Ngaba Sondele Kuphi Ufo lwesifo sikashukela?
Labo abanesifo sikashukela se-type 1 (i-diabetes mellitus) abavelisi nayiphi insulini-iiseli ze-beta ezivelisa i-insulin (i-β-cells) kwiipancreas zazo azisebenzi kakuhle ngenxa yezizathu ezingekho ipesenti eziyi-100 ezicacileyo. Njengendlela yokulawula amanqanaba eshukela egazi, zithembela kwi-insulin eyenziwe ngabantu, ukufaka i-insulin rhoqo ngeentsuku zonke okanye ukufaka ipompo ye-insulin, ukubalwa kwe-carbohydrate , kwaye rhoqo ukuvavanya ishukela legazi .
Nangona kunjalo, izazinzulu zihlola ukudala iislet zeeseti zesistim (iiselin-cell cells) ukusuka kwiiseli ezinama-stem, ngenjongo yokutshintshela ezi seteli ukunceda abo abanesifo sikashukela bashenxise i-insulin. Ukutshintshwa kweeseli ezitshintshiweyo ezivela kwiiseli ezinamaqonga yindawo yophuhliso yophando kwaye okwamanje isetyenziswe kwizifundo zezilwanyana. Nangona kunjalo, ngokweZiko leSizwe lezeMpilo, kukho ezinye iindidi zeendlela ezisetyenzisiweyo ezisetyenziselwa ukutshintshwa kwezityalo ezisetyenziselwa abantu abakhethiweyo abanesifo sikashukela.
Yintoni i-Islet Transplantation Cell?
I-Pancreatic islet cell transplant, eyaziwa ngokuba yi-beta cell transplant, yinkqubo apho iiseli ze-beta, ezivela kubanikeli bomntu okanye iiseli ezidalwe kubhobhu, zifakelwa kumntu onesifo seswekile. Ithemba kukuba i-secrecy insulin kunye nokuncedisa ukulawula i-blood glucose, njengokuba iiseli ze-beta zisebenza ngokuqhelekileyo.
Kuza kube namhlanje, izigulane ezitshintshiweyo kunye neeseti zesibonelelo somntu oshonile zingenziwa i-insulin ezizimeleyo iminyaka emininzi.
Nangona kunjalo, esi sicwangciso sincitshiswa ngenxa yobunqongophala kunye nomgangatho we-islet islet. Ukongezelela, kubalulekile ukuba uqaphele ukuba ukufakelwa kweseli yinkqubo yokulinga kwaye iya kubhalwe phantsi kwangoko ubude bubuchwepheshe bubekwe ngempumelelo ngokwaneleyo ukuba lubekwe uphawu lwezonyango.
Okwangoku, iindidi ezimbini zokufakelwa kwezityalo zikhona.
Allo-Utshintsho
Olu hlobo lokutshintshwa kwezinto luquka ukuthatha iisel cell ukusuka kumnikeli oshonile kwaye uzihlambulule. Emva kokuhlanjululwa, iiseli zicutshungulwa kwaye zidluliselwa kummkeli.
Olu hlobo lokufakelwa kwesityalo luye lusetyenziswa kwezinye izigulane ezine-diabetes ye-type 1 apho i-sugar sugar iyanzima ukuyilawula. Ngokufanelekileyo, ukufakelwa kwegazi kwakuza kubangela amazinga aqhelekileyo egazi ngegazi ngaphandle kokusetyenziswa kwe-insulin injections okanye i-infusions, okanye ubuncinci kunokunciphisa inani le-insulin efunekayo. Enye injongo kukunciphisa u- hypoglycemia ukungazi- imeko eyingozi apho abantu abanakukwazi ukufumana isiphumo segazi eliphantsi.
Izigulana zokutshintshwa zifumana izibilini ezimbini eziphakathi kwama-400,000 ukuya kuma-500,000 iislet nganye. Emva kokufakwa, iiseli ze-beta kulezi ziqithi ziqala ukwenza kunye nokukhulula i-insulin.
Xa ufumana iiseli zokutshintshwa, kufuneka ube neziyobisi ezikhuselekileyo zokukhusela ukulahlwa. Oku kunokunyanzelisa isifo sikashukela kuba ngaphezu kwexesha ezi ntlobo zamachiza, ezifana ne-corticosteroids, zinokunyusa ukukhushulwa kwe-insulin, okubangele ukunyuka kwe-ushukela wegazi. Ezinye iintlobo zeziyobisi ezinokuzikhusela zinganciphisa i-cell cell ye-beta ukukhulula i-insulin.
