So oduruyɛfo bi akyerɛw wo aduru bi pɛn, nanso anyɛ adwuma amma wo, ɛwom mpo sɛ ɛyɛɛ adwuma maa w’adamfo bi de? Anaasɛ woanya nsunsuanso bɔne a wo nkutoo na wunya fi nnuru bi a afoforo nni mu pɛn? Ebia woasusuw ho sɛ, "Dɛn nti na saa aduru yi nyɛ adwuma mma me?" So woasusuw pɛn sɛ nea enti a ɛte saa no betumi ayɛ w’awosu? So ɛnyɛ nwonwa? Yiw, saa awosu mu nkwaadɔm nketenkete a ɛwɔ yɛn nipadua mu yi betumi asesa ɔkwan a aduru bi a yɛnom fa so yɛ adwuma koraa. Ɛnnɛ yɛreka aduruyɛ mu nnwuma foforo a ɛho hia sen biara no mu biako ho asɛm. Ɛno ne Pharmacogenomics.
Sɛ yɛbɛka no tiawa a, dɛn ne Pharmacogenomics?
Asɛmfua yi ware kakra na ɛte sɛ nea ɛyɛ den, ɛnte saa? Nanso momma yɛnbubu mu. Afei ɛyɛ mmerɛw yiye. Ɛyɛ nsɛmfua abien a wɔaka abom.
1. Nnuruyɛ ho adesua: Eyi kyerɛ nnuruyɛ ho adesua . Ɛne sɛ, sɛnea wɔde aduru bi di dwuma, nea ɛyɛ nipadua no, ne nea efi mu ba.
2. Genomics: Eyi kyerɛ awosu mu nkwaadɔm ne ne dwumadi ho adesua .
Enti sɛ saa abien yi bom a, Pharmacogenomics yɛ sɛnea yɛn awosu mu nkwaadɔm yɛ n’ade wɔ nnuru a yɛnom no ho adesua. Sɛ yɛbɛka no tiawa a, ɛfa sɛnea wubehu sɛnea aduru bi a wɔde ma wo bɛyɛ adwuma yiye, anaasɛ ebetumi de ɔhaw ahorow aba, a egyina w’awosu mu nneɛma so.
Eyi yɛ aduruyɛ foforo bi a wɔfrɛ no "Precision Medicine" dea. Ɛkyerɛ "aduru pɔtee bi." Sɛ́ anka ɛbɛma obiara aduru koro no, esusuw nneɛma te sɛ w’awosu mu nkwaadɔm, w’asetra kwan, ne baabi a wote ho, na ɛpaw ayaresa a ɛfata wo pɔtee . Fa no sɛ wobɛkɔ sotɔɔ mu na woatɔ atade a ne kɛse yɛ pɛ ma obiara, sen sɛ wobɛkɔ obi a ɔpam ntade nkyɛn na woayɛ atade bi sɛnea w’ankasa wosusuw. Eyi te saa ara.
Mprempren, wɔde saa kwan yi di dwuma ma nyarewa ne nnuru kakraa bi pɛ. Sɛ nhwɛso no, wɔde saa mfiridwuma yi di dwuma ma HIV, kokoram ahorow bi, adwenemhaw, ne nnuru bi a wɔde sa komayare. Nanso saa afuw yi renya nkɔso ntɛmntɛm yiye. Nhwehwɛmufo gye di sɛ bere tiaa bi mu no, pharmacogenomics bɛboa nnuruyɛfo ma wɔapaw nnuru a ɛfata sen biara ama nyarewa a ɛtaa ba mpo.
Ɔkwan bɛn so na yɛn awosu mu nneɛma ka nnuru?
Sɛ yɛbɛte eyi ase a, ɛsɛ sɛ yedi kan hwɛ nea awosu mu nneɛma yɛ wɔ yɛn nipadua mu. Susuw yɛn awosu mu nkwaadɔm ho sɛ akwankyerɛ nhoma a edi mũ a yɛde kyekye yɛn nipadua na yɛde yɛ adwuma. Nkwammoaa a ɛwɔ yɛn nipadua mu no yɛ adwuma sɛnea akwankyerɛ a ɛwɔ akwankyerɛ nhoma yi mu no te.
