How to create a world where no one dies waiting for a transplant | Luhan Yang

Prevodilac: Ivana Korom Lektor: Tijana Mihajlović

Hi everyone.

Zdravo svima.

I would like to introduce you to Laika.

Želim da vas upoznam sa Lajkom.

To most of us, Laika is simply a very cute pig.

Većini nas, Lajka je samo veoma slatko prase.

However, to hundreds of thousands of patients in need of a lifesaving organ

Međutim, stotinama hiljada pacijenata

koji čekaju organ koji im može spasiti život,

Laika is a symbol of hope.

Lajka je simbol nade.

You see, ever since the 1970s,

Vidite, još od 1970-ih,

when organ transplants became a real option

kada je transplantacija organa postala moguća

for patients with kidney failure and other organ diseases,

pacijentima kojima su otkazali bubrezi i koji imaju druge bolesti organa,

organ supply has been an issue.

problem je bio nedostatak organa.

Over the last few decades,

Tokom poslednjih nekoliko decenija,

the issue only worsened as organ demand has exponentially increased.

problem se pogoršao jer se potreba za organima znato povećala.

Currently in the US,

Trenutno u SAD

there are close to 115,000 patients

ima blizu 115 000 pacijenata

in need of a lifesaving organ transplant.

kojima je potrebna transplantacija.

By the end of my talk,

Do kraja mog govora,

one more patient will be added to this list.

na ovoj listi će se naći još jedan pacijent.

Today, about 100 people will get a new organ,

Danas će oko 100 ljudi dobiti novi organ,

a chance to start their life anew,

šansu da počne svoj život iznova,

and yet by the end of today,

a ipak, do kraja dana,

20 others will die waiting.

20 drugih ljudi će umreti čekajući.

The situation is heartbreaking

Situacija je srceparajuća

for patients, for their families

za pacijente, za njihove porodice

and for the doctors who want to do more.

i za lekare koji žele da učine više.

In some parts of the world,

U nekim delovima sveta,

the situation also becomes a disturbing social issue.

ova situacija je postala uznemirujuć društveni problem.

In Asia, for example,

U Aziji, na primer,

media outlets reported that desperate patients

mediji izveštavaju da očajni pacijenti

are obtaining organs from the cruel black market.

nabavljaju organe sa okrutnog crnog tržišta.

It is clear that a solution is needed to this crisis.

Jasno je da ova krizna situacija zahteva rešenje.

Human lives are at stake.

U pitanju su ljudski životi.

As a biologist and a geneticist,

Kao biologa i genetičara,

it has become my mission to help solve this problem.

moja misija je postala da pomognem u rešavanju ovog problema.

Today, I am optimistic to say that we are on our way there,

Danas mogu optimistično da kažem da smo na putu rešenja,

thanks to Laika.

zahvaljujući Lajki.

Using gene editing technology,

Koristeći tehnologiju izmene gena,

it's now possible to exquisitely create a human-transplantable organ

sada je moguće precizno stvoriti organ koji je moguće presaditi u ljude,

that can be safely grown in pigs.

a koji može bezbedno da se razvija u svinjama.

Before we jump into the incredible science that makes it happen,

Pre nego što pređemo na neverovatnu nauku koja ovo omogućava,

let's have a better understanding what xenotransplantation is.

hajde da se bliže pozabavimo ksenotransplantacijom.

It's a process of transplanting animal organs into humans.

To je proces transplantacije životinjskih organa u ljude.

You may want to ask, why pig organs?

Možda ćete se zapitati zašto svinjski organi.

Because some pigs carry organs with similar size and physiology

Zato što neke svinje imaju organe slične veličine i fiziologije

to human organs.

kao što su ljudski organi.

Over the last half a century,

Tokom poslednjih pola veka,

pioneers of transplantation have tried hard to make it happen,

pioniri transplantacije uporno pokušavaju da to ostvare,

but with limited to no success.

ali uz malo uspeha ili bezuspešno.

Why is that?

Zašto?

Two fundamental hurdles stood in the way.

Dve bitne prepreke su im stajale na putu.

First is a problem of rejection.

Prva je problem odbijanja.

When our immune system sees a new organ as foreign,

Kada naš imuni sistem prepozna novi organ kao strani,

it will reject it.

odbiće ga.

Second, and this one is specific to the organs from the pig,

Druga, karakteristična za svinjske organe,

every pig carries a virus that is benign to the pig,

je ta što svaka svinja nosi virus koji je bezopasan za nju,

but can be transmitted into humans.

ali se može preneti na ljude.

It is called the porcine endogenous retrovirus (PERV),

On se zove svinjski endogeni retrovirus, PERV,

and this virus has the potential to cause a viral epidemic similar to HIV.

koji može uzrokovati virusnu epidemiju sličnu HIV-u.

