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

Translator: Marco Antonio Alonso Iglesias Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

So I'm a neurosurgeon.

Son neurocirurxiá

And like most of my colleagues,

e coma moitos dos meus colegas

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

teño que tratar a cotío con traxedias humanas.

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

Doume conta de como a túa vida pode cambiar nun segundo

after a major stroke or after a car accident.

tras unha embolia cerebral ou un accidente de coche.

And what is very frustrating for us neurosurgeons

Faise moi frustrante para nós como neurocirurxiáns

is to realize that unlike other organs of the body,

constatar que ao contrario que outros órganos do corpo,

the brain has very little ability for self-repair.

o cerebro ten moi pouca capacidade para autorrepararse.

And after a major injury of your central nervous system,

Despois dunha lesión grave do sistema nervioso central

the patients often remain with a severe handicap.

os pacientes polo xeral fican con secuelas graves.

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

Esa é probablemente a razón pola que decidín

to be a functional neurosurgeon.

ser neurociruxián funcional.

What is a functional neurosurgeon?

Que é un neurocirurxián funcional?

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

É un doutor que intenta mellorar unha función neurolóxica

through different surgical strategies.

ao través de diferentes técnicas cirúrxicas.

You've certainly heard of one of the famous ones

Seguramente escoitaron falar dunha moi coñecida

called deep brain stimulation,

chamada estimulación cerebral profunda,

where you implant an electrode in the depths of the brain

na cal implantamos un eléctrodo no interior do cerebro

in order to modulate a circuit of neurons

para modular un circuíto neuronal

to improve a neurological function.

que mellore unha función neurolóxica.

It's really an amazing technology

É unha tecnoloxía asombrosa

in that it has improved the destiny of patients

que está a mellorar as probabilidades dos pacientes

with Parkinson's disease,

coa enfermidade de Párkinson,

with severe tremor, with severe pain.

con fortes tremores, con moita dor.

However, neuromodulation does not mean neuro-repair.

De calquera xeito, a neuromodulación non quere dicir neurorreparación.

And the dream of functional neurosurgeons

O soño dos neurocirurxiáns funcionais

is to repair the brain.

e reparar o cerebro.

I think

Penso

that we are approaching this dream.

que estamos achegándonos a este soño.

And I would like to show you

Gustaríame mostrarvos

that we are very close to this.

que estamos moi preto disto.

And that with a little bit of help,

Como cunha pequena axuda,

the brain is able to help itself.

o cerebro é quen de repararse a si mesmo.

So the story started 15 years ago.

Esta historia comezou hai 15 anos.

At that time, I was a chief resident

Daquela, eu era xefa de residentes

working days and nights in the emergency room.

e pasaba días e días nas salas de urxencias

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

A miúdo tiña que ocuparme de pacientes con traumas na cabeza

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

Podedes imaxinar que cando un paciente vén cun trauma grave na cabeza,

his brain is swelling

o seu cerebro inflámase

and he's increasing his intracranial pressure.

e auméntalle a presión intracranial.

And in order to save his life,

Para salvar a súa vida,

you have to decrease this intracranial pressure.

tes que diminuír esa presión intracranial,

And to do that,

e para facer iso,

you sometimes have to remove a piece of swollen brain.

ás veces tiñamos que extraer un anaco de cerebro inflamado

So instead of throwing away these pieces of swollen brain,

No canto de tirar eses anacos

we decided with Jean-François Brunet,

decidimos, xunto con Jean-François Brunet,

who is a colleague of mine, a biologist,

que é un colega meu, biólogo,

to study them.

estudalos.

What do I mean by that?

Que quero dicir?

We wanted to grow cells from these pieces of tissue.

Quixemos cultivar células obtidas deses anacos de tecido.

It's not an easy task.

Non é unha tarefa sinxela.

Growing cells from a piece of tissue

Cultivar células dun anaco de tecido

is a bit the same as growing very small children

é case coma criar meniños pequerrechos

out from their family.

lonxe das súas familias.

So you need to find the right nutrients,

Así que necesitas atopar os nutrientes adecuados,

the warmth, the humidity

a temperatura, a humidade

and all the nice environments to make them thrive.

e os ambientes adecuados para que saian adiante.

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

Iso foi exactamente o que fixemos con esas células.

And after many attempts,

Despois de moitos intentos,

Jean-François did it.

Jean-François conseguiuno.

And that's what he saw under his microscope.

Isto foi o que vimos baixo o seu microscopio.

And that was, for us, a major surprise.

E foi, para nós, unha gran sorpresa.

Why?

Por que?

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

Porque parecía o mesmiño ca un cultivo de células nai,

with large green cells surrounding small, immature cells.

con células grandes e verdes, arredor das células pequenas e inmaturas.

And you may remember from biology class

Lembraredes da clase de bioloxía

that stem cells are immature cells,

que esas células nai son células inmaturas,

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

capaces de transformarse en calquera célula do corpo.

