Siddharthan Chandran: Can the damaged brain repair itself?

306,891 views ・ 2014-02-24

TED


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譯者: Chih Ying (Naomi) Chuang 審譯者: Harry Chen
00:12
I'm very pleased to be here today
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今天我感到非常開心來這裡,
00:14
to talk to you all about how we might repair
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要跟你們大家談: 「如何我們有可能修復
00:16
the damaged brain,
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受損的大腦」
00:18
and I'm particularly excited by this field,
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這方面使我特別地感到振奮,
00:21
because as a neurologist myself,
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因為我身為一個神經學專家,
00:23
I believe that this offers one of the great ways
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我相信這提供了 一個最棒的辦法,
00:25
that we might be able to offer hope
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讓我們也許有能力送上希望
00:27
for patients who today live with devastating
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給病人們, 那些今天活著帶有造成損傷、
尚未能治癒的大腦病變的人。
00:30
and yet untreatable diseases of the brain.
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00:33
So here's the problem.
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問題就在這裡,
00:36
You can see here the picture of somebody's brain
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你可以看到這是某人大腦的圖片,
00:38
with Alzheimer's disease
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是患有阿滋海默症的人。
00:40
next to a healthy brain,
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旁邊還有健康的大腦圖片,
00:42
and what's obvious is, in the Alzheimer's brain,
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很明顯的是在患有 阿滋海默症的大腦中
00:44
ringed red, there's obvious damage -- atrophy, scarring.
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被紅線圈起來的是明顯的損傷---
萎縮和傷疤。
00:49
And I could show you equivalent pictures
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我還可以讓你看更多同性質的照片,
00:51
from other disease: multiple sclerosis,
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來自其他大腦病變:多發性硬化症、
00:53
motor neuron disease, Parkinson's disease,
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運動神經疾病、巴金森氏症、
00:56
even Huntington's disease,
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甚至還有亨丁頓氏症,
00:58
and they would all tell a similar story.
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而且它們都訴說著相似的故事,
01:01
And collectively these brain disorders represent
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還有這些大腦失常集合性地代表
01:03
one of the major public health threats of our time.
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我們此生主要的一個公眾健康威脅。
01:06
And the numbers here are really rather staggering.
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況且這人數真的讓人傻眼,
01:11
At any one time, there are 35 million people today
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以今天而言有三千五百萬人,
01:14
living with one of these brain diseases,
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患有這些病變的其中一種,
01:17
and the annual cost globally
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而且年度的花費全球性來說
01:19
is 700 billion dollars.
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是七千億美金。
01:21
I mean, just think about that.
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就單單想一下那個金額,
01:23
That's greater than one percent
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那是遠大於百分之1
01:25
of the global GDP.
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的全球國內生產毛額。
01:27
And it gets worse,
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而且還會變糟,
01:29
because all these numbers are rising
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因為人數、花費等所有的數據 一直在上升中,
01:32
because these are by and large
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因為這些絕大部分是
01:33
age-related diseases, and we're living longer.
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年齡相關疾病而我們正活得更長壽。
01:36
So the question we really need to ask ourselves is,
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所以我們真正需要問我們自己的問題是
01:39
why, given the devastating impact of these diseases
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什麼原因使得破壞性影響的 這些大腦病變
發生在個人身上?
01:43
to the individual,
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01:44
never mind the scale of the societal problem,
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先不要關心到後續 造成的社會問題的規模。
01:47
why are there no effective treatments?
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為什麼沒有能成功的療法?
01:50
Now in order to consider this,
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現在為了要認真思考這問題,
01:52
I first need to give you a crash course
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我必須先給你們上一堂速成課,
01:55
in how the brain works.
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有關大腦是如何運作。
01:57
So in other words, I need to tell you
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所以換句話說我必須告訴你們
01:59
everything I learned at medical school.
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我在醫學院裡學到的所有一切。
02:01
(Laughter)
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(笑聲)
02:03
But believe me, this isn't going to take very long.
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不過相信我! 這預計不會花太久,
02:05
Okay? (Laughter)
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可以吧?
