1
|
Kirkeby A, Nelander J, Hoban DB, Rogelius N, Bjartmarz H, Storm P, Fiorenzano A, Adler AF, Vale S, Mudannayake J, Zhang Y, Cardoso T, Mattsson B, Landau AM, Glud AN, Sørensen JC, Lillethorup TP, Lowdell M, Carvalho C, Bain O, van Vliet T, Lindvall O, Björklund A, Harry B, Cutting E, Widner H, Paul G, Barker RA, Parmar M. Preclinical quality, safety, and efficacy of a human embryonic stem cell-derived product for the treatment of Parkinson's disease, STEM-PD. Cell Stem Cell 2023; 30:1299-1314.e9. [PMID: 37802036 DOI: 10.1016/j.stem.2023.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/06/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023]
Abstract
Cell replacement therapies for Parkinson's disease (PD) based on transplantation of pluripotent stem cell-derived dopaminergic neurons are now entering clinical trials. Here, we present quality, safety, and efficacy data supporting the first-in-human STEM-PD phase I/IIa clinical trial along with the trial design. The STEM-PD product was manufactured under GMP and quality tested in vitro and in vivo to meet regulatory requirements. Importantly, no adverse effects were observed upon testing of the product in a 39-week rat GLP safety study for toxicity, tumorigenicity, and biodistribution, and a non-GLP efficacy study confirmed that the transplanted cells mediated full functional recovery in a pre-clinical rat model of PD. We further observed highly comparable efficacy results between two different GMP batches, verifying that the product can be serially manufactured. A fully in vivo-tested batch of STEM-PD is now being used in a clinical trial of 8 patients with moderate PD, initiated in 2022.
Collapse
Affiliation(s)
- Agnete Kirkeby
- Wallenberg Neuroscience Center, Wallenberg Center for Molecular Medicine and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden; Novo Nordisk Foundation Center for Stem Cell Medicine (reNEW) and Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark.
| | - Jenny Nelander
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Deirdre B Hoban
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Nina Rogelius
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Hjálmar Bjartmarz
- Department of Neurosurgery, Skåne University Hospital, 221 85 Lund, Sweden
| | - Petter Storm
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Alessandro Fiorenzano
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Andrew F Adler
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Shelby Vale
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Janitha Mudannayake
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Yu Zhang
- Wallenberg Neuroscience Center, Wallenberg Center for Molecular Medicine and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden; Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Tiago Cardoso
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Bengt Mattsson
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Anne M Landau
- Department of Nuclear Medicine & PET-Center and Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Andreas N Glud
- Center for Experimental Neuroscience (CENSE), Department of Neurosurgery, Department of Clinical Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Jens C Sørensen
- Center for Experimental Neuroscience (CENSE), Department of Neurosurgery, Department of Clinical Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Thea P Lillethorup
- Department of Nuclear Medicine & PET-Center and Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Mark Lowdell
- Centre for Cell, Gene and Tissue Therapeutics, Royal Free NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK
| | - Carla Carvalho
- Centre for Cell, Gene and Tissue Therapeutics, Royal Free NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK
| | - Owen Bain
- Centre for Cell, Gene and Tissue Therapeutics, Royal Free NHS Foundation Trust, Royal Free Hospital, London NW3 2QG, UK
| | | | - Olle Lindvall
- Lund Stem Cell Center and Department of Clinical Sciences Lund, Lund University, 221 84 Lund, Sweden
| | - Anders Björklund
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Bronwen Harry
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0PY, UK
| | - Emma Cutting
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0PY, UK
| | - Håkan Widner
- Department of Neurology, Skåne University Hospital, 221 85 Lund, Sweden
| | - Gesine Paul
- Department of Neurology, Skåne University Hospital, 221 85 Lund, Sweden; Wallenberg Neuroscience Center, Wallenberg Center for Molecular Medicine, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden
| | - Roger A Barker
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0PY, UK; Wellcome-MRC Cambridge Stem Cell Institute, Cambridge CB2 0AW, UK
| | - Malin Parmar
- Wallenberg Neuroscience Center, MultiPark and Lund Stem Cell Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden.
| |
Collapse
|
2
|
Martinez-Curiel R, Jansson L, Tsupykov O, Avaliani N, Aretio-Medina C, Hidalgo I, Monni E, Bengzon J, Skibo G, Lindvall O, Kokaia Z, Palma-Tortosa S. Oligodendrocytes in human induced pluripotent stem cell-derived cortical grafts remyelinate adult rat and human cortical neurons. Stem Cell Reports 2023; 18:1643-1656. [PMID: 37236198 PMCID: PMC10444570 DOI: 10.1016/j.stemcr.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Neuronal loss and axonal demyelination underlie long-term functional impairments in patients affected by brain disorders such as ischemic stroke. Stem cell-based approaches reconstructing and remyelinating brain neural circuitry, leading to recovery, are highly warranted. Here, we demonstrate the in vitro and in vivo production of myelinating oligodendrocytes from a human induced pluripotent stem cell (iPSC)-derived long-term neuroepithelial stem (lt-NES) cell line, which also gives rise to neurons with the capacity to integrate into stroke-injured, adult rat cortical networks. Most importantly, the generated oligodendrocytes survive and form myelin-ensheathing human axons in the host tissue after grafting onto adult human cortical organotypic cultures. This lt-NES cell line is the first human stem cell source that, after intracerebral delivery, can repair both injured neural circuitries and demyelinated axons. Our findings provide supportive evidence for the potential future use of human iPSC-derived cell lines to promote effective clinical recovery following brain injuries.
Collapse
Affiliation(s)
- Raquel Martinez-Curiel
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, 22184 Lund, Sweden
| | - Linda Jansson
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, 22184 Lund, Sweden
| | - Oleg Tsupykov
- Department of Cytology, Bogomoletz Institute of Physiology; Institute of Genetic and Regenerative Medicine, Strazhesko National Scientific Center of Cardiology, Clinical and Regenerative Medicine, 01024 Kyiv, Ukraine
| | | | - Constanza Aretio-Medina
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, 22184 Lund, Sweden
| | - Isabel Hidalgo
- Division of Molecular Hematology, Wallenberg Center for Molecular Medicine, Lund Stem Cell Center, Lund University, 22184 Lund, Sweden
| | - Emanuela Monni
- Lund Stem Cell Center, Lund University, 22184 Lund, Sweden
| | - Johan Bengzon
- Division of Neurosurgery, Department of Clinical Sciences Lund, University Hospital, 22184 Lund, Sweden
| | - Galyna Skibo
- Department of Cytology, Bogomoletz Institute of Physiology; Institute of Genetic and Regenerative Medicine, Strazhesko National Scientific Center of Cardiology, Clinical and Regenerative Medicine, 01024 Kyiv, Ukraine
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, 22184 Lund, Sweden
| | - Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, 22184 Lund, Sweden.
| | - Sara Palma-Tortosa
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, 22184 Lund, Sweden
| |
Collapse
|
3
|
Ohlis A, Narusyte J, Lindvall O, Dalman C, Hollander AC. [Long term outcome of children diagnosed with resignation syndrome in the Stockholm Region 2005-2012]. Lakartidningen 2022; 119:21171. [PMID: 35730113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the early 2000s, some children in asylum seeking families in Sweden showed severe reduction in function, including pervasive refusal to eat, drink, walk, talk or care for themselves. In 2014 this was to be named the resignation syndrome (ICD-10 F32.3A). The purpose of our study was to compare education and health-related outcomes over time between those with and without these symptoms, in a group of children from Central Asia who have been asylum seekers and received a residence permit in Sweden. We found that between the years 2005-2012, in the child and adolescent mental health services (CAMHS) in the Stockholm Region, 103 children showed symptoms of resignation, of whom 43 (43%) showed the most severe symptoms. Children with resignation syndrome assessed and cared for by CAMHS had similar need of outpatient care as other children of the same origin who had been treated by CAMHS for other conditions. They did not have an increased need for inpatient care compared with other children of the same origin, and they passed upper secondary school and past-secondary education to the same extent as other children of the same origin.
Collapse
Affiliation(s)
- Anna Ohlis
- med dr, överläkare, institutionen för global folkhälsa, Karolinska institutet, Stockholm
| | - Jurgita Narusyte
- med dr, avdelningen för försäkringsmedicin vid institutionen för klinisk neurovetenskap, Karolinska institutet, Stockholm
| | | | - Christina Dalman
- professor, överläkare, institutionen för global folkhälsa, Karolinska institutet, Stockholm
| | | |
Collapse
|
4
|
Dias DO, Kalkitsas J, Kelahmetoglu Y, Estrada CP, Tatarishvili J, Holl D, Jansson L, Banitalebi S, Amiry-Moghaddam M, Ernst A, Huttner HB, Kokaia Z, Lindvall O, Brundin L, Frisén J, Göritz C. Pericyte-derived fibrotic scarring is conserved across diverse central nervous system lesions. Nat Commun 2021; 12:5501. [PMID: 34535655 PMCID: PMC8448846 DOI: 10.1038/s41467-021-25585-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/17/2021] [Indexed: 12/04/2022] Open
Abstract
Fibrotic scar tissue limits central nervous system regeneration in adult mammals. The extent of fibrotic tissue generation and distribution of stromal cells across different lesions in the brain and spinal cord has not been systematically investigated in mice and humans. Furthermore, it is unknown whether scar-forming stromal cells have the same origin throughout the central nervous system and in different types of lesions. In the current study, we compared fibrotic scarring in human pathological tissue and corresponding mouse models of penetrating and non-penetrating spinal cord injury, traumatic brain injury, ischemic stroke, multiple sclerosis and glioblastoma. We show that the extent and distribution of stromal cells are specific to the type of lesion and, in most cases, similar between mice and humans. Employing in vivo lineage tracing, we report that in all mouse models that develop fibrotic tissue, the primary source of scar-forming fibroblasts is a discrete subset of perivascular cells, termed type A pericytes. Perivascular cells with a type A pericyte marker profile also exist in the human brain and spinal cord. We uncover type A pericyte-derived fibrosis as a conserved mechanism that may be explored as a therapeutic target to improve recovery after central nervous system lesions.
Collapse
Affiliation(s)
- David O Dias
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Jannis Kalkitsas
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Yildiz Kelahmetoglu
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia P Estrada
- Department of Clinical Neuroscience, Karolinska University Hospital, Solna, Sweden
| | | | - Daniel Holl
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Jansson
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Shervin Banitalebi
- Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Mahmood Amiry-Moghaddam
- Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Aurélie Ernst
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
- Group Genome Instability in Tumors, German Cancer Research Center, Heidelberg, Germany
| | - Hagen B Huttner
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Zaal Kokaia
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Olle Lindvall
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Lou Brundin
- Department of Clinical Neuroscience, Karolinska University Hospital, Solna, Sweden
| | - Jonas Frisén
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Göritz
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.
- Ming Wai Lau Centre for Reparative Medicine, Stockholm Node, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
5
|
Abstract
Upcoming clinical trials assessing transplantation of stem cell-derived dopaminergic neurons into the striatum in patients with Parkinson's disease could generate groundbreaking results on neuronal replacement in the human brain. However, as highlighted here, the road toward a clinically competitive treatment for this multisystem disorder will probably be long and winding.