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

O cerebro adulto ten células nai, pero son moi escasas

and they're located in deep and small niches

e atópanse en profundas e pequenas áreas

in the depths of the brain.

do interior do cerebro.

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

Foi sorprendente obter esta clase de cultivos de células nai

from the superficial part of swollen brain we had

provenientes de fragmentos de cerebro que conseguimos

in the operating theater.

no quirófano.

And there was another intriguing observation:

Alí había outro achado intrigante:

Regular stem cells are very active cells --

polo xeral as células nai son células moi activas--

cells that divide, divide, divide very quickly.

células que se dividen, dividen e dividen moi rápido.

And they never die, they're immortal cells.

Elas nunca morren, son células inmortais.

But these cells behave differently.

Pero estas células eran diferentes

They divide slowly,

Elas dividíanse de vagar,

and after a few weeks of culture,

e despois dunhas semanas de cultivo,

they even died.

sempre morrían.

So we were in front of a strange new cell population

Atopabámonos fronte a unha estraña nova poboación celular

that looked like stem cells but behaved differently.

semellante ás células nai pero cun comportamento distinto.

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

E levounos bastante tempo comprender de onde proviñan.

They come from these cells.

Proveñen destas células.

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

Esas células azuis e encarnadas son células positivas á doblecortina.

All of you have them in your brain.

Todos vós as tedes no voso cerebro.

They represent four percent of your cortical brain cells.

Representan o catro por cento das vosas células corticais cerebrais.

They have a very important role during the development stage.

Xogan un papel moi importante durante o estadio de desenvolvemento.

When you were fetuses,

Cando erades fetos,

they helped your brain to fold itself.

axudáronlle ao voso cerebro a formar as circunvolucións.

But why do they stay in your head?

Pero por que seguen na vosa cabeza?

This, we don't know.

Iso non o sabemos.

We think that they may participate in brain repair

Cremos que poden intervir na reparación cerebral

because we find them in higher concentration

porque nós atopámolas en concentracións máis altas

preto de lesións cerebrais.

close to brain lesions.

But it's not so sure.

Pero non é seguro.

But there is one clear thing --

Porén, unha cousa está clara...

that from these cells,

grazas a estas células,

we got our stem cell culture.

nós tivemos o noso cultivo de células nai.

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

Estabamos fronte a unha posible fonte de células

to repair the brain.

para reparar o cerebro.

And we had to prove this.

e tiñamos que demostralo.

So to prove it,

Así que para demostralo,

we decided to design an experimental paradigm.

decidimos deseñar un paradigma experimental.

The idea was to biopsy a piece of brain

A idea foi biopsiar un anaco de cerebro

in a non-eloquent area of the brain,

nunha parte non esencial do cerebro,

and then to culture the cells

e despois cultivar as células

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

do mesmo xeito que Jean-François fixera no seu laboratorio.

And then label them, to put color in them

E despois etiquetalas, colorealas

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

de xeito que fósemos capaces de rastrexalas no cerebro.

And the last step was to re-implant them

O derradeiro paso sería reimplantalas

in the same individual.

no mesmo individuo.

We call these

Nós chamámoslle a isto

autologous grafts -- autografts.

enxertos autólogos -- autoenxertos.

So the first question we had,

A primeira pregunta que nos fixemos foi:

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

"Que ocorrería se reimplantásemos esas células nun cerebro normal,

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

e que ocorrería se as reimplantásemos

in a lesioned brain?"

nun cerebro lesionado?"

Thanks to the help of professor Eric Rouiller,

Grazas a axuda do profesor Eric Rouiller,

we worked with monkeys.

traballamos con monos.

So in the first-case scenario,

No primeiro suposto,

we re-implanted the cells in the normal brain

reimplantamos as células nun cerebro san

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

e o que vimos foi que desapareceran por completo ás poucas semanas

as if they were taken from the brain,

coma se fosen sacadas do cerebro,

they go back home,

volveron á casa,

the space is already busy,

o lugar xa estaba ocupado,

they are not needed there, so they disappear.

alí non eran necesarias, así que desapareceron.

In the second-case scenario,

No segundo suposto,

we performed the lesion,

nós recreamos a lesión,

we re-implanted exactly the same cells,

reimplantamos exactamente as mesmas células,

and in this case, the cells remained --

e neste caso, as células permaneceron...

and they became mature neurons.

e convertéronse en neuronas maduras.

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

Esta foi a imaxe que nós puidemos observar baixo o microscopio

Those are the cells that were re-implanted.

Estas son as células que reimplantáramos.

And the proof they carry,

A proba que portan,

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

estas pequenas manchas, esas son as células que nos etiquetamos

in vitro, when they were in culture.

in vitro, cando elas estaban no cultivo.

But we could not stop here, of course.

Non nos detivemos aí, por suposto.

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

Poderían esas células tamén axudarlle a un mono a recuperarse tras unha lesión?