02:08
So the brain is terribly simple:
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大腦組織真的再簡單不過,
02:10
it's made up of four cells,
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它是由四種細胞組成的,
02:13
and two of them are shown here.
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這邊展示了其中的兩種,
02:14
There's the nerve cell,
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有神經細胞、
02:16
and then there's the myelinating cell,
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再來是髓鞘細胞,
02:18
or the insulating cell.
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或叫絕緣細胞。
02:19
It's called oligodendrocyte.
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這叫寡突膠細胞。
02:22
And when these four cells work together
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當四種細胞一起運作,
02:23
in health and harmony,
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是在健康跟和諧之下,
02:25
they create an extraordinary symphony of electrical activity,
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它們像電流般的傳輸行為 譜了出色的交響曲,
02:29
and it is this electrical activity
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而且正是這些像電流般 的傳輸行為,
02:31
that underpins our ability to think, to emote,
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支持我們去思考、表達情緒、
記住、學習、移動、 感知等等的能力。
02:35
to remember, to learn, move, feel and so on.
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02:38
But equally, each of these individual four cells
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但同等地每一個這四種細胞
單獨或一起可能不受控制或者死掉,
02:41
alone or together, can go rogue or die,
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02:47
and when that happens, you get damage.
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當這情況發生時你就會受到傷害,
02:49
You get damaged wiring.
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你會發生大腦網絡損壞、
02:50
You get disrupted connections.
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你會發生大腦連結中斷,
02:53
And that's evident here with the slower conduction.
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這邊就是證據, 有著較慢的大腦傳輸。
02:57
But ultimately, this damage will manifest
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最終這種損壞將肯定地表示
03:00
as disease, clearly.
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是大腦病變。
03:02
And if the starting dying nerve cell
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如果最先開始死掉的神經細胞,
03:05
is a motor nerve, for example,
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例如是運動神經細胞
03:07
you'll get motor neuron disease.
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你就會有運動神經細胞病變。
03:09
So I'd like to give you a real-life illustration
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因此,我想要給你們 看一個真人實例,
03:12
of what happens with motor neuron disease.
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患有運動神經細胞病變 會有甚麼事發生?
03:16
So this is a patient of mine called John.
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這位是我的一位病人叫約翰
03:18
John I saw just last week in the clinic.
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我才在上個星期的門診看過約翰,
03:21
And I've asked John to tell us something about what were his problems
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我請約翰來告訴我們 有關他當時有甚麼毛病,
03:25
that led to the initial diagnosis
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造成之後首次診斷 是運動神經細胞病變。
03:27
of motor neuron disease.
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03:28
John: I was diagnosed in October in 2011,
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我在2011年十月時就診的,
(吃力呼吸)
03:33
and the main problem was a breathing problem,
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當時主要的問題是有關呼吸方面,
呼吸困難。
03:37
difficulty breathing.
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03:38
Siddharthan Chandran: I don't know if you caught all of that, but what John was telling us
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我不知道你是否全部聽清楚了, 約翰想告訴我們
03:41
was that difficulty with breathing
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是呼吸的時候會有困難,
03:43
led eventually to the diagnosis
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導致最後的診斷出
03:45
of motor neuron disease.
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運動神經細胞病變。
約翰從那次診斷到現在 已過了18個月,
03:48
So John's now 18 months further down in that journey,
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03:51
and I've now asked him to tell us something about
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我現在請他來告訴我們關於
他目前的困境。
03:54
his current predicament.
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03:56
John: What I've got now is the breathing's gotten worse.
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我現在變得呼吸更吃力、
我的手、上肢、下肢變得無力,
03:59
I've got weakness in my hands, my arms and my legs.
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所以基本上我大部分時間都 坐在輪椅裡。
04:05
So basically I'm in a wheelchair most of the time.
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04:09
SC: John's just told us he's in a wheelchair
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約翰告訴我們他是坐著輪椅
04:12
most of the time.
