Article

Cell replacement therapy has been tested clinically in Parkinson's disease (PD)
and Huntington's disease (HD), epilepsy, spinal cord injury, and stroke. The
clinical outcomes have been variable, perhaps partly because of the differing
levels of preclinical, basic experimental evidence that was available prior to
the trials. The most promising results have been seen in PD trials, with
encouraging ones in HD. A common feature of most trials is that they have
concentrated on the biological and technical aspects of transplantation without
presupposing that the outcomes might be influenced by events after the surgery.
The growing evidence of plasticity demonstrated by the brain and grafts in
response to environmental and training stimuli such as rehabilitation
interventions has been mostly neglected throughout the clinical application of
cell therapy. This review suggests that a different approach may be required to
maximize recovery: postoperative experiences, including rehabilitation with
explicit behavioral retraining, could have marked direct as well as positive
secondary effects on the integration and function of grafted cells in the host
neural system. The knowledge gained about brain plasticity following brain damage
needs to be linked with what we know about promoting intrinsic recovery processes
and how this can boost neurobiological and surgical strategies for repair at the
clinical level. With proof of principle now established, a rich area for
innovative research with profound therapeutic application is open for
investigation.

Langue : ANGLAIS