Ukuphumelela Kwesifo Sokuzivikela Kwezingane Ezizimele: Ukwelashwa Kwamaseli e-CAR-T Kwelapha Isiguli Se-Lupus

NgoJuni 2023, u-Uresa oneminyaka engu-15 ubudala wathola ukwelashwa kwamaseli e-CAR-T e-Erlangen University Hospital, okwaba ukusetshenziswa kokuqala kwalolu hlobo lokwelashwa olusha ukuze kuncishiswe ukuqhubeka kwe-systemic lupus erythematosus (SLE), isifo esibi kakhulu sokuzivikela komzimba. Ngemva konyaka, i-Uresa izizwa iphilile njengakuqala, ngaphandle komkhuhlane omncane omncane.

U-Uresa ungumntwana wokuqala owelashwa nge-SLE Ukwelashwa nge-immunotherapy e-Erlangen University's German Center for Immunotherapy (DZI). Impumelelo yalolu hlobo lokwelashwa oluqondene nomuntu ngamunye ishicilelwe kuyi-The Lancet.

UDkt. Tobias Krickau, udokotela wamathambo ezingane eMnyangweni Wezingane Nezokwelapha Kwabantwana e-Erlangen University Hospital, uchaze ukuhluka kokusebenzisa amaseli e-CAR-T ukwelapha Izifo Zokuzivikela NgokuzenzakalelayoNgaphambilini, ukwelashwa kwe-CAR-T kwakuvunyelwe kuphela emidlavuzeni ethile yegazi ethuthukile.

Ngemva kokuba yonke eminye imithi yehlulekile ukulawula i-SLE ye-Uresa eba yimbi, ithimba labacwaningi labhekana nesinqumo esinzima: ingabe la maseli omzimba aklanywe ngendlela efanele kufanele asetshenziswe enganeni enesifo sokuzivikela komzimba? Impendulo yayingakaze ibonwe, njengoba akekho owake wazama ukwelashwa kwe-CAR-T kwezifo zokuzivikela komzimba ezinganeni ngaphambili.

Ukwelashwa ngamaseli e-CAR-T kuhilela ukukhipha amanye amaseli omzimba esiguli (amaseli e-T), ukuwahlomisa ngama-receptor e-chimeric antigen (CAR) elabhorethri ehlanzekile ekhethekile, bese kufakwa kabusha la maseli aguquliwe esigulini. La maseli e-CAR-T ajikeleza egazini, eqondisa futhi ebhubhisa amaseli e-B asebenza ngokuzenzakalelayo (ayingozi).

Izimpawu zika-Uresa zaqala ekwindla ka-2022, okuhlanganisa i-migraines, ukukhathala, ubuhlungu bamalunga nemisipha, kanye nokuqubuka kobuso—izimpawu ezivamile ze-lupus. Naphezu kokwelashwa okujulile, isimo sakhe saba sibi kakhulu, sathinta izinso zakhe futhi sabangela izinkinga ezinkulu.

Ekuqaleni kuka-2023, ngemuva kokulaliswa esibhedlela kaningi kanye nokwelashwa, okuhlanganisa ukwelashwa ngamakhemikhali okucindezela amasosha omzimba kanye nokushintshaniswa kwe-plasma, isimo sika-Uresa saba sibi kakhulu kwaze kwaba yilapho edinga i-dialysis. Njengoba ayehlukanisiwe nabangane nomndeni, izinga lempilo yakhe lehla kakhulu.

Ithimba lezokwelapha e-Erlangen University, eliholwa nguSolwazi uMackensen, livumile ukukhiqiza nokusebenzisa amaseli e-CAR-T e-Uresa ngemuva kwezingxoxo eziningiliziwe. Lokhu kusetshenziswa ngozwelo kokwelashwa kwe-CAR-T kwaqalwa ngaphansi komthetho waseJalimane wezidakamizwa kanye nemithethonqubo yokusetshenziswa ngozwelo.

Uhlelo lokwelapha amaseli e-CAR-T e-Erlangen, oluholwa nguSolwazi Georg Schett noSolwazi Mackensen, belulokhu luphatha iziguli ezinezifo ezahlukahlukene zokuzivikela komzimba, okuhlanganisa ne-SLE, kusukela ngo-2021. Impumelelo yabo ngeziguli ezingu-15 yanyatheliswa kuyi-New England Journal of Medicine ngoFebhuwari 2024, futhi okwamanje benza ucwaningo lwe-CASTLE nabahlanganyeli abangu-24, bonke bebonisa intuthuko enkulu.

Ukuze alungiselele ukwelashwa ngamaseli e-CAR-T, u-Uresa wenziwa i-chemotherapy ephansi ukuze avule isikhala samaseli e-CAR-T egazini lakhe. Ngomhlaka-26 Juni 2023, u-Uresa wathola amaseli akhe e-CAR-T aqondene naye. Ngesonto lesithathu ngemva kokwelashwa, ukusebenza kwezinso zakhe kanye nezinkomba ze-lupus kwathuthuka, futhi izimpawu zakhe zanyamalala kancane kancane.

Inqubo yokwelashwa yayihilela ukuhlanganiswa ngokucophelela ukuqinisekisa ukusebenza kahle kwe-chemotherapy kanye nokuvikelwa kokusebenza kwezinso okusele. I-Uresa yathola imiphumela emibi emincane kuphela futhi yakhishwa ngosuku lwe-11 ngemuva kokwelashwa.

Ngasekupheleni kukaJulayi 2023, u-Uresa wabuyela ekhaya, waqeda izivivinyo zakhe, futhi wazibekela imigomo emisha yekusasa lakhe, okuhlanganisa ukuzimela nokuthola inja. Wajabula kakhulu ukuhlangana nabangani futhi aphinde aphile impilo evamile yobusha.

USolwazi Mackensen uchaze ukuthi i-Uresa isenawo amaseli e-CAR-T egazini layo, okusho ukuthi idinga ukumpontshelwa ama-antibody njalo ngenyanga kuze kube yilapho amaseli ayo e-B eselulama. UDkt. Krickau ugcizelele ukuthi impumelelo yokwelashwa kwe-Uresa ibangelwe ukubambisana okuseduze kwemikhakha eminingi yezokwelapha e-German Center for Immunotherapy.

I-Uresa ayisayidingi imithi noma i-dialysis, futhi izinso zakhe sezilulame ngokuphelele. UDkt. Krickau nethimba lakhe bahlela izifundo ezengeziwe zokuhlola amandla amaseli e-CAR-T ekwelapheni ezinye izifo zokuzivikela komzimba ezinganeni.

Leli cala elibalulekile libonisa amandla okwelashwa ngamaseli e-CAR-T okuhlinzeka ngokukhululeka kwesikhathi eside kweziguli zezingane ezinezifo ezinzima zokuzivikela komzimba njenge-SLE. Impumelelo yokwelashwa kwe-Uresa igcizelela ukubaluleka kokungenelela kwangaphambi kwesikhathi kanye nokubambisana kwemikhakha eminingi. Kudingeka izifundo ezengeziwe zezokwelapha ukuqinisekisa ukuphepha kwesikhathi eside kanye nokusebenza kahle kokwelashwa kwamaseli e-CAR-T ezinganeni ezinezifo zokuzivikela komzimba.