Cross-species intracerebral grafting of embryonic swine dopaminergic neurons

Xenografts of MHC-Deficient Mouse Embryonic Mesencephalon Improve Behavioral Recovery in Hemiparkinsonian Rats

The limited availability of human embryonic tissue for dopamine cell transplants in Parkinson's patients has led to an increased interest in using xenogeneic donor tissue. Unfortunately, without aggressive immunosup-pression, such brain xenografts are rejected by the host immune system. Chronic brain xenograft rejection is largely mediated by helper T cells, which require presentation of xenoantigens by major histocompatability complex (MHC) class II for their activation. We examined survival and function of xenografts of E13 mouse mesencephalon deficient in either MHC class I, class II, or both after transplantation into adult hemiparkinsonian rats without immunosuppression. Recipients received grafts from C57BL/6 mice that were either: 1) wild-type (wt), 2) MHC class I knockout (KO), 3) MHC class II KO, 4) MHC class I and II double KO, or 5) saline sham transplants. At 6 weeks after transplantation, recipients of MHC class I KO, class II KO, and double KO xenografts significantly reduced methamphetamine-induced circling rate while rats with wt xenografts and sham-operated rats showed no improvement. MHC class II KO grafts had the greatest number of surviving dopamine neurons. All transplants, including saline sham controls, contained infiltrating host MHC class II-positive cells. Saline sham grafts and MHC class II KO xenografts contained significantly fewer infiltrating host MHC class II-positive cells than did wt grafts. Our results show that MHC class II-deficient xenografts survive transplantation for at least 6 weeks in the absence of immunosup-pression, reduce rotational asymmetry, and provoke lesser immune reaction than wt grafts.

The Influence of Donor Age on the Survival of Solid and Suspension Intraparenchymal Human Embryonic Nigral Grafts

In many species, graft survival and graft-derived behavioral recovery are affected by the embryonic donor age. We compared the ability of solid and suspension grafts of human embryonic mesencephalic dopaminergic (DA) neurons at different embryonic stages to survive intra-parenchymal transplantation into 6-OHDA lesioned immunosuppressed rats. Suspension grafts survived best when donor age was between postconception (PC) days 34 and 56. Transplants displayed numerous healthy tyrosine hydroxylase immunoreactive (TH-IR) neurons which sent extensive neuritic processes into the host striatum. Suspension grafts survived poorly when donor age was greater than 65 days. Solid implants displayed comparable viability of TH-IR neurons when donor age was between 44 and 65 days. No solid grafts contained TH-IR cells when donor tissue was older than 72 days. The suspension and solid methods of transplantation resulted in comparable survival of robust grafts, but solid grafts resulted in more intergraft variability than suspension grafts, particularly among the more marginal implants. Our results demonstrate that the upper limit for survival of human embryonic DA suspension grafts correlates well with the period of development of the human nigrostriatal pathway. The “window” for donor age of solid human embryonic DA grafts appears to be extended by about 9 days in comparison to suspension grafts. These data suggest that the upper age limit for grafting human mesencephalic DA neurons should be PC day 56 for suspension grafts, and PC day 65 for solid implants. Older donors are likely to produce grafts with fewer surviving DA neurons.

Individual Human Serum Differs in the Amount of Antibodies with Affinity for Pig Fetal Ventral Mesencephalic Cells and the Ability to Lyse These Cells by Complement Activation

Xenografting pig fetal ventral mesencephalic (pfVM) cells to repair the dopamine deficit in patients with Parkinson's disease is the focus of both experimental and clinical investigations. Although there have been marked advances in the experimental and even clinical application of these xenogeneic transplantations, questions regarding the host's xenospecific immune response remain unanswered. It has been shown that human serum is able to lyse pfVM tissue by both anti-gal-gal and non-anti-gal-gal antibodies by complement activation. The aim of this study was to investigate whether interindividual differences exist in the levels of pfVM cell-specific IgM and IgG subclass antibodies, their ability to lyse pfVM cells in vitro and the relationship between both. Pig fetal VM cells were incubated with heat-inactivated serum from 10 different individuals and binding of IgM antibodies and IgG subclass antibodies to pfVM cells was analyzed by flow cytometry. The ability to lyse pfVM cells was analyzed exposing 51Cr-labeled pfVM cells to fresh serum or isolated IgM and IgG from the same individuals and subsequent determination of released 51Cr from lysed cells. Strong differences were found between individuals in the levels of pfVM cell-specific IgM antibodies: antibody levels differed up to 40-fold. pfVM-specific IgG1 and IgG2 levels were only detectable in a few individuals. The ability to lyse pfVM cells ranged from negligible lysis up to 66.5% specific lysis. There was a strong correlation between the levels of individual pfVM-specific IgM antibodies and the ability to lyse pfVM cells in vitro. Isolated IgM, but not IgG, was able to lyse pfVM cells in the presence of complement. In conclusion, the interindividual differences in the levels of IgM with affinity for pfVM cells and their ability to lyse pfVM cells in vitro are considerable. Only few individuals possessed IgG1 and IgG2 subclass antibodies with affinity for pfVM. These findings may influence patient selection for porcine transplants and chances of graft survival in individual patients.

