ʻO ke ʻano hana hou loa o ka hoʻohana ʻana i kāu mau cell ponoʻī e hakakā i ka maʻi kanesa (CAR T-cell Therapy)

Ua manaʻo paha ʻoe e hiki i ko kākou kino ke hakakā i ka maʻi kanesa ma kāna iho? ʻOiaʻiʻo, he ʻōnaehana pale akamai loa ko ko kākou kino i kapa ʻia ʻo ka ʻōnaehana pale. Loaʻa iā ia kahi ʻāpana kūikawā i kapa ʻia ʻo nā T-cells, e like me nā koa. ʻO kā lākou hana ka ʻimi a luku i nā germs haole a me nā cell mutated e komo i loko o ke kino. Akā i kekahi manawa, maalea loa nā cell cancer. Peʻe lākou mai kēia mau T cell, hoʻopunipuni iā ​​lākou a ulu i loko o ke kino. I kēlā mau manawa, e kamaʻilio mākou e pili ana i kahi lāʻau hou a kupaianaha e kōkua i kā mākou mau T cell ponoʻī e ʻike a luku i nā cell cancer ma ka hāʻawi ʻana iā lākou i "hoʻomaʻamaʻa kūikawā."

I ka ʻōlelo maʻalahi, he aha ka CAR T-cell therapy?

ʻOiai paha e kani paʻakikī ka inoa, he maʻalahi loa ke kumumanaʻo. ʻO ka CAR T-cell therapy kahi ʻano immunotherapy. Pili ia i ka lawe ʻana i kekahi o kāu mau T cell ponoʻī a hoʻololi i ka genetics iā lākou i loko o kahi keʻena hoʻokolohua.

E noʻonoʻo i kāu mau pūnaewele T e like me nā mākaʻi. Ua like nā pūnaewele maʻi kanesa me nā ʻaihue i hūnā ʻia. ʻO ka maʻamau, ʻaʻole hiki i nā mākaʻi ke ʻike i kēia mau ʻaihue. ʻO ka lāʻau lapaʻau CAR T-cell ua like ia me ka hāʻawi ʻana i kāu mau mākaʻi (nā pūnaewele T) i kahi aniani kūikawā. Ua kapa ʻia kēia aniani he 'Chimeric Antigen Receptor' (CAR) . Hana ʻia ia ma ka lab a hoʻopili ʻia i nā pūnaewele T.

I kēia manawa, ke kau ʻia kēia aniani kūikawā, hiki i nā pūnaewele T ke ʻike pololei i nā protein kikoʻī (antigens) ma luna o ka ʻili o nā pūnaewele kanesa. Ua ʻike maopopo ʻia nā pūnaewele kanesa i hūnā ʻia ma mua. ʻO nā pūnaewele T, ka mea i loaʻa i kēia mau mana nui, a laila hele pololei e hoʻouka i nā pūnaewele kanesa a luku iā lākou. He kōkua nui kēia lāʻau lapaʻau i ka ho'ōla piha ʻana i kekahi mau ʻano kanesa koko a me ke kōkua ʻana i nā poʻe ʻē aʻe e ola lōʻihi me ke kanesa.

He aha nā ʻano maʻi ʻaʻai koko e mālama ʻia e kēia lāʻau?

I kēia manawa, hoʻohana wale ʻia ka lāʻau lapaʻau CAR T-cell no kekahi mau ʻano maʻi koko i pane ʻole i nā lāʻau ʻē aʻe (e like me ka chemotherapy) a i ʻole i hoʻi mai ma hope o ka lāʻau. ʻOiai he lāʻau hou loa ia, ʻaʻole ia e hāʻawi ʻia i nā maʻi kanesa āpau.

Hōʻike ka papa ma lalo nei i nā ʻano maʻi kanesa i ʻāpono ʻia ai kēia lāʻau.

Pehea e hana ʻia ai kēia kaʻina hana lapaʻau?

Hana ʻia kēia kaʻina holoʻokoʻa ma kekahi mau ʻanuʻu. Ua like ia me ke aʻo ʻana i nā koa no ke kaua a laila hoʻouna hou iā lākou i ke kahua kaua.

KaʻAnuʻu Hana 1: Ke hōʻiliʻili ʻana i kāu mau pūnaewele T

ʻO ka mea mua, pono kou kino e hōʻiliʻili i nā hunaola koko keʻokeʻo, ʻoiai nā hunaola T. Hana ʻia kēia ma o ke kaʻina hana i kapa ʻia ʻo leukapheresis . Pili kēia i ka hoʻouna ʻana i kou koko ma o kahi mīkini, kahi e hoʻokaʻawale ai i nā hunaola koko keʻokeʻo wale nō, a hoʻihoʻi i ke koena o ke koko i kou kino. Ua like kēia me ka hāʻawi ʻana i ke koko, akā lawe wale ʻia kahi hapa o ke koko a hoʻihoʻi ʻia ke koena.

