A sequential intrastriatal dopaminergic graft strategy in the rodent model for Parkinson's disease: implications for graft survival and targeting

Optimal placement of intrastriatal dopaminergic grafts is likely crucial to optimize clinical recovery in Parkinson's disease (PD). The target sites of dopaminergic grafts vary among clinical trials and may partially explain the variable results in clinical efficacy reported thus far. In this study we hypothesized that a subsequent dopaminergic graft may promote functional recovery following a suboptimal initial graft. To test this hypothesis, rats with unilateral 6-hydroxydopamine lesions of the right nigrostriatal pathway were randomly divided into three groups. The first group received 900,000 fetal nigral cells in the medial striatum only (n = 6). The second group received 900,000 cells in both the medial and lateral striatum simultaneously (1.8 million total; n = 8). The final group received a second graft of 900,000 cells in the lateral striatum 6 weeks following initial transplantation of a medial graft (n = 6). Amphetamine-induced circling behavior was significantly reduced in both simultaneous and sequential graft groups at 9 and 12 weeks following transplantation of the initial graft. However, no recovery was noted in the single medial graft group at those time points. Furthermore, increased survival of dopaminergic cells was observed in the lateral graft of sequentially grafted animals compared with the medial graft. We conclude that a well-positioned subsequent graft can restore function in animals with a suboptimal initial graft and that the initial graft may improve survival of the second graft. These results are further discussed in relation to their important clinical implication for neural transplantation in PD.     

胎脑黑质细胞悬液脑实质内移植与脑室内移植的效果比较

为了比较胎脑黑质细胞悬液脑裨移植与脑室内移植的效果，作者观察了接受了上述移植处理后的ＰＤ大鼠旋转行为的变化和移植部位组织学及免疫组化行征，结果发现胎脑黑质细胞悬液脑实质内移植有利于移植和的对宿主脑组织成神经再技配，其远期效果比脑室内移植的效果更，更持久。     

Comparison of embryonic stem cell-derived dopamine neuron grafts and fetal ventral mesencephalic tissue grafts: morphology and function

In this study we compared the function and morphology of two types of neural grafts: allografts of fetal ventral mesencephalic (VM) tissue and xenografts of embryonic stem cell (ESC)-derived dopamine neurons. Mouse embryonic stem cells were cultured and exposed to differentiation factors that induced approximately 10% of the cells to express a dopaminergic phenotype. These cells were then harvested and implanted into the denervated striatum of rats with unilateral lesions of the nigrostriatal pathway. Another group of lesioned rats received allografts of fetal ventral mesencephalic tissue. While both types of grafts yield a similar number of tyrosine hydroxylase (TH)-positive cells, amphetamine-induced rotational behavior was differentially affected by these grafts: rotational behavior was significantly reduced in lesioned rats receiving allografts of fetal VM tissue while ESC grafts had slight but insignificant effects on rotational scores. Densitometry measures of TH+ fiber outgrowth revealed a similar area of reinnervation and a comparable number of TH+ cells for ESC graft when compared with VM grafts. These data suggest there are similarities and also distinct differences in the manner in which ESC and VM grafts interact with the denervated striatum.     

胎脑黑质移植物在帕金森病大鼠纹状体内长期存活（TH免疫组化及印…

运用细胞免疫组织化学技术和免疫印迹试验手段,观察了胎脑黑质多巴胺神经元移植到ＰＤ大鼠纹状体内存活、发育、生长的变化规律,发现移植物在宿主脑组织内有“发育延迟”现象,随着移植时间延长,移植物多巴胺神经元能够对宿主神经建立神经再支配作用,并且,这种神经再支配作用更有利于移植物有效地发挥功能。     

Combining neuroprotective treatment of embryonic nigral donor tissue with mild hypothermia of the graft recipient