Xenogeneic Cell Therapy: Current Progress and Future Developments in Porcine Cell Transplantation

The multitude of distinct cell types present in mature and developing tissues display unique physiologic characteristics. Cellular therapy is a novel technology with the promise of utilizing this diversity to treat a wide range of human degenerative diseases. Intractable diseases, disorders, and injuries are characterized by cell death or aberrant cellular function. Cell transplantation can replace diseased or lost tissue to provide restorative therapy for these conditions. The limited use of cell transplants as a basis for current therapy can, in part, be attributed to the lack of available human cells suitable for transplantation. This has prevented further realization of the promise of cell transplantation as a platform technology. Accordingly, cell-based therapies such as blood transfusions, for which the cells are readily available, are a standard part of current medical practice. Despite numerous attempts to expand primary human cells in tissue culture, current technological limitations of this approach in regard to proliferative capacity and maintenance of the differentiated phenotype has prevented their use for transplantation. Further, use of human stem cells for the derivation of specific cell types for transplantation is an area of future application with great potential, but hurdles remain in regard to deriving and sufficiently expanding these multi-potential cells. Thus, it appears that primary cells are at present a superior source for transplantation. This review focuses on pigs as a source of a variety of primary cells to advance cell therapy to the clinic and implement achievement of its full potential. We outline the advantages and disadvantages of xenogeneic cell therapy while underscoring the utility of transplantable porcine cells for the treatment of human disease. © 1998 Elsevier Science Inc.

Neural stem/progenitor cells as a promising candidate for regenerative therapy of the central nervous system

Neural transplantation is a promising therapeutic strategy for neurodegenerative diseases and other disorders of the central nervous system (CNS) such as Parkinson and Huntington diseases, multiple sclerosis or stroke. Although cell replacement therapy already went through clinical trials for some of these diseases using fetal human neuroblasts, several significant limitations led to the search for alternative cell sources that would be more suitable for intracerebral transplantation.Taking into account logistical and ethical issues linked to the use of tissue derived from human fetuses, and the immunologically special status of the CNS allowing the occurrence of deleterious immune reactions, neural stem/progenitor cells (NSPCs) appear to be an interesting cell source candidate. In addition to their ability for replacing cell populations lost during the pathological events, NSPCs also display surprising therapeutic effects of neuroprotection and immunomodulation. A better knowledge of the mechanisms involved in these specific characteristics will hopefully lead in the future to a successful use of NSPCs in regenerative medicine for CNS disorders.

Cell-based therapeutic approaches for Parkinson's disease: progress and perspectives

Motor dysfunctions in Parkinson's disease are believed to be primarily due to the degeneration of dopaminergic neurons located in the substantia nigra pars compacta. Because a single-type cell population is depleted, Parkinson's disease is considered a primary target for cell replacement-based therapeutic strategies. Extensive studies have confirmed transplantation of donor neurons could be beneficial, yet identifying an alternative cell source is clearly essential. Human embryonic stem cells (hESCs) have been proposed as a renewable source of dopaminergic neurons for transplantation in Parkinson's disease; other potential sources could include neural stem cells (hNSCs) and adult mesenchymal stem cells (hMSCs). However, numerous difficulties avert practical application of stem cell-based therapeutic approaches for the treatment of Parkinson's disease. Among the latter, ethical, safety (including xeno- and tumor formation-associated risks) and technical issues stand out. This review aims to provide a balanced and updated outlook on various issues associated with stem cells in regard to their potential in the treatment of Parkinson's disease. Essential features of the individual stem cell subtypes, principles of available differentiation protocols, transplantation, and safety issues are discussed extensively.

Treatment of neurodegenerative diseases with neural cell transplantation

Neural cell transplantation is an emerging therapy that may provide an effective treatment for neurodegenerative disorders. The most extensive work with neural transplants has been carried out for Parkinson's and Huntington's diseases. However, intensive efforts are also being made for the treatment of other neurological indications, such as spinal cord repair, stroke, epilepsy, multiple sclerosis (MS), Alzheimer's disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), to name just a few. The major barrier for the successful application of cells as therapeutics is achieving long-term survival and function. The CNS has proven to be ideal for transplantation, in part because immune rejection is attenuated in the CNS compared to peripheral locations. However, some form of immunosuppression is desirable for optimal allograft survival and required for xenograft survival. This review will focus on the challenges of restoring function to something as intricate as the CNS and on the limitations imposed by this complexity on any cellular therapeutic.