Ade titiriw a ɛsɛ sɛ wɔde akwankyerɛ ahorow yi yɛ ne enzymes.Protein molecule ahorow a wɔfrɛ no enzymes a wɔyɛ. Enzyme te sɛ adwumayɛfo nketewa wɔ yɛn nipadua mu. Saa adwumayɛfo yi wɔ nnwuma mpempem pii. Nnwuma yi mu biako a ɛho hia sen biara ne sɛ yɛbɛsɛe nnuru a yɛnom no, anaasɛ yɛbɛma yɛn nipadua no ayɛ adwuma.
Fa no sɛ worenom aduru bi. Ɛnkɔ tẽẽ nkɔsa yare no. Ɛsɛ sɛ saa aduru no di kan kɔ adwumayɛbea ahorow a ɛwɔ yɛn nipadua mu (sɛ nhwɛso no, mmerɛbo), baabi a adwumayɛfo a wɔwɔ hɔ (i.e. enzymes) bubu, bubu, na wɔma nipadua no tumi de di dwuma.
Afei susuw ho hwɛ, sɛ saa enzymes yi ntumi nyɛ adwuma yiye esiane awosu mu nsakrae a ɛwɔ nnipa binom mu nti a, dɛn na ɛba?
- Sɛ enzymes no yɛ adwuma ntɛmntɛm dodo a: Aduru a wonom no, ansa na atumi atwe na aka yare no, sɛe na woyi fi nipadua no mu ntɛmntɛm. Afei dodow a ɛfata no nnɔɔso mma wo. Aduru no bɛte nka sɛ ɛnyɛ adwuma.
- Sɛ enzymes no yɛ adwuma ntɛmntɛm dodo a: Aduru a wonom no sɛe ntɛmntɛm dodo wɔ wo nipadua mu. Afei aduru no boaboa ano wɔ wo nipadua mu wɔ dodow a ɛdɔɔso mu. Eyi betumi ama woanom nnuru a ɛboro so wɔ dodow a ɛfata mpo so na ɛde ɔhaw ahorow a emu yɛ den aba .
- Sɛ enzyme no ntumi nyɛ adwuma koraa a: Ɛtɔ mmere bi a, esiane awosu mu nsakrae nti, nipadua no tumi gyae enzyme a yɛreka ho asɛm no yɛ. Afei ebia aduru no rennyɛ adwuma mma wo koraa.
Saa na nsakrae nketenkete mpo a ɛba yɛn awosu mu nkwaadɔm mu no betumi anya nnuru a yɛnom no so nkɛntɛnso kɛse.
Sɔhwɛ bɛn na wɔde hu awosu mu nsakrae yi?
Yɛfrɛ eyi pharmacogenomic sɔhwɛ . Eyi nso yɛ awosu mu nhwehwɛmu. Ɛhwɛ wo DNA na ɛhwehwɛ nsakrae biara a ɛba awosu mu nkwaadɔm pɔtee biako anaa nea ɛboro saa mu a ɛka sɛnea aduru bi sɛe no.
Mpɛn pii no wɔde mogya anaa anom aduru na edi dwuma wɔ nhwehwɛmu yi mu . Ɛyɛ mmerɛw yiye. Wo duruyɛfo de saa nhwɛsode yi kɔ aduruyɛdan mu. Mfiridwumayɛfo a wɔwɔ hɔ no hwehwɛ wo DNA mu hwɛ sɛ nsakrae bi aba awosu mu nkwaadɔm a ɛfa ho no mu anaa.
Wo duruyɛfo begyina w’ayaresa tebea ne nnuru ko a wɔayɛ nhyehyɛe sɛ wɔde bɛma wo so asi awosu mu nkwaadɔm a ɛsɛ sɛ wosɔ hwɛ ho gyinae.
Tebea bɛn mu na ɛho hia sɛ wɔyɛ nnuru a ɛma nipadua no yɛ adwuma no mu nhwehwɛmu?
