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

Prevoditelj: Senzos Osijek Recezent: Ivan Stamenković

So I'm a neurosurgeon.

Ja sam neurokirurg.

And like most of my colleagues,

I kao većina mojih kolega,

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

svaki sam dan suočena s ljudskim tragedijama.

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

Razumijem kako se život može promijeniti iz sekunde u sekundu

after a major stroke or after a car accident.

nakon teškog moždanog udara ili nakon prometne nesreće.

And what is very frustrating for us neurosurgeons

Vrlo je frustrirajuće nama neurokirurzima

is to realize that unlike other organs of the body,

shvatiti da za razliku od ostalih organa u tijelu,

the brain has very little ability for self-repair.

mozak ima jako male mogućnosti samostalnog popravka.

And after a major injury of your central nervous system,

Nakon teže ozlijede središnjeg živčanog sustava,

the patients often remain with a severe handicap.

pacijentima često ostaju trajne posljedice.

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

To je vjerojatno razlog zašto sam odlučila

to be a functional neurosurgeon.

biti funkcionalni neurokirurg.

What is a functional neurosurgeon?

Što je funkcionalni neurokirurg?

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

To je liječnik koji pokušava poboljšati neurološke funkcije

through different surgical strategies.

uz pomoć raznih kirurških tehnika.

You've certainly heard of one of the famous ones

Sigurno ste čuli za jednu od poznatijih

called deep brain stimulation,

poput duboke moždane stimulacije,

where you implant an electrode in the depths of the brain

kod koje se elektroda usađuje u dubinu mozga

in order to modulate a circuit of neurons

kako bi upravljali sklopom neurona

to improve a neurological function.

i poboljšali neurološku funkciju.

It's really an amazing technology

Uistinu je nevjerojatna tehnologija

in that it has improved the destiny of patients

po tome što je poboljšala sudbinu pacijenata

with Parkinson's disease,

s Parkinsonovom bolešću,

with severe tremor, with severe pain.

s teškim tremorom, sa snažnim bolovima.

However, neuromodulation does not mean neuro-repair.

Međutim, neuromodulacija ne znači popravak.

And the dream of functional neurosurgeons

I san funkcionalnih neurokirurga

is to repair the brain.

je popraviti mozak.

I think

Mislim

that we are approaching this dream.

da se približavamo ovom snu.

And I would like to show you

Željela bih vam pokazati

that we are very close to this.

da smo vrlo blizu tome.

And that with a little bit of help,

Uz vrlo malu pomoć,

the brain is able to help itself.

mozak si može sam pomoći.

So the story started 15 years ago.

Priča je počela prije 15 godina.

At that time, I was a chief resident

U to sam vrijeme bila glavni specijalizant,

working days and nights in the emergency room.

radila danju i noću u hitnoj službi.

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

Često sam skrbila o pacijentima s traumama glave.

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

Morate pretpostaviti da kada vam pacijent dođe s teškom traumom glave,

his brain is swelling

njegov mozak otiče

and he's increasing his intracranial pressure.

i intakranijski tlak raste.

And in order to save his life,

Kako bi spasili njegov život,

you have to decrease this intracranial pressure.

morate smanjiti taj intrakranijalni tlak.

And to do that,

Da bi to učinili,

you sometimes have to remove a piece of swollen brain.

nekada morate ukloniti dio oteknutog mozga.

So instead of throwing away these pieces of swollen brain,

Ali umjesto bacanja tih komada oteknutog mozga,

we decided with Jean-François Brunet,

odlučili smo, sa Jean-François Brunetom,

who is a colleague of mine, a biologist,

koji je moj kolega, biolog,

to study them.

proučavati ih.

What do I mean by that?

Što time mislim?

We wanted to grow cells from these pieces of tissue.

Htjeli smo uzgojiti stanice iz tih komada tkiva.

It's not an easy task.

To nije jednostavan zadatak.

Growing cells from a piece of tissue

Uzgajanje stanica iz komada tkiva

is a bit the same as growing very small children

gotovo je isto kao razvijanje vrlo male djece

out from their family.

iz njihove obitelji.

So you need to find the right nutrients,

Morate naći prave hranjive tvari,

the warmth, the humidity

toplinu, vlagu,

and all the nice environments to make them thrive.

i pravu okolinu kako bi napredovali.

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

Upravo smo to morali učiniti s ovim stanicama.

And after many attempts,

Nakon brojnih pokušaja,

Jean-François did it.

Jean-François je uspio.

And that's what he saw under his microscope.

I to je vidio pod svojim mikroskopom.

And that was, for us, a major surprise.

To je za nas bilo veliko iznenađenje.

Why?

Zašto?

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

Zato što ovo izgleda potpuno isto kao kultura matičnih stanica,

with large green cells surrounding small, immature cells.

s velikim zelenim stanicama koje okružuju male, nezrele stanice.

And you may remember from biology class

Možda se sjećate sa sati biologije

that stem cells are immature cells,

da su matične stanice nezrele stanice,

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

koje se mogu pretvoriti u bilo koji tip stanica u tijelu.