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

Para isto, adestramos os monos para dominar unha tarefa manual.

They had to retrieve food pellets from a tray.

Tiñan que tirar boliñas de comida dunha bandexa.

They were very good at it.

Facíano moi ben.

And when they had reached a plateau of performance,

Cando alcanzaron unha certa habilidade,

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

causámoslles unha lesión no córtex motor correspondente ao control da man.

So the monkeys were plegic,

De xeito que os monos quedaron eivados,

they could not move their hand anymore.

xa non eran quen de mover a man.

And exactly the same as humans would do,

Igual que ocorrería nos seres humanos,

they spontaneously recovered to a certain extent,

recuperáronse espontaneamente ata certo nivel,

exactly the same as after a stroke.

igualiño ca despois dunha embolia cerebral.

Patients are completely plegic,

Pacientes totalmente eivados,

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

que intentan recuperarse grazas ao mecanismo de plasticidade cerebral,

they recover to a certain extent,

facéndoo ata un certo nivel,

exactly the same for the monkey.

exactamente o mesmo para os monos.

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

Entón, cando nos aseguramos que os monos alcanzaran o seu límite

of spontaneous recovery,

de recuperación espontánea,

we implanted his own cells.

reimplantámoslles as súas propias células,

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

No lado esquerdo, vese o mono que se recuperou espontaneamente.

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

Isto é arredor do 40 ao 50 por cento da súa destreza

before the lesion.

previa á lesión.

He's not so accurate, not so quick.

Non é moi preciso, nin moi rápido.

And look now when we re-implant the cells:

Mirade agora, ao reimplantar as células,

Two months after re-implantation, the same individual.

dous meses despois da reimplantación, o mesmo individuo.

(Applause)

(Aplausos)

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

Foron uns resultados moi emocionantes para nós, en serio.

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

Dende ese intre, nós comprendemos moito mellor estas células.

We know that we can cryopreserve them,

Sabemos que podemos criopreservalas,

we can use them later on.

para empregalas máis adiante.

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

Sabemos que podemos empregalas noutros modelos neuropatolóxicos,

like Parkinson's disease, for example.

coma a enfermidade de Párkinson.

But our dream is still to implant them in humans.

Pero o noso soño é aínda implantalas nos humanos.

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

Eu teño a esperanza de sermos quen de mostrarvos axiña

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

que o cerebro humano estanos a dar as ferramentas para autorrepararse.

Thank you.

Grazas.

(Applause)

(Aplausos)

Bruno Giussani: Jocelyne, this is amazing,

Bruno Giussani: Jocelyne, isto é asombroso.

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

Estou seguro de que agora mesmo, hai ducias de persoas no público

possibly even a majority,

posiblemente a maioría,

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

que están a pensar,"Eu sei de alguén que pode usar isto."

I do, in any case.

Eu estou, desde logo.

And of course the question is,

E por suposto a pregunta é:

what are the biggest obstacles

cales son os maiores obstáculos

before you can go into human clinical trials?

antes de que poidas facer ensaios clínicos en humanos?

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

Jocelyne Bloch: Os meirandes obstáculos son as regulacións. (Risos)

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

Así que, a partir destes bos resultados, necesitas obter

about two kilograms of papers and forms

arredor de dous kg de papeis e formularios

to be able to go through these kind of trials.

para ser quen de desenvolver este tipo de ensaios.

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

BG: O cal é comprensible, o cerebro é delicado, etc.

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

JB: Si, así é, pero cómpre moito tempo

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

e moita paciencia e case un equipo profesional para facelo, sabes.

BG: If you project yourself --

BG: Se te imaxinas a ti mesma...

having done the research

despois da investigación,

and having tried to get permission to start the trials,

intentando obter os permisos para comezar os ensaios,

if you project yourself out in time,

se te proxectas a ti mesma no tempo,

how many years before somebody gets into a hospital

cantos anos pasarán antes de que alguén chegue a un hospital

and this therapy is available?

e dispoña desta terapia?

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

JB: Isto é moi difícil de dicir.

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

Depende, primeio, da aprobación do ensaio.

Will the regulation allow us to do it soon?

Permitiránolo a regulación de aquí a pouco?

And then, you have to perform this kind of study

Despois, tes que preparar este tipo de estudo

in a small group of patients.

nun pequeno grupo de pacientes.

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

Vai levar, seguro, moito tempo seleccionar os pacientes,

do the treatment

facer o tratamento

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

e avaliar se é axeitado empregar esta clase de tratamento.

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

E despois haberá que desenvolver isto nun ensaio multicéntrico.

You have to really prove first that it's useful

Primeiro haberá que demostrar realmente que é útil

before offering this treatment up for everybody.

antes de ofrecerlle este tratamento para todo o mundo

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

BG: E seguro, por suposto. JB: Por suposto.

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

BG: Jocelyne, grazas por vir a TED e contarnos isto.

BG: Thank you.

JB: Grazas.

(Applause)

(Aplausos)