Mankhwala Atsopano Atsopano

Potsegulira gawo la zasayansi la 77 la American Diabetes Association, a Millman Labs oyambitsa Jeffrey Millman ndi wamkulu wa ntchito ya JDRF Aaron Kowalski adakambirana za njira ziwiri ziti zomwe zingakhale zothandiza kwambiri pagulu la matenda ashuga 1, pomwe Jeffrey Millman adalimbikitsa luso kumuika, ndipo Aaron Kowalski watseka njira yapa pampu.

Milman, mwina pozindikira kuti anali kale pachiwopsezo, adacheza kwambiri akutsindika momwe kulimba kwa njira yolowera m'malo amisala kwakhala ikuyenda bwino m'zaka zaposachedwa. Malinga ndi iye, lingaliro lakukonzekera maselo owoneka bwino (maselo a beta) ndi kagwiritsidwe kake kupita kwa anthu omwe ali ndi matenda amtundu woyamba 1 kumawoneka kosavuta, koma pochita pali zopinga zazikulu.

Mpaka posachedwa, maselo osinthira amatengedwa kuchokera kwa opereka omwe adamwalira, ndipo panali zovuta za kuchuluka ndi konse. Posachedwa, ofufuza ayamba kukulitsa maselo a islet kuchokera kuma stem cell mu labotor. Deffrey Millman akuti adachulukitsa kuchuluka, koma osati nthawi zonse. Ma cell a Laborator sanadutse magawo akukulira a maselo ofunikira kuti azitha kugwira bwino ntchito panthawi ya mayeso.

Tsopano zinthu zikusintha, Dr. Douglas Melton wa Harvard Institute for Stem Cels wapeza njira yolimbikitsira kayendedwe ka maselo a cell ndikukulitsa maselo a beta kuti azikula. D.Millman adaphunzitsidwa ndi D.Melton, ndipo akuti njirayi ndi yosavuta kuposa momwe ntchito ya Douglas Melton idapangidwira.

"Tsopano titha kupanga maselo amenewa mwa odwala," akutero D. Millman.
Komabe, zikuwoneka kuti kuchuluka kwa ma cell a beta sikumathetsabe mavuto onse ndi njira yopatsirana. Anthu omwe ali ndi matenda amtundu wa 1 omwe akudwala mankhwala a beta cell transplant ayenera kumwa mankhwala kuti ateteze chitetezo cha mthupi, popeza ma cell a beta omwe adalilidwa amakana. Ntchito ikuchitikanso kuti mtundu wa maselo okulirapo ukhale wabwino. Pakadali pano, maselo abwino kwambiri a beta omwe amakhala mu labotore amatengera mtundu woyipa kwambiri wa maselo a beta omwe amapangidwa ndi thupi lokha. Jeffrey Millman akukhulupirira kuti mtundu wa maselo okulira mu labotore udzasintha m'zaka zikubwerazi.
"Kupanga kwa maselo a beta kumveka bwino," akutero. "Maselo amenewa adzakhala abwino kwambiri m'zaka zochepa."

Koma pomwe D. Millman akunena zakuyenda bwino komwe kumaphatikizapo odwala ochepa, kuchuluka kwa odwala omwe adavala bwino ma pump insulin kumapeto kuli masauzande ndipo izi zimapangitsa udindo wa A. Kowalski kukhala wosavuta pakukambirana uku.

Kutsutsana kwa A. Kowalski ndikosavuta - mapampu otsekeka akugwira ntchito kale ndipo amapangitsa moyo kukhala wosavuta kwa anthu omwe ali ndi mtundu woyamba. Kuti akwaniritse mlandu wake, adapeza kuchuluka komwe oimira JDRF amatchula, kuphatikizapo kafukufuku wosonyeza kuti anthu ambiri omwe ali ndi matenda amtundu wa 1 samakwaniritsa zolinga za A1C (glycated hemoglobin) zofunika kupewetsa zovuta za nthawi yayitali. A. Kowalski ndi ena ku JDRF akuti izi siziri chifukwa anthu sakuyesa, koma chowonadi ndichakuti ntchito yotsanzira kapangidwe kanu kapamba ndizovuta kwambiri.

Mapampu otsekedwa-ozungulira amapangitsa izi kukhala zosavuta, akutero. Zatsimikiziridwa kuti pakuyesa kwa mapampu omwe amafunikirabe kusintha kwa bolus kuti azidya zakudya, komabe, kusinthasintha kwa glucose kumachepetsedwa kwambiri ndipo indices za A1C (GH) zimayendetsedwa bwino. Mayesowa adawonetsanso kuti tekinoloji yotseka ya lupu ikukhudza kwambiri anthu omwe ali ndi mtundu 1 amagona ndipo sangathe kuwongolera shuga. Achinyamata omwe amayesa matupi awo kapena kuiwala za bolus amakhalanso ndi mwayi wowongolera shuga monga maphunziro.

