New methods of treating various diseases

New methods of treating various diseases

I. Oncology: Revolution in the fight against cancer

A. Targete therapy: an individual approach to each tumor

Targeted therapy, or target therapy, is a class of drugs that affect specific molecular targets involved in growth, progression and distribution of cancer. Unlike traditional chemotherapy, which affects both cancer and healthy cells, targeted therapy is more selective, which allows reducing side effects and increasing the effectiveness of treatment.

1. The mechanisms of action:

  • Inhibitor tyrosinekinase (ITC): ITK is blocked by tyrosinkinase enzymes that play a key role in transmitting signals that regulate the growth and division of cells. Examples: imatinib (treatment of chronic myelolecosis), erlotinib (treatment of lung cancer), so -refill (treatment of liver and kidney cancer).
  • Monoclonal antibodies (ma): MA are artificially created antibodies that are associated with certain proteins on the surface of cancer cells or in their environment. This can lead to blocking the signal paths, stimulating the immune system for the attack of cancer cells or the delivery of toxic substances directly to the tumor. Examples: Trustuzumab (treatment of breast cancer of Her2-positive), Bevacizumab (treatment of cancer of the colon, lung, kidneys), rituximab (treatment of non-Rhodkhkinsky lymphoma).
  • Proteas inhibitors: Proteasomes are cellular complexes responsible for the destruction of damaged or unnecessary proteins. Proteas inhibitors, such as Bortzomib, block this function, leading to the accumulation of proteins necessary for the survival of cancer cells and their subsequent death. Used to treat multiple myeloma.
  • Inhibitors cycle-dependent kinaz (CDK): CDK is enzymes that regulate the cell cycle. CDK inhibitors, such as Palbocyclib, Ribocyclib and Abemacyclib, block their activity, stopping the growth of cancer cells. They are used to treat breast cancer ER-positive, HER2-negative.
  • Inhibitors of control points of immunity: More details in the section on immunotherapy.

2. Advantages of targeted therapy:

  • Higher selectivity: Less side effects compared to chemotherapy.
  • The possibility of individualization of treatment: The definition of molecular targets in the tumor allows you to choose the most effective drug.
  • Improving survival: In some cases, targeted therapy significantly increases the life expectancy of patients.

3. Restricted targeted therapies:

  • Development of resistance: Cancer cells can mutate and gain resistance to targeted drugs.
  • The need to determine molecular targets: Molecular genetic studies are required to identify targeted therapy.
  • High cost: Targeted drugs are often more expensive than traditional chemotherapy.
  • Not always effective: Targeted therapy is not a universal solution and can be ineffective in some cases.

4. The future of targeted therapy:

The development of new targeted drugs aimed at previously inaccessible targets, as well as the development of strategies to overcome resistance to existing drugs. The combination of targeted therapy with other treatment methods, such as immunotherapy and chemotherapy, also seems to be a promising direction.

B. Immunotherapy: mobilization of the immune system against cancer

Immunotherapy is a method of treating cancer, which uses the patient’s own immune system to combat the tumor. Immunotherapy can work in different ways, including by enhancing the immune response to cancer cells, blocking signals that allow cancer cells to avoid the immune system, or teaching immune cells to recognize and attack cancer cells.

1. The mechanisms of action:

  • Inhibitors of control points of immunity: Cancer cells often use immunity control points to avoid the attack of the immune system. Inhibitors of control points of immunity, such as anti-CTLA-4 (IPILIMUMAB), anti-PD-1 (nivolumab, pembroralizumab) and anti-PD-L1 (athezolyzumab, durvalumab), block these control points, allowing immune cells (T-lymphocytes) to recognize and destroy cancer cells.
  • Car-T-cell therapy: CAR-T cells are the patient’s T-lymphocytes that are genetically modified for the expression of a chimeric antigenic receptor (CAR), which allows them to recognize and contact certain proteins on the surface of cancer cells. After the modification of Car-T cells, they are introduced back to the patient, where they find and destroy cancer cells. Car-T-cell therapy is used to treat some types of leukemia and lymphoma.
  • Oncolytic viruses: Oncolytic viruses are viruses that selectively infect and destroy cancer cells without damaging healthy cells. After infection of the cancer cell, the virus propagates and causes its death. Oncolytic viruses can also stimulate the immune response against cancer.
  • Cancer vaccines: Cancer vaccines are designed to stimulate the immune system to attack cancer cells. They can contain cancer antigens (proteins present on the surface of cancer cells), DNA or RNA, which encode cancer antigens, or weakened or killed cancer cells.

