The brain may be able to repair itself -- with help | Jocelyne Bloch

Translator: Anela Muhic Reviewer: Ivan Stamenkovic

So I'm a neurosurgeon.

Dakle, ja sam neurohirurg.

And like most of my colleagues,

i kao većina mojih kolega,

I have to deal, every day, with human tragedies.

svaki dan se suočavam sa ljudskom tragedijom.

I realize how your life can change from one second to the other

Shvatila sam kako se život može promijeniti u sekundi,

after a major stroke or after a car accident.

nakon velikog moždanog udara ili automobilske nesreće.

And what is very frustrating for us neurosurgeons

Ono što je veoma frustrirajuće za nas neurohirurge

is to realize that unlike other organs of the body,

jeste shvatiti, da za razliku od drugih organa tijela,

the brain has very little ability for self-repair.

mozak ima veoma malu sposobnost da može samostalno zacijeliti.

And after a major injury of your central nervous system,

I nakon velike ozljede vašeg centralnog nervnog sistema,

the patients often remain with a severe handicap.

pacijenti često ostaju sa teškim hendikepom.

And that's probably the reason why I've chosen

I to je vjerojatno razlog zašto sam izabrala

to be a functional neurosurgeon.

da budem funkcionalni neurohirurg.

What is a functional neurosurgeon?

Ko je funkcionalni neurohirurg?

It's a doctor who is trying to improve a neurological function

To je doktor koji se trudi da poboljša neurološku funkciju

through different surgical strategies.

kroz različite hirurški strategije.

You've certainly heard of one of the famous ones

Sigurno ste čuli za jedan od najpoznatijih

called deep brain stimulation,

naziva duboka stimulacija mozga

where you implant an electrode in the depths of the brain

gdje se ugrade elektrode u dubini mozga

in order to modulate a circuit of neurons

kako bi se modulirao krug neurona

to improve a neurological function.

za poboljšanje neurološke funkcije.

It's really an amazing technology

To je zapanjujuća tehnologija

in that it has improved the destiny of patients

koja se usavršila zbog sudbine pacijenata

with Parkinson's disease,

sa Parkinsonovom bolesti,

with severe tremor, with severe pain.

sa ozbiljnim podrhtavanjem, uz jake bolove.

However, neuromodulation does not mean neuro-repair.

Međutim, neuromodulacija ne znači neuronske popravke.

And the dream of functional neurosurgeons

San funkcionalnog neurohirurga

is to repair the brain.

jeste da izliječi mozak.

I think

Mislim

that we are approaching this dream.

da se približavamo tom snu.

And I would like to show you

Željela bih Vam pokazati

that we are very close to this.

da smo veoma blizu tome.

And that with a little bit of help,

I da uz malo pomoći,

the brain is able to help itself.

mozak je u stanju da si pomogne.

So the story started 15 years ago.

Dakle, priča počinje prije 15 godina.

At that time, I was a chief resident

U to vrijeme, bila sam glavni stanovnik

working days and nights in the emergency room.

radnih dana i noći u hitnoj.

I often had to take care of patients with head trauma.

Često sam morala brinuti o pacijentima sa povredama glave.

You have to imagine that when a patient comes in with a severe head trauma,

Možete zamisliti da kada pacijent dođe sa teškim povredama glave,

his brain is swelling

natečenim mozgom,

and he's increasing his intracranial pressure.

njegov intrakranijalni pritisak je povećavajući.

And in order to save his life,

A kako bi spasili njegov život,

you have to decrease this intracranial pressure.

morate smanjiti taj intrakranijalni pritisak.

And to do that,

A da bi to napravili,

you sometimes have to remove a piece of swollen brain.

ponekad morate ukloniti dio natečenog mozga.

So instead of throwing away these pieces of swollen brain,

Dakle, umjesto odklanjanja tog dijela natečenog mozga,

we decided with Jean-François Brunet,

odlučili smo sa Jean-François Brunet,

who is a colleague of mine, a biologist,

mojim kolegom, biologom,

to study them.

da proučavamo.

What do I mean by that?

Šta mislim pod tim?

We wanted to grow cells from these pieces of tissue.

Željeli smo da rastu ćelije od tih komada tkiva.

It's not an easy task.

Nije lagan zadatak.

Growing cells from a piece of tissue

Rast ćelija od komada tkiva

is a bit the same as growing very small children

je isto što i rast veoma male dijece

out from their family.

iz svoje porodice.

