The Cost Of The Donor Register Is 10 Times Less Than The Cost Of The Construction Of The Zenit-Arena Stadium

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The Cost Of The Donor Register Is 10 Times Less Than The Cost Of The Construction Of The Zenit-Arena Stadium
The Cost Of The Donor Register Is 10 Times Less Than The Cost Of The Construction Of The Zenit-Arena Stadium

Video: The Cost Of The Donor Register Is 10 Times Less Than The Cost Of The Construction Of The Zenit-Arena Stadium

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Video: Стадион Зенит-Арена | Технологии | Телеканал «Страна» 2023, February

The cost of the donor register is 10 times less than the cost of the construction of the Zenit-Arena stadium

What is HLA-typing, why bone marrow transplantation is needed, how dangerous it is, and why the National Registry of Bone Marrow Donors is so important, scientists from the N.I. Russian National Research Medical University told MedNews. Pirogov - the winner of the All-Russian Prize "Souchastie", dedicated to the development of free donation of blood and its components.

“The cost of the donor register is 10 times less than the cost of the stadium construction
“The cost of the donor register is 10 times less than the cost of the stadium construction

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3,000 Russians undergo bone marrow transplantation every year. What is HLA-typing, why bone marrow transplantation is needed, how dangerous it is, and why the National Registry of Bone Marrow Donors is so important, scientists from the N.I. Russian National Research Medical University told MedNews. Pirogov - the winner of the All-Russian Prize "Souchastie", dedicated to the development of free donation of blood and its components.

The Civic Chamber of the Russian Federation summed up the results of the VIII All-Russian Prize "Participation" for the contribution to the development of blood donation. According to Elena Stefanyuk, Director of the National Health Development Fund, Deputy Head of the Coordination Center for Blood Donation at the RF OP, this year more than 350 applications from 52 regions of Russia were submitted. In total, more than 100 awards were presented for achievements in the development of free donation of blood and its components. Among the laureates and winners of the main, creative and children's competition are institutions of the Blood Service, non-profit organizations and initiative groups, representatives of business, government authorities, the media, blood donors themselves, creative people of various professions and ages from more than 40 regions of Russia.

For the first time in the history of the Prize, one organization - RNIMU named after N.I. Pirogova - won in four nominations at once. For the best project aimed at increasing the share of regular donors and the development of responsible donation, the best scenario for an event that can be replicated as a successful practice - the quest “A Drop of Life”, the video “You don’t need to be a superhero to save lives” and # DonorTV about donation at the University and not only.

And at the University itself the other day there was a massive donor campaign, during which more than half of its participants underwent HLA typing and were included in the register of potential bone marrow donors. About the new direction of the university donor action, and why HLA-typing and the National Registry of Bone Marrow Donors are so important, the Vice-Rector for Research of the Russian National Research Medical University named after N.I. Pirogova, Doctor of Biological Sciences Denis Rebrikov and head of the Medical Department, head of the donor movement of the university Tigran Muradyan.

Immune system transplant

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Denis Vladimirovich, what is bone marrow transplantation for?

- This is a method of treating blood oncological diseases, in which blood cells stop performing their functions and begin to multiply uncontrollably. There is only one way out of this situation - it is necessary to destroy such "asocial" cells. This is possible, but then you will have to actually destroy the entire immune system, because it is also formed by blood cells. The human body becomes defenseless against many viruses and bacteria, and can die from infectious diseases. But if you do not restart the hematopoietic system, then he will die from cancer. Therefore, today bone marrow transplantation is the only option for many of these patients. Biomaterial for transplantation is blood stem cells from a donor.

What kind of transplant is there?

- There are two types of transplantation: related and unrelated. Related material is taken from parents, siblings, or even children (after they reach the age of 18). The main disadvantage of related transplantation is that only about half of the donor and recipient histocompatibility genes important for transplantation coincide, and the second part is foreign. And from a medical point of view, this is a problem, since during transplantation it is important that the organ is not rejected by the recipient.

