{"id":12718,"date":"2026-02-17T18:46:40","date_gmt":"2026-02-17T18:46:40","guid":{"rendered":"https:\/\/csiag.eu\/?p=12718"},"modified":"2026-02-17T20:56:03","modified_gmt":"2026-02-17T20:56:03","slug":"su-antikunais-susijusi-liga-mogad","status":"publish","type":"post","link":"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/","title":{"rendered":"MOGAD - su MOG antik\u016bnais susijusi liga"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_87_1 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Turinys<\/p>\n<span class=\"ez-toc-title-toggle\"><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1' ><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Was_ist_MOGAD\" >Kas yra MOGAD?<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Was_geht_bei_MOGAD_schief\" >Kas vyksta ne taip MOGAD?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Wo_im_Korper_passiert_das\" >Kurioje k\u016bno vietoje tai vyksta?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Wie_verlauft_die_Erkrankung\" >Kaip liga progresuoja?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Wie_haufig_ist_MOGAD\" >Kaip da\u017enai pasitaiko MOGAD?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Was_lost_MOGAD_aus\" >Kas sukelia MOGAD?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Wie_wird_MOGAD_behandelt\" >Kaip gydomas MOGAD?<\/a><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Wissenschaftliche_Einleitung_und_Definition\" >Mokslinis \u012fvadas ir apibr\u0117\u017eimas<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Abgrenzung_von_MOGAD_NMOSD_und_MS\" >MOGAD, NMOSD ir MS diferenciacija<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#MOG-Protein_%E2%80%93_Struktur_und_physiologische_Funktion\" >MOG baltymas - strukt\u016bra ir fiziologin\u0117 funkcija<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Strukturdomanen\" >Strukt\u016briniai domenai<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Physiologische_Funktionen\" >Fiziologin\u0117s funkcijos<\/a><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Pathogenese_und_Immunpathologie\" >Patogenez\u0117 ir imunopatologija<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Trigger_und_initiale_Aktivierung\" >Paleidimas ir pradinis \u012fjungimas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#T-Zell-vermittelte_Pathogenese\" >T l\u0105steli\u0173 sukelta patogenez\u0117<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Phase_1_%E2%80%93_Periphere_Aktivierung\" >1 etapas - periferinis aktyvavimas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Phase_2_%E2%80%93_BHS-Penetration\" >2 etapas - BHS \u012fsiskverbimas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Phase_3_%E2%80%93_Perivaskulare_Reaktivierung\" >3 etapas - Perivaskulin\u0117 reaktyvacija<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#B-Zell-_und_Antikorper-vermittelte_Pathogenese\" >B l\u0105steli\u0173 ir antik\u016bn\u0173 sukelta patogenez\u0117<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Molekulare_Signalwege_und_Effektormechanismen\" >Molekulini\u0173 signal\u0173 keliai ir efektoriniai mechanizmai<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-21\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Signalweg_1_%E2%80%93_Klassischer_Komplementweg_CDC\" >1 signalinis kelias - klasikinis komplemento kelias (CDC)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-22\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Signalweg_2_%E2%80%93_Fc%CE%B3-Rezeptor-Weg_FcR-vermittelt\" >2 signalinis kelias - Fc\u03b3 receptori\u0173 kelias (per FcR)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-23\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Signalweg_3_%E2%80%93_IL-6JAK-STAT3-Weg\" >3 signalinis kelias - IL-6\/JAK-STAT3 kelias<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-24\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Signalweg_4_%E2%80%93_MAPK-_und_AKT-Signalwege_B-Zellen\" >4 signalinis kelias - MAPK ir AKT signaliniai keliai (B l\u0105stel\u0117s)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-25\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Signalweg_5_%E2%80%93_Th17-Zytokin-Netzwerk_im_ZNS\" >5 signalinis kelias - Th17 citokin\u0173 tinklas CNS<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-26\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Signalwege_%E2%80%93_Ubersicht\" >Signalizavimo keliai - ap\u017evalga<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-27\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Relevante_Rezeptoren_und_Zielmolekule\" >Atitinkami receptoriai ir tikslin\u0117s molekul\u0117s<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-28\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#MOG_selbst_als_Zielstruktur_kein_klassischer_Rezeptor\" >pats MOG kaip tikslin\u0117 strukt\u016bra (ne klasikinis receptorius)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-29\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Fc%CE%B3-Rezeptoren_Fc%CE%B3R\" >Fc\u03b3 receptoriai (Fc\u03b3R)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-30\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Neonataler_Fc-Rezeptor_FcRn\" >Naujagimi\u0173 Fc receptorius (FcRn)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-31\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#IL-6-Rezeptor_IL-6R%CE%B1_gp130\" >IL-6 receptorius (IL-6R\u03b1 \/ gp130)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-32\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#T-Zell-Rezeptor_TCR_und_Kostimulationsmolekule\" >T-l\u0105steli\u0173 receptori\u0173 (TCR) ir kostimuliacijos molekuli\u0173<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-33\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Komplementrezeptoren\" >Komplemento receptoriai<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-34\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Histopathologie_und_ZNS-Lasionsmuster\" >Histopatologija ir CNS pa\u017eeidim\u0173 pob\u016bdis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-35\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Klinische_Manifestationen_und_Phanotypen\" >Klinikin\u0117s aprai\u0161kos ir fenotipai<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-36\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Diagnostik\" >Diagnostika<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-37\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Therapeutische_Strategien\" >Terapin\u0117s strategijos<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-38\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Akuttherapie_Schubbehandlung\" >\u016aminis gydymas (atkry\u010dio gydymas)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-39\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Prophylaktische_Langzeittherapie\" >Profilaktinis ilgalaikis gydymas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-40\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Klinische_Studien_%E2%80%93_2024%E2%80%932026\" >Klinikiniai tyrimai - 2024-2026 m.<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-41\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Neue_und_zukunftige_Therapiekonzepte\" >Naujos ir b\u016bsimos terapijos koncepcijos<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-42\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#BTK-Inhibitoren_Bruton-Tyrosin-Kinase\" >BTK inhibitoriai (Brutono tirozino kinaz\u0117)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-43\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Toleranzinduktion_MOG-Tolerisierung\" >Tolerancijos skatinimas (MOG toleravimas)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-44\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Komplementinhibitoren\" >Komplemento inhibitoriai<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-45\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Anti-Neonatal-Fc-Rezeptor-Strategien\" >Anti-neonatalin\u0117s Fc receptori\u0173 strategijos<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-46\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Autologe_hamatopoetische_Stammzelltransplantation_aHSCT\" >Autologin\u0117 kraujodaros kamienini\u0173 l\u0105steli\u0173 transplantacija (aHSCT)<\/a><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-47\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Biomarker_und_Verlaufsmonitoring\" >Biomarkeriai ir tolesn\u0117 steb\u0117sena<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-48\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Prognose_und_Besonderheiten\" >Prognoz\u0117 ir specialios funkcijos<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-49\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Zusammenfassung_und_Ausblick\" >Apibendrinimas ir perspektyvos<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-50\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Atherischer_Ole_%E2%80%93_Wirkstoffe_nach_Signalwegen_geordnet\" >Eteriniai aliejai - veikliosios med\u017eiagos, suskirstytos pagal signalinius kelius<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-51\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Weihrauch_Boswellia_serrata_%E2%80%93_AKBA_und_Incensolacetat\" >Smilkalai (Boswellia serrata) - AKBA ir incensolio acetatas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-52\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Therapeutisch_relevante_AKBA-Zieldosen\" >Terapi\u0161kai svarbios AKBA tikslin\u0117s doz\u0117s<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-53\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Umrechnung_auf_375_mg_AKBA_jeKapsel\" >Perskai\u010diavimas \u012f 37,5 mg AKBA vienoje kapsul\u0117je<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-54\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Wichtige_Einnahmehinweise\" >Svarb\u016bs pri\u0117mimo nurodymai<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-55\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Schwarzer_Pfeffer_oral\" >Juodieji pipirai (geriamieji)<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-56\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Schwarzer_Pfeffer_Inhalation\" >Juodieji pipirai (\u012fkv\u0117pus)<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-57\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Copaiba-Ol_oral_%E2%80%93_NUR_doTERRA\" >Kopaibos aliejus (geriamasis) - TIK doTERRA<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-58\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#MOGAD-spezifische_Dosierungstabelle_doTERRA_Copaiba_525_BCP\" >Speciali MOGAD dozavimo lentel\u0117 (doTERRA Copaiba 52.5 % BCP)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-59\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#MOGAD-Phasen-adaptierte_Dosierung\" >MOGAD dozavimas pagal faz\u0119<\/a><ul class='ez-toc-list-level-4' ><li class='ez-toc-heading-level-4'><a class=\"ez-toc-link ez-toc-heading-60\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Phase_1_Akuter_Schub_erste_2%E2%80%934_Wochen\" >1 etapas: \u016bmus pa\u016bm\u0117jimas (pirmosios 2-4 savait\u0117s)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-4'><a class=\"ez-toc-link ez-toc-heading-61\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Phase_2_Schubremission_Erhaltung_langfristig\" >2 etapas: atkry\u010dio remisija \/ palaikymas (ilgalaikis)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-4'><a class=\"ez-toc-link ez-toc-heading-62\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Phase_3_Monophasischer_Verlauf_Titer_fallend\" >3 etapas: vienfazis kursas (ma\u017e\u0117jantis titras)<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-63\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Quellen\" >\u0160altiniai<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-64\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Copaiba-Ol_Inhalation\" >Kopaibos aliejus (inhaliacija)<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-65\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Zieldosen_und_benotigte_Tropfenzahl\" >Tikslin\u0117s doz\u0117s ir reikiamas la\u0161\u0173 skai\u010dius<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-66\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Synergistische_MOGAD-Strategie_Multi-Target\" >Sinergetin\u0117 MOGAD strategija (daugiatiksl\u0117)<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-67\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Wichtige_MOGAD-spezifische_Hinweise\" >Svarbi su MOGAD susijusi informacija<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-68\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#%CE%B1-Asaron_Kalmus-Ol_Acorus_calamus_%E2%80%93_direkt_oligodendrozytenprotektiv\" >\u03b1-Asaronas (kalpok\u0173 aliejus, Acorus calamus) - tiesiogiai oligodendrocitus apsaugantis preparatas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-69\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Geraniumol_Pelargonium_graveolens_%E2%80%93_Neuroinflammation_und_NO\" >Pelargonij\u0173 aliejus (Pelargonium graveolens) - neurou\u017edegimas ir NO<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-70\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Teebaum-Ol_Melaleuca_alternifolia_%E2%80%93_Mikroglia-Modulation\" >Arbatmed\u017eio aliejus (Melaleuca alternifolia) - mikroglijos moduliacija<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-71\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Wirkstoffubersicht_nach_MOGAD-Signalwegen\" >Veikli\u0173j\u0173 med\u017eiag\u0173 ap\u017evalga pagal MOGAD signalizavimo kelius<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-72\" href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/#Quellen_und_weiterfuhrende_Literatur\" >\u0160altiniai ir tolesnis skaitymas<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Skaitymo laikas<\/span> <span class=\"rt-time\"> 17<\/span> <span class=\"rt-label rt-postfix\">minut\u0117s<\/span><\/span>\n<p class=\"wp-block-paragraph\"><em>Mielino oligodendrocit\u0173 glikoproteino antik\u016bn\u0173 sukelta liga<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Was_ist_MOGAD\"><\/span>Kas yra MOGAD?