First steps towards brain transplants

Press, 7 December 1988, Page 23

First steps towards brain transplants

From

DANIEL Q. HANEY,

of the

Associated Press, in Boston.

When Dr Abraham Lieberman gives talks about brain transplants, he flashes two faces on the screen: Albert Einstein, and Moe of the “Three Stoogles.” People have become used to the idea of shifting kidneys, livers, even hearts, from person to person. But the seat of intellect and personality is unquestionably special. Despite his illustration of the differences, brain-wise, between people, Lieberman says the organ is just as transferable as others.

“Brain is tissue, and it can be transplanted as tissue, the way liver and kidney can,” he says. Even though doctors aren’t swapping whole brains, or even thinking seriously about it, they have taken the first tentative steps toward transplanting small parts of brains — or related tissue from elsewhere in the body or from foetuses — to cure the ills of the body’s most important and mysterious organ. Experimental efforts have been reported in Mexico, England, Sweden and the United States.

Although such therapy has just started, the ethical thickets surrounding it are already being explored, mainly because of one big and unresolved question: where will the brains come from?

Dr Lieberman is a neurologist at New York University. There doctors are trying to reverse Parkinson’s disease by removing chemical-producing tissue from the adrenal glands and implanting it in the victims’ brains.

At Tennessee’s Vanderbilt University, doctors have used a similar approach to treating Huntington’s disease. Some day, brain transplants may control a variety of other degenerative disorders, including Alzheimer’s disease. For now, most of the early testing is centred on Parkinson’s, a reasonable place to start. Unlike many other brain diseases, it is limited to a small region of the brain. Its underlying complexities are fairly well understood.lt is one of the most common brain diseases. Once it was considered to be exclusively a disease of the elderly, but it is being diagnosed increasingly in younger people, even in their 20s. and 30s. Parkinson’s results from gradual destruction of a part of the brain called the nigral tissue, which makes an essential mes-sage-carrying chemical, dopa-

mine. Victims often suffer tremors and have trouble controlling their movements. Some find it hard to stand unaided, and they walk, if at all, with short, shuffling steps. Patients may even be unable to hold their heads erect. There is no cure. The disease is slowly progressive, although its worst effects can be held off for a few years with Levodopa and other drugs. The brain surgery goal is to replace damaged tissue so the brain will make its own dopamine again. There are several sources of tissue — aborted foetuses, living organ donors, the dead, and the victim’s own body. The most common approach in Parkinson’s is to transfer dopa-mine-making tissue from one place to another in the patient. The adrenal glands, which lie above the kidneys, also produce dopamine, so doctors implant adrenal tissue in the patient’s brain.

Dr Peter Black, of Brigham and Women’s Hospital, says at least 11 United States medical centres have performed this kind of operation on 70 people.

“It’s not a miracle cure,” he says, “about half are better to some degree, and 10 per cent are convincingly improved.”

Dr Lieberman said the most impressive of his 11 patients is a doctor who could not walk or even stand before the surgery. Although he is far from cured, he can walk unassisted, live alone and go outside. He says the surgery is in such an early, crude stage that doctors are unsure exactly what tissue to transplant, where to put it or what it does. “It’s like we are giving bread mould to people and don’t even know what penicillin is. That’s the level we are at.”

It is the only hope for some people who are going downhill and no longer respond to medicine.

There are drawbacks beyond the mediocre results so far. It is expensive ($NZ47,000 to $157,000), and it is such a gruelling procedure — actually two major operations, on the abdomen and the head — that many elderly Parkinson’s victims are simply too sick to stand it. To improve the outcome, doctors are considering other, potentially better, tissue sources. One is adrenal glands from young kidney donors. Another is foetuses.