Around 80-95% of the immature dopaminergic neurons die when embryonic ventral mesencephalic tissue is transplanted. Cell death occurs both during the preparation of donor tissue and after graft implantation, but the effect of combining successful neuroprotective treatments before and after transplantation has not been extensively investigated. We therefore treated embryonic rat mesencephalic tissue with a combination of the lipid peroxidation inhibitor tirilazad mesylate (3 microM) and the caspase inhibitor Ac.YVAD.cmk (500 microM) and transplanted the tissue into hemiparkinsonian rats kept hypothermic (32-33 degrees C) or normothermic (37 degrees C) during, and 90 min following, graft surgery. Suspension cell number did not differ between untreated or tirilazad/YVAD-treated preparations prior to transplantation. When graft survival was evaluated 6 weeks after implantation, both tirilazad/YVAD pretreatment and mild hypothermia increased the survival of transplanted dopaminergic neurons. Approximately 50-57% of the embryonic dopaminergic neurons survived the dissociation and grafting procedure in rats rendered hypothermic, but there was no significant additive effect on graft survival with a combined treatment. All groups of rats exhibited behavioral recovery in the amphetamine-induced rotation test. There was a significantly enhanced functional capacity of grafts placed in hypothermic as compared to normothermic rats. However, tirilazad/YVAD pretreated implants did not afford greater behavioral improvement than control-treated grafts. Our results suggest that neuroprotective treatments administered prior to and immediately after neural graft implantation may under certain conditions rescue, at least in part, the same subset of dopaminergic neurons. The study also emphasizes the importance of the immediate time after grafting for transplant survival, with relevance both for primary mesencephalic implants and stem cell grafts.     

Local effects of dexamethasone on immune reaction in neural transplantation

This study was performed to see whether local injection of dexamethasone may protect the neural grafts from immunological rejection and increase the successive rate of graft. Rats with unilateral 6-hydroxydopamine lesions of the mesostriatal dopamine pathway received fetal ventral mesencephalic (FVM) cells and dexamethasone in two regions of the striatum and showed significant (P<0.001) reduction in rotational asymmetry as compared to the non-immunosuppressed group. A significantly greater number of total TH-ir cells (P<0.001) and fewer number of total GFAP -ir cells (P<0.001) and inflammatory cells were observed in the striatum of animals in immunosuppressed group than those in non-immunosuppressed group. This results indicated that local injection of dexamethasone could not only reduce the immune rejection and increase the survival grafted cell but also avoid the side effects brought by long systemic administer of immunosuppressant.     

帕金森病样大鼠牛嗜铬细胞脑内移植后的行为和组织学观察

目的 观察牛肾上腺嗜铬细胞异种移植于帕金森病（ＰＤ）样大鼠脑内的效果及移植物的存活情况。方法 将用酶消化和机械分离及纯化的牛肾上腺嗜铬细胞移植于ＰＤ样大鼠的脑纹状体内（损毁同侧）,以阿朴吗啡诱发的异常旋转行为为观察指标,比较细胞移植组、生理盐水组和非移植组间及移植前、后旋转行为的变化。结果 细胞移植组的ＰＤ样大鼠移植后的旋转行为较移植前明显改善（Ｐ〈０．０１）,而生理盐水组和非移植组的改善不明显;     

Simultaneous intrastriatal and intranigral fetal dopaminergic grafts in patients with Parkinson disease: a pilot study. Report of three cases

The main neural transplantation strategy in Parkinson disease (PD) has been focused on reinnervating the striatum. The clinical results reported in patients who receive transplants have been limited and do not justify the use of neural transplantation as a routine therapeutic procedure for PD. Identifying the optimal target for transplantation may be one of the critical factors for optimizing clinical outcomes. Evidence from preclinical studies indicates that simultaneous intrastriatal and intranigral grafts (double grafts) may produce a more complete functional recovery. The authors report the clinical and positron emission tomography (PET) scanning results in three patients enrolled in a safety and feasibility pilot study who received double grafts and who have been followed for up to 13 months posttransplantation. Patients included in the study had idiopathic PD. All patients underwent detailed assessments before and after surgery, in accordance with the Core Assessment Program for Intracerebral Transplantation. The patients received implants of fetal mesencephalic cell suspensions in the putamen and substantia nigra (SN) bilaterally. There were no intraoperative or perioperative complications. Follow-up PET scans demonstrated an increase in the mean fluorodopa uptake constant values in the putamen and SN 12 months postsurgery. Improvements were also noted in the total Unified Parkinson's Disease Rating Scale, Hoehn and Yahr, Schwab and England, and pronation/supination scores after transplantation. The authors demonstrate the feasibility of reinnervating the SN and striatum by using a double transplant strategy in humans.     

