The brain may be able to repair itself -- with help | Jocelyne Bloch

譯者: Wink Wong 審譯者: Becky Yuan

So I'm a neurosurgeon.

我是一位神經㚈科醫生。

And like most of my colleagues,

就像我的大部分同事一樣，

I have to deal, every day, with human tragedies.

我每天要面對很多人間悲剧。

I realize how your life can change from one second to the other

使我明白到人可能因為一次 嚴重中風或車禍，

after a major stroke or after a car accident.

而瞬間改變一生的命運。

And what is very frustrating for us neurosurgeons

最令我們這些神經學家苦惱的，

is to realize that unlike other organs of the body,

就是知道腦部不似其他器官，

the brain has very little ability for self-repair.

很難自我修復。

And after a major injury of your central nervous system,

病人的中央神經系統 受到嚴重受創後，

the patients often remain with a severe handicap.

最後常常變成嚴重殘障。

And that's probably the reason why I've chosen

可能因為這樣，

to be a functional neurosurgeon.

我決定成為功能性神經㚈科醫生。

What is a functional neurosurgeon?

功能性神經㚈科醫生 做什麼工作呢？

It's a doctor who is trying to improve a neurological function

這些醫生採用不同的㚈科方法，

through different surgical strategies.

致力改善神經功能。

You've certainly heard of one of the famous ones

各位一定聽過其中一個著名的方法

called deep brain stimulation,

叫做腦部深層刺激手術。

where you implant an electrode in the depths of the brain

就是植入一種電極在腦部深層，

in order to modulate a circuit of neurons

改變神經元的迴路，

to improve a neurological function.

繼而改善神經系統的功能。

It's really an amazing technology

這種科技實在神奇，

in that it has improved the destiny of patients

因為它已經改變一些病人的命運，

with Parkinson's disease,

例如柏金遜症、

with severe tremor, with severe pain.

嚴重腦震盪和痛症。

However, neuromodulation does not mean neuro-repair.

但是神經調節並不是修復神經。

And the dream of functional neurosurgeons

功能性㚈科醫生的夢想

is to repair the brain.

就是修復腦部。

I think

我想

that we are approaching this dream.

我們正朝著這個夢想前進。

And I would like to show you

而且我想告訴大家

that we are very close to this.

我們很快實現夢想。

And that with a little bit of help,

只需要一點的幫忙，

the brain is able to help itself.

腦部就能自我修復。

So the story started 15 years ago.

這件事源自15年前，

At that time, I was a chief resident

那時我是駐院總醫師，

working days and nights in the emergency room.

在急診室日夜不停工作。

I often had to take care of patients with head trauma.

常常要照顧腦創傷病人。

You have to imagine that when a patient comes in with a severe head trauma,

可以想像當一個病人頭部 受到重創入院，

his brain is swelling

他的腦部不斷腫脹，

and he's increasing his intracranial pressure.

顱內壓增加，

And in order to save his life,

為了拯救他的生命，

you have to decrease this intracranial pressure.

一定要降低顱內壓。

And to do that,

因此

you sometimes have to remove a piece of swollen brain.

有時需要替病人移除一塊 腫脹的腦組織。

So instead of throwing away these pieces of swollen brain,

我們沒有把那塊腦組織丟棄，

we decided with Jean-François Brunet,

反而決定跟我的一位同事，

who is a colleague of mine, a biologist,

那是生物學家Jean-Francois Brunet

to study them.

一同硏究。

What do I mean by that?

我那樣說是什麼意思呢？

We wanted to grow cells from these pieces of tissue.

那時我們想從這些腦組織 培育細胞。

It's not an easy task.

但這是並非容易的事。

Growing cells from a piece of tissue

從一塊腦組織培育細胞

is a bit the same as growing very small children

就像把一個幼童跟家人分開，

out from their family.

由我們養育一樣。

So you need to find the right nutrients,

所以一定要找到適合的營養食物、

the warmth, the humidity

溫暖和濕度的環境，

and all the nice environments to make them thrive.

和所有良好的外圍 使他們茁壯成長。

So that's exactly what we had to do with these cells.

這正是我們培養 這些細胞的想法。

And after many attempts,

經過多次嘗試，

Jean-François did it.

Jean-Francois 終於成功。

And that's what he saw under his microscope.

這是他在顯微鏡下看到的東西。

And that was, for us, a major surprise.

我們知道結果後，感到很驚訝。

Why?

為什麼？

Because this looks exactly the same as a stem cell culture,

因為這個情況就跟培養 幹細胞一樣，

with large green cells surrounding small, immature cells.