Without an effective way to address these issues,

Bez pravog načina na koji bismo ove probleme rešili,

the field of xenotransplantation has been on hold for more than one decade.

polje ksenotransplantacije je bilo na čekanju više od deceniju.

Little progress has been made, until now.

Napravljeno je malo pomaka, sve do sada.

Let me share with you how I got here today with Laika.

Ispričaću vam kako sam dospela ovde sa Lajkom.

My journey started from Emei Mountain in China.

Moje putovanje je počelo na planini Emei u Kini.

That is the place well described in a lot of legendary stories,

To je mesto opisano u mnogim legendama,

like the "Crouching Tiger, Hidden Dragon."

kao što je „Pritajeni tigar, skriveni zmaj.“

That is the place I call home.

To je mesto koje zovem dom.

Growing up in the mountain,

Odrastajući na planini,

I started to have a strong connection with nature.

počela sam da razvijam snažnu vezu sa prirodom.

This is me when I was seven years old

Ovo sam ja kad sam imala sedam godina

standing in front of an ancient Buddhist temple

kako stojim ispred drevnog budističkog hrama

with a monkey on my shoulder.

sa majmunom na ramenu.

I still vividly remember how my friends and I

Još se jasno sećam kako smo moji prijatelji i ja

would toss peanuts around to distract the monkeys

bacali kikiriki da odvratimo pažnju majmunima

so that we could cross to hike through the valley.

i da možemo da pešačimo kroz dolinu.

I love nature.

Volim prirodu.

When it was time to choose a field of study,

Kada je trebalo da izaberem šta ću studirati,

I chose to study biology at Peking University in Beijing.

izabrala sam biologiju na Univerzitetu u Pekingu.

However, the more I learned,

Međutim, što sam više učila,

the more questions I had.

više pitanja sam imala.

How could our genetic makeup be so similar to animals

Kako naš genetički sklop može biti tako sličan životinjskom,

and yet we look so different?

a ipak izgledamo skroz drugačije?

How is our immune system capable of fighting off so many pathogens

Kako je naš imuni sistem sposoban da se izbori sa toliko patogena,

but smart enough not to attack ourselves.

ali opet tako pametan da nas ne napada.

Questions like this tormented me.

Ovakva pitanja su me mučila.

I know it sounds nerdy, but you know I'm a scientist.

Znam da zvuči štreberski, ali, znate, ja sam naučnica.

After college, I decided I didn't want to just ask the questions,

Nakon studija, odlučila sam da ne želim samo da postavljam pitanja,

I wanted to answer them, so I did.

već i da na njih odgovorim, pa i jesam.

In 2008, I was lucky enough to be accepted

Godine 2008. sam imala sreću da me prime

into the PhD program at Harvard University

na doktorske studije na Harvardu

and worked with Dr. George Church.

i da radim sa dr Džordžom Čerčom.

While working in Church's lab,

Radeći u njegovoj laboratoriji,

I started to learn and experiment with the genetic makeup of mammals.

počela sam da učim i eksperimentišem sa genetskim sastavom sisara.

Among all the experiments,

Među svim eksperimentima,

one particular one took me closer to Laika.

jedan konkretno me je doveo korak bliže Lajki.

In 2013, my colleagues and I made changes in a human cell

Godine 2013, moje kolege i ja smo promenili ljudsku ćeliju,

using a tool you may have heard about

koristeći alat za koji ste možda čuli,

called CRISPR.

a zove se CRISPR.

We were one of the first two groups

Bili smo jedna od prve dve grupe

to report the successful use of such a tool in changing our DNA.

koja je uspešno primenila ovakav alat za promenu našeg DNK.

It was an exciting moment in scientific discovery.

Bio je to uzbudljiv trenutak u naučnom otkriću.

The gene-editing tool CRISPR has two components.

Alat za izmenu gena CRISPR ima dve komponente.

It has a scissor called the enzyme CRISPR

Ima makaze zvane enzim CRISPR

and what is called a guide RNA.

i nešto što se zove vodič RNK.

Think about it as genetic scissors with a microscope.

Zamislite genetske makaze sa mikroskopom.

The microscope is a guide RNA,

Mikroskop je vodič RNK,

which brings the scissors to the place we want to cut

koji navodi makaze do mesta gde želimo da sečemo

and says, "Here it is,"

i kaže: „Evo ga“,

and the enzyme CRISPR just cuts and repairs the DNA in the way we want.

a enzim CRISPR prosto seče i popravlja DNK kako mi želimo.

Shortly after we reported our study,

Ubrzo nakon što smo podneli izveštaj o našoj studiji,

physicians at Mass General Hospital were intrigued by the medical applications

lekari u Opštoj bolnici u Masačusetsu su bili intrigirani medicinskim primenama

of our research.

našeg istraživanja.