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在大部分時間裡。
04:14
So what these two clips show
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所以這兩段短片所要表達的
不只是有關大腦病變的 嚴重傷害性的後果,
04:17
is not just the devastating consequence of the disease,
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04:19
but they also tell us something about
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而它們也告訴我們有關
04:21
the shocking pace of the disease,
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病變驚人的惡化速度,
04:23
because in just 18 months,
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因為只是在18個月之內,
04:26
a fit adult man has been rendered
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一個健全的成年男人已經給送上
了輪椅而且要依靠呼吸器。
04:29
wheelchair- and respirator-dependent.
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04:32
And let's face it, John could be anybody's father,
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讓我們正視它, 約翰有可能是任何人的父親、
兄弟或朋友。
04:35
brother or friend.
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04:37
So that's what happens when the motor nerve dies.
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這就是當運動神經細胞 死亡時會發生的事。
04:39
But what happens when that myelin cell dies?
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那髓鞘細胞死亡時又會如何?
04:44
You get multiple sclerosis.
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你將患有多發性硬化症。
04:46
So the scan on your left
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所以在你左手邊的掃描
04:48
is an illustration of the brain,
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正是一張大腦的圖片,
04:51
and it's a map of the connections of the brain,
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而且它也是大腦連結路徑的地圖,
04:53
and superimposed upon which
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上面又被標記出的是
04:55
are areas of damage.
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大腦受損的地方,
04:57
We call them lesions of demyelination.
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我們稱作「去髓鞘損傷」,
04:59
But they're damage, and they're white.
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不過它們壞掉了、還有是白色的。
05:02
So I know what you're thinking here.
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我知道你在想什麼,
05:03
You're thinking, "My God, this bloke came up
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你正在想,「我的天哪! 這傢伙上台來,
05:06
and said he's going to talk about hope,
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說他想談的是希望,
05:08
and all he's done is give a really rather bleak
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所有他做的事就是說了再無望不過
05:10
and depressing tale."
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以及令人沮喪的故事。」
05:12
I've told you these diseases are terrible.
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我剛跟你說過這些病變是可怕的。
05:13
They're devastating, numbers are rising,
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它們是傷害性的、數字一直上升中的、
05:16
the costs are ridiculous, and worst of all,
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費用是太離譜的,且最糟糕的是
05:18
we have no treatment. Where's the hope?
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我們沒有治療方法,希望在哪裡呢?
05:20
Well, you know what? I think there is hope.
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你們知道嗎我認為是有希望的,
05:23
And there's hope in this next section,
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而且希望就在旁邊那張剖面圖裡,
05:25
of this brain section of somebody else with M.S.,
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是某位患有多發性硬化症病人 的大腦剖面圖,
05:28
because what it illustrates
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因為令人驚訝地是它說明了,
05:29
is, amazingly, the brain can repair itself.
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大腦能夠自癒,
05:32
It just doesn't do it well enough.
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它只是自癒做得還不夠好。
05:34
And so again, there are two things I want to show you.
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有兩件事我要告訴你。
05:36
First of all is the damage of this patient with M.S.
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首先,是患有多發性硬化症的 這個病人大腦有損傷。
05:40
And again, it's another one of these white masses.
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再來一次就是這些白色區塊的一塊。
但很重要地,是這個被紅色圈起來的地方
05:43
But crucially, the area that's ringed red
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05:47
highlights an area that is pale blue.
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註記了一個淡藍色的區域,
05:49
But that area that is pale blue was once white.
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但是那個淡藍色的區域原本是白色的。
05:52
So it was damaged. It's now repaired.
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就是說它曾經是受損的, 現在已經修復了。
05:55
Just to be clear: It's not because of doctors.
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再澄清一些,這不是醫生們造成的。
05:58
It's in spite of doctors, not because of doctors.
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這是醫生以外的因素, 不是醫生們造成的。
06:01
This is spontaneous repair.
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這是自主性的修復。
06:03
It's amazing and it's occurred
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這很令人驚奇的而且它發生了
06:04
because there are stem cells in the brain, even,
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就是因為大腦中有幹細胞,
06:07
which can enable new myelin, new insulation,
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甚至可以使新的髓鞘細胞、絕緣體
06:11
to be laid down over the damaged nerves.
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包覆在受損的神經上。
06:13
And this observation is important for two reasons.