Mprempren wɔnyɛ saa sɔhwɛ yi mma yare biara anaa nnuru biara. Nanso, ebia wo duruyɛfo bɛkamfo nhwehwɛmu yi akyerɛ bere a ɔresa tebea pɔtee bi no. Ma yɛnhwɛ nhwɛso ahorow bi. Sɛ wopɛ sɛ wote saa nsɛm yi ase yiye a, hwɛ pon a ɛwɔ ase hɔ no.
| Aduruyɛ mu tebea | Gene/enzyme a ɛfa ho | Nkɛntɛnso ne nkyerɛkyerɛmu a ɛnyɛ den |
|---|---|---|
| Cholesterol a ɛdɔɔso | SLCO1B1 awosu mu abɔde | Nnipa a wɔwɔ saa awosu mu nkwaadɔm yi mu ahorow bi betumi anya ntini mu yaw kɛse na wɔayɛ mmerɛw bere a wɔnom nnuru a wɔfrɛ no statin (e.g., Simvastatin, Atorvastatin) de brɛ srade ase no. Sɛ wohu eyi ntɛm wɔ sɔhwɛ no mu a , ebia wo duruyɛfo betumi akyerɛw wo aduru foforo. |
| Hahaahayɔ | CYP2D6 ne CYP2C19 awosu mu nkwaadɔm | Saa awosu mu nkwaadɔm mu nsakrae yi sesa sɛnea nnuru bi a ekum adwenemhaw no mu paapae wɔ nipadua no mu no. Ebinom fam no, aduru no yɛ adwuma yiye paa. Wɔ afoforo fam no, ɛde ɔhaw pii ba. Saa sɔhwɛ yi betumi aboa ma wɔapaw nnuru a etu mpɔn sen biara a enni nsunsuanso bɔne kakraa bi . |
| Kokoram ahorow | Awosu mu nkwaadɔm ahorow (sɛ nhwɛso no, HER2, TPMT, UGT1A1, DPD) . |
|
| Mogya a ɛbɛtɔ no a wobesiw ano | CYP2C19 gene ne afoforo | Ɛsɛ sɛ wɔde warfarin a ɛma mogya yɛ mmerɛw no ma nnipa a wɔwɔ awosu mu nsakrae ahorow bi no dodow a ɛba fam koraa . Afei nso, ebia aduru clopidogrel (Plavix®) no rentumi nyɛ adwuma koraa wɔ nnipa binom mu esiane nsakrae a ɛwɔ CYP2C19 enzyme no mu nti. |
| HIV a ɛma obi nya ɔyare mmoawa | HLA-B ne CYP2B6 awosu mu nkwaadɔm | Nnipa a wɔwɔ HLA-B awosu mu abɔde pɔtee bi betumi anya honam ani yare a emu yɛ den sɛ wɔma wɔn aduru Abacavir a. Enti, sɔhwɛ yi yɛ ahyɛde ansa na wɔde saa aduru yi ama. |
| Nkwammoaa a ɛko tia nyarewa ho haw ahorow | TPMT, NUDT15, CYP3A5, ne nea ɛwɔ hɔ no | Bere a wɔde akwaa foforo te sɛ asaabo foforo akyi no, sɛnea nnuru a ɛma nipadua no tumi ko tia nyarewa (e.g., Azathioprine, Tacrolimus) no yɛ adwuma yiye no gyina saa awosu mu nkwaadɔm yi so. Nsakrae a ɛba saa awosu mu nkwaadɔm yi mu nso betumi ama asiane a ɛwɔ hɔ sɛ nipadua no bɛpo akwaa a wɔde ahyɛ mu no ayɛ kɛse . |
Mfaso bɛn na ɛwɔ saa kwan yi so?
Bere a Pharmacogenomics adwuma no renya nkɔso no, yebenya so mfaso kɛse.
- Ayaresa a ahobammɔ wom: Nnuruyɛfo betumi ahu nnuru a ebetumi de ɔhaw ahorow a emu yɛ den aba anaasɛ wɔanom boro so wɔ nnipa binom mu, enti wobetumi akwati saa nnuru no na wɔama wo nnuru a ahobammɔ wom sen biara .
- Ayaresa a ɛyɛ adwuma yiye ne ɛka a wɔtew so: Fa no sɛ, ɛsɛ sɛ wosakra nnuru 3-4 ma yare bi, na awiei koraa no wunya aduru a ɛfata. Enkosi saa bere no, wo bere, wo sika, ne wo mmɔdenbɔ sɛe. Na wuhu amane kosi sɛ yare no bɛtɔ. Nanso sɛ sɔhwɛ yi tumi de aduru a edi kan a wɔde ma no asa yare no a , anka ɛno bɛyɛ kɛse dɛn?
