Ingabe Siseduze Nomuthi Wegazi Sikashukela?
Labo abanesifo sikashukela sohlobo lwe-1 (isifo sikashukela mellitus) abavelisi i-insulini-amaseli e-beta okukhiqiza i-insulini (β-amaseli) ema-pancreas awo asebenzi kahle ngenxa yezizathu ezingekho amaphesenti angu-100 ahlanzekile. Njengendlela yokuphatha amazinga kashukela egazi, athembele kwi-insulin eyenziwe ngabantu, ukujova insulin izikhathi eziningi nsuku zonke noma ukugqoka i-insulin pump, ukubalwa kwe-carbohydrate , futhi njalo ukuhlola ushukela wegazi .
Kodwa-ke, ososayensi bahlola ukudala amangqamuzana e-islet amaseli (amaseli okwenza i-insulin) avela kumaseli e-stem, ngenhloso yokufakelwa kabusha lawa maseli ukusiza labo abanesifo sikashukela baqede i-insulin. Ukutshala isletthi amaseli akhiqizwa kusuka emaqenjini ama-stem yindawo eqhubekayo yophando futhi okwamanje isetshenziselwa izifundo zesilwane. Kodwa-ke, ngokusho kwamaNational Institutes of Health, kunezinye izinhlobo ezimbili ze-islet cell transplantation esetshenziswe kakhulu kubantu abakhethwe ngokucophelela abanesifo sikashukela.
Kuyini Islet Ukufakelwa Kamaselula?
I-Pancreatic islet transplant islet, eyaziwa nangokuthi ukufakelwa kwe-beta cell, iyindlela inqubo yokuthi amangqamuzana e-beta, avela kubanikeli bomuntu noma amangqamuzana adalwe ebhodini, aphinde afakwe kumuntu onesifo sikashukela sohlobo 1. Ithemba liwukuthi bahlanganisa i-insulini futhi basize ukulawula i-blood glucose, njengamaseli ejwayelekile asebenzisa i-beta.
Kuze kube manje, iziguli ezifakwe esitokisini se-donor efile zingenziwa i-insulin eziyiminyaka eminingi.
Kodwa-ke, leli qhinga lilinganiselwe ngenxa yokungabi nalutho kanye nekhwalithi ye-islet islet amaseli. Ngaphezu kwalokho, kubalulekile ukuthi uqaphele ukuthi ukufakelwa kwe-cell kuyinkqubo yokuhlola futhi kuzobekwa uphawu olufanayo kuze kube yilapho ubuchwepheshe bokufakelwa kabusha bubhekwa njengokuphumelela ngokwanele ukuba kubhalwe ukuthi ukwelashwa.
Njengamanje, kukhona izinhlobo ezimbili zokufakelwa kabusha.
I-Allo-Ukufakelwa
Lolu hlobo lokufakelwa kabusha luhilela ukuthatha islet amaseli kumnikeli oshonile nokuwahlanza. Ngemva kokuhlanzwa, amaseli asetshenziselwa futhi adluliselwe kumamukeli.
Lolu hlobo lokufakelwa kabusha luye lwasetshenzwa kwezinye iziguli ezine-diabetes ye-type 1 ezinesifo soshukela egazini kunzima kakhulu ukuzilawula. Ngokufanelekile, ukufakelwa kwezitshalo kungabangela amazinga ajwayelekile egazi ngegazi ngaphandle kokusetshenziswa kwama-insulin noma ama-infusions, noma okungenani kunganciphisa inani le-insulin edingekayo. Omunye umgomo ukunciphisa ukuqwashisa kwe-hypoglycemia -isimo esiyingozi lapho abantu bengakwazi ukuzwa ushukela wegazi eliphansi.
Iziguli zokutshala izihlahla zithola ama-infusions amabili ngezilinganiso ezilinganiselwa ku-400,000 kuya ku-500,000 iziqhingi. Uma sekufakiwe, amaseli e-beta kulezi ziqhingi aqala ukwenza futhi akhulule i-insulin.
Uma uthola amangqamuzana wokufakelwa, kufanele ube nezidakamizwa zokuzivikela ekuvimbeleni ukwenqatshwa. Lokhu kungabangela isifo sikashukela ngoba ngokuhamba kwesikhathi lezi zinhlobo zezidakamizwa, ezifana ne-corticosteroids, zingandisa ukwanda kwe-insulin, okwenza kube nokwanda kwezishukela zegazi. Ezinye izinhlobo zezidakamizwa zokuzivikela zinganciphisa ikhono le-beta cell ukukhulula i-insulini.
