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NIH Record Eight New Udall Centers Announced
NINDS, Parkinson's Advocates Testify Before Congress

By Shannon E. Garnett

NINDS director Dr. Gerald Fischbach recently joined actor Michael J. Fox and other Parkinson's disease research advocates on Capitol Hill to discuss the explosion of scientific advances in the study of this disorder.

In testimony before the Senate appropriations subcommittee on labor, health, and human services, education and related agencies, Fischbach said that with sufficient funding scientists should be able to cure Parkinson's disease within 5 to 10 years. He also announced that NINDS is funding eight new Morris K. Udall Parkinson's Disease Research Centers of Excellence, bringing the total to 11 such centers the institute now funds and representing a total commitment of $73 million to be spent on Parkinson's disease research over the next 5 years.

Actor Michael J. Fox testifies.

"Finding a cure for Parkinson's is not like sending a man to the moon or making the atom bomb, where a resolute effort to apply what is known produced success," said Fischbach. "We still need to learn a great deal before we can stop this disease, but I am encouraged that the pace of discovery is increasing each year, and that we are on the right track."

More than half a million Americans have Parkinson's disease, a debilitating neurological disorder that progressively impairs control of body movement, interferes with walking and talking, and often leads to rigid immobility. Symptoms of the disease — which include tremor, stiff limbs, slow or absent movement, lack of facial expression, a shuffling gait, a distinctive stoop, and in some patients, depression and dementia — result from degeneration of nerve cells in the brain, particularly those involved in the production of the chemical dopamine. Although standard treatment with the drug combination levodopa/carbidopa can restore normal movement to many early in the course of the disease, the treatment loses effectiveness as Parkinson's progresses.

NINDS director Dr. Gerald Fischbach outlines advances in Parkinson's disease research in testimony on Capitol Hill.

Despite the current dire description of the disorder, according to Fischbach there are several reasons for hope. His optimism is based on recent advances in a number of Parkinson's disease research areas including:

Cell Death: Scientists have discovered that nerve cells often follow a "final common path" to degeneration in Parkinson's disease and in many other disorders. Apoptosis, this death program, is often called "cell suicide" because cells participate in their own destruction by activating a cascade of enzymes that disrupt the integrity of genes and normal cell metabolism. Each step in the cascade offers new therapeutic targets to halt the progression of the disorder.

Levodopa: When first introduced, levodopa — a drug that helps replenish the brain's diminishing supply of dopamine — seemed to be a miracle drug liberating Parkinson's patients from immobility. Unfortunately the effects of levodopa are not sufficiently lasting, side effects can be serious and, most importantly, the drug cannot halt the underlying death of nerve cells. As researchers learn more about dopamine and other neurotransmitters in the brain, they are also learning how to prolong and enhance the effects of levodopa and develop new drugs.

Neurotrophic factors: An entirely new class of therapeutic drugs — neurotrophic factors — were identified as natural brain chemicals that promote the growth and survival of nerve cells in the development of the nervous system. Scientists are now learning how neurotrophic factors can be used to protect against neurodegeneration in adult brains, with promising results in animal models of Parkinson's disease.

Surgery: Years of analysis of the brain circuits that control movement are leading to dramatic advances in the surgical treatment of Parkinson's disease. Pallidotomy, a surgical procedure designed to rebalance the normal interplay of brain circuits that initiate and restrain voluntary movement, is now carried out with exquisite precision, guided by advanced brain imaging and microelectrode recordings from single brain cells. Another new technology is brain stimulation through electrodes implanted deep in the brain. This procedure not only relieves symptoms of the disorder, but may also slow progression of the disease. Researchers will continue to pursue this possibility and determine the long-term consequences of these surgical procedures.

Stem cells: Cell implantation offers hope for actually replacing nerve cells lost in Parkinson's and many other diseases. Neural stem cells — cells that have the capacity to renew themselves indefinitely and to specialize to form all cell types found in the brain — offer a potentially unlimited supply of dopamine cells. Stem cell therapy has already produced dramatic success in animal models of Parkinson's and other neurological diseases.

The additional funding would be used to study the environmental causes of Parkinson's disease, and to continue research efforts at NINDS including new surgical therapies such as deep brain stimulation, the genetics of Parkinson's disease, improved animal models for Parkinson's disease, better methods to deliver drugs to the brain and stem cell research.

The centers, which were developed in response to Senate bill 535 — also known as the Udall bill in honor of the former congressman who died in December 1998 after a long battle with Parkinson's disease — will play a key role in coordinating and carrying out research efforts in the disorder.

The new Udall centers are located at Brigham and Women's Hospital Center for Neurologic Diseases in Boston; Neurological Institute at Columbia University; University of Virginia Health System; the Mayo Clinic in Jacksonville, Fla.; University of Kentucky; Duke University; University of California at Los Angeles; and Harvard Medical School and McLean Hospital in Belmont, Mass.

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