Isifo i-Alzheimer's sisalokhu singenye yezinselelo ezinkulu zezempilo zekhulu lama-21. Njengoba abantu abangaphezu kwezigidi ezingu-57 bethintekile emhlabeni wonke futhi ukubikezela okubonisa ukuthi kuzoba nezigidi ezingu-139 ngo-2050, umphakathi wesayensi kanye nezinhlelo zezempilo bafuna ngabomvu amathuluzi okuxilongwa kusenesikhathi kanye nokwelashwa ukuze banciphise inqubekela phambili yaso. Kulesi simo, intuthuko kuma-biomarker kanye nezici eziyingozi iyabusa ezindabeni, kodwa futhi idala impikiswano enkulu mayelana nokufinyelela ngokulinganayo kuzo.
ESpain, isinqumo sakamuva esenziwe nguMnyango Wezempilo sokukhipha imithi i-lecanemab (Leqembi) kanye ne-donanemab (Kisunla), ukwelashwa kokuqala okukhonjiswe ukuthi kubambezela ukuqhubeka kwesifo i-Alzheimer's, kusuka ekuxhasweni komphakathi kudale ukungezwani phakathi kukahulumeni kanye neziguli eziyinhloko kanye nezinhlangano ezikhethekile. Okwamanje, ucwaningo luqhubeka ngokushesha: kusukela ekuhlolweni kwegazi okuthola lesi sifo ngokunemba okungaphezu kuka-90% kuya kuma-nanoparticles akwazi ukuvuselela ama-neurons kumamodeli ezilwane. Konke lokhu kwenzeka esimweni lapho ukucwaswa komphakathi kusalokhu kuyisithiyo ekuxilongweni kwasekuqaleni.
Ukuhlolwa kwegazi: inguquko ekuxilongweni kwasekuqaleni
Ukuqinisekiswa kwesifo i-Alzheimer's kuye kwathembela ezindleleni ezihlaselayo noma ezibizayo, njengezimbobo ze-lumbar noma i-positron emission tomography (PET) scans. Kodwa-ke, ukuhlolwa kwegazi okusekelwe ku-biomarker kuyawushintsha umdlalo . I-US FDA muva nje igunyaze ukuhlolwa kwe-Elecsys pTau217, okwakhiwe nguRoche no-Eli Lilly, okulinganisa iphrotheni ye-p-tau217 futhi kubikezela ngokunembile ukuqongelela kwama-beta-amyloid plaques ebuchosheni. Lokhu kuhlolwa, osekuvunyelwe kakade eYurophu ngoMeyi, kuzotholakala kubahlaziyi belabhoratri abangaphezu kuka-4.500 e-United States, okwandisa kakhulu ukufinyelela ekuhlolweni okungahlaseli kakhulu.
Kodwa lokhu kusungula izinto akugcini lapho. Ithimba labacwaningi e-Xuanwu Hospital yaseBeijing Capital Medical University lisungule indlela yokuxilonga esekelwe egazini esebenzisa i-real-time ultrasound-guided protein misfolding cyclic amplification (PMCA) ukuthola umsebenzi wokutshala imbewu we-beta-amyloid aggregation ku-plasma. Imiphumela, eyanyatheliswa kuyi-Chinese Medical Journal, ikhombisa ukunemba kokuxilonga okungaphezu kuka-90% eqenjini lokuqinisekisa, elalihlanganisa abahlanganyeli abangu-429. Le ndlela, eqeda ukuxilonga zingakapheli amahora angu-24, ingahlonza ama-oligomers e-Aβ ngamanani aphansi njenge-1 femtomol, okwenza kube ithuluzi elithembisayo lokuhlola i -Alzheimer's kusenesikhathi kusetshenziswa ama-biomarker ekunakekelweni okuyinhloko.
Kubalulekile ukuqaphela ukuthi lokhu kuhlolwa kwegazi akuzona izivivinyo zokuxilonga ezizimele. Njengoba ilabhorethri eyakha i-Elecsys pTau217 ixwayisa, umphumela omuhle ubonisa amathuba aphezulu e-amyloid pathology, kodwa ayisunguli ukuxilongwa ngokwayo ngaphandle kokuhlolwa okuphelele kwezokwelapha . Ukuchazwa kumele kwenziwe kanye nolunye ulwazi lwezokwelapha, futhi kungenzeka ukuthi kube nemiphumela engamanga noma imiphumela engacaci. Noma kunjalo, ukulula kwalezi zivivinyo, njengokusebenzisa ithonsi elilodwa legazi ukuthuthukisa ukuxilongwa , kuzosiza iziguli nemindeni ukuqinisekisa noma ukuqeda i-Alzheimer's ezigabeni zokuqala, lapho ukungenelela kungasebenza kangcono.