2. KaʻAnuʻu Hana: E hoʻouna i nā pūnaewele T i ka lab a hoʻololi iā lākou

ʻO ka mea aʻe, hoʻouna ʻia nā pūnaewele T i lawe ʻia mai ou aku i kahi keʻena hoʻokolohua kūikawā. Ma laila, hoʻohana nā kānaka ʻepekema i ka ʻenekinia genetic e hoʻokomo i ka CAR (Chimeric Antigen Receptor) a mākou i kamaʻilio ai ma mua i loko o nā pūnaewele T. A laila, hoʻoulu ʻia kēia mau pūnaewele CAR T hou i mana nui ʻia i loko o ka keʻena hoʻokolohua a hiki i ka loaʻa ʻana o nā miliona o lākou. He ʻekolu a ʻeono pule kēia hana.He lōʻihi paha ka manawa.

3. KaʻAnuʻu Hana: Ke hoʻomākaukau ʻana i kou kino

A hiki i ka wā e hoʻomohala ʻia ai nā CAR T-cell i loko o ka lab, hiki i kāu kauka ke hāʻawi iā ʻoe i nā lāʻau lapaʻau ʻē aʻe (bridging therapy), e like me ka chemotherapy, e kāohi i kāu maʻi kanesa.

A laila, i kekahi mau lā ma mua o ka hāʻawi ʻia ʻana o nā CAR T-cell hou i hana ʻia iā ʻoe, e hāʻawi ʻia ʻoe i kahi chemotherapy haʻahaʻa. Ua kapa ʻia ʻo ia he lymphodepleting chemotherapy . Hana kēia ma ka hoʻopau ʻana i nā cell immune o kou kino, e hana ana i kahi ʻano maikaʻi aʻe no nā CAR T-cell hou, super e hana.

4. KaʻAnuʻu Hana: Hoʻihoʻi i nā pūnaewele T nui i ke kino

ʻO kēia ka hanana nui. E like me ka hāʻawi ʻana i kahi hopena saline, ua hoʻokomo ʻia nā CAR T-cells i hana hou ʻia i loko o kou kino ma o kahi vein (laina intravenous - IV). He 5 a 30 mau minuke kēia. Ke komo kēia mau cells i loko o ke kino, hoʻomaka lākou e hoʻonui iā lākou iho, e ʻimi ana a luku i nā cell cancer. Ma muli o ka noho ʻana o kēia mau cell i loko o ke kino no ka manawa lōʻihi a hakakā i ka maʻi kanesa, kapa kekahi i kēia lāʻau lapaʻau he "lāʻau ola."

He aha ka mea e hana ʻia ma hope o ka mālama ʻana? He aha nā pilikia?

No ka mea he lāʻau lapaʻau ikaika loa kēia, i kekahi manawa hiki ke loaʻa nā hopena ʻaoʻao koʻikoʻi. No laila, pono ʻoe e noho ma ka haukapila no hoʻokahi pule a ʻumi lā ma hope o ka lāʻau lapaʻau. E nānā pono nā kauka a me nā kahu maʻi iā ʻoe.

Nā hopena ʻaoʻao nui

ʻElua mau hopena nui a maʻamau o kēia lāʻau lapaʻau. ʻOiai hiki ke hoʻoweliweli kēia mau mea, ua lako pono nā hui lapaʻau e mālama iā lākou.

Pehea ka holomua o kēia lāʻau lapaʻau?

Ua lawe mai ka lāʻau lapaʻau CAR T-cell i ka manaʻolana hou i nā poʻe he nui e hakakā nei i nā maʻi ʻaʻai koko, ʻoiai ka poʻe i pane ʻole i nā lāʻau ʻē aʻe.

• Eia kekahi laʻana, ʻoi aku ma mua o 85% o nā keiki i loaʻa i kēia lāʻau no ka leukemia lymphoblastic acute (ALL) o nā keiki i hoʻōla piha ʻia ko lākou maʻi kanesa ma hope o ka lāʻau lapaʻau. A, 60% o lākou i noho ʻole i ka maʻi kanesa i hoʻokahi makahiki ma hope o ka lāʻau lapaʻau.

Ke holomua nei kēia ʻenehana. Ke hoʻāʻo mau nei nā kānaka noiʻi a puni ka honua e hoʻomaikaʻi i kēia lāʻau lapaʻau, hōʻemi i nā hopena ʻaoʻao, a ʻike inā hiki ke hoʻohana ʻia no nā ʻano maʻi ʻē aʻe.

Āhea ʻoe e ʻike ai i ke kauka?

ʻO nā hopena ʻaoʻao o kēia lāʻau lapaʻau, ʻoiai ʻo Cytokine Release Syndrome a me nā pilikia neurological, hiki ke hoʻoweliweli i ke ola . No laila, ma mua o kou haʻalele ʻana i ka haukapila, e nīnau i kāu kauka i nā hōʻailona āu e makaʻala pono ai.

Inā hoʻomau nā hōʻailona e like me ke kuni, ke anu, ka ʻeha poʻo, a me ka luaʻi, he hōʻailona paha ia o kahi maʻi koʻikoʻi. Inā pēlā, e kelepona koke i kāu kauka a i ʻole e hele i ka Emergency Department (ETU) o ka haukapila.

Inā loaʻa iā ʻoe a i ʻole kekahi āu i ʻike ai he maʻi ʻaʻai koko, e kamaʻilio me kāu kauka e pili ana inā kūpono ka lāʻau lapaʻau CAR T-cell iā ʻoe. ʻOiai ʻaʻole no nā kānaka āpau kēia lāʻau lapaʻau, hiki iā ia ke lilo i mea hoʻololi ola no ke kanaka kūpono.