The results were published in the latest issue of Lancet.

The patients, half of whom live on Long Island, are in advanced stages of the illness and were no longer responding to medicines when they signed on for the experimental therapy. The study was conducted by Andrew Feigin, MD, director of Neuroscience Experimental Therapeutics at The Feinstein Institute for Medical Research and his colleagues in collaboration with Parkinson's scientists at New York Presbyterian Hospital-Weill Cornell Medical Center in Manhattan.

One woman and 11 men received a surgical infusion of fluid containing a viral vector and genes for a protein called GAD, glutamic acid decarboxylase. This enzyme is critical in controlling a neurotransmitter called GABA. In Parkinson's, GABA is reduced in an area of the brain called the subthalamic nucleus. This region is working on overdrive in the disease process and GABA is an inhibitory transmitter and is important in trying to calm this hyper-reactive circuit.

The gene therapy would be used to reduce symptoms and not alter the underlying disease process. Finding novel therapies are key as many Parkinson's patients stop develop complications after prolonged use of traditional medicines.

The Feinstein's David Eidelberg, MD, took brain scans before, during and after the treatment and the scans show that the brain is re-working these abnormal circuits. Dr. Feigin said that patients had about a 27 percent improvement in symptoms, although the study was an open label design. The scientists are now designing a double-blind placebo controlled trial that would enroll far more patients in an attempt to see whether the gene therapy is effective in reducing symptoms.

The patients' scans showed a quieting of these areas, on the side of the brain where the genes were infused. The study was designed to inject the genes into one side of the brain. Normally, Parkinson's patients have worsening symptoms on one side of the body.

The novel strategy included packing genes that make an inhibitory chemical called GABA into pieces of viruses that have been rendered non-infectious. They began studying the experimental treatment in Parkinson's patients in 2003. Some patients continue to show improvement. Parkinson's patients have been willing to step up to the operating table for relief from the tremors, stiffness and rigidity that characterize the disease.

Decades ago, surgeons began to make lesions in parts of the brain involved in the disease, which lessened symptoms. Fetal stem cell surgery was pioneered in Parkinson's patients. And in the past decade, the deep brain stimulation has worked in as many as 70 percent of patients who have opted for the surgical procedure. If it doesn't work, the electrodes can be removed. (By comparison, it would be impossible to reverse gene therapy.)

"Gene therapy could be a more natural way to treat the disease," said Dr. Feigin. "This important study shows that gene therapy can be performed safely and may benefits patients."

The gene therapy technique was developed by Neurologix, a New Jersey-based company.

Parkinson's is a movement disorder caused by a progressive depletion of the brain chemical dopamine in the substantia nigra. These dopamine-containing cells control movement. When 70 to 80 percent of these cells are destroyed, a person develops the first symptoms of disease: tremors, slowed movement, muscle rigidity and problems with balance. The main medication used in Parkinson's is L-dopa, which replaces dopamine in cells that are still working normally. Over time, the cell death is so massive that the effects of the medication disappear.

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In his paper, Maris reviews new approaches to treatments for a particularly challenging set of patients--children whose neuroblastoma has relapsed in an aggressive form. One particular technique being used and studied at Children's Hospital employs radioactive isotopes that zero in on neuroblastoma cells to selectively kill those cells with radiation. Other tools include retinoids--biological molecules that hone in on cancer cells, angiogenesis inhibitors that cut off a tumor's blood supply, and tyrosine kinase inhibitors that interrupt a critical step in the tumor's growth process.

"These approaches are targeted therapies--aimed in highly selective ways at cancer cells, but sparing healthy cells," said Maris. "But in order to best guide us to the most appropriate treatments, we need greater understanding of the abnormal biological events that give rise to neuroblastoma." One crucial technique for identifying biological pathways is through studies of the gene mutations and variations involved in different types of neuroblastoma, and Maris's team is calling on the sophisticated gene-hunting facilities at the new Center for Applied Genomics at Children's Hospital to advance that knowledge.

"Our goal is to match the most appropriate treatment with precise molecular targets in biological pathways, so we can intervene to stop neuroblastoma in its tracks," said Maris.

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