They reached out to us,

Oni su nam se obratili

and together, we began to see the potential to use CRISPR

i zajedno smo počeli da uviđamo potencijal korišćenja CRISPR-a

to solve the organ shortage crisis.

u rešavanju krize nedostatka organa.

How do we do it?

Kako to radimo?

It is simple, yet very complex.

Prosto je, a opet kompleksno.

We started by making changes in a pig's cell to make it virus-free

Počeli smo praveći izmene u svinjskoj ćeliji da je oslobodimo virusa

and human-immune-compatible.

i učinimo kompatibilnom za ljudski imunitet.

The nucleus of that cell is then implanted into a pig egg

Jezgro te ćelije se zatim usadi u jaje svinje

and allowed to divide into an embryo.

i deli u embrion.

The resulting embryo is then placed into the uterus of a surrogate mother

Rezultirajući embrion se zatim postavlja u matericu surogat majke

and allowed to divide into a pig.

i razvija se u svinju.

Basically, it's a process of cloning.

U suštini, to je proces kloniranja.

The piglet then carries organs whose genetic makeup

Prasence zatim nosi organe čiji genetski sastav,

hopefully wouldn't be rejected by the human immune system.

ljudski imuni sistem, nadajmo se, neće odbiti.

In 2015, our team decided to tackle the viral transmission problem first.

U 2015, naš tim je odlučio da se prvo pozabavi problemom prenošenja virusa.

We wanted to take out all 62 copies of the PERV virus

Želeli smo da izdvojimo sve 62 kopije virusa PERV

from the pig genome,

iz genoma svinje,

but at the time, it was nearly mission impossible.

ali je to tada bila skoro nemoguća misija.

Even with CRISPR,

Čak i sa alatom CRISPR,

we could only do one or two modifications within a cell.

mogli smo samo da napravimo jednu ili dve modifikacije u ćeliji.

The record for number of modifications we can do in a particular cell was five.

Najveći broj modifikacija koje možemo napraviti u određenoj ćeliji je bio pet.

We had to increase the throughput by more than tenfold to achieve that.

Morali smo da povećamo protok više od desetostruko da bismo to postigli.

With very careful design and hundreds of trials,

Pažljivim dizajnom i stotinama proba,

we successfully took out all the virus,

uspešno smo odstranili ceo virus

broke the record.

i oborili rekord.

More importantly, our studies showed

Što je još važnije, naše studije su pokazale

that we could eliminate the possibility of this dangerous virus

da možemo ukloniti mogućnost da se ovaj opasan virus

being transmitted into humans.

prenese na ljude.

Last year, with a modified cell and cloning technology,

Prošle godine, sa modifikovanom ćelijom i tehnologijom kloniranja,

our startup, eGenesis, produced Laika,

naša startap kompanija, eGenesis, je proizvela Lajku,

the first pig of its kind born without PERV.

prvo prase svoje vrste rođeno bez PERV-a.

(Applause)

(Aplauz)

Laika represents the first critical step

Lajka predstavlja prvi presudan korak

in establishing safe xenotransplantation.

u uspostavljanju bezbedne ksenotransplantacije.

It is also a platform

Takođe je platforma

that we can do further genetic modification on

pomoću koje možemo raditi dalju genetsku modifikaciju,

to solve the immunology problem.

kako bismo rešili problem imunologije.

Since then, we have created more than 30 pigs without PERV,

Od tada, stvorili smo više od 30 svinja bez virusa PERV

and they may be the most advanced geno-modified animal living on earth.

i one su možda najnaprednije genetski modifikovane životinje na zemlji.

We named Laika after the Soviet dog

Lajku smo nazvali po sovjetskom psu

who was the first animal to orbit the earth.

koji je bio prva životinja koja je kružila oko Zemlje.

We hope Laika and her siblings

Nadamo se da će nas Lajka i njena braća i sestre

can lead us into a new frontier of science and medicine.

povesti do novih granica nauke i medicine.

Imagine a world where patients who suffer from liver failure

Zamislite svet u kome pacijenti kojima je otkazala jetra

can be saved with a new liver

mogu biti spašeni novom jetrom

without having to wait for a donation

bez čekanja na donaciju

or another human to die.

ili da drugo ljudsko biće umre.

Imagine a world where people with diabetes

Zamislite svet u kome ljudi sa dijabetesom

do not have to rely on insulin after every meal

ne moraju da se oslanjaju na insulin posle svakog obroka

because we can provide them with good pancreatic cells

jer im mi možemo obezbediti dobre ćelije pankreasa

that can produce insulin on their own.

koje same mogu proizvoditi insulin.

And imagine a world where patients with kidney failure

I zamislite svet u kojem pacijenti sa insuficijencijom bubrega

do not have to face the burden of dialysis.

ne moraju da idu na dijalizu.

