Imiti mishya yaba izanye iherezo ku ndwara zo kwishimagura

Mu gihe kuri benshi kwishimagura bitera asyi, kandi bibabangamira, burya umwe kuri batanu muri twe ahura no kwishimagura bimara ibyumweru cyangwa amezi. Gusa umuti mushya ubu uratanga icyizere.

Shayanne Boulet yari afite imyaka 18 ari kurangiza umwaka wa mbere wa kaminuza ubwo yagize atya atangira kuryaryatwa bikamutera guhora yishimagura.

Ati: "Bwa mbere nagize ngo ni eczema, ariko byari bikabije kuntera kumera nabi.

"Sinashoboraga gukaraba amazi ashyushye, sinashoboraga kwiga ntekanye, sinaryamaga neza kuko namaraga nk’amasaha abiri mu buriri nishima, bikaba ngombwa ko mbyuka nkisukura kuko amaraso yabaga yuzuye ku mashuka."

Shayanne bamusanzemo indwara yitwa prurigo nodularis (PN), indwara ifata uruhu igatera kuryaryatwa bikabije.

Iyi ndwara ni imwe muri nyinshi zitera kwishima cyane – mu buvuzi bavuga ko ari ukwishimagura bimara hejuru y’ibyumweru bitandatu. Kwishima cyane bishobora kuva ku ndwara z’uruhu nka eczema, psoriasis, ariko kandi n’indwara z’impyiko, umwijima, ndetse na cancer ya lymphoma. Hari ubwo kwishima gushobora kumara imyaka.

Kwishimagura bitesha umutwe. Ibi ni ibintu abarwaye indwara ya psoriasis bazi neza, kuko uburibwe buzana n’iyi ndwara bugereranywa no kurumagurwa n’intozi nyinshi.

Abarwaye umwijima hamwe n’abarwaye cancer hari ubwo bashobora guhagarika imiti ikiza bafata kuko ibatera kwishimagura birenze.

Brian Kim inzobere mu bijyanye na neuroimmunology wo muri Icahn School of Medicine i Mount Sinai muri New York avuga ko "inyigo zerekanye ko kuryaryatwa guhoraho bitera kurwara kimwe n’ububabare buhoraho", ati: "ariko navuga ko byo binarushaho".

Yongeraho ati: "Mu buribwe buhoraho ugera igihe cyo kuba ikinya – aho ni ku bubabare bwa ‘gatandatu ku 10’ budashira – ushobora kubusinzirana. Kuryaryatwa guhoraho ko kurihariye kuko byo ntibituma ugoheka. Ababirwaye bamara ijoro ryose bikwatagura. Ibyo gusa bishobora gutuma umuntu aremba kurushaho."

Gusa, kugeza vuba aha abahanga muri siyanse ntabwo mu by’ukuri bumvaga igitera kuryaryatwa bihoraho. Kuryaryatwa gukaze ariko byo, bisa n’ibizwi neza ibyabyo. Iyo umubu ukurumye, cyangwa se nk’isusa igukozeho, utunyangingo tw’ubwirinzi turekura imisemburo ya histamine yo kurinda uruhu rwo hejuru bigatuma rushya bigatanga ‘signal’ yo kuryaryatwa ku ruti rw’umugongo no ku bwonko.

Nubwo biryana, kuryaryatwa gukabije gutya gushobora kuvurwa n’imiti ya antihistamines cyangwa ‘topical steroids’. Ariko antihistamines ntacyo ikora ku kuryaryatwa guhoraho.

Abahanga bari bazi ko kuryaryatwa ari ubwoko bw’uburibwe bworoheje

Kubera iyo mpamvu, habaye iterambere rito mu kuvura kuryaryatwa mu myaka 360, ubwo ku nshuro ya mbere iyi ndwara yari isobanuwe n’abaganga.