Pakadali pano, makina okhawo omwe anali otsekemera pamsika ndi Medtronic 670G. Medtronic adayamba kugulitsa pampu ya insulin masiku angapo asanayambe gawo la 77 la American Diabetes Association. A. Kowalski akumvetsa kuti pampu wosakanizidwa sindiwo “kapamba wochita kupanga” kapena mankhwala. Komabe, akuti maubwino owonjezerawa ndi opindulitsa kwambiri, makamaka chifukwa akupezeka pano.

"Ngati cholinga ndikupanga chipangizo chomwe chimagwira ngati foni ya beta, ndiye kuti ndicholinga chachikulu," adatero.
Tsopano popeza Medtronic yadutsa bwino kuvomerezedwa ndi FDA, JDRF ikufuna opanga ena a makina otsekeka a loop kulowa msika. Medtronic ikugwiranso ntchito kuti ipetse mapampu a insulin, popeza kuvala zida zazikulu zamankhwala kulinso kovuta.

“Palibe. sichimavala pompo wa insulin kuti musangalale, ”adatero A. Kowalski. Ananenanso kuti: "Ngati mukufuna kugwiritsa ntchito matekinoloje awa, muyenera kuchepetsa nkhawa zomwe mungagwiritse ntchito matekinoloje awa."
Alibe chiyembekezo chogwiritsa ntchito mapampu apamadzi a insulin awiri omwe amagwiritsa ntchito insulin kutsitsa shuga ndi glucagon kuti akhalebe osachepera. Mapampu owonjezera a mahomoni ndi njira yoyeserera yochotsetsa chiopsezo cha hypoglycemia, koma A. Kowalski sanagawane kwambiri pazomwe amamutsutsa. JDRF imabzala mitundu yambiri yamatenda a matenda amtundu woyamba, koma ma pampu apakati amakono samakhudza mndandanda wazomwe bungweli likuchita patsogolo.

A. Kovalsky adapereka mfundo zake ndikuwoneka ngati katswiri yemwe amadziwa bwino ukadaulo wokhazikika. Komabe, pokambirana izi adasiya "khomo lotseguka", osapatula kuti kupatsirana kwa beta-cell kapena chithandizo china chingakhale chithandizo chabwino kwambiri cha matenda ashuga amtundu 1 kuposa pampu zotsekeka-zotseka.

Thambo la kapamba ndi maselo a beta

Asayansi ndi madokotala pakadali pano ali ndi kuthekera kwakukulu pakugwira ntchito. Ukadaulo wapita patsogolo modabwitsa; maziko azomwe asayansi komanso othandiza pantchito yopanga zimachulukirachulukira. Amayesa kutumiza ma bio osiyanasiyana kwa anthu odwala matenda ashuga amtundu woyamba: kuchokera ku zikondamoyo zonse mpaka tiziwalo tosiyanasiyana. Mitsinje ikuluikulu yotsatira ya sayansi imasiyanitsidwa, kutengera zomwe akufuna kupititsa odwala:

• kufalikira kwa gawo lina la kapamba,
• kufalitsa kwa ma islets a Langerhans kapena maselo a beta payokha,
• Kuyika kwa masinthidwewo a tsinde, kotero kuti amasanduka maselo a beta.

Zochitika zofunikira zapezeka pakuwonetsa impso za operekera limodzi ndi gawo la kapamba mwa odwala omwe ali ndi matenda a shuga 1 omwe adayamba kulephera kwa impso. Chiwopsezo chopulumuka cha odwala pambuyo pa kuphatikiza kosakanikirana kotereku tsopano chikuchulukitsa 90% mchaka choyamba. Chachikulu ndikusankha mankhwala oyenera pokana kukana ndi chitetezo cha mthupi.

Opaleshoni yotere itatha, odwala amatha kusungunulira insulin kwa zaka 1-2, koma kenako ntchito ya kondani yomwe adaika kuti ipange insulin imatha. Kugwiritsidwa ntchito kwa kuphatikizika kwa impso ndi gawo la kapamba kumachitika pokhapokha ngati matenda a shuga 1 amavuta ndi nephropathy, i.e., kuwonongeka kwa impso. Nthawi zina odwala matenda ashuga, chithandizo chotere sichikulimbikitsidwa. Chiwopsezo cha zovuta panthawi ndi pambuyo pa opareshoni ndiochuluka kwambiri ndipo chimaposa phindu lomwe lingakhalepo. Kumwa mankhwala kuti muchepetse chitetezo chathupi kumabweretsa zotsatira zoyipa, ndipo ngakhale zili choncho, pali mwayi wambiri wokanidwa.