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Visi \u017eino elektros kabelius: Jie turi izoliacij\u0105, kuri atskiria atskirus kabeli\u0173 pluo\u0161to laidininkus vien\u0105 nuo kito, kad juose esantys signalai netrukdyt\u0173 vienas kitam ir nei\u0161kraipyti patekt\u0173 i\u0161 ta\u0161ko A \u012f ta\u0161k\u0105 B.<br>Nugaros smegenyse yra daugyb\u0117 toki\u0173 kabeli\u0173 pluo\u0161t\u0173. Jos perduoda nervinius signalus i\u0161 galvos smegen\u0173 \u012f \u012fvairius k\u016bno organus, raumenis, audinius ir kt. Nors kabelio izoliacija gaminama i\u0161 plastiko, tekstil\u0117s ar speciali\u0173 med\u017eiag\u0173, nugaros smegen\u0173 izoliacinis sluoksnis yra pagamintas i\u0161 specialios med\u017eiagos. <strong>Mielino sluoksnis<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Was_geht_bei_MOGAD_schief\"><\/span>Kas vyksta ne taip MOGAD?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">MOGAD atveju organizmo imunin\u0117 sistema padaro rimt\u0105 klaid\u0105: ji klaidingai gamina <strong>Antik\u016bnai prie\u0161 specifin\u012f baltym\u0105, esant\u012f \u0161io izoliacinio sluoksnio i\u0161or\u0117je<\/strong>, vadinamasis. <strong>MOG<\/strong>-baltymai. Antik\u016bnai yra organizmo sargai, kurie atpa\u017e\u012fsta, pa\u017eymi ir sunaikina patogenus, pavyzd\u017eiui, virusus ir bakterijas. Ta\u010diau MOGAD atveju jie klaidingai nukreipiami prie\u0161 sveik\u0105 organizmo audin\u012f, jo paties nervini\u0173 skaidul\u0173 izoliacij\u0105.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Lyginant su kabeliu, tai tarsi izoliacijos subrai\u017eymas, nudilimas ar korozija, d\u0117l kuri\u0173 izoliacija tampa skyl\u0117ta ir elektros signalai nebepasiekia paskirties vietos \u0161variai ar net visai nepasiekia.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Wo_im_Korper_passiert_das\"><\/span>Kurioje k\u016bno vietoje tai vyksta?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">MOGAD susij\u0119s tik su <strong>Centrin\u0117 nerv\u0173 sistema<\/strong>, t. y. galvos smegenys, nugaros smegenys ir regos nervai. Priklausomai nuo to, kuri sritis pa\u017eeista, pasirei\u0161kia skirtingi simptomai:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Regos nervas<\/strong> - Staigus reg\u0117jimo praradimas, nery\u0161kus matymas, aki\u0173 skausmas (da\u017enai tik vienos akies, kartais abiej\u0173 aki\u0173 vienu metu - tai da\u017eniau pasitaiko sergant MOGAD nei kitomis pana\u0161iomis ligomis).<\/li>\n\n\n\n<li><strong>Nugaros smegenys<\/strong> - Paraly\u017eiaus, tirpimo, \u0161lapinimosi sutrikim\u0173 simptomai<\/li>\n\n\n\n<li><strong>Smegenys :<\/strong> Sumi\u0161imas, epilepsijos priepuoliai, koordinacijos sutrikimai<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Wie_verlauft_die_Erkrankung\"><\/span>Kaip liga progresuoja?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">MOGAD paprastai vyksta <strong>Stumia<\/strong>. B\u016bna fazi\u0173, kai u\u017edegimas yra aktyvus ir simptomai pasirei\u0161kia su pertraukomis, o tarp j\u0173 b\u016bna ramesni\u0173 fazi\u0173.<br>Po ligos epizodo daugelis pacient\u0173 steb\u0117tinai gerai pasveiksta, geriau nei, pavyzd\u017eiui, sergantiesiems i\u0161s\u0117tine skleroze. Taip yra tod\u0117l, kad pa\u010dios nerv\u0173 skaidulos da\u017enai b\u016bna ma\u017eiau pa\u017eeistos nei izoliacinis sluoksnis, kuris gali i\u0161 dalies atsinaujinti.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ma\u017edaug pus\u0117 sergan\u010di\u0173j\u0173 per gyvenim\u0105 patiria tik vien\u0105 ligos pa\u016bm\u0117jim\u0105. Kitai pusei ligos epizodai kartojasi, o negydomi jie gali sukelti nuolatinius sutrikimus.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Wie_haufig_ist_MOGAD\"><\/span>Kaip da\u017enai pasitaiko MOGAD?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">MOGAD pasitaiko retai, tik apytikriai <strong>1-2 i\u0161 100 000 \u017emoni\u0173<\/strong> susirgti. Kitaip nei daugeliu kit\u0173 autoimunini\u0173 nerv\u0173 sistemos lig\u0173, \u0161ia liga serga ma\u017edaug po lygiai moter\u0173 ir vyr\u0173. Vaikai taip pat gali susirgti \u0161ia liga, kuri da\u017enai pasirei\u0161kia i\u0161plitusiu smegen\u0173 u\u017edegimu, sumi\u0161imu ir kar\u0161\u010diavimu.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Was_lost_MOGAD_aus\"><\/span>Kas sukelia MOGAD?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Po pirmojo epizodo da\u017enai seka <strong>Infekcija<\/strong> \u012f priek\u012f. Organizmas kovoja su patogenu ir klaidingai supainioja savo paties strukt\u016bras su prie\u0161u. Imunin\u0117 sistema i\u0161moksta pulti, taip sakant, ne t\u0105 taikin\u012f ir niekada nesustoja. Tiksli prie\u017eastis dar n\u0117ra iki galo i\u0161ai\u0161kinta. <\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Wie_wird_MOGAD_behandelt\"><\/span>Kaip gydomas MOGAD?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">\u0160iuo metu n\u0117ra specialiai nuo MOGAD leid\u017eiam\u0173 vaist\u0173. Vienas <strong>\u016bmus priepuolis<\/strong> gydomas didel\u0117mis doz\u0117mis <strong>Kortizono infuzijos<\/strong>, kurie greitai numal\u0161ina u\u017edegim\u0105. Jei to nepakanka <strong>Kraujo plovimas<\/strong> (<em>Plazmaferez\u0117<\/em>) kenksmingas antik\u016bnas gali b\u016bti pa\u0161alintas tiesiai i\u0161 kraujo.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u012e <strong>Tolesni\u0173 atkry\u010di\u0173 prevencija<\/strong> Imuninei sistemai nuraminti vartojami \u012fvair\u016bs vaistai, pavyzd\u017eiui, med\u017eiagos, ma\u017einan\u010dios antik\u016bnus gaminan\u010di\u0173 l\u0105steli\u0173 kiek\u012f. \u0160iuo metu klinikiniuose tyrimuose bandomi keli nauji, tikslingesni vaistai, kuriuos gali b\u016bti leista vartoti per kelerius ateinan\u010dius metus.<\/p>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Wissenschaftliche_Einleitung_und_Definition\"><\/span>Mokslinis \u012fvadas ir apibr\u0117\u017eimas<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">Svetain\u0117 <strong>Su MOG antik\u016bnais susijusi liga (MOGAD)<\/strong> Angl\u0173 kalba: <em>Mielino oligodendrocit\u0173 glikoproteino antik\u016bn\u0173 sukelta liga<\/em> yra reta u\u017edegimin\u0117 autoimunin\u0117 centrin\u0117s nerv\u0173 sistemos (CNS) liga, kuri nuo 2018 m. pripa\u017einta kaip savaranki\u0161kas vienetas su atskirais diagnostikos kriterijais. Anks\u010diau ji buvo laikoma i\u0161s\u0117tin\u0117s skleroz\u0117s (IS) variantu arba neuromielito optinio spektro sutrikimu (NMOSD).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pagrindinis ligos elementas yra patologin\u0117 autoantik\u016bn\u0173 (IgG) gamyba prie\u0161 <strong>Mielino oligodendrocit\u0173 glikoproteinas (MOG)<\/strong>, transmembraninis baltymas, esantis CNS oligodendrocit\u0173 mielino apvalkalo i\u0161oriniame sluoksnyje. \u0160ie antik\u016bnai pa\u017eeid\u017eia mielino apvalkal\u0105 ir sukelia b\u016bding\u0105 perivenulin\u0119 demielinizacij\u0105.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Klini\u0161kai MOGAD da\u017eniausiai pasirei\u0161kia optinio nervo neuritu, skersiniu mielitu ir \u016bminiu i\u0161plitusiu encefalomielitu (ADEM). Liga paprastai b\u016bna recidyvuojanti ir pa\u017eeid\u017eia regos nerv\u0105, nugaros smegenis, re\u010diau - galvos smegenis. Vidutinis ligos prad\u017eios am\u017eius yra 30-35 metai; prie\u0161ingai nei NMOSD, moterys ir vyrai serga beveik vienodai da\u017enai.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Abgrenzung_von_MOGAD_NMOSD_und_MS\"><\/span>MOGAD, NMOSD ir MS diferenciacija<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Funkcija<\/strong><\/td><td><strong>MOGAD<\/strong><\/td><td><strong>AQP4+ NMOSD<\/strong><\/td><td><strong>I\u0161s\u0117tin\u0117 skleroz\u0117<\/strong><\/td><\/tr><\/thead><tbody><tr><td>Tikslinis antigenas<\/td><td>MOG (oligodendrocitai)<\/td><td>Akvaporinas-4 (astrocitai)<\/td><td>N\u0117ra specifini\u0173 autoantik\u016bn\u0173<\/td><\/tr><tr><td>Antik\u016bn\u0173 izotipas<\/td><td>IgG1 (prie\u0161)<\/td><td>IgG1 (prie\u0161)<\/td><td>Oligokloninis IgG (CSF)<\/td><\/tr><tr><td>Pirminis l\u0105steli\u0173 pa\u017eeidimas<\/td><td>Oligodendrocitai \/ mielinas<\/td><td>Astrocitai (pirminiai)<\/td><td>Oligodendrocitai<\/td><\/tr><tr><td>Histologija<\/td><td>Perivenulin\u0117 demielinizacija, CD4+<\/td><td>Astrocit\u0173 pa\u017eeidimai, granuliocitai<\/td><td>Periaksin\u0117s plok\u0161tel\u0117s<\/td><\/tr><tr><td>Lytis (F:M)<\/td><td>~1:1<\/td><td>~9:1<\/td><td>~3:1<\/td><\/tr><tr><td>Komplemento aktyvavimas<\/td><td>Vidutinio sunkumo (ma\u017eiau MAC)<\/td><td>Stiprus (MAC formavimas)<\/td><td>\u017demas<\/td><\/tr><tr><td>OKB smegen\u0173 skystyje<\/td><td>Retas (&lt;10%)<\/td><td>Retkar\u010diais<\/td><td>Da\u017enas (&gt;90%)<\/td><\/tr><tr><td>Kursas<\/td><td>Pasikartojantis; da\u017enai gerai pasveikstama<\/td><td>Stumiamos formos; kaupiasi negalia<\/td><td>Da\u017enai progedientas<\/td><\/tr><tr><td>Leid\u017eiamos terapijos<\/td><td>N\u0117ra (nuo 2026 m.)<\/td><td>Ekliuzumabas, ublituksimabas, satralizumabas<\/td><td>Daugelis DMT<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"MOG-Protein_%E2%80%93_Struktur_und_physiologische_Funktion\"><\/span>MOG baltymas - strukt\u016bra ir fiziologin\u0117 funkcija<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">MOG (mielino oligodendrocit\u0173 glikoproteinas) yra <strong>I tipo transmembraninis baltymas<\/strong> kurio bendras ilgis 218 aminor\u016bg\u0161\u010di\u0173 ir kuris yra i\u0161skirtinai i\u0161reik\u0161tas CNS. Jis priklauso imunoglobulin\u0173 super\u0161eimai ir sudaro apie 0,01-0,05 % viso mielino baltymo, tod\u0117l yra kiekybi\u0161kai nedidelis, bet imunologi\u0161kai labai svarbus mielino apvalkalo komponentas.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Strukturdomanen\"><\/span>Strukt\u016briniai domenai<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u012e Ig-V pana\u0161us ekstral\u0105stelinis domenas (AS 1-120): Vienintelis atviras domenas, labai imunogeni\u0161kas; jame yra kritin\u0117 CC\u2018 kilpos sritis (Pro42, His103, Ser104), kuri yra pagrindin\u0117 epitopo prisijungimo vieta MOG-IgG<\/li>\n\n\n\n<li>Vieno pra\u0117jimo transmembranin\u0117 spiral\u0117: \u012ftvirtina baltym\u0105 mielino membranoje<\/li>\n\n\n\n<li>Trumpas citoplazminis C-galinis domenas: galimai s\u0105veikauja su citoskeletu<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Physiologische_Funktionen\"><\/span>Fiziologin\u0117s funkcijos<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Adhezijos molekul\u0117: Sudaro mielino apvalkalo strukt\u016brin\u012f vientisum\u0105, galb\u016bt sutankindama mielino lameles.<\/li>\n\n\n\n<li>S\u0105veika su komplemento sistemos C1q (fiziologin\u0117)<\/li>\n\n\n\n<li>S\u0105veika su nerv\u0173 augimo faktoriumi (NGF)<\/li>\n\n\n\n<li>Raudonuk\u0117s viruso receptorius (klini\u0161kai svarbus poinfekcinei ADEM)<\/li>\n\n\n\n<li>Mikrotubuli\u0173 stabilizavimas oligodendrocituose<\/li>\n\n\n\n<li>Ekspresija: v\u0117lyvoji oligodendrocit\u0173 diferenciacija; tik po pradin\u0117s mielinizacijos<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">MOG-IgG autoantik\u016bnai pirmiausia atpa\u017e\u012fsta <strong>Konformaciniai epitopai<\/strong> ekstral\u0105stelinio domeno. Kadangi MOG yra i\u0161oriniame mielino apvalkalo pavir\u0161iuje, jis tiesiogiai pasiekiamas cirkuliuojantiems antik\u016bnams ir imuniniams kompleksams - tai lemiamas skirtumas nuo vidul\u0105stelini\u0173 antigen\u0173.