Tyrosine hydroxylase and acetylcholinesterase in the domestic pig mesencephalon: An immunocytochemical and histochemical study

The mesencephalon of the young domestic pig was studied by tyrosine hydroxylase (TH) immunocytochemistry and acetylcholinesterase (AChE) histochemistry with focus on the substantia nigra (SN), the ventral tegmental area (VTA), and related areas. The purpose was to obtain information on the organization of the mesencephalic, TH immunoreactive (TH-i), and dopaminergic areas of the pig, in order to provide the necessary background for the possible use of the pig as an alternative large animal experimental model for research on Parkinson's disease, including the use of encapsulated pig dopaminergic neurons for intracerebral xenotransplantation. Significant findings in the pig, compared to observations in other species, included the presence of prominent bundles of TH-i dendrites passing in a dorsoventral direction from pars compacta into pars reticulata at middle and caudal levels of the SN, and the presence of a distinct TH-i substantia nigra pars lateralis (SNL). Caudally in the pig mesencephalon, the retrorubral field (RRF) was found to be very extensive. The view of the RRF, SN, and VTA as parts of the same integrated system was indicated by the crisscrossing of TH-i dendrites at the transitions between these areas. Estimation of the number of TH-i neurons in the SN and the VTA showed that these nuclei were of equal size in the pig. Further, it was found that TH-i nerve cells were present in the midline between the VTA in the interfascicular and rostral linear groups. TH-i nerve cells were also present in the otherwise serotoninergic dorsal raphe nuclei, just as other TH-i cells formed a perirubral cell group. AChE-positive neurons were present in both SN and VTA, and appeared to have the same size and morphology as the TH-i neurons in these areas. Within both nuclei, there were local differences in the AChE staining density, but perhaps more significantly were some marked differences in the structure of the AChE-positive neuropil of the two areas. We anticipate that the present description of the cellular organization of the TH-i dopaminergic areas in the domestic pig ventral mesencephalon will be useful for the development of a nonprimate, large animal, experimental model of Parkinson's disease.

Is there a future for neural transplantation?

Traditionally neural transplantation has had as its central tenet the replacement of missing neurons that have been lost because of neurodegenerative processes, as exemplified by diseases such as Parkinson disease (PD). However, the effectiveness and widespread application of this approach clinically has been limited, primarily because of the poor donor supply of human fetal neural tissue and the incomplete neurobiological understanding of the circuit reconstruction required to normalize function in these diseases. So, in PD the progress from promising neural transplantation in animal models to proof-of-principle, open-labeled clinical transplants, to randomized, placebo-controlled studies of neural transplantation has not been straightforward. The emergence of previously undescribed adverse effects and lack of significant functional advantage in recent clinical studies has been disappointing and has served to cast a new, and perhaps more realistic, perspective on this treatment approach. In fact, there have been calls by some involved in neural transplantation to return to the drawing board before pressing on with further clinical trials, and the return to basic experimentation. This therefore precipitates the question - is there a future for neural transplantation? It is important to remember that there are a number of possible explanations for the disappointing results from the recent clinical trials in PD, ranging from the mode of transplantation to patient selection. Nevertheless, almost irrespective of these reasons for the current trial results, there have always been significant practical and ethical problems with using human fetal tissue, and so a number of alternative cell sources have been investigated. These alternative sources include stem cells, which are attractive for cell-based therapies because of their potential ease of isolation, propagation and manipulation, and their ability in some cases to migrate to areas of pathology and differentiate into specific and appropriate cell types. Furthermore, the availability of stem cells derived from non-embryonic sources (e.g. adult stem cells derived from the sub-ventricular zone) has removed some of the ethical limitations associated with the use of embryonic human tissue. These potentially beneficial aspects of stem cells means that there is a future for neural transplantation as a means of treating patients with a range of neurological disorders, although whether this will ever translate into a truly effective, widely available therapy remains unknown.

Intracerebral cytokine profiles in adult rats grafted with neural tissue of different immunological disparity

To understand graft rejection in cell based therapies for brain repair we have quantified IL-1beta, IL-2, IL-4, IL-10, IL-12p40, IFN-gamma and TNF-alpha mRNA levels using real-time PCR, at days 4, 14, and 42 post-transplantation, in rats engrafted with syngeneic, allogeneic, concordant and discordant xenogeneic neural tissues. In addition, in the discordant xenografts immunohistochemistry and in situ hybridization were applied to detect local expression of IFN-gamma, TNF-alpha, IL-10 and TGF-beta. Allografts remained non-rejected but expressed IL-1beta, TNF-alpha and IL-4 transcripts but not IL-12p40 and IFN-gamma. Xenografts demonstrated distinct cytokine profiles that differed from syngeneic and allogeneic grafts. Non-rejected discordant xenografts contained higher levels of TNF-alpha transcripts and lower levels of IL-2 transcripts than the rejected ones at day 42. Discordant xenografts displayed a stronger and earlier expression of IL-1beta and TNF-alpha, followed by T-helper 1 and T-helper 2 associated cytokine expression. The number of cells expressing mRNA encoding TNF-alpha and TGF-beta was significantly increased over time in the discordant group. In conclusion, the immunological disparity of the implanted tissue explains survival rates and is associated with different cytokine profiles. In allografts, a chronic inflammatory reaction was detected and in xenogeneic grafts a delayed hypersensitivity like reaction may be involved in rejection.

