Izifundo zeSigaba sesibili Ziphakamise isisindo esiphakeme I-Estriol May ingaba nenzuzo ku-MS
Abesifazane abakhulelwe abane-multiple sclerosis banamaphesenti angama-70 anciphisa ingozi yokuphindaphinda ngesikhathi se-trimester yesithathu, futhi ochwepheshe bakholelwa ukuthi i-hormone ye-sex estriol ingadlala indima ebalulekile kulokhu kuvikelwa.
I-Estriol uhlobo lo-estrogen oluhlukile ekukhulelweni. Yenziwe yi-placenta futhi ifinyelela emazingeni aphezulu kakhulu ngesikhathi se-trimester yesithathu.
Izindaba ezithakazelisayo ukuthi ososayensi bayasondela ekusebenziseni i-estriol ukuphatha abantu abane-MS, ngethemba lokuthi lizophuza isifo sabo.
Isayensi Ngokusebenzisa i-Estriol Yokunciphisa I-MS Ibuyela emuva
Kunezifundo ezimbili zesigaba 2 eziphakamisa ukuthi i-estriol ingase iphumelele ekunciphiseni ukubuyela kwe-MS. Izifundo zesigaba sesi-2 zenziwa ukuhlola ukuphepha kwemithi nokuthi ngabe ingaba yinzuzo yini noma cha. Izifundo ze-Phase 3, ezinkulu nangaphezulu, zidinga ukuvunyelwa kwemithi yi-United States Food and Drug Administration (FDA). Ngakho konke lokhu kuyidatha kakhulu kakhulu, kepha kungakhathaliseki ukuthi kuyini okuthakazelisayo.
Esifundweni seminyaka emibili ka-2016 ku -Lancet Neurology , abesifazane abangu-164 abane-MS yokubuyisela emuva (abaneminyaka engama-18 kuya ku-50) babenomsebenzi wokuthola ama-8mg we-estriol nsuku zonke noma iphilisi ye-placebo nsuku zonke. Abahlanganyeli noma abaphenyi bokufunda babengazi ukuthi iyiphi ipilisi eyayisakazwa yimuphi owesifazane. Abahlanganyeli bathatha iphilisi ye-estriol yansuku zonke noma iphilisi ye-placebo kanye nomjovo wabo ojwayelekile wansuku zonke wama-20mg we- Copaxone (i-acatiate ye-glatiramer) -bonke ababambiqhaza babevele baqala.
Imiphumela yocwaningo yabonisa ukuthi emva kwezinyanga ezingu-12, kunciphisa okukhulu ngonyaka wokuphindaphinda kwamanani kubamba iqhaza abathatha i-Copaxone ne-estriol, uma kuqhathaniswa nalabo abathatha i-Copaxone ne-placebo. Kodwa ekupheleni kweminyaka emibili, ukwehla kwamanani okuphindaphindiwe ngonyaka phakathi kwalabo abathatha i-estriol nalabo abathatha indawo ye-placebo babalulekile kuphela (uma kunjalo).
Nakuba imiphumela yocwaningo ekuqaleni ithembise, akucaci ukuthi kungani ukunciphisa okufanayo okuphindaphindiwe kwakungabonakali emva kweminyaka emibili, njengoba kubonwe ngemuva konyaka owodwa. Ochwepheshe bakhombisa ukuthi ukuphinda isifundo ngenani elikhulu labahlanganyeli kungaba usizo.
Ngenye inothi, iqembu le-Copaxone ne-estriol lalinokuthuthukiswa okukhulu ngokukhathala kwabo, uma kuqhathaniswa neqembu leCopaxone kuphela.
Izindaba ezinhle ukuthi i-estriol yayibekezelele kahle ekutadisheni. Ngokwesibonelo, ngokuthuthukisa isifo sebele se-fibrocystic , umdlavuza webele, noma u- uterine wining (konke okukhathazayo kokuthatha uhlobo lwe-estrogen), kwakungekho umehluko omkhulu phakathi kwabesifazane abathatha u-estriol nalabo ababengenalo. Ukwahlukana okuyinhloko phakathi kwamaqembu amabili kwakungenxa yokuthi imijikelezo engavamile yokuya esikhathini yayivamile kulaba besifazane ababethatha i-estriol kunabesifazane ababengenalo. Ukutheleleka kwama-vaginal kwakungavamile kulabo besifazane ababethatha i-estriol kunabesifazane ababengenalo.
Kwesinye isifundo esincane se-2002 ku- The Annals of Neurology, abesifazane abayishumi abakhulelwe abane-MS baphathwe nge-8mg nsuku zonke ye-estriol futhi bahlolwa nge-MRIs yocansi. Imiphumela yabonisa ukwehla okuphawulekayo kwenani lezilonda ezikhulisa i-gadolinium ezinyangeni ezingu-6 ngenkathi ukwelashwa nge-estriol, uma kuqhathaniswa nezinyanga eziyisithupha ngaphambi kokuphathwa kwe-estriol.
