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Caution Urged on Brain Grafts for Parkinson’s

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Times Science Writer

Brain grafts of adrenal tissues produce “significant improvement” in victims of Parkinson’s disease, but the procedure did not work as well as had been hoped and should still be considered experimental, according to the first published report by American physicians on the effectiveness of the controversial procedure.

But by showing that the adrenal transplants are not as effective as they had at first seemed to be, the new report seems likely to encourage the search for alternatives to adrenal tissues, such as genetically engineered tissues or the still more controversial use of fetal brain cells.

Parkinson’s disease, which affects more than 1 million Americans, causes trembling, muscular rigidity and, frequently, impairment of thought processes. It is caused by the death of brain cells that secrete the neurotransmitter dopamine, and the surgical procedure is designed to replace the dead cells with other dopamine-secreting cells.

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“We found that, at least in our hands, there was a relatively significant risk associated with (the adrenal grafts), and I don’t think that the improvements are enough . . . to justify that the procedure be used routinely,” said Dr. C. Warren Olanow of the University of South Florida in Tampa, one of the three neurologists who prepared the report scheduled to be published Thursday in the New England Journal of Medicine.

The three neurologists operated on 16 men and three women with an average age of 54, all of whom had severe cases of the disorder. In the past, “there have never been enough cases in any one institution to give any security about the results,” said Murray Goldstein, head of the branch of the National Institutes of Health that funds much U.S. brain grafting research.

“By pooling the results from three research units, they have come up with a larger number of experiences so that we can have more confidence in their findings,” he said.

“This gives us a more realistic picture (of the efficacy of adrenal transplants),” added Dr. Abraham Lieberman, a neurologist at New York University and chairman of the American Parkinson’s Disease Assn.’s scientific advisory board. “It will spur more research because it shows that something is there.”

Interest in the adrenal transplant procedure was stimulated by a report two years by Dr. Ignacio Madrazo of La Raza Medical Center in Mexico City that two Parkinson’s disease victims receiving brain grafts of tissue from the adrenal glands, walnut-sized organs sitting on top of the kidney, showed a remarkable recovery from their disorder and required much less medication.

Olanow, Dr. Christopher G. Goetz of Rush-Presbyterian-St. Luke’s Medical Center in Chicago and Dr. William C. Koller of the University of Kansas in Kansas City agreed to use the exact procedure used by Madrazo and found that, contrary to Madrazo’s report, the grafts did not relieve the patients’ need for medication, but they improved the effectiveness of the drugs.

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