We are striving to create that world,

Stremimo da stvorimo takav svet,

a world without organ shortage.

svet bez nedostatka organa.

We finally have the tool to tackle the problem

Konačno imamo sredstvo da se suočimo sa ovim problemom

we could never tackle before,

sa kojim pre nismo mogli,

and Laika is just the beginning of our journey.

a Lajka je samo početak našeg putovanja.

We have to be very humble in front of nature,

Moramo biti jako ponizni pred prirodom,

because there are more issues to be addressed,

jer postoji više problema kojima se treba pozabaviti,

including immunology

uključujući imunologiju

and things we couldn't even anticipate at this point.

i stvari koje ne možemo ni zamisliti u ovom trenutku.

However, it is our responsibility to translate the cutting-edge science

Međutim, naša je odgovornost da primenimo ovu inovativnu nauku

into medicine to save the lives of all the patients who are waiting.

na medicinu da bismo spasili živote svih pacijenata koji čekaju.

Thank you very much.

Hvala vam mnogo.

(Applause)

(Aplauz)

Chris Anderson: I mean, Luhan, this is extraordinary work here.

Kris Anderson: Mislim, Luan, ovo je sjajan posao.

Come forward.

Priđi.

So what's the next steps here? You've got rid of the virus.

Koji vam je sledeći korak? Rešili ste se virusa.

The next steps involve trying to get to the point

Naredni koraci podrazumevaju da pokušamo da postignemo

where a human body won't reject a transplant.

da ljudsko telo ne odbije novi organ.

What's involved in solving that?

Šta to podrazumeva?

Luhan Yang: It's a very complicated process.

Luan Jang: To je jako komplikovan proces.

So we need to take out the antigen of the pigs.

Moramo da izdvojimo antigen svinja.

In addition, we can learn a lot from cancer.

Takođe, možemo mnogo naučiti iz raka.

How can cancer invade or circumvent our immune system

Kako rak može da napadne ili zaobiđe naš imuni sistem,

so that we can utilize the trick of cancer

kako bismo iskoristili taj njegov trik

and implement that on the pig organ

i primenili ga na svinjski organ

to fool our immune system to not attack the organ.

da zavaramo naš imuni sistem da ne napada organ.

CA: When would you estimate, when do you hope

KA: Kada procenjujete, kada se nadate

that the first successful transplant would happen?

da će biti izvedena prva uspešna transplantacija?

LY: It would be irresponsible for me to give you any number.

LJ: Bilo bi neodgovorno s moje strane da vam dajem bilo kakve brojke.

CA: We're at TED. We're always irresponsible.

KA: Na TED-u smo. Mi smo uvek neodgovorni.

LY: But we are working day and night

LJ: Ali radimo danonoćno

trying to make this happen for the patients.

da to ostvarimo za pacijente.

CA: So not even, you won't say that you think it could happen

KA: Nećete nam čak ni reći da mislite da bi moglo da se desi

within a decade or within five years or something?

u toku naredne decenije ili narednih pet godina ili slično?

LY: For sure we hope it happens within one decade.

LJ: Definitivno se nadamo da će se desiti u roku od decenije.

(Laughter)

(Smeh)

CA: So there's a lot of people here who would be very, very excited at that,

KA: Ima mnogo ljudi ovde koji bi se veoma obradovali tome,

the potential is extraordinary.

potencijal je sjajan.

There will be some other people here who are going,

Biće i drugih ljudi koji će biti u fazonu:

"That pig is too cute.

"To prase je preslatko.

Humans shouldn't be exploiting something so cute for our benefit."

Ljudi ne bi trebalo da iskorišćavaju nešto tako slatko za svoju korist."

Do you have any response to that?

Da li imate nešto da kažete na to?

LY: Yeah, sure.

LJ: Da, naravno.

So imagine one pig can save eight people's lives.

Zamislite da jedna svinja može spasiti osam ljudskih života.

In addition, similar to human donation,

Takođe, kao i sa ljudskom donacijom,

if we only harvest one kidney from the pig,

ako uzmemo samo jedan bubreg od svinje,

the pig can still be alive,

ona može preživeti,

so we are very mindful about the issues,

pa smo vrlo obazrivi sa ovim problemima,

but I think our goal is just to address the unmet medical need

ali mislim da je naš cilj da se pozabavimo nezadovoljenom medicinskom potrebom

for those patients and their families.

za te pacijente i njihove porodice.

CA: Plus, no one can say that to you if they eat bacon, right?

KA: Plus, niko ko jede slaninu vam ne može to zameriti, je l' da?

LY: That's a good point.

LJ: To je tačno.

(Laughter)

(Smeh)

CA: Luhan, thank you so much. LY: Thank you so much.

KA: Luan, mnogo ti hvala. LJ: Hvala vama.

(Applause)

(Aplauz)