Kupita Patsogolo kwa Matenda Odziteteza ku Matenda a Ana: Chithandizo cha Maselo a CAR-T Chimachiritsa Wodwala wa Lupus

Mu June 2023, Uresa wazaka 15 adalandira chithandizo cha maselo a CAR-T ku Erlangen University Hospital, chomwe chinali choyamba kugwiritsidwa ntchito kwa chithandizo chatsopanochi kuti achepetse kupita patsogolo kwa systemic lupus erythematosus (SLE), matenda oopsa a autoimmune. Patatha chaka chimodzi, Uresa akumva bwino kwambiri kuposa kale lonse, kupatulapo chimfine chaching'ono.

Uresa ndiye mwana woyamba kulandira chithandizo cha SLE Chithandizo cha Immunotherapy ku Erlangen University's German Center for Immunotherapy (DZI). Kupambana kwa chithandizo chapaderachi kwasindikizidwa mu The Lancet.

Dr. Tobias Krickau, katswiri wa matenda a nyamakazi ya ana ku Dipatimenti ya Zachipatala cha Ana ndi Achinyamata ku Erlangen University Hospital, anafotokoza za kupadera kwa kugwiritsa ntchito maselo a CAR-T pochiza matenda. Matenda Odziteteza KuthupiKale, chithandizo cha CAR-T chinali chovomerezeka kokha pa khansa zina zam'magazi zomwe zapita patsogolo.

Pambuyo poti mankhwala ena onse alephera kulamulira SLE ya Uresa yomwe ikuipiraipira, gulu lofufuza linakumana ndi chisankho chovuta: kodi maselo oteteza thupi awa ayenera kugwiritsidwa ntchito kwa mwana yemwe ali ndi matenda a autoimmune? Yankho lake linali losayembekezereka, chifukwa palibe amene anayesapo chithandizo cha CAR-T cha matenda a autoimmune a ana kale.

Chithandizo cha maselo a CAR-T chimaphatikizapo kuchotsa maselo ena a chitetezo cha mthupi (maselo a T), kuwapatsa ma receptor a chimeric antigen (CAR) mu labu yoyera yapadera, kenako n’kuyikanso maselo osinthidwawa mwa wodwalayo. Maselo a CAR-T awa amayendayenda m’magazi, kulunjika ndi kuwononga maselo a B omwe amagwira ntchito okha (oopsa).

Zizindikiro za Uresa zinayamba mu autumn 2022, kuphatikizapo mutu waching'alang'ala, kutopa, kupweteka kwa mafupa ndi minofu, komanso ziphuphu pankhope—zizindikiro zodziwika bwino za lupus. Ngakhale kuti adalandira chithandizo chamankhwala champhamvu, matenda ake anakula kwambiri, zomwe zinakhudza impso zake komanso zinayambitsa mavuto aakulu.

Kumayambiriro kwa chaka cha 2023, atagonekedwa m'chipatala kangapo komanso kulandira chithandizo, kuphatikizapo mankhwala oletsa chitetezo chamthupi komanso kusinthana kwa plasma, matenda a Uresa anakula kwambiri mpaka kufika poti anafunika dialysis. Popeza anali kutali ndi abwenzi ndi abale ake, moyo wake unatsika kwambiri.

Gulu lachipatala ku Erlangen University, lotsogozedwa ndi Pulofesa Mackensen, linagwirizana kupanga ndikugwiritsa ntchito maselo a CAR-T ku Uresa pambuyo pokambirana mwatsatanetsatane. Kugwiritsa ntchito bwino mankhwala a CAR-T kunayambitsidwa motsatira lamulo la Germany loletsa kugwiritsa ntchito mankhwala osokoneza bongo komanso malamulo okhudza kugwiritsa ntchito mankhwala mwachifundo.

Pulogalamu yothandizira maselo a CAR-T ku Erlangen, yotsogozedwa ndi Pulofesa Georg Schett ndi Pulofesa Mackensen, yakhala ikuchiza odwala omwe ali ndi matenda osiyanasiyana a autoimmune, kuphatikizapo SLE, kuyambira 2021. Kupambana kwawo ndi odwala 15 kudasindikizidwa mu New England Journal of Medicine mu February 2024, ndipo pakadali pano akuchita kafukufuku wa CASTLE ndi ophunzira 24, onse akuwonetsa kusintha kwakukulu.

Pokonzekera chithandizo cha maselo a CAR-T, Uresa adapatsidwa mankhwala a chemotherapy ochepa kuti apatse malo maselo a CAR-T m'magazi mwake. Pa June 26, 2023, Uresa adalandira maselo ake a CAR-T omwe adamupangira. Pofika sabata yachitatu atatha kulandira chithandizo, ntchito ya impso zake ndi zizindikiro za lupus zinayamba kusintha, ndipo zizindikiro zake zinatha pang'onopang'ono.

Njira yothandizirayi inaphatikizapo kuyanjana bwino kuti zitsimikizire kuti mankhwala a chemotherapy akugwira ntchito bwino komanso kuti impso zotsala zigwire ntchito bwino. Uresa adakumana ndi zotsatirapo zochepa chabe ndipo adatulutsidwa m'chipatala patatha masiku 11 atalandira chithandizo.

Pofika kumapeto kwa Julayi 2023, Uresa anabwerera kunyumba, anamaliza mayeso ake, ndipo anakhazikitsa zolinga zatsopano za tsogolo lake, kuphatikizapo kudziyimira pawokha komanso kukhala ndi galu. Anasangalala kwambiri kubwereranso ndi anzake ndikuyambiranso moyo wabwinobwino wachinyamata.

Pulofesa Mackensen anafotokoza kuti Uresa akadali ndi maselo ambiri a CAR-T m'magazi mwake, zomwe zikutanthauza kuti amafunika kupatsidwa ma antibodies mwezi uliwonse mpaka maselo ake a B achire. Dr. Krickau adagogomezera kuti kupambana kwa chithandizo cha Uresa kudachitika chifukwa cha mgwirizano wapafupi wa madokotala ambiri ku German Center for Immunotherapy.

Uresa sakufunikanso mankhwala aliwonse kapena dialysis, ndipo impso zake zachira mokwanira. Dr. Krickau ndi gulu lake akukonzekera maphunziro ena kuti afufuze kuthekera kwa maselo a CAR-T pochiza matenda ena a autoimmune a ana.

Nkhani yofunika kwambiri iyi ikuwonetsa kuthekera kwa chithandizo cha maselo a CAR-T kupereka chikhululukiro cha nthawi yayitali kwa odwala omwe ali ndi matenda oopsa a chitetezo chamthupi monga SLE. Kupambana kwa chithandizo cha Uresa kukuwonetsa kufunika kochitapo kanthu mwachangu komanso mgwirizano m'magulu osiyanasiyana. Maphunziro ena azachipatala akufunika kuti atsimikizire chitetezo cha nthawi yayitali komanso kugwira ntchito bwino kwa chithandizo cha maselo a CAR-T kwa ana omwe ali ndi matenda a chitetezo chamthupi.