CAR-T yeSystemic Lupus Erythematosus (SLE)

Ms.C murwere akarapwa SLE kuburikidza neCAR-T therapy zvinobudirira. Heino nyaya yake.

Pfupiso yeNyaya:

Mai C, mukadzi ane makore makumi matatu nemaviri ekuberekwa, vanga vachirwara nechirwere chesystemic lupus erythematosus (SLE) kwemakore maviri. Kunyangwe vachirapwa kakawanda, chirwere chavo chakaramba chisingadzoreki. Vakatambura nezviratidzo zvakakomba, zvinosanganisira nephritis, kurwadziwa kwemajoini, uye mapundu asingaperi, izvo zvakakanganisa zvikuru hupenyu hwavo.

Mamiriro Ekurapwa Pamberi Pekurapwa:

Chirwere cheSLE chaMs. C chakaratidzwa nezviratidzo zvakakomba, zvinosanganisira kurwadziwa kwemajoini kunopedza simba, nephritis inodzokororwa, uye mapundu asingaperi. Kuongororwa kwemurabhoritari kwakaratidza kuti ma antibodies eDNA ane tambo mbiri akakwira uye mazinga eC3 neC4 akaderera, zvichiratidza chirwere chinoshanda. NeSystemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) score ye16, chirwere chaMs. C chakaonekwa sechakanyanya, uye mishonga yekudzivirira muviri yakakundikana kuunza zororo.

Sarudzo yekurapa neCAR-T:

Zvichitevera dambudziko ravo rekusagadzikana, Mai C vakanyoreswa mukuyedzwa kwekiriniki kweCAR-T cell therapy—kurapa kwakatangwa patsva kwemamwe magomarara, asi ikozvino kuri kuongororwa kwezvirwere zve autoimmune zvakaita seSLE. CAR-T therapy inoshanda nekugadzira majini eT cells emurwere kuti iongorore mamwe masero ekudzivirira muviri anoita basa guru mukuita kwechirwere.

Maitiro Ekurapa CAR-T:

1. Kusarudzwa kweMurwere: Kurwara kwaMs. C kwakasimba uye kusingashande zvakanaka kwakaita kuti vave munhu akakodzera kurapwa neCAR-T.

2. Kugadzirira: Vasati vagamuchira masero eCAR-T, Mai C vakagadziriswa chemotherapy, danho rakajairika rekuderedza huwandu hwemalymphocytes avo aripo uye kugadzirira masoja avo ekudzivirira muviri kuti apihwe CAR-T.

3. Uinjiniya hweT-cell: Masero eT aMs. C akaunganidzwa ndokugadziriswa murabhoritari kuti abudise chimeric antigen receptors (CAR) yakanangana nemaantigen eCD19 neBCMA. Maantigen aya anowanzo kuwanikwa pamusoro pemasero eB, ayo anoita basa rakakosha mukusashanda zvakanaka kwemuviri kunoonekwa muSLE.

4. Kuiswa kweCAR-T Cell: Mushure mekuwedzerwa uye kuyedzwa kwemhando yepamusoro, masero eCAR-T akagadziriswa akaiswazve mumuviri waMs. C. Kuwedzerwa uku kwakaratidza kutanga kwechitsauko chitsva mukurwisa kwake lupus.

5. Kuongororwa kweVarwere Vari Muchipatara: Mai C vakanyatso tariswa kwemazuva makumi maviri nemashanu mushure mekupinzwa mushonga uyu kuti vave nechokwadi chekuti mushonga wacho wakachengeteka uye unoshanda. Vashandi vezvehutano vakanyatso tarisa zviratidzo zvemigumisiro yakaipa, yakaita se cytokine release syndrome (CRS), iyo inowanzo shandiswa pakurapa neCAR-T.

Mhedzisiro yeKurapwa:

1. Mhinduro Yenguva Pfupi: Mukati memavhiki matatu chete mushure mekuiswa mushonga uyu, Mai C vakaona kuvandudzika kukuru muzviratidzo zvavo. Marwadzo avo emapfupa nekuzvimba zvakaderera, uye mapundu airamba achimutambudza kwemakore akatanga kupera. Kuongororwa kwerabhoritari kwakaratidzawo kuti masero eB muropa ravo akanga abviswa zvinobudirira, zvichiratidza kuti masero eCAR-T akanga abudirira kurwisa zvikamu zvemuviri wavo zvaisashanda zvakanaka.

2. Kuongorora Kwepakati Penguva (Mwedzi Mitatu): Pamwedzi mitatu, chirwere chaMs. C chakanga chisisipo zvachose, uye chibodzwa chake cheSLEDAI-2K chakaderera kubva pa16 kusvika pa2. Chirwere chake chenephritis, chainyanya kushungurudza vasati varapwa, chakanga chava kudzorwa, nekudzikira kukuru kweproteinuria. Pamusoro pezvo, huwandu hwake hwema anti-stranded DNA antibody hwakanga hwadzikira, uye huwandu hwake hweC3 neC4 hwakanga hwadzokera pahunhu, zvichiratidza kudzorerwa kwehunhu hwemuviri.

3. Mhedzisiro Yenguva Refu (Mwedzi 12): Gore rimwe chete mushure mekugamuchira kurapwa kweCAR-T, Mai C vakaramba vasina mishonga uye vasina zviratidzo zvekudzokera shure kweSLE. Masoja avo ekudzivirira muviri akanga adzoka zvishoma nezvishoma, uye kunyange zvazvo masero avo eB akanga adzoka, haana kuratidza chero basa rekurwisa zvirwere. Kunze kwekunge vaine CRS isina kusimba, Mai C havana kuwana migumisiro yakaipa panguva yese yekurapwa.

Ruzivo rwakawanda rwekurapa:

Kurapa kweCAR-T kwakaratidza tarisiro huru mukurapa systemic lupus erythematosus (SLE), kunyanya kune varwere vane mhando dzakakomba dzechirwere ichi dzisingarapike. Ongororo dzichangoburwa dzinoratidza kushanda kwadzo, varwere vazhinji vachiwana zororo kwenguva refu vasina mishonga.

Muongororo yakaitwa nevarwere vasere, vese vakaratidza kuti chirwere chavo chapera mushure mekugamuchira CAR-T cell therapy yakanangana neCD19-positive B-cells. Kurapa uku kwakaita kuti B-cells idzi dzipere, idzo dzinokonzera kugadzirwa kweautoantibodies inokuvadza muSLE. Zvakakosha kuti, kunyangwe mushure mekugadzurwa kweB-cell, chirwere ichi hachina kudzoka, uye varwere vakakwanisa kuramba vaine mhinduro dzakajairika dzekudzivirira muviri kumajekiseni. Izvi zvinoratidza kuti CAR-T therapy inogara kwenguva refu pamasimba ekudzivirira muviri, kunyanya mukumisa kurwiswa kweSLE neautoimmune.

Chidzidzo chekutevera varwere kwemwedzi inopfuura gumi nemitatu chakaratidza kuti vese vakapinda muchirongwa ichi vakaderera zvakanyanya mukushanda kwechirwere, uye hapana kudzoka kwechirwere kwakaonekwa. Uyezve, kurapwa kwacho kwaiwanzo bvumidzwa zvakanaka, uye migumisiro isina kusimba senge cytokine release syndrome (CRS) yaigoneka.

Mhedzisiro iyi inoratidza kuti kurapwa neCAR-T kunogona kupa mhinduro inoshanda uye yenguva refu kune varwere vane SLE isingashande, zvichigona kubvisa kudiwa kwekurapwa kwekudzivirira muviri kwehupenyu hwese.