Collapse
Affiliation(s)
- Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, SE-221 84 Lund, Sweden.
| |
Collapse
|
6
|
Memanishvili T, Monni E, Tatarishivili J, Lindvall O, Tsiskaridze A, Kokaia Z, Tornero D. Poly(ester amide) microspheres are efficient vehicles for long-term intracerebral growth factor delivery and improve functional recovery after stroke. Biomed Mater 2020; 15:065020. [DOI: 10.1088/1748-605x/aba4f6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
7
|
Santopolo G, Magnusson JP, Lindvall O, Kokaia Z, Frisén J. Blocking Notch-Signaling Increases Neurogenesis in the Striatum after Stroke. Cells 2020; 9:E1732. [PMID: 32698472 PMCID: PMC7409130 DOI: 10.3390/cells9071732] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
Stroke triggers neurogenesis in the striatum in mice, with new neurons deriving in part from the nearby subventricular zone and in part from parenchymal astrocytes. The initiation of neurogenesis by astrocytes within the striatum is triggered by reduced Notch-signaling, and blocking this signaling pathway by deletion of the gene encoding the obligate Notch coactivator Rbpj is sufficient to activate neurogenesis by striatal astrocytes in the absence of an injury. Here we report that blocking Notch-signaling in stroke increases the neurogenic response to stroke 3.5-fold in mice. Deletion of Rbpj results in the recruitment of a larger number of parenchymal astrocytes to neurogenesis and over larger areas of the striatum. These data suggest inhibition of Notch-signaling as a potential translational strategy to promote neuronal regeneration after stroke.
Collapse
Affiliation(s)
- Giuseppe Santopolo
- Department of Cell and Molecular Biology, Karolinska Institute, SE-171 77 Stockholm, Sweden; (G.S.); (J.P.M.)
| | - Jens P. Magnusson
- Department of Cell and Molecular Biology, Karolinska Institute, SE-171 77 Stockholm, Sweden; (G.S.); (J.P.M.)
| | - Olle Lindvall
- Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden; (O.L.); (Z.K.)
| | - Zaal Kokaia
- Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden; (O.L.); (Z.K.)
| | - Jonas Frisén
- Department of Cell and Molecular Biology, Karolinska Institute, SE-171 77 Stockholm, Sweden; (G.S.); (J.P.M.)
| |
Collapse
|
8
|
Grønning Hansen M, Laterza C, Palma-Tortosa S, Kvist G, Monni E, Tsupykov O, Tornero D, Uoshima N, Soriano J, Bengzon J, Martino G, Skibo G, Lindvall O, Kokaia Z. Grafted human pluripotent stem cell-derived cortical neurons integrate into adult human cortical neural circuitry. Stem Cells Transl Med 2020; 9:1365-1377. [PMID: 32602201 PMCID: PMC7581452 DOI: 10.1002/sctm.20-0134] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/27/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Abstract
Several neurodegenerative diseases cause loss of cortical neurons, leading to sensory, motor, and cognitive impairments. Studies in different animal models have raised the possibility that transplantation of human cortical neuronal progenitors, generated from pluripotent stem cells, might be developed into a novel therapeutic strategy for disorders affecting cerebral cortex. For example, we have shown that human long‐term neuroepithelial‐like stem (lt‐NES) cell‐derived cortical neurons, produced from induced pluripotent stem cells and transplanted into stroke‐injured adult rat cortex, improve neurological deficits and establish both afferent and efferent morphological and functional connections with host cortical neurons. So far, all studies with human pluripotent stem cell‐derived neurons have been carried out using xenotransplantation in animal models. Whether these neurons can integrate also into adult human brain circuitry is unknown. Here, we show that cortically fated lt‐NES cells, which are able to form functional synaptic networks in cell culture, differentiate to mature, layer‐specific cortical neurons when transplanted ex vivo onto organotypic cultures of adult human cortex. The grafted neurons are functional and establish both afferent and efferent synapses with adult human cortical neurons in the slices as evidenced by immuno‐electron microscopy, rabies virus retrograde monosynaptic tracing, and whole‐cell patch‐clamp recordings. Our findings provide the first evidence that pluripotent stem cell‐derived neurons can integrate into adult host neural networks also in a human‐to‐human grafting situation, thereby supporting their potential future clinical use to promote recovery by neuronal replacement in the patient's diseased brain.
Collapse
Affiliation(s)
| | - Cecilia Laterza
- Lund Stem Cell Center, Lund University, Lund, Sweden.,Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Sara Palma-Tortosa
- Lund Stem Cell Center, Lund University, Lund, Sweden.,Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Giedre Kvist
- Lund Stem Cell Center, Lund University, Lund, Sweden.,Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Emanuela Monni
- Lund Stem Cell Center, Lund University, Lund, Sweden.,Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Oleg Tsupykov
- Bogomoletz Institute of Physiology and State Institute of Genetic and Regenerative Medicine, Kyiv, Ukraine
| | - Daniel Tornero
- Laboratory of Stem Cells and Regenerative Medicine, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Naomi Uoshima
- Lund Stem Cell Center, Lund University, Lund, Sweden.,Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Jordi Soriano
- Departament de Física de la Matèria Condensada, Institute of Complex Systems (UBICS), Universitat de Barcelona, Barcelona, Spain
| | - Johan Bengzon
- Lund Stem Cell Center, Lund University, Lund, Sweden.,Division of Neurosurgery, Department of Clinical Sciences Lund, University Hospital, Lund, Sweden
| | - Gianvito Martino
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Galyna Skibo
- Bogomoletz Institute of Physiology and State Institute of Genetic and Regenerative Medicine, Kyiv, Ukraine
| | - Olle Lindvall
- Lund Stem Cell Center, Lund University, Lund, Sweden.,Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Zaal Kokaia
- Lund Stem Cell Center, Lund University, Lund, Sweden.,Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| |
Collapse
|
9
|
Abstract
In this issue of Cell Stem Cell, Peruzzotti-Jametti et al. (2018) demonstrate how neural stem cells, transplanted in a mouse model of multiple sclerosis, respond to extracellular succinate and modulate neuroinflammation by releasing anti-inflammatory prostaglandin E2 and scavenging succinate. This mechanism reduces CNS damage and ameliorates motor impairment.
Collapse
Affiliation(s)
- Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, Stem Cell Center, Lund University Hospital, SE-221 84 Lund, Sweden.
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Stem Cell Center, Lund University Hospital, SE-221 84 Lund, Sweden
| |
Collapse
|
10
|
Miskinyte G, Grønning Hansen M, Monni E, Lam M, Bengzon J, Lindvall O, Ahlenius H, Kokaia Z. Transcription factor programming of human ES cells generates functional neurons expressing both upper and deep layer cortical markers. PLoS One 2018; 13:e0204688. [PMID: 30307948 PMCID: PMC6181302 DOI: 10.1371/journal.pone.0204688] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
Human neurodegenerative disorders affect specific types of cortical neurons. Efficient protocols for the generation of such neurons for cell replacement, disease modeling and drug screening are highly warranted. Current methods for the production of cortical neurons from human embryonic stem (ES) cells are often time-consuming and inefficient, and the functional properties of the generated cells have been incompletely characterized. Here we have used transcription factor (TF) programming with the aim to induce rapid differentiation of human ES cells to layer-specific cortical neurons (hES-iNs). Three different combinations of TFs, NEUROGENIN 2 (NGN2) only, NGN2 plus Forebrain Embryonic Zinc Finger-Like Protein 2 (FEZF2), and NGN2 plus Special AT-Rich Sequence-Binding Protein 2 (SATB2), were delivered to human ES cells by lentiviral vectors. We observed only subtle differences between the TF combinations, which all gave rise to the formation of pyramidal-shaped cells, morphologically resembling adult human cortical neurons expressing cortical projection neuron (PN) markers and with mature electrophysiological properties. Using ex vivo transplantation to human organotypic cultures, we found that the hES-iNs could integrate into adult human cortical networks. We obtained no evidence that the hES-iNs had acquired a distinct cortical layer phenotype. Instead, our single-cell data showed that the hES-iNs, similar to fetal human cortical neurons, expressed both upper and deep layer cortical neuronal markers. Taken together, our findings provide evidence that TF programming can direct human ES cells towards cortical neurons but that the generated cells are transcriptionally profiled to generate both upper and deep layer cortical neurons. Therefore, most likely additional cues will be needed if these cells should adopt a specific cortical layer and area identity.
Collapse
Affiliation(s)
- Giedre Miskinyte
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | | | - Emanuela Monni
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Matti Lam
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Stem Cells, Aging and Neurodegeneration Group, University Hospital, Lund, Sweden
| | - Johan Bengzon
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Division of Neurosurgery, Department of Clinical Sciences Lund, University Hospital, Lund, Sweden
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Henrik Ahlenius
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Stem Cells, Aging and Neurodegeneration Group, University Hospital, Lund, Sweden
| | - Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
- * E-mail:
| |
Collapse
|
11
|
Laterza C, Uoshima N, Tornero D, Wilhelmsson U, Stokowska A, Ge R, Pekny M, Lindvall O, Kokaia Z. Attenuation of reactive gliosis in stroke-injured mouse brain does not affect neurogenesis from grafted human iPSC-derived neural progenitors. PLoS One 2018; 13:e0192118. [PMID: 29401502 PMCID: PMC5798785 DOI: 10.1371/journal.pone.0192118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
Induced pluripotent stem cells (iPSCs) or their progeny, derived from human somatic cells, can give rise to functional improvements after intracerebral transplantation in animal models of stroke. Previous studies have indicated that reactive gliosis, which is associated with stroke, inhibits neurogenesis from both endogenous and grafted neural stem/progenitor cells (NSPCs) of rodent origin. Here we have assessed whether reactive astrocytes affect the fate of human iPSC-derived NSPCs transplanted into stroke-injured brain. Mice with genetically attenuated reactive gliosis (deficient for GFAP and vimentin) were subjected to cortical stroke and cells were implanted adjacent to the ischemic lesion one week later. At 8 weeks after transplantation, immunohistochemical analysis showed that attenuated reactive gliosis did not affect neurogenesis or commitment towards glial lineage of the grafted NSPCs. Our findings, obtained in a human-to-mouse xenograft experiment, provide evidence that the reactive gliosis in stroke-injured brain does not affect the formation of new neurons from intracortically grafted human iPSC-derived NSPCs. However, for a potential clinical translation of these cells in stroke, it will be important to clarify whether the lack of effect of reactive gliosis on neurogenesis is observed also in a human-to-human experimental setting.
