Family doctor

The key to a breakthrough in Parkinson's Disease could lie in using the brain's own dormant cells, according to New Zealand professor of anatomy Richard Faull.

Professor Faull has told a recent Parkinson's Disease conference in Auckland that while transplanting cells from aborted fetuses into those with parkinsonism has shown almost miraculous results in some cases, there are a lot of ethical problems with using terminated fetuses.

Instead, professor Faull believes a breakthrough in the treatment of Parkinson's disease lies in the possibility of getting an individual's own primitive brain cells to start producing the brain chemical, dopamine, or to stop those cells from dying, or getting the cells to live longer.

People with Parkinson's disease have a shortage of dopamine which leads to incorrect messages being sent to the movement control centre in the brain, causing tremors, stiffness and slow movement.

Faull said in future it may be possible to culture the brain's own immature cells and turn them into dopamine producing cells and then transfer them back to the patient.

Currently the main treatment for Parkinson's disease is the use of the drug levodopa which is converted into dopamine in the brain. However, the problem with this drug and similar therapies is that they lose their effectiveness over time.

Faull said there had been a recent resurgence in the use of brain surgery to control symptoms of Parkinson's disease, with the development of more advanced scanning technology. These operations were highly successful in certain groups of patients.

The operations known as thalamotomy and pallidotomy involve the use of a probe to destroy a tiny part of the brain which is involved in the symptoms of Parkinson's disease.

Another operation has been developed which involves use of a device, similar to a pacemaker, to stimulate the same area of the brain, which is likely become more widespread for some groups of patients in future.

The mechanical device is inserted into the collar bone with a wire attached to the deep part of the brain responsible for sending incorrect messages to the movement centre. The patient can use a magnet rubbed over the device to turn it on and off, and to stimulate the area when necessary.

So far, professor Faull said the transplant of fetal cells into the brain to start producing dopamine had shown a lot of promise.

"These embryonic cells will actually grow and survive and will produce new connections and they will produce chemicals but they have to be very young immature cells."

However, he has outlined several reasons why this is unlikely to become an accepted medical treatment at this stage; including ethical problems, poor cell survival, availability of abortion tissue and variable evaluation methods.

Parkinson's disease effects about one in 10,000 people and while the average onset is over the age of 55, the disease is beginning to show in younger people. The reason for this is unknown.

Faull believes the best hope of an effective treatment in Parkinson's Disease is to prevent the dopamine cells from dying or finding a way to turn on the brain's own immature cells which do nothing and make them produce dopamine.

Professor Faull's own research at Auckland Medical School has shown the ability to prevent dopamine cells from dying in rats treated with growth factors. However, it will be several years before the trials of the growth factors can begin on humans.

Another possibility for the future is taking the brain's dormant, immature cells and culturing them in the laboratory by instructing them with genetic information to make dopamine and then transferring them back to the patient. Professor Faull said this technology has the potential to work for several medical conditions.