Printing a human kidney | Anthony Atala

翻译人员: Xiaoqiao Xie 校对人员: Zhang XinYue

There's actually a major health crisis today

现今社会主要的健康危机，

in terms of the shortage of organs.

就是器官短缺。

The fact is that we're living longer.

我们越活越长了。

Medicine has done a much better job

是医药学的进步

of making us live longer,

帮助我们越活越长。

and the problem is, as we age,

问题是，我们越老，

our organs tend to fail more,

我们的器官越爱失灵。

and so currently

现今社会，

there are not enough organs to go around.

没有足够的器官来替补。

In fact, in the last 10 years,

事实上，过去十年间，

the number of patients requiring an organ has doubled,

需要器官移植的人加了一倍，

while in the same time,

但同时

the actual number of transplants has barely gone up.

器官移植手术并没有增多。

So this is now a public health crisis.

所以说这现在是个全社会的健康危机。

So that's where this field comes in

这就是我们这个领域的研究要解决的问题，

that we call the field of regenerative medicine.

我们管它叫再生医学。

It really involves many different areas.

再生医学包括很多研究领域，

You can use, actually, scaffolds,

你可以使用，事实上，模子，

biomaterials --

加上生物材料——

they're like the piece of your blouse or your shirt --

好像是从你的衬衫上取下一片——

but specific materials you can actually implant in patients

但是它们是为了放入人体而特殊制作的。

and they will do well and help you regenerate.

这些生物材料很安全，还能帮助你自身的组织再生。

Or we can use cells alone,

或者我们也可以仅仅使用细胞，

either your very own cells

或是你自己的细胞，

or different stem cell populations.

或是他人的干细胞。

Or we can use both.

或者同时使用两种技术，

We can use, actually, biomaterials

事实上，我们可以移植生物材料

and the cells together.

同时一起移植细胞。

And that's where the field is today.

这就是当今再生医学的研究水平。

But it's actually not a new field.

这并不是个新兴科学，

Interestingly, this is a book

有趣的是，有本书

that was published back in 1938.

在1938年就出版了，

It's titled "The Culture of Organs."

名字叫“器官培养”。

The first author, Alexis Carrel, a Nobel Prize winner.

书的第一作者，艾利克斯 卡如，是个诺贝尔奖得主。

He actually devised some of the same technologies

他发明了一些相同技术，

used today for suturing blood vessels,

今天我们缝合血管的时候还在沿用。

and some of the blood vessel grafts we use today

我们今天用的一些血管移植片

were actually designed by Alexis.

其实是艾利克斯设计的。

But I want you to note his co-author:

请大家注意书的另一个作者：

Charles Lindbergh.

查尔斯 林德伯格。

That's the same Charles Lindbergh

就是这个查尔斯 林德伯格，

who actually spent the rest of his life

投入了毕生精力，

working with Alexis

与艾利克斯一起工作

at the Rockefeller Institute in New York

在纽约的洛克菲勒研究院，

in the area of the culture of organs.

研究器官培养。

So if the field's been around for so long,

所以再生医学其实已经有很长的历史了。

why so few clinical advances?

那么，为什么在临床上没有什么突破呢？

And that really has to do to many different challenges.

这是因为（在临床上）有很多不同的难关。

But if I were to point to three challenges,

我认为前三位的挑战，

the first one is actually the design of materials

第一就数材料学，

that could go in your body

设计什么样的生物材料，能置入人体

and do well over time.

不引起任何问题。

And many advances now,

我们已经有了很多突破，

we can do that fairly readily.

在这方面我们进步神速。

The second challenge was cells.

第二个大挑战，就是活细胞。

We could not get enough of your cells to grow outside of your body.

我们没法得到在体外培养足够数量的细胞。

Over the last 20 years, we've basically tackled that.

过去的二十年间，我们就卡在这里。

Many scientists can now grow many different types of cells.

如今很多科学家已经能在体外养活很多种的细胞——

Plus we have stem cells.