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

Mozak odraslog čovjeka ima matične stanice, ali jako su rijetke

and they're located in deep and small niches

i nalaze se duboko u malim udubinama

in the depths of the brain.

u dubinama mozga.

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

Iznenadilo nas je što smo dobili ovakvu kulturu matičnih stanica

from the superficial part of swollen brain we had

iz površinskog sloja otečenog mozga kojeg smo imali

in the operating theater.

u operacijskoj sali.

And there was another intriguing observation:

Primjetili smo još nešto zanimljivo:

Regular stem cells are very active cells --

Normalne su matične stanice vrlo aktivne stanice -

cells that divide, divide, divide very quickly.

stanice koje se dijele, dijele, dijele vrlo brzo.

And they never die, they're immortal cells.

I nikad ne umiru, besmrtne su stanice.

But these cells behave differently.

Ali ove se stanice ponašaju drugačije.

They divide slowly,

Dijele se polako,

and after a few weeks of culture,

i nakon nekoliko tjedana kultiviranja,

they even died.

čak su i umrle.

So we were in front of a strange new cell population

Bili smo pred čudnom novom populacijom stanica

that looked like stem cells but behaved differently.

koje su izgledale kao matične stanice ali su se ponašale drugačije.

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

Trebalo nam je dugo vremena da bi shvatili odakle su došle.

They come from these cells.

Došle su od ovih stanica.

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

Ove plave i crvene stanice su doublecortin-pozitivne stanice.

All of you have them in your brain.

Svi ih imate u svom mozgu.

They represent four percent of your cortical brain cells.

Predstavljaju četiri posto kortikalnih stanica.

They have a very important role during the development stage.

One imaju vrlo važnu ulogu tijekom razvoja.

When you were fetuses,

Kad ste bili fetusi,

they helped your brain to fold itself.

pomogle su u razvoju vašeg mozga.

But why do they stay in your head?

Ali zašto ostaju u glavi?

This, we don't know.

Ovo ne znamo.

We think that they may participate in brain repair

Mislimo da možda imaju ulogu u oporavku mozga

because we find them in higher concentration

jer ih nalazimo u većoj koncentraciji

close to brain lesions.

u blizini moždanih lezija.

But it's not so sure.

Ali nije sigurno.

But there is one clear thing --

No jedna je stvar jasna -

that from these cells,

da smo iz ovih stanica,

we got our stem cell culture.

dobili našu kulturu matičnih stanica.

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

Bili smo pred potencijalnim novim izvorom stanica

to repair the brain.

za popravak mozga.

And we had to prove this.

I morali smo ovo dokazati.

So to prove it,

A da bi to dokazali,

we decided to design an experimental paradigm.

odlučili smo dizajnirati eksperimentalni primjer.

The idea was to biopsy a piece of brain

Ideja je bila biopirati dio mozga

in a non-eloquent area of the brain,

u dijelu mozga koji nije ključan

and then to culture the cells

i zatim kultivirati stanice

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

točno onako kako je to Jean-François učinio u svom laboratoriju.

And then label them, to put color in them

I zatim ih označiti, obojati ih

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

kako bismo ih mogli pratiti u mozgu.

And the last step was to re-implant them

Zadnji je korak bio ponovo ih ugraditi

in the same individual.

u istu jedinku.

We call these

To zovemo

autologous grafts -- autografts.

autolognim graftovima - autografovima.

So the first question we had,

Prvo pitanje koje smo imali,

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

"Što će se dogoditi ako reimplantiramo ove stanice u normalan mozak,

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

i što će se dogoditi ako reimplantiramo iste stanice

in a lesioned brain?"

u ozlijeđeni mozak?"

Thanks to the help of professor Eric Rouiller,

Zahvaljujući pomoći profesora Erica Rouillera,

we worked with monkeys.

radili smo s majmunima.

So in the first-case scenario,

U prvom scenariju,

we re-implanted the cells in the normal brain

reimplantirali smo stanice u normalan mozak

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

i primjetili da one potpuno nestaju nakon prvih nekoliko tjedana,

as if they were taken from the brain,

kao da su odnešene iz mozga,

they go back home,

odu natrag kući,

the space is already busy,

taj je prostor već zauzet,

they are not needed there, so they disappear.

nisu tamo potrebne, i nestanu.

In the second-case scenario,

U drugom slučaju,

we performed the lesion,

izvršili smo leziju,

we re-implanted exactly the same cells,

reimplantirali iste te stanice,

and in this case, the cells remained --

ali sada, stanice su ostale tu -

and they became mature neurons.

i postale zreli neuroni.

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

I to je slika onoga što smo mogli vidjeti pod mikroskopom.

Those are the cells that were re-implanted.

To su stanice koje smo reimplantirali.

And the proof they carry,

I dokaz nose na sebi,

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

ove male točkice, to su stanice koje smo obojili

in vitro, when they were in culture.

in vitro, dok su još bile u kulturi.

But we could not stop here, of course.