Prenatal 3,4-methylenedioxymethamphetamine (ecstasy) alters exploratory behavior, reduces monoamine metabolism, and increases forebrain tyrosine hydroxylase fiber density of juvenile rats

3,4-Methylenedioxymethamphetamine (MDMA; ecstasy) use has risen among women of childbearing age. Consequently, there is a substantial risk for fetal exposure from women who are, or become pregnant while abusing MDMA. However, attempts to demonstrate that prenatal MDMA results in neurochemical alterations in rat models have failed. MDMA administration to neonatal rats (third trimester equivalent) results in significant and persistent neurochemical and behavioral alterations, yet human epidemiologic data suggest that the vast majority of prenatal exposure is limited to the first trimester. The following study was conducted to reexamine the potential for prenatal MDMA administration to produce lasting postnatal neurochemical and behavioral alterations using a new rodent model. Pregnant rats were administered twice-daily injections of MDMA (15 mg/kg sc) or saline from embryonic days (E) 14-20. Prenatally exposed pups were examined on postnatal days (P) 3 and 21. At P3, MDMA offspring showed reductions in the dopamine metabolite homovanillic acid which persisted through P21, along with reductions in the serotonin (5-HT) metabolite, 5-HIAA. Prenatally exposed MDMA animals at P21 also had reduced dopamine and 5-HT turnover in the nucleus accumbens. Increases in tyrosine hydroxylase fiber density were found in the frontal cortex, striatum and nucleus accumbens of MDMA animals. In addition, prenatal MDMA significantly increased locomotor activity of P21 pups in a 20-min novel cage environment. These findings provide the first evidence of lasting neurochemical and behavioral alterations following prenatal MDMA. Further investigation is warranted to elucidate possible mechanisms of action and to monitor children gestationally exposed to MDMA.

Porcine neural xenografts in rats and mice: donor tissue development and characteristics of rejection

Embryonic ventral mesencephalic tissue from the pig is a potential alternative donor tissue for neural transplantation to Parkinson's disease patients. For stable graft survival, the host immune response has to be prevented. This study was performed in order to analyze the mechanisms and dynamics of neural xenograft rejection, as well as neurobiological properties of the donor tissue. Adult normal mice and rats, and cyclosporin A-treated rats, received intrastriatal transplants of dissociated embryonic ventral mesencephalic pig tissue that was 27 or 29 embryonic days of age (E27 and E29). The animals were perfused at 2, 4, 6, and 12 weeks after grafting and the brains were processed for immunohistochemistry of dopaminergic (tyrosine hydroxylase positive) neurons, CD4(+) and CD8(+) lymphocytes, natural killer cells, macrophages, microglia, and astrocytes. Thirty-five rats received daily injections of BrdU for 5 consecutive days at different time points after transplantation and were perfused at 6 weeks. These animals were analyzed for proliferation of cells in the donor tissue, both in healthy and in rejecting grafts. No tyrosine hydroxylase-positive cells proliferated after grafting. Our results demonstrated that E27 was superior to E29 donor tissue for neurobiological reasons. Cyclosporin A immunosuppression was protective only during the first weeks and failed to protect the grafts in a long-term perspective. Grafts in mice were invariably rejected between 2 and 4 weeks after transplantation, while occasional grafts in untreated rats survived up to 12 weeks without signs of an ongoing rejection process. CD8(+) lymphocytes and microglia cells are most likely important effector cells in the late, cyclosporin A-resistant rejection process.

Effects of immunosuppressive treatment on host responses against intracerebral porcine neural tissue xenografts in rats

BACKGROUND

Embryonic xenogeneic neural tissue is an alternative for transplantation in Parkinson's disease, but immune responses limit the application. The aims of this study were to enhance the in vitro viability rates by donor tissue pretreatment; to compare the efficacy of cyclosporine A (CsA) and tacrolimus (FK) in inhibiting xenograft rejection in rats; to evaluate additional inductive therapy with prednisolone (PRE) or mycophenolate mofetil (MMF).

METHODS

Tirilazad (a lipid peroxidase inhibitor) or FK and acYVAD-cmk (a caspase inhibitor), were added to embryonic porcine ventral mesencephalic tissue and viability was assessed in vitro. Tirilazad-treated tissue was grafted to the striatum of rats that were either left untreated or immunosuppressed with FK (1 mg/kg) or CsA (15 mg/kg) alone or in combination with a 2-week PRE (20 mg/kg) or MMF (40 mg/kg) induction course. Xenograft survival and host responses were determined using immunohistochemistry.

RESULTS

Pretreatment with tirilazad enhanced tissue survival in vitro. After transplantation into untreated controls, there was no graft survival at twelve weeks. Neural cell counts were significantly improved in immunosuppressed recipients, but there were no differences between the treatment groups. Additional inductive treatment reduced the infiltration with CD4+ and CD8+ cells, and macrophage infiltration was reduced compared with animals given CsA or FK alone.

CONCLUSION

Pretreatment of the donor tissue with free-radical scavengers reduces cell loss caused by tissue trauma. Porcine neural tissue xenografts survive significantly better in animals immunosuppressed with either FK or CsA. Additional inductive treatment with PRE or MMF reduced the infiltration of host cells into the xenografts.

