He aha ka maʻi immunotherapy?

ʻO ka Immunotherapy ke hoʻohana ʻia nā ʻāpana o ka ʻōnaehana pale o ka mea maʻi e hakakā i ka maʻi a me ka maʻi maʻi, i kēia hihia ke kanesa. Hana ʻia kēia ma ka hoʻoulu ʻana i ka ʻōnaehana pale e hana ʻoi aku ka ikaika, a i ʻole ka hāʻawi ʻana i nā ʻāpana ʻōnaehana pale e hakakā i ka maʻi a i ʻole ka maʻi.

Ua ʻike ʻo Kauka William Coley ua kōkua ka maʻi ma hope o ka ʻoki ʻana i kekahi mau maʻi maʻi maʻi. Ua hoʻāʻo ʻo ia e mālama i nā poʻe maʻi maʻi maʻi ma o ka hoʻopili ʻana iā lākou me ka bacteria. ʻO kēia ke kumu no ka immunotherapy hou, ʻoiai ʻaʻole mākou e hoʻopili i nā maʻi; Hoʻoikaika mākou i kā lākou ʻōnaehana pale me ka hoʻohana ʻana i nā ʻano hana like ʻole a hāʻawi i kā lākou ʻōnaehana pale ʻana i nā mea hana e hakakā ai.

Hoʻonui kekahi mau ʻano o ka maʻi immunotherapy i ka ʻōnaehana pale ma ke ʻano holoʻokoʻa, aʻo nā mea ʻē aʻe e hoʻohana i ka ʻōnaehana pale e hoʻouka pololei i nā maʻi kanesa. Ua loaʻa i nā mea noiʻi ke ala e loaʻa ai ka ʻōnaehana pale o ke kanaka e ʻike ai i nā maʻi maʻi maʻi i loko o ke kino a hoʻoikaika i kāna pane.

ʻEkolu ʻano o ka maʻi immunotherapy: nā antibodies monoclonal, nā lāʻau lapaʻau maʻi kanesa, a me nā immunotherapy non-specific. ʻO ka hoʻopunipuni me ka immunotherapy ka maʻi kanesa ke noʻonoʻo nei i nā antigens i ka cell cancer, a i ʻole nā ​​antigens i pili me ka maʻi kanesa a i ʻole ka ʻōnaehana pale.

Nā ʻano o ka Immunotherapy a me kā lākou noi maʻi maʻi

ʻO nā antibodies monoclonal i hana ʻia e ke kanaka a i ʻike ʻia paha mai nā keʻokeʻo keʻokeʻo keʻokeʻo o ka mea maʻi, a hoʻohana ʻia no ka huli ʻana i ka ʻōnaehana pale a i ʻole nā ​​antibodies kikoʻī ma nā keʻena maʻi maʻi.

ʻO ka hana mua i ka hana ʻana i nā antibodies monoclonal ʻo ia ka ʻike ʻana i ka antigen kūpono e ʻimi ai. He paʻakikī kēia me ka maʻi kanesa no ka mea he nui nā antigens i pili. ʻOi aku ka paʻa o kekahi mau maʻi maʻi maʻi i nā antibodies monoclonal ma mua o nā mea ʻē aʻe, akā, no ka pili ʻana o nā antigens i kekahi mau ʻano o nā maʻi maʻi, e ʻoi aku ka maikaʻi o nā antibodies monoclonal.

ʻElua ʻano o nā antibodies monoclonal; ʻO ka mea mua, he conjugated monoclonal antibodies. Loaʻa iā lākou nā ʻāpana radioactive a i ʻole nā ​​​​lāʻau chemotherapy i hoʻopili ʻia i ka antibody. Huli a hoʻopili ka antibody i ke keʻena maʻi maʻi kahi e hiki ke lawelawe pololei ʻia ka lāʻau a i ʻole ka ʻāpana. ʻOi aku ka pōʻino o kēia lāʻau lapaʻau ma mua o ke ʻano o ka chemo a i ʻole radioactive therapy.

