{"id":4286,"date":"2022-12-12T14:45:01","date_gmt":"2022-12-12T13:45:01","guid":{"rendered":"https:\/\/www.mc-praha.cz\/mcp\/?p=4286"},"modified":"2022-12-13T10:00:39","modified_gmt":"2022-12-13T09:00:39","slug":"uspesne-pripady-lecby-hiv-pozitivnich-kmenovymi-bunkami","status":"publish","type":"post","link":"https:\/\/www.mc-praha.cz\/mcp\/uspesne-pripady-lecby-hiv-pozitivnich-kmenovymi-bunkami\/","title":{"rendered":"\u00dasp\u011b\u0161n\u00e9 p\u0159\u00edpady l\u00e9\u010dby HIV pozitivn\u00edch kmenov\u00fdmi bu\u0148kami"},"content":{"rendered":"<p><strong>V roce 1988 Sv\u011btov\u00e1 zdravotnick\u00e1 organizace (WHO) vyhl\u00e1sila 1. prosinec Sv\u011btov\u00fdm dnem boje proti AIDS, kdy si ka\u017edoro\u010dn\u011b p\u0159ipom\u00edn\u00e1me ob\u011bti t\u00e9to z\u00e1ke\u0159n\u00e9 nemoci a nutnost b\u00fdt v\u016f\u010di n\u00ed st\u00e1le ve st\u0159ehu. Presto\u017ee HIV pozitivn\u00ed pacienti v\u010das l\u00e9\u010den\u00ed modern\u00edmi l\u00e9ky maj\u00ed dnes nad\u011bji del\u0161\u00edho do\u017eit\u00ed, nen\u00ed dobojov\u00e1no. Definitivn\u00ed l\u00e9k proti HIV je st\u00e1le v nedohlednu, stejn\u011b jako \u00fa\u010dinn\u00e1 o\u010dkovac\u00ed l\u00e1tka. D\u00edky nov\u00fdm v\u011bdeck\u00fdm postup\u016fm, v\u010detn\u011b transplantace kmenov\u00fdch bun\u011bk, v\u0161ak byly v boji s HIV zaznamen\u00e1ny n\u011bkter\u00e9 zaj\u00edmav\u00e9 \u00fasp\u011bchy.<\/strong><\/p>\n<p>AIDS p\u0159edstavuje z\u00e1va\u017en\u00e9 smrteln\u00e9 onemocn\u011bn\u00ed zp\u016fsoben\u00e9 HIV neboli virem lidsk\u00e9 imunodeficience. Vyskytuje se hlavn\u011b v krvi, ejakul\u00e1tu, preejakul\u00e1tu a vagin\u00e1ln\u00edch sekretech. Virus pat\u0159\u00ed mezi retroviry a je p\u0159en\u00e1\u0161en pohlavn\u00edm stykem, kontaktem s krv\u00ed infikovan\u00e9ho jedince nebo z matky na plod. Prim\u00e1rn\u011b napad\u00e1 bu\u0148ky imunitn\u00edho syst\u00e9mu, zejm\u00e9na pomocn\u00e9 T-lymfocyty (typ b\u00edl\u00fdch krvinek) nesouc\u00ed na povrchu receptor CD4. Aby se HIV do t\u011bchto bun\u011bk dostal, mus\u00ed se nejprve nav\u00e1zat na CD4 a n\u011bkter\u00fd z koreceptor\u016f, nap\u0159\u00edklad CCR5. V populaci se vz\u00e1cn\u011b vyskytuje mutace v genu pro CCR5, jej\u00ed\u017e homozygotn\u00ed nositel\u00e9 maj\u00ed lymfocyty bez funk\u010dn\u00edho CCR5, a jsou tak v\u016f\u010di n\u011bkter\u00fdm typ\u016fm HIV imunn\u00ed. V krvi je tento virus detekovateln\u00fd a\u017e od 10. dne po p\u0159enosu, 30. den po infikov\u00e1n\u00ed je hladina HIV protil\u00e1tek nejvy\u0161\u0161\u00ed a naka\u017een\u00fd jedinec je v tomto obdob\u00ed nejv\u00edce infek\u010dn\u00ed. Vzhledem k napaden\u00ed CD4+ T-lymfocyt\u016f se u nel\u00e9\u010den\u00fdch jedinc\u016f \u010dasto objev\u00ed siln\u00e1 imunodeficience a s t\u00edm i \u0159ada zdravotn\u00edch komplikac\u00ed, p\u0159edev\u0161\u00edm infek\u010dn\u00edch, onkologick\u00fdch nebo kardiovaskul\u00e1rn\u00edch.