Kwaye ekugqibeleni, ezi ntlobo zamachiza zinciphisa umzimba wokuzivikela, onokunyusa umngcipheko wokusuleleka. Ngenxa yoko, kucacile ukuba le nkqubo ayifani ngaphandle kwemingcele kunye nokungaqiniseki.
I-Allo-transplants ayiqhutyelwa kuzo zonke izibhedlele-izibhedlele kufuneka zibe nemvume kwi-United States Yokutya kunye noLawulo lweeDrug (FDA) malunga nophando lwezonyango kwi-islet transplantation. Ugqirha ogxile kwi-imaging yezokwelapha, i-radiologist, ngokuqhelekileyo ngulowo owenza iziqu. Usebenzisa i-x-ray kunye ne-imaging ultrasound ukukhokela ukufakwa kwecatheter (ithambo elincinci, iplastiki) ngokuchithwa okuncinane kwisisu esisentla ukuya kwi-veal vein (isiswini esikhulu esinika igazi kwisibindi).
Xa i-catheter ifakwe kwisithuba esifanelekileyo iiseli zeetlet ziyacinywa ngokukhawuleza. Ngokuqhelekileyo, izigulane zinikezwa i-anethesia yendawo kunye nokukhusela ngexesha le nkqubo.
Abaphandi bakholelwa ukuba izigulane zifuna malunga ne-350 ukuya ku-750 yezigidi zeeseli ukuyeka ukusebenzisa i-insulin ngokupheleleyo. Ngenxa yoko, ezininzi izigulana zidinga ukutshintshwa kwezinto ezininzi.
Ukutshintshwa ngokuzenzekelayo
Olu hlobo lokutshintshwa kwentshukumo lwenziwa emva kokususwa ngokupheleleyo kwepascreas (i-pancreatectomy) kwizigulane ezineenkathazo ezinzima kwaye ezingapheliyo ezingenakulawulwa ngamanye unyango. Injongo kukuba kugcinwe ukuveliswa kwe-insulin kunye nokugcinwa kwemfihlo ngenxa yokuba ukususwa kwee-pancreas kunokukhokelela umntu ukuba ahlakulele isifo sikashukela.
Izigulane ezine-type 1 zesifo sikashukela asikwazi ukufumana olu hlobo lokutshintshwa kwegazi.
Iinkonzo
Xa kuthelekiswa nequmrhu elipheleleyo lokutshintshwa, islet cell allo-transplants ayinakuncipha kakhulu. Ukuphumelela kwe-allo-transplantation kuyakuphucula ukulawula i-glucose yegazi kunye nokunciphisa okanye ukunciphisa ukusetshenziswa kwe-insulin ixesha elide. Oku kuya kuthetha ukuba izigulane aziyi ku funeka zijobe i-insulin okanye zifake i-insulin ngeepom ezininzi ngamaxesha. Ulungelo olungcono lwezeshukela egazini lunokunciphisa okanye luthintele umngcipheko wesifo sikashukela esinjengesifo senhliziyo, ukuphazamiseka kwentsholongwane yesifo sikashukela (umonakalo weentlanzi), kunye ne-retinopathy (umonakalo wamehlo).
Ukongezelela, kunye ne-allo-transplantation, emva kokufakelwa kokutshintshwa kunokunciphisa u-hypoglycemia ukungazi, ukunceda izigulane zivale iimpawu ezinjenge-sweating, shaking, ukwanda kwentliziyo, ukuxhalaba, okanye ukulamba ngokufanelekileyo.
Mngcipheko
Inkqubo yokutshintshwa inganyusa umngcipheko wokulapha kunye negazi. Kukho nethuba lokuba iiseli ezitshintshiweyo zingasebenzi kakuhle okanye nonke. Ukongeza, zonke iiseli zingasebenzi ngokukhawuleza kwaye zingathatha ixesha ukuqala ukusebenza ngokufanelekileyo. Ngoko ke, abafumanayo bangadinga ukuthatha i-insulin de iiseli ziqale ukusebenza ngokufanelekileyo.