Kufufuza kuthekera kwa kusinthanitsa kwa ma islets a Langerhans kapena maselo amtundu wa beta ali pagawo loyesa nyama. Zadziwika kuti kupatsirana mabwalo amtundu wa Langerhans ndikopindulitsa kwambiri kuposa ma cell a beta. Kugwiritsa ntchito njira imeneyi pochiza matenda amtundu wa 1 wodwala akadali kutali kwambiri.

Kugwiritsa ntchito kwa maselo a tsinde kubwezeretsa kuchuluka kwa maselo a beta kwakhala kofukufuku pa gawo la njira zatsopano zochizira matenda ashuga. Maselo a stem ndi maselo omwe amatha kupanga maselo "apadera" atsopano, kuphatikiza ma cell a beta omwe amapanga insulin. Mothandizidwa ndi maselo a tsinde, akuyesera kuti awonetsetse kuti maselo atsopano a beta awonekera mthupi, osati mu kapamba, komanso chiwindi ndi ndulu. Padzatenga nthawi yayitali kuti njira iyi isagwiritsidwe ntchito mosamala komanso moyenera kuchiza odwala matenda ashuga.

Kubalana ndi kusakanikirana kwa ma cell a beta

Ofufuzawo akuyesa kukonza njira zopangira maselo a insulin. Mwachidziwikire, ntchitoyi yathetsedwa kale, tsopano tikufunika kupanga njirayi kukhala yayikulu komanso yotsika mtengo. Asayansi akusunthasuntha mbali iyi. Ngati mukuchulukitsa maselo a beta okwanira, ndiye kuti amatha kuwaika mosavuta mthupi la wodwala yemwe ali ndi matenda a shuga 1, motero amuchiritseni.

Ngati chitetezo cha mthupi sichingayambenso kuwononga maselo a beta, ndiye kuti kupanga insulin yachilendo kumatha kukhalabe moyo wanu wonse. Ngati vutoli la autoimmune likupitilira, ndiye kuti wodwalayo amangofunika kulowetsa gawo lina la "cell" yake ya beta. Njirayi imatha kubwerezedwa nthawi zambiri momwe ingafunikire.

Mu ngalande zapancreatic, mumakhala maselo omwe ali "oyatsogolera" a maselo a beta. Chithandizo china chatsopano cha matenda ashuga chomwe chingakulimbikitseni ndikupangitsa kusintha kwa "omwe ali patsogolo" kukhala maselo athunthu a beta. Zomwe mukusowa ndi jakisoni wa proteni wapadera. Njirayi ikuyesedwa (kale pagulu!) M'malo angapo ofufuza kuti muwone kuyesa ndi zotsatira zake.

Njira ina ndikuyambitsa majini omwe amachititsa kuti insulini ipangike m'maselo a chiwindi kapena impso. Pogwiritsa ntchito njirayi, asayansi adatha kale kuchiza matenda a shuga m'magazi a labotale, koma asanayambe kuyesa kwa anthu, zopinga zambiri zimafunikabe kugonjetsedwa.

Makampani awiri ampikisano omwe akupikisana nawo akuyesa njira yatsopano yatsopano ya matenda ashuga. Amalimbikitsa kugwiritsa ntchito jakisoni wa mapuloteni ena apadera kuti alimbikitse maselo a beta kuti achulukane mkati mwa kapamba. Izi zitha kuchitidwa mpaka ma cell onse a beta atayika m'malo mwake. Mu nyama, njirayi imanenedwa kuti imagwira ntchito bwino. Kampani yayikulu yopanga zamankhwala Eli Lilly yalowa nawo kafukufukuyu

Ndi mankhwala onse atsopano a shuga omwe alembedwa pamwambapa, pali vuto wamba - chitetezo cha mthupi chimapitilizabe kuwononga maselo atsopano a beta. Gawo lotsatira likulongosola njira zomwe zingatheke pothana ndi vutoli.

Momwe Mungayimitsire Kulimbana ndi Matenda a Beta

Odwala ambiri omwe ali ndi matenda ashuga, ngakhale omwe ali ndi matenda amtundu 1, amasunga ochepa maselo a beta omwe akupitilirabe. Tsoka ilo, chitetezo chamthupi cha anthu awa chimapanga matupi oyera a magazi omwe amawononga ma cell a beta pamlingo womwewo akamachulukana, kapenanso mwachangu.

