Àìtó Ẹ̀yà ara fún Ìyípadà: Ìyípadà Enzymatic ti Ẹgbẹ́ Ẹjẹ ti Awọn kidinrin Oluranlọwọ ati Ẹdọfóró 

Lilo awọn enzymu ti o yẹ, awọn oniwadi yọ awọn antigens ẹgbẹ ẹjẹ ABO kuro lati inu kidinrin oluranlowo ati ẹdọfóró ex-vivo, lati bori aiṣedeede ẹgbẹ ẹjẹ ABO. Ọna yii le yanju aito awọn ẹya ara nipa imudara wiwa ti awọn ẹya ara oluranlọwọ fun gbigbe ni riro ati jẹ ki ilana ipinpin ẹya ara jẹ deede ati daradara siwaju sii. 

Ninu iwadi ti a tẹjade laipẹ, awọn oniwadi lo enzymu alpha-galactosidase kan lati Bacteroides ẹlẹgẹ ati ni aṣeyọri yọ iru B ẹgbẹ ẹjẹ antigens lati eda eniyan kidinrin (that remained unused for transplantation) lakoko perfusion ex-vivo nitorinaa yiyipada ẹgbẹ ẹjẹ ti kidirin si oluranlọwọ agbaye O. Eyi ni ọran akọkọ ti gbogbo eto ara ABO. ẹjẹ iyipada ẹgbẹ ninu eniyan nipasẹ yiyọ enzymatic ti iru B ẹjẹ awọn antigens ẹgbẹ¹. 

Ninu iwadi miiran ti o jọra lori ẹdọforo, awọn onimo ijinlẹ sayensi yipada ẹjẹ ẹgbẹ A ẹdọforo si ẹjẹ Ẹgbẹ O ẹdọforo lakoko perfusion ẹdọfóró ex-vivo nipa lilo awọn enzymu meji, FpGalNAc deacetylase ati FpGalactosaminidase. Ko si awọn ayipada pataki ni ilera ti ẹdọfóró pẹlu ipalara ti ara-ara-ara ni a ṣe akiyesi^2,3.  

o kan bi ẹjẹ gbigbe ẹjẹ, ABO ẹgbẹ ẹjẹ ti o baamu jẹ ifosiwewe bọtini ni ipin awọn ẹya ara laarin awọn olugba ti ifojusọna. Wiwa awọn antigens A ati/tabi B ninu awọn ara oluranlọwọ jẹ ki ipin yan ati ihamọ. Bi abajade, ipin jẹ aiṣedeede. Agbara lati ṣe iyipada ABO ẹjẹ ẹgbẹ ti awọn ara ex-vivo si oluranlọwọ agbaye nipa yiyọ awọn antigens A ati/tabi B yoo faagun adagun adagun ti awọn ara oluranlọwọ ibaramu ABO lati yanju iṣoro ti aito eto ara ati imudara ododo ni ipin awọn ẹya ara fun asopo.   

Awọn ọna pupọ (gẹgẹbi yiyọkuro antibody, splenectomy, anti-CD20 monoclonal antibody, ati imunoglobulin inu iṣọn-ẹjẹ) ni a ti gbiyanju ni iṣaaju lati mu ilọsiwaju ti asopo pọ si sibẹsibẹ aipe ABO ti jẹ ọran kan. Imọran lati pa awọn antigens A/B kuro ni enzymatically wa ni ọdun 2007 nigbati awọn oniwadi dinku apakan apakan A/B antigens ni obo nipa lilo enzyme ABase⁴. Laipẹ lẹhinna, wọn ni anfani lati yọ 82% ti antijeni ati 95% ti B antijeni ninu eda eniyan A/B pupa ẹjẹ awọn sẹẹli lilo ABase⁵.  

Ọna ti yiyọkuro antijeni enzymatic A/B lati awọn ara oluranlọwọ ti de ọjọ-ori si fun awọn gbigbe ti kidinrin ati ẹdọfóró. Sibẹsibẹ, awọn ẹri kekere wa ni awọn iwe-iwe ti lilo ti ọna yii si awọn gbigbe ẹdọ. Dipo, desensitisation^6,7 pẹlu awọn egboogi dabi pe o ni idaduro ileri fun imudara aṣeyọri bi daradara bi adagun ti awọn gbigbe ẹdọ.  

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To jo: 

1. S MacMillan, SA Hosgood, ML Nicholson, O004 ẹjẹ yiyọ antijeni ẹgbẹ kuro ninu kidinrin eniyan nipa lilo imọ-ẹrọ perfusion ex-vivo normothermic machine, Iwe akọọlẹ ti Iṣẹ abẹ ti Ilu Gẹẹsi, Iwọn didun 109, Issue Supplement_4, Oṣu Kẹjọ 2022, znac242.004, https://doi.org/10.1093/bjs/znac242.004 | https://academic.oup.com/bjs/article/109/Supplement_4/znac242.004/6648600 

2. Wang A., et al 2021. Dagbasoke Universal ABO Iru Ẹjẹ Olufowosi pẹlu Ex Vivo Enzymatic Itoju: Ẹri kan ti Concept Feasibility Stud. Iwe akọọlẹ ti Ọkàn ati Iṣipopada ẹdọfóró. Iwọn didun 40, Issue 4, Supplement, s15-s16, Kẹrin 01, 2021. DOI: https://doi.org/10.1016/j.healun.2021.01.1773 

3. Wang A., et al 2022. Ex vivo enzymatic treatment to iyipada eje type A olugbeowosile ẹdọforo sinu gbogbo ẹjẹ iru ẹdọforo. Oogun Translational Imọ. 16 Feb 2022. Vol 14, Issue 632. DOI: https://doi.org/10.1126/scitranslmed.abm7190  

4. Kobayashi, T., et al 2007. Yiyan Strategi fun Bibori ABO Incompatibility. Gbigbe: May 15, 2007 - Iwọn didun 83 - Oro 9 - p 1284-1286. DOI: https://doi.org/10.1097/01.tp.0000260634.85690.c4 

5. Kobayashi T., et al 2009. Yiyọ ti ẹjẹ ẹgbẹ A / B antigen ninu awọn ara nipasẹ ex vivo ati ni vivo isakoso ti endo-ß-galactosidase (ABAse) fun ABO-incompatibility asopo. Imuniloji gbigbe. Iwọn 20, atejade 3, January 2009, Oju-iwe 132-138. DOI: https://doi.org/10.1016/j.trim.2008.09.007 

6. Dogar AW et al 2022. ABO incomompatible ngbe olugbeowosile ẹdọ asopo pẹlu antibody titer ti 1: 4: First irú Iroyin lati Pakistan. Annals of Medicine and Surgery Volume 81, Oṣu Kẹsan 2022, 104463. DOI: https://doi.org/10.1016/j.amsu.2022.104463 

7. Akamatsu N., et al 2021. Rituximab Desensitization ni Awọn olugba Iṣipopada Ẹdọ Pẹlu Awọn Agbofinro HLA Kan pato Oluranlọwọ ti tẹlẹ: Iwadi jakejado Orilẹ-ede Japanese. Asopo Taara. Ọdun 2021 Oṣu Kẹjọ; 7 (8): e729. Atejade lori ayelujara 2021 Jul 16. DOI: https://doi.org/10.1097/TXD.0000000000001180  

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