Izifundo zeSigaba sesi-2 Siphakamise isisindo esiphakamileyo i-Estriol Meyi inokuzuza kwi-MS
Abafazi abakhulelweyo abane-multiple sclerosis bane-70% eyanciphisa umngcipheko wokuba baphinde baphinde baphinde babuyele kwisithathu se-trimester, kunye neengcali zikholelwa ukuba i-hormone yesterol isetyol inokudlala indima ebalulekileyo kule khuselo.
U-Estriol luhlobo lwe-estrogen ekhethekileyo ukukhulelwa. Yenziwe yi-placenta kwaye ifinyelela kumanqanaba akhe aphezulu ngelixa lesithathu lesithathu.
Iindaba ezivuyisayo kukuba izazinzulu zikhangele ngakumbi ekusebenziseni i-estriol ukuphatha abantu abane-MS, ngeentembelo eziza kuthoba isifo sabo.
Inzululwazi emva kokusebenzisa i-Estriol ukunciphisa i-MS kwakhona
Kukho izifundo ezimbini zesigaba 2 ezibonisa ukuba i-estriol inokusebenza ekunciphiseni ukubuyela kwe-MS. Izifundo zeSigaba sesi-2 zenziwe ukuvavanya ukhuseleko lwamayeza kwaye nokuba ingaba luncedo. Izifundo zeSigaba sesi-3, ezikhulu kunye nexesha elide, zifuneka ukuba kuvunywe ngamachiza yi-United States Yokutya kunye neDrug Administration (FDA). Ngoko ke yonke into iyimfuneko yamandulo, kodwa kodwa iyanceda.
Kwiminyaka emibili ye-2016 isifundo kwi -Lancet Neurology , abafazi abangama-164 abane-MS yokubuyisela kwakhona (abaneminyaka engama-18 ukuya ku-50) babenomsebenzi wokufumana i-8mg ye-estriol imihla ngemihla okanye ipilisi ye-placebo yonke imihla. Abathathi-nxaxheba okanye abaphandi besafunda babesaziphi iipilisi ezazisasazwa kuyo. Abathathi-nxaxheba bathabatha ipilisi yosuku lwe-estriol okanye ipilisi ye-placebo kunye nejoqo yabo yemihla ngemihla eyi-20mg ye- Copaxone (i-acetate ye-glatiramer) -bonke abathathi-nxaxheba babesanda kuqalisa.
Iziphumo zolu phando zibonise ukuba emva kweenyanga ezili-12, kukho ukuhla kwehla kwimivuzo yokuphindaphinda ngonyaka kubathathi-nxaxheba abathatha iCopaxone kunye ne-estriol, xa kuthelekiswa nalabo bathatha iCopaxone kunye ne-placebo. Kodwa ekupheleni kweminyaka emibini, ukwehla kwimivuzo yokuphindaphinda ngonyaka phakathi kwabo bathatha i-estriol kwaye abo bathatha indawo ye-placebo babaluleke kakhulu (ukuba kukho konke).
Nangona iziphumo zezifundo ziqale ukuthembisa, akucaci ukuba kutheni ukunciphisa ukuphindaphindwa okufanayo kwakungekho kubonwa emva kweminyaka emibini, njengoko kwabonakala emva konyaka omnye. Iingcali zithi ukuphinda isifundo kunye nenani elikhulu labathathi-nxaxheba liya kuba luncedo.
Kwenye inqaku, iqela leCopaxone kunye ne-estriol lalinokuphucuka okukhulu kunye nokukhathala kwabo, xa kuthelekiswa neqela leCopaxone kuphela.
Iindaba ezilungileyo kukuba i-estriol yayinyamezeleke ekufundeni. Ngokomzekelo, ngokuphuhlisa isifo se-fibrocystic, isifo somhlaza wesifuba, okanye i- uterine yambini (zonke iinkxalabo zokuthatha uhlobo lwe-estrogen), kwakungekho nantlukwano enkulu phakathi kwabasetyhini abathatha u-estriol kunye nabangenalo. Ulwahlulo olulodwa kuphela phakathi kwamaqela amabini kukuba ukuhamba kwexesha elingavumelekanga kokuya esikhathini kwakuqhelekileyo kubasetyhini abathatha u-estriol kunabesifazana abangenalo. Ukusuleleka kwintsholongwane engama-vaginal yayingavamile kakhulu kwabesetyhini ababethatha i-estriol kunabesifazana abangenalo.
Kwisifundo esincinane se-2002 kwi -Annals ye-Neurology, abafazi abalishumi abangabathwali abane-MS baphathwe nge-8mg yemihla ngemihla ye-estriol kwaye bafumana i-MRIs yengqondo ngenyanga. Iziphumo zityhila ukuhla kwehle kakhulu kwinani lezilonda-gadolinium eziphuculayo kwiinyanga ezintandathu ngexesha lotyando nge-estriol, xa kuthelekiswa neenyanga ezi-6 ngaphambi kokuphathwa kwe-estriol.