Futhi ekugcineni, lezi zinhlobo zezidakamizwa zinciphisa isimiso somzimba sokuzivikela, esingakwandisa ingozi yokutheleleka. Ngakho-ke, kucacile ukuthi le nqubo ayifuni ngaphandle kwemingcele nokungaqiniseki.
Ama-Allo-transplants awaqhutshwa kuzo zonke izibhedlela-izibhedlela kumele zibe nemvume evela e-United States Food and Drug Administration (FDA) ukuze kwenziwe ucwaningo olusemtholampilo ekutshaleni islet. Udokotela ogxile ekucabangeni kwezokwelapha, i-radiologist, ngokuvamile nguye owenza ukuguqula. Usebenzisa i-x-ray ne-imaging ye-ultrasound ukuqondisa ukufakwa kwe-catheter (ithambo elincane, elincane leplastiki) ngokunciphisa okuncane esiswini esingenhla kuya emthonjeni we-portal (umuthi omkhulu ohlinzeka igazi esibindi).
Uma i-catheter ifakwe endaweni efanele islet iseli liqhutshwa kancane kancane. Ngokuvamile, iziguli zinikezwa i-anethesia yendawo kanye nokudambisa phakathi nenqubo.
Abacwaningi bakholelwa ukuthi iziguli zidinga ama-350 kuya ku-750 million amaseli ukuyeka ukusetshenziswa kwe-insulini ngokuphelele. Ngakho-ke, iziguli eziningi zidinga ukuguquka okuningi.
Ukutshala ngokuzenzakalela
Lolu hlobo lokufakelwa kabusha luyenziwa ngemuva kokususwa ngokuphelele kwe-pancreas (i-pancreatectomy) kuziguli ezine-pancreatitis ezinzima futhi ezingapheli ezingakwazi ukuphathwa ezinye izifo. Umqondo uwukugcina ukukhiqizwa kwe-insulin nokufihla ngoba ukususwa kwe-pancreas kungaholela umuntu ukuba ahlakulele isifo sikashukela.
Iziguli ezine-type 1 zesifo sikashukela azikwazi ukuthola lolu hlobo lokufakelwa kabusha.
Izinzuzo
Uma kuqhathaniswa nokufakelwa kwezitho zomzimba, islet cell allo-transplants ayifuni kakhulu. Ukuphumelela kwe-allo-transplantation kungathuthukisa ukulawula i-blood glucose nokukhawulela noma ukunciphisa ukusetshenziswa kwe-insulin isikhathi esithile. Lokhu kusho ukuthi iziguli ngeke kudingeke ukuthi zijove i-insulin noma zinike i-insulini ngepom izikhathi eziningi ngosuku. Ukulawulwa kweshukela okungcono kwegazi kungase kuncishiswe noma kunciphise ingozi yesifo sikashukela njengesifo senhliziyo, isifo sofuba esihlobene nesifo sikashukela (ukulimala kwamantombazane), nokulimala kwe-retinopathy (umonakalo weso).
Ukwengeza, nge-allo-transplantation, ngisho nokusebenza okuyingxenye emva kokufakelwa kungahlehlise ukungaqapheli kwe-hypoglycemia, ukusiza iziguli ukuba zizwe izimpawu ezifana nokujuluka, ukuthuthumela, ukwanda kwenhliziyo, ukukhathazeka, noma ukulamba, futhi ukuphatha ngendlela efanele.
Izingozi
Inqubo yokufakelwa ingakhuphula ingozi yokuphuma kwegazi kanye negazi. Kukhona nethuba lokuthi amangqamuzana asetshenziswe angahle asebenze kahle noma nhlobo. Ngaphezu kwalokho, wonke amaseli angeke asebenze ngokushesha futhi angathatha isikhathi ukuqala ukusebenza kahle. Ngakho-ke, abamukeli bangadinga ukuthatha i-insulin kuze kube yilapho amaseli aqala ukusebenza kahle.
