Dopaminergic neurons generated from monkey embryonic stem cells function in a Parkinson primate model

Parkinson disease (PD) is a neurodegenerative disorder characterized by loss of midbrain dopaminergic (DA) neurons. ES cells are currently the most promising donor cell source for cell-replacement therapy in PD. We previously described a strong neuralizing activity present on the surface of stromal cells, named stromal cell-derived inducing activity (SDIA). In this study, we generated neurospheres composed of neural progenitors from monkey ES cells, which are capable of producing large numbers of DA neurons. We demonstrated that FGF20, preferentially expressed in the substantia nigra, acts synergistically with FGF2 to increase the number of DA neurons in ES cell-derived neurospheres. We also analyzed the effect of transplantation of DA neurons generated from monkey ES cells into 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-treated (MPTP-treated) monkeys, a primate model for PD. Behavioral studies and functional imaging revealed that the transplanted cells functioned as DA neurons and attenuated MPTP-induced neurological symptoms.     

Embryonic stem cells as a cell source for treating Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative disease characterised by a loss of midbrain dopaminergic (DA) neurons. Transplantation of DA neurons represents a promising treatment for PD, and embryonic stem (ES) cells are a good candidate source for DA neurons. However, although recent reports have demonstrated that DA neurons can be efficiently induced from ES cells and function therapeutically in an animal model of PD, many problems remain to be solved in order for ES cells to be used for clinical applications. This review will describe the current status of this field and the obstacles yet to be overcome, and will outline future research approaches from the clinical perspective.     

Protein-based human iPS cells efficiently generate functional dopamine neurons and can treat a rat model of Parkinson disease

Parkinson disease (PD) involves the selective loss of midbrain dopamine (mDA) neurons and is a possible target disease for stem cell-based therapy. Human induced pluripotent stem cells (hiPSCs) are a potentially unlimited source of patient-specific cells for transplantation. However, it is critical to evaluate the safety of hiPSCs generated by different reprogramming methods. Here, we compared multiple hiPSC lines derived by virus- and protein-based reprogramming to human ES cells (hESCs). Neuronal precursor cells (NPCs) and dopamine (DA) neurons delivered from lentivirus-based hiPSCs exhibited residual expression of exogenous reprogramming genes, but those cells derived from retrovirus- and protein-based hiPSCs did not. Furthermore, NPCs derived from virus-based hiPSCs exhibited early senescence and apoptotic cell death during passaging, which was preceded by abrupt induction of p53. In contrast, NPCs derived from hESCs and protein-based hiPSCs were highly expandable without senescence. DA neurons derived from protein-based hiPSCs exhibited gene expression, physiological, and electrophysiological properties similar to those of mDA neurons. Transplantation of these cells into rats with striatal lesions, a model of PD, significantly rescued motor deficits. These data support the clinical potential of protein-based hiPSCs for personalized cell therapy of PD.     

Recovery From Experimental Parkinsonism by Semaphorin-guided Axonal Growth of Grafted Dopamine Neurons

Cell therapy in animal models of Parkinson''s disease (PD) is effective after intrastriatal grafting of dopamine (DA) neurons, whereas intranigral transplantation of dopaminergic cells does not cause consistent behavioral recovery. One strategy to promote axonal growth of dopaminergic neurons from the substantia nigra (SN) to the striatum is degradation of inhibitory components such as chondroitin sulphate proteoglycans (CSPG). An alternative is the guidance of DA axons by chemotropic agents. Semaphorins 3A and 3C enhance axonal growth of embryonic stem (ES) cell–derived dopaminergic neurons in vitro, while Semaphorin 3C also attracts them. We asked whether intranigral transplantation of DA neurons, combined with either degradation of CSPG or with grafts of Semaphorin 3–expressing cells, towards the striatum, is effective in establishing a new nigrostriatal dopaminergic pathway in rats with unilateral depletion of DA neurons. We found depolarization-induced DA release in dorsal striatum, DA axonal projections from SN to striatum, and concomitant behavioral improvement in Semaphorin 3–treated animals. These effects were absent in animals that received intranigral transplants combined with Chondroitinase ABC treatment, although partial degradation of CSPG was observed. These results are evidence that Semaphorin 3–directed long-distance axonal growth of dopaminergic neurons, resulting in behavioral improvement, is possible in adult diseased brains.     