加上我们还有干细胞。

But even now, 2011,

但即便是这一刻，2011年，

there's still certain cells that we just can't grow from the patient.

有些类型的细胞我们就是没有办法在体外养活。

Liver cells, nerve cells, pancreatic cells --

比如肝脏细胞，神经细胞，胰腺细胞——

we still can't grow them even today.

即使是今天我们还是在体外养不活。

And the third challenge is vascularity,

第三个挑战是建立血管网，

the actual supply of blood

有了血液的供给

to allow those organs or tissues to survive

我们再造的器官或者组织

once we regenerate them.

才能存活。

So we can actually use biomaterials now.

这里我们就要用到生物材料。

This is actually a biomaterial.

这就是一种生物材料。

We can weave them, knit them, or we can make them like you see here.

我们或编或织，或者像是做棉花糖一样

This is actually like a cotton candy machine.

像你们现在看到的，做出生物材料。

You saw the spray going in.

你能看到有喷雾，

That was like the fibers of the cotton candy

就像是棉花糖的糖线，

creating this structure, this tubularized structure,

做出这个框架，很多的管状结构。

which is a biomaterial

这是我们用的

that we can then use

生物材料，

to help your body regenerate

来帮助你身体器官

using your very own cells to do so.

用你自己的细胞再生。

And that's exactly what we did here.

这是我们做的一个案例。

This is actually a patient

这是个真的病人，

who [was] presented with a deceased organ,

他有个报废的器官，

and we then created one of these smart biomaterials,

我们做了一个挺光鲜的生物材料

and then we then used that smart biomaterial

用它来

to replace and repair

替换下旧的器官，

that patient's structure.

修复好这个病人的器官结构。

What we did was we actually

具体来说我们

used the biomaterial as a bridge

用这个生物材料搭了个桥，

so that the cells in the organ

这样这个器官里的细胞

could walk on that bridge, if you will,

就能够在桥上生长，

and help to bridge the gap

补上缺口，

to regenerate that tissue.

这样组织就再生了。

And you see that patient now six months after

你能看到这个病人的X光片，手术后六个月，

with an X-ray showing you the regenerated tissue,

组织的再生，

which is fully regenerated

当你在显微镜下分析时，

when you analyze it under the microscope.

能看到这是百分之百的再生。

We can also use cells alone.

我们也可以单用细胞移植。

These are actually cells that we obtained.

这些是我们得到的真的细胞，

These are stem cells that we create from specific sources,

它们都是我们从各种渠道得到的干细胞。

and we can drive them to become heart cells,

我们可以使它们长成心脏细胞，

and they start beating in culture.

它们在培养皿中就能开始搏动，

So they know what to do.

这说明它们知道该干什么，

The cells genetically know what to do,

它们靠基因中的信息知道该怎么工作。

and they start beating together.

它们还能同步搏动。

Now today, many clinical trials

现今许多的临床试验

are using different kinds of stem cells

都在用各种各样的干细胞

for heart disease.

来治疗心脏病。

So that's actually now in patients.

它们已经在病人身上起作用了。

Or if we're going to use larger structures

如果我们想一直更大号的人造组织

to replace larger structures,

来替换大块的身体组织，

we can then use the patient's own cells,

我们可以使用病人自己的细胞，

or some cell population,

或者细胞群，

and the biomaterials,

加上生物材料，

the scaffolds, together.

模子，全要用到。

So the concept here:

基本上，

so if you do have a deceased or injured organ,

如果你的某个器官死亡了，或者损坏了，

we take a very small piece of that tissue,

我们可以在这个器官上取下一小块，

less than half the size of a postage stamp.

小到半个邮票的大小。

We then tease the cells apart,

然后我们把细胞摇下来，

we grow the cells outside the body.

在体外培养。

We then take a scaffold, a biomaterial --

之后我们将用生物材料做一个模子，

again, looks very much like a piece of your blouse or your shirt --

这片材料就像从你的衬衫上取下的一片，

we then shape that material,

我们可以给它塑型，

and we then use those cells to coat that material

再把培养的细胞涂上去，

one layer at a time --

一层层地涂——

very much like baking a layer cake, if you will.