The DaNeX study of embryonic mesencephalic, dopaminergic tissue grafted to a minipig model of Parkinson's disease: preliminary findings of effect of MPTP poisoning on striatal dopaminergic markers

A multicenter study is under way to investigate the efficacy of allografting of embryonic mesencephalic neurons in a pig model of Parkinson's disease. We have first established that a stable parkinsonian syndrome can be established by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) intoxication of adult male Göttingen minipigs. We are now using positron emission tomography (PET) methods for testing the physiological responses to MPTP intoxication and the time course of the response to several treatment strategies. We now report preliminary results obtained in 11 pigs employed in the initial phase of the study; the completed study shall ultimately include 30 pigs. Animals were randomly assigned to one of five groups: 1) Control, 2) MPTP intoxication, 3) MPTP intoxication followed by allograft, 4) MPTP intoxication followed by allograft with immunosuppression, and 5) MPTP intoxication followed by allograft with immunosuppression and co-grafting of immortalized HiB5 cells, which had been manipulated to secrete glia cell line-derived neurotrophic factor (GDNF) (approximately 2 ng GDNF/h/10(5) cells). MPTP was administered (1 mg/kg/day, SC) for 7-10 days until the pigs had developed mild parkinsonian symptoms of muscle rigidity, hypokinesia, and impaired coordination, especially of the hind limbs. Approximately 2 weeks after the last MPTP dose, animals received a T1-weighted magnetic resonance imaging (MRI) scan, and a series of dynamic PET recordings. After the first series of PET scans, four grafts of porcine embryonic mesencephalic tissue (E28 days) were placed in each striatum of some MPTP-intoxicated pigs, using MRI-based stereotactic techniques. Immunosuppression of some animals with cyclosporin and prednisolone began just prior to surgery. Two more series of PET scans were performed at 4-month intervals after surgery. After the last scans, pigs were killed and the brains were perfused for unbiased stereological examination of cytological and histochemical markers in striatum and substantial nigra. The behavioral impairment of the animals (the "Parkinson's score") had been evaluated throughout the 8-month period. Kinetic analysis of the first set of PET scans has indicated that the rate constant for the decarboxylation of FDOPA in catecholamine fibers was reduced by 33% in striatum of the mildly parkinsonian pigs. The rate of association of [11C]NS-2214 to catecholamine uptake sites was reduced by 62% in the same groups of pigs. No significant difference was found in the binding potential of [11C]raclopride to the dopamine D2-like receptors in striatum of the MPTP-intoxicated versus control pigs. These preliminary results are suggestive that the activity of DOPA decarboxylase may be upregulated in the partially denervated pig striatum.

Intrastriatal ventral mesencephalic xenografts of porcine tissue in rats: immune responses and functional effects

Transplantation of neural tissue from other species has the potential to improve function in patients with neurodegenerative disorders. We investigated the functional effects of embryonic porcine dopaminergic neurons transplanted in a rat model of Parkinson's disease and the immune responses to the grafts in immunosuppressed and nonimmunosuppressed hosts. Twenty-three rats with unilateral 6-hydroxydopamine lesions received dissociated, 27-day-old embryonic porcine ventral mesencephalic tissue in the right striatum. Eighteen rats received cyclosporine (10 mg/kg, IP, daily) during the whole period of 14 weeks, in combination with prednisolone (20 mg/kg, IP, daily) the first 4 days. Five rats served as nonimmunosuppressed controls. All rats were tested for amphetamine-induced rotational behavior at 3-week intervals. Two immunosuppressed rats were excluded due to severe side effects of the treatment. Functional recovery was seen in 9 of 16 immunosuppressed rats at 12 weeks. Six animals remained functionally recovered at 14 weeks and contained an average of 5750+/-1450 (SEM) dopaminergic neurons. Between 9 and 14 weeks, three immunosuppressed rats rejected their grafts, based on rotation scores and immunohistochemical demonstration of cell infiltrates. One additional immunosuppressed rat showed evidence of ongoing rejection at 14 weeks. The striata in animals with ongoing or recent rejection contained large numbers of CD4- and CD8-positive lymphocytes, NK cells, macrophages, and microglia cells, whereas scar tissue was found in rats with grafts rejected at earlier time points (n = 11). Embryonic porcine ventral mesencephalic tissue matures in the adult rat striatum, reinnervates the host brain, and restores behavioral defects. Immunosuppressive treatment was necessary for long-term graft survival and functional recovery, but did not sufficiently protect from rejection mechanisms. Porcine neural tissue is an interesting alternative to embryonic human tissue for intracerebral transplantation in neurodegenerative diseases. However, to achieve stable graft survival in discordant xenogeneic combinations, an appropriate immunosuppressive treatment or donor tissue modifications are needed.

Neural tissue xenotransplantation: what is needed prior to clinical trials in Parkinson's disease? Neural Tissue Xenografting Project

Embryonic allografted human tissue in patients with Parkinson's disease has been shown to survive and ameliorate many of the symptoms of this disease. Despite this success, the practical problems of using this tissue coupled to the ethical restrictions of using aborted human fetal tissue have lead to an exploration for alternative sources of suitable material for grafting, including xenogeneic embryonic dopaminergic-rich neural tissue. Nevertheless, xenografted neural tissue itself generates a number of practical, ethical, safety, and immunological issues that have to be addressed prior to any clinical xenotransplant program. In this article we review these critical issues and set out the criteria that we consider need to be met in the development of our clinical xenotransplantation research programs. We advocate that these, or similar, criteria should be adopted and made explicit by other centers contemplating similar clinical trials.