2. Advantages of immunotherapy:

  • Potentially long -term effect: In some cases, immunotherapy can lead to prolonged remission when cancer does not return for many years.
  • Efficiency in metastatic cancer: Immunotherapy can be effective in the treatment of metastatic cancer, which has spread to other organs.
  • Less side effects: Side effects of immunotherapy often differ from the side effects of chemotherapy and can be less severe.

3. Restrictions on immunotherapy:

  • Only some patients have effectiveness: Immunotherapy does not work in all patients, and analyzes are necessary to determine the probability of response to treatment.
  • Autoimmune side effects: Immunotherapy can lead to autoimmune side effects when the immune system attacks the healthy tissues of the body.
  • High cost: Immunotherapy can be expensive.

4. The future of immunotherapy:

The development of new immunotherapeutic drugs that are more effective and have less side effects. A combination of immunotherapy with other treatment methods such as targeted therapy and chemotherapy. The study of mechanisms that determine the response to immunotherapy for the development of prognostic biomarkers and strategies for the individualization of treatment.

C. Genetic therapy in oncology: editing the genome of cancer cells

Gene therapy is a promising approach to cancer treatment, which includes a change in the genetic material of cancer cells or immune cells to stop the growth and spread of cancer.

1. The mechanisms of action:

  • Introduction of tumor-soup genes: Some cancer cells have mutations in tumor-spress genes, which prevent uncontrolled cell growth. Gene therapy can be used to introduce copies of normal tumor tumor genes into cancer cells, restoring their function and stopping the growth of cancer.
  • Introduction of suicidal genes: Saubic genes encode enzymes that turn a non -toxic substance into a toxic substance that kills cancer cells. These genes are inserted into cancer cells, and then a non -toxic substance is introduced to the patient, which turns into toxin, which kills cancer cells.
  • Modification of the genes of immune cells: Gene therapy can be used to modify the genes of immune cells, such as T-lymphocytes, to improve their ability to recognize and attack cancer cells (Car-T-cell therapy).
  • Using CRISPR-CAS9: CRISPR -CAS9 is a genome editing technology that allows you to accurately edit DNA in cells. In oncology, CRISPR-CAS9 can be used to turn off genes that contribute to cancer growth, or to correct mutations that cause cancer.

2. Advantages of genetic therapy:

  • Potentially long -term effect: Gene therapy can lead to prolonged remission when cancer does not return for many years.
  • The possibility of treating hard -to -healing types of cancer: Gene therapy can be effective in the treatment of cancer types, which are not amenable to traditional methods of treatment.

3. Restrictions on genetic therapy:

  • Delivery of genes to cancer cells: Delivery of genes to cancer cells is a difficult task, since it is necessary to ensure that the genes fall only into cancer cells and do not damage healthy cells.
  • The risk of inappropriate effects: CRISPR-CAS9 can sometimes edit DNA in inappropriate places, which can lead to undesirable side effects.
  • High cost: Gene therapy can be expensive.

4. The future of genetic therapy:

Development of more effective and safe methods for delivery of genes to cancer cells. Improving the accuracy of CRISPR-CAS9 technology. The study of mechanisms that determine the response to gene therapy for the development of prognostic biomarkers and strategies for the individualization of treatment.

D. Radiation therapy of a new generation: the exact effect on the tumor

Modern radiation therapy is significantly different from the one used decades ago. Thanks to the development of technology, it has become more accurate, effective and less toxic for healthy tissues.

