What If a Simple Blood Test Could Detect Cancer? | Hani Goodarzi | TED

翻译人员: Vivian 'Yiwen' Zhao 校对人员: suya f.

Catching cancer at its earliest stages,

癌症在初期最容易治疗，

when it's most treatable, can save countless lives.

尽早地诊断 可以挽救无数的生命。

But the million-dollar question is:

但关键的问题是：

in an otherwise healthy body made up of trillions of cells,

在一个数万亿细胞 组成的健康的身体里，

how can we zero in on a small group of rogue cancer cells?

我们如何才能发现 那一小部分恶性的癌细胞？

The answer, I think,

这个问题的答案，

may be rooted in something that, thanks to the pandemic,

由于新冠疫情，

we have all come to know quite well, and that is RNA.

是我们都很熟悉的 核糖核酸 (RNA)。

I think these days, everyone has a basic understanding of how RNA works.

我想大家都比较了解 RNA的工作原理，

Again, thanks to the COVID vaccines.

我重申，这要归功于新冠疫苗。

But basically, RNA is transcribed from DNA in the cell,

RNA是从细胞中的DNA转录而来，

and messenger RNA specifically serves as a template for protein synthesis.

而信使核糖核酸（mRNA）， 是一种专门用作蛋白质合成的模板。

So usually the more mRNA you have in the cell,

细胞里的mRNA越多，

the more protein you get.

蛋白质就越多。

But our discovery is a little bit different.

但我们的发现略有不同。

We have found a new class of RNAs

我们找到了一种新型的RNA，

that have changed how we think about cancer detection.

它改变了我们对癌症检测的看法。

These are relatively small RNAs,

这些是相对较小的RNA，

and they don't actually code for any protein.

它们实际上不编码蛋白质。

So they're non-coding.

所以它们没有编码能力。

And since we found them, we got to name them.

既然我们发现了他们， 便要给它们命名。

And we have called them orphan non-coding RNAs

我们称其为 “孤儿非编码型RNA”

or oncRNAs for short.

简称oncRNA。

These oncRNAs have not only changed

这些oncRNA不仅改变了 癌症检测的方法，

and transformed our approach to cancer detection

from blood non-invasively,

例如非侵入性血液检测，

but they've also helped open a window into the tumor itself for us.

还为我们打开了一扇 了解肿瘤的窗口。

So leveraging these RNAs,

通过良好的利用这些RNA，

we are not only detecting cancer earlier,

我们不仅可以更早地发现癌症，

we are actually peering into its biology.

还能窥探其生物学特性。

So with that short introduction, let me break down the science for you.

那么在简短的介绍后， 下面我将为您分解一下其背后的科学。

As you may know, every cell in our body shares the same genetic code

众所周知，人体内的细胞 共同共享着遗传密码。

as every other cell.

It's as if our cells have access to the same pantry,

好比我们的细胞使用着 同一个食品储藏室，

but then they use different recipes

随后他们将相同的食材 混合搭配成不同的菜肴。

to mix the same ingredients into different dishes.

It's actually the diversity in genomic recipes

这些多元化的基因组配方，

that gives us the more than 200 cell types we have in our bodies,

赋予了人体的 200 多种细胞类型。

each with their own distinct role and function,

每种细胞有其独特的作用和功能，

like skin cells, for example, or neurons.

例如皮肤细胞或神经元。

And as you can imagine,

您可以想象，

there is a complex machinery in place in the cell that governs this process

细胞内有一套复杂的机制 来控制这一过程，

and tells the cell for each of its 20,000 genes

它告诉细胞内的 20,000 个基因，

how much of them it needs to express

多少基因可以合成一个 健康和功能良好的细胞。

to be a healthy, well-functioning cell.

Now, cancer cells, being the resourceful survivalists that they are,

但癌细胞是一种 足智多谋的生存者，

they actually hijack components of this machinery to their advantage.

它们为了自己的利益 劫持了这个机器的部件。

And they do this to increase the expression of genes

这个做法是为了提高基因的表达量，

that will help the tumor grow and spread throughout the body,

以此帮助肿瘤在全身生长和扩散，

or silence or down-regulate genes whose job is to keep cancer in check.

或使那些负责监控癌症的基因 保持沉默或下调。

Another way of putting this

换言之，

is that cancer cells are basically hacking that original genomic recipe

癌细胞基本上是在破解 之前提到的原始基因组配方。

that I told you about.

Now a few years ago, we made an interesting discovery

我们在几年前有一个有趣的发现，

that is actually a consequence of this genomic reprogramming

那就是癌细胞的基因组重编程，

that happens in cancer cells, is actually a hallmark of cancer.

实际上是癌症的标志物。

Basically, parts of the genome that is normally silent

基本上，基因组中平时处于沉默状态

and inactive in healthy cells

和非活动状态的健康细胞，

becomes activated in cancer.

会在癌症中被激活。

And a direct consequence of this activation

这种激活的直接后果

is the birth of a new kind of RNA.

是一种新型RNA的诞生。

That we only see these RNAs in cancer,

我们只能在癌症中看到这些RNA，

but not really in healthy cells.

