eberling
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | - Patrik Brundin
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | | | - Leah Mursaleen
- The Cure Parkinson’s Trust, London, UK
- School of Life Sciences, University of Westminster, UK and School of Pharmacy, University College London, UK
| | | | | | - Alasdair Coles
- Department of Clinical Neuroscience, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Brian Fiske
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, USA
| | | | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Rockville, MD, USA
| | | | | | - Anthony E. Lang
- The Edmond J Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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