Safety and tolerability assessment of intrastriatal neural allografts in five patients with Huntington's disease

This study describes issues related to the safety and tolerability of fetal striatal neural allografts as assessed in five patients with Huntington's disease. Huntington's disease (HD) is characterized by motor, cognitive, an d behavioral disturbances. The latter include psychological disturbances an d, as a consequence, we took particular care to analyze behavioral changes, in addition to the usual "safety" follow-up. We conducted multidisciplinar y follow-up at least 2 years before and 1 year after grafting. Psychologica l care extended to close relatives. The grafting procedure itself was altog ether safe and uneventful, and there were no apparent clinical deleterious effects for 1 year, The immunosuppressive treatment, however, was complicat ed by various problems (irregular compliance, errors of handling, side effe cts). Direct psychological consequences of the transplantation procedure we re rare and not worrisome, although mood alteration requiring treatment was observed in one patient. Indirectly, however, the procedure required patie nts and relatives to accept constraints that tended to complicate familial situations already marred by aggressivity and depression. All patients and close relatives expressed major expectations, in spite of our strong and re peated cautioning. It is clearly important to be aware of these particular conditions since they may eventually translate into psychological difficult ies in coping with the long-term clinical outcome of the procedure, if not beneficial. Despite an overall good tolerance, therefore, this follow-up ca lls for caution regarding the involvement of HD patients in experimental su rgical protocols. (C) 2000 Academic Press.