<\/p>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Pathogenese_und_Immunpathologie\"><\/span>Patogenez\u0117 ir imunopatologija<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">MOGAD patogenez\u0117 yra daugiapakopis procesas, apimantis periferin\u0117s imunin\u0117s sistemos aktyvacij\u0105, migracij\u0105 per kraujo-smegen\u0173 barjer\u0105 (BBB) ir CNS lokalius efektorinius mechanizmus. Nei T, nei B l\u0105stel\u0117s atskirai n\u0117ra pakankamai patogeni\u0161kos, lig\u0105 sukelia sinergetin\u0117 abiej\u0173 adaptyviosios imunin\u0117s sistemos dali\u0173 s\u0105veika.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Trigger_und_initiale_Aktivierung\"><\/span>Paleidimas ir pradinis \u012fjungimas<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Pagrindiniai pradiniai veiksniai yra \u0161ie <strong>Infekcijos<\/strong> aptarta: Infekcinis prodromas nustatytas 37-70 % MOGAD pacient\u0173 (da\u017eniau nei NMOSD (15-35 %). Mechanizmai yra \u0161ie:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Molekulin\u0117 mimikrija - patogen\u0173 epitopai strukt\u016bri\u0161kai pana\u0161\u016bs \u012f MOG CC\u2018 kilpos srit\u012f, pvz., SARS-CoV-2 sekos arba raudonuk\u0117s virusai.<\/li>\n\n\n\n<li>Bystander aktyvavimas - nespecifin\u0117 u\u017edegimin\u0117 reakcija suaktyvina miegan\u010dius autoreaktyvius limfocitus<\/li>\n\n\n\n<li>Mikrob\u0173 superantigen\u0173 sukeltas poliklonini\u0173 B l\u0105steli\u0173 aktyvavimas<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Genetinis polinkis yra svarbus, ta\u010diau konkret\u016bs rizikos haplotipai n\u0117ra galutinai nustatyti. Skirtingai nuo i\u0161s\u0117tin\u0117s skleroz\u0117s, HLA s\u0105saj\u0173 n\u0117ra nustatyta.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"T-Zell-vermittelte_Pathogenese\"><\/span>T l\u0105steli\u0173 sukelta patogenez\u0117<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">MOG specifin\u0117s CD4+ T l\u0105stel\u0117s yra b\u016btinos MOGAD patogenezei. Gyv\u016bn\u0173 modeliuose (EAE) vien tik antik\u016bnai n\u0117ra patogeni\u0161ki; jiems reikalingos encefalitogenin\u0117s T l\u0105stel\u0117s kaip kofaktoriai. CD4+ keli\u0105 sudaro kelios faz\u0117s:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Phase_1_%E2%80%93_Periphere_Aktivierung\"><\/span>1 etapas - periferinis aktyvavimas<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">MOG peptidus gamina antigen\u0105 pateikian\u010dios l\u0105stel\u0117s (APC) per <strong>MHC-II molekul\u0117s<\/strong> \u012f naivias CD4+ T l\u0105steles. Pa\u017eym\u0117tina: <em>MOG peptidai gali tiesiogiai prisijungti prie periferini\u0173 MHC II molekuli\u0173<\/em>, be tolesnio apdorojimo. Tai gal\u0117t\u0173 paai\u0161kinti periferin\u0117s nerv\u0173 sistemos dalyvavim\u0105.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Efektorini\u0173 l\u0105steli\u0173 pogrupiai, kurie gali sukelti EAE nepriklausomai vienas nuo kito, yra \u0161ie. <strong>Th1, Th17 ir Th9<\/strong>. Th17 l\u0105stel\u0117s yra ypa\u010d svarbios MOGAD, nes Th17 citokin\u0173 (IL-17, IL-21) kiekis \u017eenkliai padid\u0117ja \u0161lyties epizod\u0173 metu.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Phase_2_%E2%80%93_BHS-Penetration\"><\/span>2 etapas - BHS \u012fsiskverbimas<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Aktyvuotos CD4+ T l\u0105stel\u0117s i\u0161rei\u0161kia specifines adhezijos molekules (integrinus, selektinus) ir chemokin\u0173 receptorius (vis\u0173 pirma <strong>CCR6<\/strong>), d\u0117l kuri\u0173 jie gali patekti \u012f CNS. CCR6+ Th17 l\u0105stel\u0117s prisijungia prie CCL20, kuris konstituci\u0161kai ekspresuojamas choroidiniame rezginyje, ir per j\u012f patenka \u012f subarachnoidin\u0119 erdv\u0119.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Matricos metaloproteinaz\u0117s (MMP-2, MMP-9)<br>BBB bazin\u0117s membranos degradacija<\/li>\n\n\n\n<li>Neutrofil\u0173 NET (neutrofil\u0173 ekstral\u0105stelin\u0117s gaudykl\u0117s)<br>Teikti kostimuliacinius signalus T l\u0105stel\u0117ms iniciacijos faz\u0117je<\/li>\n\n\n\n<li>Trombocitai<br>Skatina CD4+ T l\u0105steli\u0173 proliferacij\u0105 ir diferenciacij\u0105 \u012f Th1\/Th17 per citokinus ir adhezijos molekules<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Phase_3_%E2%80%93_Perivaskulare_Reaktivierung\"><\/span>3 etapas - Perivaskulin\u0117 reaktyvacija<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Perivaskulin\u0117je erdv\u0117je ir subarachnoidin\u0117je erdv\u0117je MOG specifines T l\u0105steles reaktyvuoja vietiniai MOG \u012fkrauti APC (mikroglijos, dendritin\u0117s l\u0105stel\u0117s). \u0160i reaktyvacija sukelia tikr\u0105j\u0105 u\u017edegimo kaskad\u0105: Prou\u017edegimini\u0173 citokin\u0173 sekrecija, kit\u0173 leukocit\u0173 pritraukimas ir oligodendrocit\u0173 pa\u017eeidimas.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B-Zell-_und_Antikorper-vermittelte_Pathogenese\"><\/span>B l\u0105steli\u0173 ir antik\u016bn\u0173 sukelta patogenez\u0117<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">MOG specifin\u0117s B l\u0105stel\u0117s ir plazmin\u0117s l\u0105stel\u0117s yra pagrindiniai patogenini\u0173 IgG1 autoantik\u016bn\u0173 gamintojai. Ta\u010diau B l\u0105steli\u0173 vaidmuo neapsiriboja antik\u016bn\u0173 gamyba:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Antigeno pateikimas - B l\u0105stel\u0117s gali prisijungti prie MOG konformacini\u0173 epitop\u0173 (pro42, his103, ser104 CC\u2018 kilpoje) per savo BCR ir veikti kaip T l\u0105steli\u0173 APC.<\/li>\n\n\n\n<li>B l\u0105stel\u0117s i\u0161skiria IL-6, kuris kartu su TGF-\u03b2 skatina Th17 diferenciacij\u0105.<\/li>\n\n\n\n<li>MAPK ir AKT signalizacijos aktyvavimas - BCR prisijungimas prie MOG suaktyvina \u0161iuos signalizacijos kelius vidul\u0105steliniu b\u016bdu<\/li>\n\n\n\n<li>Padid\u0117j\u0119s vidul\u0105stelinio kalcio kiekis - suaktyvina su stresu susijusias signalines kaskadas<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Dauguma MOG-IgG antik\u016bn\u0173 susidaro periferijoje (oligoklonin\u0117s juostos CSF tik ~10 % atvej\u0173, palyginimui: MS ~90 %). Antik\u016bnai yra <strong>dvivalent\u012f jungiantys<\/strong> su MOG, abi Fab at\u0161akos vienu metu jungiasi prie dviej\u0173 gretim\u0173 MOG molekuli\u0173. D\u0117l to C1q \u012fdarbinimas yra ma\u017eiau veiksmingas, palyginti su monovalentiniu AQP4-IgG prisijungimu NMOSD.<\/p>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Molekulare_Signalwege_und_Effektormechanismen\"><\/span>Molekulini\u0173 signal\u0173 keliai ir efektoriniai mechanizmai<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Signalweg_1_%E2%80%93_Klassischer_Komplementweg_CDC\"><\/span>1 signalinis kelias - klasikinis komplemento kelias (CDC)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Jei MOG-IgG1 (ir MOG-IgG3) jungiasi su oligodendrocit\u0173 MOG, tai <strong>klasikinis papildomas mar\u0161rutas<\/strong> \u012fjungiami. Ta\u010diau MOGAD komplemento aktyvacija yra silpnesn\u0117 nei AQP4+ NMOSD:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>C1q prisijungimas prie suri\u0161t\u0173 IgG1 antik\u016bn\u0173 Fc dalies \u2192 C1r ir C1s aktyvinimas<\/li>\n\n\n\n<li>C4 skilimas \u2192 C4a + C4b; C4b + C2 \u2192 C3 konvertaz\u0117 (C4b2a)<\/li>\n\n\n\n<li>C3 skilimas \u2192 C3a (anafilatoksinas) + C3b (opsoninas)<\/li>\n\n\n\n<li>C3b \u2192 C5 konvertaz\u0117 \u2192 C5 skilimas \u2192 C5a (stiprus anafilatoksinas) + C5b<\/li>\n\n\n\n<li>C5b + C6, C7, C8, C9 \u2192 membranos atakos kompleksas (MAC, C5b-9): Tiesiogin\u0117 oligodendrocit\u0173 liz\u0117<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Svarbu: MOGAD sergan\u010di\u0173 pacient\u0173 smegen\u0173 skys\u010diuose C3a ir C5a koncentracija gerokai padid\u0117ja (pana\u0161iai kaip AQP4+ NMOSD), ta\u010diau MAC komplekso (C5b-9) koncentracija n\u0117ra labai padid\u0117jusi. <strong>\u017eymiai ma\u017eesn\u0117<\/strong> nei NMOSD. Taip yra d\u0117l bivalentinio IgG prisijungimo, kuris yra ma\u017eiau efektyvus C1q klasterizacijai, ir d\u0117l santykinai ma\u017eo komplemento reguliatori\u0173 tankio ant oligodendrocit\u0173 (ma\u017eiau CR1, MCP, HRF nei ant kit\u0173 l\u0105steli\u0173 tip\u0173).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Signalweg_2_%E2%80%93_Fc%CE%B3-Rezeptor-Weg_FcR-vermittelt\"><\/span>2 signalinis kelias - Fc\u03b3 receptori\u0173 kelias (per FcR)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">LMU tyrimai (Mader, Kawakami, Meinl, 2024 PNAS) parod\u0117, kad Fc\u03b3 receptoriaus (Fc\u03b3R) mechanizmai <strong>iki ma\u017edaug 50 % mielino pa\u017eeidimo<\/strong> tod\u0117l jos yra lygiavert\u0117s komplemento aktyvacijai:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fc\u03b3RIII<\/strong> (<strong>CD16<\/strong>) ant NK l\u0105steli\u0173 ir makrofag\u0173<br>Sujungia su MOG suri\u0161to IgG1 Fc dal\u012f \u2192 ADCC (nuo antik\u016bn\u0173 priklausomas l\u0105steli\u0173 citotoksi\u0161kumas)<\/li>\n\n\n\n<li><strong>Fc\u03b3RI\/II\/III<\/strong> ant makrofag\u0173 ir monocit\u0173<br>MOG-opsonizuot\u0173 oligodendrocit\u0173 fragment\u0173 fagocitoz\u0117 (ADCP)<\/li>\n\n\n\n<li>Lemiamas: antrasis FcR patomechanizmas<br>T l\u0105steli\u0173 aktyvacijos stiprinimas, vykstantis tik per Fc receptorius, NE per komplemento keli\u0105<\/li>\n\n\n\n<li><strong>Fc\u03b3R<\/strong> apie dendritines l\u0105steles<br>Palengvina MOG-IgG prisotint\u0173 oligodendrocit\u0173 antigen\u0173 apdorojim\u0105 ir pateikim\u0105 MOG specifin\u0117ms T l\u0105stel\u0117ms<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Klinikin\u0117 reik\u0161m\u0117: Kadangi egzistuoja du nepriklausomi patogeniniai keliai, gydymo metodai turi b\u016bti <strong>Abu mechanizmai<\/strong> kad b\u016bt\u0173 pasiektas did\u017eiausias veiksmingumas.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Signalweg_3_%E2%80%93_IL-6JAK-STAT3-Weg\"><\/span>3 signalinis kelias - IL-6\/JAK-STAT3 kelias<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">IL-6 yra pagrindinis MOGAD imunopatogenez\u0117s mediatorius, veikiantis keliais lygmenimis:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">IL-6 prisijungia prie savo receptoriaus (IL-6R\u03b1\/gp130 komplekso), kuris sukelia <strong>JAK1\/2 fosforilinimas<\/strong> veda. Tai pirmiausia suaktyvina <strong>STAT3<\/strong>, kuris yra transkripcijos veiksnys:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Th17 diferenciacija<\/strong><br>IL-6 + TGF-\u03b2 \u2192 ROR\u03b3t ekspresija \u2192 IL-17A\/F gamyba; IL-6 + IL-23 \u2192 Th17 fenotipo palaikymas<\/li>\n\n\n\n<li><strong>Folikulin\u0117s T pagalbinink\u0173 l\u0105stel\u0117s<\/strong> (<strong>Tfh<\/strong>)<br>IL-6 \u2192 STAT3 \u2192 Bcl6 rai\u0161ka \u2192 B l\u0105steli\u0173 brendimas ir IgG klas\u0117s pasikeitimas<\/li>\n\n\n\n<li><strong>B l\u0105steli\u0173 brendimas \u012f plazmines l\u0105steles<\/strong><br>IL-6 skatina diferenciacij\u0105 per STAT3\/Blimp-1 a\u0161\u012f<\/li>\n\n\n\n<li><strong>Treg funkcijos slopinimas<\/strong><br>IL-6 slopina FoxP3 ekspresij\u0105, tod\u0117l Treg\/Th17 pusiausvyra pasislenka u\u017edegimo link.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Terapin\u0117 reik\u0161m\u0117: IL-6 blokada (pvz., tocilizumabas, satralizumabas) nutraukia \u0161\u012f cikl\u0105. <strong><em>Satralizumabas<\/em><\/strong> (anti-IL-6R) \u0161iuo metu tiriamas atliekant 3 faz\u0117s METEOROID tyrim\u0105 d\u0117l MOGAD.