I.V. Galanin, T.A. Scoromets, N.N. Bukhartsev, B.K. Shakenova, A.V. Lukyanov
(Bekhterev Research Psycho-Neurological Institute, Saint Petersburg)
Neurotransplantation development was stimulated by resistance of some psychic and neurological diseases to therapy. In contrast to classic transplantation, neurotransplantation has some peculiarities. Firstly, the CNS has a privileged position from an immunologic point of view, as it possesses neither lymph flow nor an afferent link of an immune response due to absence of antigen-presenting cells. Secondly, immature donor tissue has no specific proteins, being antigens and forming a basis of histocompatibility. Use of an autoradiographic method allowed to watch donor neuronal cells, marked with thymidine, and to make sure, that they were alive and formed bonds with a recipientís nervous tissue.
A history of neurotransplantation is described, embracing a period from the first experiment up to its first clinical use. Barriers (moral, ethic, religious, legal, methodological), encountered on the way of its development, are discussed. The areas of neurotransplantation use are presented on the basis of the authorsí personal and world experience. New alternative methods of getting such a donor material as stem cells, prospects and fields of its use are considered.
Employees of the Department of Surgery of Nervous and Psychic Diseases (the Bekhterev Research Psycho-Neurological Institute) were the first in Russia to obtain positive results of treatment of marked mental deficiency and a syndrome of chronic verbal halucinosis with the help of this method. It was used in patient P., aged 13. When he was 8, there appeared auditory hallucination of a commenting and then imperative character with manifestations of psychic automatism. The patient started to take subtoxic and toxic doses of neuroleptics at the age of 9. He did it continuously and was subject to long-term (up to 9 months) and frequent (8 times) hospitalization to the Childrenís Psychiatric Hospital. There was a progressive deterioration of a state. A preoperative period was characterized by imperative hallucinosis, determining his behavior, episodes of outward aggression (2-3 times a day), intelligence reduction (IQ of 57), partial self-service, necessity of constant control.
PET data were indicative of multi-focal disorders of glucose metabolism. They manifested themselves in hyper- and hypometabolism in the cortex and subcortical structures against a background of marked interhemispheric asymmetry. Metabolic disorders in some structures reached 37%. Neurotransplantation resulted in reduction of a hallucination syndrome, complete self-service, studying in a secondary school and, what is more, studying music (IQ of 72). It happened a year after operation. PET data demonstrated a positive dynamics of metabolism. It became normal. There were no serious symptoms in 3 years. The patient finished the secondary and music schools. He mastered playing a bayan (a kind of accordion) and guitar. Today he tries to compose music and keeps the house (IQ of 96). Drug therapy, consists in taking 0.5 g of rispolept (in a day) and tranquilizers (episodically). It should be mentioned, that PET control examination, carried out in 3 years, revealed no metabolic disorders in brain substance.