就像是烤层层叠叠的蛋糕一样。

We then place it in an oven-like device,

当我们把这块“蛋糕”放进“烤箱”，

and we're able to create that structure

就能使这个组织重生，

and bring it out.

把它取出来用。

This is actually a heart valve

这里是我们作出的

that we've engineered,

真的心脏瓣膜。

and you can see here, we have the structure of the heart valve

你能看到我们先有了瓣膜的框架，

and we've seeded that with cells,

再把细胞种上去，

and then we exercise it.

然后让它锻炼锻炼。

So you see the leaflets opening and closing --

我们可以看到这个瓣膜上

of this heart valve

尖瓣小叶开开合合——

that's currently being used experimentally

这现在还在试验阶段，

to try to get it to further studies.

我们希望能更深入的研究。

Another technology

另一个我们用在

that we have used in patients

病人身上的技术是

actually involves bladders.

关于膀胱移植的。

We actually take a very small piece of the bladder from the patient --

我们能从病人的膀胱上取下一小块来——

less than half the size of a postage stamp.

比半块邮票还小，

We then grow the cells outside the body,

然后进行体外细胞培养，

take the scaffold, coat the scaffold with the cells --

在拿个模子，涂上细胞——

the patient's own cells, two different cell types.

病人自己的两种细胞，

We then put it in this oven-like device.

然后把模子放进“烤箱”，

It has the same conditions as the human body --

它有和体内同样的环境——

37 degrees centigrade, 95 percent oxygen.

三十五摄氏度，百分之九十五氧气，

A few weeks later, you have your engineered organ

几星期后，就有人造器官了，

that we're able to implant back into the patient.

我们能把它们移植回到病人身上。

For these specific patients, we actually just suture these materials.

有些特殊的病人，我们只需要把这些材料缝上去就成了。

We use three-dimensional imagining analysis,

我们可以用三维图像系统描图，

but we actually created these biomaterials by hand.

然后用手工制作。

But we now have better ways

现在我们有更好的方法

to create these structures with the cells.

来用细胞作出器官。

We use now some type of technologies,

我们现在用几种技术

where for solid organs, for example,

来做块状的器官，比如

like the liver,

肝脏。

what we do is we take discard livers.

我们的作法是拿个遗弃的肝脏，

As you know, a lot of organs are actually discarded, not used.

要知道，很多器官都被丢弃不用了。

So we can take these liver structures,

我们把别人不要的

which are not going to be used,

肝脏拿来，

and we then put them in a washing machine-like structure

把它们放在类似洗衣机的机器里，

that will allow the cells to be washed away.

把细胞都洗下来。

Two weeks later,

两周后

you have something that looks like a liver.

你得到一个像是肝脏的东西

You can hold it like a liver,

你可以把它托在手上，

but it has no cells; it's just a skeleton of the liver.

但是这个肝脏没有任何细胞，这只是个肝脏的架子。

And we then can re-perfuse the liver with cells,

我们之后从血管

preserving the blood vessel tree.

把细胞灌进这个肝脏里。

So we actually perfuse first the blood vessel tree

所以我们其实是先把病人的血管细胞

with the patient's own blood vessel cells,

从血管里灌进去，

and we then infiltrate the parenchyma with the liver cells.

然后把用病人的肝脏细胞渗透进去。

And we now have been able just to show

上个月，

the creation of human liver tissue

我们才用这个技术

just this past month

得以成功地

using this technology.

造出了人类的肝脏。

Another technology that we've used

另一个技术是我们以前用过的，

is actually that of printing.

就是打印器官的技术。

This is actually a desktop inkjet printer,

这是办公室用的打印机

but instead of using ink,

只是我们不用墨粉

we're using cells.

我们用的是活细胞。

And you can actually see here the printhead

你可以看到打印头

going through and printing this structure,

左右移动，打印出一块组织，

and it takes about 40 minutes to print this structure.

