Treatment strategies for neurodegenerative diseases based on trophic factors and cell transplantation techniques.

Treatment strategies based on transfer of genes, molecules, or cells to the central nervous system are summarized. When neurons are already degenerated, functional compensation can be effected by grafts of syngeneic or allogenic tissue to the target area. This technique is undergoing clinical trials in Parkinson's disease. Before degeneration has occurred, it may be possible to rescue "stressed" neurons, and stimulate terminal outgrowth using treatment with neurotrophic factors. Such approaches, with an emphasis on the NGF family of neurotrophins and their receptors, are reviewed. Finally, new molecular biology techniques may permit the transfer of genes directly into non-dividing cells of the central nervous system. These three approaches may have a more general applicability, and become important not only in neurodegenerative diseases, but also in other afflictions of the nervous system such as ischemia, stroke and injury.