IDIOPATHIC PARKINSON DISEASE (IPD) & AUTOLOGOUS BONE MARROW DERIVED PROGENITOR CELL TRANSPLANT (ABMD-PCT)

F Pérez Chávez, JE Novoa, MA Medina, M Soto, R Rangel Guerra, V Plachin, R Estela, J Ravera, F Gordillo, R Cazares, A Pérez Chávez, P Alterwain, A Ortega & R Caride
Depto de Medicina Interna. Servicios de Hematologia & Endocrinologia Hospital Policial-DNSP. Hospital de San Carlos, MSP-ASSE. Centro de Terapia Celular Clinica Real. Montevideo, Uruguay. Departamento de Patología Clínica & Servicios Médicos. UANL, México. CellTher Program.

Background: the term parkinsonism refers to a syndrome characterized by any of a combination of six clinical features:rest tremor, bradikinesia, rigidity, postural instability
flexed posture and freezing. The most common cause of parkinsonism is idiopathic Parkinson’s disease, a neurodegenerative disease, first described by an english physician Dr. James Parkinson in 1817. Over time, the disease progress to involve the contralateral side of the body and postural instability, flexed posture and freezing of gait eventually develop. Depression occurs in 50% of patients, and dementia develop, espe cially in individuals with older age at onset. Current therapy can not avoid progression.

the term parkinsonism refers to a syndrome characterized by any of a combination of six clinical features:rest tremor, bradikinesia, rigidity, postural instabilityflexed posture and freezing. The most common cause of parkinsonism is idiopathic Parkinson’s disease, a neurodegenerative disease, first described by an english physician Dr. James Parkinson in 1817. Over time, the disease progress to involve the contralateral side of the body and postural instability, flexed posture and freezing of gait eventually develop. Depression occurs in 50% of patients, and dementia develop, espe cially in individuals with older age at onset. Current therapy can not avoid progression.

Aims:

• Control of clinical symptoms and signs of the disease, and quality of life.
• evaluate other aditional therapeutic effects.
• evaluate side effects of the ABMD-PC transplant in this group of patients.

Methods: from october 2007 to january 2008, 15 patients were evaluable to be included on this protocol with neurological diagnosis of idiopathic parkinsons disease.
10 men and 5 women. Median age was 70 years old (59 – 87).
The diagnosis was done in all the cases by a MD specialist in Clinical Neurology. For the initial evaluation score and follow up the UPDRS (Unified Parkinson Disease Research System) scale was employed. The control group was the same cohort of patients in the six months before ABMD-PC transplant.
All the patients signed informed consent. Exclusion criteria: cáncer in the last 5 years, IV degree diabetic retinopa thy, active smoking, morbid obesity and short life spectancy (less than 6 months). Local anaesthesia was employed in 7 patientes with xilocaine 2% for harvest and transplantation in the gastrocnemius muscle. General anaesthesia with Propofol was received for the rest of patients (8/15). Cell concentration was obtained by gradient of density. Mobilization with filgrastim was employed, 5 ug/kg/weight daily (two doses) before transplantation (48 hs). Unmanipulated autologous bone marrow derived progenitor cells were injected in one of the lower limbs in 2 ml aliquots. Mean harvest volume was 2,5 ml/kg/body weight. The mean number of transplanted mononuclear cells was 2,2×109/kg body weight. All the patients received after ABMD-PC transplant, enoxaparine 40 mg/sub cut daily or nadroparine 3800 IU anti-Xa, clopidogrel 75 mg po and pentoxiphilin 400 mg/daily po, during 30 days. The control population was the group of transplanted patients during the 6 months before ABMD-PC transplant. Each patient was regularly (monthly) evaluated for the Neurology and Hematology Team on the basis of the UPDRS scale score.Results: the procedure mortality rate was 0%. The only complication of this treatment was local hemathoma in the transplanted leg (3%). 60% of patients showed a positive answer to treatment with desappear of IPD symptoms; in the first transplanted patients, until for 120 days. Conclusions: autologous bone marrow derived progenitor cell transplant, by the Conzi-Fortunato effectä, can be performed safely and appears to be a benefical complementary therapy for patients with idiopathic Parkinson’s disease. www.cellther.org

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