The unique procedure of hRPE stem cell implantation for Parkinson's disease had been under research and extended clinical trial (American/German cooperation) since 2000.
Although the results were successful, as of today, such treatments are still not available to the individual patient in these countries. The fact that hRPE cells are difficult to acquire and also the above mentioned reasons, may be the reason for that. It is common knowledge that as of today, Beijing Tiantan Puhua hospital is one of the only medical facilities in the world that offer this procedure to patients.
In the years 2004, a clinical trial was done at Beijing University Stem Cell Research Center. Beijing Tiantan Puhua Hospital was one of the participating hospitals in this trial. Publications were done in Chinese only and unfortunately we cannot provide the scientific data of this trial.
However, the trial tried to determine the safety of the specific procedure of hRPE stem cells implantation for Parkinson's disease patients, and based on its positive results Tiantan Puhua has started conducting and providing this procedure.
Based on 5 years of experience, we have established a protocol that proved to be both safe and efficient for patients.
We provide individualized treatments to patients under a certain protocol that was developed by our neurologists and neurosurgeons.
Why should I consider stem cell treatment for Parkinson's disease?
Sustainability of improvements is limited to maximum of several years. Stem cell implantation does not provide a solution to the cause of PD and therefore cannot cure the disease. There is no know treatment for Parkinson's disease, apart from stem cell transplantation, which will help slowing down the progression of the disease.
Stem cell implantation can only provide functional improvements, which are:
1) Biological and not chemical (therefore, providing a 'healthier' solution, avoiding the debilitating side effects of drugs and stimulating a natural production of dopamine in patients).
2) A solution that has relatively long term effect and can therefore delay the progression of the disease while improving the quality of patients' lives.
What improvements should I expect?
Some patients have been able to reduce drugs consumption after treatments, while others experienced better effect of drugs in controlling their symptoms.
Usually, Parkinson's disease patients see improvements in their mobility, speech, rigidity and spasticity. Most patients report on improvements during hospitalization, and later report on further improvements after going back to their home countries.
The mental aspect of Parkinson's disease usually improves as well, although we cannot fully estimate to what extent, as it depends on the overall improvements you shall experience following stem cell treatment.
Different patients have responded differently to the implantation. Some have experienced a more significant shift in their condition, while others had more minor improvements. We see among patients a normal curve, where most patients get 10%-20% improvement in their conditions, a smaller number gets 30% to even 40% improvements (rare, but possible) and on the other side of the scale a small number of patients that got minor to no results.
Since the time we started to conduct the direct brain injection procedure for hRPE stem cells implantation, 3 patients have experienced a reaction response immediately after the operation, which was treated in the hospital. No patient has ever reported on a negative response (in the long term) after treatment.
Could hRPE stem cells be obtained from my retina, as an autologous source?
Stem cells could not be obtained from your retina, since it would mean losing sight. Retina is the only part of the Central Nervous System that is visible, and derivation of stem cells from a live person would result in damaging the eyes. The cells are obtained from donations that are extracted by qualified hospitals and kept in cells banks (similarly to donation of other organs). The cells are then cultured in Beijing Tiantan Puhua hospital's stem cell lab before implantation.
Is there a category of patient condition that only allows lumbar puncture (e.g. brain abnormalities, presence of diseases other than PD), and conversely, is there a category where surgery is required to obtain significant improvement?
Usually, patients which suffer from any cardio-vascular problems, high blood pressure, heart disease, mental disease or other, or, which are in advance age or very advance stage of the disease will not qualify for the procedure.
What is the presumed advantage of direct injection over the less intrusive lumbar puncture?
The main advantages of this procedure are:
1) A direct injection into the brain has a direct impact on the brain functioning and makes sure that the cells go directly into the desired target.
2) hRPE are very potent cells and very accurate in providing a solution to Parkinson's disease. They are adult (fully mature) stem cells, which make them very safe, and have the natural quality of developing into Dopamine-producing cells.
However, it is important to remember that a direct brain injection is not the only method of implantation offered, and the majority of our patients who have been implanted via lumbar puncture have experienced good results as well.