<\/p>\n<p>Pro pacienty je toho \u010dasu dostupn\u00e1 antiretrovirov\u00e1 terapie, kter\u00e1 potla\u010duje replikaci HIV, zlep\u0161uje funkce imunitn\u00edho syst\u00e9mu a sni\u017euje riziko rozvoje AIDS. A\u010dkoli je tato terapie v mnoh\u00fdch p\u0159\u00edpadech \u017eivot prodlu\u017euj\u00edc\u00ed, nen\u00ed stoprocentn\u011b \u00fa\u010dinn\u00e1. Proto v\u011bdci a l\u00e9ka\u0159i testuj\u00ed dal\u0161\u00ed mo\u017en\u00e9 l\u00e9\u010debn\u00e9 metody a postupy, mezi kter\u00e9 pat\u0159\u00ed i netradi\u010dn\u00ed terapie s vyu\u017eit\u00edm kmenov\u00fdch bun\u011bk.<\/p>\n<p>Prvn\u00edm pacientem l\u00e9\u010den\u00fdm kmenov\u00fdmi bu\u0148kami byl tzv. Berl\u00ednsk\u00fd pacient, u kter\u00e9ho byla prok\u00e1z\u00e1na HIV pozitivita v roce 1995. Zdravotn\u00ed stav mu zkomplikovala akutn\u00ed myeloidn\u00ed leuk\u00e9mie (AML). Byla nasazena chemoterapie, kter\u00e1 se v tomto p\u0159\u00edpad\u011b neosv\u011bd\u010dila. O\u0161et\u0159uj\u00edc\u00ed l\u00e9ka\u0159 pacientovi pot\u00e9 nab\u00eddl terapii kmenov\u00fdmi bu\u0148kami z kostn\u00ed d\u0159en\u011b od d\u00e1rce s homozygotn\u00ed mutac\u00ed \u039432 v genu CCR5 (CCR5\u039432\/\u039432), kterou absolvoval v roce 2006. Po transplantaci ihned vysadil antiretrovirotika. Po 3 m\u011bs\u00edc\u00edch nebyly detekov\u00e1ny HIV protil\u00e1tky ani leuk\u00e9mie. Pacient zem\u0159el v roce 2020 na recidivu leuk\u00e9mie, na n\u00ed\u017e opakovan\u00e1 l\u00e9\u010dba kmenov\u00fdmi bu\u0148kami od stejn\u00e9ho d\u00e1rce ji\u017e nezabrala.<\/p>\n<p>V roce 2019 byl hl\u00e1\u0161en\u00fd dal\u0161\u00ed p\u0159\u00edpad pacienta s HIV trp\u00edc\u00edho Hodgkinov\u00fdm lymfomem (tzv. Lond\u00fdnsk\u00fd pacient), kter\u00fd i p\u0159es max. 20% \u0161anci na p\u0159e\u017eit\u00ed podstoupil v roce 2016 transplantaci kmenov\u00fdch bun\u011bk z kostn\u00ed d\u0159en\u011b od vhodn\u00e9ho d\u00e1rce s mutac\u00ed v genu CCR5. Rok po transplantaci vysadil l\u00e9ky a zd\u00e1 se, \u017ee jeho nemoc je prozat\u00edm v remisi.<\/p>\n<p>Letos byl uve\u0159ejn\u011bn p\u0159\u00edpad HIV pozitivn\u00ed 66let\u00e9 Ameri\u010danky s AML, kter\u00e1 podstoupila v roce 2017 transplantaci kmenov\u00fdch bun\u011bk z pupe\u010dn\u00edkov\u00e9 krve od d\u00e1rce imunn\u00edho v\u016f\u010di kmeni HIV, kter\u00fd byl u t\u00e9to pacientky detekov\u00e1n. Po 36 m\u011bs\u00edc\u00edch od transplantace p\u0159estala pacientka u\u017e\u00edvat l\u00e9ky a po 14 m\u011bs\u00edc\u00edch od vysazen\u00ed l\u00e9k\u016f u n\u00ed nebyly detekov\u00e1ny rezervo\u00e1ry replika\u010dn\u00edch \u010d\u00e1stic viru, HIV protil\u00e1tky, a dokonce byla prok\u00e1z\u00e1na odolnost in vitro v\u016f\u010di laboratorn\u00edmu a autologn\u00edmu HIV viru. Nemoc je prozat\u00edm v remisi a pacientka je nad\u00e1le pod p\u0159\u00edsn\u00fdm dohledem l\u00e9ka\u0159\u016f.