Kevin Stone: The bio-future of joint replacement

Prevodilac: Jelena Nedjic Lektor: Marija Milenovic

So let me just start with my story.

Počeo bih sa svojom ličnom pričom.

So I tore my knee joint meniscus cartilage

Igrajući fudbal na fakultetu, povredio sam

playing soccer in college.

hrskavicu meniskusa.

Then I went on to tear my ACL, the ligament in my knee,

Potom sam povredio svoj ACL, ligament kolena

and then developed an arthritic knee.

i razvilo mi se artritisno koleno.

And I'm sure that many of you in this audience have that same story,

Siguran sam da mnogi od vas u publici dele istu priču.

and, by the way, I married a woman

Uzgred, moja žena

who has exactly the same story.

je doživela istu stvar. Sve ovo me je motivisalo

So this motivated me to become an orthopedic surgeon

da postanem ortoped i da proverim da li bih mogao da se

and to see if I couldn't focus on solutions for those problems

skoncetrišem na traženje rešenja za ove probleme

that would keep me playing sports and not limit me.

koji bi mi omogućili da igram fudbal i ne bi me ograničavali.

So with that, let me just show you a quick video

Imajući to u vidu, sada bih vam pustio kratak snimak

to get you in the mood of what we're trying to explain.

kako bih vam približio šta želim da objasnim.

Narrator: We are all aware of the risk of cancer,

Pripovedač: "Svi smo svesni rizika za oboljenje od raka,

but there's another disease

ali postoji još jedna bolest od koje će

that's destined to affect even more of us: arthritis.

zasigurno oboleti još više ljudi: artritis.

Cancer may kill you, but when you look at the numbers,

Rak može da vas ubije, ali kada analizirate brojke shvatite

arthritis ruins more lives.

da artritis uništava više života. Ukoliko pretpostavimo

Assuming you live a long life, there's a 50 percent chance

da ćete dugo živeti, imate 50% šanse

you'll develop arthritis.

da obolite od artritisa.

And it's not just aging that causes arthritis.

Starenje nije jedini uzrok artritisa. Regularne povrede

Common injuries can lead to decades of pain,

mogu uzrokovati decenije bola, do momenta

until our joints quite literally grind to a halt.

kada naši zglobovi bukvalno postanu nefunkcionalni.

Desperate for a solution, we've turned to engineering

Očajnički tražeći rešenje, okrenuli smo se pravljenju

to design artificial components

i dizajniranju veštačkih delova kojima bismo

to replace our worn-out body parts,

zamenili istrošene delove naših tela,

but in the midst of the modern buzz

ali usred ove moderne popularizacije

around the promises of a bionic body,

potencijala bioničkog tela, zar ne bi trebalo

shouldn't we stop and ask if there's a better, more natural way?

da zastanemo i da se upitamo da li postoji bolji, prirodniji način?

Let's consider an alternative path.

Hajde da analiziramo alternativno rešenje.

What if all the replacements our bodies need

Šta ako rezervni delovi koji su neophodni našim telima

already exist in nature,

već postoje u priordi,

or within our own stem cells?

ili se nalaze u našim matičnim ćelijama?

This is the field of biologic replacements,

Ovde govorimo o biološkim zamenama,

where we replace worn-out parts with new, natural ones.

gde zamenjujemo istrošene delove novim, prirodnim delovima."

Kevin Stone: And so, the mission is:

Kevin Stoun: Tako da je naša misija sledeća:

how do I treat these things biologically?

kako se biološkim putem mogu lečiti ove stvari?

And let's talk about both what I did for my wife,

Sada ću vam ispričati šta sam uradio za svoju ženu

and what I've done for hundreds of other patients.

i stotine drugih pacijenata. Pa prva stvar

First thing for my wife,

koju bih spomenuo i u slučaju moje žene,

and the most common thing I hear from my patients,

a i generalno najčešće to čujem od pacijenata

particularly in the 40- to 80-year-old age group, 70-year-old age group,

naročito onih koji imaju između 40 i 80 godina, kod sedamdesetogodišnjaka,

is they come in and say,

je to da oni dođu i pitaju: " Doktore, da li postoji

"Hey, Doc, isn't there just a shock absorber you can put in my knee?

neki "amortizer" koji biste stavili u moje koleno?

I'm not ready for joint replacement."

Nisam spreman za zamenu zgloba." Njoj sam uradio

And so for her, I put in a human meniscus allograft donor

alograft transplantaciju i stavio ljudski meniskus

right into that [knee] joint space.

pravo u predeo zgloba kolena.

And [the allograft] replaces [the missing meniscus].

To zamenjuje meniskus koji nedostaje.

