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.

A Bosphorus submarine passage and the reinvention of neurosurgery

One of the major themes characterizing the emergence of modern neurosurgery has been the concept of technology transfer and the application of a broad spectrum of revolutionary elements of technology from both physical and biological science. These transference applications are now apparent in modern neurosurgery as it is practiced on all continents of the globe. More than 3 decades ago, these ideas that now have come to fruition were in states of formulation. This article describes and further documents one such fertile cauldron of ideas and practical realities--the United States Navy Nuclear Submarine Service and its role and affect on the life and professional career of an academic neurosurgeon who was active in areas of progress as modernity was established for the early 21st century.

Transplantation of immortalized mesencephalic progenitors (CSM14.1 cells) into the neonatal parkinsonian rat caudate putamen

The present study analyzed whether grafts of the mesencephalic progenitor cell line CSM14.1 into the neonatal rat caudate putamen (CPu) differentiate into neurons and whether this is accompanied by a functional improvement in 6-hydroxydopamine (6-OHDA)-lesioned animals. As in previous studies, a neuronal differentiation of CSM14.1 cells transplanted into the CPu of adult animals could not be observed, so we here used neonatal rats, because graft location and host age seemingly are crucial parameters for neural transplant differentiation and integration. Rats bilaterally lesioned at postnatal day 1 by intraventricular 6-OHDA-injections 2 days later received 100,000 CSM14.1 cells prelabelled with the fluorescent dye PKH26 into the right CPu. Five weeks after grafting, the cylinder test was performed, and the data compared with data from age-matched intact controls and bilaterally lesioned-only animals. Brain slices immunostained for tyrosine hydroxylase (TH) were quantified by optical densitometry. We observed a significant preference of left forelimb use exclusively in transplanted animals. In these rats, TH-containing perikarya were found in the grafted CPu, presumedly leading to the significant increase of TH-immunoreactive fibers in this region. Moreover, confocal laser microscopy revealed a differentiation of transplanted PKH26-labelled CSM14.1 cells into neuronal nuclei antigen or TH-immunoreactive cells. Thus, CSM14.1 cells differentiate into TH-containing neurons, which most probably contribute to the preferred forelimb use, indicating a functional integration of CSM14.1 cells into the host basal ganglia loops during early postnatal development. These findings that are in contrast to observations in adult rats suggest instructive cues for neuronal differentiation and integration given by the neonatal microenvironment.

Human neural stem cell transplantation in the MPTP-lesioned mouse

Human neural stem cells have exhibited a remarkable versatility to respond to environmental signals. Their characterization in models of neurotoxic injury may provide insight into human disease treatment paradigms. This study investigates the survival and migration of transplanted human stem cells and tyrosine hydroxylase immunoreactivity in the parkinsonian 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-lesioned mouse model, using antisera recognizing human nuclear protein (hNuc) and tyrosine hydroxylase (TH). Our results indicate long-term (up to 90 days) survival of human stem cell xenograft in the MPTP-lesioned mouse and the presence of hNuc-immunoreactive cells at sites distal to the transplant core. Few TH-positive cells are identified in the striatum by immunoperoxidase staining and using immunofluorescent double labeling, infrequent TH-immunoreactive, transplanted cells are identified.

Orphan neurones and amine excess: the functional neuropathology of Parkinsonism and neuropsychiatric disease

The aetiology and treatment of Parkinsonism is currently conceptualised within a dopamine (DA) deficiency-repletion framework. Loss of striatal DA is thought to cause motor impairment of which tremor, bradykinaesia and rigidity are prominent features. Repletion of deficient DA should at least minimise parkinsonian signs and symptoms. In Section 2, based on extensive pre-clinical and clinical findings, the instability of this approach to Parkinsonism is scrutinised as the existing negative findings challenging the DA deficiency hypothesis are reviewed and reinterpreted. In Section 3 it is suggested that Parkinsonism is due to a DA excess far from the striatum in the area of the posterior lateral hypothalamus (PLH) and the substantia nigra (SN). This unique area, around the diencephalon/mesencephalon border (DCMCB), is packed with many ascending and descending fibres which undergo functional transformation during degeneration, collectively labelled 'orphan neurones'. These malformed cells remain functional resulting in pathological release of transmitter and perpetual neurotoxicity. Orphan neurone formation is commonly observed in the PLH of animals and in man exhibiting Parkinsonism. The mechanism by which orphan neurones impair motor function is analogous to that seen in the diseased human heart. From this perspective, to conceptualise orphan neurones at the DCMCB as 'Time bombs in the brain' is neither fanciful nor unrealistic [E.M. Stricker, M.J. Zigmond, Comments on effects of nigro-striatal dopamine lesions, Appetite 5 (1984) 266-267] as the DA excess phenomenon demands a different therapeutic approach for the management of Parkinsonism. In Section 4 the focus is on this novel concept of treatment strategies by concentrating on non-invasive, pharmacological and surgical modification of functional orphan neurones as they affect adjacent systems. The Orphan neurone/DA excess hypothesis permits a more comprehensive and defendable interpretation of the interrelationship between Parkinsonism and schizophrenia and other related disorders.

