It’s common for TV to fast-track medical innovation. Take the present season of Gray’s Anatomy, which featured a serious storyline a few “remedy” for Parkinson’s illness. The drama sequence adopted a staff of researchers and medical doctors as they used a groundbreaking surgical process utilizing skin-derived stem cells.
In actual life, regardless of a long time of analysis and big positive factors in technical information round stem cell therapies for Parkinson’s illness, these therapies stay out of attain for most individuals with the illness. Parkinson’s is a mind dysfunction that worsens over time and causes the loss of life of sure nerve cells that usually produce dopamine, which helps coordinate muscle motion. Essentially the most generally used surgical remedy for Parkinson’s is deep mind stimulation, which delivers electrical pulses to mind areas affecting motor signs, comparable to tremors and rigidity.
Nonetheless, given the stakes of this continual progressive neurological illness dealing with about 1 million People, it’s value unpacking simply how far-fetched the Hollywood depiction is – or isn’t.
On the present, medical doctors take stem cells from a pores and skin biopsy of a personality with Parkinson’s illness and, “by way of a posh course of,” rework these cells into dopamine-producing cells. Folks with Parkinson’s sometimes have low dopamine ranges within the putamen, part of the mind concerned in motion. By injecting new dopamine-producing cells into the character’s forebrain, the place the putamen is discovered, the medical doctors intention to spice up dopamine ranges.
The process kicks off with a CT scan, which provides the surgical staff photographs of what’s described as “an interactive 3D roadmap” of the character’s mind. After just a few extra fast steps – together with drilling of burr holes to forestall strain from increase within the mind – a robotic arm brings a hole needle into place. A researcher then removes the stem cells from a cooler and examines them underneath a microscope to substantiate that sufficient cells are alive. Lastly, the cells are injected into the character’s forebrain, beginning with one aspect after which transferring to the opposite.
A lot of what’s depicted on the present is real looking – if simplified and futuristic – in line with Willard Kasoff, MD, an affiliate professor of neurosurgery on the Lewis Katz College of Medication at Temple College and director of stereotactic and purposeful neurosurgery at Temple College Hospital.
“It is not science fiction, however it’s a future present,” he says.
There have been a number of thrilling stem cell improvements focusing on Parkinson’s lately that, on the floor, are paying homage to Gray’s Anatomy’s televised “remedy.”
In 2017 and 2018, as an example, medical doctors reprogrammed pores and skin cells taken from an individual with Parkinson’s to create “substitute dopamine neurons,” which received implanted into the particular person’s mind. Extra not too long ago, a scientific trial concerned injecting stem cells into the brains of individuals with Parkinson’s with a view to restore their dopamine ranges, full with a GPS-like mind scan exhibiting neurosurgeons the place to inject the cells. Upcoming scientific trials may even use Parkinson’s sufferers’ pores and skin cells to provide substitute dopamine neurons for transplantation.
However such therapies received’t essentially be broadly out there anytime quickly, in line with Kasoff. “Cell transplantation is extremely tough and complex,” he says. “It has been labored on for many years, and it is nonetheless early, early analysis trials. So even that form of remedy is probably going years and years away.”
A number of the therapies depend on genetic engineering to transform stem cells into neural progenitor cells, which might become varied cell sorts discovered within the mind – a course of often called differentiating. Neurosurgeons also can direct how neural progenitor cells change, comparable to guiding them to develop into dopamine neurons. The hope is that after these cells are transplanted into the mind, they’ll “work out what to do, or be advised what to do by the encircling cells,” says Kasoff.
Even when the trials succeed, they might not characterize a remedy. As a result of the therapies are directed on the putamen and the substantia nigra (an space the place neuron loss can have an effect on dopamine ranges), they solely tackle motor signs. Parkinson’s illness additionally impacts considering abilities, steadiness, and different capabilities all through the physique. Cognitive decline can result in dementia and loss of life.
“The concept which you could remedy Parkinson’s by placing cells within the substantia nigra or the putamen might be not true,” Kasoff says.
Additionally, Parkinson’s is usually considered a illness of 1 cell kind: the dopaminergic cells within the substantia nigra. However in actuality, Kasoff explains, it’s probably a illness with “hundreds of cell sorts,” which makes any potential stem cell-derived remedy extraordinarily complicated. Kind 1 diabetes, alternatively, is a illness of just one cell kind, and new therapies utilizing insulin-producing cells derived from stem cells might quantity to a remedy.
As for Parkinson’s, says Kasoff, “it could be that the subsequent stem cell trial hits the jackpot, after which we’ll be on to the subsequent step.” That would imply determining the place to transplant stem cells for the cognitive and balance-related signs of the illness, as an example.
In the end, he says, “the hope is that what occurs on the present is precisely what is going to occur sooner or later sooner or later.”