Clinical outcome of cotransplantation of peripheral nerve and adrenal medulla in patients with Parkinson's disease. Clínica Puerta de Hierro Neural Transplantation Group

OBJECT: Transplants of adrenal medulla (AM) and fetal ventral mesencephalon (FVM) are currently being tested as therapeutic alternatives in patients with Parkinson's disease (PD). At the Clínica Puerta de Hierro in Madrid, a controlled clinical trial is underway to establish which donor tissue, if any, is the best for open surgical implantation in patients with PD. METHODS: Since 1987, varying degrees of clinical improvement have been achieved in Grade IV and V parkinsonian patients by implanting perfused AM and FVM into the right caudate nucleus. To investigate further whether implantation of different types of donor tissues results in qualitatively and quantitatively different degrees of recovery, four patients with Grade IV or V PD received implants of pre-coincubated autologous AM and intercostal nerve in the caudate nucleus. Four nonsurgically treated patients served as a control group. Three years posttransplantation, longer on phases (46.2%+/-10.4% of the day presurgery to 87.5%+/-10.4% of the day 36 months postsurgery) and improved symptoms in on and off phases persist in all four cases, with reduced dyskinesias (67.1%+/-9.2% of the day in on phases presurgery to 17%+/-13.8% of the day in on phases 36 months postsurgery). Progress appears to be stepwise, starting within weeks of tranplantation and becoming clinically significant in the 2nd and 3rd months (similar to our AM- and sooner than in our FVM-implanted patients), followed by a period of stability and, after a second wave of improvement 12 to 18 months posttransplantation (similar to FVM implants), has continued (87.5+/-7 points presurgery to 46+/-5.6 points 36 months postsurgery). In the experimental group, doses of levodopa have been reduced by more than 60% and dopamine agonist use has not resumed. In contrast, there have been no significant clinical changes in the control group. CONCLUSIONS: Implantation of tissue other than fetal tissue can promote a long-term improvement in the clinical symptomatology of seriously disabled parkinsonian patients. This finding is supported by the autopsy report of a patient with PD who had undergone grafting of AM plus peripheral nerve in which it was demonstrated that a large number of tyrosine hydroxylase-positive cells survive 1 year after implantation. In addition, there was a dense network of host dopaminergic fibers around the graft.     

Delta opioid peptide augments functional effects and intrastriatal graft survival of rat fetal ventral mesencephalic cells

Delta enkephalin analogue [D-Ala(2),D-Leu(5)]enkephalin (DADLE) has been shown to protect dopamine transporters from methamphetamine-induced neurotoxicity. In the present study, we demonstrate that exposure of embryonic ventral mesencephalic cells to DADLE (0.01 g/ml), prior to intrastriatal transplantation, enhanced functional recovery and graft survival in 6-hydroxydopamine-induced hemiparkinsonian rats. At 6 and 8 weeks posttransplantation, animals that received DADLE-treated cell grafts exhibited significantly higher (near normal) spontaneous locomotor behaviors, as well as trends of greater reversal of motor asymmetrical behaviors compared with animals that received nontreated cell grafts. Histological examination revealed that animals transplanted with DADLE-treated cell grafts exhibited about twice the number of surviving tyrosine hydroxylase-immunoreactive grafted neurons compared with those animals that received nontreated cell grafts. These results suggest that DADLE should be considered as an adjunctive agent for neural transplantation therapy in Parkinson's disease.     