ʻO ka lua o ka ʻano he monoclonal antibodies olohelohe a, e like me ka manaʻo o ka inoa, ʻaʻohe o kēia mau lāʻau chemotherapy a i ʻole nā ​​​​mea radioactive i hoʻopili ʻia iā lākou. Ke hana nei kēia ʻano antibody iā ia iho, ʻoiai e hoʻopili mau ana lākou i nā antigens ma nā pūnaewele maʻi maʻi a me nā cell non-cancerous a i ʻole nā ​​​​protein lana manuahi.

Hoʻonui kekahi i ka pane ʻana i ka pale ma o ka hana ʻana ma ke ʻano he māka no nā pūnae T i ka wā i hoʻopili ʻia i nā pūnaeau maʻi maʻi. Hoʻonui ka poʻe ʻē aʻe i ka ʻōnaehana pale ma ke ʻano holoʻokoʻa ma o ka huli ʻana i nā ʻōnaehana pale. ʻO kahi laʻana o nā antibodies monoclonal olohelohe (NmAbs) ʻo ia ka lāʻau "Alemtuzumab" i hana ʻia e Campath. Hoʻohana ʻia ʻo Alemtuzumab no nā maʻi me ka maʻi maʻi lymphocytic leukemia (CLL). Hoʻopaʻa nā antibodies i ka antigen CD52 ma nā lymphocytes, me nā cell leukemia, a huki i nā cell immune o ka poʻe maʻi e luku i nā sela maʻi.

ʻO nā lāʻau lapaʻau maʻi maʻi, kahi ʻano ʻē aʻe o ka monoclonal antibody, e hoʻopaʻa i ka pane kūlohelohe i nā maʻi a me nā maʻi e hiki ke alakaʻi i ka maʻi kanesa. Me ka hoʻohana ʻana i nā loina like o ka lāʻau lapaʻau maʻamau, ʻo ka manaʻo nui o nā lāʻau lapaʻau maʻi maʻi e hana ma ke ʻano he mea pale ma mua o ke ana therapeutic.

Hana like nā lāʻau lapaʻau maʻi maʻi maʻamau i ke ʻano o ka hoʻoulu ʻana i ka ʻōnaehana pale, akā naʻe me ka maʻi maʻi maʻi e kuhikuhi ʻia ana ka ʻōnaehana pale i ka hoʻouka ʻana i nā cell cancer i hana ʻia e kahi maʻi ma mua o ka maʻi maʻi ponoʻī.

Ua ʻike ʻia ua pili kekahi mau maʻi o ka maʻi papilloma kanaka (HPV) i ka ʻāʻī, anal, puʻu, a me kekahi mau maʻi maʻi maʻi ʻē aʻe. Eia hou, ʻoi aku ka nui o ka pilikia o ka poʻe me ka maʻi hepatitis B mau loa (HBV).

I kekahi manawa, no ka hana ʻana i ka lāʻau lapaʻau no ka HPV, no ka laʻana, ʻo ka mea maʻi i loaʻa i ka maʻi papilloma kanaka e lawe ʻia kahi laʻana o ko lākou mau keʻokeʻo keʻokeʻo. E hōʻikeʻia kēia mau pūnaewele i nā mea kiko'ī, i ka wā e hoʻokomo houʻia i ka pūnaewele immune o ka mea maʻi, e hoʻonui i ka pane palekana. ʻO ka lāʻau lapaʻau i hana ʻia ma kēia ʻano e pili pono i ke kanaka i lawe ʻia mai ke koko keʻokeʻo. ʻO kēia no ka mea e hoʻopaʻa ʻia nā keʻokeʻo keʻokeʻo me ka DNA o ke kanaka e ʻae ai i ka hoʻopili piha ʻana i ke kano i loko o kā lākou ʻōnaehana pale.

ʻAʻole hoʻopaʻa pololei ka immunotherapy i ka maʻi maʻi ʻaʻole kikoʻī akā hoʻoulu i ka ʻōnaehana pale āpau. Hana ʻia kēia ʻano immunotherapy ma o nā cytokines a me nā lāʻau lapaʻau e kuhikuhi ana i nā ʻōnaehana pale.

