Ukushoda Kwezitho Zokufakelwa: Ukuguqulwa Kwe-Enzymatic Kweqembu Legazi Lezinso Ezinikelayo namaphaphu 

Besebenzisa ama-enzyme afanelekile, abacwaningi basusa ama-antigen eqembu legazi le-ABO kumnikeli wezinso namaphaphu ex-vivo, ukuze banqobe ukungafani kweqembu legazi le-ABO. Le ndlela ingaxazulula ukushoda kwezitho zomzimba ngokwenza ngcono ukutholakala kwezitho ezinikelayo ukuze zitshalwe kabusha futhi yenze inqubo yokwabiwa kwezitho ibe nhle futhi isebenze kahle. 

Ocwaningweni olusanda kushicilelwa, abacwaningi basebenzisa i-alpha-galactosidase enzyme evela Bacteroides fragilis futhi ikhishwe ngempumelelo uhlobo B iqembu legazi ama-antigens avela kubantu izinso (eyayihlala ingasetshenziselwa ukufakelwa kabusha) ngesikhathi sokugcotshwa kwe-ex-vivo ngaleyo ndlela kuguqule iqembu legazi lezinso libe ngumnikeli wendawo yonke u-O. Lesi yisimo sokuqala sesitho sonke se-ABO igazi ukuguqulwa kweqembu kubantu ngokususa i-enzymatic yohlobo B igazi ama-antigen eqembu¹. 

Kolunye ucwaningo olufanayo lwamaphaphu, ososayensi baguquka igazi iqembu A amaphaphu ukuze igazi iqembu O amaphaphu ngesikhathi sokugcwaliswa kwamaphaphu kwakudala kusetshenziswa ama-enzyme amabili, i-FpGalNAc deacetylase ne-FpGalactosaminidase. Azikho izinguquko eziphawulekayo empilweni yamaphaphu kuhlanganise nokulimala okwenziwe ngama-antibody ezibonwe^2,3.  

Just like igazi ukumpontshelwa, ukufaniswa kweqembu legazi le-ABO kuyisici esibalulekile ekwabiweni kwezitho phakathi kwabazoba ngabamukeli. Ukuba khona kwama-antigen A kanye/noma B ezithweni zabanikeli kwenza ukwaba kube okukhethayo futhi kube nemingcele. Ngenxa yalokho, ukwaba akusebenzi kahle. Amandla okuguqula i-ABO igazi iqembu lezitho ze-ex-vivo kumnikeli womhlaba wonke ngokususa ama-antigens angu-A kanye/noma we-B linganweba iqoqo lezitho zokunikela ezihambisana ne-ABO ukuze kuxazululwe inkinga yokushoda kwezitho zomzimba futhi kuthuthukise ubulungisa ekwabiweni kwezitho zomzimba. ukufakelwa kabusha.   

Izindlela ezimbalwa (njengokususwa kwamasosha omzimba, i-splenectomy, i-anti-CD20 monoclonal antibody, kanye ne-intravenous immunoglobulin) zizanyiwe esikhathini esidlule ukuze kuthuthukiswe impumelelo yokufakelwa kodwa ukungahambisani kwe-ABO kwahlala kuyindaba. Isiphakamiso sokuqeda ama-antigens e-A/B nge-enzymatic safika ngo-2007 lapho abacwaningi benciphisa kancane ama-antigen e-A/B emfeneni besebenzisa i-enzyme ye-ABase.⁴. Ngokushesha ngemva kwalokho, bakwazi ukususa u-82% we-A antigen kanye no-95% we-B i-antigen ku-A/B yomuntu ebomvu igazi amaseli asebenzisa i-ABase⁵.  

Indlela yokukhishwa kwe-antigen ye-enzymatic A/B ezithweni ezinikelayo isifike eminyakeni yokuthi kufakwe izinso namaphaphu. Kodwa-ke, kunobufakazi obuncane ezincwadini zokusebenzisa le ndlela yokufakelwa kwesibindi. Kunalokho, ukungezwani komzimba^6,7 nge ama-antibodies kubonakala kunesithembiso sokuthuthukisa impumelelo kanye nenqwaba yokufakelwa kwesibindi.  

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References: 

1. S MacMillan, SA Hosgood, ML Nicholson, O004 Igazi ukususwa kweqembu le-antigen kwezinso zomuntu kusetshenziswa ubuchwepheshe bomshini wokugcwalisa i-ex-vivo normothermic, i-British Journal of Surgery, uMqulu 109, i-Issue Supplement_4, Agasti 2022, znac242.004, https://doi.org/10.1093/bjs/znac242.004 | https://academic.oup.com/bjs/article/109/Supplement_4/znac242.004/6648600 

2. Wang A., et al 2021. Ukuthuthukisa I-Universal ABO Blood Donor Lungs Nge-Ex Vivo Enzymatic Treatment: Ubufakazi Be-Concept Feasibility Stud. I-Journal of Heart and Lung Transplantation. Umqulu 40, Ukukhishwa 4, Isengezo, s15-s16, april 01, 2021. DOI: https://doi.org/10.1016/j.healun.2021.01.1773 

3. Wang A., et al 2022. Ukwelashwa kwe-Ex vivo enzymatic kuguqula uhlobo lwegazi A amaphaphu anikelayo abe amaphaphu ohlobo lwegazi lomhlaba wonke. Isayensi Yokuhumusha Imithi. 16 Feb 2022. Vol 14, Issue 632. DOI: https://doi.org/10.1126/scitranslmed.abm7190  

4. Kobayashi, T., et al 2007. Elinye Isu Lokunqoba Ukungahambelani kwe-ABO. Ukufakelwa kabusha: Meyi 15, 2007 - Umqulu 83 - Ikhishwe 9 - p 1284-1286. I-DOI: https://doi.org/10.1097/01.tp.0000260634.85690.c4 

5. Kobayashi T., et al 2009. Ukususwa kwe-antigen yeqembu legazi A/B ezithweni nge-ex vivo kanye nokuphathwa kwe-endo-ß-galactosidase (Abase) yokufakelwa okungahambisani ne-ABO. I-Transplant Immunology. Umqulu 20, Ikhishwe 3, January 2009, Amakhasi 132-138. I-DOI: https://doi.org/10.1016/j.trim.2008.09.007 

6. Dogar AW et al 2022. Ukufakelwa kwesibindi somnikeli ophilayo okungahambisani ne-ABO ene-antibody titer engu-1:4: Umbiko wokuqala ovela e-Pakistan. Annals of Medicine and Surgery Volume 81, September 2022, 104463. DOI: https://doi.org/10.1016/j.amsu.2022.104463 

7. Akamatsu N., et al 2021. I-Rituximab Desensitization Kwabamukeli Bokufakelwa Kwesibindi Ngama-Antibodies e-HLA e-HLA afomekiwe ngaphambili: Inhlolovo Yezwe Lase-Japan. Ukufakelwa Okuqondile. 2021 Aug; 7(8): e729. Ishicilelwe ku-inthanethi 2021 Jul 16. DOI: https://doi.org/10.1097/TXD.0000000000001180  

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