偏侧帕金森病样大鼠脑内移植微囊化牛嗜铬细胞的行为和组织学研究

目的 观察微囊化牛嗜铬细胞(BCC)大鼠脑内移植的效果及微囊的作用.方法 将微囊化或非微囊化BCC和空微囊分别移植于帕金森病(PD)样大鼠脑纹状体内,观察术后阿朴吗啡诱发大鼠异常旋转行为的变化;用蔗糖一磷钾酸-乙醛酸(SPG)荧光染色和HE染色观察脑组织中植入的BCC及微囊的状态.结果 空囊组PD样大鼠异常旋转行为改变不明显(n=6,P>0.05);非微囊组16只PD样大鼠中9只大鼠移植后1周旋转圈数下降到移植前的44.0%～60.9%(P<0.01),移植6个月时仍有BCC在部分受体脑内存活,移植区有较明显的炎性反应,另有7只PD样大鼠移植后异常旋转行为无明显改善(P>0.05),其脑内未见存活的BCC,移植区有较明显的炎性反应;微囊组16只PD样大鼠移植后旋转圈数下降到移植前的17.6%～35.6%(P<0.01),移植后10个月时大鼠脑内仍存在大量存活的微囊化BCC,无明显的炎性反应.微囊化BCC移植改善PD样大鼠异常旋转行为的效果明显优于非微囊者(P<0.01).结论 BCC脑内移植可改善PD样大鼠的异常旋转行为;大鼠旋转行为的改善与BCC在脑内的存活状态有关;海藻酸钠及多聚赖氨酸制作的微囊可降低异种BCC移植的排斥反应发生率.     

Pancreatic tissue grafts are reinnervated by neuro-peptidergic and cholinergic nerves within five days of transplantation

The reinnervation process is crucial for the survival and functioning of cell, tissue or organ transplants. This study was designed to examine the exact time of reinnervation of intraocular pancreatic tissue transplants in rats. The rate of survival of neuropeptide-containing cells in pancreatic tissue grafts was also investigated. Calcitonin gene-related peptide (CGRP), galanin (GAL), neuropeptide Y (NPY) were observed in the surviving nerve cell bodies of the grafts. The iridal nerves reinnervating the pancreatic grafts expressed CGRP, GAL, NPY and choline-acetyl-transferase (ChAT) on day 5, and tyrosine hydroxylase (TH) and nitric oxide synthase (bNOS) on day 6 of the transplantation period. The expression of CGRP in the reinnervating nerves was more consistent when compared to GAL, NPY, ChAT, TH and bNOS. Although all of the three neuropeptides (CGRP, GAL, NPY) were present in the surviving nerve cell bodies of the pancreatic tissue graft up to the end (day 9) of the transplantation period, the number of CGRP-immunopositive cells was consistently higher throughout the transplantation period. Hence, the number of CGRP-positive cells in the pancreatic tissue graft was significantly (P < 0.05) higher than that of GAL and NPY. In conclusion, pancreatic fragments were reinnervated by neuropeptidergic (CGRP, NPY) and cholinergic (ChAT) nerves within the first 5 days of transplantation. In addition to the reinnervation of pancreatic tissue grafts, the intrinsic neurones of the grafts also survived after transplantation. The rate of survival of CGRP-containing cells in the pancreatic tissue grafts was more consistent compared to that of NPY and GAL.     

Sympathetic reinnervation of rat kidney grafts

BACKGROUND: Reinnervation occurs in many transplanted tissues and organs. Sympathetic reinnervation in rat kidney grafts was investigated. METHODS: Rats were syngeneically transplanted with a kidney and bilaterally nephrectomized. Reinnervation was assessed by immunohistochemical staining for neuron-specific protein gene product 9.5 (PGP 9.5) and by tissue norepinephrine measurements in grafts removed 1.5 (n=6), 3 (n=7), 6 (n=8), and 9 (n=7) months after transplantation. RESULTS: PGP 9.5-positive neural structures were significantly reduced in grafts removed 1.5 and 3 months after transplantation compared with native kidneys with slightly increased numbers at 6 and 9 months after transplantation. Median transplant norepinephrine concentrations remained at approximately 3% compared with native kidneys until 9 months after transplantation. CONCLUSIONS: In transplanted rat kidneys, some reinnervation occurs in the hilum within 9 months after transplantation. This is not accompanied by a significant recovery of norepinephrine concentration in renal tissue indicating persistent sympathetic denervation.     