1. Methods of radiation therapy of a new generation:

  • IMRT (Intensity-Modulated Radiation Therapy)-radiation therapy with modulated intensity: IMRT allows doctors to modulate the intensity of the radial beam directed to the tumor, which allows you to more accurately cover the tumor and avoid damage to the surrounding healthy tissues.
  • VMAT (Volumetric Modulated Arc Therapy) – radiation therapy with volumetric modulation in the arc: VMAT is an improved version of IMRT, in which the accelerator rotates around the patient, delivering radiation continuously, which reduces treatment time and increases accuracy.
  • SBRT (stereotactic Body Radiation Therapy) – stereotactic radiation therapy of the body: SBRT is used to treat small tumors located outside the brain using high doses of radiation delivered in a small number of fractions. It is especially effective for treating lung cancer, liver and prostate gland.
  • SRS (Stereotactic Radiosurgery) – Stereotaxic radiosurgery: SRS is a radiation therapy method used to treat brain tumors and other brain diseases. She uses very high radiation doses delivered in one or more fractions with high accuracy.
  • Proton therapy: Proton therapy uses protons, not x -rays, to deliver radiation to the tumor. Protons have unique physical properties that allow them to give most of their energy at a certain point, which allows you to more accurately cover the tumor and avoid damage to the surrounding healthy tissues.

2. The advantages of radiation therapy of a new generation:

  • Increased accuracy: More accurate aiming on the tumor and avoiding damage to healthy tissues.
  • Reducing treatment time: Some methods, such as VMAT, reduce treatment time.
  • Reducing side effects: A lower effect on healthy tissues leads to a decrease in side effects.
  • The possibility of treating hard -to -reach tumors: SBRT and SRS allow you to treat tumors located in hard -to -reach places.

3. Restrictions on radiation therapy of a new generation:

  • Accessibility: Some methods, such as proton therapy, are available only in specialized centers.
  • Price: New methods of radiation therapy can be more expensive than traditional radiation therapy.

4. The future of radiation therapy:

The development of new methods of radiation therapy, which are even more accurate and effective. The use of artificial intelligence to plan the treatment and adaptation of treatment for changes in the tumor. A combination of radiation therapy with other treatment methods such as targeted therapy and immunotherapy.

II. Cardiology: new horizons in the treatment of cardiovascular diseases

A. Transcatheater implantation of the aortic valve (TAVI/TAVR): minimally invasive valve replacement

Transcatter implantation of the aortic valve (Tavi/Tavr) is the minimum invasive procedure used to replace the aortic valve in patients with aortic stenosis, when the aortic valve does not open properly. Unlike the traditional surgical replacement of the aortic valve, with TAVI/TAVR it is not required to cut the sternum.

1. PROCEDURE OF THE TAVI / TAVR:

  • The aortic valve is delivered to the heart through the catheter, which is introduced through the artery in the leg (transfemoral access), the artery in the shoulder (transbrachial access) or through a small incision in the chest (transapical access).
  • The valve expands in the aortic valve, replacing the damaged valve.
  • The catheter is deleted.

2. Advantages Tavi/Tavr:

  • The minimum invasive nature: Drafting of the sternum is not required, which leads to a smaller amount of pain, a shorter restoration time and a lower risk of complications.
  • The possibility of treating high -risk patients: Tavi/Tavr can be used to treat patients who are too sick or weak to transfer the traditional surgical change in the aortic valve.
  • A shorter stay in the hospital: Patients who have suffered TAVI/TAVR usually spend less time in the hospital than patients who have undergone a traditional surgical change in the aortic valve.

3. Tavi/Tavr restrictions:

  • The risk of complications: Although Tavi/Tavr is the minimum invasive procedure, it is still associated with the risk of complications, such as stroke, bleeding, damage to blood vessels and the need to install a pacemaker.
  • Long -term results: The long -term results of Tavi/Tavr are still studied.

4. Future Tavi/Tavr:

The development of new aortic valves, which are more durable and have less complications. Expanding indications for TAVI/TAVR, including treatment of patients with a lower risk and treatment of other diseases of the heart valves. The use of artificial intelligence to plan Tavi/Tavr procedures and predict results.

B. New anticoagulants (PLA): Safe and effective prevention of thrombosis

New oral anticoagulants (PLA), also known as direct oral anticoagulants (SOA), are a class of drugs used to prevent blood clots. Unlike warfarin, a traditional anticoagulant, the PLA does not require regular blood coagulation monitoring and have less drug interactions.

1. The mechanisms of action:

  • Factor inhibitors Ha: Apixban, Rivaroxaban, Edoxaban block the HA factor, a key factor in blood coagulation.
  • Direct thrombin inhibitor: Dabigatran blocks thrombin, another key factor in blood coagulation.