Kukho umngcipheko wokuthi impendulo engenziwanga ngokuzenzekelayo eyaqala ukutshabalalisa iiseli zomthonyama zomntu ingabangela kwakhona, okubangele ukuhlaselwa kwiiseli ezintsha. Abaphandi okwangoku bazama ukuphanda ukuba ukusebenzisa ezinye iindawo zomzimba ukutshintshwa kunokukhusela oku kungenzeki.
Ukuze ukhusele ukulahlwa kweeseli, kufuneka uthathe imishanguzo ye-immunosuppressive eyanciphisa isistim somzimba. Ezi zi yobisi zinganokwandisa ushukela wegazi. Amachiza omzimba angenayo imfuneko xa kuthengiswa ngokuzenzekelayo ngenxa yokuba amangqamuzana afakwe kwi-body body.
Imida
Enye imbambano enkulu kukuba kukho ukunqongophala kweeseli zamaseli ezivela kubaxhasi-amaninzi amaninzi awanalo ngokwaneleyo iiseli ezempilo ukutshintshela kwaye akukho nabanikeli abaneleyo.
Njengoko unokucinga, lolu hlobo lwenkqubo luyindleko. Nangona izigulane zingasindisa imali kwi-insulin, iindleko zenkqubo, ukuqeshwa, kunye neyeza zokuzikhusela ngokuzikhusela zidala izithintelo zemali ezithintela ukusetyenziswa okubanzi kwisitrat allo-transplantation.
Ixesha elizayo
Iingcali zenzululwazi ziyasebenza kanzima ukuya kutshintshela i-cell cell. Kukho uphando olwenzela ikhono lokwenza iiseli zomntu ze-beta kwii-stem zelibhu ebhodini. Kukholelwa ukuba ezi iiseli ziza kuvelisa inani elincinci leeseletthi ezisebenzayo. Kwaye nangona kukho ukuphucula amaninzi, umsebenzi omningi kufuneka uyenziwe kule ndawo ngaphambi kokuba utshintsho lube yindlela yokwelapha. Ukufezekisa le ndlela kungasenza sisinye isinyathelo sisondele ekuphiliseni isifo sikashukela.
ILizwi
Islet transplantation ye-Islet, ngokukodwa i-allo-transplantation, isetyenziselwa ngokukhetha abantu abaninzi abanesifo sikashukela esine-1 abanenkinga enzima kakhulu yokulawula iishukela zabo zegazi okanye abanomdla obunzima bokungazi kakuhle kwe-hypoglycemia. Ukutshintshwa kwenziwa kuphela kwizibhedlele zophando lwezonyango eziye zavunywa yi-FDA.
Izifundo zezilwanyana ziye zacetyiswa ukuba iiseli ze-beta ezidalwe kwiiseli ezinama-stem kwaye zisetyenziselwa ukutshintshwa zivelisa i-insulin ngokukhawuleza. Le ndlela yokuvelisa iseli ye-beta inokubonelela ngemithombo yesetyenzisileyo ethembekileyo kwaye inokuba yindleko enokuqhathaniswa neziqithiso zabantu. Akunakwenzeka kuphela oku kwandisa inani leendlela zokutshintshwa kweseli, kodwa kunokwandisa nokufumaneka kweeseli ze-beta zabantu kwiinjongo zophando.
Ukusebenzisa ii-cell stem kunokunceda izigidi zabantu, kodwa izazinzulu zinomsebenzi omningi ukuzenza ngaphambi kokufezekisa le ndlela.
> Imithombo:
> Isizwe seSizwe seSifo sikashukela kunye neGestive and Kidney Disease. Isitishi sePancreatic Transplantation.
> Pagliuca FW, et. al. Isizukulwana seseli ze-β ze-pancreatic cell in vitro. Cell. 2014 Okthoba 9; 159 (2): 428-39. i-doi: 10.1016 / j.cell.2014.09.040.
> IReporter Islet yokuThengisa iRepistry ingxelo ye sixhenxe yonyaka. IRejista yokuThengisa iIslet yokuBambisana. https://web.emmes.com/study/isl//reports/01062012_7thAnnualReport.pdf
> I-American Diabetes Association. Idatha yeNkcazo kunye neenkcukacha ngeSifo sikashukela .
> JDRF. Indlela entsha kwiiseli zeBeta.