Ngati nkotheka kupatula ma antibodies ku beta cell a kapamba, ndiye kuti asayansi amatha kupanga katemera wotsutsana nawo. Zilonda za katemera uyu zithandiza chitetezo cha mthupi kuti chiwononge chitetezo cha mthupi. Kenako maselo a beta omwe atsala adzatha kubereka popanda kusokoneza, motero matenda a shuga adzachiritsidwa. Anthu omwe kale amadwala matenda ashuga angathe kubayidwa jakisoni wobwereza zaka zingapo zilizonse. Koma sivuto, poyerekeza ndi katundu amene odwala omwe ali ndi matenda ashuga tsopano ali nawo.

Zithandizo Zatsopano za Matenda Atsopano: Zotsatira

Tsopano mukumvetsetsa chifukwa chake ndikofunikira kusunga ma cell a beta omwe mwatsalira amoyo? Choyamba, zimapangitsa shuga. Mukamapangira insulin yanu bwino, imakhala yosavuta kuthana ndi matendawa. Kachiwiri, anthu odwala matenda ashuga omwe asunga maselo a beta amoyo ndiwo adzakhala oyamba kulandira chithandizo pogwiritsa ntchito njira zatsopano mukapeza mwayi. Mutha kuthandiza maselo anu a beta kukhala ndi moyo ngati mungakhalebe ndi shuga komanso magazi a insulin kuti muchepetse nkhawa zanu. Werengani zambiri zamankhwala a matenda a shuga 1.

Anthu ambiri omwe apezeka kuti ali ndi matenda ashuga, kuphatikiza makolo a ana omwe ali ndi matenda ashuga, akhala akungokweza nthawi yayitali chifukwa cha mankhwala a insulin. Amakhulupirira kuti ngati jakisoni wa insulin akufunika, ndiye kuti wodwalayo ali ndi phazi limodzi m'manda. Odwala oterowo amadalira ma charlatans, ndipo pamapeto pake, maselo a beta a kapamba amawonongedwa aliyense, chifukwa cha kusazindikira kwawo. Mukawerenga nkhaniyi, mukumvetsetsa chifukwa chake amadzikana okha mwayi wogwiritsa ntchito njira zatsopano zochizira matenda ashuga, ngakhale zitawoneka posachedwa.

Zolinga

Lingaliro loti kufalikira kwa maselo si chinthu chatsopano. Pakalipano, ofufuza monga dotolo waku England adayang'anira Charles Paybus (Frederick Charles Pybus) (1882-1975), adayesa kupanga zingwe zamankhwala kuti azichiritsa matenda ashuga. Akatswiri ambiri, komabe, akukhulupirira kuti nthawi yamakono yogulitsa maselo a cell itabwera ndi kafukufuku wa dokotala waku America Paul Lacy (Paul Lacy) ndipo ali ndi zaka zopitilira makumi atatu. Mu 1967, gulu la Lacy lidafotokoza njira yatsopano yopangira kollagenase (yomwe idasinthidwa pambuyo pake ndi Dr. Camillo Ricordi, pomwepo adagwira ntchito ndi Dr. Lacy) yopatula zigawo za Langerhans, zomwe zidatsegulira njira kuti adzayesere nawo mtsogolo mu vitro (vitro) ndi vivo (pazamoyo) .

Kafukufuku wotsatira adawonetsa kuti ma islets omwe adalowetsedwa amatha kusintha mtundu wa matenda ashuga makoswe ndi omwe sanali anthu. Pofotokoza mwachidule msonkhano wophatikiza kupanikizana kwa ma cell mu shuga mu 1977, a Lacy adatinso zakuyenera kwa "islet cell transplantation ngati njira yothandizira kupewa kupewa matenda ashuga mwa anthu." Kupititsa patsogolo njira zodzipatula ndi njira zoyeserera kupangitsa kuti maulendo azachipatala azitha kuyambitsidwa pakatikati pa 1980s. Mayeso oyamba opambana a islet transplantation of pancreatic islet cell akutsitsa mpumulo wa nthawi yayitali wa shuga adachitika ku University of Pittsburgh mu 1990. Komabe, ngakhale njira zopitilira patsogolo pakukula, njira zocheperako ndi 10% zokha zaomwe zimapezeka mu euglycemia (shuga wabwinobwino wamagazi) kumapeto kwa ma 1990.

Mu 2000, James Shapiro ndi mnzake adasindikiza lipoti la odwala asanu ndi awiri motsatizana omwe adakwanitsa kukwaniritsa euglycemia chifukwa chogulitsidwa kuchokera ku islet pogwiritsa ntchito protocol yomwe imafunikira ma steroid ndi mashopu ambiri.Kuyambira pamenepo, njirayi yakhala ikutchedwa protocol ya Edmonton. Protocol iyi yasinthidwa ndi ma islet cell transplant padziko lonse lapansi ndikuwonjezera kwambiri kupititsa patsogolo.

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