2. Advantages of the PLA:

  • Lack of need for regular blood coagulation monitoring: This simplifies treatment and makes it more convenient for patients.
  • Less medicinal interactions: Less probability of interaction with other drugs, which reduces the risk of complications.
  • Faster start of action: The PLA begin to act faster than warfarin.
  • Predicted pharmacokinetics and pharmacodynamics: It is easier to predict how the PLA will act in the body.

3. Indications for the use of the PLA:

  • Prevention of stroke and system embolism with non -lapped atrial fibrillation.
  • Treatment and prevention of deep vein thrombosis (TGV) and pulmonary artery thromboembolism (FEL).
  • Prevention of TGV after operations to replace the hip and knee joints.

4. Restrictions of Noak:

  • The risk of bleeding: Like all anticoagulants, the PLA increase the risk of bleeding.
  • Lack of universal antidote: Although for some PLAs there are antidotes, they are not for all drugs.
  • Cannot be used for mechanical dentures of heart valves: The PLA is not recommended for patients with mechanical heart valves prostheses.

5. Future PLA:

Development of new PLA with improved safety and efficiency profiles. Development of universal antidotes for all PLA. Studying the role of the PLA in the prevention of other cardiovascular diseases.

C. Implanting Cardiverters-Defibrillers (ICD) of a new generation: personalized protection against sudden heart death

The implantable cardiover defibrillator (ICD) is a small device implanted into the chest cage, which monitors the heartbeat and delivers an electric blow if it detects dangerous arrhythmia (tachycardia or ventricular fibrillation), which can lead to sudden heart death.

1. New technologies in the ICD:

  • Submitted ICD (S-ICD): Unlike traditional ICDs, S-ICD electrodes are located under the skin without touching the heart. This reduces the risk of infection and damage to blood vessels.
  • Wireless ICD: Wireless ICDs are developed that do not require electrodes, which further reduces the risk of complications.
  • ICD with algorithms to prevent unnecessary shocks: These algorithms help to distinguish between dangerous and safe arrhythmias, preventing unnecessary shocks that can be painful and cause anxiety in patients.
  • Remote monitoring: ICD can be connected to a remote monitoring system, which allows doctors to track the operation of the device and the patient’s condition in real time.

2. The advantages of a new generation ICD:

  • Reduce the risk of complications: S-ICD and wireless ICDs reduce the risk of infection and damage to blood vessels.
  • Prevention of unnecessary shocks: Algorithms to prevent unnecessary shocks improve the quality of life of patients.
  • Remote monitoring: It improves monitoring of patients and allows doctors to respond quickly to problems.

3. Restrictions ICD:

  • Invasive procedure: ICD implantation is an invasive procedure that is associated with the risk of complications.
  • Shoki: The shock from the ICD can be painful and cause anxiety in patients.
  • Battery replacement: ICD battery must be replaced periodically.

4. The future of the ICD:

Development of more miniature and durable ICDs. Improving algorithms to prevent unnecessary shocks. Development of wireless ICDs. The use of artificial intelligence to predict the risk of sudden heart death and individualization of treatment.

D. Regenerative medicine in cardiology: restoration of a damaged heart

Regenerative medicine offers promising approaches to the restoration of the damaged heart after myocardial infarction or with heart failure.

1. The approaches of regenerative medicine in cardiology:

  • Cell therapy: The introduction of stem cells or other types of cells in a damaged heart in order to restore heart tissue. Various types of cells are used, including bone marrow stem cells, mesenchymal stem cells and cardiomyoblasts (cells that can differentiate into the cells of the heart muscle).
  • Gene therapy: The introduction of genes that stimulate the growth of new blood vessels (angiogenesis) or protect the cells of the heart muscle from damage.
  • Clack engineering: The creation of artificial heart tissues in the laboratory, which can be implanted in a damaged heart.
  • Biomaterials: The use of biomaterials to support the restoration of damaged heart tissue and stimulate angiogenesis.

2. Advantages of regenerative medicine in cardiology:

  • Potential for restoring damaged heart tissue: Unlike traditional treatment methods that only facilitate symptoms, regenerative medicine has a potential for restoring damaged heart tissue and improving the function of the heart.
  • The possibility of treating heart failure: Regenerative medicine can offer new approaches to the treatment of heart failure, a disease that is difficult to treat with traditional methods.