Impamvu imwe y’ibi ni uko abahanga muri siyanse bemeraga ko kuribwaribwa ari ubwoko bw’ububabare budakabije. Kumva ibintu gutya bishobora kuboneka no mu myaka ya 1920 ubwo umuhanga mu buvuzi w’umudage Max von Frey muri laboratoire ye yajombaga abantu akoreraho ubushakashatsi ibintu bijombana byitwa spicules. Yabonye ko uburibwe bwa mbere bukurikirwa no kuryaryatwa.

Gusa mu 2007, umuhanga muri siyanse Zhou-Feng Shen muri Washington University School of Medicine yavumbuye akaremangingo kihariye kakira kuryaryatwa gaherereye ku turemangingo twitwa neurons mu’ruti rw'umugongo. Imbeba zidafite ako karemangingo ntizashoboye kumva uburyaryate. Uko zajombwe kwose ngo buze, ntabwo zigeze zishima. Ariko zumvaga uburibwe busanzwe.

Mu yandi magambo, abahanga muri siyanse basanze hari ‘neurons’ mu ruti rw’umugongo zagenewe kumva no gutanga ubutumwa ku bwonko bw’uburyaryate.

Kuva icyo gihe, abashakashatsi bavumbuye izindi neurons zihariye ku kwakira uburyaryate. Urugero, izitwa g-proteins ziboneka kuri ‘neurons’ zifasha uruhu. Izi ziha amakuru ako kanya ku bwonko ajyanye n’uburyaryate.

Hagati aho, mu 2017, Brian Kim na bagenzi be bo ku kigo Centre for the Study of Itch and Sensory Disorders cya Washington University, bavumbuye ko guhishira (inflammation) imbere mu ruhu bishobora gutera uturemangingo turinda kurekura imisemburo y’ubutabire yitwa IL-4 na IL-13. Iyi misemburo, izwi nka cytokines, nayo ikora kuri neurons zo mu ruhu maze bigatera kuryaryatwa.

"Kimwe mu byiza by’akazi ka Brian Kim ni uko yavumbuye ko iyo misemburo muri rusange ituma abantu bafite za ‘allergies’ baryaryatwa kurushaho", ni ibivugwa na Marlys Fassett, profeseri w’indwara z’uruhu muri University of California, i San Francisco.

Fassett nawe yibanze ku wundi musemburo utera uburyaryate witwa IL-31, nawo basanze usembura neurons zagenewe uburyaryate. Akazi ka Fassett kazatangazwa vuba, kereka ko kimwe n’indi misemburo, IL-31 nawo utera uburyaryate kenshi kandi vuba.

Mu nyigo yakozwe mu 2023, Fassett yasanze mu gutera kuryaryatwa, IL-31 inagabanya guhishira (inflammation) kugira ngo kwa kuryaryatwa kugera aho kugabanuka. Ikipe ye yavanye utunyangingo tugize IL-31 mu mbeba, maze baziteza ibintu ubusanzwe bituma ziryaryatwa. Nk’uko bari babyiteze, ibyo bintu ntibyateye uburyaryate mu mbeba zidafite IL-31. Ariko, guhishira (inflammation) aho ibyo bintu babiteye kwaratumbagiye.

Fassett ati: "Ubu hashize imyaka 15 bizwi ko iyo uteye IL-31 mu ruhu cyangwa mu ruti rw’umugongo w’imbeba, iyi nyamaswa itangira kwishimagura biyibangamiye.

"Ariko icyari kikiri iyobera ni uko iyo uvanyemo uwo musemburo w’uburyaryate, aho kugira ngo guhishira kumanuke, kurazamuka. Ibyo ntabwo byumvikanaga neza, kuko akenshi mu mubiri ahari uburyaryate no guhishira byombi uba witeze ko ibyo bigendana icya rimwe."