Not all patients qualify for the direct brain implantation, while the neural stem cells implantation has proved to be very efficient in elevating Parkinson's disease symptoms and improving the patient's quality of llife.
Is lumbar puncture treatment as effective as the direct implants of stem cells into the brain?
A direct implantation into the brain saves the cells from the long route throughout the cerebral spine fluid, so in a way a stereotactic brain injection should be more effective. Moreover, it uses a special type of cells, which are considered to be most effective in treating Parkinson's disease.
However, lumbar puncture is the most common procedure done in our hospital ? about 90% of all procedures (including all medical conditions) are implantation via lumbar puncture - therefore, we have had extended experience using this method of implantation which proved to be effective and safe in treating Parkinson's disease.
Will I be able to undergo future treatments for Parkinson's disease or Deep Brain Stimulation?
If you were to have treatment in our hospital, this would not prevent you in any way from having a similar treatment in the future should your symptoms make it necessary. The stereotactic brain surgery will unable you to undergo future brain operations, such as deep brain stimulation (DBS).
Stem cell implantation via lumbar puncture will not unable you to undergo any type of treatments available worldwide (including DBS).
How will you know if I fit the criteria for stem cell treatment for Parkinson's disease?
General criteria: clear evaluation / no contra indication for treatment (such as cancer, for example) / safety of the patient to undergo the long flight and long period of treatment abroad / no related or unrelated medical conditions that may pose risk of complications during treatment / acceptable stage of disease/ age of patient.
Of your PD patients so far, approximately how many have had a direct injection, and how many lumbar puncture? What prompted you to introduce lumbar puncture as an alternative delivery method?
From all the Parkinson's patients that have been treated at Tiantan Puhua hospital over 20 patients have undergone the implantation via brain injection. As you can see, an implantation via lumbar puncture is not a lesser alternative, but a common procedure that we are highly experienced at.
The lumbar injection is a very safe and simple procedure, done under local anesthesia and has no major risk involved. It allows the cells to be administered safely, gradually and effectively. When a patient is not eligible to undergo a brain operation (from reasons of age, condition or other risk factors) the lumbar injections are a very good alternative.
Stereotactic brain injection is the least invasive brain operation. It has very high success rate and is widely used for different medical procedures (also similar to DBS procedure). Since this procedure does involve a certain risk, only patients who are eligible for this procedure in terms of general health, age, stage of disease and risk factors, are accepted for this procedure. From our experience, a direct transplantation of hRPE via stereotactic operation is a very effective treatment and recommended whenever such procedure is possible for the patient.
Long term effects:
Since stem cell therapy is still very new, there is a theoretical answer and an answer based of experience with patients:
Our first Parkinson's patient, to be treated with stem cells was treated over 5 years ago, in June 2005. She had excellent results (about 40% improvements) and she keeps those good improvements to date. Of course there are highs and lows, and she is adjusting her medications accordingly, but she has reduced her dose of medications significantly.
Most of our Parkinson's patients that had good results after the treatment kept their results to date. Some Parkinson's patients experiencing few difficult months after they return home from the hospital and sometimes experiencing difficulties with adjusting to their medications, yet after few months they stabilize and see further improvements. In conclusion, in five years we see very good long-term results, especially when the treatment is successful.
In theory, Parkinson's disease is a degenerative disease, and stem cell implantation cannot stop the mechanism of degeneration in the brain, it can only slow it down.
It is therefore hard to tell for how long the results will hold, also considering that every patient is in different stage and different condition.
I have been diagnosed just a while ago- can I be considered a candidate for treatment?
Stem cell treatment has proven to be most effective at treating neurodegenerative conditions, when applied as early as possible from the onset of the disease.
Since there hasn't been a lot of damage to the neural tissue in your brain, the effect of the treatment might be more significant than a patient who's been ill for a longer period of time and due to the damage in his brain displays more PD related symptoms.
Judging by our past patients, we feel that stem cell treatment might slow down the progression of the disease, which, in your case, could mean staying in the 1st stage of the condition for a longer period of time and maybe staying off medications for longer.