Ka pōkole o ke kino no ka hoʻololi ʻana: ka hoʻololi ʻana i ka Enzymatic o ka pūʻulu koko o nā ʻōpū hāʻawi a me nā māmā 

Me ka hoʻohana ʻana i nā enzyme kūpono, ua hoʻoneʻe nā mea noiʻi i nā antigens hui koko ABO mai ka mea hāʻawi a me ka māmā ex-vivo, e lanakila ai i ka like ʻole o ka hui koko ABO. Hiki i kēia ala ke hoʻoponopono i ka hemahema o ke kino ma o ka hoʻomaikaʻi ʻana i ka loaʻa ʻana o nā ʻano mea hāʻawi no ka hoʻololi ʻana a hoʻolilo i ke kaʻina o ka hoʻokaʻawale ʻana i ke kino i ʻoi aku ka maikaʻi a ʻoi aku ka maikaʻi. 

Ma kahi noiʻi i paʻi ʻia, ua hoʻohana nā mea noiʻi i kahi enzyme alpha-galactosidase mai Pāpale bacteria a ua hoʻopau maikaʻi ʻia ke ʻano B hui koko nā antigens mai ke kanaka nā puʻupaʻa (ʻaʻole i hoʻohana ʻia no ka hoʻololi ʻana) i ka wā ex-vivo perfusion ma laila e hoʻohuli ai i ka pūʻulu koko o ka puʻupaʻa i mea hāʻawi honua O. ʻO kēia ka hihia mua o ke kino holoʻokoʻa ABO ke koko ka hoʻololi ʻana o ka hui i nā kānaka ma o ka wehe ʻana i ka enzymatic o ke ʻano B ke koko hui antigens¹. 

Ma kekahi noiʻi like ʻole e pili ana i nā māmā, ua hoʻohuli nā ʻepekema ke koko pūʻulu A māmā i ke koko pūʻulu O i ka wā ex-vivo lung perfusion me ka hoʻohana ʻana i ʻelua enzymes, FpGalNAc deacetylase a me FpGalactosaminidase. ʻAʻole i ʻike ʻia nā loli koʻikoʻi i ke olakino o ka māmā me ka hōʻeha antibody-mediated^2,3.  

e like me ke koko ʻO ka hoʻololi ʻana, ʻo ka hui ʻana o ka hui koko ABO ka mea nui i ka hoʻokaʻawale ʻana o nā ʻōpū i waena o ka poʻe e loaʻa ana. ʻO ka loaʻa ʻana o nā antigens A a/a i ʻole B i loko o nā ʻāpana hāʻawi e hoʻokaʻawale a paʻa. ʻO ka hopena, ʻaʻole kūpono ka hoʻokaʻawale ʻana. Hiki ke hoʻololi i ka ABO ke koko ʻO ka hui o nā okano ex-vivo i ka mea hāʻawi honua ma o ka wehe ʻana i nā antigens A a / a i ʻole B e hoʻonui i ka wai o nā mea hāʻawi kūpono ABO e hoʻonā i ka pilikia o ka hemahema o ke kino a hoʻomaikaʻi i ka pono o ka hoʻokaʻawale ʻana i nā ʻāpana hoʻololi ʻana.   

Ua hoʻāʻo ʻia kekahi mau ala (e like me ka wehe ʻana i ka antibody, splenectomy, anti-CD20 monoclonal antibody, a me ka immunoglobulin intravenous) i ka wā ma mua e hoʻomaikaʻi i ka kūleʻa o ka hoʻololi ʻana akā naʻe, ua mau ka pilikia o ka ABO incompatibility. ʻO ka manaʻo e hoʻopau enzymatically i nā antigens A/B i hele mai i ka makahiki 2007 i ka wā i hōʻemi hapa ai nā mea noiʻi i nā antigens A/B i loko o ka baboon me ka hoʻohana ʻana i ka enzyme ABase⁴. Ma hope koke iho, ua hiki iā lākou ke wehe i 82% o A antigen a me 95% o B antigen i ke kanaka A/B ulaula ke koko nā pūnaewele e hoʻohana ana iā ABase⁵.  

ʻO ka hoʻokokoke ʻana o ka enzymatic A/B antigen wehe ʻia mai nā ʻāpana hāʻawi i piʻi i ka makahiki no ka hoʻololi ʻana i ka ʻōpū a me ka māmā. Eia naʻe, liʻiliʻi nā mea hōʻike i nā palapala e pili ana i ka hoʻohana ʻana i kēia ala i ka transplants ate. Akā, desensitisation^6,7 me nā pūʻali Me he mea lā e paʻa ana i ka ʻōlelo hoʻohiki no ka hoʻonui ʻana i ka kūleʻa a me ka pūnāwai o ka hoʻololi ʻana i ke ake.  

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E hoʻomaopopo ': 

1. S MacMillan, SA Hosgood, ML Nicholson, O004 ke koko ka wehe ʻana o ka hui antigen o kahi puʻupaʻa kanaka me ka hoʻohana ʻana i ka ʻenehana ex-vivo normothermic machine perfusion, British Journal of Surgery, Volume 109, Issue Supplement_4, ʻAukake 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., ¶ AL 2021. Hoʻomohala ʻana i nā māmā hāʻawi koko ʻano ABO Universal me Ex Vivo Enzymatic Treatment: He Hōʻoiaʻiʻo o ka Manaʻo Feasibility Stud. ʻO ka Journal of Heart and Lung Transplantation. Volume 40, Puka 4, Pākuʻi, s15-s16, ʻApelila 01, 2021. DOI: https://doi.org/10.1016/j.healun.2021.01.1773 

3. Wang A., ¶ AL 2022. Hoʻololi ka lapaʻau ex vivo enzymatic i nā māmā hāʻawi koko ʻano A i mau māmā ʻano koko āpau. ʻEpekema Translational Medicine. 16 Feb 2022. Vol 14, Puka 632. DOI: https://doi.org/10.1126/scitranslmed.abm7190  

4. Kobayashi, T., ¶ AL 2007. Hoʻolālā ʻokoʻa no ka lanakila ʻana i ka ABO Incompatibility. Hoʻololi: Mei 15, 2007 - Volume 83 - Puka 9 - p 1284-1286. DOI: https://doi.org/10.1097/01.tp.0000260634.85690.c4 

5. Kobayashi T., ¶ AL 2009. Ka wehe 'ana i ka hui koko A/B antigen i loko o nā kino e ex vivo a me in vivo ho'oponopono o endo-ß-galactosidase (ABase) no ka ABO-incompatible transplantation. Hoʻololi i ka Immunology. Volume 20, Puka 3, Ianuali 2009, ʻaoʻao 132-138. DOI: https://doi.org/10.1016/j.trim.2008.09.007 

6. Dogar AW ¶ AL 2022. ABO incompatible live donor ate transplant with antibody titer of 1:4: ʻO ka hōʻike hihia mua mai Pakistan. Nā Annals of Medicine and Surgery Volume 81, September 2022, 104463. DOI: https://doi.org/10.1016/j.amsu.2022.104463 

7. Akamatsu N., ¶ AL 2021. ʻO Rituximab Desensitization i ka poʻe e loaʻa ana i ka hoʻololi ʻana i ke akepaʻa me ka hāʻawi mua ʻana i nā antibodies HLA kikoʻī kikoʻī: He Nānā Lahui Kepani. Hoʻololi pololei. 2021 ʻAukake; 7(8): e729. Paʻi ʻia ma ka pūnaewele 2021 Jul 16. DOI: https://doi.org/10.1097/TXD.0000000000001180  

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