Ngaphezu kwalokho, lapho ukwelashwa kwe-esriol yabesifazane kwavalwa izinyanga eziyisithupha, inani lezilonda zabo zokukhulisa i-gadolinium libuyele kumazinga okuqala noma amazinga okuqala. Kodwa emva kwezinyanga ezine ukuqala kabusha kwe-estriol, inombolo yabo ye-lesion iphinde incishiswe ebuchosheni be-MRI-lokhu kuhlolwa emuva nangaphezulu kugcizelela kakhulu inzuzo ye-estriol kulolu cwaningo oluncane.
Ukuqonda indima ye-Estriol ku-MS
I-Estrogen yi-hormone yezocansi ikakhulukazi eyenziwa ama-ovaries amabili wesifazane futhi inesibopho sokuthuthukisa izitho zakhe zokubeletha (isisu, isisu, ama-tubespial tubes, ama-ovaries). I-Estrogen nayo idlala indima ebalulekile ekukhuleni, ukuthuthukiswa kwebele, ukukhulelwa, kanye nethambo lezempilo.
Kunezinhlobo ezintathu ezahlukene ze-estrogen ezikhiqizwa emzimbeni:
- i-estradiol
- estrone
- i-estriol
Ngokungafani ne-estradiol ne-estrone, i-estriol iyingqayizivele ekukhulelweni futhi ibopha buthakathaka kuma-receptors e-estrogen (amasayithi wokungena) aphakathi kwamaseli emzimbeni.
Ngokuzuza i-multiple sclerosis, ososayensi bakholelwa ukuthi i-estriol inendima ebalulekile ekuvikeleni isimiso sezinzwa zomphakathi. Lokhu kuphakanyiswa yizifundo ezibonisa ukuthi i-estriol ibophezela ezimpilweni ze-estrogen ohlelweni lwe-immune, ubuchopho, nomgogodla. Eqinisweni, ukunikeza u-estriol kumagundane nge-encephalitis yokuhlola okuzenzakalelayo, noma i-EAE (imodeli yegundane ye-MS), itholakale ukuvimbela ukuvuvukala kwentambo yomgogodla nokulahleka kwe-myelin-i-myelin ibe yimbozi yokuzivikela ewonakele e-MS.
Lokhu kukhulunywa, izazi zikholelwa ukuthi i-estriol iyinhlangano engavumelani ne-anti-inflammatory-okusho ukuthi ivikela ubuchopho nentambo yomgogodla ekulahlekelweni kwe-myelin ne-neriber fiber (axon), kodwa ayivimbeli ukuvuvukala esimisweni sezinzwa zomphakathi. Yingakho kungenzeka ukuthi imithi elwa nokuvuvukala (njengenye yezinkinga zokwelashwa ezikhona manje) kuzodingeka ngokuhambisana ne-estriol yokwelapha i-MS.
Lokho Kusho Ngami?
Kubalulekile ukuqaphela ukuthi i-estriol okwamanje ayivunyelwe ukusetshenziswa e-United States, nakuba isetshenziselwa ukuphatha izimpawu ze-menopausal ezifana nokuvutha okushisayo nokumelela kwamanzi eYurophu nase-Asia.
Umlayezo wekhaya owathathayo wukuthi ngenkathi i-candidate yokwelapha yase-MS ethembisayo, isayensi ye-estriol nenendima yayo ekuvikeleni umsebenzi wesifo ku-MS ayizange ikhishwe ngokugcwele. Ucwaningo oluthe xaxa luzodinga ukuqedwa kuqala, kufaka phakathi izifundo zesigaba 3. Imithi ithatha isikhathi sokuthuthukisa, okuyinto enhle ekupheleni kwempilo nokuphepha kwakho.
Imithombo:
I-Bebo BF Jr, i-Fyfe-Johnson A, i-Adlard K, i-Beam AG, i-Vanderbark AA, i-Offer H. Ukwelapha isrogen ephansi-dosigen yenza ngcono ukuhlolwa kwe-encephalomyelitis yokuhlola okuzenzakalelayo emithonjeni emibili yemifino yangaphakathi. J Immunol. 2001 Feb 1; 166 (3): 2080-9.
I-Confavreux C, i-Hutchinson M, amahora ama-MM, i-Cortinovis-Tourniaire P, i-Moreau T. Isilinganiso sokuhlobene nokukhulelwa sibuyele ekutheni i-multiple sclerosis. Ukukhulelwa ku-Multiple Sclerosis Group. N Engl J Med 1998 Jul 30; 339 (5): 285-91.
I-Spence RD, ne-Voskuhl RR: Imiphumela ye-neuroprotective ye-estrogens kanye ne-androgens ku-CNS ukuvuvukala nokuvuselelwa kwe-neurodegeneneration. Front Neuroendocrinol 2012; 33: kk. 105-115.
Sicotte et al. Ukwelashwa kwe-multiple sclerosis nge-hormone e-estriol yokukhulelwa. Ann Neurol 2002 Oct; 52 (4): 421-8.
Voskuhl RR et al. I-Estriol ihlangene ne-glatiramer acetate kubantu besifazane abane-scellosis multiple-reting-multiple-sclerosis: i-randomised, i-placebo-elawulwayo, isigaba sesivivinyo sesi-2. I-Lancet Neurol . 2016 Jan; 15 (1): 35-46.