3. Restrictions on regenerative medicine in cardiology:

  • The complexity of the delivery of cells and genes to the damaged heart: Delivery of cells and genes to a damaged heart is a difficult task, since it is necessary to ensure that cells and genes only fall into damaged tissue and do not cause unwanted side effects.
  • The risk of tumor formation: The introduction of stem cells can increase the risk of tumor formation.
  • The need for further research: Regenerative medicine in cardiology is still under development, and further research is needed to prove its effectiveness and safety.

4. The future of regenerative medicine in cardiology:

Development of more efficient and safe methods for delivery of cells and genes to a damaged heart. The use of new types of cells and biomaterials to restore heart tissue. The study of mechanisms underlying the regeneration of heart tissue.

III. Neurology: breakthroughs in the treatment of diseases of the nervous system

A. Deep brain stimulation (DBS): Modulation of neural networks for the treatment of neurological disorders

Deep brain stimulation (DBS) is a surgical procedure in which electrodes are implanted in certain areas of the brain to stimulate these areas with electrical impulses. DBS is used to treat various neurological disorders, including Parkinson’s disease, essential tremor, dystonia and obsessive-compulsive disorder (OCD).

1. The mechanism of action DBS:

The DBS mechanism has not been fully studied, but it is believed that the electrical stimulation of the brain changes the activity of neural networks involved in the occurrence of symptoms of neurological disorders.

2. DBS procedure:

  • Electrodes are implanted in certain areas of the brain under the control of neuroimaging (MRI or CT).
  • Electrodes are connected to a neurostimulator, which is implanted under the skin in the chest.
  • The neurostimulant generates electrical impulses that are transmitted through electrodes to the brain.
  • The stimulation parameters are configured by a doctor to achieve optimal control over symptoms.

3. Advantages DBS:

  • Efficiency: DBS can significantly reduce the symptoms of Parkinson’s disease, essential tremor, dystonia and okr.
  • Reversibility: DBS effects are reversible, since stimulation can be turned off or adjusted.
  • The possibility of individualization of treatment: Stimulation parameters can be adjusted individually for each patient.

4. Restrictions DBS:

  • Invasive procedure: DBS is an invasive procedure that is associated with the risk of complications, such as brain hemorrhage, infection and speech or movements.
  • Not always effective: DBS is not effective in all patients.
  • Side effects: DBS can cause side effects, such as depression, anxiety, sleep disturbance and cognitive disorders.
  • The need for regular observation: Patients who have undergone DBS need regular observation by a doctor to configure the stimulation parameters and monitor side effects.

5. New developments in DBS:

  • Adaptive DBS: Adaptive DBS is a new type of DBS, which automatically regulates stimulation parameters depending on the activity of the patient’s brain.
  • Directed DBS: Directed DBS uses electrodes that cause stimulation to more accurate areas of the brain, which can improve the effectiveness of treatment and reduce the risk of side effects.
  • Wireless DBS: DBS wireless systems are developed, which do not require a neurostimulator implanted under the skin.

B. Treatment of stroke: new methods of restoration of brain functions

A stroke is a serious disease that occurs when the blood supply to part of the brain is interrupted, which leads to damage to brain cells. Time is crucial in the treatment of a stroke, since the faster the blood supply to the brain will be restored, the less damage will be and the higher the chances of full recovery.

1. New methods of treatment of stroke:

  • Thrombolysis: Thrombolicolis is a method of treating a stroke, which includes the administration of the drug (plasminogen tissue activator – TPA) in the blood to dissolve a bloodboard that blocks the blood supply to the brain. Thrombolicolis is most effective if it is carried out within 4.5 hours after the start of the symptoms of a stroke.
  • Mechanical thrombectomy: Mechanical thrombectomy is a method of treatment of a stroke, which includes removal of a blood clot from a blood vessel in the brain using a special device, which is introduced through a catheter. Mechanical thrombectomy can be used to treat strokes caused by large blood clots that are not amenable to thrombolysis. Mechanical thrombectomy can be effective even 6-24 hours after the start of the symptoms of a stroke in certain cases.
  • Neuroprotectors: Neuroprotectors are drugs that protect brain cells from damage after a stroke. Various neuroprotectors are currently being developed and tested.
  • Rehabilitation: Rehabilitation is an important part of the recovery after a stroke. It includes physical therapy, ergotherapy, speech therapy and other types of therapy that help patients restore lost brain functions.