Collapse
Affiliation(s)
- Cecilia Laterza
- Department of Clinical Sciences, Laboratory of Stem Cells & Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Naomi Uoshima
- Department of Clinical Sciences, Laboratory of Stem Cells & Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
- Department of Anesthesiology, Tokyo Medical University, Nishishinjuku, Shinjuku-ku, Tokyo, Japan
| | - Daniel Tornero
- Department of Clinical Sciences, Laboratory of Stem Cells & Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Ulrika Wilhelmsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Laboratory of Astrocyte Biology and CNS Regeneration, Center for Brain Repair, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anna Stokowska
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Laboratory of Regenerative Neuroimmunology, Center for Brain Repair, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ruimin Ge
- Department of Clinical Sciences, Laboratory of Stem Cells & Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Milos Pekny
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Laboratory of Astrocyte Biology and CNS Regeneration, Center for Brain Repair, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Olle Lindvall
- Department of Clinical Sciences, Laboratory of Stem Cells & Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Zaal Kokaia
- Department of Clinical Sciences, Laboratory of Stem Cells & Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
- * E-mail:
| |
Collapse
|
12
|
Miskinyte G, Devaraju K, Grønning Hansen M, Monni E, Tornero D, Woods NB, Bengzon J, Ahlenius H, Lindvall O, Kokaia Z. Direct conversion of human fibroblasts to functional excitatory cortical neurons integrating into human neural networks. Stem Cell Res Ther 2017; 8:207. [PMID: 28962665 PMCID: PMC5622454 DOI: 10.1186/s13287-017-0658-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/07/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Human fibroblasts can be directly converted to several subtypes of neurons, but cortical projection neurons have not been generated. Methods Here we screened for transcription factor combinations that could potentially convert human fibroblasts to functional excitatory cortical neurons. The induced cortical (iCtx) cells were analyzed for cortical neuronal identity using immunocytochemistry, single-cell quantitative polymerase chain reaction (qPCR), electrophysiology, and their ability to integrate into human neural networks in vitro and ex vivo using electrophysiology and rabies virus tracing. Results We show that a combination of three transcription factors, BRN2, MYT1L, and FEZF2, have the ability to directly convert human fibroblasts to functional excitatory cortical neurons. The conversion efficiency was increased to about 16% by treatment with small molecules and microRNAs. The iCtx cells exhibited electrophysiological properties of functional neurons, had pyramidal-like cell morphology, and expressed key cortical projection neuronal markers. Single-cell analysis of iCtx cells revealed a complex gene expression profile, a subpopulation of them displaying a molecular signature closely resembling that of human fetal primary cortical neurons. The iCtx cells received synaptic inputs from co-cultured human fetal primary cortical neurons, contained spines, and expressed the postsynaptic excitatory scaffold protein PSD95. When transplanted ex vivo to organotypic cultures of adult human cerebral cortex, the iCtx cells exhibited morphological and electrophysiological properties of mature neurons, integrated structurally into the cortical tissue, and received synaptic inputs from adult human neurons. Conclusions Our findings indicate that functional excitatory cortical neurons, generated here for the first time by direct conversion of human somatic cells, have the capacity for synaptic integration into adult human cortex. Electronic supplementary material The online version of this article (doi:10.1186/s13287-017-0658-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Giedre Miskinyte
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden. .,Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden.
| | - Karthikeyan Devaraju
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden.,Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden
| | - Marita Grønning Hansen
- Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden
| | - Emanuela Monni
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden.,Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden
| | - Daniel Tornero
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden.,Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden
| | - Niels Bjarne Woods
- Division of Molecular Medicine and Gene Therapy, Lund University, Lund, Sweden.,Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden
| | - Johan Bengzon
- Division of Neurosurgery, Department of Clinical Sciences Lund, University Hospital, Lund, Sweden.,Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden
| | - Henrik Ahlenius
- Stem Cells, Aging and Neurodegeneration Group, University Hospital, Lund, Sweden.,Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden.,Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden
| | - Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, Lund, Sweden.,Lund Stem Cell Center, University Hospital BMC B10, Lund University, SE-221 84, Lund, Sweden
| |
Collapse
|
13
|
Ge R, Tornero D, Hirota M, Monni E, Laterza C, Lindvall O, Kokaia Z. Choroid plexus-cerebrospinal fluid route for monocyte-derived macrophages after stroke. J Neuroinflammation 2017; 14:153. [PMID: 28754163 PMCID: PMC5534106 DOI: 10.1186/s12974-017-0909-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/03/2017] [Indexed: 01/09/2023] Open
Abstract
Background Choroid plexus (CP) supports the entry of monocyte-derived macrophages (MDMs) to the central nervous system in animal models of traumatic brain injury, spinal cord injury, and Alzheimer’s disease. Whether the CP is involved in the recruitment of MDMs to the injured brain after ischemic stroke is unknown. Methods Adult male C57BL/6 mice were subjected to focal cortical ischemia by permanent occlusion of the distal branch of the right middle cerebral artery. Choroid plexus tissues were collected and analyzed for Vcam1, Madcam1, Cx3cl1, Ccl2, Nt5e, and Ifnγ expression at different timepoints after stroke using qPCR. Changes of MDMs in CP and cerebrospinal fluid (CSF) at 1 day and 3 days after stroke were analyzed using flow cytometry. Infiltration of MDMs into CP and CSF were validated using β-actin-GFP chimeric mice and Fgd5-CreERT2 x Lox-stop-lox-Tomato mice. CD115+ monocytes were isolated using a magnetic cell separation system from bone marrow of Cx3cr1-GFP or wild-type C57BL/6 donor mice. The freshly isolated monocytes or M2-like MDMs primed in vitro with IL4 and IL13 were stereotaxically injected into the lateral ventricle of stroke-affected mice to trace for their migration into ischemic hemisphere or to assess their effect on post-stroke recovery using open field, corridor, and active avoidance behavioral tests. Results We found that CP responded to cortical stroke by upregulation of gene expression for several possible mediators of MDM trafficking and, concomitantly, MDMs increased in CP and cerebrospinal fluid (CSF). We then confirmed that MDMs infiltrated from blood into CP and CSF after the insult using β-actin-GFP chimeric mice and Fgd5-CreERT2 x Lox-stop-lox-Tomato mice. When MDMs were directly administered into CSF following stroke, they homed to the ischemic hemisphere. If they had been primed in vitro prior to their administration to become M2-like macrophages, they promoted post-stroke recovery of motor and cognitive function without influencing infarct volume. Conclusions Our findings suggest the possibility that autologous transplantation of M2-like MDMs into CSF might be developed into a new strategy for promoting recovery also in patients with stroke.
Collapse
Affiliation(s)
- Ruimin Ge
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84, Lund, Sweden
| | - Daniel Tornero
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84, Lund, Sweden
| | - Masao Hirota
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84, Lund, Sweden
| | - Emanuela Monni
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84, Lund, Sweden
| | - Cecilia Laterza
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84, Lund, Sweden
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84, Lund, Sweden
| | - Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84, Lund, Sweden.
| |
Collapse
|
14
|
Laterza C, Wattananit S, Uoshima N, Ge R, Pekny R, Tornero D, Monni E, Lindvall O, Kokaia Z. Monocyte depletion early after stroke promotes neurogenesis from endogenous neural stem cells in adult brain. Exp Neurol 2017; 297:129-137. [PMID: 28746827 DOI: 10.1016/j.expneurol.2017.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/23/2017] [Accepted: 07/20/2017] [Indexed: 12/20/2022]
Abstract
Ischemic stroke, caused by middle cerebral artery occlusion, leads to long-lasting formation of new striatal neurons from neural stem/progenitor cells (NSPCs) in the subventricular zone (SVZ) of adult rodents. Concomitantly with this neurogenic response, SVZ exhibits activation of resident microglia and infiltrating monocytes. Here we show that depletion of circulating monocytes, using the anti-CCR2 antibody MC-21 during the first week after stroke, enhances striatal neurogenesis at one week post-insult, most likely by increasing short-term survival of the newly formed neuroblasts in the SVZ and adjacent striatum. Blocking monocyte recruitment did not alter the volume of the ischemic lesion but gave rise to reduced astrocyte activation in SVZ and adjacent striatum, which could contribute to the improved neuroblast survival. A similar decrease of astrocyte activation was found in and around human induced pluripotent stem cell (iPSC)-derived NSPCs transplanted into striatum at one week after stroke in monocyte-depleted mice. However, there was no effect on neurogenesis in the graft as determined 8weeks after implantation. Our findings demonstrate, for the first time, that a specific cellular component of the early inflammatory reaction in SVZ and adjacent striatum following stroke, i.e., infiltrating monocytes, compromises the short-term neurogenic response neurogenesis from endogenous NSPCs.
Collapse
Affiliation(s)
- Cecilia Laterza
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | - Somsak Wattananit
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | - Naomi Uoshima
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden; Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Ruimin Ge
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | - Roy Pekny
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | - Daniel Tornero
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | - Emanuela Monni
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | - Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden.
| |
Collapse
|
15
|
Frodl EM, Sauer H, Lindvall O, Brundin P. Effects of Hibernation or Cryopreservation on the Survival and Integration of Striatal Grafts Placed in the Ibotenate-Lesioned Rat Caudate-Putamen. Cell Transplant 2017; 4:571-7. [PMID: 8714778 DOI: 10.1177/096368979500400606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tissue storage prior to intracerebral transplantation would represent a major advantage when conducting clinical transplantation trials in that the procurement of the embryonic donor tissue and the timing of neurosurgery could be planned more efficiently. In the present study, the effects of storing rat embryonic striatal tissue at either +4°C or below freezing temperature prior to grafting to the adult striatum, were assessed with regard to transplant survival, morphology and integration. Eleven days following a unilateral injection of ibotenic acid into the head of the caudate-putamen, a control group of rats received grafts of striatal primordium prepared immediately after dissection from rat embryos (embryonic day 16). A second group of rat embryonic striatal tissue was stored at 4°C (hibernation) for 5 days and then transplanted. A third group of the striatal donor tissue was cryopreserved in liquid nitrogen for 5 days before implantation surgery. Six to seven weeks following transplantation surgery, the grafts were analysed in brain sections processed for acetylcholinesterase histochemistry, DARPP-32 (dopamine and cyclic AMP regulated phosphoprotein with a molecular weight of 32 kDa) and tyrosine hydroxylase (TH) immunocytochemistry. The mean total graft volume and the relative size of the AChE-positive regions were not significantly different between the three groups. Striatal-specific graft regions, positively stained for AChE and DARPP-32, generally exhibited TH immunoreactivity, suggesting that they had received dopaminergic afferents from the host brain. We conclude that embryonic rat striatal tissue can be cryopreserved or hibernated over 5 days without significant impairment in the yield of striatal neurons following intrastriatal implantation and without markedly affecting transplant morphology.
Collapse
Affiliation(s)
- E M Frodl
- Department of Neurology, University Hospital of Lund, Sweden
| | | | | | | |
Collapse
|
16
|
Abstract
Cell transplantation is now being explored as a new therapeutic strategy to restore function in the diseased human central nervous system. Neural grafts show long-term survival and function in patients with Parkinson's disease but the symptomatic relief needs to be increased. Cell transplantation seems justified in patients with Huntington's disease and, at a later stage, possibly also in demyelinating disorders. The further development in this research field will require systematic studies in animal experiments but also well-designed clinical trials in small groups of patients.