Fetal porcine dopaminergic cell survival in vitro and its relationship to embryonic age

One of the critical factors in the survival of embryonic neural grafts is the age at which the population of donor neurons is harvested. This is especially the case for the developing dopaminergic neurons in the embryonic ventral mesencephalon, which are used for neural grafts in Parkinson's disease (PD). The donor age for optimal harvesting of these cells has been well characterized in the mouse, rat, and marmoset, and to a lesser extent in humans. However, the best donor age for porcine ventral mesencephalic tissue has not been ascertained, even though the use of this tissue for xenografts has been explored both experimentally and clinically. In this study the effect of donor age on dopaminergic cell survival was assessed in vitro, from a range of fetal pigs aged from E24 to E35. The number of tyrosine hydroxylase (TH)-positive cells per ventral mesencephalon was then calculated after 1 and 7 days in culture. E26-E27 embryos gave the highest yield of such cells at both survival time points, suggesting that this will be the optimal age for harvesting tissues whether for experimental or clinical nigral xenograft programs.

Intrastriatal transplantation of rat adrenal chromaffin cells seeded on microcarrier beads promote long-term functional recovery in hemiparkinsonian rats

Possible biologic treatments for Parkinson's disease, a disorder caused by the deterioration of dopaminergic neurons bridging the nigrostriatal system, have recently focused on fetal cell transplantation. Because of ethical and tissue availability issues concerning fetal cell transplantation, alternative cell sources are being developed. The adrenal medulla has been used as a cell transplant source because of the capacity of the cells to provide catecholamines and to transform into a neuronal phenotype. However, adrenal tissue transplants have shown limited success, primarily because of their lack of long-term viability. Recently, seeding adrenal chromaffin cells on microcarrier beads has been shown to enhance the cell viability following neural transplantation. In the present study, we further investigated whether transplantation of rat adrenal chromaffin cells seeded on microcarrier beads into the striatum of 6-hydroxydopamine-induced hemiparkinsonian rats would result in a sustained functional recovery. Behavioral tests using the apomorphine-induced rotational and elevated body swing tests up to 12 months posttransplantation revealed a significant behavioral recovery in animals that received adrenal chromaffin cells seeded on microcarrier beads compared to animals that received adrenal chromaffin cells alone, medium alone, or beads alone. Histological examination of tissue at 14 months posttransplantation revealed evidence of tyrosine hydroxylase-positive cells and an on-going glial response in animals transplanted with adrenal chromaffin cells seeded on microcarrier beads, in contrast to absence of such immunoreactive responses in the other groups. These findings support a facilitator role for microcarrier beads in transplantation of adrenal chromaffin cells or other cells that are easily rejected by the CNS.

Somatic cell cloned transgenic bovine neurons for transplantation in parkinsonian rats

Parkinson's disease symptoms can be improved by transplanting fetal dopamine cells into the putamen of parkinsonian patients. Because the supply of human donor tissue is limited and variable, an alternative and genetically modifiable non-human source of tissue would be valuable. We have generated cloned transgenic bovine embryos, 42% of which developed beyond 40 days. Dopamine cells collected from the ventral mesencephalon of the cloned fetuses 42 to 50 days post-conception survived transplantation into immunosuppressed parkinsonian rats and cells from cloned and wild-type embryos improved motor performance. Somatic cell cloning can efficiently produce transgenic animal tissue for treating parkinsonism.

Determination of stereotaxic coordinates for the hippocampus in the domestic pig

In this study a stereotaxic instrument and a stereotaxic procedure based on external skull structures, to be used in prepubertal male Landrace pigs weighing less than 30 kg, is described. The instrument represents an adaptation of the apparatus designed by Marcilloux et al., Brain Res Bull 1989;22:591-597, but we have modified the instrument for stereotaxic procedures based on external skull structures, instead of intracerebral structures necessitating ventriculography (Marcilloux et al., Brain Res Bull 1989;22:591-597). For this reason the U-shaped frame and the ear-bar supports have been changed allowing the three-dimensional placement of the ear-bars into the oblique auditory canals. Firm fixation of the skulls of pigs weighing less than 30 kg, was furthermore secured with modified infraorbital ridges and hard palate pieces. Measurements of distances between external skull structures in animals of the same sex, age and weight showed a negligible variation, thus enabling definition of the horizontal, frontal and sagittal zero planes using external skull structures alone. Stereotaxic coordinates for the hippocampal region of male Landrace pigs weighing 10 kg were then provided and the coordinates from two different levels of the hippocampal region are presented in the text. The reliability of the stereotaxic instrument was finally secured by intrahippocampal injections of ink at predetermined coordinates.