2. New technologies in rehabilitation after a stroke:

  • Robotized rehabilitation: Robotized devices can help patients perform repeating movements and exercises that are necessary to restore motor functions.
  • Virtual reality: Virtual reality can be used to create realistic scenarios in which patients can practice skills necessary for everyday life.
  • Transcranial magnetic stimulation (TMS): TMS is a non -invasive method of brain stimulation, which can be used to improve motor functions after a stroke.

3. The future treatment of stroke:

Development of new and more effective methods of thrombolysis and mechanical thrombectomy. Development of new neuroprotectors. Improving rehabilitation programs. The use of artificial intelligence to diagnose stroke and treatment planning.

C. Therapy of multiple sclerosis (RS): control over the progression of the disease

Scattered sclerosis (RS) is an autoimmune disease that affects the central nervous system (brain and spinal cord). In RS, the immune system attacks myelin, a protective membrane of the nerve fibers, which leads to damage to the nerves and impaired transmission of nerve impulses.

1. New methods of treatment of RS:

  • Disease-modifying drugs (BMP): BMP is drugs that slow down the progression of RS and reduce the amount of exacerbations. There are several types of BMPs, including beta interferons, acetate glatiramer, fingolimod, Natalizumab, dimethylfumarat, tensomide, codricoline, icrellizumab and syponymod.
  • Cell therapy: Cell therapy is a promising new approach to the treatment of RS, which includes the use of stem cells to restore damaged myelin or modulate the immune system.
  • Transplantation of hematopoietic stem cells (TGSK): TGSK is a treatment method that includes removing the patient’s immune system and replacing it with stem cells obtained from the donor or from the patient himself. TGSK can be effective in the treatment of aggressive forms of RS.
  • Neuroprotectors: Neuroprotectors are drugs that protect nerve cells from damage. Various neuroprotectors are currently being developed and tested for the treatment of RS.

2. Strategies for the treatment of RS:

  • Excess treatment: Exacerbations of RS are usually treated with corticosteroids, which reduce inflammation in the nervous system.
  • Symptomatic treatment: Symptomatic treatment is aimed at facilitating the symptoms of RS, such as fatigue, muscle cramps, pain, urination and depression.
  • Rehabilitation: Rehabilitation can help patients with RS save and improve their functions.

3. The future treatment of RS:

Development of new and more effective BMPs. Improving cell therapy and TGSK. Development of new neuroprotectors. The use of artificial intelligence for the diagnosis of RS and treatment planning. The study of factors that affect the progression of RS.

D. New approaches to the treatment of Alzheimer’s disease (BA): on the way to victory over dementia

Alzheimer’s disease (BA) is a progressive neurodegenerative disease, which is the most common cause of dementia. BA is characterized by the accumulation of amyloid plaques and neurofibrillar balls in the brain, which leads to damage to nerve cells and impaired cognitive functions.

1. New approaches to the treatment of BA:

  • Anti -amyloid drugs: Anti -amyloid drugs are aimed at removing amyloid plaques from the brain. Adukanumab and Lekanemab are monoclonal antibodies that were approved for the treatment of BA. These drugs showed the ability to slow down the progression of the disease in the early stages.
  • Beta-secretase inhibitors (Bace): Bace inhibitors block an enzyme that is involved in the formation of amyloid. Several Bace inhibitors are in the stage of clinical trials.
  • Tau-aggregation inhibitors: Inhibitors of the TAU-agagation are aimed at preventing the formation of neurofibrillar balls consisting of Tau-protein.
  • Drugs that improve cognitive functions: Holinsterase and memantine inhibitors are drugs that are used to improve cognitive functions for BA. They do not slow down the progression of the disease, but can relieve symptoms.
  • Immunotherapy: Immunotherapy is aimed at stimulating the immune system for the attack of amymiloid plaques and neurofibrillar balls.
  • Gene therapy: Gene therapy can be used to deliver genes that protect nerve cells from damage or reduce the formation of amyloid and tau-white.

2. BA’s prevention strategies:

  • Healthy lifestyle: A healthy lifestyle that includes regular physical exercises,

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