Hoʻohana ka ʻōnaehana pale i nā wahi hōʻoia no ka pale ʻana iā ia iho mai ka hoʻouka ʻana i nā cell maʻamau a i ʻole nā ​​​​cell i loko o ke kino. Hoʻohana ʻo ia i nā molekala a i ʻole nā ​​​​pūnaewele immune i hoʻāla ʻia a i ʻole ʻia e hoʻomaka i kahi pane kūlohelohe. Hiki ke ʻike ʻole ʻia nā cell cancer e ka ʻōnaehana pale no ka mea hiki iā lākou ke loaʻa i kekahi mau antigens e hoʻohālike i nā mea o nā pūnaewele ponoʻī o ke kino no laila ʻaʻole e hoʻouka ka ʻōnaehana pale iā lākou.

ʻO nā cytokines nā mea kemika i hiki i kekahi mau pūnaewele ʻōnaehana pale ke hana. Hoʻomalu lākou i ka ulu a me ka hana o nā pūnaewele ʻōnaehana pale ʻē aʻe. ʻElua ʻano cytokines: interleukins a me interferon.

Hana ʻo Interleukins ma ke ʻano he hōʻailona kemika ma waena o ke koko keʻokeʻo. Kōkua ʻo Interleukin-2 (IL-2) i ka ulu ʻana a me ka puʻunaue ʻana o nā pūnaewele ʻōnaehana immune, ma ka hoʻohui ʻana a i ʻole ka hoʻoulu ʻana i nā cell IL-2 hiki iā ia ke hoʻonui i ka pane kūlohelohe a me ka helu kūleʻa i kekahi mau maʻi maʻi.

Kōkua ʻo Interferon i ke kino e pale aku i nā maʻi maʻi, nā maʻi a me nā maʻi maʻi. Hana lākou i kēia ma ka hoʻonui ʻana i ka hiki o kekahi mau mea pale e hoʻouka i nā maʻi maʻi a hiki ke hoʻolōʻihi i ka ulu ʻana o nā maʻi maʻi. Ua ʻae ʻia ka hoʻohana ʻana i ka interferon no nā maʻi maʻi e like me ka leukemia cell hairy cell, chronic myeologenous leukemia (CML), nā ʻano lymphoma, ka maʻi maʻi ʻaʻai, a me ka melanoma.

He aha ka mea hou i ka ʻimi noiʻi ʻana i ka Immunotherapy?

ʻAʻole he kahua hou ka Immunotherapy, ʻoiai me kāna noi i ka mālama ʻana i ka maʻi kanesa. Akā, ʻoi aku ka nui o nā noiʻi e pili ana i ke kumu o ka maʻi kanesa a pehea e ʻike maikaʻi ai iā ia, ʻoi aku ka maikaʻi o ka hiki iā mākou ke pale aku i ka maʻi a kaua aku.

Nui nā hui lāʻau lapaʻau e hele mai nei me nā lāʻau lapaʻau e hakakā ai i ka maʻi kanesa. ʻOiai ʻaʻole nui ka ʻōlelo e pili ana i nā lāʻau lapaʻau i ka wā o ka hoʻolālā ʻana (no nā kumu palekana), aia nā hoʻokolohua lapaʻau no nā lāʻau lapaʻau e hōʻike ana i ka maikaʻi i ka mālama ʻana i ka maʻi kanesa. ʻO kekahi o ia lāʻau lapaʻau ʻo CAR T-cell (Chimeric Antigen Receptor) therapy, he antibody monoclonal i hoʻohana ʻia no ka mālama ʻana i ka maʻi leukemia lymphoblastic acute.

Ke hoʻohana nei kēia lāʻau lapaʻau i nā t-cell i hōʻiliʻili ʻia mai ke koko o ka mea maʻi a hoʻomaʻamaʻa genetically iā lākou e hana i nā mea loaʻa kūikawā ma luna o ka ʻili, chimeric antigen receptors. Hoʻopili ʻia ka mea maʻi me nā keʻokeʻo keʻokeʻo i hoʻololi ʻia, a laila e ʻimi a pepehi i nā maʻi maʻi maʻi me kahi antigen kikoʻī.