Neural transplantation cannula and microinjector system: experimental and clinical experience. Technical note

The authors present a simple, reliable, and safe system for performing neural transplantation in the human brain. The device consists of a transplantation cannula and microinjector system that has been specifically designed to reduce implantation-related trauma and to maximize the number of graft deposits per injection. The system was evaluated first in an experimental rat model of Parkinson's disease (PD). Animals in which transplantation with this system had been performed showed excellent graft survival with minimal trauma to the brain. Following this experimental stage, the cannula and microinjector system were used in eight patients with PD enrolled in the Halifax Neural Transplantation Program who received bilateral putaminal transplants of fetal ventral mesencephalic tissue. A total of 16 transplantation operations and 64 trajectories were performed in the eight patients, and there were no intraoperative or perioperative complications. Magnetic resonance imaging studies obtained 24 hours after surgery revealed no evidence of tissue damage or hemorrhage. Transplant survival was confirmed by fluorodopa positron emission tomography scans obtained 6 and 12 months after surgery. As neural transplantation procedures for the treatment of neurological conditions evolve, the ability to deliver viable grafts safely will become critically important. The device presented here has proved to be of value in maximizing the number of graft deposits while minimizing implantation-related trauma to the host brain.     

周围神经移植联合神经营养因子修复脊髓传导束的实验研究

目的探讨周围神经移植联合神经营养因子修复脊髓传导束的可行性并观察其再生的情况。方法121只Wistar雄性大鼠被随机分成5组,A组(实验组,n=25):在T9水平横行切断脊髓并切除5mm,植入肋间神经和含酸性成纤维因子(acidicfibroblastgrowthfactor,aFGF)纤维蛋白凝胶;B组(水平对照组1,n=25):同法制备脊髓横断模型,断端间由含aFGF的纤维蛋白凝胶填充;C组(水平对照组2,n=25):同法制备脊髓横断模型,断端间植入肋间神经和不含aFGF的纤维蛋白凝胶;D组(水平对照组3,n=25):同法制备脊髓横断模型,断端间旷置;E组(空白对照组,n=21):仅行椎板切除术。通过BDA顺行神经示踪、FG逆行神经示踪、运动诱发电位(MEP)和大鼠BBB后肢运动功能评分,观察脊髓传导束再生的情况。结果A组在损伤区有BDA标记的神经纤维通过,在颈髓背角和腹侧角、脑干中缝核和红核、网状结构、前庭侧核以及在大脑运动皮层的第V层均发现FG标记阳性的神经细胞数。A组大鼠MEP的平均潜伏期和波幅以及BBB功能评分明显提高,与B、C和D组比较差异有统计学意义(P<0.01)。结论周围神经移植联合神经营养因子能部分修复脊髓传导束。     

Transplantation of preconditioned intestinal grafts is associated with lower inflammatory activation and remote organ injury in rats

Reperfused grafts--particularly the intestine--release free radicals and cytokines into the systemic circulation. The type of discharge, which is greatly dependent on the local injury, may also induce inflammatory activation in distant organs and leading to multiple system and organ failure. It has been suggested that intestinal grafts from tacrolimus (TRL)-pretreated donors show improved morphology and microcirculation. We studied whether transplantation of intestines from TRL-pretreated donors influenced inflammatory response and remote organ injury posttransplantation. Donor Sprague Dawley rats received TRL or saline (controls) intravenously at 6 hours prior to graft harvest. The intestinal grafts were preserved in saline for 3 hours before transplantation. At 6 and 12 hours postreperfusion hepatic and renal cortical microcirculation were assessed using laser-Doppler flowmetry (n = 8-12 per group). Blood pressure was measured; liver, kidney, and serum samples were obtained. We analyzed hepatic and renal ICAM-1 expression and caspase-3-like activity as well as plasma content of tumor necrosis factor-alpha and interleukin-6. Pretreated graft recipients had higher mean arterial pressure (82 +/- 10 vs 51 +/- 17 mm Hg, P < .05) and renal perfusion at 6 hours whereas liver perfusion was similar at both 6 and 12 hours. Liver and renal functions were also superior among recipients of pretreated grafts. Both caspase-3-like activity and ICAM-1 expression in liver and kidney were lower in pretreated graft recipients. Plasma IL-6 levels were lower in animals receiving pretreated grafts. Transplantation of intestines from TRL-pretreated donors was followed by a lower systemic inflammatory response, improved organ function and decreased remote injury early posttransplantation compared with animals receiving grafts from untreated donors.     