Collapse
Affiliation(s)
- O Lindvall
- Department of Neurology, University Hospital, Lund, Sweden
| |
Collapse
|
17
|
Tornero D, Tsupykov O, Granmo M, Rodriguez C, Grønning-Hansen M, Thelin J, Smozhanik E, Laterza C, Wattananit S, Ge R, Tatarishvili J, Grealish S, Brüstle O, Skibo G, Parmar M, Schouenborg J, Lindvall O, Kokaia Z. Synaptic inputs from stroke-injured brain to grafted human stem cell-derived neurons activated by sensory stimuli. Brain 2017; 140:692-706. [PMID: 28115364 DOI: 10.1093/brain/aww347] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/20/2016] [Indexed: 12/20/2022] Open
Abstract
Transplanted neurons derived from stem cells have been proposed to improve function in animal models of human disease by various mechanisms such as neuronal replacement. However, whether the grafted neurons receive functional synaptic inputs from the recipient's brain and integrate into host neural circuitry is unknown. Here we studied the synaptic inputs from the host brain to grafted cortical neurons derived from human induced pluripotent stem cells after transplantation into stroke-injured rat cerebral cortex. Using the rabies virus-based trans-synaptic tracing method and immunoelectron microscopy, we demonstrate that the grafted neurons receive direct synaptic inputs from neurons in different host brain areas located in a pattern similar to that of neurons projecting to the corresponding endogenous cortical neurons in the intact brain. Electrophysiological in vivo recordings from the cortical implants show that physiological sensory stimuli, i.e. cutaneous stimulation of nose and paw, can activate or inhibit spontaneous activity in grafted neurons, indicating that at least some of the afferent inputs are functional. In agreement, we find using patch-clamp recordings that a portion of grafted neurons respond to photostimulation of virally transfected, channelrhodopsin-2-expressing thalamo-cortical axons in acute brain slices. The present study demonstrates, for the first time, that the host brain regulates the activity of grafted neurons, providing strong evidence that transplanted human induced pluripotent stem cell-derived cortical neurons can become incorporated into injured cortical circuitry. Our findings support the idea that these neurons could contribute to functional recovery in stroke and other conditions causing neuronal loss in cerebral cortex.
Collapse
Affiliation(s)
- Daniel Tornero
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, BMC B10, 221 84, Lund, Sweden
| | - Oleg Tsupykov
- Bogomoletz Institute of Physiology, and State Institute of Genetic and Regenerative Medicine, 01024, Kyiv, Ukraine
| | - Marcus Granmo
- Neuronano Research Center, Lund University, Scheelevägen 2, 223 81, Lund, Sweden
| | - Cristina Rodriguez
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, BMC B10, 221 84, Lund, Sweden
| | - Marita Grønning-Hansen
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, BMC B10, 221 84, Lund, Sweden
| | - Jonas Thelin
- Neuronano Research Center, Lund University, Scheelevägen 2, 223 81, Lund, Sweden
| | - Ekaterina Smozhanik
- Bogomoletz Institute of Physiology, and State Institute of Genetic and Regenerative Medicine, 01024, Kyiv, Ukraine
| | - Cecilia Laterza
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, BMC B10, 221 84, Lund, Sweden
| | - Somsak Wattananit
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, BMC B10, 221 84, Lund, Sweden
| | - Ruimin Ge
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, BMC B10, 221 84, Lund, Sweden
| | - Jemal Tatarishvili
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, BMC B10, 221 84, Lund, Sweden
| | - Shane Grealish
- Developmental and Regenerative Neurobiology, Department of Experimental Medical Science, Wallenberg Neuroscience Center and Lund Stem Cell Center, Lund University, BMC A11, 221 84, Lund, Sweden
| | - Oliver Brüstle
- Institute of Reconstructive Neurobiology, Life and Brain Center, University of Bonn, and German Center for Neurodegenerative Diseases (DZNE), Sigmund-Freud-Straße 25, D-53127, Bonn, Germany
| | - Galina Skibo
- Bogomoletz Institute of Physiology, and State Institute of Genetic and Regenerative Medicine, 01024, Kyiv, Ukraine
| | - Malin Parmar
- Developmental and Regenerative Neurobiology, Department of Experimental Medical Science, Wallenberg Neuroscience Center and Lund Stem Cell Center, Lund University, BMC A11, 221 84, Lund, Sweden
| | - Jens Schouenborg
- Neuronano Research Center, Lund University, Scheelevägen 2, 223 81, Lund, Sweden
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, BMC B10, 221 84, Lund, Sweden
| | - Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, BMC B10, 221 84, Lund, Sweden
| |
Collapse
|
18
|
de la Rosa-Prieto C, Laterza C, Gonzalez-Ramos A, Wattananit S, Ge R, Lindvall O, Tornero D, Kokaia Z. Stroke alters behavior of human skin-derived neural progenitors after transplantation adjacent to neurogenic area in rat brain. Stem Cell Res Ther 2017; 8:59. [PMID: 28279192 PMCID: PMC5345149 DOI: 10.1186/s13287-017-0513-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 01/19/2023] Open
Abstract
Background Intracerebral transplantation of human induced pluripotent stem cells (iPSCs) can ameliorate behavioral deficits in animal models of stroke. How the ischemic lesion affects the survival of the transplanted cells, their proliferation, migration, differentiation, and function is only partly understood. Methods Here we have assessed the influence of the stroke-induced injury on grafts of human skin iPSCs-derived long-term neuroepithelial-like stem cells using transplantation into the rostral migratory stream (RMS), adjacent to the neurogenic subventricular zone, in adult rats as a model system. Results We show that the occurrence of an ischemic lesion, induced by middle cerebral artery occlusion, in the striatum close to the transplant does not alter the survival, proliferation, or generation of neuroblasts or mature neurons or astrocytes from the grafted progenitors. In contrast, the migration and axonal projection patterns of the transplanted cells are markedly influenced. In the intact brain, the grafted cells send many fibers to the main olfactory bulb through the RMS and a few of them migrate in the same direction, reaching the first one third of this pathway. In the stroke-injured brain, on the other hand, the grafted cells only migrate toward the ischemic lesion and virtually no axonal outgrowth is observed in the RMS. Conclusions Our findings indicate that signals released from the stroke-injured area regulate the migration of and fiber outgrowth from grafted human skin-derived neural progenitors and overcome the influence on these cellular properties exerted by the neurogenic area/RMS in the intact brain.
Collapse
Affiliation(s)
- Carlos de la Rosa-Prieto
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, 221 84, Lund, Sweden.,Present address: Laboratory of Human Neuroanatomy, Department of Health Sciences, Faculty of Medicine, CRIB, University of Castilla-La Mancha, 02008, Albacete, Spain
| | - Cecilia Laterza
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, 221 84, Lund, Sweden
| | - Ana Gonzalez-Ramos
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, 221 84, Lund, Sweden
| | - Somsak Wattananit
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, 221 84, Lund, Sweden
| | - Ruimin Ge
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, 221 84, Lund, Sweden
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, 221 84, Lund, Sweden
| | - Daniel Tornero
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, 221 84, Lund, Sweden.
| | - Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, 221 84, Lund, Sweden
| |
Collapse
|
19
|
Aked J, Delavaran H, Lindvall O, Norrving B, Kokaia Z, Lindgren A. Attitudes to Stem Cell Therapy Among Ischemic Stroke Survivors in the Lund Stroke Recovery Study. Stem Cells Dev 2017; 26:566-572. [PMID: 28142330 DOI: 10.1089/scd.2016.0343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Preclinical studies suggest that stem cell therapy (SCT) may improve poststroke recovery, and clinical trials investigating safety are ongoing. However, knowledge about patients' attitudes to SCT in stroke is limited. We evaluated the knowledge and attitudes to this therapeutic approach as well as possible factors influencing this among stroke patients potentially suitable for SCT. Consecutive first-ever acute ischemic stroke patients aged 20-75 years with NIH stroke scale scores 1-18 were included. Exclusion criteria were severe comorbidities or infratentorial stroke. Clinical follow-up after 3-5 years assessed severity of residual stroke symptoms, cognitive function, functional status, patient-reported outcome, and comorbidity, and after receiving standardized information, the participants also completed an eight-item questionnaire on knowledge and attitudes about SCT. The relationships between clinical variables and positive attitude to SCT were assessed with logistic regression analyses. Of 108 patients included at baseline, 84 participated at follow-up and completed the questionnaire. In total, 12% had prior knowledge of SCT. When informed, 63% were positive toward it and 36% reported willingness to participate in SCT trials. Only 5%-8% expressed ethical considerations regarding different stem cell sources. Positive attitudes to SCT were associated with male gender (OR: 3.74; 95% CI: 1.45-9.61; P < 0.01) and better patient-reported outcome (OR: 1.02; 95% CI: 1.00-1.04; P < 0.05). In conclusion, stroke patients had limited prior knowledge of SCT, yet attitudes were positive among the majority after receiving standardized and neutral information. Gender and degree of stroke recovery may influence attitudes to SCT, indicating a need for targeted information to improve knowledge about SCT.
Collapse
Affiliation(s)
- Joseph Aked
- 1 Department of Clinical Sciences Lund, Neurology, Lund University , Lund, Sweden .,2 Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital , Lund, Sweden
| | - Hossein Delavaran
- 1 Department of Clinical Sciences Lund, Neurology, Lund University , Lund, Sweden .,2 Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital , Lund, Sweden
| | - Olle Lindvall
- 1 Department of Clinical Sciences Lund, Neurology, Lund University , Lund, Sweden .,2 Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital , Lund, Sweden .,3 Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University , Lund, Sweden
| | - Bo Norrving
- 1 Department of Clinical Sciences Lund, Neurology, Lund University , Lund, Sweden .,2 Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital , Lund, Sweden
| | - Zaal Kokaia
- 1 Department of Clinical Sciences Lund, Neurology, Lund University , Lund, Sweden .,3 Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University , Lund, Sweden
| | - Arne Lindgren
- 1 Department of Clinical Sciences Lund, Neurology, Lund University , Lund, Sweden .,2 Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital , Lund, Sweden
| |
Collapse
|
20
|
Delavaran H, Aked J, Sjunnesson H, Lindvall O, Norrving B, Kokaia Z, Lindgren A. Spontaneous Recovery of Upper Extremity Motor Impairment After Ischemic Stroke: Implications for Stem Cell-Based Therapeutic Approaches. Transl Stroke Res 2017; 8:351-361. [PMID: 28205065 PMCID: PMC5493719 DOI: 10.1007/s12975-017-0523-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/29/2017] [Indexed: 01/18/2023]
Abstract
Preclinical studies suggest that stem cell therapy (SCT) may improve sensorimotor recovery after stroke. Upper extremity motor impairment (UEMI) is common after stroke, often entailing substantial disability. To evaluate the feasibility of post-stroke UEMI as a target for SCT, we examined a selected sample of stroke patients potentially suitable for SCT, aiming to assess the frequency and recovery of UEMI, as well as its relation to activity limitations and participation restrictions. Patients aged 20–75 years with first-ever ischemic stroke, and National Institutes of Health Stroke Scale (NIHSS) scores 1–18, underwent brain diffusion-weighted MRI within 4 days of stroke onset (n = 108). Survivors were followed up after 3–5 years, including assessment with NIHSS, Fugl-Meyer assessment of upper extremity (FMA-UE), modified Rankin Scale (mRS), and Stroke Impact Scale (SIS). UEMI was defined as NIHSS arm/hand score ≥1. UEMI recovery was evaluated with change in NIHSS arm/hand scores between baseline and follow-up. Of 97 survivors, 84 were available to follow-up. Among 76 subjects (of 84) without recurrent stroke, 41 had UEMI at baseline of which 10 had residual UEMI at follow-up. The FMA-UE showed moderate-severe impairment in seven of 10 survivors with residual UEMI. UEMI was correlated to mRS (rs = 0.49, p < 0.001) and the SIS social participation domain (rs = −0.38, p = 0.001). Nearly 25% of the subjects with UEMI at baseline had residual impairment after 3–5 years, whereas about 75% showed complete recovery. Most of the subjects with residual UEMI had moderate-severe impairment, which correlated strongly to dependency in daily activities and social participation restrictions. Our findings suggest that SCT targeting post-stroke UEMI may be clinically valuable with significant meaningful benefits for patients but also emphasize the need of early prognostication to detect patients that will have residual impairment in order to optimize patient selection for SCT.