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這個觀察之所以重要有兩個原因,
06:17
The first is it challenges one of the orthodoxies
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第一、是它質疑了一個正統學說
就是我們當初在醫學院裡學到的,
06:21
that we learnt at medical school,
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06:22
or at least I did, admittedly last century,
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起碼是我曾學習到, 誠然地是在上個世紀時,
06:26
which is that the brain doesn't repair itself,
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就是大腦不能自癒,
06:28
unlike, say, the bone or the liver.
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不像好比說是骨頭或肝臟。
06:32
But actually it does, but it just doesn't do it well enough.
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不過實際上它可以自癒, 只是它自癒得還不夠好。
06:35
And the second thing it does,
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它做的第二件事,
06:37
and it gives us a very clear direction of travel for new therapies --
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它給了我們一個清楚的方向 去找出新的療法,
06:41
I mean, you don't need to be a rocket scientist
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我說的是你不必是極聰明的人,
06:42
to know what to do here.
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去知道這裡要做甚麼。
06:44
You simply need to find ways of promoting
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你僅需要找出方法來促使
內生性、自主性的修復 無論如何都能啟動。
06:47
the endogenous, spontaneous repair that occurs anyway.
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06:51
So the question is, why, if we've known that
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問題是如果我們已經知道這些
06:54
for some time, as we have,
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有一段時間了,
06:56
why do we not have those treatments?
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為什麼我們還沒有治療那 些大腦損傷的方法?
07:00
And that in part reflects the complexity
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那有一部分原因反映出藥品開發
07:02
of drug development.
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的複雜性。
07:05
Now, drug development you might think of
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現在藥品開發你可能會想到
既昂貴又有風險的賭博,
07:07
as a rather expensive but risky bet,
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07:10
and the odds of this bet are roughly this:
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而這賭博的實現機率大概是
07:12
they're 10,000 to one against,
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萬分之一,
07:14
because you need to screen about 10,000 compounds
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因為你需要測試約ㄧ萬種配方,
07:17
to find that one potential winner.
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去找出那一個有可能成功的正解。
07:19
And then you need to spend 15 years
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接著你需要花15年的時間,
07:21
and spend over a billion dollars,
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07:22
and even then, you may not have a winner.
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以及支出超過10億美元,
甚至到後來你並沒有正解。
07:26
So the question for us is,
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所以我們該問的問題是,
07:27
can you change the rules of the game
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你可以改變遊戲規則嗎?
07:29
and can you shorten the odds?
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你可以縮短找到正解的時間嗎?
07:31
And in order to do that, you have to think,
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為了達到這個目的你必須去想,
07:33
where is the bottleneck in this drug discovery?
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藥品開發的瓶頸在哪?
07:36
And one of the bottlenecks is early in drug discovery.
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其中一個瓶頸在藥品開發的初期,
07:39
All that screening occurs in animal models.
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所有的測試都發生在動物實驗體上。
07:43
But we know that the proper study of mankind is man,
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不過我們知道 正確的研究人類要用真人,
07:47
to borrow from Alexander Pope.
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我借用亞歷山大.波普的話。
07:49
So the question is, can we study these diseases
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所以問題是:我們能否研究這些疾病
07:51
using human material?
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使用真人?
07:54
And of course, absolutely we can.
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當然,我們絕對可以。
07:56
We can use stem cells,
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我們可以用幹細胞,
07:57
and specifically we can use human stem cells.
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尤其是人類的幹細胞,
08:00
And human stem cells are these extraordinary
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人類的幹細胞是很不一樣
08:02
but simple cells that can do two things:
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但又簡單的細胞,可以做到兩件事情:
08:05
they can self-renew or make more of themselves,
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它們懂得再生 或是製造出更多幹細胞,
08:07
but they can also become specialized
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它們可以特化為
08:09
to make bone, liver or, crucially, nerve cells,
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骨頭、肝臟,或者很關鍵地 -神經的細胞,
08:12
maybe even the motor nerve cell
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可能甚至是運動神經細胞,
08:14
or the myelin cell.