止颤汤干预神经干细胞移植帕金森病大鼠脑内多巴胺及其代谢产物的变化

背景：如何促进脑内多巴胺含量的增加以及减少多巴胺的代谢,是治疗帕金森病的热点所在。目的：从多巴胺代谢途径角度观察止颤汤对神经干细胞移植帕金森病大鼠的脑黑质中多巴胺及其代谢产物含量的变化。方法：以大鼠脑立体定位和1-甲基-4-苯基-1,2,3,6-四氢吡啶建立帕金森病大鼠模型。应用高效液相色谱法测定帕金森病大鼠中脑多巴胺及其代谢产物的含量。结果与结论：止颤汤可以提高神经干细胞移植后帕金森病大鼠中脑多巴胺及其代谢产物双羟苯乙酸的含量,但对代谢产物高香草酸无明显影响。通过促进帕金森病大鼠干细胞移植后神经干细胞的存活,使之定向分化为多巴胺能神经元并分泌多巴胺,同时抑制多巴胺分解达到治疗作用。     

Designer receptors: therapeutic adjuncts to cell replacement therapy in Parkinson’s disease

Cell replacement for restoring neuronal populations in Parkinson’s disease has been demonstrated as a potential therapeutic strategy over several decades of studies; however, a number of issues regarding sources of replacement neurons and optimization of therapeutic efficacy in vivo have hampered clinical implementation. In this issue of the JCI, Dell’Anno and colleagues evaluated the use of induced dopaminergic (iDA) neurons that were generated by direct fibroblast reprogramming for transplantation and demonstrated that postmitotic iDA neurons stably and functionally integrate into host striatum to produce motor improvements in 6-OHDA rats, a Parkinson’s disease model. Furthermore, using designer receptors exclusively activated by designer drugs (DREADDs) in iDA grafts to noninvasively increase dopamine release from grafted neurons, the authors were able to remotely control transplanted neurons and enhance therapeutic efficacy. This initial proof-of-concept study is the first application of DREADD technology to treat neurodegenerative dysfunction, and by using DREADDs as an adjunct to iDA cell therapy, it presents a novel strategy to overcome some current caveats of cell replacement therapy.The loss of nigral dopaminergic (DA) cells in Parkinson’s disease (PD) was discovered in the mid-twentieth century (1), and DA cell replacement was quickly posited as a potential therapeutic strategy. By the late 1970s, proof-of-function studies emerged and showed that intrastriatal transplantation of fetal ventral mesenphalic (VM) tissue could survive in the dopamine-depleted striatum and improve motor function deficits in PD animal models (2). Clinical trials with VM tissue and cell suspensions have been undertaken for nearly 30 years; however, there has yet to be an approved clinical cell replacement therapy for PD. These efforts have not been for naught; a number of clinical trials have demonstrated long-term beneficial effects on motor symptoms (10+ years) and provided valuable lessons (3, 4). The hope for an effective cell replacement therapy for PD has survived the test of time, and efforts are consistently being revised and improved. However, many questions — primarily over technical optimization — have prevented widespread clinical implementation.     

Human embryonic stem cells: Possibilities for human cell transplantation

Human embryonic stem (ES) cells serve as a potentially unlimited renewable source for cell transplantation targeted to treat several diseases. One advantage of embryonic stem (ES) cells over other stem cells under research is their apparently indefinite self‐renewal capacity if cultured appropriately, and their ready differentiation into various cell phenotypes of all three germ layers. To date, a number of studies have reported the derivation of specific functional derivatives from human ES cells in vitro. While there have been clinical trials of human embryonal carcinoma (EC) cell‐derived neurons in humans there has been no attempt as yet using human ES cell derivatives. However, the latter have been transplanted into recipient animals. In some cases ES‐derived cells were shown to undergo further maturation, displayed integration with host tissue and even ameliorated the disease condition in the animal model. Recently, it has been reported that human ES cells can be genetically manipulated. Such procedures could be used to direct differentiation to a specific cell type or to reduce graft rejections by the modification of immune responses. This review highlights some of the recent advances in the field and the challenges that lie ahead before clinical trials using ES‐derived cells can be contemplated.     

Efficient and stable Sendai virus-mediated gene transfer into primate embryonic stem cells with pluripotency preserved

Efficient gene transfer and regulated transgene expression in primate embryonic stem (ES) cells are highly desirable for future applications of the cells. In the present study, we have examined using the nonintegrating Sendai virus (SeV) vector to introduce the green fluorescent protein (GFP) gene into non-human primate cynomolgus ES cells. The GFP gene was vigorously and stably expressed in the cynomolgus ES cells for a year. The cells were able to form fluorescent teratomas when transplanted into immunodeficient mice. They were also able to differentiate into fluorescent embryoid bodies, neurons, and mature blood cells. In addition, the GFP expression levels were reduced dose-dependently by the addition of an anti-RNA virus drug, ribavirin, to the culture. Thus, SeV vector will be a useful tool for efficient gene transfer into primate ES cells and the method of using antiviral drugs should allow further investigation for regulated SeV-mediated gene expression.     

