Mankhwala atsopano Amapereka Mayankho Odabwitsa M'mayesero Oyamba
Chodziwika bwino monga kutenga maselo othandizira (ACT), izi ndi mankhwala atsopano omwe amafunika kumangika maselo omwe ali ndi chitetezo cha odwala kuti azindikire ndikuukira maselo awo otupa. Ngakhale kuti mankhwalawa akuyesedwa panopa ndipo akhala akungoyesedwa ku mayesero angapo aang'ono mpaka pano, awonetsa mayankho odabwitsa kwa odwala omwe ali ndi khansa yapamwamba.
Momwe Ikugwirira Ntchito
T-maselo, mtundu wa maselo a chitetezo cha mthupi, alipo ndi mapulogalamu apamwamba pamwamba pake, otchedwa T-cell receptors, kapena TCRs. Kawirikawiri ma TCRs amamanga ma antigen kuti apange chitetezo cha mthupi. Poyesera kugwiritsa ntchito T-maselo a khansa yothandizira khansa, maselo a T amasonkhanitsidwa kuchokera mwazi wa wodwalayo. Kenaka, mu labotale, T-maselo amasinthidwa kuti apange mapepala apadera pamtunda wawo wotchedwa chimeric antigen receptors, kapena CAR, zomwe zimatha kumanga mapuloteni ena apadera a maselo a khansa.
Majini a T T-cell opangidwa ndi injini amakololedwa mu labu ndipo amaloledwa kuonjezera manambala mpaka pali mabiliyoni a iwo. Pambuyo pa kusinthidwa ndi kukolola, ma T-maselowa, omwe ali ndi CARs omwe angathe kuzindikira ndi kupha maselo ena a khansa, amabwezeretsedwanso mwa wodwalayo.
Ma CAR amenewa ndiwo mapuloteni omwe amalola T-maselo kuzindikira puloteni, kapena antigen, pa maselo otupa.
Magetsi a CAR T-cells amakula mu labu ndipo amaloledwa kuonjezera manambala mpaka pali mabiliyoni a iwo. Pakalipano, momwe amagwirira ntchito zikuwoneka kuti zimadalira mbali imodzi mwa mphamvu yawo yakukula ndi kukhalabe yogwira mwa wodwalayo atatha kubwereranso.
Lingaliro la kugwiritsira ntchito maselo amoyo kuti lichiza khansara kwenikweni si latsopano.
Zomwe taphunzira kuchokera ku zotsatira zochiritso zofanana m'zaka zapitazi zinapindulitsa podziwa mmene T-maselo amagwirira ntchito , zomwe zinapangitsa kuti zowonjezereka zitheke. Ofufuza akugwira ntchitoyi akuchenjeza kuti pali zambiri zoti ziphunzire za CAR T-cell therapy. Koma zotsatira zoyambirira kuchokera ku mayesero onga awa zakhala ndi chiyembekezo chodalirika.
Zimapindula Kwambiri
Ena ayerekezera mtundu uwu wa mankhwala ku mgwirizano wa mitundu iwiri yochiritsira: ma antibodies oyendetsa, monga rituximab, ndi makhalidwe awo enieni; ndi khansa-cell-kill-agents amene ali ndi mphamvu ya cytotoxicity - zonsezi ndi kukhalapo kwanthaŵi yaitali ya cytotoxic T-maselo, kuti chiyembekezo chikhalebebe, kuyang'anira kubwereza.
Kafukufuku akadali watsopano, motero akatswiri amalimbikitsana, koma mayesero a zachipatala ayamba kale kugwiritsa ntchito mankhwala a CAR T-cell m'matenda otsatirawa:
- Matanki apamwamba
- Matenda apamwamba kwambiri a m'matumbo a m'magazi (ONSE)
- Kufalitsa kwambiri B-cell lymphoma
A FDA adasankha CAR T-cell therapy kuti athandize anthu onse. Amayesetsanso kuti ayesedwe mobwerezabwereza komanso osakanikirana ndi ena omwe si a Hodgkin lymphoma, myeloma, ndi matenda enaake a khansa ya m'magazi (CLL) , komanso odwala omwe si a Hodgkin lymphoma ndi myeloma.