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或是髓鞘細胞。
08:16
And the challenge has long been,
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而存在了很久的挑戰是
08:18
can we harness the power,
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我們是否能獲取這份力量,
08:20
the undoubted power of these stem cells
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這些幹細胞無庸置疑的力量,
08:22
in order to realize their promise
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來實現它們為
08:24
for regenerative neurology?
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再生神經學帶來的好消息?
08:25
And I think we can now, and the reason we can
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我想我們現在可以, 而我們可以的理由
08:28
is because there have been several major discoveries
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是因為在過去的10~20年間
08:31
in the last 10, 20 years.
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有很多重大的發現。
08:33
One of them was here in Edinburgh,
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其中之一就發生在愛丁堡這裡,
08:35
and it must be the only celebrity sheep, Dolly.
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而牠必定是唯一的名羊 ~桃麗。
08:39
So Dolly was made in Edinburgh,
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桃麗是在愛丁堡製造的,
08:40
and Dolly was an example
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桃麗也是一個例子
08:42
of the first cloning of a mammal
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第一個複製哺乳類
取樣自成羊細胞。
08:45
from an adult cell.
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08:47
But I think the even more significant breakthrough
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但我認為更重大的突破,
08:50
for the purposes of our discussion today
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與我們今天的討論目的相關的
08:53
was made in 2006 by a Japanese scientist
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是2006年由一位 日本的科學家做出的,
08:55
called Yamanaka.
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是山中伸彌 (Yamanaka) 。
08:57
And what Yamaka did,
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而山中伸彌所做的,
08:58
in a fantastic form of scientific cookery,
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在一個神奇的科學大熔爐,
09:01
was he showed that four ingredients,
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是他指出四種成分,
09:03
just four ingredients,
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只要四種成分,
09:05
could effectively convert any cell, adult cell,
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能夠成功地轉換任何細胞、成人細胞
09:08
into a master stem cell.
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成為主要的幹細胞。
09:10
And the significance of this is difficult to exaggerate,
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而這個突破的重大性 高到不能再誇大,
09:13
because what it means that from anybody in this room,
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因為它表示從在這房間的每個人
09:15
but particularly patients,
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特別是病人,
09:17
you could now generate
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你可以產生
09:18
a bespoke, personalized tissue repair kit.
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客製化、個人化的細胞修復包。
09:21
Take a skin cell, make it a master pluripotent cell,
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取下皮膚細胞把它變成 主要的多功能幹細胞,
接著你可以用那些細胞,
09:24
so you could then make those cells
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1739
09:26
that are relevant to their disease,
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與大腦病變有關連的細胞
09:28
both to study but potentially to treat.
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既可用於研究,又可用於治療。
09:31
Now, the idea of that at medical school --
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這個想法在醫學院
09:33
this is a recurring theme, isn't it, me and medical school? —
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不是一直不斷上演的主題嗎? 對我和醫學院而言
09:36
would have been ridiculous,
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可以說是再荒唐不過的。
09:37
but it's an absolute reality today.
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但在今天它絕對是事實。
09:40
And I see this as the cornerstone
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我則把它視為
重建、修復與希望的基礎。
09:42
of regeneration, repair and hope.
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09:45
And whilst we're on the theme of hope,
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既然我們在談"希望"這個主題,
09:47
for those of you who might have failed at school,
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對你們也許曾在學校被當掉的人而言,
09:49
there's hope for you as well,
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你們一樣是有希望的。
09:51
because this is the school report of John Gerdon.
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因為這是約翰.格登的成績報告書:
09:54
["I believe he has ideas about becoming a scientist; on his present showing this is quite ridiculous."]
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「我相信他有想要成為科學家這想法; 以他現在的表現來說是相當荒謬的。」
09:55
So they didn't think much of him then.
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09:56
But what you may not know is that he got the Nobel Prize for medicine
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所以他們之後並不常想起他,
不過你可能不知道 他得了諾貝爾醫學獎
09:59
just three months ago.
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就在三個月之前。
10:02
So to return to the original problem,
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讓我們回到原來的問題,
10:04
what is the opportunity of these stem cells,
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這些幹細胞成功的機會在哪裡?
10:06
or this disruptive technology,
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或者這顛覆性性科學
10:08
for repairing the damaged brain,
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用來療癒受損的大腦,
10:10
which we call regenerative neurology?
