I-ZMapp, i-Favipiravir, i-Anti-virus, futhi ngethemba lokuthi ngaphezulu
Impendulo elula: asazi, kodwa sinethemba.
Ngaphambi kokuba i-Ebola isakaze eNtshonalanga Afrika ngo-2013 kuya ku-2015, akukho ukwelashwa okuye kwahlolwa ngempumelelo kubantu. Lapho lesi sifo siphume, imithi yokwelashwa yayivame ukunikezwa ukuze kube nesihawu. Iziguli zithole ukwelashwa futhi zithuthukisiwe. Kodwa-ke, inani leziguli liye lincane, izindlela zokwelashwa eziningi ngezinye izikhathi ezisetshenzisiwe, futhi ngezizathu zokuziphatha azikho iziqhathaniso ezilawulwa yi-placebo.
Ukwelashwa kweziguli ezihlotshaniswa nokuthuthukiswa kufaka phakathi: i-ZMapp, i-favipiravir, kanye negazi kwabasindile. Ucwaningo olulodwa lwe-TKM-Ebola aluhlulekile ukubonisa noma yikuphi ukuzuzisa. Kodwa-ke, ngaphambi kokuba izinto zokuqala ziphelelwe yisikhathi, okungenani abantu abangu-10 bathole i-ZMapp e-US, eLiberia, eSpain nase-UK. Kuphela ku-2 kwafa. Okungenani oyedwa uthole i-favipiravr (eFrance) ne-TKM (e-US) futhi yasinda. Iziguli kamuva zaqala u-Brincindofovir- eyodwa yafa. Kusukela kulokhu, kunzima ukutshela ezinye zezidakamizwa ngaphandle kokulingwa kwangempela okungahleliwe, kungakhathaliseki ukuthi izidakamizwa noma ukunakekelwa okuhle okusekelayo, kwenza umehluko.
Noma kunjalo, sinethemba. Inani lokufa kwe-Ebola (EBOV, iZaire) elisakazeka eNtshonalanga Afrika liphezulu kakhulu. Ekucaleni kwakucatshangwa ukuthi iphezulu kunama-80-90% (njengoba kuboniswe ezinsizeni zangaphambili kwenye indawo). Kubonakala sengathi i-45-60% eNtshonalanga Afrika. Ukunakekelwa okuhle okusekela kunganciphisa ukufa ku-1 ku-3.
Kubuye kunzima ukuqhathanisa amanani okuphila njengoba kuhlale kuphuza ekufuneni ukunakekelwa noma kudluliselwa ukunakekelwa.
Inkinga yilezi: amasheya we-ZMapp aphelile.
Kodwa manje sekukhona okuningi-kodwa ukuphuthuma kudlulile.
I-WHO (World Health Organization) kanye nezinhlangano zikahulumeni, kuhlanganise ne-US FDA (Federal Drug Administration), zisekela ukusetshenziswa nokuhawukelwa kwezidakamizwa.
Kodwa-ke, ngaphandle kokufakazela ukuthi ukwelashwa kusindisa ukuphila, kukhona ukukhathazeka ukuthi yini engase ibonakale isindisa ukuphila ingaba yingozi - noma imane iphazamise ekunakekelweni kokuphila.
Ngakho lokho kusishiya kuphi?
I-Serum ye-Convalescent
Ukwelashwa kokuqala ku-Ebola kwaqala ngokumpontshelwa igazi kulabo abasinda kulabo abanesandulela ngculaza ukulwa negciwane. Umcwaningi wasinda ekulandeleni isidingo sesidingo se-Ebola ngo-1976 (nodokotela onegciwane ngo-2014) ngemuva kokumpontshelwa kodwa kwakungacaci ukuthi ngabe i-serum yayisize. Kamuva ngo-1995, iziguli ezingu-8 zanikezwa igazi kwathi abangu-7 basinda, lapho iningi labantu (80%) lifa. Ukuhlaziywa okuqhubekayo, noma kunjalo, kuboniswe ukuthi akukho nzuzo yokumpompela (ukunyuka okuqhubekayo njengesikhathi sokusulela ukutheleleka kanye nokudlula kokuqala kokuphazamiseka). Noma kunjalo, i-World Health Organization ibonise isithakazelo ekuphenyweni kwegazi, njengoba abasindile, ngokungafani nezidakamizwa, bakhiqizwa yizifo (nakuba ukubheja kwegazi kunganciphisa).