Let us consider an example: if, say, a kidney is transplanted, then it must match the composition of the surface receptor proteins, according to which the system of recognition "friend or foe" works in the body. If these receptor proteins of the transplanted organ are not similar to the recipient's own proteins, the friend or foe system will consider the new organ to be foreign and start the process of rejection. In this case, the immune system will start attacking the transplanted organ in the same way as, for example, a bacterium that needs to be expelled. Therefore, before the start of transplantation, these surface proteins-receptors are checked, they are called genes of the main histocompatibility complex or HLA for short. But if an incomplete HLA match is allowed for organ transplants such as a kidney, then in the case of bone marrow transplants, the match should be near perfect.

In fact, this is a transplantation of a new immune system to the patient, and if it turns out to be inappropriate, then, figuratively speaking, cognitive dissonance will arise inside the body. The new immune system will perceive the entire organism of the recipient as foreign, will attack all organs and tissues of the new host, fatal systemic inflammation will develop, and the recipient will die. That is why careful selection of the material is required in the case of bone marrow transplantation. And for this, related transplantation is by no means an ideal option, because in this case, the bone marrow is a priori half foreign. Of course, this is better than nothing, but still the percentage of complications in the recipient is very high.

Therefore, the correct approach to the choice of material lies precisely in the unrelated transplantation of a donor selected from a huge database that matches perfectly. Of course, it happens that even in a large donor base it is not possible to find a 100% match, but only 90-95%. But modern medicine offers good immunosuppression techniques to reduce the percentage of complications.

Register of saviors

Is this what the Register of Potential Donors is for?

- Sure. As practice shows, in most cases it is possible to find an ideal donor from about one million donors of the Register. And if the country has a Register for a million bone marrow donors, then we can find a suitable bone marrow for transplantation for almost any recipient. Registers of potential bone marrow donors have long existed in developed countries: the USA, Europe. The register is especially large in Germany: about 7 million people, and it is constantly growing. It is clear that from such a gigantic register one can easily find several donors needed by a particular recipient, send them proposals, and there is a possibility that one of the candidates will agree to undergo the bone marrow collection procedure.

In Russia, in the absence of its own Register, the situation is as follows: Foundations collecting donations are forced to spend very large sums on the service of finding a donor abroad and collecting a transplant from him.

The advantage of its own Register is that it will unite the inhabitants of our country - genetically closer than the peoples of Europe. If the Germans are relatively close to a resident of central Russia in genetics, then the peoples of the Trans-Urals have a completely different genetics, and the probability of finding a suitable donor in the German register for, say, a Uyghur or a Tuvan is much less. From this point of view, it is precisely necessary to create a register within the country, taking into account the genetic diversity of the inhabitants of Russia, so that a donor with the required genotype can be found faster.

What does the procedure for a bone marrow harvest look like and how dangerous is it for the donor himself?

- Modern medicine offers different methods of bone marrow donation. First, the bone marrow is taken from the donor under anesthesia directly from the bone (usually from the pelvic bone) using a puncture. The second is minimally invasive: the material for transplantation is taken from a vein, as in a regular blood donation, but before that, the donor takes a drug that "expels" bone marrow cells into the bloodstream. During the procedure, the cells we need are sorted by a special apparatus directly from the blood flowing through it, and all the rest of the blood is returned to the donor.

Unlike all other types of transplantation, bone marrow transplantation is practically safe for a donor, because a very small part of the bone marrow is taken, and the remaining cells are quite enough for life and quick recovery. In the recipient, the new bone marrow is formed from the material that has been transplanted, and he has a chance for a cure.

What is typing technology?

Genotyping - determination of the genotype by HLA - today is carried out using a special high-throughput sequencing on a very powerful device - a sequencer that can simultaneously analyze material from 100 to 1000 people, determining the DNA sequence of each donor. A technological breakthrough in the field of determining the human genotype took place about 10 years ago, when second-generation sequencers appeared - devices that allow determining the DNA sequence with a performance thousands of times greater than the devices of the previous generation. In this case, not only the devices themselves are important, but also the reagents.