Human embryonic stem cells: possibilities for human cell transplantation

Human embryonic stem (ES) cells serve as a potentially unlimited renewable source for cell transplantation targeted to treat several diseases. One advantage of embryonic stem (ES) cells over other stem cells under research is their apparently indefinite self-renewal capacity if cultured appropriately, and their ready differentiation into various cell phenotypes of all three germ layers. To date, a number of studies have reported the derivation of specific functional derivatives from human ES cells in vitro. While there have been clinical trials of human embryonal carcinoma (EC) cell-derived neurons in humans there has been no attempt as yet using human ES cell derivatives. However, the latter have been transplanted into recipient animals. In some cases ES-derived cells were shown to undergo further maturation, displayed integration with host tissue and even ameliorated the disease condition in the animal model. Recently, it has been reported that human ES cells can be genetically manipulated. Such procedures could be used to direct differentiation to a specific cell type or to reduce graft rejections by the modification of immune responses. This review highlights some of the recent advances in the field and the challenges that lie ahead before clinical trials using ES-derived cells can be contemplated.     

Comparison of adult versus embryonic stem cell therapy for cardiovascular disease: Insights from molecular imaging studies

In the previous decade, cardiac cell replacement therapy has emphasized adult stem cells such as skeletal myoblasts, bone marrow mononuclear cells, and endothelial progenitor cells. Functional restoration of systolic function has been documented in most of these cases, but beneficial results have rarely persisted for significant lengths of time due to failure of cells to survive and the as yet controversial role of transdifferentiation into endogenous tissue. Future efforts at cell replacement therapy will likely focus upon cellular derivatives of embryonic stem (ES) cells, which can be induced to form any cell type of the body. Use of ES cells, however, presents several novel considerations such as teratoma formation and immune rejection. This review summarizes the current progress made in the field of cardiac cell replacement therapy and the role noninvasive imaging can play in realizing the therapeutic potential of stem cells.     

止颤汤干预神经干细胞移植帕金森病大鼠脑内多巴胺及其代谢产物的变化

背景:如何促进脑内多巴胺含量的增加以及减少多巴胺的代谢,是治疗帕金森病的热点所在.目的:从多巴胺代谢途径角度观察止颤汤对神经干细胞移植帕金森病大鼠的脑黑质中多巴胺及其代谢产物含量的变化.方法:以大鼠脑立体定位和1-甲基-4-苯基-1,2,3,6-四氢吡啶建立帕金森病大鼠模型.应用高效液相色谱法测定帕金森病大鼠中脑多巴胺及其代谢产物的含量.结果与结论:止颤汤可以提高神经干细胞移植后帕金森病大鼠中脑多巴胺及其代谢产物双羟苯乙酸的含量,但对代谢产物高香草酸无明显影响.通过促进帕金森病大鼠干细胞移植后神经干细胞的存活,使之定向分化为多巴胺能神经元并分泌多巴胺,同时抑制多巴胺分解达到治疗作用.     

Generation, culture, and differentiation of human embryonic stem cells for therapeutic applications.

Embryonic stem (ES) cells, derived from the inner cell mass of the mammalian blastocyst, can continuously proliferate in an undifferentiated state and can also be induced to differentiate into a desired cell lineage. These abilities make ES cells an appealing source for cell replacement therapies, the study of developmental biology, and drug/toxin screening studies. As compared to mouse ES cells, human ES cells have only recently been derived and studied. Although there are many differences in properties between mouse and human ES cells, the study of mouse ES cells has provided important insights into human ES cell research. In this review, we describe the advantages and disadvantages of methods used for human ES cell derivation, the expansion of human ES cells, and the current status of human ES cell differentiation research. In addition, we discuss the endeavor that scientists have undertaken toward the therapeutic application of these cells, which includes therapeutic cloning and the improvement of human ES cell culture conditions.     

Advances in stem-cell–generated transplantation therapy for Parkinson's disease

Introduction: Human pluripotent stem cells have the potential to differentiate into different cell lineages of the human body, including dopaminergic (DA) neurons. Previous studies have shown that stem-cell–derived DA neurons can improve the motor deficits of Parkinson's disease (PD) animal models. That is why current research interests focus on the development of stem-cell–derived neural cells for transplantation therapies for PD patients.

Areas covered: This review article emphasizes the safety and efficacy requirements of human pluripotent stem-cell–derived neural cells and usage of reliable preclinical animal models prior to clinical trials. The current advances and hurdles related to cell production, differentiation and transplantation are also summarized.