Ukumpontshelwa igazi kwe-convalescent kuye kwasetshenziswa eNtshonalanga Afrika, kanye neziguli okungenani ezintathu e-US.
I-Monoclonal Antibody
Ama-antibodies, etholakala ebhokisatri esikhundleni sokumpontshelwa igazi, bekulokhu ukwelashwa okuthembisayo kakhulu kuze kube manje. Imithi eyodwa, i-ZMapp evela ku-Mapp Biopharmaceutical, ixuba ama-antibodies amathathu (okuyiwona oqondile) aphikisana nomuntu (ngokumelene nama-glycoprotein ephezulu).
Ukwelashwa, ngokusebenzisa imithi emithi emi-3, kubonakala kubekezelelwe kahle. Ngeshwa, amasheya ezidakamizwa aphelile, nakuba ukukhiqizwa kwezidakamizwa eziningi kuhlelwe (ngokusebenzisa izitshalo zogwayi ezizokhula umuthi). I-FDA ivumele ukusetshenziswa ngokucela kwalesi sidakamizwa esingenakudliwa yiziguli ze-Ebola uma sitholakalayo.
Imithi ye-antiviral
Izidakamizwa zingase zilwa ngqo negciwane. Kunezidakamizwa eziningi ze-antiviral: TKM-Ebola (Tekmira Corporation), i-BCX4430, (i-Biocryst Corporation), i-AVI-7537 (i-Sarepta), i- Favipiravir (i-Fujifilms)
Ezinye izidakamizwa azibonakali ukusebenza. Isivivinyo se-TKM-Ebola sagcinwa ngoJuni 2015 ngoba kwakungabonakali siphumelele. Kwakuthemba ukuthi ngokusebenzisa uhlobo lwe-RNA (amancane ama-RNA ephazamisekayo okuthiwa i-siRNA) angagcina igciwane lingasakazeka.
Isebenzisa i-RNA emibili eboshiwe ukuze imise ukuveza izakhi zofuzo ezinamaprotheni amathathu e-Ebola (i-Zaire Ebola L polymerase, i-Viral Protein 24 (VP24), ne-VP35). Izifundo zeLab nezilwane ziye zaphumelela (kuhlanganise negciwane elifanayo, iMarburg). Ukukhathazeka ngempendulo eyingozi ye-immune kwancipha ukuhlolwa okwengeziwe, kodwa i-FDA manje isheshayo lokhu.
I-BCX4430 isebenza njengezakhi zokwakha i-DNA / RNA (i-adenosine nucleoside analog) yokuyeka ukuphindaphinda igciwane; uye waphumelela ekuvivinyweni kwe-monkey. 401.
I- avipiravir yeF , isidakamizwa esivunyiwe ngokumelene nomkhuhlane waseJapane siphumelele ezinhlobonhlobo zezilwane futhi sinikezwe ukwelashwa kwe-Ebola. Isidakamizwa kusobala ukuthi i-analog i-nucleotide ivimbela ukuphindaphinda okuqhubekayo kwegciwane.
I-Brincidofovir (i-BCV, i-CMX001) ayisasetshenziselwa i-Ebola. Ucwaningo manje selugxile kwamanye amagciwane, njenge-Adenovirus ne-CMV.
Eqinisweni, i-BCV yenzelwe ukusetshenziswa nge-DNA virus - CMV (Cytomegalovirus), i-Adenovirus. I-Ebola i-RNA virus, hhayi i-DNA virus. Umuthi uba cidofovir ngaphakathi kwamaseli. Lesi sidakamizwa sisetshenziswe ngempumelelo nge-CMV nakwamanye amagciwane e-DNA, afana ne-papillomaviruses. I-Cidofovir ingumfanekiso we-nucleotide; lilinganisa i-DNA block block futhi liphazamise i-DNA ekwandisa amagciwane e-DNA. Ngokuyinhloko akuzange isetshenziswe kuma-virus e-RNA afana ne-Ebola. Kodwa-ke, inkampani eyenza i-Brincindofovir, i-Chimerix, ibike ucwaningo lwe-laboratory ku-CDC, i-NIH ibonise umsebenzi wokulwa no-Ebola, okwakungamanje izindaba ezinhle njengoba isidakamizwa sisetshenziswe ngokuphepha kubantu ngaphambili, nakuba umsebenzi wakhe wokulwa no-Ebola ungakaqinisekiswa izilwane noma abantu okwamanje. Kungaba yi-antiviral yomlomo, eyanikeza izingozi zezingaliti ezine-Ebola, izobe ithembisa. (I-Brincindofovir ifaka ingxenye ye-lipid, noma i-fatty, ehlanganiswe ne-cidfovir, evumela ukuthi izidakamizwa zigwinyiwe, hhayi ukujova).