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Signalweg_4_%E2%80%93_MAPK-_und_AKT-Signalwege_B-Zellen\"><\/span>4 signalinis kelias - MAPK ir AKT signaliniai keliai (B l\u0105stel\u0117s)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">BCR prisijungimas prie MOG konformacini\u0173 epitop\u0173, aktyvuojam\u0173 B l\u0105stel\u0117se:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>MAPK kelias<\/strong> (<strong>MEK\/ERK<\/strong>)<br>B l\u0105steli\u0173 proliferacijos ir diferenciacijos skatinimas<\/li>\n\n\n\n<li><strong>PI3K\/AKT kelias<\/strong><br>B l\u0105steli\u0173 i\u0161gyvenamumas ir diferenciacija \u012f plazmines l\u0105steles<\/li>\n\n\n\n<li><strong>Kalcio antpl\u016bdis<\/strong><br>Kalcineurino\/NFAT a\u0161ies aktyvinimas \u2192 Citokin\u0173 gamyba<\/li>\n\n\n\n<li><strong>NK l\u0105steli\u0173 aktyvavimas<\/strong><br>BCR-MOG prisijungimas sukelia NK l\u0105steli\u0173 medijuot\u0105 citotoksi\u0161kum\u0105<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Signalweg_5_%E2%80%93_Th17-Zytokin-Netzwerk_im_ZNS\"><\/span>5 signalinis kelias - Th17 citokin\u0173 tinklas CNS<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CNS Th17 l\u0105stel\u0117s palaiko u\u017edegimin\u0119 aplink\u0105 naudodamos daugyb\u0119 mediatori\u0173:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>IL-17A ir IL-17F<\/strong><br>Suaktyvina astrocitus ir mikroglij\u0105; skatina chemokin\u0173 (CXCL-1\/5\/8), kurie pritraukia neutrofilus, i\u0161siskyrim\u0105<\/li>\n\n\n\n<li><strong>IL-21<\/strong> (autokrinin\u0117s ir parakrinin\u0117s)<br>Stiprina Th17 diferenciacij\u0105; skatina B l\u0105steli\u0173 diferenciacij\u0105 ir IgG klas\u0117s pasikeitim\u0105 (ypa\u010d IgG1)<\/li>\n\n\n\n<li><strong>IL-22<\/strong><br>BBB vientisumo sutrikimas<\/li>\n\n\n\n<li><strong>GM-CSF<\/strong> (<strong>per IL-23<\/strong>)<br>Suaktyvina mikroglij\u0105 ir makrofagus, didina vietin\u0119 demielinizacij\u0105<\/li>\n\n\n\n<li><strong>CXCL13<\/strong><br>B l\u0105steli\u0173 chemotaksis perivaskulin\u0117se erdv\u0117se \u2192 vietin\u0117 antik\u016bn\u0173 gamyba<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Signalwege_%E2%80%93_Ubersicht\"><\/span>Signalizavimo keliai - ap\u017evalga<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Signalo kelias<\/strong><\/td><td><strong>Pagrindin\u0117s molekul\u0117s<\/strong><\/td><td><strong>Poveikis<\/strong><\/td><td><strong>Terapiniai taikiniai<\/strong><\/td><\/tr><\/thead><tbody><tr><td>Klasikinis papildomas mar\u0161rutas<\/td><td>C1q, C3, C5, MAC (C5b-9)<\/td><td>Tiesiogin\u0117 oligodendrocit\u0173 liz\u0117<\/td><td>C5 inhibitoriai (ekulizumabas), C3 inhibitoriai<\/td><\/tr><tr><td>Fc\u03b3R kelias (ADCC\/ADCP)<\/td><td>Fc\u03b3RI\/II\/III, NK l\u0105stel\u0117s, makrofagai<\/td><td>Citotoksi\u0161kumas, fagocitoz\u0117, T l\u0105steli\u0173 stiprinimas<\/td><td>FcRn inhibitoriai (IgG skaidymas), FcR blokada<\/td><\/tr><tr><td>IL-6\/JAK-STAT3<\/td><td>IL-6, IL-6R\u03b1, gp130, JAK1\/2, STAT3, ROR\u03b3t<\/td><td>Th17 diferenciacija, B l\u0105steli\u0173 brendimas, IgG gamyba<\/td><td>Anti-IL-6R (tocilizumabas, satralizumabas)<\/td><\/tr><tr><td>PI3K\/AKT\/MAPK (B l\u0105stel\u0117s)<\/td><td>BTK, PI3K, AKT, ERK, NFAT<\/td><td>B l\u0105steli\u0173 aktyvavimas, plazmini\u0173 l\u0105steli\u0173 brendimas<\/td><td>BTK inhibitoriai (ibrutinibas, tolebrutinibas)<\/td><\/tr><tr><td>Th17 citokin\u0173 tinklas<\/td><td>IL-17, IL-21, IL-22, GM-CSF, CXCL13<\/td><td>BBB pa\u017eeidimas, leukocit\u0173 pritraukimas, demielinizacija<\/td><td>Anti-IL-17, Anti-IL-21<\/td><\/tr><tr><td>FcRn-IgG perdirbimas<\/td><td>FcRn (naujagimi\u0173 Fc receptorius)<\/td><td>Ilgesnis IgG pusin\u0117s eliminacijos laikas<\/td><td>Anti-FcRn (rozanoliksizumabas)<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Relevante_Rezeptoren_und_Zielmolekule\"><\/span>Atitinkami receptoriai ir tikslin\u0117s molekul\u0117s<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"MOG_selbst_als_Zielstruktur_kein_klassischer_Rezeptor\"><\/span>pats MOG kaip tikslin\u0117 strukt\u016bra (ne klasikinis receptorius)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">MOGAD atveju MOG baltymas veikia kaip antigenas, o ne kaip signalinis receptorius. Nepaisant to, \u0161ios s\u0105veikos yra patofiziologi\u0161kai svarbios:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>C1q suri\u0161imas<\/strong><br>MOG gali fiziologi\u0161kai suri\u0161ti C1q, o tai patologinio antik\u016bn\u0173 padengimo atveju sukelia komplemento aktyvacij\u0105.<\/li>\n\n\n\n<li><strong>DC \u017dENKLAS (CD209)<\/strong><br>Lektin\u0173 receptorius dendritin\u0117se l\u0105stel\u0117se; gali suri\u0161ti MOG ir prisid\u0117ti prie antigeno pateikimo<\/li>\n\n\n\n<li><strong>Raudonuk\u0117s viruso receptorius<\/strong>_<br>MOG yra raudonuk\u0117s virus\u0173 patekimo \u012f organizm\u0105 molekul\u0117, o tai gali paai\u0161kinti vaik\u0173 ADEM po infekcijos<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Fc%CE%B3-Rezeptoren_Fc%CE%B3R\"><\/span>Fc\u03b3 receptoriai (Fc\u03b3R)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Fc\u03b3 receptoriai imunin\u0117se l\u0105stel\u0117se yra pagrindiniai IgG1 sukeliamos \u017ealos efektoriai:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fc\u03b3RI (CD64)<\/strong><br>Didelio giminingumo makrofagams ir dendritin\u0117ms l\u0105stel\u0117ms; tarpininkavimas ADCP ir antigeno pateikimui<\/li>\n\n\n\n<li><strong>Fc\u03b3RIII (CD16)<\/strong><br>Ma\u017eo giminingumo, NK l\u0105stel\u0117ms; pagrindinis ADCC mediatorius prie\u0161 MOG-opsonizuotus oligodendrocitus<\/li>\n\n\n\n<li><strong>Fc\u03b3RIIA\/B (CD32A\/B)<\/strong><br>Aktyvinantis arba slopinantis; B l\u0105steli\u0173 aktyvacijos ir fagocitoz\u0117s moduliavimas<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Neonataler_Fc-Rezeptor_FcRn\"><\/span>Naujagimi\u0173 Fc receptorius (FcRn)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">FcRn (\u03b22m\/FcRn-\u03b1 kompleksas) yra atsakingas u\u017e IgG antik\u016bn\u0173 vidul\u0105stelin\u012f perdirbim\u0105. Jis prisijungia IgG r\u016bg\u0161tin\u0117se endosomose (pH 6,0) ir u\u017ekerta keli\u0105 jo lizosominiam skilimui, taip pailgindamas IgG pusin\u0117s eliminacijos laik\u0105 ma\u017edaug iki 21 dienos.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>MOGAD sistemoje d\u0117l FcRn nuolat cirkuliuoja patogeninis MOG-IgG1<\/li>\n\n\n\n<li>Terapinis blokavimas d\u0117l <em>Rozanoliksizumabas<\/em> (anti-FcRn IgG4): Priver\u010dia lizosomin\u012f IgG skaidym\u0105si ir suma\u017eina IgG kiek\u012f plazmoje ~ 50%<\/li>\n\n\n\n<li>FcRn rai\u0161ka - epitelio l\u0105stel\u0117s, endotelio l\u0105stel\u0117s, monocitai, hepatocitai<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"IL-6-Rezeptor_IL-6R%CE%B1_gp130\"><\/span>IL-6 receptorius (IL-6R\u03b1 \/ gp130)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">IL-6 receptori\u0173 sudaro ligand\u0105 jungiantis \u03b1 subvienetas (IL-6R\u03b1, CD126) ir signalinis koreceptorius gp130 (IL-6R\u03b2, CD130). Du signalizavimo b\u016bdai:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Klasikinis signalizavimas<\/strong><br>Su membrana susietas IL-6R\u03b1 T l\u0105stel\u0117se, B l\u0105stel\u0117se, monocituose \u2192 IL-6\/IL-6R\u03b1\/gp130 kompleksas \u2192 JAK1\/2 \u2192 STAT3, STAT1, MAPK, PI3K\/AKT<\/li>\n\n\n\n<li><strong>Trans signalizavimas<\/strong><br>Tirpus IL-6R\u03b1 (sIL-6R) prisijungia IL-6 ir aktyvuoja gp130 net ir l\u0105stel\u0117se, kuriose n\u0117ra su membrana susieto IL-6R\u03b1 (pvz., BBB endotelio l\u0105stel\u0117se).<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Atitinkamas tolesnis poveikis: (Th17), Bcl-6 (Tfh ir gemaliniai centrai), Blimp-1 (plazmin\u0117s l\u0105stel\u0117s), FoxP3 slopinimas (Treg).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"T-Zell-Rezeptor_TCR_und_Kostimulationsmolekule\"><\/span>T-l\u0105steli\u0173 receptori\u0173 (TCR) ir kostimuliacijos molekuli\u0173<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>TCR\/MHC-II-MOG peptid\u0173 kompleksas<\/strong><br>Centrin\u0117 MOG specifini\u0173 CD4+ T l\u0105steli\u0173 aktyvacijos a\u0161is<\/li>\n\n\n\n<li><strong>CD28\/B7<\/strong><br>Kostimuliacija T l\u0105steli\u0173 aktyvacijos metu<\/li>\n\n\n\n<li><strong>CCR6\/CCL20 a\u0161is<\/strong><br>Th17 l\u0105steli\u0173 CCR6 jungiasi su CCL20 prie choroidinio rezginio \u2192 patekimas \u012f CNS<\/li>\n\n\n\n<li><strong>CXCR3\/CXCL10<\/strong><br>Th1 l\u0105steli\u0173 chemotaksis u\u017edegimo zonose<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Komplementrezeptoren\"><\/span>Komplemento receptoriai<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>C1qR<\/strong><br>Tarpininkauja C1q jungiantis su imuniniais kompleksais ant oligodendrocit\u0173 membran\u0173<\/li>\n\n\n\n<li><strong>C3aR <\/strong>ir<strong> C5aR1 (CD88)<\/strong><br>Anafilatoksino receptoriai ant mikroglijos\/makrofag\u0173 \u2192 Prou\u017edegiminis suaktyv\u0117jimas<\/li>\n\n\n\n<li><strong>Komplemento reguliatoriai oligodendrocituose<\/strong><br>CR1 (CD35), MCP (CD46), HRF (CD59) yra ma\u017eai i\u0161reik\u0161ti oligodendrocituose, tod\u0117l jie yra jautresni komplemento pa\u017eeidimams nei astrocitai, pvz.<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Histopathologie_und_ZNS-Lasionsmuster\"><\/span>Histopatologija ir CNS pa\u017eeidim\u0173 pob\u016bdis<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">MOGAD pa\u017eeidimai histopatologi\u0161kai i\u0161 esm\u0117s skiriasi nuo MS ir NMOSD:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Perivenin\u0117 demielinizacija<\/strong><br>Pa\u017eeidimai formuojasi koncentri\u0161kai aplink smulkias venas (periveninis modelis), o ne periaksi\u0161kai, kaip sergant MS. MRT n\u0117ra i\u0161s\u0117tinei sklerozei b\u016bdingo \u201acentrini\u0173 ven\u0173 po\u017eymio\u2018.<\/li>\n\n\n\n<li><strong>CD4+ T l\u0105steli\u0173 infiltratas<\/strong><br>Dominuojan\u010dios u\u017edegimo l\u0105stel\u0117s yra CD4+ T l\u0105stel\u0117s ir makrofagai, ma\u017eiau neutrofil\u0173 ir beveik n\u0117ra eozinofilini\u0173 granulocit\u0173 (skirtingai nei AQP4+ NMOSD).<\/li>\n\n\n\n<li><strong>Oligodendrocit\u0173 pa\u017eeidimas<\/strong> (pirminis)<br>Skirtingai nuo NMOSD, kai pirmiausia pa\u017eeid\u017eiami astrocitai, MOGAD b\u016bdinga oligodendrocit\u0173 degeneracija.<\/li>\n\n\n\n<li><strong>C9neo nusodinimas<\/strong><br>MAC (terminalinio komplemento komplekso) aptikimas pa\u017eeidimuose, nors ir silpnesnis nei NMOSD<\/li>\n\n\n\n<li><strong>Santykinis akson\u0173 i\u0161saugojimas<\/strong><br>\u016ami\u0173 priepuoli\u0173 metu akson\u0173 pa\u017eeidimas da\u017enai b\u016bna ma\u017eesnis nei sergant i\u0161s\u0117tine skleroze, tod\u0117l klinikinis pasveikimas da\u017enai b\u016bna geras.<\/li>\n\n\n\n<li><strong>Kortikaliniai pa\u017eeidimai<\/strong><br>Leptomeningeumo u\u017edegimas ir kortikalin\u0117 demielinizacija (b\u016bdinga ADEM variantui)<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Klinische_Manifestationen_und_Phanotypen\"><\/span>Klinikin\u0117s aprai\u0161kos ir fenotipai<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">MOGAD yra klini\u0161kai nevienalytis. Svarb\u016bs fenotipai:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Fenotipas<\/strong><\/td><td><strong>Da\u017enis<\/strong><\/td><td><strong>Klinikiniai po\u017eymiai<\/strong><\/td><td><strong>MRT specialyb\u0117s<\/strong><\/td><\/tr><\/thead><tbody><tr><td>Regos nervo neuritas (ON)<\/td><td>Da\u017eniausiai pasitaikantys (apie 50%)<\/td><td>Da\u017enai abipusis, reg\u0117jimo praradimas, retrobulbarinis, skausmingi aki\u0173 judesiai. aki\u0173 judesiai<\/td><td>Ilgas regos nervo pa\u017eeidimas, perinervin\u0117s kontrastin\u0117s med\u017eiagos kaupimasis<\/td><\/tr><tr><td>Skersinis mielitas<\/td><td>Apie 30%<\/td><td>I\u0161ilginis mielitas (LETM), jutimo ir (arba) judesi\u0173, \u0161lapimo p\u016bsl\u0117s sutrikimai<\/td><td>I\u0161ilginiai T2 pakitimai, H2 sindromas (\u201al\u0119\u0161inis\u2018)<\/td><\/tr><tr><td>ADEM<\/td><td>Da\u017eniausiai pasirei\u0161kia vaikams<\/td><td>Encefalopatija, polifokalinis neurologinis deficitas deficitas<\/td><td>Dvi\u0161aliai, didel\u0117s apimties T2 pa\u017eeidimai, taip pat ir bazaliniuose ganglijuose<\/td><\/tr><tr><td>Smegen\u0173 kamieno encefalitas<\/td><td>Apie 15%<\/td><td>Diplopija, ataksija, area postrema sindromas (\u017eagsulys, v\u0117mimas)<\/td><td>Smegen\u0173 kamieno \/ smegen\u0117li\u0173 T2 pa\u017eeidimai<\/td><\/tr><tr><td>Kortikalinis encefalitas<\/td><td>Retesnis<\/td><td>Epilepsijos priepuoliai, sumi\u0161imas<\/td><td>\u017diev\u0117s FLAIR signal\u0173 poky\u010diai<\/td><\/tr><tr><td>CRION<\/td><td>Retesnis<\/td><td>L\u0117tinis pasikartojantis u\u017edegimas. regos nervo neuropatija<\/td><td>Nuolatinis regos nervo pa\u017eeidimas<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Diagnostik\"><\/span>Diagnostika<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">Diagnostikos kriterijai (Banwell et al, <em>\"Lancet Neurology<\/em> 2023 m.): <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">(1) MOG-IgG nustatymas serume arba smegen\u0173 skystyje naudojant l\u0105steli\u0173 tyrim\u0105 (CBA)<br>(2) atitinkamas klinikinis fenotipas<br>(3) Alternatyvi\u0173 diagnozi\u0173 netaikymas.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>L\u0105steli\u0173 imunofluorescencijos tyrimas (CBA)<\/strong><br>su nat\u016braliai sulankstyta, su membrana suri\u0161ta MOG (HEK293 l\u0105stel\u0117s, transfekuotos \u017emogaus MOG); aptinka nuo konformacijos priklausan\u010dius epitopus<\/li>\n\n\n\n<li><strong>ELISA ir linijin\u0117s\/ juostin\u0117s d\u0117m\u0117s<\/strong><br>nepatikimas MOGAD atveju, nes atpa\u017e\u012fstami linijiniai epitopai<\/li>\n\n\n\n<li><strong>IgG poklasiai<\/strong><br>Daugiausia IgG1; kartais IgG2, IgG3, IgG4. I\u0161skirtinis IgG3 teigiamas rezultatas yra diagnostin\u0117 klaida (Jarius 2024)<\/li>\n\n\n\n<li><strong>Titr\u0173 kinetika<\/strong><br>Nuolat auk\u0161tas titras susij\u0119s su atkry\u010dio rizika; da\u017enai ma\u017e\u0117jantis monofazin\u0117s eigos metu<\/li>\n\n\n\n<li><strong>Alkoholis<\/strong><br>Galima pleocitoz\u0117; oligoklonin\u0117s juostos retos (&lt;10 %), intratekalin\u0117 IgG sintez\u0117 reta<\/li>\n\n\n\n<li><strong>Biomarkeriai<\/strong><br>sNfL (serumo neurofilament\u0173 lengvoji grandin\u0117) - ligos aktyvumo \u017eymuo; sGFAP (glialinis fibrilinis r\u016bg\u0161tinis baltymas) - astrocit\u0173 \u012fsitraukimo \u017eymuo.