He rongoā te methylene blue mō ngā pirinoa?

Ko te āhua nei he pātai kotahi tēnei. Engari, he tekau mā rua kē ngā pātai rerekē e mau ana i te kākahu kotahi. He iti noa ngā mea e ōrite ana i waenga i tētahi pirinoa malaria kei roto i ngā pūtau toto whero, tētahi noke kei te whēkau, me te rauropi e takea mai ai te leishmaniasis ā-kiri, hāunga ko te kupu pirinoa. Kāore he here kia pā kino tētahi rongoā e pā kino ana ki tētahi ki ērā atu. Puritia tēnei ariā puta noa i tēnei arotake: ehara te āhuatanga antiparasitic i te āhuatanga o tētahi rāpoi ngota anake. He āhuatanga nō te rāpoi ngota me tētahi rauropi motuhake, i tētahi wāhanga motuhake o tōna huringa ora, i tētahi wāhanga motuhake hoki o te tinana.

Ina wehea ngā rauropi, ka mārama te wehe o ngā taunakitanga mō te methylene blue hei rongoā mō ngā pirinoa. Kei tētahi taha ko te malaria, kei reira ngā whakamātau tangata. Kei tērā atu taha ko ngā mea katoa: ngā ipu taiwhanga, ngā kiore, ngā maimoatanga kiri ka whakahohehia e te rama, me ngā kōrero nō te rautau ki muri. Kāore tētahi kawa whānui mō ngā pirinoa e puta mai ana i ēnei taunakitanga.

Te whakautu poto

He rongoā whakamātau tūturu mō te malaria te methylene blue. I kitea e tētahi arotake nahanaha o ngā rangahau tangata 21 e kapi ana i ngā tūroro malaria 1,504 he pānga tūturu ki te wāhanga toto, ā, he tino kaha ngā pānga ki te wāhanga gametocyte e tuku ai te mate ki ngā waeroa. I waho atu i te malaria, kāore ngā taunakitanga kua whakaputaina e tautoko ana i te whakamahi i te methylene blue hei rongoā antiparasitic whānui, hei “horoi” rānei i ngā pirinoa ā-whēkau. Tata ki ngā kitenga katoa ehara i te malaria kei raro rawa o te arawhata taunakitanga: he hohe i roto i te ipu taiwhanga, i ētahi wā he hohe i roto i te kiore, ā, kāore rawa i whakamātauria ki ngā tāngata kua pangia.

Malaria: ko te pirinoa kotahi kua whakamātauria ki te tangata

I te tau 1891, i pūrongo a Guttmann rāua ko Ehrlich mō te maimoatanga o ngā tūroro malaria ki te methylene blue, ā, tērā pea koinei te rongoā waihanga tuatahi i whakamahia ki tētahi mate tangata. Ko te hītori mai i te waikano ki te pūhui matua mō te rongoā malaria ka toro atu ki te chloroquine, i whakawhiwhia ki te matū i rangahautia tuatahitia mā tēnei waikano.

I whakahoungia ngā rangahau hou nā te hiahia i puta i ngā pirinoa ātete ki ngā rongoā. I roto i te ahurea taiwhanga, ka aukati te methylene blue i ngā momo Plasmodium falciparum e tairongo ana, e ātete ana hoki ki te chloroquine i ngā kukū nanomolar iti, ā, kua pūrongoa te mahi ngātahi me ngā pärönaki artemisinin. Hei monotherapy ki te tangata, i kitea he pōturi: i kitea e tētahi whakamātau whakahaere i ngā pakeke āhua-mate-ārai i Burkina Faso he 16 percent te reiti rahunga wawe, ā, i whakatauria e ngā kaituhi kāore e tika hei rongoā kotahi mō tētahi akoranga poto. He pai ake ngā huinga. I roto i tētahi whakamātau matapōkere i ngā tamariki 180, i tae te methylene blue me te amodiaquine ki te 95 percent o te urupare kua whakatikahia i te rā 28, ā, i tino whakaheke ngā rōpū methylene-blue e rua i te kawe gametocyte i roto i te tātari tuku i whai taha atu. I muri mai, i whakaū tētahi whakamātau huinga-toru i ngā tamariki 221 i te pānga ki te gametocyte mā te microscopy me te kitenga rāpoi ngota. Ko te hua tino mīharo i whakamahi i ngā waeroa hei pūtake ine: i roto i tētahi whakamātau phase 2 i Mali, nā te tāpiri i ngā rā e toru o te methylene blue i puta ai tētahi whakahekenga tauwaenga 100 percent o te āhei o te waeroa ki te kawe mate i mua i te rā tuarua.

