Kevin Stone: The bio-future of joint replacement

翻译人员: Dou Dou 校对人员: Chaoran Yu

So let me just start with my story.

现在开始讲述我的故事

So I tore my knee joint meniscus cartilage

在大学踢足球时

playing soccer in college.

我将我的半月板软骨撕裂

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

随后，我的前十字韧带也被撕裂了

and then developed an arthritic knee.

但不久之后，人工膝盖出现了

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

我确信在座的很多听众都经历过此类的事情

and, by the way, I married a woman

顺便说一句，我结婚了

who has exactly the same story.

我的妻子也经历过同样的事情

So this motivated me to become an orthopedic surgeon

这些事情促使我成为一名整形外科医生

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

我希望能够解决如何让我们

that would keep me playing sports and not limit me.

如何可以无拘束的运动问题

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

带着这个问题，我先让我们看一个简短的视频

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

让它带着你们了解我们所希望解决的问题

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

视频旁白：我们都很关注癌症的风险

but there's another disease

但是还有另一种疾病

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

能够比癌症还要影响更多的人—关节炎

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

癌症也许会让你死亡，但关节炎

arthritis ruins more lives.

会毁掉更多人的生活

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

假设你可活得很长命，你将有50%的概率

you'll develop arthritis.

患上关节炎

And it's not just aging that causes arthritis.

这并不是因为年老而引起的疾病

Common injuries can lead to decades of pain,

常见的损伤可以导致数十年的伤痛

until our joints quite literally grind to a halt.

直到关节经过长时间磨损而停止工作

Desperate for a solution, we've turned to engineering

我们迫切地想得到解决的方法，随之我们转向工程学

to design artificial components

以来设计人造关节

to replace our worn-out body parts,

来替代我们早已磨损且不堪重负的身体器官

but in the midst of the modern buzz

但在研究新方法时

around the promises of a bionic body,

都是围绕着仿生学这一前提

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

我们是否应该暂时停下脚步看看有没有更好、更自然的方法

Let's consider an alternative path.

让我们一起考虑一个替代方法

What if all the replacements our bodies need

如果我们将我们身体某一部分的需要替换为

already exist in nature,

已经存在的生物器官

or within our own stem cells?

又或者用我们自己的干细胞培养会怎么样

This is the field of biologic replacements,

这就是生物置换领域

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

它将我们已磨损的器官替换为新的、自然的器官

Kevin Stone: And so, the mission is:

Kevin Stone：任务就是

how do I treat these things biologically?

我们如何用生物学知识处理这类事情

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

下面然我们谈谈，我对我的妻子

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

以及数以百计的病人的治疗方法

First thing for my wife,

这是从我的妻子那里最先听到的

and the most common thing I hear from my patients,

以及从我的患者口中

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

尤其是那些40-80岁年龄组中的70岁年龄组

is they come in and say,

最常听到的是

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

嘿，医生，我的膝盖中的放得只是一个减震器对吗

I'm not ready for joint replacement."

我并没有做好换关节的准备

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

对我的妻子来说我对她进了半月板手术

right into that [knee] joint space.

在膝盖连接处行了同种异体的植入

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

这种异基因移植物替换了缺失的半月板

And then for that unstable ligament,

随后对原来的韧带进行替换

we put in a human donor ligament

我们放入了其他人捐赠的韧带

to stabilize the knee.

以使她的膝盖得到稳定的支撑

And then for the damaged arthritis on the surface,

第三，则是对关节表面的损坏

we did a stem cell paste graft,

我们进行了干细胞黏贴移植

which we designed in 1991,

这个则是我们在1991年设计出来的

to regrow that articular cartilage surface

可以使得关节软骨组织再生

and give it back a smooth surface there.

使他们还原为光滑的表面

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

左边这个是我爱人原已损坏的膝盖

and her just hiking now

但是看右边，她在四个月后的Aspen

four months later in Aspen, and doing well.

已经可以徒步旅行了，并且一切都很好

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

手术成功了，但并这个成功并不仅仅局限于我的爱人，其他患者也同样受益

The girl on the video, Jen Hudak,

视频中的女孩，Jen Hudak

just won the Superpipe in Aspen

刚刚在Aspen赢得了雪道滑雪

just nine months after having destroyed her knee,

而这发生在她膝盖损坏后的九个月

as you see in the other image --

正如你们看到视频

and having a paste graft to that knee.

她有着经过干细胞修复过的膝盖

And so we can regrow these surfaces biologically.

所以我们从生物学的角度将是可以修复关节表面的

So with all this success,

所以经过了这些的成功

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

你们也许会问为什么还不够好呢

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

这是因为还没有足够的数据来支撑这个实践

There's not enough young, healthy people

没有足够健康的年轻人

falling off their motorcycle

从他们的模特车上摔倒

and donating that tissue to us.

并且将他们的器官捐赠给我们

And the tissue's very expensive.

并且这个手术十分昂贵

And so that's not going to be a solution

这就是这个办法没有得到普及的原因

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

也使得我们将事业放眼于全球去寻找合适的生物组织

But the solution is animal tissue

随后我们用动物组织进行替代

because it's plentiful, it's cheap,

因为生物组织可以随处找到，并且价格也不高

you can get it from young, healthy tissues,

并且可以得到年轻、健康的生物组织

but the barrier is immunology.