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我們現在稱做重建神經學。
10:12
I think there are two ways you can think about this:
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我認為你有兩個方向來看它:
10:14
as a fantastic 21st-century drug discovery tool,
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當它是神奇的21世紀藥品開發的工具
10:18
and/or as a form of therapy.
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或者是一種治療手段。
10:20
So I want to tell you a little bit about both of those
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我想再多告訴你一些有關這兩者的事
10:22
in the next few moments.
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就在接下來的幾分鐘,
10:25
Drug discovery in a dish is how people often
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在培養皿裡做藥品研究是人們
10:27
talk about this.
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10:28
It's very simple: You take a patient with a disease,
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最常想到的,
這很簡單,你找一位病人
10:31
let's say motor neuron disease,
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1819
假定是患有運動神經疾病,
10:33
you take a skin sample,
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你做一個皮膚的取樣,
10:35
you do the pluripotent reprogramming,
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你把它重編為多功能幹細胞,
10:38
as I've already told you,
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就像我已經跟你說過的,
10:40
and you generate live motor nerve cells.
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你可以產生活的運動神經元細胞。
10:42
That's straightforward, because that's what
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就是這麼直接,因為那就是
10:44
pluripotent cells can do.
255
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1737
多功能幹細胞可以做到的事。
10:46
But crucially, you can then compare their behavior
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但很重要地,你可以把它們的活動
與相同的但健康的原生細胞作比較,
10:49
to their equivalent but healthy counterparts,
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2423
10:51
ideally from an unaffected relative.
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2030
理想上是與未受到影響的 周邊細胞相比,
10:53
That way, you're matching for genetic variation.
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這麼做你就吻合了基因的差異性。
10:56
And that's exactly what we did here.
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這正是我們這裡一直以來在做的事。
10:59
This was a collaboration with colleagues:
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這是同事們之間共同合作的成果,
11:01
in London, Chris Shaw; in the U.S., Steve Finkbeiner and Tom Maniatis.
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有在倫敦的克力斯.修、
美國的史蒂夫.芬博納、 湯姆.曼尼亞提斯。
11:04
And what you're looking at, and this is amazing,
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2522
而你正看著的圖片是非常讓人驚訝的,
11:07
these are living, growing, motor nerve cells
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這些是活的、一直在成長的 運動神經細胞,
11:10
from a patient with motor neuron disease.
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來自一個患運動神經疾病的病人。
11:12
It happens to be an inherited form.
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它是遺傳造成的,
11:14
I mean, just imagine that.
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11:15
This would have been unimaginable 10 years ago.
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就想像看看,
這在十年前可還無法想像的。
11:18
So apart from seeing them grow and put out processes,
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除了看著它們成長 以及死亡的過程之外,
11:21
we can also engineer them so that they fluoresce,
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我們還可以設計讓它們發出螢光,
11:24
but crucially, we can then track their individual health
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但很重要地,我們能因此追蹤 它們各自的健康
11:27
and compare the diseased motor nerve cells
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用來比較不健康的運動神經細胞
11:29
to the healthy ones.
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和健康的(運動神經)細胞。
11:31
And when you do all that and put it together,
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當你做這些事 以及把結果擺在一起時,
11:35
you realize that the diseased ones,
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你會明白不健康的細胞,
11:37
which is represented in the red line,
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被紅線代表的這邊,
11:39
are two and a half times more likely to die
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是2又1/2倍的機率會死
11:42
than the healthy counterpart.
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與健康的對照細胞相比。
11:45
And the crucial point about this is that you then have
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重點是你之後會有
非常棒的鑑定方法來找出藥品,
11:48
a fantastic assay to discover drugs,
280
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3589
11:51
because what would you ask of the drugs,
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1909
因為你想知道有關藥品的事情,
11:53
and you could do this through a high-throughput
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你就可以經由大量看完
11:55
automated screening system,
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自動播放影片系統。
11:57
you'd ask the drugs, give me one thing:
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你只要藥物幫你做一件事:
12:00
find me a drug that will bring the red line
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幫你找到一種藥可以帶紅線
12:02
closer to the blue line,
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1890
更靠近藍線,
12:04
because that drug will be a high-value candidate
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因為那種藥將會是 有高度價值的候選者,
12:08
that you could probably take direct to human trial
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2900
讓你可以高度可能地直接做人體試驗,
12:10
and almost bypass that bottleneck
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幾乎可以越過瓶頸,
12:13
that I've told you about in drug discovery
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也就是我剛跟你說會在藥物發明
12:15
with the animal models,
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用動物實驗體的不足,
12:17
if that makes sense. It's fantastic.