So you need to find the right nutrients,

Tako da je potrebno pronaći hranjive tvari,

the warmth, the humidity

toplinu, vlažnost

and all the nice environments to make them thrive.

i lijepo okruženje da bi napredovali.

So that's exactly what we had to do with these cells.

Dakle, to je upravo ono što smo uradili sa ovim ćelijama.

And after many attempts,

I nakon mnogo pokušaja,

Jean-François did it.

Jean-François je to uradio.

And that's what he saw under his microscope.

I to je vidio pod mikroskopom.

And that was, for us, a major surprise.

I to je bilo, za nas, veliko iznenađenje.

Why?

Zašto?

Because this looks exactly the same as a stem cell culture,

Jer ovo izgleda isto kao kultura matičnih ćelija,

with large green cells surrounding small, immature cells.

sa velikim zelenim ćelijama opkoljavajuće male, nezrele ćelije.

And you may remember from biology class

A možda se sjećate iz biologije

that stem cells are immature cells,

da matične ćelije su nezrele ćelije,

able to turn into any type of cell of the body.

koje se mogu pretvoriti u bilo koju vrstu ćelije tijela.

The adult brain has stem cells, but they're very rare

Mozak odrasle osobe ima matične ćelije, ali one su vrlo rijetke

and they're located in deep and small niches

i oni su locirani u dubokim i malim utočištima

in the depths of the brain.

u dubini mozga.

So it was surprising to get this kind of stem cell culture

Toliko je bilo iznenađujuće dobiti ovu vrstu kulture matičnih ćelija

from the superficial part of swollen brain we had

iz površnog dijela otečenog mozga kojeg smo imali

in the operating theater.

u operativnom pozorištu.

And there was another intriguing observation:

A tu je još jedno intrigantno zapažanje :

Regular stem cells are very active cells --

Redovne matične ćelije su vrlo aktivne ćelije --

cells that divide, divide, divide very quickly.

ćelije koje se dijele, dijele, dijele veoma brzo.

And they never die, they're immortal cells.

I one nikada ne umiru, one su besmrtne ćelije.

But these cells behave differently.

Ali, ove ćelije se ponašaju drugačije.

They divide slowly,

One se dijele polako,

and after a few weeks of culture,

i nakon nekoliko nedelja kulture,

they even died.

one čak i umru.

So we were in front of a strange new cell population

Tako smo bili ispred nepoznatih novih stanovništva ćelija

that looked like stem cells but behaved differently.

koja su izgledale kao matične ćelije ali su se ponašle drugačije.

And it took us a long time to understand where they came from.

Trebalo nam je dosta vremena da shvatimo odakle su došli.

They come from these cells.

Oni dolaze iz ove ćelije.

These blue and red cells are called doublecortin-positive cells.

Ove plave i crvene ćelije nazivaju doublecortin - pozitivne ćelije.

All of you have them in your brain.

Svi vi imate ih u mozgu.

They represent four percent of your cortical brain cells.

Oni predstavljaju četiri posto Vaših kortikalnih moždanih ćelija.

They have a very important role during the development stage.

Oni imaju vrlo važnu ulogu u fazi razvoja.

When you were fetuses,

Kada ste bili fetus,

they helped your brain to fold itself.

oni su pomogli vašem mozgu da se složi.

But why do they stay in your head?

Ali zašto oni ostaju u Vašoj glavi?

This, we don't know.

To ne znamo.

We think that they may participate in brain repair

Mi mislimo da oni mogu da učestvuju u popravku mozga

because we find them in higher concentration

jer smo ih našli u većem zgušnjavanju

close to brain lesions.

blizu oštećenja mozga.

But it's not so sure.

Ali to nije tako sigurno.

But there is one clear thing --

Ali postoji jedna jasna stvar --

that from these cells,

da iz ove ćelije,

we got our stem cell culture.

smo dobili naše kulture matičnih ćelija.

And we were in front of a potential new source of cells

Bili smo ispred potencijalnog novog izvora ćelija

to repair the brain.

da bi oporavili mozak.

And we had to prove this.

I morali smo to dokazati.

So to prove it,

Tako da bi dokazali,

we decided to design an experimental paradigm.

morali smo dizajnirati eksperimentalnu paradigmu.

The idea was to biopsy a piece of brain

Ideja je bila da se uradi biopsija dijela mozga

in a non-eloquent area of the brain,

u ne-elokventno područje mozga,

and then to culture the cells

a potom i u kulture ćelija

exactly the way Jean-François did it in his lab.

upravo kako je Jean-François to uradio u svom laboratoriju.

