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Gene Therapy Trials Show Promise Against Parkinson's
Two studies benefit patients without adverse effects, but more tests are needed to be sure.
- Oct 18 2006
The first studies of human gene therapy for Parkinson's disease have shown that the technique is safe and can reduce symptoms for patients, two groups of researchers have reported.
All of the 24 patients who received therapy in the two separate trials received some benefit and none had any significant side effects, researchers reported at neuroscience meetings Tuesday and last week.
Gene therapy has a tarnished reputation because of problems encountered in trials involving other diseases, said Katie Hood, deputy chief executive officer of the Michael J. Fox Foundation for Parkinson's Research.
The Food and Drug Administration temporarily halted gene therapy trials in 1999 after an 18-year-old being treated for a mild genetic disorder died after a violent reaction to the procedure. Trials were halted in 2005 after three French children being treated for inherited immunodeficiency disease developed leukemia and one of them died.
"It's very encouraging that two companies were able to show benefits with no significant adverse effects," Hood said. "Safety is obviously the first hurdle."
Experts and the researchers themselves, however, cautioned patients against investing too much hope in the findings because Parkinson's studies are notorious for showing placebo effects.
Only when the techniques are tested in controlled trials, now in the planning stages, will researchers be able to determine whether the benefits are real and lasting.
Parkinson's, which strikes as many as 100,000 Americans each year, is characterized by severe tremors and rigidity in the limbs, and loss of muscle control. It results from the death of brain cells that produce the neurotransmitter dopamine, which plays a key role in transmitting commands from the brain's muscle-control centers. The disorder's cause is unknown.
Both teams used the same gene therapy technology, inserting a desired gene into the common adeno-associated virus. AAV readily infects humans but has never been shown to cause disease.
One team, led by Dr. Matthew J. During of the Weill Cornell Medical Center in New York, used a gene that is the blueprint for an enzyme called glutamic acid decarboxylase. That enzyme converts chemicals in the cell into a neurotransmitter called GABA, which is essential for controlling muscle movements.
Earlier studies have shown that Parkinson's disease is marked by a deficiency of GABA in a part of the brain called the subthalamic nucleus. Injecting GABA into the brain can ease disease symptoms, but the neurotransmitter is quickly cleared, limiting its benefits.
During's team injected one side of the brains of 12 patients with one of three different concentrations of the gene therapy agent.
He told Tuesday's meeting of the Society for Neuroscience in Atlanta that all 12 patients had an improvement of at least 25% on a conventional scoring system used to assess the severity of Parkinson's symptoms, four of whom improved at least 37% and five others 40% to 65%.
The benefits have persisted for a year. Placebo benefits are usually transient, researchers noted.
Brain imaging showed an increase in metabolism on the side where patients received the gene therapy, and the amount of increase correlated with the degree of improvement in symptoms, During said.
The gene therapy agent was manufactured by Neurologix Inc. of Fort Lee, N.J., a company created by During and his colleagues to commercialize the technology. Neurologix paid for the study. During said the neurologists who assessed the patients' condition had no financial ties to the company.
The second study, led by Dr. William J. Marks Jr. of UC San Francisco, used the gene for a growth factor called neurturin, which is closely related to the better-known growth factor GDNF.
Studies have shown that injecting GDNF into the section of the brain known as the putamen can impede, and possibly reverse, the loss of dopaminesecreting cells.
Marks and his colleagues injected 12 Parkinson's patients with one of two doses of the gene therapy agent. Patients receiving the lower dose had a 40% decrease in Parkinson's symptoms, and those receiving the higher dose had a 50% reduction, he reported at last week's American Neurological Assn. meeting in Chicago. The researchers have monitored the patients for nine months.
"This is a clinically meaningful benefit that has been sustained over time," Marks said.
The gene therapy agent used by Marks was developed by Ceregene Inc. of San Diego. Marks said he had no financial ties to Ceregene.
The company paid for the trial with the Fox foundation. The foundation recently announced it would invest $1.9 million in a controlled trial of the approach.
Source: Los Angeles Times www.latimes.com/features/health/medicine/la-sci-parkinson18oct18,1,902922.story?coll=la-health-medicine
Commentary from the Parkinson's Disease Foundation
Gene Therapy Advances in PD
The advent of gene transfer techniques as a potential treatment of neurological disease is based on the concept that viral-mediated particles containing a gene that encodes for the production a needed chemical can be introduced into the brain by surgery. This focal placement leads to an enhanced and highly localized new production of the needed chemical by the brain cells in the region of implantation. Laboratory experiments have confirmed that this technique is effective in animal models of Parkinson's disease, but only recently has the technique been applied to patients with Parkinson's disease. Although there has been much publicity in newspapers and other public media on these developments, scientists have waited for completion of their initial studies to present detailed results to their scientific colleagues.
This fall, in two international scientific meetings, the two primary research teams involved with clinical trials of gene therapy have presented the results of their initial human studies that have focused on safety issues of the technique. Both teams conduct their work at universities that receive Center Grants from the Parkinson's Disease Foundation (PDF).
Representing Cornell University, MJ During presented his teamís results at the Society for Neuroscience meeting in Atlanta in October. This group has focused on developing a viral vector with the gene for an enzyme related to the neurotransmitter, gamma-amino-butyric acid (GABA). They targeted the subthalamic nucleus, a small area in the brain that is underactive in Parkinson's disease. They surgically implanted the viral particles into one subthalamic nucleus, leaving the other untouched in 12 patients with Parkinson's disease. Three doses of gene transfer particles were compared. No serious side-effects developed and by six months, the group of patients showed improvement in their parkinsonian impairments on both sides of their body. Neuroimaging techniques to reflect increased GABA activity in the brain.
Representing the combined colleagues from Rush University Medical Center (another PDF Center Grant recipient) and the University of California, San Francisco, WJ Marks reported at the American Neurological Association in Chicago on their results. They implanted into the brain region known as the putamen, viral particles with the gene for a trophic or growth factor, termed neurturin. In this study, both sides of the brain received the implant and two doses were studied. As in the first study, the procedure was safe and no serious side-effects occurred. At six months, the patient group improved in their parkinsonian signs.
These two studies are important scientific and clinical contributions. The first question on short-term safety has been answered by both of them, and patients have not developed problems related to the surgery at six months. This excellent outcome encourages additional work in the domain of gene transfer therapy.
It is essential that patients with Parkinson's disease and scientists studying Parkinson's disease recognize that much more work is needed and only the short-term safety of these techniques has been addressed so far. First, these patients need to be followed in on-going fashion, because the long-term safety of viral particles in the human brain can be determined. Second, both studies involved only patients who knew they received the treatment and the physicians evaluating their parkinsonism likewise knew that all patients were implanted with the viral particles. It is well-established that Parkinson's disease patients in clinical trials demonstrate positive responses when they are involved in clinical treatment research and that part of this positive response relates to the involvement in the program itself and occurs even if patients receive placebo treatment (ďsugar pillsĒ or an inert substance). This placebo response is particularly marked in surgical studies. Therefore, PDF recommends to all readers that these studies be watched with great interest and vigilance, and reminds them that gene transfer remains strictly experimental.
At this time, these techniques cannot be considered as treatments that improve parkinsonism. Further studies are planned and PDF will report on them as scientific data are available.
Christopher G. Goetz, M.D., Chicago Chair, PDF Medical Policy Subcommittee
Source Date: Oct 18 2006
Source Publication: Los Angeles Times
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