Fetal pig neural cells as a restorative therapy for neurodegenerative disease

With proper immunosuppression, interspecies transplantation of porcine as well as other species of neural cells survive, mature, and integrate into the host in a manner which reconstructs much of the appropriate neural circuitry. These transplants have been shown to alleviate many of the symptoms of various disorders of the central nervous system. In this study, we addressed immunological and maturation issues with regards to intracerebral transplantation of fetal porcine neural cells. First, we compared fetal neural xenograft survival in athymic nude rats versus rats immunosuppressed with cyclosporin A and found that there is little discernible difference between porcine grafts in the 2 recipients. We also found that ectopic transplantation of cells isolated from the porcine striatal primordium can survive and develop into grafts composed of both neuronal and glial phenotypes within the rat hippocampus. This fact raises the possibility that cells of a particular neurotransmitter type (e.g., GABAergic cells) developing from the striatal precursor cells can be transplanted outside the striatum of the adult brain and have physiological effects.

Histological evidence of fetal pig neural cell survival after transplantation into a patient with Parkinson's disease

The movement disorder in Parkinson's disease results from the selective degeneration of a small group of dopaminergic neurons in the substantia nigra pars compacta region of the brain. A number of exploratory studies using human fetal tissue allografts have suggested that transplantation of dopaminergic neurons may become an effective treatment for patients with Parkinson's disease and the difficulty in obtaining human fetal tissue has generated interest in finding corresponding non-human donor cells. Here we report a post-mortem histological analysis of fetal pig neural cells that were placed unilaterally into the caudate-putamen brain region of a patient suffering from Parkinson's disease. Long-term (over seven months) graft survival was found and the presence of pig dopaminergic neurons and other pig neural and glial cells is documented. Pig neurons extended axons from the graft sites into the host brain. Furthermore, other graft derived cells were observed several millimeters from the implantation sites. Markers for human microglia and T-cells showed only low reactivity in direct proximity to the grafts. This is the first documentation of neural xenograft survival in the human brain and of appropriate growth of non-human dopaminergic neurons for a potential therapeutic response in Parkinson's disease.

Article Commentary: Development of the Human Striatum: Implications for Fetal Striatal Transplantation in the Treatment of Huntington's Disease

Fetal neural transplantation has recently been demonstrated to ameliorate motor and other behavioral deficits in animal models of Huntington's disease, and reconstruct many of the damaged striatal circuits. However, there has been significant variability in the histological appearance of these grafts, most likely related to differences of the regions of dissection of the donor tissue. Selective dissection and transplantation of the lateral ventricular eminence in rodents has resulted in grafts consisting of primarily striatal-like tissue. This data, combined with data from our own and other laboratories has led to a description of the development of the human striatum, with a particular emphasis on the relevance of human striatal development to the field of fetal tissue transplantation for the treatment of Huntington's disease. If the goal of transplantation is to graft GABAergic striatal projection neurons, it is our impression that optimal grafting results will occur when transplants are derived from the lateral ventricular eminence and the lateral aspect of the body of the ventricular eminence anterior to the foramen of Monro. Optimal results are likely to occur when donor ages range from Stage 19 to 23, with possible graft success when donor age extends to as late as postovulatory week 22.

Neural xenotransplantation: reconstruction of neuronal circuitry across species barriers

Selective replacement of degenerated neurons in the adult brain with allogeneic fetal neuroblasts is a promising therapeutic modality for human neurodegenerative diseases, but is confounded with practical and potential ethical problems. To evaluate the potential of xenogeneic donors as a cell source for neural transplantation, we have critically examined the available experimental evidence in animal models pertaining to the survival, integration and function of xenogeneic fetal neuroblasts in the host brain. A statistical meta-analysis across multiple studies revealed that immunologically-related transplantation parameters (immunosuppression and donor-host phylogenetic distance) were the main determinants of neural xenograft survival. The immunological basis for xenograft rejection is reviewed in the context of novel immunoprotection strategies designed to enhance xenograft survival. Furthermore, the evidence for behavioral recovery based on anatomical and functional integration of neural xenografts in the host brain is examined with an awareness of developmental considerations. It is concluded that neural xenotransplantation offers a unique opportunity for effective neuronal replacement with significant potential for clinical use.

Grafts in the treatment of Parkinson's disease: animal models

Long-term treatment of parkinsonian patients with L-DOPA leads to a loss of efficacy over time and the appearance of important side effects such as dyskinesias. Grafts of chromaffin cells of the adrenal medulla or fetal ventral mesencephalic neurons bring behavioral improvement in animal models of Parkinson's disease. These improvements are likely to be related to the secretion of dopamine by the grafted cells and/or to the reinnervation of the host tissue. In addition, a leak in the blood-brain barrier may allow peripheral catecholamines to gain access to the brain. Lack of clear effects of grafts in parkinsonian patients may be due to their poor survival in the human brain. Improvement of grafting techniques as well as the addition of neurotrophic factors to grafts may help increase their survival and improve behavioral effects. Recently, genetic techniques have allowed the creation of genetically modified cell lines which can produce L-DOPA and these cells may be grafted in the brain. Interestingly, these cell lines may be encapsulated in permselective membranes which can protect them from immunological rejection and avoid the uncontrolled cell growth of these mitotically active cells. Grafting techniques seem to be an interesting alternative to treat parkinsonian patients. Improvement of grafting procedures may help increase survival of grafts and thus enhance behavioral improvements. Moreover, genetic modification of well-known tumor cell lines or patient's own cells such as astrocytes may help avoid the low availability as well as ethical and immunological problems linked to the use of fetal human tissue.