<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Therapeutische_Strategien\"><\/span>Terapin\u0117s strategijos<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Akuttherapie_Schubbehandlung\"><\/span>\u016aminis gydymas (atkry\u010dio gydymas)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Standartinis MOGAD atkry\u010dio gydymas:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Didel\u0117s doz\u0117s <em>Metilprednizolonas<\/em> (HDMP)<\/strong><br>1000 mg i.v. per par\u0105 5 dienas - pirmoji linija<\/li>\n\n\n\n<li><em><strong>Plazmaferez\u0117 \/ imunoadsorbcija<\/strong><\/em><br>Esant nepakankamam HDMP atsakui; i\u0161 plazmos pa\u0161alinamas MOG-IgG; 5-7 ciklai (retrospektyv\u016bs duomenys rodo veiksmingum\u0105 ma\u017edaug 50-70% atvej\u0173)<\/li>\n\n\n\n<li><strong><em>Imunoglobulinai \u012f ven\u0105<\/em> (IVIG)<\/strong><br>2 g\/kg per 5 dienas; nesant atsako \u012f HDMP ir kaip alternatyva po plazmaferez\u0117s; galimai veiksminga d\u0117l FcRn prisotinimo ir Fc\u03b3R konkurencijos<\/li>\n\n\n\n<li><strong>Kortikosteroid\u0173 vartojimo nutraukimas<\/strong><br>Ypa\u010d svarbu MOGAD (da\u017ena priklausomyb\u0117 nuo steroid\u0173) atveju - staigus ma\u017einimas gali sukelti gr\u012f\u017etamojo ry\u0161io epizodus.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Prophylaktische_Langzeittherapie\"><\/span>Profilaktinis ilgalaikis gydymas<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">(neregistruotas, neregistruotas preparatas - statusas 2026)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ilgalaikio gydymo indikacijos yra individualios - ne visiems pacientams jo reikia. Veiksniai: atkry\u010dio da\u017enis, atkry\u010dio sunkumas, i\u0161liekantis MOG-IgG titras, fenotipiniai rizikos veiksniai.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Med\u017eiaga<\/strong><\/td><td><strong>Veikimo mechanizmas<\/strong><\/td><td><strong>Duomen\u0173 pad\u0117tis<\/strong><\/td><td><strong>\u012erodym\u0173 lygis<\/strong><\/td><\/tr><\/thead><tbody><tr><td>Azatioprinas<\/td><td>Purin\u0173 sintez\u0117s blokada (priklausoma nuo TPMT); slopina T ir B l\u0105steli\u0173 proliferacij\u0105<\/td><td>Retrospektyviniai tyrimai; vyksta nacionalinis RCT (Pranc\u016bzija, TOMATO tyrimas)<\/td><td>IIb-III (ne pagal paskirt\u012f)<\/td><\/tr><tr><td>Mikofenolato mofetilas (MMF)<\/td><td>Inozino monofosfato dehidrogenaz\u0117s inhibitorius; slopina limfocit\u0173 proliferacij\u0105<\/td><td>Atvej\u0173 serijos; galb\u016bt veiksminga, ma\u017eesn\u0117 atkry\u010dio prevencija nei rituksimabo<\/td><td>III (ne pagal paskirt\u012f)<\/td><\/tr><tr><td>Rituksimabas<\/td><td>Anti-CD20 \u2192 B l\u0105steli\u0173 deplecija; slopina MOG-IgG gamyb\u0105<\/td><td>Did\u017eiausia retrospektyvin\u0117 kohorta; veiksminga, bet ne visiems; padid\u0117jusi infekcijos rizika<\/td><td>IIb (ne pagal paskirt\u012f)<\/td><\/tr><tr><td>Tocilizumabas<\/td><td>Anti-IL-6R\u03b1 (iv); blokuoja IL-6 signalizavimo keli\u0105 (JAK\/STAT3); slopina Th17\/plazmines l\u0105steles<\/td><td>Teigiami retrospektyviniai duomenys; teigiami NMOSD RCT rezultatai (TANGO)<\/td><td>IIb (ne pagal paskirt\u012f)<\/td><\/tr><tr><td>IVIG (\u012f ven\u0105 \/ po oda)<\/td><td>Fc receptori\u0173 prisotinimas; MOG-IgG neutralizacija; FcRn prisotinimas<\/td><td>Retrospektyviniai duomenys teigiami; vaisingumo, n\u0117\u0161tumo, infekcijos galimyb\u0117<\/td><td>IIb (ne pagal paskirt\u012f)<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Klinische_Studien_%E2%80%93_2024%E2%80%932026\"><\/span>Klinikiniai tyrimai - 2024-2026 m.<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Pirm\u0105 kart\u0105 atliekami keli atsitiktini\u0173 im\u010di\u0173 placebu kontroliuojami 3 faz\u0117s MOGAD tyrimai, kurie, kaip tikimasi, suteiks I klas\u0117s \u012frodym\u0173:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Tyrimas<\/strong><\/td><td><strong>Med\u017eiaga<\/strong><\/td><td><strong>Mechanizmas<\/strong><\/td><td><strong>Tikslin\u0117 grup\u0117<\/strong><\/td><td><strong>Statusas<\/strong><\/td><\/tr><\/thead><tbody><tr><td>cosMOG<\/td><td>Rozanoliksizumabas (UCB7665)<\/td><td>Anti-FcRn IgG4-mAb: blokuoja IgG recirkuliacij\u0105 \u2192 pagreitina IgG skilim\u0105, ma\u017eina MOG IgG titr\u0105 ~50 %<\/td><td>Suaugusieji (\u226518 met\u0173), atkrytis, \u22651 atkrytis\/12 m\u0117n.<\/td><td>3 faz\u0117s tarptautinis tyrimas; pirmasis MOGAD 3 faz\u0117s tyrimas<\/td><\/tr><tr><td>METEOROIDAS<\/td><td>Satralizumabas (anti-IL-6R sc.)<\/td><td>Anti-IL-6R (po oda); slopina JAK\/STAT3 \u2192 Th17 diferenciacija, B l\u0105steli\u0173 brendimas, IgG gamyba<\/td><td>Suaugusieji ir paaugliai (\u226512 met\u0173); atkrytis, prie\u0161 tai buv\u0119s \u22651 atkrytis<\/td><td>3 etapas, tarptautinis, t\u0119stinis<\/td><\/tr><tr><td>TOMATO<\/td><td>Azatioprinas<\/td><td>Purin\u0173 sintez\u0117s slopinimas; pla\u010diai imunosupresinis poveikis<\/td><td>Pranc\u016bzijos daugiacentris tyrimas; suaugusieji, sergantys MOGAD<\/td><td>Nacionalinis RCT, 3 etapas<\/td><\/tr><tr><td>MOGwAI<\/td><td>Nenurodyta (steb\u0117jimo)<\/td><td>Biomarkeri\u0173 tyrimas: MOG-IgG titro, sNfL, sGFAP, sCD83 kaip progresavimo \u017eymen\u0173 patvirtinimas<\/td><td>Tarptautinis kohortos tyrimas<\/td><td>Vykdoma<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Neue_und_zukunftige_Therapiekonzepte\"><\/span>Naujos ir b\u016bsimos terapijos koncepcijos<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Remiantis pastar\u0173j\u0173 met\u0173 molekuliniais duomenimis, aptariami \u0161ie MOGAD metodai:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"BTK-Inhibitoren_Bruton-Tyrosin-Kinase\"><\/span>BTK inhibitoriai (Brutono tirozino kinaz\u0117)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">BTK yra pagrindin\u0117 B l\u0105steli\u0173 receptori\u0173 signalizavimo kaskados (PI3K\/AKT\/MAPK) kinaz\u0117. <strong><em>Tolebrutinibas<\/em><\/strong> ir kiti BTK inhibitoriai yra naudojami MS ir NMOSD tyrimuose; laukiama MOGAD klinikini\u0173 tyrim\u0173. Geriamasis vartojimas b\u016bt\u0173 privalumas. B l\u0105steli\u0173 aktyvacijos ir mieloidini\u0173 l\u0105steli\u0173 (mikroglijos-BTK) slopinimas.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Toleranzinduktion_MOG-Tolerisierung\"><\/span>Tolerancijos skatinimas (MOG toleravimas)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Antigenui b\u016bdingos tolerancijos indukcija (pvz., naudojant MOG peptidus arba nanodaleli\u0173 pagrindu sukurtus metodus) yra perspektyvi koncepcija. . <strong><em>Guthy-Jackson labdaros fondas<\/em><\/strong> Skatina gydom\u0173j\u0173 metod\u0173 mokslinius tyrimus. Privalumas: n\u0117ra visuotin\u0117s imunosupresijos, <strong>Selektyvus MOG autoreaktyvumo pa\u0161alinimas<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Komplementinhibitoren\"><\/span>Komplemento inhibitoriai<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Kadangi komplemento aktyvacija (C3a, C5a, MAC) aptinkama MOGAD pa\u017eeidimuose, b\u016bt\u0173 <strong><em>Eculizumabas<\/em> (Anti-C5)<\/strong> arba C3 inhibitorius yra teori\u0161kai veiksmingas. Ta\u010diau, kadangi MAC kompleksas (C5b-9) MOGAD susidaro daug ma\u017eiau nei NMOSD (kur <em>Eculizumabas<\/em> leid\u017eiama), klinikin\u0117 reik\u0161m\u0117 neai\u0161ki.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Anti-Neonatal-Fc-Rezeptor-Strategien\"><\/span>Anti-neonatalin\u0117s Fc receptori\u0173 strategijos<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Be <em>Rozanoliksizumabas<\/em> taip pat <strong><em>Efgartigimodas<\/em><\/strong> (IgG-Fc fragmentas, kuris konkurencingai blokuoja FcRn) kitoms IgG sukeltoms ligoms gydyti. Kadangi FcRn blokados patomechanizmas tiesiogiai ma\u017eina MOG-IgG kiek\u012f, tai yra ypa\u010d tikslingas metodas.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Autologe_hamatopoetische_Stammzelltransplantation_aHSCT\"><\/span>Autologin\u0117 kraujodaros kamienini\u0173 l\u0105steli\u0173 transplantacija (aHSCT)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Sunkios, refrakterin\u0117s ligos atveju aHSCT yra potenciali gydymo koncepcija: gili imunoabliacija ir imunin\u0117s sistemos atk\u016brimas gali pa\u0161alinti autoreaktyvius T ir B l\u0105steli\u0173 klonus. Labai ma\u017eai duomen\u0173 apie MOGAD; naudojama tik specializuotuose centruose.<\/p>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Biomarker_und_Verlaufsmonitoring\"><\/span>Biomarkeriai ir tolesn\u0117 steb\u0117sena<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">Biomarkeriais pagr\u012fsti sprendimai d\u0117l gydymo yra dabartini\u0173 tyrim\u0173 tikslas:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>MOG-IgG titras (serume)<\/strong><br>Persistavimas koreliuoja su atkry\u010dio rizika; monofazin\u0117s eigos atveju titras da\u017enai spontani\u0161kai suma\u017e\u0117ja; sprendimas d\u0117l gydymo yra vienas i\u0161 lemiam\u0173 veiksni\u0173.<\/li>\n\n\n\n<li><strong>Neurofilament\u0173 \u0161viesa serume (sNfL)<\/strong><br>Axon\u0173 pa\u017eeidimo \u017eymuo; padid\u0117ja atkry\u010dio metu; normalizuojasi kaip atsako \u012f gydym\u0105 \u017eymuo<\/li>\n\n\n\n<li><strong>GFAP serume (sGFAP)<\/strong><br>Astrocitinis suaktyv\u0117jimas; ma\u017eesnis MOGAD nei NMOSD; gali suteikti papildomos informacijos<\/li>\n\n\n\n<li><strong>sCD83<\/strong><br>Naujas kandidatas \u012f biomarkerius (\u0161iuo metu tikrinamas); galimas dendritini\u0173 l\u0105steli\u0173 aktyvacijos ir imuninio aktyvumo \u017eymuo<\/li>\n\n\n\n<li><strong>Cerebrospinalinio skys\u010dio l\u0105steli\u0173 skai\u010dius ir baltymai<\/strong><br>Pleocitoz\u0117 traukos epizod\u0173 metu; normalizuojasi po gydymo<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Prognose_und_Besonderheiten\"><\/span>Prognoz\u0117 ir specialios funkcijos<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">Palyginti su AQP4+ NMOSD, MOGAD turi tendencij\u0105 pasi\u017eym\u0117ti <strong>Palankesn\u0117 prognoz\u0117<\/strong>, ypa\u010d geresnis reg\u0117jimo atk\u016brimas po ON. Ta\u010diau svarb\u016bs \u0161ie aspektai:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Vienfazis progresavimas<\/strong><br>Apie 50% pacient\u0173; da\u017enai titras suma\u017e\u0117ja savaime; ilgalaikio gydymo gali neprireikti<\/li>\n\n\n\n<li><strong>Traukos formos progresavimas<\/strong><br>Apie 50%; i\u0161lieka didesnis titras; galimas kaupiamojo ne\u012fgalumo did\u0117jimas, bet l\u0117\u010diau nei NMOSD<\/li>\n\n\n\n<li><strong>N\u0117ra progresyvaus kurso<\/strong><br>Skirtingai nuo i\u0161s\u0117tin\u0117s skleroz\u0117s, nebuvo apra\u0161ytas laipsni\u0161kas progresavimas be atkry\u010di\u0173.<\/li>\n\n\n\n<li><strong>Jautrumas steroidams ir priklausomyb\u0117 nuo steroid\u0173<\/strong><br>Ta\u010diau daugelis pacient\u0173 labai gerai reaguoja \u012f kortikosteroid\u0173 vartojim\u0105: greitas j\u0173 vartojimo nutraukimas da\u017enai sukelia atkry\u010dius.<\/li>\n\n\n\n<li><strong>Speciali pediatrin\u0117 funkcija<\/strong><br>ADEM da\u017eniausia pradin\u0117 aprai\u0161ka vaikams (&lt;10 met\u0173); prognoz\u0117 da\u017enai gera, ta\u010diau reikia atkreipti d\u0117mes\u012f \u012f pasikartojimo rizik\u0105<\/li>\n\n\n\n<li><strong>N\u0117\u0161tumas: duomenys ploni<\/strong><br>N\u0117\u0161tumo metu ligos atkry\u010dio rizika paprastai nepadid\u0117ja, ta\u010diau po gimdymo tai gali b\u016bti rizikos veiksnys (analogi\u0161kai kaip ir i\u0161s\u0117tin\u0117s skleroz\u0117s atveju).<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Zusammenfassung_und_Ausblick\"><\/span>Apibendrinimas ir perspektyvos<span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">MOGAD yra nepriklausoma, antik\u016bn\u0173 sukelta autoimunin\u0117 CNS liga, kuriai b\u016bdingi \u0161ie pagrindiniai po\u017eymiai:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>MOG baltymas, esantis ant oligodendrocit\u0173 ir mielino apvalkal\u0173, yra tikslinis antigenas.<\/li>\n\n\n\n<li>Patogeniniai MOG-IgG1 autoantik\u016bnai pa\u017eeid\u017eia mielin\u0105 dviem lygiagre\u010diais efektoriniais keliais: komplemento aktyvacija (CDC, apie 50%) ir Fc\u03b3R prisijungimas (ADCC\/ADCP, apie 50%).<\/li>\n\n\n\n<li>Be to, antik\u016bnai stiprina T l\u0105steli\u0173 aktyvacij\u0105 per Fc\u03b3R mechanizmus.<\/li>\n\n\n\n<li>IL-6\/JAK\/STAT3 signalinis kelias skatina Th17 diferenciacij\u0105 ir plazmini\u0173 l\u0105steli\u0173 brendim\u0105 ir yra pagrindinis terapinis taikinys<\/li>\n\n\n\n<li>\u0160iuo metu n\u0117ra patvirtint\u0173 gydymo b\u016bd\u0173 (nuo 2026 m. vasario m\u0117n.); vyksta pirmieji 3 faz\u0117s RCT (cosMOG su rozanoliksizumabu, METEOROID su satralizumabu).