一般这样的组织要花四十分钟来打印。

And there's a 3D elevator

另外（这个组织坐在）一个三维升降机（上），

that then actually goes down one layer at a time

打印时，每次打印头走到头，

each time the printhead goes through.

它会（带着这块组织）下降一层。

And then finally you're able to get that structure out.

最后你就能得到整个组织了。

You can pop that structure out of the printer and implant it.

你能把组织取下来，然后移植入病人体内。

And this is actually a piece of bone

这张幻灯片显示的

that I'm going to show you in this slide

是我们用办公室打印机

that was actually created with this desktop printer

打印出的一片真的骨头，

and implanted as you see here.

然后移植入人体的。

That was all new bone that was implanted

这里的骨头都是

using these techniques.

用这个技术移植的。

Another more advanced technology we're looking at right now,

另一个我们正在研究的更为先进的技术，

our next generation of technologies,

新一代的技术，

are more sophisticated printers.

要使用更为复杂的打印机。

This particular printer we're designing now

这个我们正在设计中的特殊的打印机

is actually one where we print right on the patient.

能够在病人身上实时打印。

So what you see here --

你看吧——

I know it sounds funny,

我知道听起来挺傻的，

but that's the way it works.

但它就是这样运作的。

Because in reality, what you want to do

因为现实中你希望做的，

is you actually want to have the patient on the bed with the wound,

是希望在病人受伤躺上病床上时，

and you have a scanner,

能有一个扫描机

basically like a flatbed scanner.

就像是个正常的平面扫描机

That's what you see here on the right side.

你能看到在这里右边；

You see a scanner technology

扫描机能先

that first scans the wound on the patient

扫描病人的伤口，

and then it comes back with the printheads

在把信息传到打印头上，

actually printing the layers that you require

打印头就在伤口上

on the patients themselves.

实时打印。

This is how it actually works.

这里展示了这个系统是怎么工作的。

Here's the scanner going through,

这里是扫描机

scanning the wound.

来回扫描伤口。

Once it's scanned,

扫描完了，

it sends information in the correct layers of cells

它就会把哪里需要

where they need to be.

新的细胞层的信息送出去。

And now you're going to see here

现在你将要看到的

a demo of this actually being done

是一个录像，显示了

in a representative wound.

这个打印机是如何在一个伤口上打印的。

And we actually do this with a gel so that you can lift the gel material.

我们其实在打印机里加了胶质，这样你就能把打印的组织提起来，

So once those cells are on the patient

当你把组织移植到病人身体里去时，

they will stick where they need to be.

它们也能成功地粘在正确的地方。

And this is actually new technology

这确实是个新技术，

still under development.

我们还在研发中。

We're also working on more sophisticated printers.

我们还在研制更为复杂的打印机，

Because in reality, our biggest challenge

因为事实上我们最大的挑战

are the solid organs.

是块状组织。

I don't know if you realize this,

我不知道你注意到了没有，

but 90 percent of the patients on the transplant list

百分之九十的等待器官移植的病人

are actually waiting for a kidney.

都是在等肾脏。

Patients are dying every day

病人天天去世，

because we don't have enough of those organs to go around.

都是因为我们没有足够的器官。

So this is more challenging --

所以这正是更大的挑战——

large organ, vascular,

大型器官，布满血管的，

a lot of blood vessel supply,

需要很多的血液供应，

a lot of cells present.

需要很多细胞。

So the strategy here is --

所以这里的策略是——

this is actually a CT scan, an X-ray --

这是个真正的CT扫描，一个X光片——

and we go layer by layer,

我们可以层层解析，

using computerized morphometric imaging analysis

使用电脑化的图像和形态分析

and 3D reconstruction

以及三维重组的技术，

to get right down to those patient's own kidneys.