E toru ngā tikanga pea e kōrerohia ana, ā, kaua ēnei e whakakotahitia hei mea kotahi. Ka aukati te waikano i te whākōkī glutathione reductase o te pirinoa i roto i te ipu whakamātautau (Ki tata ki te 6.4 micromolar), ā, ka huri redox hei tïpako e whakapau ana i ngā taurite whakaheke (kua whakaaturia puta noa i ngā reductase tangata me ngā reductase pirinoa). Engari, he ōrite tonu te tairongo o ngā pirinoa kua kore taua whākōkī nā te whakarerekētanga ira, nō reira kāore e taea e tēnei anake te whakamārama katoa; ā, ko tētahi ariā tawhito e mea ana ka whakararuraru i te tukunga heme (he hononga ki te kaha nanomolar) kāore anō kia whakamanaia ki ngā tūroro. Ko te whakarāpopototanga tika: he whaihua tūturu ki te tangata, kāore anō kia tau tētahi whāinga kotahi, kāore hoki he tūranga i roto i ngā kawa paerewa. Ko ngā kawa me ngā raraunga tuku kei roto i tā mātou arotake mō te methylene blue mō te malaria, kāore e tāruatia ana e tēnei whārangi.

Babesia me Toxoplasma: he kaha i te taiwhanga, kāore i te whare haumanu

Ko Babesia, te whanaunga o te malaria e noho ana i ngā pūtau toto whero, i patua hoki i roto i ngā ipu taiwhanga i ngā kukū submicromolar, ā, kāore ngā pirinoa kua pā ki te waikano i tipu anō (Journal of Protozoology Research); ā, i whakatauria e tētahi matawai i muri mai ko te waikano te matū kaha rawa i whakamātauria, tata ki te 0.2 micromolar (Carvalho me ōna hoa, 2020). I roto i ngā kiore, ahakoa te 50 mg/kg, he ngoikore noa te aukati, ā, kāore he rangahau babesiosis tangata.

He ōrite te tauira mō Toxoplasma. E rua ngā rangahau ahurea taiwhanga, ahakoa he tekau tau te tawhiti i waenganui, i kitea te pehanga submicromolar o ngā tachyzoite e whakaputa uri ana: 0.45 micromolar i roto i ngā macrophage i te tau 1989 me tata ki te 0.30 micromolar i roto i tētahi matawai rongoā malaria i te tau 2018. Kāore tētahi i pā ki te kiko latent bradyzoite tissue cyst, arā, te wāhanga tino uaua ā-haumanu, ā, kāore hoki i kitea he rangahau maimoatanga kararehe, tangata rānei. Ehara tētahi tau tachyzoite i roto i te ipu taiwhanga i te taunakitanga mō tētahi mate i roto i te tangata.

Leishmania me ngā trypanosome: me aro ki te rama, me aro hoki ki te kiore

Ko te nuinga o ngā tuhinga mō Leishmania e pā ana ki te photodynamic therapy, he ariā rerekē i te horomia o tētahi waikano. Nā te photoactivation i heke ai te kukū aukati ki Leishmania amazonensis mai i te tata ki te 100 ki te 20 micromolar, ā, ko ngā taunakitanga tangata katoa ko tētahi tūroro kotahi i whakawhiwhia ōna wharanga ki te antimony, ā, kotahi o aua wharanga i whakawhiwhia anō ki te waikano kua whakahohehia e te rama. I kitea e ngā rangahau hamster he āwhina nō te maimoatanga ā-kiri kua whakahohehia e te rama, engari kāore te waikano intradermal i āwhina (Sbeghen me ōna hoa, 2015). Ehara te waikano ā-rohe me te rama whero ki te kiri i te maimoatanga pūnaha.

Kei roto i ngā taunakitanga mō ngā trypanosome te hua kino tino whaihua o tēnei arotake: i patua e te methylene blue a Trypanosoma brucei in vitro, engari kāore i whakaora i ngā kiore kua pangia i te 300 mg/kg ā-waha, i te 200 mg/kg rānei mā te werohanga. Mō te mate Chagas, he taunakitanga biochemical, mā te whākōkī trypanothione reductase motuhake o te pirinoa (Buchholz me ōna hoa, 2008), me te patunga kua whakapakarihia e te rama in vitro (Barbosa me ōna hoa, 2020). Ko te whakakino-kore o te plasma kua tāpirihia he pirinoa i ngā pēke toto (Gironés me ōna hoa, 2006) e pā ana ki ngā hua toto, kaua ki ngā tūroro. Me mōhio ngā kaipānui e tae mai ana nā ngā mate e kawea ana e ngā tikitiki, he huakita te take o Lyme disease, ehara i te pirinoa; ka aromatawaihia ōna taunakitanga i roto i tā mātou arotake mō te methylene blue mō Lyme disease.