Collapse
Affiliation(s)
- Hossein Delavaran
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden.
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
| | - Joseph Aked
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
| | - Håkan Sjunnesson
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Olle Lindvall
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Zaal Kokaia
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
21
|
Aked J, Delavaran H, Lindvall O, Norrving B, Kokaia Z, Lindgren A. Abstract WP175: Attitudes to Stem Cell-based Treatments Among Ischemic Stroke Patients. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Pre-clinical studies have shown that stem cell therapy (SCT) may improve recovery after stroke, and clinical trials investigating safety are ongoing. It is important to consider stroke patients’ knowledge and attitudes about SCT, as these factors may have implications for the possible clinical use of SCT. Therefore, we examined the knowledge and attitudes about SCT among stroke patients potentially suitable for such therapy.
Methods:
We recruited consecutive first-ever ischemic stroke patients admitted to Skåne University Hospital in Lund, Sweden, in 2009-2011. Included patients were aged 20-75 years, had a National Institutes of Health Stroke Scale (NIHSS) score of 1-18, and underwent DW-MRI within 4 days of stroke onset. Patients with severe comorbidity, contraindications to MRI, and/or infratentorial stroke were excluded. A clinical follow-up was performed after 3-5 years assessing stroke severity (NIHSS), stroke recovery (NIHSS
baseline
- NIHSS
follow-up
; ΔNIHSS), functional status (modified Rankin Scale; mRS), comorbidity (Charlson Comorbidity Index; CCI), and patient-reported outcome (Stroke Impact Scale; SIS). The participants also completed an 8-part questionnaire on knowledge and attitudes about SCT.
Results:
Of 108 patients at baseline, 84 participated in the follow-up. In total, 12% had prior knowledge of SCT. Also, 63% had positive attitudes towards it. Positive attitudes towards SCT were associated with male sex (crude OR: 3.7; 95% CI: 1.5-9.6;
P
=0.006) and better patient-reported outcome (crude OR: 1.0; 95% CI: 1.0-1.0;
P
=0.034). No such associations were found for age, education, functional status and stroke severity at follow-up. Likewise, willingness to participate in clinical SCT trials was associated with male sex (crude OR: 5.4; 95% CI: 1.8-16.2;
P
=0.003) and a higher degree of stroke recovery (crude OR: 1.3; 95% CI: 1.1-1.7;
P
=0.005).
Conclusions:
Our findings may have implications for SCT trials in stroke as most stroke patients had limited knowledge about SCT, indicating a need for patient education programs. The attitudes towards SCT were mostly positive and willingness to participate in SCT trials was associated with male sex and higher degree of stroke recovery, which may affect patient selection.
Collapse
Affiliation(s)
- Joseph Aked
- Dept of Clinical Sciences, Lund Univ, Lund, Sweden
| | | | | | - Bo Norrving
- Dept of Clinical Sciences, Lund Univ, Lund, Sweden
| | - Zaal Kokaia
- Lund Stem Cell Cntr, Lund Univ, Lund, Sweden
| | | |
Collapse
|
22
|
Abstract
Somatic cells such as fibroblasts, reprogrammed to induced pluripotent stem cells, can be used to generate neural stem/progenitor cells or neuroblasts for transplantation. In this review, we summarize recent studies demonstrating that when grafted intracerebrally in animal models of stroke, reprogrammed neurons improve function, probably by several different mechanisms, e.g., trophic actions, modulation of inflammation, promotion of angiogenesis, cellular and synaptic plasticity, and neuroprotection. In our own work, we have shown that human skin-derived reprogrammed neurons, fated to cortical progeny, integrate in stroke-injured neuronal network and form functional afferent synapses with host neurons, responding to peripheral sensory stimulation. However, whether neuronal replacement plays a role for the improvement of sensory, motor, and cognitive deficits after transplantation of reprogrammed neurons is still unclear. We conclude that further preclinical studies are needed to understand the therapeutic potential of grafted reprogrammed neurons and to define a road map for their clinical translation in stroke.
Collapse
Affiliation(s)
- Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund, Sweden.
| | - Daniel Tornero
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund, Sweden
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, Lund, Sweden
| |
Collapse
|
23
|
Abstract
The efforts to develop a dopamine cell replacement therapy for Parkinson's disease have spanned over more than three decades. Based on almost 10 years of transplantation studies in animal models, the first patients receiving grafts of fetal-derived dopamine neuroblasts were operated in Lund in 1987. Over the following two decades, a total of 18 patients were transplanted and followed closely by our team with mixed but also very encouraging results. In this article we tell the story of how the preclinical and clinical transplantation program in Lund evolved. We recall the excitement when we obtained the first evidence for survival and function of transplanted neurons in the diseased human brain. We also remember the setbacks that we have experienced during these 30 years and discuss the very interesting developments that are now taking place in this exciting field.
Collapse
Affiliation(s)
- Anders Björklund
- Department of Experimental Medical Science, Wallenberg Neuroscience Center, Lund, Sweden
| | - Olle Lindvall
- Department of Clinical Sciences, and Lund Stem Cell Center, Division of Neurology, University Hospital, Lund, Sweden
| |
Collapse
|
24
|
Abstract
The clinical trials with intrastriatal transplantation of human fetal mesencephalic tissue, rich in dopaminergic neurons, in Parkinson's disease (PD) patients show that cell replacement can work and in some cases induce major, long-lasting improvement. However, owing to poor tissue availability, this approach can only be applied in very few patients, and standardization is difficult, leading to wide variation in functional outcome. Stem cells and reprogrammed cells could potentially be used to produce dopaminergic neurons for transplantation. Importantly, dopaminergic neurons of the correct substantia nigra phenotype can now be generated from human embryonic stem cells in large numbers and standardized preparations, and will soon be ready for application in patients. Also, human induced pluripotent stem cell-derived dopaminergic neurons are being considered for clinical translation. Available data justify moving forward in a responsible way with these dopaminergic neurons, which should be tested, using optimal patient selection, cell preparation and transplantation procedures, in controlled clinical studies.
Collapse
Affiliation(s)
- Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, 221 84 Lund, Sweden
| |
Collapse
|
25
|
Delavaran H, Aked J, Arvidsson A, Lindvall O, Kokaia Z, Norrving B, Lindgren A. Abstract TMP28: Upper Extremity Motor Impairment After Ischemic Stroke - Implications for Stem Cell Therapy. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tmp28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Experimental studies show that stem cells can improve motor recovery in animal stroke models. In humans, upper extremity motor impairment (UEMI) is a major consequence following stroke and can entail substantial disability. As stem cell therapy (SCT) may become clinically applicable to promote arm/hand motor recovery after stroke, we aimed to examine the frequency and recovery of UEMI, as well as its’ correlation to functional status and health-related quality of life (HRQoL), in a selected sample of stroke patients potentially suitable for SCT.
Methods:
Consecutive first-ever ischemic stroke patients (n=108) were included in the Lund Stroke Recovery Study in 2009-2011 if: they were aged 20-75 years; underwent brain DW-MRI within 4 days of stroke onset; and their baseline stroke severity was 1-18 according to the National Institutes of Health Stroke Scale (NIHSS). All survivors were invited to a clinical follow-up after 3.5-5.5 years, including: NIHSS arm and extended NIHSS hand items to assess UEMI; Fugl-Meyer upper extremity section (FM-UE) to thoroughly examine UEMI; Action Research Arm Test (ARAT) to evaluate arm/hand function; Modified Rankin Scale (mRS) to assess functional status; and Stroke Impact Scale (SIS) to evaluate HRQoL. UEMI was defined as ≥1 on NIHSS arm/hand items. UEMI recovery was assessed by the change in NIHSS arm/hand scores between baseline and follow-up (ΔNIHSS arm/hand).
Results:
Of 97 stroke survivors, 83 participated in the follow-up. Among survivors without recurrent stroke (n=76), 54% had UEMI at baseline and 28% had remaining UEMI at follow-up. The median ΔNIHSS arm/hand was [-1] (range=[-4] - 1). FM-UE scores were strongly correlated to ARAT (r
s
=0.68,
p
<0.01), mRS (r
s
=[-0.67],
p
<0.01), SIS strength domain (items 1a+1b; r
s
=0.68,
p
<0.01), and SIS hand function domain (r
s
=0.71,
p
<0.01).
Conclusions:
UEMI may be an appropriate target for SCT in stroke as UEMI is prevalent, and strongly correlates to long-term functional status and HRQoL. Our findings confirm previously reported heterogeneity in UEMI recovery, the mechanisms of which need to be addressed in future studies to optimize patient selection for SCT.
Collapse
Affiliation(s)
- Hossein Delavaran
- Dept of Neurology and Rehabilitation Medicine, Skåne Univ Hosp, Lund, Sweden
| | - Joseph Aked
- Faculty of Medicine, Lund Univ, Lund, Sweden
| | - Andreas Arvidsson
- Dept of Neurology and Rehabilitation Medicine, Skåne Univ Hosp, Lund, Sweden
| | | | - Zaal Kokaia
- Lund Stem Cell Cntr, Lund Univ, Lund, Sweden
| | - Bo Norrving
- Dept of Neurology and Rehabilitation Medicine, Skåne Univ Hosp, Lund, Sweden
| | - Arne Lindgren
- Dept of Neurology and Rehabilitation Medicine, Skåne Univ Hosp, Lund, Sweden
| |
Collapse
|
26
|
Abstract
In Parkinson's disease (PD), the main pathology underlying the motor symptoms is a loss of nigrostriatal dopaminergic neurons. Clinical trials of intrastriatal transplantation of human foetal mesencephalic tissue have shown that the grafted dopaminergic neurons re-innervate the striatum, restore striatal dopamine release and, in some cases, induce major, long-lasting improvement of motor function. However, nonmotor symptoms originating from degeneration outside the striatum or in nondopaminergic systems are not alleviated by intrastriatal implantation of dopaminergic neurons. Stem cells and reprogrammed cells could potentially be used to produce dopaminergic neurons for transplantation in patients with PD. Recent studies demonstrate that standardized preparations of dopaminergic neurons of the correct substantia nigra phenotype can be generated from human embryonic stem cells in large numbers, and they will soon be available for patient application. In addition, dopaminergic neurons derived from human induced pluripotent stem cells are being considered for clinical translation. Important challenges include the demonstration of potency (growth capacity and functional efficacy) and safety of the generated dopaminergic neurons in preclinical animal models. The dopaminergic neurons should subsequently be tested, using optimal patient selection and cell preparation and transplantation procedures, in controlled clinical studies.
Collapse
Affiliation(s)
- O Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| |
Collapse
|
27
|
Abstract
A bulk of experimental evidence supports the idea that the stroke-damaged adult brain makes an attempt to repair itself by producing new neurons also in areas where neurogenesis does not normally occur (e.g., the striatum and cerebral cortex). Knowledge about mechanisms regulating the different steps of neurogenesis after stroke is rapidly increasing but still incomplete. The functional consequences of stroke-induced neurogenesis and the level of integration of the new neurons into existing neural circuitries are poorly understood. To have a substantial impact on the recovery after stroke, this potential mechanism for self-repair needs to be enhanced, primarily by increasing the survival and differentiation of the generated neuroblasts. Moreover, for efficient repair, optimization of neurogenesis most likely needs to be combined with promotion of other endogenous neuroregenerative responses (e.g., protection and sprouting of remaining mature neurons, transplantation of neural stem/progenitor cells [NSPC]-derived neurons and glia cells, and modulation of inflammation).