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如果這有道理,會是非常棒的。
12:20
But I want to come back
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但我想回到
12:22
to how you might use stem cells directly
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如何讓你能直接使用幹細胞
12:24
to repair damage.
295
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12:25
And again there are two ways to think about this,
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1825
來修復損傷。
一樣的有兩個方向來思考這件事,
12:27
and they're not mutually exclusive.
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2015
它們不是完全不相容的。
12:29
The first, and I think in the long run
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2290
第一、我想長遠來看
12:31
the one that will give us the biggest dividend,
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這會給我們最大的好處,
12:34
but it's not thought of that way just yet,
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而且還沒有其他人這樣想過,
12:36
is to think about those stem cells that are already
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3256
是去思考那些已經在你 大腦中的幹細胞
12:40
in your brain, and I've told you that.
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就像我剛跟你說的那樣。
12:41
All of us have stem cells in the brain,
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我們所有人的大腦都有幹細胞,
12:43
even the diseased brain,
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1635
甚至在發生病變的大腦,
12:45
and surely the smart way forward
305
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1618
當然往前進的聰明的方法是
12:47
is to find ways that you can promote and activate
306
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找到讓你可以促進與活化
12:49
those stem cells in your brain already
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2036
這些已經在你大腦裡的幹細胞,
12:51
to react and respond appropriately to damage
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3187
適當地對損傷做反應、回應,
12:54
to repair it.
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來修復它。
12:56
That will be the future.
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這會是未來的前景。
12:57
There will be drugs that will do that.
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將會有藥物能夠做這件事。
13:00
But the other way is to effectively parachute in cells,
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而另外一個想法是 有效地空投進細胞,
13:04
transplant them in,
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1804
把它們移植進去,
13:06
to replace dying or lost cells, even in the brain.
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以取代正在死亡或逝去的細胞, 甚至是大腦裡面。
13:10
And I want to tell you now an experiment,
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2088
我現在要告訴你一個實驗,
13:12
it's a clinical trial that we did,
316
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1894
是一個我們做過的臨床試驗,
13:14
which recently completed,
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最近才剛做完的,
13:16
which is with colleagues in UCL,
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2517
與我們在倫敦大學學院的同事們,
13:19
David Miller in particular.
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尤其是大衛.米勒。
13:21
So this study was very simple.
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1913
這研究很簡單,
13:23
We took patients with multiple sclerosis
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3102
我們找來了患有多發性硬化症的病人們,
13:26
and asked a simple question:
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1538
想一個簡單的問題,
13:28
Would stem cells from the bone marrow
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1674
會否從骨髓中取出的幹細胞,
13:30
be protective of their nerves?
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1723
對他們的神經細胞是有保護的?
13:31
So what we did was we took this bone marrow,
325
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3845
所以我們所做的是從取出骨髓,
在實驗室裡培養幹細胞,
13:35
grew up the stem cells in the lab,
326
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2217
13:37
and then injected them back into the vein.
327
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2339
再把它們重新注入靜脈。
13:40
I'm making this sound really simple.
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1800
我試著讓這聽起來非常簡單,
13:42
It took five years off a lot of people, okay?
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3107
這花我們五年的時間、很多人力,知道嗎?
13:45
And it put gray hair on me
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1688
它也讓我有了灰頭髮,
13:46
and caused all kinds of issues.
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1481
也引起了各種問題。
13:48
But conceptually, it's essentially simple.
332
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4023
但概念上而言它是基礎地簡單。
13:52
So we've given them into the vein, right?
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3307
所以我們已經把它們送進靜脈,對吧?