Ngā noke, ngā fluke, me te kerēme mō te horoi i te whēkau

Ko Schistosoma mansoni te tauira tino kaha mō ngā noke, engari kāore tonu e ranea: i patua e te waikano ngā schistosomula i raro iho i te 10 micromolar me ngā pakeke i te 10 ki te 30 micromolar, engari i kitea i ngā kiore kua pangia he tata ki te 60 percent te pehanga o te kawenga, me te kore whakaoranga. Ko te whakamātau tangata iti i taua pepa e pā ana ki tētahi huinga rongoā kē, nō reira kāore e tika kia kīia he whakamātau waikano ki te tangata. Ki ngā torongū me ngā pakeke Strongyloides, ko ngā kukū aukati tata ki te 4 ki te 6 micromolar i whai hononga ki te kuhu o te waikano ki roto i te noke, engari i roto i ngā kiore i whakawhiwhia ā-waha, kāore he whakahaere whai tikanga o te mate. Mō te scabies me te kutu, kāore he taunakitanga maimoatanga tangata i kitea.

Kāore he whakamātau hou, he raupapa rangahau, he pūrongo take whakapono rānei e whakaatu ana ka whakakore te methylene blue ā-waha i a Giardia, Entamoeba, Strongyloides, i ngā helminth ā-whēkau rānei i te tangata. Ko te mea kua taupūhia e tata ana ko tētahi pūrongo nō te tau 1956 mō te giardiasis o te gallbladder, engari kāore he dose e wātea ana, kāore hoki he whakaoranga e taea te manatoko. He māmā te hē o te pānui i ngā pepa Giardia hou e rua: i tētahi, ko te waikano 1 percent te poke i whakaatu mai ai i ngā trophozoite, ā, i tērā atu, ko te waikano kua waimehatia te poke pānui i muri i ngā rongoā paerewa. Ehara te poke e tae ai te pirinoa ki te tae i raro i te karu whārahi i te rongoā e patu ana i taua pirinoa i roto i te whēkau. Mō Trichomonas, he photodynamic anō te rangahau kararehe kotahi: he waikano ā-tara me te rama i roto i ngā kiore kua pangia (Fonseca me ōna hoa, 2019), ehara i te horoi ā-waha.

Te whakataurite

He aha ka huri i tēnei whakautu

He tino motuhake ngā āputa, ā, ka taea te whakaingoa. Tae noa ki Mahuru 2026, kāore i kitea he whakamātau interventional tangata kua rēhitatia mō te waikano ki tētahi pirinoa ehara i te malaria, nō reira ko te mea tuatahi e ngaro ana ko tētahi rangahau tangata whakahaere i waho atu o Plasmodium. Tuarua, ko ngā kukū o te ipu taiwhanga ka puritia mō ngā rā kua rahua i ngā kararehe i ngā wā maha nā te tere o te whakakorenga, nā te hē rānei o te wāhanga tinana, e kitea ana i ngā rahunga kiore mō ngā trypanosome me Strongyloides. Tuatoru, me mutu te whakahua i ngā hua photodynamic hei taunakitanga pūnaha; ko te waikano me tētahi dose rama kua inea he ariā whakakino-kore ā-rohe, me tōna ake raruraru tuku. Tuawhā, me whai ngā kerēme ā-whēkau i ngā pūtake ine parasitological, arā, te whakakorenga i te tūtae, i te kiko rānei i roto i ngā rōpū whakahaere, kaua ko ngā whakaaro mō ngā tohu i te wā e whakamahia ana ngā kawa horoi maha-ngā-matū.

E rua ngā meka haumaru e here ana i te whakamātau whaiaro. Kāore e tika te waikano mō te hunga he glucose-6-phosphate dehydrogenase deficiency nā te mōrea hemolysis, ā, i kitea e tētahi tātari whakakotahi o ngā whakamātau malaria e whā ki ngā tamariki he nui ake ngā hekenga hemoglobin i ngā tamariki tino deficient i ngā dose antiparasitic tata ki te 15 mg/kg ia rā. He monoamine oxidase A inhibitor kaha, reversible hoki tēnei (te tikanga kei muri i te serotonin toxicity), ā, kei ngā tapanga o nāianei hei boxed warning; ka taea hoki e te mimi kikorangi te whakararu i ngā whakamātautau mimi aunoa. Kei tā mātou aratohu mahi mō te whakamahi methylene blue ngā pātai mō te dosing, te purity, me ngā interaction.

I tika te whiwhi a te methylene blue i tōna ingoa hei antiparasitic mō te malaria, i roto i ngā whakamātau matapōkere me ngā pūtake ine waeroa. I tua atu i tērā, he mana nama noa. Kia puta rā anō tētahi rangahau tangata whakahaere e whakaatu kē ana mō tētahi rauropi kua whakaingoatia, ko te tūnga ka taea te tiaki he whāiti: he rongoā malaria tūturu e ārai ana i te tukunga, kei raro tonu i te rangahau, ā, i ngā wāhi katoa kē atu he kitenga taiwhanga e tatari ana kia whakamanaia ka mau tonu tōna pānga i roto i tētahi rauropi ora.