Collapse
Affiliation(s)
- Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | - Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| |
Collapse
|
28
|
Chapman KZ, Ge R, Monni E, Tatarishvili J, Ahlenius H, Arvidsson A, Ekdahl CT, Lindvall O, Kokaia Z. Inflammation without neuronal death triggers striatal neurogenesis comparable to stroke. Neurobiol Dis 2015; 83:1-15. [DOI: 10.1016/j.nbd.2015.08.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/11/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022] Open
|
29
|
Tatarishvili J, Oki K, Monni E, Koch P, Memanishvili T, Buga AM, Verma V, Popa-Wagner A, Brüstle O, Lindvall O, Kokaia Z. Human induced pluripotent stem cells improve recovery in stroke-injured aged rats. Restor Neurol Neurosci 2015; 32:547-58. [PMID: 24916776 DOI: 10.3233/rnn-140404] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Induced pluripotent stem cells (iPSCs) improve behavior and form neurons after implantation into the stroke-injured adult rodent brain. How the aged brain responds to grafted iPSCs is unknown. We determined survival and differentiation of grafted human fibroblast-derived iPSCs and their ability to improve recovery in aged rats after stroke. METHODS Twenty-four months old rats were subjected to 30 min distal middle cerebral artery occlusion causing neocortical damage. After 48 h, animals were transplanted intracortically with human iPSC-derived long-term neuroepithelial-like stem (hiPSC-lt-NES) cells. Controls were subjected to stroke and were vehicle-injected. RESULTS Cell-grafted animals performed better than vehicle-injected recipients in cylinder test at 4 and 7 weeks. At 8 weeks, cell proliferation was low (0.7 %) and number of hiPSC-lt-NES cells corresponded to 49.2% of that of implanted cells. Transplanted cells expressed markers of neuroblasts and mature and GABAergic neurons. Cell-grafted rats exhibited less activated microglia/macrophages in injured cortex and neuronal loss was mitigated. CONCLUSIONS Our study provides the first evidence that grafted human iPSCs survive, differentiate to neurons and ameliorate functional deficits in stroke-injured aged brain.
Collapse
Affiliation(s)
- Jemal Tatarishvili
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Koichi Oki
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Emanuela Monni
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Philipp Koch
- Institute of Reconstructive Neurobiology, Life & Brain Center, University of Bonn and Hertie Fundation, Bonn, Germany
| | - Tamar Memanishvili
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden I. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Ana-Maria Buga
- Department of Psychiatry and Molecular Psychiatry, Rostock University Medical School, Rostock, Germany
| | - Vivek Verma
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Aurel Popa-Wagner
- Department of Psychiatry and Molecular Psychiatry, Rostock University Medical School, Rostock, Germany
| | - Oliver Brüstle
- Institute of Reconstructive Neurobiology, Life & Brain Center, University of Bonn and Hertie Fundation, Bonn, Germany
| | - Olle Lindvall
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Zaal Kokaia
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, Lund, Sweden
| |
Collapse
|
30
|
Magnusson JP, Goritz C, Tatarishvili J, Dias DO, Smith EMK, Lindvall O, Kokaia Z, Frisen J. A latent neurogenic program in astrocytes regulated by Notch signaling in the mouse. Science 2014; 346:237-41. [DOI: 10.1126/science.346.6206.237] [Citation(s) in RCA: 346] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
31
|
Guibentif C, Rönn R, Moraghebi R, Monni E, Madsen M, Leeb-Lundberg LF, Kokaia Z, Lindvall O, Woods NB. Norepinephrine improves de novo emergence of hematopoietic cells in human pluripotent stem cell differentiation cultures. Exp Hematol 2014. [DOI: 10.1016/j.exphem.2014.07.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Monni E, Cusulin C, Cavallaro M, Lindvall O, Kokaia Z. Human Fetal Striatum-Derived Neural Stem (NS) Cells Differentiate to Mature Neurons In Vitro and In Vivo. Curr Stem Cell Res Ther 2014; 9:338-46. [DOI: 10.2174/1574888x09666140321115803] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/22/2022]
|
33
|
Kefalopoulou Z, Politis M, Piccini P, Mencacci N, Bhatia K, Jahanshahi M, Widner H, Rehncrona S, Brundin P, Björklund A, Lindvall O, Limousin P, Quinn N, Foltynie T. Long-term clinical outcome of fetal cell transplantation for Parkinson disease: two case reports. JAMA Neurol 2014; 71:83-7. [PMID: 24217017 DOI: 10.1001/jamaneurol.2013.4749] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Recent advances in stem cell technologies have rekindled an interest in the use of cell replacement strategies for patients with Parkinson disease. This study reports the very long-term clinical outcomes of fetal cell transplantation in 2 patients with Parkinson disease. Such long-term follow-up data can usefully inform on the potential efficacy of this approach, as well as the design of trials for its further evaluation. OBSERVATIONS Two patients received intrastriatal grafts of human fetal ventral mesencephalic tissue, rich in dopaminergic neuroblasts, as restorative treatment for their Parkinson disease. To evaluate the very long-term efficacy of the grafts, clinical assessments were performed 18 and 15 years posttransplantation. Motor improvements gained gradually over the first postoperative years were sustained up to 18 years posttransplantation, while both patients have discontinued, and remained free of any, pharmacological dopaminergic therapy. CONCLUSIONS AND RELEVANCE The results from these 2 cases indicate that dopaminergic cell transplantation can offer very long-term symptomatic relief in patients with Parkinson disease and provide proof-of-concept support for future clinical trials using fetal or stem cell therapies.
Collapse
Affiliation(s)
- Zinovia Kefalopoulou
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England
| | - Marios Politis
- Department of Medicine, Hammersmith Hospital, Imperial College London, London, England
| | - Paola Piccini
- Department of Medicine, Hammersmith Hospital, Imperial College London, London, England
| | - Niccolo Mencacci
- Reta Lila Weston Laboratories and Department of Molecular Neuroscience, UCL Institute of Neurology, London, England
| | - Kailash Bhatia
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England
| | - Håkan Widner
- Division of Neurology, Department of Clinical Sciences, University Hospital, Lund, Sweden
| | - Stig Rehncrona
- Division of Neurology, Department of Clinical Sciences, University Hospital, Lund, Sweden5Division of Neurosurgery, Department of Clinical Sciences, University Hospital, Lund, Sweden
| | - Patrik Brundin
- Neuronal Survival Unit, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
| | - Anders Björklund
- Neuronal Survival Unit, Wallenberg Neuroscience Center, Lund University, Lund, Sweden7Neurobiology Unit, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
| | - Olle Lindvall
- Division of Neurology, Department of Clinical Sciences, University Hospital, Lund, Sweden
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England
| | - Niall Quinn
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, England
| |
Collapse
|
34
|
Åkerblom M, Sachdeva R, Quintino L, Wettergren EE, Chapman KZ, Manfre G, Lindvall O, Lundberg C, Jakobsson J. Visualization and genetic modification of resident brain microglia using lentiviral vectors regulated by microRNA-9. Nat Commun 2013; 4:1770. [PMID: 23612311 DOI: 10.1038/ncomms2801] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 03/26/2013] [Indexed: 11/09/2022] Open
Abstract
Functional studies of resident microglia require molecular tools for their genetic manipulation. Here we show that microRNA-9-regulated lentiviral vectors can be used for the targeted genetic modification of resident microglia in the rodent brain. Using transgenic reporter mice, we demonstrate that murine microglia lack microRNA-9 activity, whereas most other cells in the brain express microRNA-9. Injection of microRNA-9-regulated vectors into the adult rat brain induces transgene expression specifically in cells with morphological features typical of ramified microglia. The majority of transgene-expressing cells colabels with the microglia marker Iba1. We use this approach to visualize and isolate activated resident microglia without affecting circulating and infiltrating monocytes or macrophages in an excitotoxic lesion model in rat striatum. The microRNA-9-regulated vectors described here are a straightforward and powerful tool that facilitates functional studies of resident microglia.
Collapse
Affiliation(s)
- Malin Åkerblom
- Lab of Molecular Neurogenetics, Department of Experimental Medical Science, Wallenberg Neuroscience Center and Lund Stem Cell Center, Lund University, Lund 221 84, Sweden
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Tornero D, Wattananit S, Grønning Madsen M, Koch P, Wood J, Tatarishvili J, Mine Y, Ge R, Monni E, Devaraju K, Hevner RF, Brüstle O, Lindvall O, Kokaia Z. Human induced pluripotent stem cell-derived cortical neurons integrate in stroke-injured cortex and improve functional recovery. ACTA ACUST UNITED AC 2013; 136:3561-77. [PMID: 24148272 DOI: 10.1093/brain/awt278] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stem cell-based approaches to restore function after stroke through replacement of dead neurons require the generation of specific neuronal subtypes. Loss of neurons in the cerebral cortex is a major cause of stroke-induced neurological deficits in adult humans. Reprogramming of adult human somatic cells to induced pluripotent stem cells is a novel approach to produce patient-specific cells for autologous transplantation. Whether such cells can be converted to functional cortical neurons that survive and give rise to behavioural recovery after transplantation in the stroke-injured cerebral cortex is not known. We have generated progenitors in vitro, expressing specific cortical markers and giving rise to functional neurons, from long-term self-renewing neuroepithelial-like stem cells, produced from adult human fibroblast-derived induced pluripotent stem cells. At 2 months after transplantation into the stroke-damaged rat cortex, the cortically fated cells showed less proliferation and more efficient conversion to mature neurons with morphological and immunohistochemical characteristics of a cortical phenotype and higher axonal projection density as compared with non-fated cells. Pyramidal morphology and localization of the cells expressing the cortex-specific marker TBR1 in a certain layered pattern provided further evidence supporting the cortical phenotype of the fated, grafted cells, and electrophysiological recordings demonstrated their functionality. Both fated and non-fated cell-transplanted groups showed bilateral recovery of the impaired function in the stepping test compared with vehicle-injected animals. The behavioural improvement at this early time point was most likely not due to neuronal replacement and reconstruction of circuitry. At 5 months after stroke in immunocompromised rats, there was no tumour formation and the grafted cells exhibited electrophysiological properties of mature neurons with evidence of integration in host circuitry. Our findings show, for the first time, that human skin-derived induced pluripotent stem cells can be differentiated to cortical neuronal progenitors, which survive, differentiate to functional neurons and improve neurological outcome after intracortical implantation in a rat stroke model.