有大的綠色細胞包圍著 未長成的小細胞。

And you may remember from biology class

或許你會記得上生物課，

that stem cells are immature cells,

學過幹細胞是未成熟的細胞，

able to turn into any type of cell of the body.

可以變成身體任何一種細胞。

The adult brain has stem cells, but they're very rare

成人的腦部也有幹細胞， 但十分稀少。

and they're located in deep and small niches

這些細胞存在於腦部低層

in the depths of the brain.

深處小小的位置。

So it was surprising to get this kind of stem cell culture

所以能夠從手術室病人 腫脹的腦部表面，

from the superficial part of swollen brain we had

得到這些幹細胞培養組織，

in the operating theater.

實在令人感到意外。

And there was another intriguing observation:

還有另一個有趣的觀測結果：

Regular stem cells are very active cells --

正常的幹細胞非常活躍－

cells that divide, divide, divide very quickly.

它們不停分裂，非常迅速。

And they never die, they're immortal cells.

永遠不會死亡，是一種不死細胞。

But these cells behave differently.

但是這些細胞行為不一樣。

They divide slowly,

它們緩慢地分裂，

and after a few weeks of culture,

經過數星期的培養，

they even died.

它們甚至死亡。

So we were in front of a strange new cell population

所以我們面對了一群 奇怪的新細胞，

that looked like stem cells but behaved differently.

它們貌似幹細胞，但行為有分別。

And it took us a long time to understand where they came from.

我們花了很長時間， 才知道它們從那𥚃來。

They come from these cells.

就是來自這些細胞，

These blue and red cells are called doublecortin-positive cells.

這些藍色、紅色細胞叫做 微管相關蛋白正向細胞。

All of you have them in your brain.

在座各位的腦部都有這些細胞。

They represent four percent of your cortical brain cells.

它們佔了腦部皮質細胞的4％。

They have a very important role during the development stage.

對人類的成長期很重要。

When you were fetuses,

在胚胎期，

they helped your brain to fold itself.

它們幫助腦部摺疊起來。

But why do they stay in your head?

但為什麼它們仍然留在 大家的腦部呢？

This, we don't know.

這個我們不知道。

We think that they may participate in brain repair

或許它們要參與腦部的修復，

because we find them in higher concentration

因為我們發現它們 在腦損傷的附近

close to brain lesions.

比較高度聚集。

But it's not so sure.

但我們仍然不能確定。

But there is one clear thing --

但是有一件事實很清楚-

that from these cells,

我們從這些細胞，

we got our stem cell culture.

可以培養幹細胞。

And we were in front of a potential new source of cells

這些具有潛力的新細胞 就在我們面前，

to repair the brain.

它們能夠修復腦部。

And we had to prove this.

我們一定要證實這個論點。

So to prove it,

為了證實它，

we decided to design an experimental paradigm.

我們決定設計一個實驗範例。

The idea was to biopsy a piece of brain

方法是在腦部不重要的區域

in a non-eloquent area of the brain,

做活體組織切片，

and then to culture the cells

然後培殖這些細胞，

exactly the way Jean-François did it in his lab.

就跟Jean-Francois在實驗室 試驗的方法一樣。

And then label them, to put color in them

然後把它標籤再染上顏色，

in order to be able to track them in the brain.

方便追踨它在腦部的位置。

And the last step was to re-implant them

最後把它再次植入在

in the same individual.

同一個病人。

We call these

我們稱這些是

autologous grafts -- autografts.

自體移植物。

So the first question we had,

我們首先有一個疑問，

"What will happen if we re-implant these cells in a normal brain,

「如果我們再次植入這些細胞 在正常腦部，會有什麼事；

and what will happen if we re-implant the same cells

又或者再次植入有創傷的腦部，

in a lesioned brain?"

又會發生什麼事情呢？

Thanks to the help of professor Eric Rouiller,

很多謝Eric Rouiller 教授的幫忙，

we worked with monkeys.

我們一同利用猴子做研究，

So in the first-case scenario,

第一個的方案，

we re-implanted the cells in the normal brain

我們再次植入細胞 在正常的腦部，

and what we saw is that they completely disappeared after a few weeks,

數星期後，我們發現 這些細胞完全消失，

as if they were taken from the brain,

就如它們從腦部帶走，

they go back home,

後來回到從前腦部的家，

the space is already busy,

由於地方實在太擠擁，

they are not needed there, so they disappear.

