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Perspectives
of Cellular and Molecular Neurosurgery
Manfred Westphal, Peter McL.
Black
Department of Neurosurgery,
University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg,
20246, Germany [M.W.]; Department of Neurosurgery, Brigham and
Women’s Hospital, Children’s Hospital and Harvard Medical School, Bader 3, Boston, MA, USA
[P.McL.B].
Therapeutic efforts for human
glial tumors have over the past years been redirected towards a
compartmental treatment concept. The diffusely infiltrative nature
of the disease calls for therapeutic agents to reach single cells
far beyond the focus of attention which present therapies like
surgery and radiation are able to treat. Specific drug discovery
approaches which seek to define targets which are specific for
gliomas have generated therapeutic options which allow for a
highly selective development of new reagents. Combined with new
modalities for compartmental drug delivery, systemic complications
might be reduced and advantage taken of a compartmental
specificity of a target which otherwise in the context of systemic
application would not be as specific or burdened with side
effects. From the present status of therapeutic developments in
neuro-oncology it can be expected that a sufficient number of drug
targets emerge which can be exploited by means of interstitial or
intracavitary delivery, which are not neurotoxic and which may
even be imaged in their action with the new metabolic imaging
modalities. Convection enhanced delivery, conditionally
replicating oncolytic viruses and motile, genetically engineered
neural stem cells all seem to fulfill the distribution
requirements which an effective therapeutic for gliomas will need
to overcome the very limited efficacy which surgery, conventional
chemotherapy and radiation have to offer. Whereas the genomics
based discovery approaches are not specific for neuro-oncology,
the development of delivery strategies is highly specific for the
central nervous system, thus creating a unique set of organ and
disease specific therapies.
Keywords: anti-angiogenesis, convection
therapy, differential gene expression, gene-therapy, growth factor
receptors, suppressor genes
Copyright © 2004 Kluwer Academic Publishers.
All rights reserved
Source:
http://ipsapp007.kluweronline.com/IPS/content/ext/x/J/5042/I/125/A/10/abstract.htm
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