ISpain, iphakathi kwengxoxo ngokufinyelela ekwelashweni
Isinqumo se-Interministerial Commission on Drug Prices (CIPM) ngoJulayi 15 sokukhipha i-lecanemab kanye ne-donanemab efomini yomphakathi ye-National Health System (SNS) sibangele ukusabela okunamandla. I-Spanish Society of Neurology (SEN), i-Spanish Confederation of Alzheimer's and Other Dementias (Ceafa), kanye ne-Alzheimer Hub Barcelona bakholelwa ukuthi lokhu kukhishwa kwephula isimiso sokulingana ngaphakathi kwe-NHS futhi kushiya iziguli zilahliwe . Umongameli we-SEN, uJesús Porta-Etessam, uxwayisa ngokuthi ukufinyelela ekwelashweni okuvunyelwe yi-European Medicines Agency (EMA) kuyanqatshelwa kubantu abangase babhekane nokuncipha kokuqhubeka kwalesi sifo.
Le ngxabano inomqondo wokuziphatha ongenakugwenywa. Odokotela bezinzwa bangahlangana neziguli ezihlangabezana nezindinganiso zokuthola ukwelashwa okukwazi ukunciphisa lesi sifo, kodwa ezingakwazi ukukufinyelela ngenxa yezizathu zomnotho uma kufanele zisebenzise imboni ezizimele. Ukunciphisa ukufinyelela kulabo abangakwazi ukukukhokhela kuletha isithiyo sezomnotho esiphula isimiso sokulingana , kuphawula uPorta-Etessam. Ngakolunye uhlangothi, umqondisi omkhulu weCeafa, uJesús María Rodrigo, ubiza lesi sinqumo ngokuthi "asifaneleki" futhi uveza ukuthi le mithi itholakala emazweni angaphezu kwamashumi amahlanu kanye nohlelo lokunakekelwa kwempilo oluzimele lwaseSpain. "Awukwazi ukubeka intengo emisha," ugcizelela.
Ochwepheshe abaphakamisi ukufakwa okungenamibandela kwalezi zindlela zokwelapha ohlelweni lokunakekelwa kwempilo yomphakathi, kodwa kunalokho ukufinyelela okuhlelekile nokulawulwayo okuzovumela uhlelo ukuthi luzivumelanise nesigaba esisha sokwelashwa kwe-Alzheimer's. Ukunikeza le mithi kudinga ukuthola lesi sifo ezigabeni zaso zokuqala, ukuqinisekisa ukuxilongwa ngokusebenzisa ama-biomarker, kanye nokusungula ukulandelwa okukhethekile , okungaqinisekisa imodeli yokufinyelela ngezigaba. I-Alzheimer's Hub Barcelona ithumele incwadi evulekile kuMnyango Wezempilo icela ifomula yokufaka lezi zindlela zokwelapha ohlelweni lomphakathi, ixwayisa ngokuthi "iSpain ayikwazi ukuphuthelwa" leli thuba.
Ucwaningo olusezingeni eliphezulu: ama-nanoparticles kanye ne-magnetic resonance
Ngenkathi impikiswano yokuxhaswa ngezimali iqhubeka, isayensi ihlola izindlela ezintsha. Ucwaningo olushicilelwe kumagazini i-Cell Biomaterials lukhombisile ukuthi ama-nanoparticles aklanywe ngendlela ehlelekile angavuselela ama-neurons kuma-organoids obuchopho bomuntu futhi abuyisele izifunda ze-neural kumagundane . Uhlelo lwe-Nano-ERASER, olwakhiwe yi-University of South Carolina, lusebenzisa ama-antibodies ukonakalisa iphrotheni ye-PTBP1 kuma-astrocyte, okubangela ukuba abe ama-neurons asebenzayo. Ngemva kokujova kabili nje, amagundane aphathwe abonise ukwanda kobuningi be-neuronal, ukwehla kokuvuvukala kwe-neuroinflammation, kanye nokuthuthuka okuphawulekayo ekufundeni nasekukhumbuleni.
Kolunye ucwaningo, ososayensi e-Mass General Brigham Neuroscience Institute bathole ukuthi iphethini yokuwohloka kobuchopho ebonakalayo kuma-MRI scan ingabikezela ukuthi isifo i-Alzheimer's siqala ngokushesha kangakanani . Ucwaningo, olushicilelwe ku-Neurology, luhlaziye idatha evela kubantu abangu-130 abaneminyaka ephakathi kuka-40 no-64 abanokukhubazeka okuncane kokuqonda. Ngesikhathi sokulandelela okujwayelekile kweminyaka emibili, ama-65% athuthukela ekubeni yi-dementia, kanti labo abanokukhubazeka okukhulu ezindaweni eziphethe inkumbulo nokucabanga babenamathuba amaningi okuthola i-dementia kusenesikhathi. Lolu lwazi lungasiza iziguli, imindeni, nodokotela ukuthi bahlele ukunakekelwa kwesikhathi esizayo kanye nezindlu.