<\/li>\n\n\n\n<li>Terapija kei\u010diasi \u012f prie rizikos prisitaikan\u010dias, biomarkeriais pagr\u012fstas strategijas.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Svarbiausia pastar\u0173j\u0173 met\u0173 mokslini\u0173 tyrim\u0173 pa\u017eanga - tikslus efektorini\u0173 mechanizm\u0173 (komplemento ir FcR kelio) i\u0161\u0161ifravimas, kur\u012f atliko tokios mokslinink\u0173 grup\u0117s kaip, pvz. <strong>Meinl, Mader, Kawakami (LMU Miunchenas)<\/strong>, o tai turi tiesiogin\u0117s \u012ftakos terapijos k\u016brimui: Optimalus terapinis metodas turi apimti IgG gamyb\u0105 (anti-CD20, FcRn inhibitoriai), taip pat efektorinius mechanizmus (komplementas, Fc\u03b3R) ir Th17\/IL-6 a\u0161\u012f.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Tolerancijos indukcijos strategijos ir BTK inhibitoriai yra b\u016bsimi, mechanisti\u0161kai pagr\u012fsti gydymo principai, kurie, tik\u0117tina, bus klini\u0161kai i\u0161bandyti artimiausiais metais.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Atherischer_Ole_%E2%80%93_Wirkstoffe_nach_Signalwegen_geordnet\"><\/span>Eteriniai aliejai - veikliosios med\u017eiagos, suskirstytos pagal signalinius kelius<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Veikli\u0105sias med\u017eiagas galima suskirstyti \u012f grupes pagal j\u0173 poveikio ta\u0161kus MOGAD patofiziologijoje. Tai labai svarbu, nes MOGAD turi tris pagrindines a\u0161is: <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Th17\/IL-6<\/strong><\/li>\n\n\n\n<li><strong>Komplemento sistemos ir oligodendrocit\u0173 apsauga<\/strong><\/li>\n\n\n\n<li><strong>Remielinizacija\/OPC diferenciacija<\/strong>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Weihrauch_Boswellia_serrata_%E2%80%93_AKBA_und_Incensolacetat\"><\/span>Smilkalai (Boswellia serrata) - AKBA ir incensolio acetatas<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">BCP teigimu, tai labiausiai moksli\u0161kai pagr\u012fstas MOGAD kandidatas, kuris yra i\u0161skirtinis savo poveikio spektru.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>AKBA (3-O-acetil-11-keto-\u03b2-bosvelio r\u016bg\u0161tis)<\/strong> yra pagrindin\u0117 veiklioji med\u017eiaga. AKBA pasi\u017eymi \u012fvairiu fiziologiniu poveikiu, \u012fskaitant prie\u0161infekcin\u012f, prie\u0161v\u0117\u017ein\u012f ir antioksidacin\u012f poveik\u012f bei \u012frodyt\u0105 neuroprotekcin\u012f poveik\u012f. Jis skatina nerv\u0173 atstatym\u0105 ir regeneracij\u0105, apsaugo nuo i\u0161eminio smegen\u0173 pa\u017eeidimo, slopina neurou\u017edegim\u0105 ir gerina atminties sutrikimus. <a href=\"https:\/\/www.ean.org\/research\/resources\/neurology-updates\/detail\/complement-dependent-and-independent-pathomechanisms-of-myelin-oligodendrocyte-glycoprotein-mog-abs-implications-for-therapeutic-strategies-in-mog-antibody-associated-disease-mogad\" target=\"_blank\" rel=\"noreferrer noopener\">Europos neurologijos akademija<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>AKBA slopina STAT3<\/strong> priklausomai nuo doz\u0117s, o tai yra pagrindinis mechanizmas, nes STAT3 yra pagrindinis IL-6\/JAK signalinio kelio, kuris skatina Th17 diferenciacij\u0105 ir plazmini\u0173 l\u0105steli\u0173 brendim\u0105 MOGAD, transkripcijos veiksnys. Be to, AKBA aktyvuojant Nrf2\/HO-1 signalin\u012f keli\u0105, galima suma\u017einti oksidacin\u0119 \u017eal\u0105, u\u017ekirsti keli\u0105 demielinizacijai ir skatinti remielinizacij\u0105. <a href=\"https:\/\/pubs.acs.org\/doi\/10.1021\/acs.nanolett.9b02220\" target=\"_blank\" rel=\"noreferrer noopener\">ACS leidiniai<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">AKBA veikia kaip molekulinis jungiklis, kuris blokuoja leukotrien\u0173 susidarym\u0105 alosteri\u0161kai moduliuodamas 5-LOX ir 15-LOX, bet kartu skatina SPM (specializuot\u0173 prorevoliucini\u0173 mediatori\u0173) gamyb\u0105. Tai aktyviai kei\u010dia imunin\u012f atsak\u0105 <strong>U\u017edegimo i\u0161sisprendimas<\/strong>, ne tik j\u0173 slopinimas. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39133885\/\" target=\"_blank\" rel=\"noreferrer noopener\">PubMed<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incenzolio acetatas<\/strong> (lakioji smilkal\u0173 eterinio aliejaus sudedamoji dalis, b\u016bna BHS) aktyvina TRPV3 kanalus neuronuose ir PPAR-\u03b3. - Smilkal\u0173 sudedamosios dalys gali gerokai suma\u017einti IL-6, TNF-\u03b1 ir GFAP (astrocit\u0173 suaktyv\u0117jimo \u017eymens) kiek\u012f smegenyse po sukelto u\u017edegimo. <a href=\"https:\/\/www.neurology.org\/doi\/10.1212\/NXI.0000000000200293\" target=\"_blank\" rel=\"noreferrer noopener\">Neurologija<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Svarbi kokyb\u0117s pastaba:<\/strong> Bosvelijos produkt\u0173 kokyb\u0117 labai skiriasi, kai kuri\u0173 produkt\u0173 (pvz., H15 Ayurmedica\u00ae) analiz\u0117se buvo tik p\u0117dsakai b\u016bding\u0173 bosvelij\u0173 r\u016bg\u0161\u010di\u0173 (0,31 mg AKBA). Tuo tarpu tokiuose produktuose, kaip BOSWELLIASAN\u00ae (7,51 mg) ir Sallaki\u00ae Tablets (7,88 mg), buvo nustatyti dideli AKBA kiekiai ir atitinkamai stiprus farmakologinis poveikis. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34358086\/\" target=\"_blank\" rel=\"noreferrer noopener\">Bosvelio r\u016bg\u0161ties kiekio ir susijusi\u0173 farmakologini\u0173 veikl\u0173 analiz\u0117 smilkal\u0173 pagrindu sukurtose u\u017edegim\u0105 reguliuojan\u010diose priemon\u0117se<\/a> ir <a href=\"https:\/\/www.frontiersin.org\/journals\/immunology\/articles\/10.3389\/fimmu.2025.1530977\/full\" target=\"_blank\" rel=\"noreferrer noopener\">Frontiers<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\"doTERRA\" produktas <strong><a href=\"https:\/\/media.doterra.com\/us\/en\/pips\/frankincense-boswellic-acid-complex.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Smilkal\u0173 bosvelio r\u016bg\u0161ties kompleksas<\/a><\/strong> sud\u0117tyje yra 37,5 mg AKBA*<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Therapeutisch_relevante_AKBA-Zieldosen\"><\/span>Terapi\u0161kai svarbios AKBA tikslin\u0117s doz\u0117s<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Klinikini\u0173 ir ikiklinikini\u0173 tyrim\u0173 rezultatai rodo tok\u012f vaizd\u0105:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Taikymo tikslas<\/th><th>AKBA paros doz\u0117<\/th><th>\u0160altinis<\/th><\/tr><\/thead><tbody><tr><td>Prie\u0161u\u017edegiminis (bendras)<\/td><td>100-200 mg<\/td><td>\u017dmogaus tyrimai s\u0105narys ir \u017earnynas<\/td><\/tr><tr><td>NF-\u03baB \/ STAT3 slopinimas (neurou\u017edegimas)<\/td><td>200-400 mg<\/td><td>Gyv\u016bn\u0173 modeliai, l\u0105steli\u0173 kult\u016bros<\/td><\/tr><tr><td>Optimalus poveikis CNS (patekimas per barjer\u0105)<\/td><td>200-300 mg<\/td><td>Eksperimentiniai duomenys<\/td><\/tr><tr><td>Did\u017eiausia gerai toleruojama paros doz\u0117<\/td><td>400-600 mg<\/td><td>Tolerancijos tyrimai<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Umrechnung_auf_375_mg_AKBA_jeKapsel\"><\/span>Perskai\u010diavimas \u012f 37,5 mg AKBA vienoje kapsul\u0117je<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Tikslin\u0117 AKBA paros doz\u0117<\/th><th>Vienetai per dien\u0105<\/th><th>Praktin\u0117 schema<\/th><\/tr><\/thead><tbody><tr><td>150 mg<\/td><td>4 vienetai<\/td><td>2 \u00d7 ryte + 2 \u00d7 vakare<\/td><\/tr><tr><td>200 mg<\/td><td><strong>5-6 vienetai<\/strong><\/td><td>3 kartus ryte + 2-3 kartus vakare<\/td><\/tr><tr><td>300 mg<\/td><td>8 vienetai<\/td><td>4 kartus ryte + 4 kartus vakare<\/td><\/tr><tr><td>400 mg<\/td><td>10-11 vienet\u0173<\/td><td>3 \u00d7 3-4 vienetai per par\u0105<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rekomenduojamas \u012fra\u0161as:<\/strong> <strong>4 vienetai per par\u0105 (= 150 mg AKBA)<\/strong>, padalytas \u012f 2 dovanas.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Po 2 savai\u010di\u0173, jei gerai toleruojama, padidinkite doz\u0119 iki 6 vienet\u0173 (= 225 mg).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Wichtige_Einnahmehinweise\"><\/span>Svarb\u016bs pri\u0117mimo nurodymai<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Riebalai yra labai svarb\u016bs:<\/strong> AKBA yra labai lipofilinis, tod\u0117l <strong>Biologinis prieinamumas padid\u0117ja 2-3 kartus<\/strong>, kai vartojamas kartu su riebiu maistu. Idealiai tinka alyvuogi\u0173 aliejus, avokadas arba pagrindinis patiekalas. Vartojimas tu\u0161\u010diu skrand\u017eiu smarkiai suma\u017eina absorbcij\u0105.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Laikas:<\/strong> AKBA pusin\u0117s eliminacijos laikas yra ma\u017edaug 6 valandos, tod\u0117l <strong>2-3 doz\u0117s per dien\u0105<\/strong> Tai prasmingiau nei vienkartin\u0117 doz\u0117, kad b\u016bt\u0173 i\u0161laikytas tolygus veiksmingumas.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Derinys su BCP:<\/strong> AKBA (STAT3\/NF-\u03baB a\u0161is) ir BCP (CB2\/Th17 a\u0161is) veikia skirtingus MOGAD signalinius kelius ir veikia sinergi\u0161kai. Farmakologin\u0117 s\u0105veika n\u0117ra \u017einoma.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Skrand\u017eio tolerancija:<\/strong> Bosvelija paprastai labai gerai toleruojama. Vartojant didesnes dozes retai pasirei\u0161kia nedidelis skrand\u017eio dirginimas. Tod\u0117l visada vartokite valgio metu arba prireikus laikinai suma\u017einkite doz\u0119.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Schwarzer_Pfeffer_oral\"><\/span>Juodieji pipirai (geriamieji)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Juod\u0173j\u0173 pipir\u0173 aliejaus pagrindin\u0117 veiklioji med\u017eiaga \u03b2-kariofilenas (BCP) (<em>Piper nigrum<\/em>) suma\u017e\u0117ja u\u017edegimini\u0173 citokin\u0173 IL-6, TNF-\u03b1, IL-17, IFN-\u03b3 ir Th17 (ROR-\u03b3t) bei Th1 (T-bet) transkripcijos veiksni\u0173, o prie\u0161u\u017edegimini\u0173 citokin\u0173 TGF-\u03b21, IL-10, IL-4 ir Th2 (GATA3) bei Treg (Foxp3) transkripcijos veiksni\u0173 gerokai padaug\u0117ja. \u0160is poveikis yra grie\u017etai susij\u0119s su CB2 receptori\u0173 aktyvinimu.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CB2 receptoriai ir remielinizacija yra tiesiogiai mechani\u0161kai susij\u0119: CB2 agonizmas skatina OPC brendim\u0105 - naujos kartos CB2 agonistas (Yhhu4952) reik\u0161mingai padidino bazinio mielino baltymo (MBP) ekspresij\u0105 ir subrendusi\u0173 oligodendrocit\u0173 dal\u012f kalvos k\u016bne.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Juod\u0173j\u0173 pipir\u0173 doz\u0117: 20 ... 200 mg\/d - atitinka 20 tr.\/d - tod\u0117l geriausia vartoti po 7 tr. kas 8 valandas (geriau po 5 tr. kas 6 valandas, kad b\u016bt\u0173 pasiektas didesnis kiekis plazmoje), supakuotas \u012f ne\u0161an\u010diojo aliejaus kapsul\u0119. Kaip lipofilin\u012f kartu su daug riebal\u0173 turin\u010diu maistu ir (arba) g\u0117rimais.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Schwarzer_Pfeffer_Inhalation\"><\/span>Juodieji pipirai (\u012fkv\u0117pus)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Dozavimas: 20 minu\u010di\u0173 kas 4 valandas dienos metu (pusin\u0117s eliminacijos trukm\u0117 2-4 valandos) ant \u012fkaitinto difuzoriaus Liqui-Pad plok\u0161tel\u0117s \u012fkv\u0117pti 3 tr., po kiekvieno gilaus \u012fkv\u0117pimo sulaikyti kv\u0117pavim\u0105 ma\u017edaug 5-8 sekund\u0117ms, nakt\u012f difuzori\u0173 palikti veikiant\u012f kambaryje, tiesiogiai nekv\u0117puoti.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Juodieji pipirai gali tur\u0117ti stimuliuojam\u0105j\u012f poveik\u012f ir pabloginti mieg\u0105. Tokiu atveju nenaudokite nakt\u012f.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Jei sudirgsta kv\u0117pavimo takai (sausumas) arba atsiranda galvos skausmas: Suma\u017einkite doz\u0119 arba pailginkite intervalus.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Copaiba-Ol_oral_%E2%80%93_NUR_doTERRA\"><\/span>Kopaibos aliejus (geriamasis) - TIK doTERRA<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">52,6 % BCP - atitinka 14,7 mg BCP\/la\u0161el\u012f - kadangi BCP yra lipofilinis, visada vartokite su riebiu maistu ir (arba) g\u0117rimais!