Quantitative analysis of pro- and anti-inflammatory cytokine mRNA in neural graft rejection

The central nervous system (CNS) has been considered an immunologically privileged site. However, this concept is now changing because rejection of histoincompatible neural grafts is commonly observed in the CNS. To be able to use neural transplantation as therapy for human diseases, it is important to determine factors that are related to brain-graft rejection. In the present study, we examined the phenotype of infiltrating T cells around grafts in the cerebra that had received xenogeneic (mouse to rat) neural transplants. Furthermore, the amount of pro- and anti-inflammatory cytokine mRNA was determined by competitive PCR at various time points after the neural transplantation. Immunohistochemical examination revealed that both CD4-positive and CD8-positive T cells infiltrated the CNS parenchyma. In competitive PCR analysis, levels of IFN-gamma and perforin in xenografts on days 10 and 13 post-transplantation (PT) were higher than those in isografts (rat to rat) at the same stage, whereas the levels of TNF-alpha, which was detected only on day 7 PT, were not significantly different between the two groups. With regard to anti-inflammatory cytokines, TGF-beta1 mRNA was recognized throughout the examination period, but there was no significant difference between xeno- and iso-grafts at most time points. These findings suggest that IFN-gamma and perforin secreted by infiltrating CD4-positive and CD8-positive T cells, respectively, play an important role in neural graft rejection. The responses of anti-inflammatory cytokines seem to be nonspecific reactions to grafts or surgical procedures.

In the realm of ideas: the advent of advanced surgery of the human cerebrum and neurosurgical education

High technology has recently exerted remarkable positive forces within the field of neurological surgery. Striking developments in brain imaging, stereotaxy, molecular biology, radiation physics and complex data management promise to revolutionize surgery of the human cerebrum. These changes are not without profound impact on national health care economics and present enormous philosophical and educational challenges which will create considerable turmoil over the next decades.

The Richard C. Schneider Lecture. New dimensions of neurosurgery in the realm of high technology: possibilities, practicalities, realities