I-AVI-7537 isebenzisa i-molecule ye-RNA eguquliwe ukuze iphinde ihlasele iphrotheni ye-VP24.
Imithi evunyelwe
Indlela elula yokwelapha i-Ebola kungaba ukuthola imithi eyaziwa ukuthi iphephile ephumelelayo ngokumelene ne-Ebola. Ukuhlolwa kwezidakamizwa kakade kuvunyelwe umsebenzi we-anti-Ebola kuye kwaveza ukukhethwa kwezidakamizwa ze-estrogen (SERMs) ezikhethiwe, njenge-Clomiphene ne-Torimefene esetshenziselwa ukwelashwa kwesifazane nokubelethwe umdlavuza wamabele, njengokwelapha okungenzeka.
Ezinye izidakamizwa kungenzeka. I-Ebola ithinta i-cascade ye-clotting eyenza ama-clots bese ephuma. Isidakamizwa esisha (esisha) esingasithinta i-clotting rNAPC2 safundwa kanye nomuthi owaziwayo, i-rhAPC (i-Protein C eyenziwe kabusha eyenziwe ngabantu) enethemba elithile. Ngokufanayo, abanye baphikisana nezidakamizwa zokunciphisa i-cholesterol esekelwe kwezinye izifo. Ngokufanayo, i-interferon ibhekwe ukusetshenziswa kwe-Ebola. Udokotela othile uye wasebenzisa i-HIV, i-Lamivudine, i-nucleoside analog, ezigulini ze-Ebola ezingase ziholele ekufundeni okuqhubekayo.
Imithi yama-Fake
I-FDA ixwayise ngokusetshenziswa kwemithi engavunyelwe. Izidakamizwa eziningi zizwakala kahle - ezengqikithi - kepha ngaphandle kokuvivinywa, akucaci ukuthi ziyasiza yini noma ziyingozi.
Umgomo
Umgomo wokuvimbela ukutheleleka wawuzoba kuhle. Kukhona manje umgomo ohlolwe futhi usebenza ngempumelelo.
Ngaphambi kwesigameko se-2013-2015, kwakukhona imishanguzo eyakhelwe i-Ebola, kodwa ayizange ihlolwe ngokwanele. Omunye umuthi wokugoma wawuvivinywa ngesiguli esisodwa; kungenzeka ukuthi wasiza ngemuva komcwaningi we-Ebola we-needlestick ka-2009. Lo mgomo, umgomo we-VSV (i-recombinant vesicular stomatitis virus vector eveza igciwane le-Ebola glycoprotein) uye wahlolwa futhi ezinhlobonhlobo zezilwane (kodwa hhayi kunoma imuphi omunye umuntu) futhi uboniswe ukuthi usebenza kahle ngisho nangamahora angu-24 ngemuva kokuvezwa. Kwakuwumgomo wokuhlolwa we-VSV owahlolwa futhi ubonakala sengathi usebenza eGuinea.
Ekuqaleni kwalesi sifo, kwakukhona amaqembu amaningi nohulumeni abasebenzela ukuhlola nokusebenzisa imishanguzo. Uhulumeni waseCanada uzinikezele ukusabalalisa izimpahla ezilinganiselwe zalomgomo wokuhlola. I-NIH ihlongoze ukuthi ihlolwe ngokushesha omunye umjovo wokugoma. Uhulumeni waseChina kamuva ngo-2015 naye waqala ukuhlola umuthi wokugoma, usebenzisa i-adenovirus-vector.
Ekugcineni, kungase kube nemigomo eminingi. Ngeshwa, okuningi kokuhlolwa kuzothatha isikhathi kakhulu ukusiza izinkulungwane ezafa ngo-2013-2015. Kunzima kakhulu ukuhlola imishanguzo uma kunezifo ezimbalwa.