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Zukünftige intrauterine Therapien

Future intrauterine therapies

Zusammenfassung

Hintergrund

Technische Weiterentwicklungen ermöglichen es, fetale Erkrankungen immer früher zu diagnostizieren und auch zu therapieren.

Fragestellung

Welche intrauterinen Therapien erwarten uns in der näheren Zukunft?

Material und Methode

Im Artikel werden verschiedene zukünftige fetale Therapien vorgestellt.

Ergebnisse

Aktuell laufende Studien werden zeigen, ob ein passagerer Trachealverschluss bei der fetalen Zwerchfellhernie einen Vorteil bringt und ob damit innovative Trachealverschlussmethoden zum Einsatz kommen werden. Operieren mittels HIFU („high intensity focused ultrasound“) könnte zur Gefäßverödung bei fetalen Tumoren eingesetzt werden. Mit dem Einsatz von EXTEND (EXTra-uterine Environment for Neonatal Development) wären kranke Feten einer Therapie leichter zugänglich und könnten zwischen 23–27 SSW weiter ausreifen. Fc-Rezeptor-Antikörper (AK) könnten den Transport pathologischer AK zum Feten und damit eine intrauterine Bluttransfusion bei fetaler Anämie verhindern. Fetale Stammzellen könnten zur Therapie verschiedenster fetaler Krankheiten, z. B. bei der Osteogenesis imperfecta, eingesetzt werden. Mittels der Genschere „CRISPR/CAS“ („clustered regularly interspaced short palindromic repeats“/„CRISPR-associated protein“) könnte in Zukunft eine pränatale Therapie verschiedenster genetischer Erkrankungen, wie z. B. der zystischen Fibrose oder einer β‑Thalassämie, möglich sein.

Schlussfolgerung

In der Zukunft werden weniger invasive Techniken wie HIFU und AK-, aber auch Stammzell- und Gentherapien ihren Einsatz in der fetalen Therapie finden.

Abstract

Background

Technical advancements enable earlier diagnosis and therapy of fetal diseases.

Objectives

The aim of this article is to present future intrauterine therapies.

Material and methods

Various fetal therapies of the future will be discussed.

Results

Studies currently underway will show whether tracheal occlusion (TO) benefits fetuses with congenital diaphragmatic hernia and, if so, whether innovative TO will be applied. Coagulation of fetal tumor vessels might be performed by high intensity focused ultrasound (HIFU). Use of the extra-uterine environment for neonatal development (EXTEND) could make fetuses with disease more accessible to treatment and enable further maturation between gestational weeks 23 and 27. Fc-receptor antibodies, which inhibit antibody transfer to the fetus, might be used instead of fetal blood transfusions for severe fetal anemia. Fetal stem cells could be used to treat a wide range of fetal diseases, including osteogenesis imperfecta. The application of the gene scissor “CRISPR/CAS” may help to treat gene defects such as cystic fibrosis and β‑thalassemia.

Conclusion

In the future, less invasive procedures such as HIFU and antibody therapies, as well as stem cell and gene therapies, will be implemented in fetal therapy.

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Author information

Correspondence to Prof. Dr. Nicole Ochsenbein-Kölble.

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Interessenkonflikt

N. Ochsenbein-Kölble gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

R. Zimmermann, Zürich

K. Vetter, Berlin

A. Schröer, Berlin

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Cite this article

Ochsenbein-Kölble, N. Zukünftige intrauterine Therapien. Gynäkologe (2020). https://doi.org/10.1007/s00129-020-04567-6

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Schlüsselwörter

  • Kongenitale Zwerchfellhernien
  • Osteogenesis imperfecta
  • Zystische Fibrose
  • Fetale Stammzellen
  • Thalassämie

Keywords

  • Hernias, diaphragmatic, congenital
  • Osteogenesis imperfecta
  • Cystic fibrosis
  • Fetal stem cells
  • Thalassemia