DOPAMINERGIC TRANSPLANTS IN PATIENTS WITH PARKINSONS-DISEASE - NEUROANATOMICAL CORRELATES OF CLINICAL RECOVERY

For the past 15 years, patients with Parkinson's disease have particip ated in clinical trials evaluating the efficacy of intrastriatal dopam ine transplants. Principally, two donor tissues have been employed, th e chromaffin cells of the adrenal medulla and fetal ventral mesencepha lon. The clinical response following each type of transplant has been variable. In general, the magnitude and the duration of the clinical r esponse is greater with fetal dopaminergic neurons than with adrenal m edullary grafts. Postmortem studies of patients receiving adrenal medu llary grafts or fetal nigral implants provide a neuroanatomical framew ork for the clinical response. Adrenal grafts survive poorly following implantation into the striatum, but they are capable of inducing spro uting of host-derived fibers within the caudate nucleus. In contrast, robust survival of fetal nigral implants can be achieved within the hu man brain which can provide extensive reinnervation to the parkinsonia n striatum. These findings are strikingly similar to what has been see n in rodent and nonhuman primate models of PD. This paper describes th e neuroanatomical correlates of dopamine brain grafting in humans and elucidates the pattern of changes seen in dopaminergic systems which a re associated with clinical benefit. (C) 1997 Academic Press.