Collapse
Affiliation(s)
- Daniel Tornero
- 1 Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Centre, University Hospital, SE-221 84 Lund, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Devaraju K, Barnabé-Heider F, Kokaia Z, Lindvall O. FoxJ1-expressing cells contribute to neurogenesis in forebrain of adult rats: evidence from in vivo electroporation combined with piggyBac transposon. Exp Cell Res 2013; 319:2790-800. [PMID: 24075965 DOI: 10.1016/j.yexcr.2013.08.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/23/2013] [Accepted: 08/25/2013] [Indexed: 01/03/2023]
Abstract
Ependymal cells in the lateral ventricular wall are considered to be post-mitotic but can give rise to neuroblasts and astrocytes after stroke in adult mice due to insult-induced suppression of Notch signaling. The transcription factor FoxJ1, which has been used to characterize mouse ependymal cells, is also expressed by a subset of astrocytes. Cells expressing FoxJ1, which drives the expression of motile cilia, contribute to early postnatal neurogenesis in mouse olfactory bulb. The distribution and progeny of FoxJ1-expressing cells in rat forebrain are unknown. Here we show using immunohistochemistry that the overall majority of FoxJ1-expressing cells in the lateral ventricular wall of adult rats are ependymal cells with a minor population being astrocytes. To allow for long-term fate mapping of FoxJ1-derived cells, we used the piggyBac system for in vivo gene transfer with electroporation. Using this method, we found that FoxJ1-expressing cells, presumably the astrocytes, give rise to neuroblasts and mature neurons in the olfactory bulb both in intact and stroke-damaged brain of adult rats. No significant contribution of FoxJ1-derived cells to stroke-induced striatal neurogenesis was detected. These data indicate that in the adult rat brain, FoxJ1-expressing cells contribute to the formation of new neurons in the olfactory bulb but are not involved in the cellular repair after stroke.
Collapse
Affiliation(s)
- Karthikeyan Devaraju
- Laboratory of Stem Cells and Restorative Neurology, Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | | | | | | |
Collapse
|
37
|
Cusulin C, Monni E, Ahlenius H, Wood J, Brune JC, Lindvall O, Kokaia Z. Embryonic stem cell-derived neural stem cells fuse with microglia and mature neurons. Stem Cells 2013; 30:2657-71. [PMID: 22961761 DOI: 10.1002/stem.1227] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 08/10/2012] [Indexed: 12/12/2022]
Abstract
Transplantation of neural stem cells (NSCs) is a novel strategy to restore function in the diseased brain, acting through multiple mechanisms, for example, neuronal replacement, neuroprotection, and modulation of inflammation. Whether transplanted NSCs can operate by fusing with microglial cells or mature neurons is largely unknown. Here, we have studied the interaction of a mouse embryonic stem cell-derived neural stem (NS) cell line with rat and mouse microglia and neurons in vitro and in vivo. We show that NS cells spontaneously fuse with cocultured cortical neurons, and that this process requires the presence of microglia. Our in vitro data indicate that the NS cells can first fuse with microglia and then with neurons. The fused NS/microglial cells express markers and retain genetic and functional characteristics of both parental cell types, being able to respond to microglia-specific stimuli (LPS and IL-4/IL-13) and to differentiate to neurons and astrocytes. The NS cells fuse with microglia, at least partly, through interaction between phosphatidylserine exposed on the surface of NS cells and CD36 receptor on microglia. Transplantation of NS cells into rodent cortex results in fusion with mature pyramidal neurons, which often carry two nuclei, a process probably mediated by microglia. The fusogenic role of microglia could be even more important after NSC transplantation into brains affected by neurodegenerative diseases associated with microglia activation. It remains to be elucidated how the occurrence of the fused cells will influence the functional outcome after NSC transplantation in the diseased brain.
Collapse
Affiliation(s)
- Carlo Cusulin
- Laboratory of Stem Cells and Restorative Neurology, Department of Laboratory Medicine, University Hospital, SE-22184 Lund, Sweden
| | | | | | | | | | | | | |
Collapse
|
38
|
Guibentif C, Rönn R, Moraghebi R, Monni E, Madsen M, Kokaia Z, Lindvall O, Woods NB. Norepinephrine improves the generation of hematopoietic cells from human pluripotent stem cells. Exp Hematol 2013. [DOI: 10.1016/j.exphem.2013.05.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Bianco P, Barker R, Brüstle O, Cattaneo E, Clevers H, Daley GQ, De Luca M, Goldstein L, Lindvall O, Mummery C, Robey PG, Sattler de Sousa e Brito C, Smith A. Regulation of stem cell therapies under attack in Europe: for whom the bell tolls. EMBO J 2013; 32:1489-95. [PMID: 23644381 PMCID: PMC3671253 DOI: 10.1038/emboj.2013.114] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 04/29/2013] [Indexed: 02/02/2023] Open
Abstract
At the time of writing, the Italian Parliament is debating a new law that would make it legal to practice an unproven stem cell treatment in public hospitals. The treatment, offered by a private non-medical organization, may not be safe, lacks a rationale, and violates current national laws and European regulations. This case raises multiple concerns, most prominently the urgent need to protect patients who are severely ill, exposed to significant risks, and vulnerable to exploitation. The scientific community must consider the context-social, financial, medical, legal-in which stem cell science is currently situated and the need for stringent regulation. Additional concerns are emerging. These emanate from the novel climate, created within science itself, and stem cell science in particular, by the currently prevailing model of 'translational medicine'. Only rigorous science and rigorous regulation can ensure translation of science into effective therapies rather than into ineffective market products, and mark, at the same time, the sharp distinction between the striving for new therapies and the deceit of patients.
Collapse
Affiliation(s)
- Paolo Bianco
- Department of Molecular Medicine, University of Rome ‘La Sapienza', Rome, Italy,Departmento di Medicina Sperimentale, University of Rome ‘La Sapienza', Rome, Italy. E-mail:
| | - Roger Barker
- John van Geest Centre for Brain Repair, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Oliver Brüstle
- Institute of Reconstructive Neurobiology, LIFE & BRAIN Centre, University of Bonn, Bonn, Germany
| | - Elena Cattaneo
- Department of Biosciences and Centre of Stem Cell Research (UniStem), University of Milan, Milan, Italy
| | | | | | - Michele De Luca
- Center for Regenerative Medicine ‘Stefano Ferrari', University of Modena and Reggio Emilia, Modena, Italy
| | - Lawrence Goldstein
- Department of Cellular and Molecular Medicine and Department of Neurosciences University of California at San Diego School of Medicine, San Diego, CA, USA
| | - Olle Lindvall
- Lund Stem Cell Center, University Hospital, Lund, Sweden
| | - Christine Mummery
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pamela G Robey
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | | | - Austin Smith
- Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
| |
Collapse
|
40
|
Lindvall O. Developing dopaminergic cell therapy for Parkinson's disease-give up or move forward? Mov Disord 2013; 28:268-73. [DOI: 10.1002/mds.25378] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/25/2012] [Accepted: 01/03/2013] [Indexed: 01/24/2023] Open
Affiliation(s)
- Olle Lindvall
- Lund Stem Cell Center; University Hospital; Lund; Sweden
| |
Collapse
|
41
|
Mine Y, Tatarishvili J, Oki K, Monni E, Kokaia Z, Lindvall O. Grafted human neural stem cells enhance several steps of endogenous neurogenesis and improve behavioral recovery after middle cerebral artery occlusion in rats. Neurobiol Dis 2012; 52:191-203. [PMID: 23276704 DOI: 10.1016/j.nbd.2012.12.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/30/2012] [Accepted: 12/18/2012] [Indexed: 12/12/2022] Open
Abstract
Neural stem/progenitor cells (NSPCs) in subventricular zone (SVZ) produce new striatal neurons during several months after stroke, which may contribute to recovery. Intracerebral grafts of NSPCs can exert beneficial effects after stroke through neuronal replacement, trophic actions, neuroprotection, and modulation of inflammation. Here we have explored whether human fetal striatum-derived NSPC-grafts influence striatal neurogenesis and promote recovery in stroke-damaged brain. T cell-deficient rats were subjected to 1h middle cerebral artery occlusion (MCAO). Human fetal NSPCs or vehicle were implanted into ipsilateral striatum 48 h after MCAO, animals were assessed behaviorally, and perfused at 6 or 14 weeks. Grafted human NSPCs survived in all rats, and a subpopulation had differentiated to neuroblasts or mature neurons at 6 and 14 weeks. Numbers of proliferating cells in SVZ and new migrating neuroblasts and mature neurons were higher, and numbers of activated microglia/macrophages were lower in the ischemic striatum of NSPC-grafted compared to vehicle-injected group both at 6 and 14 weeks. A fraction of grafted NSPCs projected axons from striatum to globus pallidus. The NSPC-grafted rats showed improved functional recovery in stepping and cylinder tests from 6 and 12 weeks, respectively. Our data show, for the first time, that intrastriatal implants of human fetal NSPCs exert a long-term enhancement of several steps of striatal neurogensis after stroke. The grafts also suppress striatal inflammation and ameliorate neurological deficits. Our findings support the idea that combination of NSPC transplantation and stimulation of neurogenesis from endogenous NSPCs may become a valuable strategy for functional restoration after stroke.
Collapse
Affiliation(s)
- Yutaka Mine
- Laboratory of Stem Cells and Restorative Neurology, University Hospital, SE-221 84 Lund, Sweden
| | | | | | | | | | | |
Collapse
|
42
|
Oki K, Tatarishvili J, Wood J, Koch P, Wattananit S, Mine Y, Monni E, Tornero D, Ahlenius H, Ladewig J, Brüstle O, Lindvall O, Kokaia Z. Human-induced pluripotent stem cells form functional neurons and improve recovery after grafting in stroke-damaged brain. Stem Cells 2012; 30:1120-33. [PMID: 22495829 DOI: 10.1002/stem.1104] [Citation(s) in RCA: 226] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Reprogramming of adult human somatic cells to induced pluripotent stem cells (iPSCs) is a novel approach to produce patient-specific cells for autologous transplantation. Whether such cells survive long-term, differentiate to functional neurons, and induce recovery in the stroke-injured brain are unclear. We have transplanted long-term self-renewing neuroepithelial-like stem cells, generated from adult human fibroblast-derived iPSCs, into the stroke-damaged mouse and rat striatum or cortex. Recovery of forepaw movements was observed already at 1 week after transplantation. Improvement was most likely not due to neuronal replacement but was associated with increased vascular endothelial growth factor levels, probably enhancing endogenous plasticity. Transplanted cells stopped proliferating, could survive without forming tumors for at least 4 months, and differentiated to morphologically mature neurons of different subtypes. Neurons in intrastriatal grafts sent axonal projections to the globus pallidus. Grafted cells exhibited electrophysiological properties of mature neurons and received synaptic input from host neurons. Our study provides the first evidence that transplantation of human iPSC-derived cells is a safe and efficient approach to promote recovery after stroke and can be used to supply the injured brain with new neurons for replacement.