来观察这些病人自己的肾脏。

We then are able to actually image those,

我们能够观察这些肾脏，

do 360 degree rotation

三百六十度旋转，

to analyze the kidney

这样就能全方位地

in its full volumetric characteristics,

研究整个肾脏。

and we then are able

之后我们就能

to actually take this information

应用这些信息，

and then scan this

扫描

in a printing computerized form.

变成打印出的层层电子图。

So we go layer by layer through the organ,

这样我们就能层层深入

analyzing each layer as we go through the organ,

解析这个器官的每一层，

and we then are able to send that information, as you see here,

之后我们就能把信息送出去，像你这里看到的，

through the computer

送到计算机里去

and actually design the organ

然后为病人

for the patient.

设计出新的器官

This actually shows the actual printer.

这里是一家真的打印机。

And this actually shows that printing.

它也在真的打印。

In fact, we actually have the printer right here.

事实上，我们在现场就有一个。

So while we've been talking today,

在我们今天演讲的过程中，

you can actually see the printer

你们能看到这架打印机

back here in the back stage.

就在后台。

That's actually the actual printer right now,

这就是我们用的打印机，

and that's been printing this kidney structure

它一直在打印这个肾脏，

that you see here.

你们能看到。

It takes about seven hours to print a kidney,

一般打印一个肾脏要七个小时，

so this is about three hours into it now.

这个已经打印了三个小时了。

And Dr. Kang's going to walk onstage right now,

康医生将到前台来，

and we're actually going to show you one of these kidneys

我们将给你看一个我们

that we printed a little bit earlier today.

今天早些时候打印的肾脏。

Put a pair of gloves here.

让我戴上手套。

Thank you.

谢谢你。

Go backwards.

到后面来一点

So, these gloves are a little bit small on me, but here it is.

这些手套有点小，好了

You can actually see that kidney

你现在能看到这个肾脏

as it was printed earlier today.

我们今天早些时候打印的。

(Applause)

（掌声）

Has a little bit of consistency to it.

还有一点粘。

This is Dr. Kang who's been working with us on this project,

这是康医生，他和我们一起为这个项目工作

and part of our team.

是我们队伍的一份子。

Thank you, Dr. Kang. I appreciate it.

谢谢你康医生，我很感谢。

(Applause)

（掌声）

So this is actually a new generation.

这就是新一代的打印机，

This is actually the printer that you see here onstage.

这个我们在台上看到的。

And this is actually a new technology we're working on now.

这是我们正在研究的新技术。

In reality, we now have a long history of doing this.

其实我们已经做这个技术很长时间了，

I'm going to share with you a clip

我想和你们分享一个小片段，

in terms of technology we have had in patients now for a while.

关于我们用在病人身上已有一段时间的技术。

And this is actually a very brief clip --

这是个很短的片段——

only about 30 seconds --

只有三十秒——

of a patient who actually received an organ.

是一个作了器官移植的病人，

(Video) Luke Massella: I was really sick. I could barely get out of bed.

（录像）路克 马萨拉：“我曾经病得很重，都不能下床。

I was missing school. It was pretty much miserable.

我没法上学，生活很惨淡。

I couldn't go out

我不能出门，

and play basketball at recess

课间不能打篮球，

without feeling like I was going to pass out

因为每每一回教室

when I got back inside.

我就感觉要昏倒。

I felt so sick.

我觉得特别痛苦。

I was facing basically a lifetime of dialysis,

我面临的是基本上终生的透析，

and I don't even like to think about what my life would be like

简直不能想象

if I was on that.

生活会是什么样子。

So after the surgery,

手术之后，

life got a lot better for me.

生活对我变得容易多了。

I was able to do more things.

我能做的事情多了很多。

I was able to wrestle in high school.

我能在学校里玩摔跤，

I became the captain of the team, and that was great.

我成了摔跤队长，感觉真棒。

I was able to be a normal kid with my friends.

我能够像个正常人一样有朋友，

And because they used my own cells to build this bladder,

全是因为医生用了我自身的细胞，给我做了个膀胱。

it's going to be with me.

我的新膀胱将伴随着我。

I've got it for life, so I'm all set.

