Terapi pencegahan tuberkulosis dan perkembangan sistem penghantaran obat bertarget makrofag
DOI:
https://doi.org/10.25170/djm.v25i2.4206Keywords:
infeksi tuberkulosis, terapi pencegahan tuberkulosis, penargetan makrofag, penghantaran obat pulmonal, manosaAbstract
Pendahuluan: Infeksi tuberkulosis (TB) dapat menetap tanpa manifestasi klinis dan berkembang menjadi TB, terutama pada individu berisiko tinggi. Terapi pencegahan tuberkulosis (TPT) merupakan komponen penting dalam pengendalian TB. Sistem penghantaran obat melalui paru-paru dan bertarget pada makrofag dikembangkan untuk meningkatkan paparan obat intraseluler serta berpotensi mengurangi toksisitas sistemik.
Metode: Tinjauan pustaka naratif terstruktur dilakukan melalui PubMed, Scopus, dan Google Scholar. Kata kunci yang digunakan meliputi “tuberculosis infection”, “latent tuberculosis infection”, “LTBI”, “tuberculosis preventive treatment”, “drug delivery system”, “nanoparticle”, “nanostructured lipid carrier”, “solid lipid nanoparticle”, “liposome”, “microsphere”, “proliposome”, “pulmonary delivery”, “inhalation”, “alveolar macrophage targeting”, dan “mannose”. Bukti terkini diprioritaskan, sedangkan penelitian lama yang bersifat seminal tetap disertakan apabila relevan secara langsung dengan desain pembawa dan penargetan makrofag.
Hasil: Pedoman World Health Organization tahun 2024 merekomendasikan kaskade TPT yang meliputi identifikasi kelompok berisiko tinggi, penyingkiran penyakit TB, pemeriksaan infeksi TB sesuai indikasi, pemilihan regimen secara individual, pemantauan efek samping, dan dukungan kepatuhan. Sistem penghantaran yang diteliti mencakup nanostructured lipid carrier, liposom, mikrosfer, nanopartikel lipid padat, dan proliposom. Formulasi rifampisin atau isoniazid, terutama yang difungsionalisasi dengan ligan terkait manosa, umumnya meningkatkan pengambilan oleh makrofag atau memperpanjang paparan obat lokal pada penelitian formulasi, in vitro, ex vivo, atau hewan. Bukti masih heterogen dan terutama bersifat praklinis.
Simpulan: Sistem penghantaran obat melalui paru-paru dan bertarget pada makrofag menunjukkan potensi praklinis untuk meningkatkan penghantaran intraseluler obat antituberkulosis. Namun, efektivitas klinis, keamanan inhalasi, reproduksibilitas, dan kemampuannya untuk mempersingkat TPT belum dapat dipastikan. Penelitian farmakokinetik, toksikologi, dan uji klinis masih diperlukan sebelum penerapan secara rutin.
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