- Nnuru a wɔde wɔn ani asi so: Nsakrae a ɛba awosu mu abɔde pɔtee bi mu na ɛde nyarewa bi ba. Enti nhwehwɛmufo betumi ayɛ nnuru foforo a ɛde wɔn ani si nsakrae a ɛba saa awosu mu abɔde mu no so tẽẽ . Eyi ho hia yiye wɔ nyarewa te sɛ kokoram a wɔsa mu.
Nanso eyi wɔ ne anohyeto...
Ɛmfa ho sɛnea saa kwan yi ye no, enni biribiara ho dwuma. Sɛ oduruyɛfo repaw aduru bi a, nsusuw awosu mu nneɛma ho kɛkɛ. Nneɛma foforo pii wɔ hɔ a ɛsɛ sɛ yesusuw ho.
Nea ɛho hia ne sɛ, w’awosu yɛ asɛm no fã bi kɛkɛ. Nneɛma foforo pii wɔ hɔ a ɛka sɛnea aduru bi yɛ adwuma.
Ɛsɛ sɛ oduruyɛfo nso dwen nneɛma afoforo te sɛ:
- Nnuru afoforo a worenom mprempren: Nnuru bi a worenom ama tebea biako ne foforo ama tebea foforo betumi aka wo nipadua wɔ ɔkwan bi so a ɛbɛma asɛe.
- Ayaresa mu tebea afoforo a wowɔ: Sɛ nhwɛso no, sɛ wowɔ mmerɛbo anaa asaabo mu haw a, ebetumi aka ɔkwan a wɔfa so yi aduru no fi nipadua no mu.
- W’asetra kwan: Nea wudi ne nea wonom, sɛ́ woteɛteɛ w’apɔw mu anaasɛ wonyɛ saa, ne nneɛma te sɛ sigaretnom ne nsanom mpo betumi aka sɛnea w’aduru no sɛe yiye.
Nea ɛka ho no, nsɛnnennen afoforo pii wɔ hɔ:
- Ɛka: Ɛwom sɛ ɛka a wɔbɔ wɔ awosu mu nhwehwɛmu ahorow yi ho no so retew nkakrankakra de, nanso ebia ɛda so ara yɛ nea ne bo yɛ den dodo sɛ nnipa binom ntumi ntua.
- Nneɛma a wontumi nkɔ hɔ: Wɔnnya nnyaa mmeae a wɔbɛyɛ sɔhwɛ ahorow yi wɔ Sri Lanka baabiara. Wobetumi anya bi wɔ mmeae kakraa bi pɛ.
Nanso, saa "Precision Medicine" adwuma yi renya nkɔso ntɛmntɛm yiye. Sɛ wowɔ nsɛmmisa bi fa eyi ho a, nsuro sɛ wo ne wo duruyɛfo bɛkasa . Bisa no sɛ mfaso bi wɔ so sɛ wobɛyɛ wo tebea no ho nhwehwɛmu a ɛte sɛɛ anaa.
Nkrasɛm a Wɔde Kɔ Fie
- Pharmacogenomics yɛ sɛnea w’awosu mu nkwaadɔm nya nnuru a wonom no so nkɛntɛnso ara kwa.
- Ɛdenam saa kwan yi so no, wo duruyɛfo betumi apaw aduru a ahobammɔ wom na etu mpɔn sen biara ama wo.
- Eyi da so ara yɛ adwuma a ɛrenya nkɔso. Mprempren wɔde sa nyarewa pɔtee kakraa bi te sɛ HIV, kokoram, ne adwenemhaw.
- Ɛnyɛ w’awosu mu nkwaadɔm nkutoo na ɛkyerɛ sɛ ebia aduru bi bɛyɛ adwuma ama wo anaa. W’asetra kwan, nnuru afoforo a wonom, ne ayaresa tebea afoforo nso di dwuma.
- Sɛ wowɔ nsɛmmisa bi fa eyi ho a, onipa a oye sen biara na ɔfata sen biara a wo ne wo bɛkasa ne wo duruyɛfo.
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