<\/p>\n<p>Na z\u00e1klad\u011b uveden\u00fdch p\u0159\u00edklad\u016f se l\u00e9\u010dba HIV pomoc\u00ed transplantace kmenov\u00fdch bun\u011bk jev\u00ed jako jedna z mo\u017en\u00fdch strategi\u00ed, p\u0159esto\u017ee je aplikovateln\u00e1 jen v ur\u010dit\u00fdch p\u0159\u00edpadech, je spojen\u00e1 s \u010dasovou i finan\u010dn\u00ed n\u00e1ro\u010dnost\u00ed a v neposledn\u00ed \u0159ad\u011b i se zdravotn\u00edmi riziky.<\/p>\n<p>Mgr. Krist\u00edna \u0160urekov\u00e1<\/p>\n<p>12.12.2022<\/p>\n<p>Zdroje:<\/p>\n<p>Deeks SG, Overbaugh J, Phillips A, Buchbinder S (2015): HIV infection. Nature Reviews Disease Primers, 1, 1-22.<br \/>\nBrown TR (2015): I am the Berlin pacient: a personal reflection. AIDS Research and Human Retroviruses, 31, 2-3.<br \/>\nH\u00fctter G, Nowak D, Mossner M, Ganepola S, M\u00fc\u03b2ig A, Allers K, Schneider T, Hofmann J et al. (2009): Long-term control of HIV by CCR5 Delta32\/Delta32 stem-cell transplantation. The New England Journal of Medicine, 360, 692-698.<br \/>\nGupta RK, Peppa D, Hill AL, G\u00e1lvez C, Salgado M, Pace M, McCoy LE, Griffith SA et al. (2020): Evidence for HIV-1 cure after CCR5\u039432\/\u039432 allogeneic haemopoietic stem-cell transplantation 30 months post analytical treatment interruption: a case report. Lancet, 7, e-340-47.<br \/>\nBryson Y et al. (2022): HIV-1 remission with CCR5 \u039432\u039432 haplo-cord transplant in a US woman: IMPAACT P1107. CROI Boston. https:\/\/www.impaactnetwork.org\/sites\/default\/files\/inline-files\/Final%20IMPAACTP1107_FINAL%20CROI%20%20revised%2012Feb2022%20BRYSON%203.pdf<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>V roce 1988 Sv\u011btov\u00e1 zdravotnick\u00e1 organizace (WHO) vyhl\u00e1sila 1. prosinec Sv\u011btov\u00fdm dnem boje proti AIDS, [&hellip;]<\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"image","meta":{"_uag_custom_page_level_css":""},"categories":[1],"tags":[],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false,"boldthemes_grid":false,"boldthemes_grid_11":false,"boldthemes_grid_22":false,"boldthemes_grid_21":false,"boldthemes_grid_12":false,"boldthemes_latest_posts":false,"boldthemes_grid_gallery":false},"uagb_author_info":{"display_name":"Ane\u017eka Klubalov\u00e1","author_link":"https:\/\/www.mc-praha.cz\/mcp\/author\/aklubalova\/"},"uagb_comment_info":0,"uagb_excerpt":"V roce 1988 Sv\u011btov\u00e1 zdravotnick\u00e1 organizace (WHO) vyhl\u00e1sila 1. prosinec Sv\u011btov\u00fdm dnem boje proti AIDS, [&hellip;]","post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/posts\/4286"}],"collection":[{"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/comments?post=4286"}],"version-history":[{"count":4,"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/posts\/4286\/revisions"}],"predecessor-version":[{"id":4291,"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/posts\/4286\/revisions\/4291"}],"wp:attachment":[{"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/media?parent=4286"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/categories?post=4286"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.mc-praha.cz\/mcp\/wp-json\/wp\/v2\/tags?post=4286"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}