而在健康细胞中却看不到。

Now over the past few years,

在过去的几年里，

we have spent a lot of time basically mapping these cancer-emergent RNAs

我们花了很多时间 去绘制致癌RNA图谱，

across human cancers.

是横跨多种癌症分型的。

And as I told you earlier,

正如之前所说， 它们称为oncRNA。

we have come to name them oncRNAs.

Now, what is even more interesting

而更有趣的是，

is that which oncRNAs I see in a given sample is not random.

所选取样本中的oncRNA 不是随机的。

It's actually tied back to the type or subtype of cancer

它和我正在研究的 癌症类型和亚型相关。

that I'm looking at.

So collectively, oncRNAs actually provide a digital molecular barcode

总的来说， oncRNA实际上提供了

that captures cancer cell identity.

捕获癌细胞身份的 数字分子条形码。

And it's actually unique to the type or subtype of cancer.

并且是癌症类型或亚型 所独有的条形码。

But how are these molecular barcodes actually useful?

那么这些分子条形码 有什么用处呢？

So it turns out oncRNAs are not actually confined to cancer cells.

事实证明， oncRNA并不局限于癌细胞。

Some of them are nicely packaged and released into the blood.

有些带着很好的包装 被释放到血液中。

And this is something that healthy cells do as well with other small RNAs.

这也是健康细胞 和其他小型RNA都会做的事情。

And with all of this introduction, I hope you know where I'm going with this.

经过这些介绍后， 我想您能猜到接下来的内容。

Basically, if oncRNAs are only expressed in cancer cells,

如果oncRNA仅表达与癌细胞中，

and some of them do in fact find their way into the bloodstream,

而其中一些确实进入了血液，

doesn't it mean that we should be able to detect them

是否意味着我们应该能在 癌症患者的血液样本中检测出它们？

in blood samples from cancer patients?

The answer, turns out, is yes, but with an asterisk.

答案是肯定的，但带有附加条件。

So the oncRNAs that we detect in blood samples from patients

我们在患者血液样本中 检测到的oncRNA

actually form a partial barcode.

确实形成了部分条形码。

And it's only a partial barcode

它是不完整的，

because only a subset of oncRNAs

因为实际上只有一部分oncRNA

are actually secreted from cancer cells into the blood.

可以从癌细胞分泌到血液中。

And even a smaller subset can be reliably detected

其中只有更小一部分， 能在少量血液中被可靠的检测到。

in a small volume of blood.

However, thanks to the magic of machine learning and AI,

但由于机器学习和人工智能的进步，

we can actually use this partial information

我们可以使用这一小部分的信息，

to reconstruct the original barcode that resides in the tumor.

来重建肿瘤中的原始条形码。

And we can match that deconstruction

并且我们可以将解构出的信息，

against our catalog of oncRNA barcodes across cancers

与我们的癌症目录里的 oncRNA条形码相匹配，

to not only --

这样不仅可以检测疾病的存在，

to not only detect the presence of the disease,

but also identify its type or subtype.

还可以识别其类型或亚型。

And actually, as we grow,

实际上，随着我们的进步，

fundamentally increase the number of these oncRNA catalogs that we have built,

我们将会从根本上 增加oncRNA目录的数量，

we can go deeper and deeper into the biology of the disease as well.

使我们可以更深入地 研究该疾病的生物学特性。

Now, with help from our clinical collaborators at UCSF,

目前，在加州大学旧金山分校 临床合作者的帮助下，

we have come a step closer to actually bringing this platform to the clinic.

我们更进一步的 将这个平台引入临床。

In a preliminary study across 200 breast cancer patients,

在一项针对 200 名 乳腺癌患者的初步研究中，

we have actually shown that we can use oncRNAs

事实证明，我们可以运用oncRNA

to detect residual disease in patients

来检测患者接受治疗后的疾病残留，

after they have received treatment,

and knowing which patients have remaining disease,

识别出 哪些患者有预留疾病，

tells clinicians who needs additional treatment or monitoring

便可告诉临床医生哪些患者在术后

after the surgery.

需要额外的治疗或监测。

And this way, patients receive more treatment

这样患者只有在需要时，

only when it's needed.

才会接受更多的治疗。

I truly believe that the next decade is the decade of cancer screening.

我坚信，未来十年 是癌症筛查的十年。

And as you can imagine, blood detection of cancers

您可以想象，通过血液检测癌症

is a major frontier in that war.

将是这场战争的主要前沿。

And I hope to have convinced you today that leveraging powerful AI

我希望今天的演讲 成功的说服了您，

built on top of molecular barcodes of oncRNAs,

oncRNA的分子条形码， 结合人工智能的强大力量，

we can envision a future that’s precise and sensitive,

使我们可以预见 一个精确和灵敏的未来，

but more importantly,

并且是个非常容易实现的未来。

very accessible.

Blood detection of cancers is not just the hope,

通过血液检测癌症 不再是种美好的愿望，

but it's actually a reality.

而是已经到来的现实。

Thank you.

谢谢。

(Applause)

（掌声）