Collapse
Affiliation(s)
- Koichi Oki
- Laboratory of Neural Stem Cell Biology and Therapy, University Hospital, Lund, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Delavaran H, Sjunnesson H, Arvidsson A, Lindvall O, Norrving B, van Westen D, Kokaia Z, Lindgren A. Proximity of brain infarcts to regions of endogenous neurogenesis and involvement of striatum in ischaemic stroke. Eur J Neurol 2012; 20:473-479. [PMID: 23057628 DOI: 10.1111/j.1468-1331.2012.03877.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/21/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Clinical stroke trials with stem cell-based approaches aiming for trophic actions, modulation of inflammation and neuroprotection are ongoing. However, experimental studies also suggest that neuronal replacement by grafted neural stem cells (NSCs) and possibly by endogenous NSCs from the subventricular zone (SVZ) may restore function in the stroke-damaged striatum. To evaluate the potential clinical impact of these findings, we analyzed the spatial relationship of infarcts to the SVZ and the proportion of individuals with striatal lesions in a consecutive series of ischaemic stroke patients. METHODS Patients aged 20-75 years with first-ever ischaemic stroke underwent DW-MRI of the brain within 4 days after stroke onset. We analyzed location, size, number of acute focal ischaemic abnormalities and their spatial relationship to the SVZ. Stroke severity was assessed using NIH Stroke Scale (NIHSS). RESULTS Of 108 included patients, the distance from the nearest margin of the infarct(s) to the SVZ was ≤2 mm in 51/102 patients with visible ischaemic lesions on DW-MRI. Twenty-four patients had involvement of striatum. Eight of these had predominantly striatal lesions, that is >50% of the total ischaemic lesion volume was located in caudate nucleus and/or putamen. These 8 patients had a median NIHSS of 3. CONCLUSIONS Many stroke patients have infarcts located close to the SVZ, providing some supportive evidence that optimized endogenous neurogenesis may have therapeutic potential. However, predominantly striatal infarcts are rare and tend to give mild neurological deficits, indicating that striatum should not be the primary target for neuronal replacement efforts in humans.
Collapse
Affiliation(s)
- H Delavaran
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - H Sjunnesson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - A Arvidsson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - O Lindvall
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden.,Lund Stem Cell Center, Lund, Sweden
| | - B Norrving
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - D van Westen
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - Z Kokaia
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden.,Lund Stem Cell Center, Lund, Sweden
| | - A Lindgren
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
44
|
Abstract
The remarkable advancements in basic stem cell research with implications for several central nervous system disorders have so far not been translated into clinically effective therapies. Here I discuss some of the underlying problems and how they could be overcome.
Collapse
Affiliation(s)
- Olle Lindvall
- Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden.
| |
Collapse
|
45
|
Ribeiro D, Laguna Goya R, Ravindran G, Vuono R, Parish CL, Foldi C, Piroth T, Yang S, Parmar M, Nikkhah G, Hjerling-Leffler J, Lindvall O, Barker RA, Arenas E. Efficient expansion and dopaminergic differentiation of human fetal ventral midbrain neural stem cells by midbrain morphogens. Neurobiol Dis 2012; 49:118-27. [PMID: 22940632 DOI: 10.1016/j.nbd.2012.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 07/18/2012] [Accepted: 08/16/2012] [Indexed: 11/30/2022] Open
Abstract
Human fetal midbrain tissue grafting has provided proof-of-concept for dopamine cell replacement therapy (CRT) in Parkinson's disease (PD). However, limited tissue availability has hindered the development and widespread use of this experimental therapy. Here we present a method for generating large numbers of midbrain dopaminergic (DA) neurons based on expanding and differentiating neural stem/progenitor cells present in the human ventral midbrain (hVM) tissue. Our results show that hVM neurospheres (hVMN) with low cell numbers, unlike their rodent counterparts, expand the total number of cells 3-fold, whilst retaining their capacity to differentiate into midbrain DA neurons. Moreover, Wnt5a promoted DA differentiation of expanded cells resulting in improved morphological maturation, midbrain DA marker expression, DA release and electrophysiological properties. This method results in cell preparations that, after expansion and differentiation, can contain 6-fold more midbrain DA neurons than the starting VM preparation. Thus, our results provide evidence that by improving expansion and differentiation of progenitors present in the hVM it is possible to greatly enrich cell preparations for DA neurons. This method could substantially reduce the amount of human fetal midbrain tissue necessary for CRT in patients with PD, which could have major implications for the widespread adoption of this approach.
Collapse
Affiliation(s)
- Diogo Ribeiro
- Laboratory of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, S-171 77 Stockholm, Sweden
| | - Rocio Laguna Goya
- Cambridge Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK
| | - Geeta Ravindran
- Laboratory of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, S-171 77 Stockholm, Sweden
| | - Romina Vuono
- Cambridge Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK
| | - Clare L Parish
- Laboratory of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, S-171 77 Stockholm, Sweden
| | - Claire Foldi
- Laboratory of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, S-171 77 Stockholm, Sweden
| | - Tobias Piroth
- Laboratory of Molecular Neurosurgery and Neurological Clinic, Department of Stereotactical Neurosurgery, University Freiburg Medical Center, Breisacher Str. 64, 79106 Freiburg i. B., Germany
| | - Shanzheng Yang
- Laboratory of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, S-171 77 Stockholm, Sweden
| | - Malin Parmar
- Department of Experimental Medical Science, Wallenberg Neuroscience Center and Lund Stem Cell Center, Lund University, BMC A11, 22184 Lund, Sweden
| | - Guido Nikkhah
- Laboratory of Molecular Neurosurgery and Neurological Clinic, Department of Stereotactical Neurosurgery, University Freiburg Medical Center, Breisacher Str. 64, 79106 Freiburg i. B., Germany
| | - Jens Hjerling-Leffler
- Laboratory of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, S-171 77 Stockholm, Sweden
| | - Olle Lindvall
- Laboratory of Neurogenesis and Cell Therapy, Wallenberg Neuroscience Center and Lund Stem Cell Center, University Hospital, SE-221 84 Lund, Sweden
| | - Roger A Barker
- Cambridge Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK
| | - Ernest Arenas
- Laboratory of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, S-171 77 Stockholm, Sweden.
| |
Collapse
|
46
|
Abstract
Stem cells and their derivatives show tremendous potential for treating many disorders, including neurodegenerative diseases. We discuss here the challenges and potential for the translation of stem-cell-based approaches into treatments for Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis.
Collapse
Affiliation(s)
- Olle Lindvall
- Wallenberg Neuroscience Center, University Hospital, SE-221 84 Lund, Sweden.
| | | | | | | | | |
Collapse
|
47
|
Svensson J, Ghatnekar O, Lindgren A, Lindvall O, Norrving B, Persson U, Kokaia Z. Societal Value of Stem Cell Therapy in Stroke – A Modeling Study. Cerebrovasc Dis 2012; 33:532-9. [DOI: 10.1159/000337765] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/27/2012] [Indexed: 01/01/2023] Open
|
48
|
Biscaro B, Lindvall O, Tesco G, Ekdahl CT, Nitsch RM. Inhibition of microglial activation protects hippocampal neurogenesis and improves cognitive deficits in a transgenic mouse model for Alzheimer's disease. NEURODEGENER DIS 2012; 9:187-98. [PMID: 22584394 DOI: 10.1159/000330363] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 06/28/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Activated microglia with macrophage-like functions invade and surround β-amyloid (Aβ) plaques in Alzheimer's disease (AD), possibly contributing to the turnover of Aβ, but they can also secrete proinflammatory factors that may be involved in the pathogenesis of AD. Microglia are known to modulate adult hippocampal neurogenesis. OBJECTIVES/METHODS To determine the role of microglia on neurogenesis in brains with Aβ pathology, we inhibited microglial activation with the tetracycline derivative minocycline in doubly transgenic mice expressing mutant human amyloid precursor protein (APP) and mutant human presenilin-1 (PS1). RESULTS Minocycline increased the survival of new dentate granule cells in APP/PS1 mice indicated by more BrdU+/NeuN+ cells as compared to vehicle-treated transgenic littermates, accompanied by improved behavioral performance in a hippocampus-dependent learning task. Both brain levels of Aβ and Aβ-related morphological deficits in the new neurons labeled with GFP-expressing retrovirus were unaffected in minocycline-treated mice. CONCLUSIONS These results suggest a role for microglia in Aβ-related functional deficits and in suppressing the survival of new neurons, and show that modulation of microglial function with minocycline can protect hippocampal neurogenesis in the presence of Aβ pathology.
Collapse
Affiliation(s)
- Barbara Biscaro
- Division of Psychiatry Research, University of Zurich, Zurich, Switzerland.
| | | | | | | | | |
Collapse
|
49
|
Jackson J, Chugh D, Nilsson P, Wood J, Carlström K, Lindvall O, Ekdahl CT. Altered synaptic properties during integration of adult-born hippocampal neurons following a seizure insult. PLoS One 2012; 7:e35557. [PMID: 22539981 PMCID: PMC3335066 DOI: 10.1371/journal.pone.0035557] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 03/20/2012] [Indexed: 12/20/2022] Open
Abstract
Pathological conditions affect several stages of neurogenesis in the adult brain, including proliferation, survival, cell fate, migration, and functional integration. Here we explored how a pathological environment modulates the heterogeneous afferent synaptic input that shapes the functional properties of newly formed neurons. We analyzed the expression of adhesion molecules and other synaptic proteins on adult-born hippocampal neurons formed after electrically-induced partial status epilepticus (pSE). New cells were labeled with a GFP-retroviral vector one week after pSE. One and three weeks thereafter, synaptic proteins were present on dendritic spines and shafts, but without differences between pSE and control group. In contrast, at six weeks, we found fewer dendritic spines and decreased expression of the scaffolding protein PSD-95 on spines, without changes in expression of the adhesion molecules N-cadherin or neuroligin-1, primarily located at excitatory synapses. Moreover, we detected an increased expression of the inhibitory scaffolding protein gephyrin in newborn but not mature neurons after SE. However, this increase was not accompanied by a difference in GABA expression, and there was even a region-specific decrease in the adhesion molecule neuroligin-2 expression, both in newborn and mature neurons. Neuroligin-2 clusters co-localized with presynaptic cholecystokinin terminals, which were also reduced. The expression of neuroligin-4 and glycine receptor was unchanged. Increased postsynaptic clustering of gephyrin, without an accompanying increase in GABAergic input or neuroligin-2 and -4 expression, the latter important for clustering of GABA(A) and glycine receptors, respectively, could imply an increased but altered inhibitory connectivity specific for newborn neurons. The changes were transient and expression of both gephyrin and NL-2 was normalized 3 months post-SE. Our findings indicate that seizure-induced brain pathology alters the sub-cellular expression of synaptic adhesion molecules and scaffolding proteins related to particularly inhibitory but also excitatory synapses, which may yield functional consequences for the integration of adult-born neurons.
Collapse
Affiliation(s)
- Johanna Jackson
- Laboratory of Neurogenesis and Cell Therapy, Wallenberg Neuroscience Center, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Deepti Chugh
- Laboratory of Neurogenesis and Cell Therapy, Wallenberg Neuroscience Center, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Per Nilsson
- Laboratory of Neurogenesis and Cell Therapy, Wallenberg Neuroscience Center, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - James Wood
- Laboratory of Neurogenesis and Cell Therapy, Wallenberg Neuroscience Center, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Karl Carlström
- Laboratory of Neurogenesis and Cell Therapy, Wallenberg Neuroscience Center, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Olle Lindvall
- Laboratory of Neurogenesis and Cell Therapy, Wallenberg Neuroscience Center, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Christine T. Ekdahl
- Laboratory of Neurogenesis and Cell Therapy, Wallenberg Neuroscience Center, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Inflammation and Stem Cell Therapy Group, Division of Clinical Neurophysiology, Lund, Sweden
- * E-mail:
| |
Collapse
|
50
|
Politis M, Wu K, Loane C, Quinn NP, Brooks DJ, Oertel WH, Bjorklund A, Lindvall O, Piccini P. Serotonin Neuron Loss and Nonmotor Symptoms Continue in Parkinson's Patients Treated with Dopamine Grafts. Sci Transl Med 2012; 4:128ra41. [DOI: 10.1126/scitranslmed.3003391] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|