And then for that unstable ligament,

Za rešenje problema nestabilnog ligamenta,

we put in a human donor ligament

implantirali smo humani ligament donora

to stabilize the knee.

kako bismo stabilizovali koleno.

And then for the damaged arthritis on the surface,

Kako bismo rešili problem artritisa na površini,

we did a stem cell paste graft,

odradili smo transplant matičnim ćelijama,

which we designed in 1991,

koji smo dizajnirali 1991.

to regrow that articular cartilage surface

kako bismo regenerisali hrskavicu na površini zgloba

and give it back a smooth surface there.

i ponovo uspostavili glatku površinu.

So here's my wife's bad knee on the left,

Sa leve strane možete videti povređeno koleno moje žene,

and her just hiking now

a ovde je vidite na planinarenju četiri meseca

four months later in Aspen, and doing well.

nakon toga u Aspenu, gde se oseća dobro.

And it works, not just for my wife, but certainly for other patients.

Ovo funkcioniše, ne samo u slučaju moje žene, već sigurno i za druge pacijente.

The girl on the video, Jen Hudak,

Devojka sa ovog snimka, Džen Hudak,

just won the Superpipe in Aspen

je upravo osvojila "Superpipe" u Aspenu

just nine months after having destroyed her knee,

samo devet meseci nakon što je uništila svoje koleno,

as you see in the other image --

kao što vidite na drugoj fotografiji,

and having a paste graft to that knee.

a potom joj je stavljen implant u to koleno,

And so we can regrow these surfaces biologically.

tako da možemo biološki da regenerišemo tu površinu.

So with all this success,

S obzirom na ovoliki uspeh,

why isn't that good enough, you might ask.

možda se pitate zašto to nije dovoljno.

Well the reason is because there's not enough donor cycles.

Razlog je što ne postoji dovoljno donora tih organa.

There's not enough young, healthy people

Nema dovoljno mladih, zdravih ljudi

falling off their motorcycle

koji doživljavaju saobraćajne nesreće

and donating that tissue to us.

i potom doniraju to tkivo nama.

And the tissue's very expensive.

To tkivo je veoma skupo.

And so that's not going to be a solution

Tako da to neće biti rešenje koje će dovesti

that's going to get us global with biologic tissue.

do globalne upotrebe bioloških tkiva.

But the solution is animal tissue

Rešenje leži u tkivu životinja,

because it's plentiful, it's cheap,

jer ga ima u izobilju, jeftino je,

you can get it from young, healthy tissues,

možete ga izolovati iz mladog, zdravog tkiva,

but the barrier is immunology.

ali tu postoji imunološka prepreka.

And the specific barrier

Specifična prepreka je

is a specific epitope

određeni epitop koji nazivamo

called the galactosyl, or gal epitope.

galaktozil ili gal-epitop.

So if we're going to transplant animal tissues to people,

Ako želimo da transplantiramo životinjsko tkivo ljudima,

we have to figure out a way to get rid of that epitope.

moramo da smislimo način kako da uklonimo taj epitop.

So my story in working with animal tissues

Moja priča o radu sa životinjskim tkivima

starts in 1984.

je počela 1984. godine.

And I started first

Počeo sam rad koristeći

with cow Achilles tendon,

Ahilovu tetivu krave,

where we would take the cow Achilles tendon,

pri čemu bismo izolovali Ahilovu tetivu krave,

which is type-I collagen,

a to je čist kolagen tipa I,

strip it of its antigens

potom bismo uklonili antigene tako što smo

by degrading it with an acid and detergent wash

ih razgrađivali pranjem u kiselinama i deterdžentima

and forming it into a regeneration template.

i uspostavili smo uzorak za regeneraciju.

We would then take that regeneration template

Onda bismo iskoristili tu regenerativnu osnovu

and insert it into the missing meniscus cartilage

i implantirali bismo je u istrošenu hrskavicu meniskusa

to regrow that in a patient's knee.

kako bi došlo do obnavljanja pacijentovog kolena.

We've now done that procedure,

Odradili smo tu proceduru,

and it's been done worldwide in over 4,000 cases,

i odrađeno je širom sveta 4.000 operacija,

so it's an FDA-approved and worldwide-accepted way

to je FDA odobrena (Food and Drug Administration) i širom sveta

to regrow the meniscus.

prihvaćena metoda za obnavljanje meniskusa.

And that's great when I can degrade the tissue.

To je odlično kada sam u stanju da razgradim tkivo.

But what happens for your ligament when I need an intact ligament?

Ali šta se dešava sa vašim ligamentom kada je meni neophodan netaknut ligament?

