“ GA – Tubernak ”-i filtvis rezistentuli tuberkulozis ( MDR-TB ) imunoTerapiaSi

1. “GA–Tubernak”-i filtvis rezistentuli tuberkulozis (MDR-TB) imunoTerapiaSi l. vaSakiZe, v. toronjaZe, q. barbaqaZe, m. gaCeCilaZe tuberkulozis da filtvis daavadebaTa erovnuli centri

2. tuberkulozi warmoadgens monoinfeqciuri daavadebiT gamowveuli sikvdilianobis mTavar mizezs da dReisaTvis rCeba msoflio jandacvis seriozul problemad. • tuberkulozTan dakavSirebuli erT-erTi urTulesi problema, romelmac bolo dros iCina Tavi, aris daavadebis rezistentuli formebi MDRTB, XDRTB da XXDRTB anu daavadeba, romelic gamowveulia mikobaqteriebis wamlebisadmi gamZle formebiT.

3. rezistentuli tuberkulozi ar emorCileba standartul antiTB qimioTerapias da misi mkurnaloba saWiro xdeba me-2 rigis preaparatebiT, romlebic zogadad naklebefeqturia da amave dros xasiaTdeba mZime gverdiTi movlenebiT. • antiTB qimiopreaparatebis Zlieri toqsikuri moqmedeba da umarTavi gverdiTi movlenebi xSirad xdeba mkurnalobis Sewyvetis da misi araefeqturobis mizezi

4. medikosebis Zalisxmeva mimarTulia qimioTerapiis efeqturobis amaRlebisken, rac maT Soris gulisxmobs: _ qimiopreaparatebis toqsikuri gverdiTi movlenebis Semsubuqebas _ makroorganizmis imunorezistentobis amaRlebas • makroorganizmis imunorezistentobis amaRleba erT-erTi aucilebeli pirobaa tuberkulozis efeqturi mkurnalobis, gansakuTrebiT _ rezistentuli formebis dros

5. dadgenilia, rom tuberkulozis dros, gansakuTrebiT misi mZime formebis SemTxvevebSi imunur sistemaSi mimdinare cvlilebebi dakavSirebulia ZiriTadad T _ sistemis deficitTan, romelic win uswrebs an viTardeba daavadebis procesSi da gvxvdeba 80-90%. • cvlilebebi xasiaTdeba imunokompetentur ujredebSi ganviTarebuli struqturuli cvlilebebiT, rac T limfocitebis damaregulirebeli subpopulaciebis deficits iwvevs.

6. fTiziatriul praqtikaSi aris sakmao gamocdileba imunoTerapiis da imuno-modulatorebis gamoyenebis (levomizoli, natrinukleinati da a.S.) dadebiTi Sedegebis Sesaxeb • am mimarTulebiT Cveni yuradReba miipyro samamulo warmoebis, mcenareuli warmoSobis peptiduri bunebis samkurnalo saSualebam GA-Tubernak – ma, romelic warmoadgens imunotropuli Tvisebebis mqone peptidebis standartizebul kompleqss.

7. GA-Tubernak- i Seqmnilia cnobili preparatis GA-40 bazaze. • afinuri da ioncvladi qromatografiis meTodiT GA-40 –gan amoRebulia citotoqsikuri aqtivobis peptidebi da miRebulia axali imunotropuli kombinacia • GA-Tubernak – i Seicavs 7 mcire zomis peptids molekuluri masiT 10/50 kilodaltoni • wina klinikuri kvlevebis procesSi dadgenili GA-Tubernak – is imunoTerapiuli moqmedeba

8. kvleva daigegma da Catarda saqarTvelos Sromis, janmrTelobis da socialuri dacvis saministros samedicino saqmianobis saxelmwifo regulirebis saagentos momarTvis safuZvelze tuberkulozis da filtvis daavadebaTa erovnul centrSi 2009 w 1 oqtombridan _ 2010 wlis Tebervlis CaTvliT.

9. kvlevis mizani iyo samamulo warmoebis preparatis GA-Tubernak – is moqmedebis efeqturobis Sefaseba filtvis tuberkuloziT daavadebul pirTa kompleqsur paTogenozur mkurnalobaSi • kvlevis amocanebSi Sedioda preparatis moqmedebis Sefaseba: _ pacientebis klinikur-laboratoriuli monacemebis dinamikaze _ imunologiuri maCveneblebis dinamikaze _ qimiopreparatebis gverdiT movlenebze da maTi marTvis procesze _ preparatis usafrTxoebis Sefaseba

10. kvleva Catarda filtvis tuberkulozis rezistentuli formiT (MDRTB) daavadebul 50 pacientTan (werilobiTi Tanxmobis Semdeg) • 30 pacienti iyo ZiriTadi jgufi, sadac standartuli antiTB qimioTerapiasTan erTad tardeboda imunoTerapia GA-Tubernak – iT • 20 pacienti iyo sakontrolo jgufi, sadac tardeboda mxolod standartuli antiTB qimioTerapia (gaidlainis mixedviT) • kvlevaSi CarTvis Cvenebas warmoadgenda limfopenia (<19%), rogorcimunosupresis gamoxatuleba