Ali, naravno, nismo tu mogli stati.

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

Pomažu li ove stanice majmunu u oporavku nakon lezije?

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

Za to smo trenirali majmune da izvrše test manualne spretnosti.

They had to retrieve food pellets from a tray.

Morali su dohvatiti komadiće hrane iz posudica.

They were very good at it.

Bili su vrlo dobri u tome.

And when they had reached a plateau of performance,

I kad su dostigli vrhunac spretnosti,

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

načinili smo leziju u motoričkom korteksu odgovornom za pokrete ruku.

So the monkeys were plegic,

Majmuni su bili plegični,

they could not move their hand anymore.

nisu više mogli micati rukama.

And exactly the same as humans would do,

I isto kao i kod ljudi,

they spontaneously recovered to a certain extent,

spontano su se oporavili do određene mjere,

exactly the same as after a stroke.

potpuno isto kao i nakon moždanog udara.

Patients are completely plegic,

Pacijenti su potpuno plegični,

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

i pokušaju se oporaviti zahvaljujući mehanizmu plastičnosti mozga,

they recover to a certain extent,

oporave se do određene mjere,

exactly the same for the monkey.

isto kao i kod majmuna.

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

Kad smo bili sigurni da je majmun dosegao vrhunac

of spontaneous recovery,

spontanog oporavka,

we implanted his own cells.

implantirali smo njegove stanice.

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

Na lijevoj strani vidite majmuna koji se spontano oporavio.

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

Sada je na 40 do 50 posto prijašnjih performansi

before the lesion.

prije lezije.

He's not so accurate, not so quick.

Nije tako precizan, niti brz.

And look now when we re-implant the cells:

I pogledajte sada, kada reimplantiramo stanice:

Two months after re-implantation, the same individual.

Dva mjeseca nakon reimplantacije, ista jedinka.

(Applause)

(Pljesak)

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

To su bili vrlo dobri rezultati za nas, kažem vam.

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

Otada, shvatili smo mnogo više o ovim stanicama.

We know that we can cryopreserve them,

Znamo da ih možemo krioprezervirati,

we can use them later on.

možemo ih koristiti kasnije.

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

Znamo da ih možemo koristiti u drugim neuropatološkim oblicima,

like Parkinson's disease, for example.

poput Parkinsonove bolesti, na primjer.

But our dream is still to implant them in humans.

Ali naš je san i dalje implantirati ih u ljude.

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

I uistinu se nadam da ću vam uskoro moći pokazati

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

da nam ljudski mozak daje alate za samostalan popravak.

Thank you.

Hvala vam.

(Applause)

(Pljesak)

Bruno Giussani: Jocelyne, this is amazing,

Bruno Giussani: Jocelyne, ovo je nevjerojatno,

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

sugran sam da sada deseci ljudi u publici,

possibly even a majority,

vjerojatno čak i većina,

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

razmišljaju, "Znam nekoga kome bi ovo pomoglo."

I do, in any case.

Ja razmišljam o tome, u svakom slučaju.

And of course the question is,

Naravno, pitanje je,

what are the biggest obstacles

koje su najveće prepreke

before you can go into human clinical trials?

u kliničkim studijama na ljudima?

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

Jocelyne Bloch: Najveća su prepreka propisi. (Smijeh)

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

Od ovih uzbudljivih rezultata, morete popuniti

about two kilograms of papers and forms

oko dva kilograma papirologije

to be able to go through these kind of trials.

da bi ova testiranja mogla nastaviti

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

BG: Što je razumljivo, mozak je delikatan, itd.

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

JB: Da, jest, ali potrebno je puno vremena

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

i mnogo strpljenja i gotovo profesionalan tim za to, znate?

BG: If you project yourself --

BG: Ako možete projicirati -

having done the research

napravili ste istraživanje

and having tried to get permission to start the trials,

i tražili ste odobrenje za početak studija,

if you project yourself out in time,

ako možete predvidjeti,

how many years before somebody gets into a hospital

koliko je potrebno godina da kada netko dođe u bolnicu

and this therapy is available?

ima ovu terapiju dostupnu?

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

JB: Vrlo je teško reći.

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

Ovisi, prvo, o odobrenju studija

Will the regulation allow us to do it soon?

Hoće li nam propisi dozvoliti da krenemo uskoro?

And then, you have to perform this kind of study

I zatim, morate napraviti ovakvu studiju

in a small group of patients.

na maloj skupini pacijenata.

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

Potrebno je dosta vremena za odabir pacijenata,

do the treatment

za provođenje terapije

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

i procjenu je li ovakvo liječenje potrebno.

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

I zatim morate razviti multicentričnu studiju.

You have to really prove first that it's useful

Morate prvo dokazati da je korisno

before offering this treatment up for everybody.

prije nego ovu terapiju ponudite svima.

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

BG: I sigurno, naravno. JB: Naravno.

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

BG: Jocelyne, hvala vam što ste došli na TED podijeliti ovo.

BG: Thank you.

BG: Hvala vam.

(Applause)

(Pljesak)