Bisa naho neurons zo mu ruhu zikoreshwa na IL-31 nazo zihagurutsa igisubizo cy’ubwirinzi bw’umubiri, ngo bugabanye guhishira. Ibi byavumbuwe ni ingenzi, kuko bivuze ko imiti irwanya kuribaribwa yibasira IL-31 ishobora kuzana ingaruka zitateganyijwe, bigateza guhishira (inflammation) gukabije.

Kuvura kuryaryatwa

Iyo miti ubu irimo gukorwa. Urugero nemolizumab, yibanda kuri IL-31, iherutse gusoza icyiciro cya kabiri n’icya gatatu cy’igerageza mu kuvura indwara ya Atopic dermatitis (AD), ubwoko bwa eczema butera kuma, kuryaryatwa no guhishira k’uruhu.

Abantu bafite iyi ndwara ubu bashobora kwandikirwa umuti wa dupilumab, umuti uherutse kwemezwa ko ukumira imisemburo ya IL-4 na IL-13. Indi miti nka EP262, abrocitinib, na upadacitinib nayo iri mu kicyiro cya gatatu cy’igerageza mu kuvura AD.

Izindi ndwara zitera uburyaryate butera kwishimagura nazo zishobora kuvuzwa imiti mishya. Urugero muri uyu mwaka, Gil Yosipovitch, profeseri w’indwara z’uruhu muri University of Miller School of Medicine yakoranye na Brian Kim n’abandi barangiza icyiciro cya gatatu cyo kugerageza gukoresha dupilumab mu kuvura ya ndwara ya PN, imwe Shayanne yarwaye.

Nyuma y’ibyumweru 24, 60% by’abahawe dupilumab bagize kugabanuka kugaragara ko kuryaryatwa ugereranyije na 18% by’abahawe umuti usa n’uwo ariko udakora (placebo). Ku bw’ibyo, ikigo cya Amerika kigenzura imiti, FDA, ubu cyemeje dupilumab mu kuvura abarwaye PN.

"PN ni imwe mu ndwara ziganje zo kuryaryatwa abavuzi b’uruhu bahura nazo, kandi kugeza vuba aha nta miti myiza yari ihari, abarwayi rero bagorwaga bikomeye." Ni ibivugwa na Yosipovitch.

Yongeraho ati: "Iki ni igihe cyiza cyane ku barwayi bacu. Ubu noneho bamenya ko hari icyizere. Nari mfite abarwayi benshi bari babaye kandi bari mu kwiheba ariko baraje barambwira ngo ‘wa muti wakijije ubuzima bwanjye’."

Hagati aho, Brian Kim nawe ari mu bushakashatsi bushya agerageza umuti wa difelikefalin mu kuvura indwara yitwa notalgia paresthetica — indwara irangwa no guhora uryaryatwa kandi ushaka kwishima hejuru mu gice cyo hejuru mu mugongo.

Difelikefalin yamaze kwemezwa na FDA mu kuvura kuryaryatwa kugereranyije n’ugukabije kuvuye ku ndwara y’impyiko ku bantu bakuru bakorerwa hemodialysis.

Gusa, icyiciro cya kabiri cyo kugerageza, cyerekanye ko uyu muti ushobora no kuvura na notalgia paresthetica.

Iyi miti yombi iratanga icyizere kitari kiriho kugeza vuba aha.

Shayanne wabaye umwe mu bakoreweho igerageza na Yosipovitch, ati: "Ubu ndiyumva nkanjye nanone, nshobora gukomeza ubuzima bwanjye busanzwe.

"Rimwe na rimwe ndaryaryatwa buhoro, ariko bimara nk’iminota 10 gusa, ubuzima bwanjye ubu bumeze neza cyane kurusha mbere."

Mu gihe dupilumab idakora ku barwayi bose, indi miti myinshi nayo irimo gutegurwa.

Yosipovitch ati: "Nizera ko mu myaka itanu iri imbere tuzaba tubasha kuvura benshi muri aba barwayi, rero iki ni igihe gishimishije abaganga nkanjye bitaye ku kababaro k’aba barwayi imyaka myinshi."