The more powerful such a device is, the cheaper the unit of information will cost. Because DNA is just a carrier of information. If you write down the complete sequence of the human genome on a simple flash drive, it will take about 3GB. But this is the final, assembled version of the genome, while the "raw" information for analysis, obtained from the sequencer, takes about 100 GB. Interestingly, even out of the final 3 GB of the fully assembled genome, only 2% of useful information is available - that is, the entire individual “instruction” about how we work is in a 60 MB file! This demonstrates the tremendous efficiency of recording information that living systems have invented in the course of evolution. We haven't even come close to such efficiency yet. Perhaps that is why we are not yet able to “assemble” such complex systems as a human being.

And what are the problems with the creation of a domestic Register?

- In Russia, there have been several attempts to create such Registers, but all of them stopped at the figure of several tens of thousands of samples in the database, and did not grow further. The total number of potential donors in all these registers is about 70 thousand - and this is very small for the normal operation of the system. It seems expedient to combine all existing registers into a single federal register, adding it to the number of at least 500 thousand, and better - a million potential bone marrow donors. It is from this number that effective and fast work on finding suitable donors begins.

Recently, Rusfond has joined the active development of this area. Thanks to the advent of new generation sequencing, which makes it possible to reduce the cost and speed up the genotyping procedure, the set of genotypes has significantly accelerated. If earlier genotyping of one sample cost about 20 thousand rubles, today it is already about 7 thousand rubles. The high cost of such research is, among other things, in reagents. Rusfond cooperates with one of the Russian biotechnological companies - DNA-Technology - in the direction of creating our Russian reagent, which allows such a study to be carried out for less money - about 4 thousand rubles.

In today's prices, a register of one million potential donors will cost 5-7 billion rubles. With many hundreds and even thousands of lives saved a year. Compare: the construction of the Zenit-Arena stadium in St. Petersburg cost about 50 billion rubles, and in order for the country to have a full-fledged, functional register with a good probability of finding a donor for all patients who need it, only a tenth of these costs are needed!

If now this system works, if Rusfond manages to start quickly replenishing the database with new genotypes, the state will probably join in this. Moreover, now the creation of such a Register has become very possible, including in terms of price indicators. In general, the whole process of creating a full-fledged Register (from a million samples) can take 2-3 years, if you buy sequencers and fine-tune an effective donor recruiting system.

That is, the second problem is donors?

Yes, volunteers who agree to enter the Register are no less a problem than the cost of genotyping. People are afraid of becoming bone marrow donors. RNIMU them. N.I. Pirogov, in particular, our donor movement is cooperating with Rusfond in this regard. It turned out that among medical students there is a high percentage of those who agree to enter the Register: almost every donor donated blood for HLA typing. Rusfond together with the Vasya Perevoshchikov National Registry of Bone Marrow Donors performed typing during our fall Donor Week. And I was very pleased with the result, because in a week to replenish the Register with almost a thousand samples is a very good result.

The samples collected for typing will be frozen and will wait until the laboratory can analyze them. The laboratory can process about several hundred samples per week. But the main thing is that these samples have been received, and they will enter the Register anyway.

Donor import substitution

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Tigran Gagikovich, what is the participation of the university in the creation of the National Register?

- Medical students are the healthiest and most responsible category of donors. The donor movement at our University has existed for a long time, and this year we began to collect biological material for HLA typing. During one week alone, 886 people signed an agreement and donated a blood sample for inclusion in the Register. These are very good indicators. Naturally, a lot of work was done: we told potential donors about the contraindications for donation, how it happens. In order not to frighten on the one hand, but on the other hand, so that the donor understands what he will face after finding a suitable patient who needs a transplant of his stem cells.

Two months before the action, we started discussing it on social networks. We have students who once underwent a bone marrow transplant, but we did not know about it. For their part, they told how it was. A donor was found for one student in early childhood in the Israeli registry. And when students learn that there are people among them who were saved by bone marrow transplantation, they begin to understand even better the importance of the idea. We have a student who became a stem cell donor herself. They found her in the Russian Register. And she told the students about it. I say - students, but this is much broader, these are residents, graduate students, and employees (typing is carried out for people under the age of 45).

If such a process is established in other universities, and not only in medicine, then with the help of young people, I think we will have an excellent Register, where it will be possible to conduct an effective search for donors. We are ready to share our experience, we are ready to go to universities with our technology, to tell how we were able to combine these two actions at a sufficiently high level.

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