Ofufuza amayembekeza kuti CAR T-cell therapy tsiku lina idzakhala mankhwala ochizira a B-cell malignancies monga ALL AND Chronic Lymphocytic leukemia. Ofufuza omwe amagwira ntchito ndi CAR-T-maselo adziwitsanso mtundu uwu wa mankhwala monga "mlatho" wopatsira mafupa a mafupa onse kwa odwala onse omwe amasiya kuyankha mankhwala a chemotherapy.
Chiyeso chimodzi chinagwiritsa ntchito kugwiritsa ntchito CAR T-maselo mwa odwala akuluakulu 15, ndipo ambiri mwa iwo anali atakula kwambiri a B-cell lymphoma. Ngakhale mosakayikira anali mayesero ang'onoang'ono, chiyembekezo chimabwera chifukwa chakuti ambiri mwa odwalawa ankachitidwa ndi CAR T-maselo ali ndi mayankho athunthu kapena aang'ono.
Palinso chiyembekezo kuti CAR T-cell therapy ingagwiritsidwe ntchito popewera kubwereza. Zowonjezera zina zomwe zimapangitsa kuti munthu akhale ndi chiyembekezo chimaphatikizapo kufalikira kwa maselo opatsirana pambuyo pa kulowetsedwa, kuphatikizapo anthu 1,000; ndi kukhalapo kwa CAR T-maselo m'katikati mwa mitsempha, malo "opatulika" omwe maselo a khansa okha omwe apulumuka mankhwala a chemotherapy kapena ma radiation akhoza kubisala. Pa odwala awiri omwe akuyendetsedwa ndi matenda a NCI, mwachitsanzo, chipatala cha CAR T chinathetsa khansara chomwe chinafalikira m'katikati mwa mitsempha.
Zotsatira Zotsatira
Pamene chiwerengero chachikulu cha maselo a T ogwiritsidwa ntchito akubwezeretsedwanso mwa wodwalayo, maselo awa T amatulutsa cytokines mochuluka. Izi zingayambitse matenda a cytokine-release, omwe amadziwika ndi fever yambiri ndipo amatsitsa magazi. Ma cytokines ndi zizindikiro za mankhwala, ndipo matenda a cytokine-release release ndi ovuta omwe amachiritsidwa ndi CAR T-maselo.
Odwala omwe ali ndi chiopsezo chachikulu cha khansa asanalandire maselo a CAR T akuwoneka kuti ali ndi vuto lalikulu la matenda a cytokine-release. Ochita kafukufuku amachenjeza kuti ngakhale kuti zinthu zikuwayendera bwino, kafufuzidwe kafukufuku amafunika kuti CAR T-cell therapy ikhale yosasinthika, kwa odwala onse monga mwachitsanzo. Kufufuza ndi odwala ambiri ndi nthawi yowonjezereka yakuitanidwa ndi kuyendetsedwa.
Pa Horizon
Malinga ndi zomwe zikuchitika bwino pakalipano, magulu angapo ofufuza kafukufuku m'dziko lonse lapansi akuyesetsa kuti apange t-maselo opangidwa ndi injini ya khansa zina, kuphatikizapo zotupa zowopsa monga khansa ya pancreatic ndi khansa ya ubongo.
> Zotsatira:
> CAR T-Cell Thérapie: Maselo Opanga Opaleshoni a Odwala Kuti Apewe Khansa Zawo. http://www.cancer.gov/cancertopics/research-updates/2013/CAR-T-Selo.
> Barrett DM, Singh N, Porter DL, Grupp SA, June CH. Chimeric Antigen Receptor Therapy kwa khansa. Annu Rev Med . 2014; 65: 333-347.
> Chimeric Antigen Receptor T-Maselo. http://www.lymphomation.org/programing-t-cells.htm.