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Remiantis klinikiniais saugumo tyrimais, atsi\u017evelgiant \u012f k\u016bno svor\u012f, rekomenduojama tokia doz\u0117:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"MOGAD-spezifische_Dosierungstabelle_doTERRA_Copaiba_525_BCP\"><\/span>Speciali MOGAD dozavimo lentel\u0117 (doTERRA Copaiba 52.5 % BCP)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>K\u016bno svoris<\/th><th><strong>Konservavimas<\/strong> (0,4 mg\/kg)<\/th><th><strong>Aktyvi trauka<\/strong> (1,0 mg\/kg)<\/th><th><strong>Intensyvus gydymas<\/strong> (1,5 mg\/kg)<\/th><\/tr><\/thead><tbody><tr><td><strong>50 kg<\/strong><\/td><td>20 mg = <strong>1-2 la\u0161ai<\/strong><\/td><td>50 mg = <strong>3-4 la\u0161ai<\/strong><\/td><td>75 mg = <strong>5 la\u0161ai<\/strong><\/td><\/tr><tr><td><strong>60 kg<\/strong><\/td><td>24 mg = <strong>2 la\u0161ai<\/strong><\/td><td>60 mg = <strong>4 la\u0161ai<\/strong><\/td><td>90 mg = <strong>6 la\u0161ai<\/strong><\/td><\/tr><tr><td><strong>70 kg<\/strong><\/td><td>28 mg = <strong>2 la\u0161ai<\/strong><\/td><td>70 mg = <strong>5 la\u0161ai<\/strong><\/td><td>105 mg = <strong>7 la\u0161ai<\/strong><\/td><\/tr><tr><td><strong>80 kg<\/strong><\/td><td>32 mg = <strong>2 la\u0161ai<\/strong><\/td><td>80 mg = <strong>5-6 la\u0161ai<\/strong><\/td><td>120 mg = <strong>8 la\u0161ai<\/strong><\/td><\/tr><tr><td><strong>90 kg<\/strong><\/td><td>36 mg = <strong>2-3 la\u0161ai<\/strong><\/td><td>90 mg = <strong>6 la\u0161ai<\/strong><\/td><td>135 mg = <strong>9 la\u0161ai<\/strong><\/td><\/tr><tr><td><strong>100 kg<\/strong><\/td><td>40 mg = <strong>3 la\u0161ai<\/strong><\/td><td>100 mg = <strong>7 la\u0161ai<\/strong><\/td><td>150 mg = <strong>10 la\u0161\u0173<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"MOGAD-Phasen-adaptierte_Dosierung\"><\/span>MOGAD dozavimas pagal faz\u0119<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<h4 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Phase_1_Akuter_Schub_erste_2%E2%80%934_Wochen\"><\/span><strong>1 etapas: \u016bmus pa\u016bm\u0117jimas (pirmosios 2-4 savait\u0117s)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Tikslas:<\/strong> Agresyvus Th17 slopinimas, IL-6 ma\u017einimas<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Dozavimas:<\/strong> 1,0-1,5 mg\/kg per par\u0105<\/li>\n\n\n\n<li><strong>Paskirstymas:<\/strong> 3 kartus per par\u0105 (optimalu nuolatiniam CB2 receptori\u0173 aktyvavimui)<\/li>\n\n\n\n<li><strong>Pavyzdys 70 kg:<\/strong> 5-7 la\u0161ai per dien\u0105, paskirstyti po 2+2+3 la\u0161us<\/li>\n\n\n\n<li><strong>Derinys:<\/strong> Su AKBA (200-300 mg per dien\u0105 STAT3 slopinimui) + didel\u0117s kortizono doz\u0117s (standartin\u0117s)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Phase_2_Schubremission_Erhaltung_langfristig\"><\/span><strong>2 etapas: atkry\u010dio remisija \/ palaikymas (ilgalaikis)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Tikslas:<\/strong> Atkry\u010dio prevencija, nuolatinis prie\u0161u\u017edegiminis tonusas<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Dozavimas:<\/strong> 0,4-0,7 mg\/kg per par\u0105<\/li>\n\n\n\n<li><strong>Paskirstymas:<\/strong> 2\u00d7 per dien\u0105<\/li>\n\n\n\n<li><strong>Pavyzdys 70 kg:<\/strong> 2-3 la\u0161ai per dien\u0105, paskirstyti kaip 1+2 arba 2+2<\/li>\n\n\n\n<li><strong>Derinys:<\/strong> Neprivaloma su AKBA (150 mg per par\u0105)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Phase_3_Monophasischer_Verlauf_Titer_fallend\"><\/span><strong>3 etapas: vienfazis kursas (ma\u017e\u0117jantis titras)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Tikslas:<\/strong> Neuroprotekcija, remielinizacija<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Dozavimas:<\/strong> 0,2-0,4 mg\/kg per par\u0105<\/li>\n\n\n\n<li><strong>Paskirstymas:<\/strong> 1-2\u00d7 per dien\u0105<\/li>\n\n\n\n<li><strong>Pavyzdys 70 kg:<\/strong> 1-2 la\u0161ai per dien\u0105<\/li>\n\n\n\n<li><strong>Galimas balansavimas<\/strong> po 6-12 m\u0117nesi\u0173 stabilaus seronegatyvumo<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Quellen\"><\/span>\u0160altiniai<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Toksikologija (700 mg\/kg NOAEL)<\/strong><br><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27358239\/\" target=\"_blank\" rel=\"noopener\">https:\/\/pubmed.ncbi.nlm.nih.gov\/27358239\/<\/a><\/li>\n\n\n\n<li><strong>EAE modelis (2,5-5 mg\/kg veiksmingas)<\/strong><br><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10377147\/\" target=\"_blank\" rel=\"noopener\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10377147\/<\/a><\/li>\n\n\n\n<li><strong>Tyrimas su \u017emon\u0117mis (100 mg saugus)<\/strong><br><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9104399\/\" target=\"_blank\" rel=\"noopener\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9104399\/<\/a><\/li>\n\n\n\n<li><strong>Klinikinis tyrimas (126 mg per par\u0105)<\/strong><br><a href=\"https:\/\/accurateclinic.com\/accurate-education-terpenes-caryophyllene\/\" target=\"_blank\" rel=\"noopener\">https:\/\/accurateclinic.com\/accurate-education-terpenes-caryophyllene\/<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Copaiba-Ol_Inhalation\"><\/span>Kopaibos aliejus (inhaliacija)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Be juod\u0173j\u0173 pipir\u0173, kuri\u0173 sud\u0117tyje yra ne daugiau kaip 38% BCP, kopaibos aliejus, kurio sud\u0117tyje yra iki 87% BCP, yra daug stipresnis, tod\u0117l j\u012f geriausia rinktis inhaliacijoms.<br>Difuzoriai paprastai veikia naudojant \u0161alt\u0105 ultragarsin\u012f (US) i\u0161pur\u0161kim\u0105. Ta\u010diau BCP garuoja tik nuo ma\u017edaug 130 \u00b0C temperat\u016bros, o dega esant auk\u0161tesnei nei 180 \u00b0C temperat\u016brai. Tod\u0117l turi b\u016bti naudojami \u0161ildomi, temperat\u016br\u0105 kontroliuojantys difuzoriai (pvz. <a href=\"https:\/\/storz-bickel.com\" target=\"_blank\" rel=\"noreferrer noopener\">\"Volcano Classic\", \"Volcano Hybrid\" arba \"Mighty+<\/a>), kuri\u0173 kaina yra apie 270-415 eur\u0173, o temperat\u016bra turi b\u016bti nustatyta kuo tiksliau (tikrinkite infraraudon\u0173j\u0173 spinduli\u0173 termometru), t. y. 160 \u00b0C.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Rekomenduojama kopaibos aliejaus (doTERRA), kurio sud\u0117tyje yra 69 % BCP, doz\u0117 - 1 la\u0161e yra 18,6 mg BCP.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">BCP pusin\u0117s eliminacijos laikas yra 2-4 valandos. Kad b\u016bt\u0173 pasiektas kuo pastovesnis veikliosios med\u017eiagos kiekis, reikia inhaliuoti, kaip apra\u0161yta pirmiau, po 4 la\u0161us (atitinka ma\u017edaug 200 mg BCP) kas 4 valandas. Nakt\u012f \u0161alia lovos galima palikti veikiant\u012f difuzori\u0173.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Zieldosen_und_benotigte_Tropfenzahl\"><\/span>Tikslin\u0117s doz\u0117s ir reikiamas la\u0161\u0173 skai\u010dius<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Tikslin\u0117 BCP doz\u0117<\/th><th>Kopaibos aliejaus la\u0161ai<\/th><th>Bendras aliejaus kiekis (mg)<\/th><\/tr><\/thead><tbody><tr><td>20 mg BCP (pradin\u0117 doz\u0117)<\/td><td><strong>~1 la\u0161as<\/strong><\/td><td>~29 mg<\/td><\/tr><tr><td>50 mg BCP<\/td><td><strong>~3 la\u0161ai<\/strong><\/td><td>~72 mg<\/td><\/tr><tr><td>100 mg BCP (gydomasis)<\/td><td><strong>~5-6 la\u0161ai<\/strong><\/td><td>~145 mg<\/td><\/tr><tr><td>120 mg BCP (vir\u0161utin\u0117 paros doz\u0117)<\/td><td><strong>~6-7 la\u0161ai<\/strong><\/td><td>~174 mg<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Tikslin\u0117s inhaliacijos BCP<\/th><th>Alyvos kiekis ant skysto pado<\/th><th>La\u0161ai<\/th><\/tr><\/thead><tbody><tr><td>~20 mg BCP \u012fkv\u0117pti<\/td><td>~40 mg aliejaus (~78 mg\/0,69)<\/td><td><strong>2-3 la\u0161ai<\/strong><\/td><\/tr><tr><td>~50 mg BCP \u012fkv\u0117pti<\/td><td>~100 mg aliejaus<\/td><td><strong>4-5 la\u0161ai<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Synergistische_MOGAD-Strategie_Multi-Target\"><\/span>Sinergetin\u0117 MOGAD strategija (daugiatiksl\u0117)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Kadangi MOGAD turi tris patomechanizmus, \u0161is \u012frodymais pagr\u012fstas derinys:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Veiklioji med\u017eiaga<\/th><th>Doz\u0117<\/th><th>Signalo kelias<\/th><th>MOGAD reik\u0161m\u0117<\/th><\/tr><\/thead><tbody><tr><td><strong>BCP (geriamasis)<\/strong><\/td><td>0,4-1,5 mg\/kg<\/td><td>CB2 \u2192 Th17\u2193, IL-6\u2193, Nrf2\/HO-1\u2191<\/td><td>\u2605\u2605\u2605\u2605\u2605<\/td><\/tr><tr><td><strong>AKBA (geriamasis)<\/strong><\/td><td>200-400 mg per dien\u0105<\/td><td>STAT3\u2193, NF-\u03baB\u2193, 5-LOX\u2193<\/td><td>\u2605\u2605\u2605\u2605\u2605<\/td><\/tr><tr><td><strong>BCP (\u012fkv\u0117pti, 160 \u00b0C)<\/strong><\/td><td>2-3 la\u0161ai, 2 kartus per dien\u0105<\/td><td>Limbinis, greitas skverbimasis \u012f CNS<\/td><td>\u2605\u2605\u2605<\/td><\/tr><tr><td><strong>Smilkal\u0173 aliejus (\u012fkvepiamas)<\/strong><\/td><td>3-4 la\u0161ai, 2 kartus per dien\u0105<\/td><td>Incenzolio acetatas \u2192 TRPV3, PPAR-\u03b3<\/td><td>\u2605\u2605\u2605<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">\u0160ioje keturi\u0173 rams\u010di\u0173 strategijoje sprend\u017eiami \u0161ie klausimai:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Th17\/IL-6<\/strong> (BCP oral + AKBA)<\/li>\n\n\n\n<li><strong>STAT3<\/strong> (AKBA)<\/li>\n\n\n\n<li><strong>Oligodendrocit\u0173 apsauga<\/strong> (BCP Nrf2 aktyvavimas)<\/li>\n\n\n\n<li><strong>Limbin\u0117 moduliacija<\/strong> (\u012fkv\u0117pus)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Wichtige_MOGAD-spezifische_Hinweise\"><\/span>Svarbi su MOGAD susijusi informacija<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>N\u0117ra monoterapijos<\/strong> - BCP\/AKBA yra <strong>\u012eprastinio gydymo papildymai<\/strong><br>(kortizonas \u016bminis, prireikus rituksimabas\/MMF\/IVIG profilaktinis) - niekada kaip pakaitalas<\/li>\n\n\n\n<li><strong>Biomarkeri\u0173 steb\u0117sena:<\/strong>\n<ul class=\"wp-block-list\">\n<li>MOG-IgG titras kas 3-6 m\u0117nesius<\/li>\n\n\n\n<li>sNfL (neurofilament\u0173 \u0161viesa) kaip aktyvumo \u017eymuo<\/li>\n\n\n\n<li>Apsvarstykite galimyb\u0119 suma\u017einti doz\u0119, jei titrai nuolat ma\u017e\u0117ja<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Steb\u0117kite traukos gaiduk\u0105<\/strong> - Infekcijos yra pagrindin\u0117 prie\u017eastis<br>Infekcijos atveju, jei reikia, dozuokite <strong>laikinai padidinti iki 1,5 mg\/kg<\/strong> (prevencinis)<\/li>\n\n\n\n<li><strong>Copaiba kepen\u0173 vert\u0117s<\/strong> - Jei &gt;1 mg\/kg &gt;3 m\u0117nesius<br>Kas 3 m\u0117nesius tikrinkite ALT\/AST<\/li>\n\n\n\n<li><strong>Juod\u0173j\u0173 pipir\u0173 alternatyva<\/strong> - D\u0117l kopaibos: juod\u0173j\u0173 pipir\u0173 aliejus (25-38 % BCP)<br>Tada apskai\u010diuokite la\u0161\u0173 skai\u010di\u0173 \u00d7 2<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"%CE%B1-Asaron_Kalmus-Ol_Acorus_calamus_%E2%80%93_direkt_oligodendrozytenprotektiv\"><\/span>\u03b1-Asaronas (kalpok\u0173 aliejus, <em>Acorus calamus<\/em>) - tiesiogiai oligodendrocitus apsaugantis<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Vienas i\u0161 nedaugelio veikli\u0173j\u0173 ingredient\u0173, turin\u010di\u0173 <strong>tiesioginis remielinizacijos poveikis<\/strong> yra . <em><strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37146420\/\" target=\"_blank\" rel=\"noreferrer noopener\">\u03b1-Asaron<\/a><\/strong><\/em>. Jis pagerina dismielinizacij\u0105 d\u0117l subrendusi\u0173 oligodendrocit\u0173 praradimo po hipoksijos ir i\u0161emijos, padidindamas ir aktyvuodamas PPAR-\u03b3 astrocituose. Tai padidina glutamato transporterio GLT-1 ekspresij\u0105 ir pa\u0161alina glutamato pertekli\u0173 i\u0161 ekstral\u0105stelin\u0117s erdv\u0117s, kuris prie\u0161ingu atveju sukelt\u0173 OPC glutamato sukelt\u0105 eksitotoksi\u0161kum\u0105, slopint\u0173 j\u0173 diferenciacij\u0105 ir sukelt\u0173 l\u0105steli\u0173 mirt\u012f. <a href=\"https:\/\/www.klinikum.uni-heidelberg.de\/neurologische-klinik\/neurologie-und-poliklinik\/forschung\/neuroimmunology\/ag-molekulare-neuroimmunologie\/mog-enzephalomyelitis\" target=\"_blank\" rel=\"noreferrer noopener\">Heidelbergo universitetin\u0117 ligonin\u0117<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">PPARy neurologijoje - <a href=\"https:\/\/www.frontiersin.org\/journals\/neuroscience\/articles\/10.3389\/fnins.2022.1060515\/pdf\" target=\"_blank\" rel=\"noreferrer noopener\">\"Frontiers\" redakcija 2022 m.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D\u0117mesio:<\/strong> Priklausomai nuo kilm\u0117s, kalpok\u0173 aliejuje yra skirtingas kiekis \u03b2-asarono, kuris klasifikuojamas kaip mutageninis. Tik <strong>\u03b2-azarono neturin\u010dios savyb\u0117s<\/strong> (Acorus calamus var. americanus).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pagal dabartin\u012f status\u0105 (2026 02 02) rinkos prieinamumas nepateiktas.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Geraniumol_Pelargonium_graveolens_%E2%80%93_Neuroinflammation_und_NO\"><\/span>Pelargonij\u0173 aliejus (<em>Pelargonija (Pelargonium graveolens)<\/em>) - Neurou\u017edegimas ir NO<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7922935\/\" rel=\"nofollow noopener\" target=\"_blank\">Pelargonij\u0173 aliejus<\/a> gali b\u016bti naudingas sergant neurodegeneracin\u0117mis ligomis, kuri\u0173 patofiziologij\u0105 sudaro neurou\u017edegimas.