Ngaphezu kwalokho, ucwaningo oluholwa ngumcwaningi uTeodora Markova waseBrandeis University luveze ukuthi amazinga aphezulu eprotheyini ye-tau ahlobene kakhulu nokwehla kwemizwa ngesikhathi sokuguga . Ucwaningo, olushicilelwe ku-JNeurosci, luphawule ukuthi izinga lokuqongelela kwe-tau ebuchosheni lilawule ngqo ukuthi imizwa yabahlanganyeli yayiba mibi ngokushesha kangakanani, ngisho nakubantu abanamakhono okuqonda aphelele. Lokhu okutholakele kusikisela ukuthi ukuqapha izindlela zengqondo kungahambisana nezinye izinyathelo zezokwelapha ekuhloleni ingozi yokuthola izifo eziwohlokayo zemizwa.
Isici somuntu: ukuphula isihlamba
Phakathi kwentuthuko yesayensi kanye nezingxoxo zezombusazwe, indaba yomlingisi waseBrithani oneminyaka engu-85 ubudala uPeter Marinker inikeza isifundo ngobuntu kanye nokuqina. Etholakale ene-Alzheimer's eminyakeni emibili edlule, uMarinker ulungiselela ukudlala umdlalo kaSamuel Beckett ojulile othi "Krapp's Last Tape" eyedwa eCockpit Theatre yaseLondon. Ithimba lokukhiqiza lishintshe lo mdlalo ngezikrini ze-teleprompter, i-earpiece encane, kanye nomphathi wesiteji esiteji ukuze amkhumbuze imigqa yakhe uma ekhohlwa. Umqondisi uDave Wybrow ugcizelela ukuthi akukhona "ukufihla" lesi sifo, kodwa mayelana nokubonisa ukuthi umsebenzi wokubambisana nowokudala usengenzeka ngemuva kokuxilongwa.
Indaba kaMarinker ibaluleke kakhulu uma kubhekwa idatha evela kwi-Alzheimer's Society: abantu abangu-42% abaphila ne-dementia bazizwa benamahloni ngezimpawu zabo , kanti umuntu oyedwa kwabahlanu abanezinkinga zokukhumbula ugwema ukuya kudokotela ngenxa yokwesaba ukusabela kwabangane nomndeni. Ubandlululo luhlala luyisithiyo esikhulu ekuxilongweni kusenesikhathi. "Lokho uPeter akwenzayo kugqamisa ukuthi ukuxilongwa akusona ukuphela," kusho uTaiyaba Zeria, umqondisi wezinsizakalo zokusekela i-dementia e-Alzheimer's Society eLondon. UMarinker, owake wadlala le ndima ngo-1983, uchaza lo msebenzi njengengoma yakhe "emangalisayo ye-swan": "Ngisesigabeni sokuqala salesi sifo, ngakho-ke ngidinga ukusebenzisa kahle lesi sigaba futhi ngizilungiselele ngangokunokwenzeka esigabeni esiphakathi," esho ehleka kancane.
Ekugcineni, inhlanganisela yentuthuko yokuxilonga, izindlela zokwelapha ezintsha, kanye nokulwa nobandlululo kuveza isithombe esinethemba kodwa esiyinkimbinkimbi. Umphakathi wesayensi uyavuma ukuthi ukutholwa kusenesikhathi kanye nokufinyelela ngokulinganayo ekwelashweni kubalulekile ekushintsheni inkambo yesifo . Ngenkathi iSpain iphikisana ngokuthi ingafakwa kanjani imithi emisha ohlelweni lwayo lwezempilo lomphakathi, ucwaningo luyaqhubeka nokuqhubekela phambili kumathuluzi anembe kakhulu futhi angangeni kakhulu. Inselelo ayiyona nje isayensi, kodwa futhi ingokwezenhlalo nakwezepolitiki: ukuqinisekisa ukuthi izinzuzo zokusungula izinto ezintsha zifinyelela kuzo zonke iziguli, kungakhathaliseki ukuthi zingakanani ngokwezimali. Indaba kaPeter Marinker, intuthuko kuma-biomarker, kanye nezindlela zokwelapha ezintsha zinikeza izizathu zethemba, kodwa futhi zisebenza njengesikhumbuzo sokuthi kuningi okusamele kwenziwe ukuguqula isifo i-Alzheimer's kusuka ekuxilongweni okubi kube yisimo esilawulekayo umuntu angaphila naso ngesithunzi.
