A new experimental treatment for stroke victims is being tested at the University of Pittsburgh. The treatment involves the delicate implantation of nerve cells in the region of the brain damaged by stroke. The trial began in June of 1998 and twelve implant surgery treatments have been made so far. The hope is that the implanted nerve cells will restore function to the area of the brain damaged by the stroke. This may allow stroke victims to regain some lost capabilities such as use of a hand or repair of faulty memory.
Douglas Kondziolka is the neurosurgeon at the University of Pittsburgh Medical Center who is leading the study and performing the treatments. Dr. Kondziolka has specialized in minimally invasive brain surgery including tumor biopsies, nerve injections, and delicate operations for Parkinson's disease. Each of these treatments is performed through fine needles using computed tomography (CT) image guidance and a stereotactic frame mounted on the patient's head to create a physical landmark on the CT images.
CT guidance using the stereotactic frame is a critical component of this experimental procedure. Doctors must first screw a rigid metal frame into the bones of the patient's skull. The process of mounting a stereotactic frame to a patient's head is routine in the treatment of other brain disorders such as the radiotherapy of brain cancer and other brain tumors. The stereotactic frame and CT images aid surgeons in the precise physical guidance of long, fine needles into the small portion of the brain injured by the stroke.
The basis of this treatment started in 1984 when cell biologist Peter W. Andrews found that he could use retinoic acid (a chemical related to vitamin A) to coax embryonal cancer cells to turn into neurons (nerve cells). Layton BioScience has produced the laboratory-grown nerve cells under license. These cells have now been used in the dozen treatments performed as part of the trial.
It will take several years, and several more studies involving many dozens of patients, before researchers will know for certain whether this treatment can help to repair the devastation left by a stroke. To date the only conclusion Dr. Kondziolka has reached from the initial study is that implanting these cells into the brains of stroke victims does not seem to make their condition any worse.
After the surgery, patients are studied with PET scanning and functional magnetic resonance imaging to see whether the implants have produced any visible change in the way the damaged portions of their brains are working. Three of the patients believe the treatment has made them better, yet the gains are small and scarcely noticeable on objective tests of neurologic function. Dr. Kondziolka's biggest fear was that the implant surgery might produce complications such as bleeding, infection, rejection of the foreign cells, even worsening of the existing brain damage. However, the only common side effect so far has been fatigue related to cyclosporine, a drug that patients take for eight weeks after surgery to keep the immune system from rejecting the implanted cells.
Dr. Kondziolka says that in the future other researchers may test such implants to treat spinal cord injuries and Huntington's disease, a degenerative brain disorder.
For more information on this experimental treatment, please see the March 9, 1999 Washington Post article "Brain Repair: Doctors Implant Transformed Cancer Cells to Boost Recovery From Stroke," By Susan Okie. This article may be found at the Washington Post website at http://www.washingtonpost.com/wp-srv/WPlate/1999-03/09/150l-030999-idx.asp
Updated: January 27, 2000