伴我一生。我别无它求了。”

(Applause)

（掌声）

Juan Enriquez: These experiments sometimes work,

胡安 安瑞奎兹：这些试验有时还真灵，

and it's very cool when they do.

灵的时候是很酷的。

Luke, come up please.

路克，请上台来。

(Applause)

（掌声）

So Luke, before last night,

路克，直到昨晚

when's the last time you saw Tony?

上次你见到安东尼医生是什么时候？

LM: Ten years ago, when I had my surgery --

路克：十年前，我做手术的时候——

and it's really great to see him.

能见到他真好。

(Laughter)

（笑声）

(Applause)

（掌声）

JE: And tell us a little bit about what you're doing.

胡克：和大家讲讲你现在在做什么。

LM: Well right now I'm in college at the University of Connecticut.

路克：我现在在上大学，在康涅狄格州立大学。

I'm a sophomore and studying communications, TV and mass media,

我上二年级，学传媒信息，电视和媒体专业。

and basically trying to live life like a normal kid,

我试着过正常人的生活，

which I always wanted growing up.

这是我梦想的长大后的样子。

But it was hard to do that when I was born with spina bifida

当时很难做到，因为我生来就有脊柱裂，

and my kidneys and bladder weren't working.

我的肾脏和膀胱都不能正常工作。

I went through about 16 surgeries,

我做过十六个外科手术，

and it seemed impossible to do that

最后十岁的时候肾脏还是衰竭了，

when I was in kidney failure when I was 10.

快要死了。

And this surgery came along

这个移植手术降临了，

and basically made me who I am today

让我成为了今天的我，

and saved my life.

救了我。

(Applause)

（掌声）

JE: And Tony's done hundreds of these?

胡克：安东尼一定做了上百个这样的手术了吧？

LM: What I know from, he's working really hard in his lab

路克：据我所知，他在实验室里辛勤工作，

and coming up with crazy stuff.

创造了很多新奇古怪的方案。

I know I was one of the first 10 people to have this surgery.

我知道我是前十个接受这项手术的病人，

And when I was 10, I didn't realize how amazing it was.

那时候我才十岁，我不知道这有多酷。

I was a little kid, and I was like,

我只是个孩子。我当时只是：

"Yeah. I'll have that. I'll have that surgery."

“好吧，又一个手术，我做就是了。”

(Laughter)

（笑声）

All I wanted to do was to get better,

我当时想做的仅仅是活的健康一点，

and I didn't realize how amazing it really was until now that I'm older

没有意识到手术的伟大之处，直到我长大了。

and I see the amazing things that he's doing.

现在我明白他做的研究有多么伟大。

JE: When you got this call out of the blue --

胡克：当你突然间接到我们的电话——

Tony's really shy,

安东尼是很害羞的一个人，

and it took a lot of convincing

我们很是费了一番唇舌

to get somebody as modest as Tony

才得到他这么低调的人的同意，

to allow us to bring Luke.

把路克带到现场来。

So Luke, you go to your communications professors --

路克，当你去你的传媒学教授说——

you're majoring in communications --

传媒学是你的专业——

and you ask them for permission to come to TED,

当你征得他们的同意来上TED时，

which might have a little bit to do with communications,

这多少和传媒学有点关系，

and what was their reaction?

他们有什么反应？

LM: Most of my professors were all for it,

路克：我的大部分教授都赞同，

and they said, "Bring pictures

他们说：“照照片回来，

and show me the clips online," and "I'm happy for you."

给我网上的录像看。”或者是：“真替你高兴。”

There were a couple that were a little stubborn,

有几个有点保留，

but I had to talk to them.

但是我说服了他们，

I pulled them aside.

我都搞定了。

JE: Well, it's an honor and a privilege to meet you.

胡克：今天见面真是我的荣幸

Thank you so much. (LM: Thank you so much.)

谢谢你。（路克：谢谢你们。）

JE: Thank you, Tony.

胡克：谢谢你，安东尼医生。

(Applause)

（掌声）