Fueled by a buoyant economy, popular attitudes and demands, and parallel progress in transferable technical and biological areas, neurosurgery has enjoyed a remarkable quarter of a century of progress. Developmental trends in the discipline have included the following: 1) a refinement of preoperative definition of the structural substrate, 2) miniaturization of operative corridors, 3) reduction of operative trauma, 4) increased effectiveness at the target site, and 5) incorporation of improved technical adjuvants and physical operative tools into treatment protocols. In particular, the computer has become a formidable ally in diagnostic and surgical events. Trends in technical development indicate that we are entering an exciting era of advanced surgery of the human cerebrum, which is heralded by the following: 1) current developments in areas of imaging, sensors, and visualization; 2) new devices for localization and navigation; 3) new capabilities for action at the target point; and 4) innovative concepts related to advanced operative venues. Imaging has provided structurally based surgical maps, which now are being given the new dimension of function in complex and integrated formats for preoperative planning and intraoperative tactical direction. Cerebral localization and navigation based on these advances promise to provide further refinement to the field of stereotactic neurosurgery, as linked systems are superseded by more flexible nonlinked methodologies in functionally defined volume-oriented navigational databases. Target point action now includes not only ablative capabilities through micro-operative methods and the use of stereotactically directed high-energy forms but also the emergence of restorative capabilities through applications of principles of genetic engineering in the areas of molecular and cellular neurosurgery. Complex, dedicated, and self-contained operative venues will be required to optimize the emergence and development of these computer-oriented micro/stereotactic capabilities, which appear to be unavoidably required as locales for the practice and development of virtual reality-based stations for operative rehearsal, simulation, training, and, ultimately, enhancement of operative events through robotic interfaces. Primary impetus for progress has relied upon new combinations of technologies, disciplines, and industries. Philosophical and practical problems include the spectrum of availability of these methods to the population at large, the training of individuals to properly administer these methods, defining the acceptable envelope of expertise, and maintaining suitable delivery and progress while containing spiraling costs. Advanced neurological surgery and the use and development of high-technology adjuvants require a robust economy that has a populace willing to invest in the luxury of such developments. The current socioeconomic situation is fragile from the standpoint of both economics and attitudes of the patients and health care providers, with diversion of economic resources, redistribution of funding bases, modification of patient referrals, practice styles, and service attitudes undermining progress. Economic pressures have brought high-technology methods under great scrutiny regarding their effectiveness and cost-effectiveness. Reform proposals have specifically targeted technology-oriented services, and the Office of Technology Assessment has recommended increasing the use of managed care providers who look to information on cost-effectiveness and clinical practice guidelines to establish efficient management strategies and issue "report cards." Although the premise is laudable and "gimmickry" needs to be identified, it might be argued that such scrutiny and control might be overbearing and overused, impeding appropriate delivery and progress.

Parkinson's disease, trophic factors, and adrenal medullary chromaffin cell grafting: basic and clinical studies

Neural transplantation is one of the promising approaches for the treatment of Parkinson's disease. Although the strategy of using adrenal medulla as donor tissue, rather than fetal nigra tissue, started as an alternative method, recent experimental studies demonstrated the efficacy of adrenal medulla grafting as a neurotrophic source. Many methods to increase the survival of grafted chromaffin cells have been developed, some of which have already been applied clinically with encouraging results. This review summarizes the advancements of adrenal medulla grafting in basic and clinical studies. Special attention is focused on the relationship with neurotrophic factors and how we can enhance the survival of grafted chromaffin cells.

Adrenal medulla in neural grafting and neural plasticity

The recent history of neural transplantation using the adrenal medulla parallels an evolution in our thinking about neural grafting as a therapeutic approach to treat neurodegenerative diseases such as Parkinson's disease. Initially, neural grafting was an approach to study development and regeneration. With the discovery that adrenal chromaffin cell grafts would ameliorate some of the motor deficits associated with the loss of striatal dopamine, adrenal grafts were used to provide dopamine to the dopamine-depleted striatum. However, subsequent studies showed poor chromaffin cell survival unless trophic factors were present at the site of transplantation. These experiments lead to the appreciation of the complex interactions between neurotrophic factors, inflammatory cytokines, the grafted tissue, and the host brain's response. Thus, we find ourselves again using neural transplantation as an approach to help us better understand central nervous system plasticity and the features this plasticity shares in common with development and regeneration.

Scientific and ethical concerns in neural fetal tissue transplantation

This report presents a brief overview of the medical and ethical issues involved with the procurement, preparation, safety, efficacy, and subject protection of human fetal central nervous system tissue in the context of neural transplantation. The ethical perspectives from which to view the clinical use of fetal tissue include the following: 1) that fetal tissue from elective abortions is a surgical specimen; 2) that the use of such tissue involves fetal experimentation in which the fetus is a subject; and 3) that fetal tissue is considered as a cadaveric organ specimen, similar to other organs, but with special considerations compared with adult cadaveric tissue. The latter approach appears to be the most applicable and is parallel to the use of cadaveric organs and tissues after a declaration of brain death. Additional issues include the following: 1) the safety and quality of fetal tissue for implantation; 2) the hypothesis that "legitimization" and "redemption" (potentially positive effects of tissue donation in general) may lead to an increase in elective abortion rates; 3) the ethical issues of the validity and value of human experimentation involving neural grafting; and 4) the type of consent to be obtained and the appropriate timing. Elective abortions, however, probably will continue to be the primary source of fetal tissue for grafting for some time, until other tissue sources become available.