Expert opinion: Before entering the clinic, transplantable cell populations must be differentiated and characterized according to good manufacturing practice (GMP) regulations both in vitro and in vivo. Taking into account the rapid development of the stem-cell field and technological improvements in cell preparations and GMP facilities, we think that pluripotent stem-cell–derived DA neurons will offer a relevant cell therapy option for treatment of PD in the near future.     

Conditions for Tumor-free and Dopamine Neuron�Cenriched Grafts After Transplanting Human ES Cell�Cderived Neural Precursor Cells

We have previously demonstrated derivation of neural precursor (NP) cells of a midbrain-type from human embryonic stem (hES) cells to yield an enriched population of dopamine (DA) neurons. These hES-derived NPs can be expanded in vitro through multiple passages without altering their DA neurogenic potential. Here, we studied two aspects of these hES-NP cells that are critical issues in cell therapeutic approaches for Parkinson''s disease (PD): cell survival and tumorigenic potential. Neuroepithelial rosettes, a potentially tumorigenic structure, disappeared during hES-NP cell expansion in vitro. Although a minor population of cells positive for Oct3/4, a marker specific for undifferentiated hES cells, persisted in culture during hES-NP cell expansion, they could be completely eliminated by subculturing hES-NPs under differentiation-inducing conditions. Consistently, no tumors/teratomas are formed in rats grafted with multipassaged hES-NPs. However, extensively expanded hES-NP cells easily underwent cell death during differentiation in vitro and after transplantation in vivo. Transgenic expression of Bcl-XL and sonic hedgehog (SHH) completely overcame the cell survival problems without increasing tumor formation. These findings indicate that hES-NP cell expansion in conjunction with Bcl-XL+SHH transgene expression may provide a renewable and safe source of DA neurons for transplantation in PD.     

Neurorestoration in Parkinson's disease by cell replacement and endogenous regeneration

Parkinson's disease (PD) is characterised by a continuous and selective loss of dopaminergic neurons in the substantia nigra pars compacta with a subsequent reduction of the neurotransmitter dopamine. Thus, the prospect of replacing the missing or damaged dopaminergic cells is very attractive. Possible regenerative therapies include transplanting developing neural tissue or neural stem cells into the degenerated host brain and inducing proliferation of endogenous stem cells by pharmacological manipulations. Neural stem cells, with the capacity to self renew and produce the major cell types of the brain, exist in the developing and adult CNS. These cells can be generated and expanded in vitro while retaining the potential to differentiate into nervous tissue. However, one major problem is the control of growth and differentiation of these cells. This review discusses new data on stem cell technology in cell replacement strategies in PD as well as endogenous dopaminergic regeneration.     

Neurorestoration in Parkinson’s disease by cell replacement and endogenous regeneration

Parkinson’s disease (PD) is characterised by a continuous and selective loss of dopaminergic neurons in the substantia nigra pars compacta with a subsequent reduction of the neurotransmitter dopamine. Thus, the prospect of replacing the missing or damaged dopaminergic cells is very attractive. Possible regenerative therapies include transplanting developing neural tissue or neural stem cells into the degenerated host brain and inducing proliferation of endogenous stem cells by pharmacological manipulations. Neural stem cells, with the capacity to self renew and produce the major cell types of the brain, exist in the developing and adult CNS. These cells can be generated and expanded in vitro while retaining the potential to differentiate into nervous tissue. However, one major problem is the control of growth and differentiation of these cells. This review discusses new data on stem cell technology in cell replacement strategies in PD as well as endogenous dopaminergic regeneration.     

Stem cell-based therapy for Parkinson's disease

Motor dysfunctions in Parkinson's disease are considered to be primarily due to the degeneration of dopaminergic neurons in the substantia nigra pars compacta. Pharmacological therapies based on the principle of dopamine replacement are extremely valuable, but suffer from two main drawbacks: troubling side effects (e.g. dyskinesia) and loss of efficacy with disease progression. Transplantation of embryonic dopaminergic neurons has emerged as a therapeutic alternative. Enthusiasm following the success of the initial open-label trials has been dampened by the negative outcome of double-blind placebo controlled trials. Additionally, the emergence of graft-related dyskinesia indicates that the experimental grafting procedure requires further refinement before it can be developed into a therapy. Shortage of embryonic donor tissue limits large-scale clinical transplantation trials. We review three of the most attractive tissue sources of dopaminergic neurons for cell replacement therapy: human embryonic ventral mesencephalic tissue, embryonic and adult multipotent region-specific stem cells and embryonic stem cells. Recent developments in embryonic stem cell research and on their implications for a future transplantation therapy in Parkinson's disease are described. Finally, we discuss how human embryonic stem cells can be differentiated into dopaminergic neurons, and issues such as the numbers of dopaminergic neurons required for success and the risk for teratoma formation after implantation.