Kukhona futhi ingozi ukuthi impendulo yokuzimela eyayiqala ukubhubhisa amangqamuzana omuntu womuntu angabangela futhi, okuholela ekuhlaselweni kwamaseli amasha. Abacwaningi okwamanje bazama ukuphenya uma ukusebenzisa ezinye izindawo zomzimba ukufakelwa kungavimbela lokhu ukuthi kwenzeke.
Ukuze ugweme ukulahlwa kwamaseli, kufanele uthathe imithi yokuzivikela ekunciphiseni amasosha omzimba. Lezi zidakamizwa zingakwandisa ushukela wegazi. Imithi ye-immunosuppressive ayidingi lapho kwenzeka ukufakelwa okuzenzakalelayo ngoba amangqamuzana afakwe emzimbeni owodwa.
Ukulinganiselwa
Esinye isithiyo esikhulu ukuthi kukhona ukusweleka kwezingqamuzana zamaseli ezivela kubanikeli-izikhathi eziningi azikho amangqamuzana anempilo okwanele ukutshala futhi azikho abanikeli abanele.
Njengoba ungacabanga, lolu hlobo lwenqubo lubuye lubize. Ngenkathi iziguli zingase zisindise imali kwi-insulin, izindleko zenkambiso, ukuqashwa, kanye nemithi yokuzivikela emzimbeni kudala izivimbela zezimali ezivimbela ukusetshenziswa okusabalalisa kwesisitjhini se-allo-transplantation.
Okulindelekile esikhathini esizayo
Ososayensi basebenza kanzima ukuze baphumelele ukufakelwa islet cell transplantation. Kube khona ucwaningo oluveza ikhono lokudala amaseli e-beta wabantu kusuka kumaseli we-stem ebhodini. Kukholelwa ukuthi lawa maseli angakhiqiza inani elikhulu lama-islet amaseli. Futhi nakuba kuye kwaba nentuthuko eminingi, umsebenzi omningi kufanele wenziwe kule ndawo ngaphambi kokuba ukufakelwa kwezitshalo kube yindlela yokwelapha. Ukufeza le ndlela kungasenza senze isinyathelo esiseduze ekuphulukeleni isifo sikashukela.
Izwi elivela
Ukufakelwa kwe-Islet cell, ikakhulukazi i-allo-transplantation, okwamanje isetshenziselwa abantu abakhethiwe kakhulu abanesifo sikashukela sohlobo 1 abanenkinga enzima kakhulu yokuphatha ushukela wabo wegazi noma abanenkinga enkulu yokungaziwa kwe-hypoglycemia. Ukuguqulwa kwenziwa kuphela kwizibhedlela zokwenza ucwaningo eziye zavunyelwa yi-FDA.
Ucwaningo lwezilwane seluphakamise ukuthi amaseli e-beta adalwe kusuka kumaseli asezingeni futhi asetshenziselwa ukufakelwa kabusha akhiqiza i-insulin ngokushesha. Le ndlela yokukhiqizwa kwamaseli e-beta inganikeza umthombo weselula onokwethenjelwa futhi ongase ube namandla kakhulu uma kuqhathaniswa neziqhingi zabantu. Lokhu akukona nje kuphela ukwandisa inamba yezinhlelo zokufakelwa kwe-cell islet, kepha kungakwandisa nokutholakala kwamaseli e-beta abantu ngezinhloso zocwaningo.
Ukusebenzisa amangqamuzana e-stem angasiza izigidi zabantu, kodwa ososayensi banomsebenzi omkhulu ongakwenza ngaphambi kokufeza le ndlela.
> Imithombo:
> Isikhungo Sikazwelonke Sesifo Sikashukela Nesifo Sezinyosi Nezinso. I-Plantation Islet Transplantation.
> Pagliuca FW, et. al. Isizukulwane samaseli we-pancreatic β esebenzayo ku-vitro. Iseli. 2014 Oct 9; 159 (2): 428-39. i-doi: 10.1016 / j.cell.2014.09.040.
> Irejista yokuThuthukisa islet yokubambisana Umbiko wonyaka wesikhombisa. Isibhalisi se-Isitatimende sokuThuthukisa Islet esihlanganyelwe. https://web.emmes.com/study/isl//reports/01062012_7thAnnualReport.pdf
> I-American Diabetes Association. Imininingwane Eminye Imininingwane Nezibalo NgeSifo SeShukela .
> JDRF. Indlela entsha yamaseli e-Beta.