Long-term follow-up of adrenal medullary transplantation for Parkinson's disease

Long-term follow-up of eight patients who underwent stereotactic grafting of adrenal medullary tissue into unilateral or bilateral caudate nuclei is presented. We demonstrate that this procedure can be performed with minimal risk. Our results show little benefit when the group as a whole is analyzed. A subgroup of four patients was identified who responded to the procedure, as evidenced by a reduction in motor scores, reduction in medication requirements, and greater "on" time. Three of these patients continue to accrue benefit after 2 years. No characterization of a responder profile was evident. We conclude that a modest benefit is derived from this procedure that may persist for as long as 2 years. Future clinical studies to evaluate grafting procedures are encouraged.

The effect of a new immunosuppressive agent, FK-506, on xenogeneic neural transplantation in rodents

This study examines the effect of a novel immunosuppressive agent FK-506 (FK) on the survivability of embryonic (E14) rat ventral mesencephalic tissue after intracerebral grafting to the lateral ventricle of adult mice. The recipient mice were given FK in doses of 10 mg/kg or 1 mg/kg for 2 weeks postgrafting, at which time they were sacrificed and histologically processed except for one group of animals on the high dose (10 mg/kg). In this group most animals died from side effects of the drug during the following days. Only the mice receiving the high dose of FK displayed healthy grafts without signs of rejection.

The use of genetically altered astrocytes to provide nerve growth factor to adrenal chromaffin cells grafted into the striatum

Transplantation of adrenal chromaffin cells into the striatum of Parkinson's disease patients is unlikely to become a reliable therapy unless techniques are devised to improve cell survival. To address this issue, we investigated the use of genetically altered astrocytes that constitutively secrete beta-nerve growth factor (NGF) to provide trophic support for adrenal chromaffin cells grafted into the dopamine-denervated striatum of the rat. Primary rat astrocytes were altered genetically in vitro by infection with a retroviral vector harboring a mouse beta-NGF transgene under constitutive long terminal repeat transcriptional control. Confluent cultures of these genetically altered astrocytes secrete NGF into their culture medium at a rate of approximately 9 pg/10(5) cells/h. This rate of NGF secretion is at least 10-fold higher than that of confluent sister cultures of uninfected astrocytes. The effects of the NGF-secreting astrocytes on the survival and neuronal transformation of dissociated adrenal chromaffin cells were assessed in vitro and following transplantation into the dopamine-denervated striatum of the adult rat. In vitro experiments demonstrated that neuritic outgrowth is stimulated when postnatal day 12 chromaffin cells are grown on a monolayer of the genetically altered astrocytes. When co-grafted with genetically altered astrocytes, young postnatal chromaffin cells displayed extensive neuritic outgrowth within the host brain 2 weeks postimplantation, whereas chromaffin cells grafted alone or with normal astrocytes retain an endocrine-like morphology. Survival of the chromaffin cells is also enhanced 3-6-fold when co-grafted with the genetically altered astrocytes. In addition, the neuronally transformed chromaffin cells appear to lose adrenergic properties as assessed by diminished immunoreactivity to the adrenergic marker, phenylethanolamine-N-methyltransferase. Although their survival is also enhanced approximately 4-fold relative to controls, adult chromaffin cells do not convert to a neuronal morphology when co-grafted with the genetically altered astrocytes. These studies demonstrate that rat astrocytes carrying a mouse NGF transgene provide trophic support for intrastriatal chromaffin cell grafts.

Neural transplantation for Parkinson's disease: a critical appraisal

The medical treatment of severe Parkinson's disease is presently problematical and neural transplantation has been proposed as an additional therapy. While functional improvement in animal models of Parkinson's disease has been reported following neural grafting, the treatment of human Parkinsonian patients by adrenal medulla autografting into the neostriatum has produced little clinical improvement overall, and is associated with significant morbidity. Although recent grafting of human foetal dopaminergic neurons has shown more promise, many of the case reports lack rigorous assessment and long term follow-up. Further laboratory experimentation in animal models, particularly primates, to ascertain the mechanism of action of the grafts, the optimal sites for grafting, and the immunological responses to grafting, is essential. The future success of neural transplantation for Parkinson's disease may depend on the development of novel strategies such as the use of growth factors to aid cell survival, regulate neurotransmitter levels and promote connectivity. However, at present, the clinical application of neural transplantation for Parkinson's disease is premature.

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.