Development of dopaminergic neurons in the human substantia nigra

A series of 29 human embryonic brains were examined in order to characterize the ontogeny of dopaminergic neurons within the developing substantia nigra. Embryos from Postconception Weeks 4.0 to 11.2 (last menstrual period 6.0-13.2) were studied. Immunohistochemical staining was performed using a polyclonal antibody to tyrosine hydroxylase. Tyrosine hydroxylase-like immunoreactivity was first seen in cells of the ventral mesencephalon at 6.5 weeks adjacent to the ventricular zone. Ventral migration of TH-positive cells began at 6.7 weeks. Neural process extension was first identified in tyrosine hydroxylase-positive neurons at 8.0 weeks. The ascending nigrostriatal bundle was also first demonstrated at 8.0 weeks. Tyrosine hydroxylase containing neurites were seen initially in the developing putamen at 9.0 weeks. Only a few tyrosine hydroxylase-positive cells remained adjacent to the ventricular zone at Week 10.0 and all had disappeared from the ventricular zone by 11.2 weeks. At this latter stage, a large number of dopaminergic cells had elaborated neural processes. The sequence of developmental events of human mesencephalic dopaminergic neurons is similar to the equivalent period of ontogeny in other mammals. The duration of the developmental period is, however, significantly protracted.

Immunocytochemical demonstration of the calcium-binding proteins calbindin-D 28k and parvalbumin in the subiculum, hippocampus and dentate area of the domestic pig

The distribution of the calcium-binding proteins calbindin-D 28k (CaBP) and parvalbumin (PV) in the hippocampal region of the domestic pig was demonstrated by immunocytochemistry. Scattered CaBP-immunoreactive cell bodies were present in the subiculum, stratum oriens, pyramidal cell layer and stratum radiatum of the hippocampal regio superior and inferior, and the outer plexiform layer and outer hilar cell layer of the dentate hilus. Other cell bodies and bundles of stained fibers were present in stratum moleculare of regio superior and inferior, and in the outer third of the molecular layer of the fascia dentata. Terminal-like CaBP-immunoreactivity was seen in the subiculum and around cell bodies in the pyramidal cell layer of regio superior and inferior and the dentate granular cell layer. Scattered PV-immunoreactive cell bodies were present in stratum oriens and the pyramidal cell layer of regio superior and inferior, and in the outer plexiform layer and outer hilar cell layer of the dentate hilus. Terminal-like PV-immunoreactivity surrounded the cell bodies in the pyramidal cell layer of regio superior and inferior and in the dentate granular cell layer. The distribution of CaBP and PV in the pig hippocampus is compared to that of other more commonly used experimental animals. Whereas the distribution of PV-immunoreactivity in the pig hippocampus appears identical to that of the rat hippocampus, the distribution of CaBP-immunoreactivity in the pig hippocampus differs markedly from that of the rat hippocampus, the most prominent feature being a lack of CaBP-immunoreactivity in the granule cells, mossy fibers and pyramidal cells in the pig. The functional implications of calcium-binding proteins in the brain are discussed.

Xenografting of fetal pig ventral mesencephalon corrects motor asymmetry in the rat model of Parkinson's disease

A suspension of cells from embryonic day 21 fetal pig ventral mesencephalon was transplanted into the striatum of 20 immunosuppressed rats with 6-hydroxydopamine-induced lesions of the nigrostriatal dopamine pathway. Of these rats, 15 showed reduction of amphetamine-induced ipsilateral rotation by 9 weeks and complete reversal of rotation by 14-17 weeks. Animals maintained stable reversal of rotations (contralateral direction) until cessation of Cyclosporin A (CyA) treatment at 15-20 weeks. Within 4-9 weeks after CyA removal, these rats showed exclusively ipsilateral rotations during behavioral testing which were comparable to pre-transplant levels, suggesting that the grafts were rejected upon cessation of CyA treatment. Rats were sacrificed and tyrosine hydroxylase (TH) immunohistochemistry was performed at several time points, both on and off CyA, to examine a possible correlation between the degree of rotational behavior and the number of TH-positive surviving grafted cells. Staining showed large numbers (230-12,329) of TH-positive surviving cells in animals displaying a high degree of rotational correction (1.6 to -9.6 net ipsilateral rotations/min) after cessation of CyA treatment. Two control groups, those transplanted with non-neuronal cells from the pig ventral mesencephalon (n = 5) and those receiving only daily CyA injections (n = 4) showed no significant reduction of net ipsilateral rotations throughout the experiment. No TH-positive surviving cells were seen in the one non-neuronal transplant analyzed. This data demonstrates long-term retention of xenografted tissue with immunosuppression and its concomitant restoration of normal motor behavior in the rat model of Parkinson's disease.