Xenografts of MHC-deficient mouse embryonic mesencephalon improve behavioral recovery in hemiparkinsonian rats

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

超顺磁氧化铁、增强型绿色荧光蛋白双标中脑神经干细胞移植治疗帕金森病

目的 观察超顺磁氧化铁(SPIO)、增强型绿色荧光蛋白(EGFP)双标中脑神经干细胞(mNSCs)移植对帕金森病(PD)大鼠的治疗作用.方法 6-羟多巴胺立体定向注射建立PD大鼠模型,随机分为对照组(n=12)和细胞移植组(n=12).将SPIO、EGFP双标mNSCs移植到PD大鼠纹状体区.阿朴吗啡(APO)诱导PD大鼠旋转行为评估细胞移植的治疗作用.磁共振成像动态观察移植细胞的存活和迁移,免疫荧光组织化学研究移植细胞的存活、迁移和分化.结果 与对照组比较,SPIO、EGFP双标mNSCs移植能显著改善APO诱导PD大鼠的异常旋转行为(P＜0.01);大多数移植细胞停留于移植原位,仅少数细胞向周围脑组织迁移;移植8周后,大多数mNSCs保持其未分化状态(37±6)%或分化为神经胶质细胞(36±4)%,仅少数细胞分化为DA神经元(6±2)%.结论 通过MRI成像可对体内移植的SPIO标记细胞进行活体示踪.SPIO、EGFP双标mNSCs移植可显著改善PD大鼠的运动障碍.     

Complex sensorimotor behavioral changes after terminal striatal 6-OHDA lesion and transplantation of dopaminergic embryonic micrografts

In this study sensorimotor behavioral changes were monitored in rats following bilateral 6-hydroxydopamine (6-OHDA) axon terminal lesion and uni- or bilateral implantation of embryonic dopaminergic (DA) micrografts. A total of 28 microg of 6-OHDA was distributed over four injection tracts in the dorsolateral part of the caudate-putamen (CPU) bilaterally followed 4 months later by the implantation of DA micrografts spread over seven implantation tracts placed within the denervated area. Bilaterally 6-OHDA-lesioned animals exhibited significantly reduced behavioral performance scores in tests of explorational and stepping behavior as well as in skilled forelimb use. However, in contrast to the established medial forebrain bundle (MFB) lesion model of PD, these animals showed a spontaneous recovery in the side falling and skilled forelimb behavior and no deficits in overnight locomotor activity at 6 months after the lesion. Unilateral DA micrografts elicited a substantial amphetamine-induced rotational bias contralateral to the graft, but led to a significant impairment of contralateral skilled forelimb use and reduced scores in overnight locomotor activity. Bilateral DA micrografts caused a significant, though partial, increase in explorational and backhand stepping behavior, but resulted also in a significant decrease in performance levels in overnight locomotor activity and skilled forelimb use on both paws. In conclusion, DA grafts placed ectopically in the CPU in the partial lesion model of PD result in a double innervation of the GABAergic striatal neurons, arising from the residual nigrostriatal DA projections of the host and from the graft-derived DA efferent fibers. These two DA fiber systems may indeed function in a cooperative and competitive manner depending on their respective and different afferent and efferent connections, which, in turn, may lead to positive or negative influences on basal ganglia function and behavioral performances. The different patterns of 6-OHDA lesion and transplant-induced behavioral changes demonstrated in the present study compared to the "classical" MFB lesion model of PD may thus provide further insights in the complex functional organization of the basal ganglia and, thereby, may help to further optimize restorative strategies for neurodegenerative diseases, such as Parkinson's disease.