但是，该种方法的障碍就是免疫问题

And the specific barrier

这种特别的障碍是由

is a specific epitope

特殊的抗原决定基所导致

called the galactosyl, or gal epitope.

这种抗原决定基就是”半乳糖基“

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

所以，如果我们想将动物组织移植到人类的身体上

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

则必须找到一种方法去除掉半乳糖基

So my story in working with animal tissues

所以我的工作

starts in 1984.

从1984年开始研究动物组织

And I started first

我首先从

with cow Achilles tendon,

牛的跟腱开始

where we would take the cow Achilles tendon,

我们可以将牛的跟腱中的

which is type-I collagen,

一种胶原质

strip it of its antigens

从其抗原中分离

by degrading it with an acid and detergent wash

进过一种酸和清洁剂的冲洗降解

and forming it into a regeneration template.

使其成为一种再生模板

We would then take that regeneration template

我们随后可以将这个再生模板

and insert it into the missing meniscus cartilage

插入半月板软骨撕裂处

to regrow that in a patient's knee.

让其在患者的膝盖再生

We've now done that procedure,

直到现在，通过使用这种方法

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

我们已经在全球范围内治愈了逾4000位患者

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

所以这是一个可以被美国食品及药物管理局以及全世界所接受的

to regrow the meniscus.

膝盖半月板再生法

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

而且当我们能够降解生物组织时将会更好

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

但是，当你需要一个完整的韧带时

I can't grind it up in a blender.

我不能将其在搅拌机里将其磨碎

So in that case,

所以，这种情况下

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

我必须进行研究设计，与我一起设计的还有Uri Galili和Tom Turek

an enzyme wash

我们一起设计一种酶洗之法

to wash away, or strip,

用一种特殊的酶

those galactosyl epitopes

以洗掉或脱离掉

with a specific enzyme.

那些半乳糖抗原决定基

And we call that a "gal stripping" technique.

这种酶素洗法我们称之为“半乳糖脱离”技术

What we do is humanize the tissue.

我们所做的就是将组织做的更加人性化

It's by gal stripping that tissue

用半乳糖脱离法

we humanize it (Laughter),

我们可以将其处理的更加接近人的组织

and then we can put it back

然后我们就可以

into a patient's knee.

将这个组织放回患者的膝盖处

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

我们已经做过这个实验，现在我们采用猪的韧带

young, healthy, big tissue,

年轻的、健康的、大的组织

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

将其放入是为患者的体内，当然这个实验是经过美国食品药品监督管理局的批准

and then one of our patients went on to have

不久，其中一位患者就继续参加了

three Canadian Masters Downhill championships --

三个加拿大斜坡大师冠军赛

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

当然，这都是经过他自己称之为“猪膝盖”的做功。这让我们了解到这种方法管用

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

而且，一个更大规模的临床试验将要进行

So what about the next step?

那么我们的下一步将会做什么

What about getting to a total biologic knee replacement,

做一个整体生物膝盖置换怎么样

not just the parts?

不再局限于一个部分

How are we going to revolutionize artificial joint replacement?

我们如何对人在关节置换进行革命性改变

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

这就是我们如何做这件事情

So what we're going to do is take

我们将会用一个

an articular cartilage

来自年轻、健康的猪的

from a young, healthy pig,

关节软骨

strip it of its antigens,

剥离掉它的抗原

load it with your stem cells,

载上你自己的干细胞

then put it back on to that

然后将其放回

arthritic surface in your knee,

你自己膝盖处的关节

tack it on there, have you heal that surface

将其固定，让你自己治愈破损的表面

and then create a new biologic surface for your knee.

并让其自己为你的膝盖生长一个新的生物表面

So that's our biologic approach right now.

这就是我们现在的生物方法

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

我们可以用部分组织让你的膝盖得以重生

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

我们将原组织表面生成一个全新的表面

But we have other advantages from the animal kingdom.

但是，我们可以从动物王国哪里得到其他的利益

There's a benefit of 400 million years

这个利益是他们有四亿年的

of ambulation.

移动历史

We can harness those benefits.

我们可以利用那些有事

We can use thicker, younger, better tissues

我们可以利用那些更加厚实、年轻

than you might have injured in your knee,

比你自身更好的组织

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

或比你40、50、60岁时更好的组织

We can do it as an outpatient procedure.

我们可以将其发展为门诊式的程序

We can strip that tissue very economically,

我们还可以将脱离技术发展为更为经济的方法

and so this is how we can get biologic knee replacement

这就是我们如何在全球范围内

to go global.

获得生物膝盖置换的方法

And so welcome to super biologics.

欢迎进入生物学的世界

It's not hardware.

他不是硬件

It's not software.

也不是软件

It's bioware.

是生物部件

It's version 2.0 of you.

是你身体部件的第二代

And so with that, coming to a --

我深信不久人们将会在

(Laughter)

（笑声）

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

各个医院中见到它的使用

Thank you very much.

谢谢

(Applause)

（掌声）