Ukongezelela, xa unyango lwe-esriol lwabesetyhini lugqitywa iinyanga ezintandathu, inani lezilonda zaso-gadolinium-enhancing libuyele kumanyathelo okuxhatshazwa okanye amanqanaba esiseko. Kodwa emva kweenyanga ezine zokuqalisa i-estriol, inamba yabo yesilonda iphinde iyancitshiswe kwingqondo ye-MRI-ngoku ukuvavanya nokuvavanya kugxininisa inzuzo ye-estriol kule sifundo esincinci.
Ukuqonda umsebenzi we-Estriol kwi-MS
I-Estrogen yi-hormone yesini esakhiwa yi-ovaries yamabhinqa kwaye ixanduva lokuphuhlisa izitho zakhe zokuzala (isisu, isondo, i-fallopian tubes, ovaries). I-Estrogen idlala indima ebalulekileyo kwimihla, ukukhulelwa kwebele, ukukhulelwa, kunye nempilo yethambo.
Kukho iintlobo ezahlukeneyo ze-estrogen eziveliswa emzimbeni:
- estradiol
- estrone
- i-estriol
Ngokungafani ne-estradiol kunye ne-estrone, i-estriol iyingqayizivele yokukhulelwa kwaye ibophelela ngokusweleka kwi-estrogen receptors (izingosi zokungena) eziphakathi kwamaseli emzimbeni.
Ngokuxhamla i-multiple sclerosis, izazinzulu zikholelwa ukuba i-estriol inendima ebalulekileyo ekukhuseleni inkqubo ye-nervous central. Oku kuphakanyiswa zizifundo ezibonisa ukubopha i-estriol kwi-estrogen receptors kwisistim somzimba, ubuchopho kunye nentambo yomthambo. Enyanisweni, ukunika i-estriol kwiigundane kunye ne-experimental encephalitis, okanye i-EAE (imodeli yemouse ye-MS), yafunyanwa ekuthintela umthambo wokugqithisa kunye nokulahleka kwe-myelin-i-myelin ibe yintambo ekhuselekileyo eyenziwa kwi-MS.
Oko kuthethwa, iingcali zikholelwa ukuba i-estriol ingaphezulu kwe-neuroprotective kwaye ingaphantsi kwe-anti-inflammatory-ithetha ukuba ikhusela ingqondo kunye nomgudu womgogodla kwi-myelin kunye ne-nerve fiber (axon) ukulahleka, kodwa ayikuthinteli ukuvuvukala kwinkqubo yesantya ephakathi. Yingakho kusenokwenzeka ukuba imishanguzo echasayo (njengenye yezinto ezikhoyo zonyango-ngokuguqulwa kwesifo) kuya kufuneka idibene kunye ne-estriol yokunyanga i-MS.
Lithetha ntoni Oku?
Kubalulekile ukuba uqaphele ukuba i-estriol ayiyikuvunyelwa okwamanje kwi-United States, nangona isetyenziselwa ukunyanga iimpawu ze-menopausal ezifana nokutshisa okutshisayo kunye nokomama wesisu eYurophu nase-Asia.
Ukuthatha umyalezo wekhaya apha kukuba ngelixa umviwa othembisayo wonyango lwe-MS, isayensi emva kwe-estriol kunye nendima yayo ekukhuseleni umsebenzi wesifo kwi-MS akayekanga. Uphando olungakumbi kufuneka luzaliswe kuqala, kubandakanywa nezifundo zesigaba se-3. Iipilisi zithatha ixesha lokuphuhlisa, into efanelekileyo ekupheleni kwempilo kunye nokhuseleko.
Imithombo:
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I-Confavreux C, i-Hutchinson M, ii-Hours MM, i-Cortinovis-Tourniaire P, i-Moreau T. Ireyithi yokuxilwa kwe-pregnancy ephindaphinda kwi-sclerosis. Ukukhulelwa kwiqela le-Multiple Sclerosis. N Engl J Med 1998 Julayi 30; 339 (5): 285-91.
Spence RD, kunye neVoskuhl RR: Impembelelo ye-neuroprotective ye-estrogens kunye ne-androgens kwi-CNS ukuvuvukala kunye ne-neurodegeneneration. Front Neuroendocrinol 2012; 33: iphe. 105-115.
Sicotte et al. Unyango lwe-multiple sclerosis nge-hormone estriol yokukhulelwa. Ann Neurol 2002 Oct; 52 (4): 421-8.
Voskuhl RR et al. I-Estriol idibene ne-glatiramer acetate kubafazi ngokuphindaphinda-ukubuyisela i-sclerosis ezininzi: i-random, i-placebo-elawulwayo, isigaba sesi-2 sesilingo. Lancet Neurol . 2016 Jan; 15 (1): 35-46.