13:55
So in order to measure whether this was successful or not,
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3633
為了評量到底這個手段成不成功,
13:59
we measured the optic nerve
335
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1748
我們評量視神經,
14:01
as our outcome measure.
336
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1686
作為我們的評量結果。
14:02
And that's a good thing to measure in M.S.,
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1765
對要來評量多發性硬化症病人 也是一件好事
14:04
because patients with M.S. sadly suffer
338
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2073
因為患有多發性硬化症的病人不幸地遭受
14:06
with problems with vision --
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1472
與視力有關的問題,
14:08
loss of vision, unclear vision.
340
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2190
如失明、看不清楚,
14:10
And so we measured the size of the optic nerve
341
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2083
所以我們評量視神經的大小
14:12
using the scans with David Miller
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與大衛.米勒一起用掃描器
14:14
three times -- 12 months, six months,
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三遍:12個月前、6個月前、
14:16
and before the infusion --
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以及注射之前。
14:18
and you can see the gently declining red line.
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你可以看到那稍微降低的紅線。
14:21
And that's telling you that the optic nerve is shrinking,
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那是要告知你視神經正在萎縮中,
14:23
which makes sense, because their nerves are dying.
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那講得通的,因為他們的 神經細胞正在死亡中。
14:25
We then gave the stem cell infusion
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接著我們做了幹細胞注射,
14:28
and repeated the measurement twice --
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又做了兩次評量,
14:30
three months and six months --
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3個月後和6個月後,
14:31
and to our surprise, almost,
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讓我們大部分人驚訝的是
14:33
the line's gone up.
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那條紅線往上爬升了。
14:36
That suggests that the intervention
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這表明了介入注射
14:38
has been protective.
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是有保護性的,
14:40
I don't think myself that what's happened
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我個人不認為
14:42
is that those stem cells have made new myelin
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是因為那些幹細胞 製造出新的髓鞘細胞,
14:44
or new nerves.
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或是新的神經細胞,
14:45
What I think they've done is they've promoted
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我認為它們做到的是它們促使
14:48
the endogenous stem cells, or precursor cells,
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了內生性的幹細胞或者前身細胞
14:50
to do their job, wake up, lay down new myelin.
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去做它們的工作, 醒來、覆蓋上新的髓鞘,
14:54
So this is a proof of concept.
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這是一個有證據的想法,
14:56
I'm very excited about that.
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我可是對這感到興奮的。
14:58
So I just want to end with the theme I began on,
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所以我就想要用 我剛開始談的主題做結束,
15:01
which was regeneration and hope.
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也就是再生與希望。
15:03
So here I've asked John
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我也問過了約翰
15:05
what his hopes are for the future.
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他對未來有什麼希望?
15:07
John: I would hope that
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我會希望
15:09
sometime in the future
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在未來的某個時點
15:11
through the research that you people are doing,
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經由你們現在在做的研究
15:13
we can come up with a cure
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我們能找出解藥,
15:15
so that people like me can lead a normal life.
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然後和我一樣的人 能夠過正常的生活。
15:19
SC: I mean, that speaks volumes.
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我想,這很明確。
15:22
But I'd like to close by first of all thanking John --
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不過我想先謝謝約翰來作結尾,
15:24
thanking John for allowing me to share
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謝謝約翰同意我來分享
15:26
his insights and these clips with you all.
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他的想法和這些短片給你們大家。
15:29
But I'd also like to add to John and to others
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但我還想要做補充給約翰和其他人,
15:32
that my own view is, I'm hopeful for the future.
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我個人的觀點是 我對未來是有希望的。
15:34
I do believe that the disruptive technologies
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我相信這些顛覆性的科技
15:37
like stem cells that I've tried to explain to you
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像是我試著解釋 給你們聽的幹細胞
15:39
do offer very real hope.
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的確帶來希望。
15:40
And I do think that the day that we might be able
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我認為那一天, 我們可能有能力
15:42
to repair the damaged brain
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修復受損的大腦的那天,
15:44
is sooner than we think.
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是比我們想像的來得快。
15:45
Thank you.
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謝謝。
15:47
(Applause)
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(掌聲)
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