<br>Pagrindin\u0117 veiklioji med\u017eiaga <em>Citronelolis<\/em> pasi\u017eym\u0117jo puikiu slopinamuoju poveikiu NO gamybai, esant didesn\u0117ms koncentracijoms, tod\u0117l lemiam\u0105 reik\u0161m\u0119 turi sinergetin\u0117 komponent\u0173 s\u0105veika.<br>Citronelolis taip pat slopina NF-\u03baB - tai tiesiogiai susij\u0119 su mikroglijos aktyvavimu MOGAD.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Teebaum-Ol_Melaleuca_alternifolia_%E2%80%93_Mikroglia-Modulation\"><\/span>Arbatmed\u017eio aliejus (<em>Melaleuca alternifolia<\/em>) - Mikroglijos moduliacija<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10350368\/\" target=\"_blank\" rel=\"noreferrer noopener\">Arbatmed\u017eio aliejus<\/a> ir jo pagrindiniai komponentai slopina AChE ir BChE bei LOX. Oksidacinio streso optimizavimas pasitelkiant antioksidacines savybes, neurou\u017edegimo slopinim\u0105 ir AChE \/ BChE slopinim\u0105 gali veiksmingai prisid\u0117ti prie neuron\u0173 l\u0105steli\u0173 \u017e\u016bties prevencijos kaip bendros strategijos.<br>Terpinen-4-olis (pagrindin\u0117 veiklioji med\u017eiaga) taip pat specifi\u0161kai slopina mikroglijos M1 poliarizacij\u0105.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Wirkstoffubersicht_nach_MOGAD-Signalwegen\"><\/span>Veikli\u0173j\u0173 med\u017eiag\u0173 ap\u017evalga pagal MOGAD signalizavimo kelius<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Veiklioji med\u017eiaga<\/th><th>Naftos \u0161altinis<\/th><th>MOGAD signalizavimo kelias<\/th><th>\u012erodym\u0173 svarumas<\/th><\/tr><\/thead><tbody><tr><td><strong>\u03b2-kariofilenas (BCP)<\/strong><\/td><td>Juodieji pipirai, kopaiba<\/td><td>CB2 \u2192 Nrf2\/HO-1, PPAR-\u03b3; Th17\u2193, IL-6\u2193<\/td><td>\u2605\u2605\u2605\u2605 (EAE modelis)<\/td><\/tr><tr><td><strong>AKBA<\/strong><\/td><td>Smilkalai (<em>Bosvelija serrata<\/em>)<\/td><td>STAT3\u2193, NF-\u03baB\u2193, 5-LOX\u2193, SPM\u2191, Nrf2\/HO-1\u2191<\/td><td>\u2605\u2605\u2605\u2605 (CNS tyrimai)<\/td><\/tr><tr><td><strong>Incenzolio acetatas<\/strong><\/td><td>Smilkalai (lakioji dalis)<\/td><td>TRPV3, PPAR-\u03b3, IL-6\u2193, GFAP\u2193<\/td><td>\u2605\u2605\u2605\u2605 (gyv\u016bn\u0173 modelis)<\/td><\/tr><tr><td><strong>\u03b1-Asaron<\/strong><\/td><td>Kalakutiena (Calamus) (<em>Acorus calamus<\/em>)<\/td><td>PPAR-\u03b3 \u2192 GLT-1\u2191 \u2192 OPC apsauga, tiesiogin\u0117 remielinizacija<\/td><td>\u2605\u2605\u2605\u2605 (hipoksijos modelis)<\/td><\/tr><tr><td><strong>Linalolis<\/strong><\/td><td>Levandos, melisos<\/td><td>NMDA moduliacija, SERT, neuroprotekcija<\/td><td>\u2605\u2605\u2605<\/td><\/tr><tr><td><strong>1,8-cineolas<\/strong><\/td><td>Eukaliptas, rozmarinas<\/td><td>AChE slopinimas, antioksidantas<\/td><td>\u2605\u2605\u2605\u2605 (\u012frodyta smegenyse)<\/td><\/tr><tr><td><strong>Citronelolis<\/strong><\/td><td>Pelargonijos<\/td><td>NO\u2193, NF-\u03baB\u2193, sinerginis poveikis<\/td><td>\u2605\u2605<\/td><\/tr><tr><td><strong>Terpinen-4-olis<\/strong><\/td><td>Arbatmedis<\/td><td>Mikroglijos M1\u2193, LOX\u2193, AChE\u2193<\/td><td>\u2605\u2605<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Quellen_und_weiterfuhrende_Literatur\"><\/span><strong>\u0160altiniai ir tolesnis skaitymas<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Banwell B et al - Lancet Neurol. 2023;22:268-282<\/strong> Diagnostikos kriterijai MOGAD<br><strong>PubMed (nemokamai):<\/strong> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36706773\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/pubmed.ncbi.nlm.nih.gov\/36706773\/<\/a> <br><strong>ScienceDirect (santrauka nemokama, pilnas tekstas mokamas):<\/strong> <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1474442222004318\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1474442222004318<\/a> <br><strong>DOI:<\/strong> <a href=\"https:\/\/doi.org\/10.1016\/S1474-4422(22)00431-8\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1016\/S1474-4422(22)00431-8<\/a><\/li>\n\n\n\n<li><strong>Mader S ir kiti - PNAS 2023<\/strong> <em>(Pastaba: m\u016bs\u0173 dokumente vadinama \u201ePNAS 2024\" - teisingi publikavimo metai yra 2023 m. kovas)<\/em> Komplemento ir FcR patomechanizmas, LMU Miunchenas<br><strong>PNAS pilnas tekstas (nemokamai):<\/strong> <a href=\"https:\/\/www.pnas.org\/doi\/10.1073\/pnas.2300648120\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.pnas.org\/doi\/10.1073\/pnas.2300648120<\/a> <br><strong>LMU prane\u0161imas spaudai (su paai\u0161kinimais):<\/strong> <a href=\"https:\/\/www.med.lmu.de\/bmc\/en\/news\/latest-news\/news-overview\/news\/autoimmune-disease-mogad-insights-into-pathomechanisms.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.med.lmu.de\/bmc\/en\/news\/latest-news\/news-overview\/news\/autoimmune-disease-mogad-insights-into-pathomechanisms.html<\/a> <br><strong>EAN komentarai:<\/strong> <a href=\"https:\/\/www.ean.org\/research\/resources\/neurology-updates\/detail\/complement-dependent-and-independent-pathomechanisms-of-myelin-oligodendrocyte-glycoprotein-mog-abs-implications-for-therapeutic-strategies-in-mog-antibody-associated-disease-mogad\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.ean.org\/research\/resources\/neurology-updates\/detail\/complement-dependent-and-independent-pathomechanisms-of-myelin-oligodendrocyte-glycoprotein-mog-abs-implications-for-therapeutic-strategies-in-mog-antibody-associated-disease-mogad<\/a> <\/li>\n\n\n\n<li><strong>Kaneko K ir kiti - Neurol Neuroimmunol Neuroinflamm. 2024;11(5):e200293<\/strong> CSF komplemento aktyvavimas<br>Straipsnis e200293 yra <strong>negalima rasti tiesiogiai<\/strong> - Ta\u010diau galima rasti susijus\u012f MOGAD ap\u017evalgin\u012f straipsn\u012f tame pa\u010diame numeryje (e200275 Moseley\/Zamvil):<br><strong>Neurologija NXI (e200275, tas pats numeris):<\/strong> <a href=\"https:\/\/www.neurology.org\/doi\/10.1212\/NXI.0000000000200275\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.neurology.org\/doi\/10.1212\/NXI.0000000000200275<\/a> <br><strong>PubMed paie\u0161ka Kaneko 2024 MOGAD CSF:<\/strong> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38996203\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/pubmed.ncbi.nlm.nih.gov\/38996203\/<\/a> <em>(nuoroda \u012f e200275 - rekomenduojama tiesiogin\u0117 PubMed paie\u0161ka e200293)<\/em><\/li>\n\n\n\n<li><strong>Cho EB ir kiti - Front Immunol. 2024;15:1320094<\/strong> Papildomas modelis MOGAD ir NMOSD<br><strong>Frontiers (nemokamas pilnas tekstas):<\/strong> <a href=\"https:\/\/doi.org\/10.3389\/fimmu.2024.1320094\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.3389\/fimmu.2024.1320094<\/a> <em>(DOI tiesiogiai prieinama)<\/em><\/li>\n\n\n\n<li><strong>Frontiers Immunol. 2025 - EAE modeliai, MOGAD patogenez\u0117<\/strong> <em>(Dokumente apskritai nurodoma - tai nuoroda \u012f ap\u017evalgin\u012f straipsn\u012f apie signalizacijos kelius ir (arba) patomechanizmus)<\/em><br><strong>Frontiers Immunol. 2025 (Sun et al., PMID 40406135):<\/strong> <a href=\"https:\/\/doi.org\/10.3389\/fimmu.2025.1535571\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.3389\/fimmu.2025.1535571<\/a><\/li>\n\n\n\n<li><strong>PMC 2023 - I\u0161sami ap\u017evalga Patofiziologija MOGAD<\/strong><br><strong>PMC Visas tekstas (nemokamai):<\/strong> <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9597055\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9597055\/<\/a><\/li>\n\n\n\n<li><strong>PMC 2024 - atnaujinta ap\u017evalga Klinikinis spektras, patogenez\u0117, gydymas<\/strong><br><strong>PubMed\/PMC (Trewin et al., Autoimmun Rev 2025):<\/strong> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39577549\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/pubmed.ncbi.nlm.nih.gov\/39577549\/<\/a><br><strong>PMC pilnas tekstas:<\/strong> <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9294102\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9294102\/<\/a> <em>(Monoklonini\u0173 antik\u016bn\u0173 terapija NMOSD\/MOGAD)<\/em><\/li>\n\n\n\n<li><strong>St\u00f6gbauer J et al - Autoimmunity Reviews 2025;103970<\/strong> Terapiniai metodai Suaugusiesiems MOGAD<br><strong>ScienceDirect (atvira prieiga, nemokamas pilnas tekstas):<\/strong> <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1568997225002319\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1568997225002319<\/a> <br><strong>DOI:<\/strong> <a href=\"https:\/\/doi.org\/10.1016\/j.autrev.2025.103970\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1016\/j.autrev.2025.103970<\/a> <br><strong>Santrauka vokie\u010di\u0173 kalba:<\/strong> <a href=\"https:\/\/www.reine-nervensache.de\/therapieansaetze-bei-mogad-von-der-akutbehandlung-zur-langfristigen-strategie\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.reine-nervensache.de\/therapieansaetze-bei-mogad-von-der-akutbehandlung-zur-langfristigen-strategie\/<\/a> <\/li>\n\n\n\n<li><strong>Ekspert\u0173 nuomon\u0117 apie naujus vaistus 2025 m. - klinikini\u0173 tyrim\u0173 kra\u0161tovaizdis<\/strong><br><strong>Tandfonline (santrauka nemokama, pilnas tekstas mokamas):<\/strong> <a href=\"https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/14728214.2025.2565189\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/14728214.2025.2565189<\/a><br><strong>DOI:<\/strong> <a href=\"https:\/\/doi.org\/10.1080\/14728214.2025.2565189\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1080\/14728214.2025.2565189<\/a><br><\/li>\n\n\n\n<li><strong>NEMOS tyrimo grup\u0117<\/strong> <a href=\"https:\/\/www.nemos-net.de\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nemos-net.de<\/a><br><\/li>\n\n\n\n<li><strong>\u012e pacient\u0105 orientuoto tyrimo ap\u017evalga (cosMOG\/METEOROID):<\/strong><br>MOG projektas - <a href=\"https:\/\/mogproject.org\/clinical-trials\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/mogproject.org\/clinical-trials\/<\/a><br>ClinicalTrials.gov - cosMOG - <a href=\"https:\/\/clinicaltrials.gov\/study\/NCT05063162\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/clinicaltrials.gov\/study\/NCT05063162<\/a><\/li>\n<\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"wp-block-paragraph\">Visas turinys buvo kruop\u0161\u010diai i\u0161tirtas ir atspindi dabartin\u012f (2026 02 02) paskelbt\u0105 \u017eini\u0173 lyg\u012f. Jis skirtas tik informacijos tikslais ir nepakei\u010dia profesionalios gydytojo konsultacijos.<br>Visos dozavimo rekomendacijos turi b\u016bti suderintos su gydan\u010diu gydytoju. <br>Susij\u0119 tyrimai suteikia gydytojui papildomos medicinin\u0117s ir mokslin\u0117s informacijos.<\/p>\n<\/blockquote>","protected":false},"excerpt":{"rendered":"<p><span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Skaitymo laikas<\/span> <span class=\"rt-time\"> 17<\/span> <span class=\"rt-label rt-postfix\">minut\u0117s<\/span><\/span>Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Was ist MOGAD? Jeder kennt elektrische Leitungen: Sie sind mit einer Isolierung versehen, die die einzelne Leiter im Kableb\u00fcndel von einander trennt, damit die Signale in ihnen einander nicht st\u00f6ren und unverf\u00e4lscht von A nach B gelangen.Das R\u00fcckenmark beinhaltet einen ganzen Strang vieler solcher Kabelb\u00fcndel. Sie leiten die Nervensignale vom&hellip;&nbsp;<a href=\"https:\/\/csiag.eu\/lt\/blog\/2026\/02\/17\/mogad-mog-antikoerper-assoziierte-erkrankung\/\" rel=\"bookmark\">Skaityti daugiau \"<span class=\"screen-reader-text\">MOGAD - su MOG antik\u016bnais susijusi liga<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[1078,354],"tags":[94,5721,5717,5720,5714,5713,5711,5715,5719,5716,77,90,5712,5718],"class_list":["post-12718","post","type-post","status-publish","format-standard","hentry","category-medizin","category-medizin-gesundheit","tag-antikoerper","tag-bcp","tag-glykoprotein","tag-igg","tag-mog","tag-mogad","tag-molekulare-signalwege","tag-myelin","tag-myelinscheide","tag-oligodendrozyten","tag-pathophysiologie","tag-rezeptoren","tag-therapiekonzepte","tag-transmebranprotein"],"modified_by":"Achim Goerner","_links":{"self":[{"href":"https:\/\/csiag.eu\/lt\/wp-json\/wp\/v2\/posts\/12718","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/csiag.eu\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csiag.eu\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csiag.eu\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/csiag.eu\/lt\/wp-json\/wp\/v2\/comments?post=12718"}],"version-history":[{"count":0,"href":"https:\/\/csiag.eu\/lt\/wp-json\/wp\/v2\/posts\/12718\/revisions"}],"wp:attachment":[{"href":"https:\/\/csiag.eu\/lt\/wp-json\/wp\/v2\/media?parent=12718"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csiag.eu\/lt\/wp-json\/wp\/v2\/categories?post=12718"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csiag.eu\/lt\/wp-json\/wp\/v2\/tags?post=12718"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}