Ua haʻi ʻo Kauka SA Rosenberg iā Nature Reviews Clinical Oncology e hiki i ka CAR T-cell therapy ke "lilo i mea lapaʻau maʻamau no kekahi mau maʻi maʻi B-cell". Ua mālama ka Halemai o nā keiki o Philadelphia i nā hoʻokolohua no ka maʻi leukemia a me ka lymphoma me ka hoʻohana ʻana i ka CAR T-cell therapy. Ua nalowale nā ​​hōʻailona a pau o ka maʻi kanesa mai 27 mai 30 mau maʻi, 19 o kēlā 27 i koe i ke kala ʻana, 15 mau kānaka ʻaʻole e loaʻa hou i ka lāʻau lapaʻau, a ʻo 4 o ka poʻe e neʻe nei e loaʻa i nā ʻano lāʻau lapaʻau ʻē aʻe.

He hōʻailona kēia i kahi lapaʻau kūleʻa loa, a me ka nui o ke kala kala ʻana hiki iā ʻoe ke kali i mua e ʻike i nā lāʻau lapaʻau CAR T-cell hou aʻe (a me nā mea ʻē aʻe e like me ia) i ka wā e hiki mai ana. CAR T-cell therapy "ʻoi aku ka ikaika ma mua o nā mea āpau e hiki iā mākou ke hoʻokō [me nā ʻano ʻē aʻe o ka immunotherapy e noʻonoʻo ʻia]" wahi a Kauka Crystal Mackall mai ka National Cancer Institute (NCI).

Ua ʻōlelo ʻo Dr. Lee mai NCI, ʻo ka "hōʻike ikaika e hōʻike ana ʻo CAR T-cell therapy he alahaka kūpono i ka hoʻololi ʻana i ka iwi iwi no nā poʻe maʻi ʻaʻole e pane hou ana i ka chemotherapy". Me nā hōʻailona o ka monoclonal antibody therapy ʻoi aku ka liʻiliʻi ma mua o ka chemotherapy, ke ʻimi nei ʻo ia i kahi ʻano ʻoi aku ka maikaʻi o ka lāʻau lapaʻau.

He haʻahaʻa haʻahaʻa ke ola o ka maʻi kanesa ma kahi o 15% ma mua o 5 mau makahiki i hoʻohālikelike ʻia i ka maʻi maʻi umauma 89%. ʻO Nivolumab kahi lāʻau lapaʻau i hoʻohana ʻia no ka mālama ʻana i ka maʻi maʻi ʻaʻai liʻiliʻi liʻiliʻi a me ka melanoma. Ua hoʻāʻo ʻia ma kahi hui o 129 me ka maʻi kanesa maʻi.

Hāʻawi ka poʻe i hui i nā ʻano o 1, 3, a i ʻole 10mg/kg o ke kaumaha kino o Nivolumab a hiki i 96 mahina. Ma hope o 2 mau makahiki o ka mālama ʻana, ʻo 25% ka nui o ke ola, he piʻi maikaʻi no ka maʻi maʻi make e like me ka maʻi kanesa. Ua hoʻāʻo pū ʻia ʻo Nivolumab no nā poʻe me ka melanoma, a ua hōʻike ʻia nā hoʻāʻo i ka piʻi ʻana o ke ola mai 0% ma mua o ʻekolu mau makahiki me ka mālama ʻole ʻana i ka 40% me ka hoʻohana ʻana iā Nivolumab.

Hoʻopaʻa ka lāʻau lapaʻau i ka PD-1 antigen receptor ma nā keʻokeʻo keʻokeʻo keʻokeʻo no laila ʻaʻole e launa pū me ia nā mea maʻi kanesa; ʻoi aku ka maʻalahi o ka ʻōnaehana pale e ʻike i ka maʻi kanesa a hoʻopau iā ia e like me ia. I ka wā o ka hoʻāʻo ʻana ua ʻike ʻia ua pane ka poʻe me ka antibody PD-L1 i ka poʻe me ka ʻole, ʻoiai ʻaʻole ʻike ʻia ke kumu ma hope.

Aia pū kekahi DNA immunotherapy, e hoʻohana ana i nā plasmids o nā sela o kahi maʻi i mea e hana ai i kahi kano. Ke hoʻokomo ʻia ke kano i loko o ka mea maʻi, hoʻololi ia i ka DNA o kekahi mau cell e hoʻokō i kahi hana kikoʻī.