I can't grind it up in a blender.

Ne mogu da ga sameljem u blenderu.

So in that case,

U tom slučaju, moram da dizajniram

I have to design -- and we designed with Uri Galili and Tom Turek --

i zajedno sa Urijem Galilijem i Tomom Turekom smo to uradili,

an enzyme wash

enzimatski tretman

to wash away, or strip,

da operemo ili skinemo,

those galactosyl epitopes

te galaktozil-epitope

with a specific enzyme.

pomoću posebnog enzima.

And we call that a "gal stripping" technique.

Ovo zovemo tehnikom uklanjanja gala.

What we do is humanize the tissue.

Ono što radimo je dodavanje tkivu humanih svojstava.

It's by gal stripping that tissue

Pomoću enzimskog tretmana,

we humanize it (Laughter),

mi ga činimo humanim (smeh),

and then we can put it back

a potom deo tog organa možemo da

into a patient's knee.

implantiramo u koleno pacijenta.

And we've done that. Now we've taken pig ligament --

To smo i uradili. Uzeli smo ligament svinje,

young, healthy, big tissue,

mlado, zdravo, veliko tkivo,

put it into 10 patients in an FDA-approved trial --

i implantirali u 10 pacijenata u istraživanju koje je FDA odobreno,

and then one of our patients went on to have

nakon toga je jedan od naših pacijenata osvojio

three Canadian Masters Downhill championships --

tri "Masters Downhill" prvenstva u Kanadi pomoću svog

on his "pig-lig," as he calls it. So we know it can work.

"prasećeg ligamenta", kako ga on zove. Tako da znamo da to radi.

And there's a wide clinical trial of this tissue now pending.

Opsežno kliničko istraživanje koje iziskuje ovo tkivo je sada

So what about the next step?

na listi čekanja. Šta bi bio sledeći korak?

What about getting to a total biologic knee replacement,

Da li bismo mogli potpuno da zamenimo biološko koleno,

not just the parts?

a ne samo njegove delove?

How are we going to revolutionize artificial joint replacement?

Kako ćemo dovesti do revolucije u zameni veštačkih zglobova?

Well here's how we're going to do it.

Ovako ćemo to uraditi.

So what we're going to do is take

Mi ćemo prosto uzeti

an articular cartilage

hrskavicu zgloba

from a young, healthy pig,

mlade, zdrave svinje,

strip it of its antigens,

očistićemo je od antigena,

load it with your stem cells,

natovariti je matičnim ćelijama,

then put it back on to that

a onda bismo to implantirali

arthritic surface in your knee,

na zglobnu površinu u Vašem kolenu,

tack it on there, have you heal that surface

pričvrstili bismo je tu i ta površina bi se prvo zarasla

and then create a new biologic surface for your knee.

i potom bi proizvela novu biološka površinu na vašem kolenu.

So that's our biologic approach right now.

Trenutno je to naš biološki pristup.

We're going to rebuild your knee with the parts.

Napravićemo ponovo Vaše koleno pomoću ovih delova.

We're going to resurface it with a completely new surface.

I obložićemo ga potpuno novim slojem.

But we have other advantages from the animal kingdom.

Postoje i druge prednosti koje nalazimo u svetu životinja.

There's a benefit of 400 million years

Tu su i beneficije napretka

of ambulation.

u poslednjih 400 miliona godina.

We can harness those benefits.

Možemo iskoristiti sve prednosti.

We can use thicker, younger, better tissues

Možemo koristiti jača, mlađa, bolja tkiva

than you might have injured in your knee,

u odnosu na ona koje ste povredili u svom kolenu,

or that you might have when you're 40, 50 or 60.

ili u odnosu na tkivo koje imate u 40-im, 50-im ili 60-im.

We can do it as an outpatient procedure.

To možemo da uradimo bez hospitalizacije pacijenta.

We can strip that tissue very economically,

Možemo veoma ekonomično da prečistimo to tkivo,

and so this is how we can get biologic knee replacement

i tako bismo uspeli da biološku zamenu kolena

to go global.

učinimo globalnim fenomenom.

And so welcome to super biologics.

Dobrodošli u svet super biologa.

It's not hardware.

To nije hardver.

It's not software.

To nije softver.

It's bioware.

To je biover.

It's version 2.0 of you.

Ovo je napredna, 2.0 verzija vas samih.

And so with that, coming to a --

I za kraj, uskoro u,

(Laughter)

(smeh)

coming to an operating theater near you soon, I believe.

verujem, uskoro u pozorištu za operacije u vašoj blizini.

Thank you very much.

Mnogo vam hvala.

(Applause)

(Aplauz).