Maris 2022: Hanyar juyin juya hali zuwa CAR-T Kwayar salula yana da yuwuwar juyar da abin da ya zama axiom na likita: cewa gagarumin tasirin maganin akan ciwace-ciwacen daji yana zuwa ne ta hanyar kashe manyan haɗari ga lafiyar haƙuri.
Marasa lafiya da aka yi musu magani da ɗan gyare-gyaren sigar CAR-T da aka amince da su sun sami fa'ida kwatankwacin karatun da suka gabata, amma ba tare da mummunan tasirin da wani lokaci ke aika marasa lafiya zuwa asibiti kuma suna buƙatar ƙarin jiyya masu tsada.
Dangane da bayanan da aka fitar kwanan nan, gwajin ya yi rajistar mutane 25 kawai a China. Masana sun yi imanin cewa idan za a iya kwafin binciken, ɗan ƙaramin tinkering na iya sa CAR-T ya zama mafi aminci kuma mafi sauƙi.
Jill O'Donnell-Tormey, Shugaba na Cibiyar Nazarin Ciwon daji, wata ƙungiya mai zaman kanta ta ce "Wannan yana da alama yana da alƙawarin gaske." "Tabbas, an fara wasan ne, amma martanin da suka samu daga mutane 25 da suka gani zuwa yanzu abin ban mamaki ne."
Ana yin maganin CAR-T ta hanyar ɗaukar ƙwayoyin garkuwar jiki na majiyyaci, ta hanyar canza su ta hanyar ƙwayoyin cuta don cutar da ciwace-ciwacen daji, sannan a yi musu allura da abubuwan da ke ƙarfafa garkuwar jiki don shiga cikin yaƙin. Masana kimiyya sun mayar da hankali kan mataki na ƙarshe a cikin hanya don ƙirƙirar magani mafi aminci.
Sun fara da Novartis' Kymriah, wanda aka amince da shi don magance cututtukan jini iri biyu, sa'an nan kuma suka ƙirƙiri nasu analogues, kowannensu da aka dinka tare da jerin amino acid daban-daban. Sun lura da wani abu mai ban sha'awa lokacin da suka gwada waɗannan maye gurbi a cikin mice: Ɗaya daga cikin gyare-gyaren CAR-Ts ya iya kashe kwayoyin cutar kansa ba tare da haifar da amsawar zazzaɓi ba ko haifar da kumburin kwakwalwa, wanda shine biyu daga cikin manyan abubuwan da suka fi dacewa da maganin tantanin halitta.
It also passed human testing. The altered Kymriah caused no major cases of cytokine release syndrome, an immune flareup frequent in CAR-T cells, and no neurotoxicity, according to the study published in Nature Medicine. In Novartis’ published research, however, more than half of the patients had cytokine release, and around a quarter had neurological issues.
Dokta Si-Yi Chen, farfesa a fannin rigakafi a Jami'ar Kudancin California kuma marubucin farko na jaridar, ya ce, "Wannan babban abin mamaki ne a gare mu." Abokan aikin Chen suma sun cika da mamaki.
CAR-T da aka gyara ya duba ya sami wuri mai daɗi na rigakafi, yana jawo isassun cytokines don yin tasiri akan cutar kansa ba tare da haifar da ɓarna ba. Sai dai ba a san dalilin hakan ba. Yana yiwuwa CAR-Ts masu lasisi kamar Kymriah da Kimiyyar Gileyad Yescarta suna da ƙarfi sosai, kuma ƙaramin jiyya na iya samun sakamako iri ɗaya tare da ƙarancin haɗari. Hakanan yana iya zama al'amari na dama.
Dr. Loretta Nastoupil, chief of the linzoma department at MD Anderson Cancer Center in Houston, said, “I would look at this with a bit of caution, or cautious hope.” “Understanding the processes behind its efficacy will be crucial.
Akwai kuma batun yin aiki na dogon lokaci, wanda ya wuce tushen kimiyya. CAR-T da aka amince da su akai-akai suna haifar da remission na dogon lokaci. Dokta Michel Sadelain, masanin rigakafi a Cibiyar Ciwon daji ta Memorial Sloan Kettering, ya ce dabarar Chen ta zama mafi aminci a cikin gajeren lokaci, amma dole ne a ga ko tasirin zai dore.
"Matsalar ita ce idan kun raunana CAR, hakan yana da ban tsoro idan kun rage samar da cytokine, amma kuna iya rage tasirin warkewa?" Sadelain ya bayyana. “A nan ne babbar alamar tambaya take. "Lokaci ne kawai zai nuna," in ji mai ba da labarin.
Baya ga waɗannan abubuwan da ke damun, tsammanin CAR-T mafi aminci na iya faɗaɗa damar samun magani wanda a halin yanzu kawai ake samu a manyan cibiyoyin ciwon daji. Illolin maganin sau da yawa suna buƙatar kulawar ƙwararru da ƙwarewar da ba za a iya isa ga asibitocin al'umma ba, wanda ke iyakance adadin marasa lafiya da za a iya yi musu magani.
Sai kuma farashin. Farashin magani na CAR-T ya haura dala 370,000 a kowacce jiyya, ko da yake hakan bai hada da kudin asibiti ko magungunan hana rigakafi ba. A cewar Avery Posey, an immunotherapy mai bincike a Jami'ar Pennsylvania, farashin ƙarshe a cikin mafi tsanani lokuta akai-akai kusan $1 miliyan.
"Abin da mazauna Penn ke kira 'CAR-Tastrophy," in ji Posey game da haɗuwa da illa na rigakafi da kuma neurotoxicity.
