Organ Shortage for Transplantation: Enzymatic Conversion of Blood Group of Pub raum thiab ntsws 

Siv cov enzymes tsim nyog, cov kws tshawb fawb tshem tawm ABO cov ntshav pab pawg antigens los ntawm cov neeg pub lub raum thiab lub ntsws ex-vivo, kom kov yeej ABO cov ntshav tsis sib haum. Txoj hauv kev no tuaj yeem daws qhov tsis txaus ntawm lub cev los ntawm kev txhim kho qhov muaj cov khoom nruab nrog cev rau kev hloov pauv ntau thiab ua kom cov txheej txheem ntawm kev faib khoom nruab nrog cev ncaj ncees thiab ua haujlwm tau zoo dua. 

Hauv kev tshawb fawb uas nyuam qhuav luam tawm, cov kws tshawb fawb tau siv cov enzyme alpha-galactosidase los ntawm Bacteroides fragilis thiab tau tshem tawm cov antigens ntawm pawg ntshav hom B ntawm tib neeg lub raum (uas tseem tsis tau siv rau kev hloov pauv) thaum lub sijhawm ex-vivo perfusion yog li hloov cov pawg ntshav ntawm lub raum mus rau tus neeg pub dawb O. Qhov no yog thawj qhov xwm txheej ntawm tag nrho cov ntshav ABO hloov pauv hauv tib neeg los ntawm kev tshem tawm cov antigens ntawm pawg ntshav hom B ¹.

Hauv lwm txoj kev tshawb fawb zoo sib xws txog lub ntsws, cov kws tshawb fawb tau hloov cov ntshav pawg A rau cov ntshav pawg O thaum lub sijhawm ex-vivo lub ntsws perfusion siv ob lub enzymes, FpGalNAc deacetylase thiab FpGalactosaminidase. Tsis muaj kev hloov pauv tseem ceeb hauv kev noj qab haus huv ntawm lub ntsws suav nrog kev raug mob los ntawm cov tshuaj tiv thaiv kab mob tau pom ^2,3.

Ib yam li kev hloov ntshav , kev sib phim pawg ntshav ABO yog qhov tseem ceeb hauv kev faib cov noob caj noob ces ntawm cov neeg tau txais. Muaj cov antigens A thiab/lossis B hauv cov noob caj noob ces pub dawb ua rau kev faib xaiv thiab txwv. Yog li ntawd, kev faib tsis ua haujlwm zoo. Lub peev xwm hloov pawg ntshav ABO ntawm cov noob caj noob ces ex-vivo mus rau cov neeg pub dawb thoob ntiaj teb los ntawm kev tshem tawm cov antigens A thiab/lossis B yuav nthuav dav cov noob caj noob ces pub dawb sib xws ABO kom daws tau qhov teeb meem ntawm kev tsis txaus noob caj noob ces thiab txhim kho kev ncaj ncees hauv kev faib cov noob caj noob ces rau kev hloov pauv.

Muaj ntau txoj kev (xws li kev tshem tawm cov tshuaj tiv thaiv kab mob, kev phais lub noob qes, tshuaj tiv thaiv CD20 monoclonal antibody, thiab tshuaj immunoglobulin rau hauv cov hlab ntsha) tau raug sim ua ntej los txhim kho kev vam meej ntawm kev hloov pauv txawm li cas los xij qhov tsis sib xws ntawm ABO tseem yog teeb meem. Cov lus qhia kom tshem tawm cov tshuaj A/B antigens los ntawm enzymatically tau tshwm sim hauv xyoo 2007 thaum cov kws tshawb fawb tau txo cov tshuaj A/B antigens hauv baboon siv ABase enzyme ^4. Tsis ntev tom qab ntawd, lawv tau tshem tawm 82% ntawm A antigen thiab 95% ntawm B antigen hauv tib neeg cov ntshav liab A/B siv ABase ⁵.

Txoj kev siv enzymatic A/B antigen los tshem tawm ntawm cov noob qes pub dawb tau dhau los ua ib txoj kev hloov raum thiab ntsws. Txawm li cas los xij, tsis muaj pov thawj ntau hauv cov ntaub ntawv txog kev siv txoj kev no rau kev hloov siab. Hloov chaw, kev txo qhov rhiab heev ^6,7 nrog cov tshuaj tiv thaiv kab mob zoo li muaj kev cia siab rau kev txhim kho kev vam meej nrog rau kev hloov siab ntau dua.

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References: 

1. S MacMillan, SA Hosgood, ML Nicholson, O004 ntshav pab pawg antigen tshem tawm ntawm tib neeg lub raum siv ex-vivo normothermic tshuab perfusion technology, British Journal of Surgery, Volume 109, Issue Supplement_4, August 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., thiab al 2021. Tsim Universal ABO Ntshav Hom Pub Lungs nrog Ex Vivo Enzymatic Treatment: Ib Daim Ntawv Pov Thawj ntawm Lub Tswv Yim Feasibility Stud. Phau ntawv Journal of Heart and Lung Transplantation. Volume 40, Issue 4, Supplement, s15-s16, April 01, 2021. DOI: https://doi.org/10.1016/j.healun.2021.01.1773 

3. Wang A., thiab al 2022. Ex vivo enzymatic kev kho mob hloov cov ntshav hom A pub rau lub ntsws mus rau hauv lub ntsws universal. Science Translational Tshuaj. 16 Feb 2022. Vol 14, Issue 632. DOI: https://doi.org/10.1126/scitranslmed.abm7190  

4. Kev, T., thiab al 2007. Lwm Lub Tswv Yim rau Kev Tshaj Tawm ABO Incompatibility. Kev hloov pauv: Tsib Hlis 15, 2007 - Ntu 83 - Nqe 9 - p 1284-1286. DOI: https://doi.org/10.1097/01.tp.0000260634.85690.c4 

5. Kobayashi T. thiab al 2009. Kev tshem tawm cov ntshav pab pawg A/B antigen hauv lub cev los ntawm ex vivo thiab hauv vivo tswj hwm endo-ß-galactosidase (ABase) rau ABO-incompatible transplantation. Hloov Immunology. Nqe 20, Nqe 3, Lub Ib Hlis 2009, Nplooj 132-138. DOI: https://doi.org/10.1016/j.trim.2008.09.007 

6. Dogar AW thiab al 2022. ABO incompatible nyob pub lub siab hloov nrog cov tshuaj tiv thaiv titer ntawm 1: 4: Thawj rooj plaub qhia los ntawm Pakistan. Annals of Medicine and Surgery Volume 81, September 2022, 104463. DOI: https://doi.org/10.1016/j.amsu.2022.104463 

7. Akamatsu N., thiab al 2021. Rituximab Desensitization nyob rau hauv daim siab Transplant Recipients With Preformed Donor-specific HLA Antibodies: A Japanese Nationwide Survey. Hloov Direct. Aug 2021; 7 (8): e729. Published online 2021 Jul 16. DOI: https://doi.org/10.1097/TXD.0000000000001180  

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