And then label them, to put color in them

I onda ih označe, u njima stave boju

in order to be able to track them in the brain.

kako bi mogli da ih prate u mozgu.

And the last step was to re-implant them

I posljednji korak je bio da se ponovno ugradi

in the same individual.

u iste ličnosti.

We call these

Zovemo ih

autologous grafts -- autografts.

autologni transplantati - autograftovi.

So the first question we had,

Dakle, prvo pitanje koje smo imali,

"What will happen if we re-implant these cells in a normal brain,

"Šta će se dogoditi ako implantiramo ćelije u normalni mozak,

and what will happen if we re-implant the same cells

i šta će se desiti ako ponovo implantiramo iste ćelije

in a lesioned brain?"

u ozlijeđen mozak?"

Thanks to the help of professor Eric Rouiller,

Zahvaljujući pomoći profesora Eric Rouiller,

we worked with monkeys.

radili smo s majmunima.

So in the first-case scenario,

Dakle, u prvom slučaju scenarija,

we re-implanted the cells in the normal brain

mi smo ponovo implantirali ćelije u normalni mozak

and what we saw is that they completely disappeared after a few weeks,

a ono što smo vidjeli je da su potpuno nestali nakon nekoliko sedmica,

as if they were taken from the brain,

kao da su uzeti iz mozga,

they go back home,

oni se vraćaju kući,

the space is already busy,

prostor je već zauzet,

they are not needed there, so they disappear.

nisu potrebni tamo, tako da nestaju.

In the second-case scenario,

U drugom slučaju scenarija,

we performed the lesion,

izvršavali smo lezije,

we re-implanted exactly the same cells,

ponovo smo implantirali isti ćelije,

and in this case, the cells remained --

i, u ovom slučaju, ćelije su ostale --

and they became mature neurons.

i postale zreli neuron.

And that's the image of what we could observe under the microscope.

I to je slika onoga što smo mogli da posmatramo pod mikroskopom.

Those are the cells that were re-implanted.

To su ćelije koje su ponovo implantirane.

And the proof they carry,

A kao dokaz oni donose,

these little spots, those are the cells that we've labeled

ova mala mjesta, to su ćelije koje smo označili

in vitro, when they were in culture.

in vitro, kada su bili u kulturi.

But we could not stop here, of course.

Naravno, nismo se mogli zaustaviti ovdje.

Do these cells also help a monkey to recover after a lesion?

Da li će ove ćelije pomoći majmunima da se oporave nakon lezije?

So for that, we trained monkeys to perform a manual dexterity task.

Što se tiče toga, obučavali smo majmune da obavljaju ručno spretnost zadatka.

They had to retrieve food pellets from a tray.

Oni su morali da izvade hranu peleta iz poslužavnika.

They were very good at it.

Bili su jako dobri u tome.

And when they had reached a plateau of performance,

I kad su postigli plato performansi,

we did a lesion in the motor cortex corresponding to the hand motion.

radili smo lezije motornog korteksa odgovarajućim pokretom ruke.

So the monkeys were plegic,

Dakle, majmuni su plegic,

they could not move their hand anymore.

oni više nisu mogli pomjerati ruku.

And exactly the same as humans would do,

I isto tako bi i ljudi radili,

they spontaneously recovered to a certain extent,

oni bi se spontano oporavili u određenoj mjeri,

exactly the same as after a stroke.

isto kao i nakon moždanog udara.

Patients are completely plegic,

Pacijenti su potpuno plegic,

and then they try to recover due to a brain plasticity mechanism,

oni se pokušavaju da se oporave zbog mehanizma mozga plastičnost,

they recover to a certain extent,

oni se oporavljaju do jedne mjere,

exactly the same for the monkey.

isto vrijedi i za majmune.

So when we were sure that the monkey had reached his plateau

Dakle, kada smo bili sigurni da je majmun stigao do platoa

of spontaneous recovery,

od spontanog oporavka,

we implanted his own cells.

mi smo implantirani njegove vlastite ćelije.

So on the left side, you see the monkey that has spontaneously recovered.

Dakle, na lijevoj strani, vidite majmuna koji je se spontano oporavio.

He's at about 40 to 50 percent of his previous performance

On je oko 40 do 50 posto njegovog prethodnog performansa

before the lesion.

prije lezije.

