Combining cell transplants or gene therapy with deep brain stimulation for Parkinson’s disease.
Rowland NC, Starr PA, Larson PS, Ostrem JL, Marks WJ Jr, Lim DA Combining cell transplants or gene therapy with deep brain stimulation for Parkinson’s disease. Movement Disorders, Mov Disord. 2014 Dec 17. doi: 10.1002/mds.26083.
Review: Parkinson’s disease (PD) affects 1-2% of people over 60 and is a very costly disease to treat. Current treatment reduces symptoms but does not stop or slow the disease nor reverse the neuronal loss that occurs. This article presents a “conceptual framework” for cell transplant or gene therapy in combination with current medicinal and surgical treatments that may actually address the neuronal loss in PD. Prior research has not shown great effectiveness with such therapy. The cell treatments have shown improvement over time, however, and may prove to be beneficial with continued randomized trials. A similar route was tried and proven beneficial with deep brain stimulation (DBS) and medications for reduction of symptoms of PD. The authors suggest that adding a third treatment to DBS and medications may continue the symptom reduction as well as address the neuronal loss. One challenge with randomized trials studying cell transplants is having a group that does not receive therapy to compare to the group that does. Some researchers have excluded patients that have undergone DBS, as it has been shown to be a very effective symptom reducing treatment. People with PD (PWP) may not want to volunteer for cell transplant trials as they may prefer to undergo the symptom reducing treatment to improve their quality of life rather than try an experimental treatment that 1. may not show improvement for “months or years” and 2. may have a variety of risk factors. The authors suggest that future studies could complete DBS and cell transplant at the same time in surgery for one group and only complete DBS for a second group. This approach would permit both groups to receive desired symptom reduction treatment, and provide a way to compare the effectiveness of the additional gene therapy treatment. The dual DBS/cell transplant option would also reduce the cost of such a clinical trial as the DBS surgery is already covered by healthcare systems. This approach would likely be more amenable to approval by research regulating bodies, as the patient would not need an additional surgery for the experimental treatment; the patient could have both surgeries completed at the same time, reducing many risks for the PWP. The addition of cell transplants or gene therapies may prove to be yet another step forward in the treatment of PD, improving the quality of life for many PWP.