11. cxrili #1P pacientebis ganawileba sqesis da asakis mixedviT

12. yvela pacients kvlevis dawyebis win da dinamikaSi 2-jer utardeboda klinikur _Ro” da laboratoriuli gamokvleva • imunologiuri gamokvlevebi (dinamikaSi) moicavda: • limfocitebis populaciebis da subpopulaciebis raodenobis gansazRvras GD3,CD4,CD8,CD19 sawinaaRmdego monoklonuri antisxeulebis gamoyenebiT, arapirdapiri imunofluorescentos meTodiT • imunomaregulirebeli subpopulaciebis dasaxasiaTeblad gamoyenebuli iyo maTi Tanafardobis CD4/CD8 indeqsi (imi) • T ujreduli funqciis aqtivoba Seiswavleboda blastotransformaciis uanriT.

13. GA-Tubernak-iT imunoTerapia tardeboda instruqciis sruli dacviT: • ineqcia keTdeboda kunTSi an kunTqveS 2 mkg/kg wonaze (0,01m/w-1m/w) • I Tvis ganmavlobaSi ineqcia keTdeba dReSi orjer 12 sT intervaliT • II da III Tves _ dReSi erTxel 24 saaTiani intervaliT • mkurnaloba moicavs 3 kurss, TiTo kursi Seadgens 23 ineqcias • kursebs Soris Sesveneba _ 7 dRe

14. cxrili #2K klinikur-laboratoriuli da rentgenologiuri parametrebis dinamika “GA-TUBERNAK”-iT mkurnalobis fonze

15. cxrili 3filtvis tuberkuloziT daavadebul avadmyofebSi imunologiurimaCveneblebis dinamika mkurnalobis procesSi X P<0,001 sxvaobis sarwmunoeba sawyisi donis normis mimarT XX P<0,001 sxvaobis sarwmunoeba imunoTerapiis, qimioTerapiis mimarT XXX P<0,01 sxvaobis sarwmunoeba qimioTerapiis sawyisi donis mimarT

16. sur.1. imunuri statusis cvlileba imunoTerapiis fonze da sakontrolo jgufSi იმუნური სტატუსი გაუმჯობესდა იმუნური სტატუსი დაქვეითდა იმუნური სტატუსი დარჩა უცვლელი

17. daskvna • samamulo warmoebis imunoTerapiuli preparatis GA-Tubernak-is gamoyeneba filtvis rezistentuli tuberkuloziT daavadebuli pacientebis kompleqsur mkurnalobaSi: _ aumjobesebs pacientis imunuri pasuxis parametrebs _ dadebiTad moqmedebs klinikur dinamikaze _ amcirebs antiTB qimiopreparatebis gverdiTi movlenebis simZimes da aiolebs maT marTvas _ aris usafrTxo da ar iwvevs usiamovno gverdiT efeqtebs • SeiZleba gamoyenebuli iyos mkurnalobis nebismier etapze Cvenebis mixedviT

18. gmadlobT yuradRebisaTvis

19. GA-Tubernak • Seqmnilia imunotropuli da antikanurogenuli preparatis GA-40 –is safuZvelze, saidanac afinuri da ioncvladi qromatografiis meTodiT misi Semadgeneli peptidebidan amoRebulia citotoqsikuri aqtivobis peptidebi • Sedegad miRebulia Zlieri imunotropuli peptidebis kombinacia, romelic Seicavs 7 mcire zomis peptids molekuluri masiT 10-50 kilodaltoni

20. peptidebi, rogorc mcire molekulebi advilad transportirdeba organizmis qsovilebs Soris da gaaCniaT liganduri tropuloba, anu specifikuri urTierTqmedebis unari membranul receptorebTan moqmedeben nano – da piko _ kontrastebSi • 7 peptidis pirveladi struqturis tandemurma analizma LTQ FTICR mass speqtrofotometris gamoyenebiT gamoavlina, rom maT msoflioSi analogi ar moepovebaT

21. gamokvlevebiT dadgenilia, rom GA-Tubernak – i iwvevs: _ B da T limfocitebisraodenobrivi da funqciuri maCveneblebis aRdgenas _ T _helperebis, T _citotoqsikuri ujredebis, NK-cels, makrogamebis, neitrofilebis, granulocitebis fagocitebis aqtivacias; _ T h da T suar ujredebis Tanafardobis normalizebas _ citoginebis produqciis inducirebas, maT Soris TNF-α γ-interferonis _ aRadgens Rerovani hemopoezuri ujredebis funqciur aqtivobas _ periferiuli sisxlis maCveneblebis normalizebas

22. GA-Tubernak- i • iwvevs mineraluri cvlis normalizebas (Na,K,Ca da • aqvs antioqsidenturi aqtivoba da mZime metalebis eliminaciis unari • ar iwvevs lokalur anTebas da alergiul reaqciebs • ar axdens gavlenas lipidebis da naxSirwylebis metabolizmze • ar iwvevs morfologiur da histostruqturul cvlilebebs Sinagan organoebSi