He's not so accurate, not so quick.

On nije toliko precizan, nije toliko brz.

And look now when we re-implant the cells:

Pogledajte sada, kada smo ponovo implantirali ćelije:

Two months after re-implantation, the same individual.

Dva mjeseca nakon ponovne implantacije, ista ličnost.

(Applause)

(Aplauz)

It was also very exciting results for us, I tell you.

Iskreno da Vam kažem, to je bio veoma uzbudljiv rezultat za nas.

Since that time, we've understood much more about these cells.

Od tada smo shvatili mnogo više o ovim ćelijama.

We know that we can cryopreserve them,

Znamo da ih možemo sa krioprezervacijom,

we can use them later on.

koristiti kasnije.

We know that we can apply them in other neuropathological models,

Znamo da ih možemo primijeniti u drugim neuropatološkim modelima,

like Parkinson's disease, for example.

kao što je Parkinsonova bolest.

But our dream is still to implant them in humans.

Ali, naš san je i dalje da ih usadimo u ljude.

And I really hope that I'll be able to show you soon

I zaista se nadam da ću biti u stanju da Vam to uskoro i pokažem

that the human brain is giving us the tools to repair itself.

da nam ljudski mozak daje alate za oporavak sebe.

Thank you.

Hvala Vam.

(Applause)

(Aplauz)

Bruno Giussani: Jocelyne, this is amazing,

Jocelyne, ovo je nevjerovatno,

and I'm sure that right now, there are several dozen people in the audience,

i siguran sam da trenutno postoje nekoliko desetina ljudi u publici,

possibly even a majority,

možda čak i većina,

who are thinking, "I know somebody who can use this."

koji razmišljaju, "Znam nekog kome može da koristi ovo. "

I do, in any case.

Ja, u svakom slučaju.

And of course the question is,

I naravno pitanje je,

what are the biggest obstacles

koje su najveće prepreke

before you can go into human clinical trials?

prije nego što možete ići u ljudska klinička ispitivanja?

Jocelyne Bloch: The biggest obstacles are regulations. (Laughs)

Najveće prepreke su propisi. (Smijeh)

So, from these exciting results, you need to fill out

Dakle, od ovih uzbudljivih rezultata, trebate popuniti

about two kilograms of papers and forms

oko dva kilograma radova i oblika

to be able to go through these kind of trials.

da bi mogli proći kroz ove vrsta suđenja.

BG: Which is understandable, the brain is delicate, etc.

BG: Što je i razumljivo, mozak je delikatna, itd

JB: Yes, it is, but it takes a long time

JB: Da, to je, ali to dugo traje

and a lot of patience and almost a professional team to do it, you know?

i puno strpljenja i skoro stručni tim ti reba da to uradi, znaš?

BG: If you project yourself --

Ako projekat -

having done the research

završi istraživanje

and having tried to get permission to start the trials,

i nakon što je pokušao da dobije dozvolu za početak suđenja,

if you project yourself out in time,

i ako je projekat u vremenu,

how many years before somebody gets into a hospital

koliko godina treba prije nego li neko dođe u bolnicu

and this therapy is available?

da ova terapija bude na raspolaganju?

JB: So, it's very difficult to say.

Dakle, to je vrlo teško reći.

It depends, first, on the approval of the trial.

To ovisi, prvo, o odobrenju suđenja.

Will the regulation allow us to do it soon?

Hoće li nam propis omogućiti da to učinimo uskoro?

And then, you have to perform this kind of study

I onda, morate obavljati takvu vrstu studija

in a small group of patients.

u maloj grupi pacijenata.

So it takes, already, a long time to select the patients,

Tako da je potrebno, dugo vremena za odabir pacijenata,

do the treatment

da se učini tretman

and evaluate if it's useful to do this kind of treatment.

i procijeni da li je to korisno za ovu vrstu liječenja.

And then you have to deploy this to a multicentric trial.

I onda morate razviti to multicentrično suđenje.

You have to really prove first that it's useful

Morate zaista dokazati prvo, da je to korisno

before offering this treatment up for everybody.

za svakoga prije ponude ovog tretmana.

BG: And safe, of course. JB: Of course.

- I sigurno, naravno. - Naravno.

BG: Jocelyne, thank you for coming to TED and sharing this.

Jocelyne, hvala vam što ste došli na TED i podijelili ovo.

BG: Thank you.

Hvala Vam.

(Applause)

(Aplauz)