所以沒需要再逗留， 唯有自行消失。

In the second-case scenario,

第二個方案，

we performed the lesion,

我們替𤠣腦做一個傷口，

we re-implanted exactly the same cells,

跟著再次植入完全一樣的細胞，

and in this case, the cells remained --

這一次細胞繼續留下來-

and they became mature neurons.

而且變成成熟的神經元。

And that's the image of what we could observe under the microscope.

這是我們在顯微鏡下 觀察到的影像。

Those are the cells that were re-implanted.

這是再次植入的細胞。

And the proof they carry,

它們帶了實證，

these little spots, those are the cells that we've labeled

這些小點就是我們培養細胞時，

in vitro, when they were in culture.

在試管𥚃標籤而成的。

But we could not stop here, of course.

當然我們不會就此停下來。

Do these cells also help a monkey to recover after a lesion?

這些細胞是否可以幫助 有腦創傷的猴子恢復呢？

So for that, we trained monkeys to perform a manual dexterity task.

因此我們訓練猴子做一些 手指靈巧的動作。

They had to retrieve food pellets from a tray.

牠們要從托盤拿起食物粒。

They were very good at it.

猴子做得勝任有餘。

And when they had reached a plateau of performance,

當訓練牠們到了穩定期時，

we did a lesion in the motor cortex corresponding to the hand motion.

我們替牠們手部動作相應的腦部 皮質做了一個傷口。

So the monkeys were plegic,

於是猴子癱瘓了，

they could not move their hand anymore.

雙手不能移動，

And exactly the same as humans would do,

就跟人類的情況一樣，

they spontaneously recovered to a certain extent,

猴子中風後，

exactly the same as after a stroke.

身體自行恢復到某個程度。

Patients are completely plegic,

病人完全癱瘓，

and then they try to recover due to a brain plasticity mechanism,

病人希望康復，由於腦部的 可塑性機制，

they recover to a certain extent,

病人能夠恢復到某一程度，

exactly the same for the monkey.

就跟猴子的情況完全一樣。

So when we were sure that the monkey had reached his plateau

當我們確定猴子已經完成

of spontaneous recovery,

身體自行恢復的階段，

we implanted his own cells.

我們便植入牠自己的細胞。

So on the left side, you see the monkey that has spontaneously recovered.

在左方，你可以見到猴子 已經自行恢復。

He's at about 40 to 50 percent of his previous performance

牠跟未有腦損傷時的表現，

before the lesion.

大概做到4至5成。

He's not so accurate, not so quick.

牠的動作並不那麼準確和敏捷。

And look now when we re-implant the cells:

再看看，我們再次植入這些細胞：

Two months after re-implantation, the same individual.

兩個月後，同一隻猴子。

(Applause)

（鼓掌聲）

It was also very exciting results for us, I tell you.

那是令人非常興奮的結果。

Since that time, we've understood much more about these cells.

從此我們更加了解這些細胞。

We know that we can cryopreserve them,

也知道可以把細胞超低溫冷凍，

we can use them later on.

留待日後再用。

We know that we can apply them in other neuropathological models,

我們可以應用在其他 神經病理模式。

like Parkinson's disease, for example.

例如柏金遜症。

But our dream is still to implant them in humans.

但是我們的夢想仍是 把細胞植入人腦。

And I really hope that I'll be able to show you soon

我真的希望很快顯示各位面前，

that the human brain is giving us the tools to repair itself.

我們可以利用人腦成為 人體自我修復的功具。

Thank you.

謝謝。

(Applause)

（鼓掌聲）

Bruno Giussani: Jocelyne, this is amazing,

Bruno Glussani： Jocelyne， 真是令人驚嘆呢，

and I'm sure that right now, there are several dozen people in the audience,

我肯定在座有很多觀眾，

possibly even a majority,

甚至可能大部分人

who are thinking, "I know somebody who can use this."

都在想：「我知道某人可以 接受這個治療。」

I do, in any case.

無論如何我也認同。

And of course the question is,

但問題是

what are the biggest obstacles

什麼是你進行人體臨床試驗時，

before you can go into human clinical trials?

最大的阻力呢？

Jocelyne Bloch: The biggest obstacles are regulations. (Laughs)

Jocelyne Bloch: 最大的阻力 就是規條。（笑聲）

So, from these exciting results, you need to fill out

雖然有這些令人興奮的結果，

about two kilograms of papers and forms

但要填寫大約2公斤的表格，

to be able to go through these kind of trials.

才能獲准去做這些試驗。

BG: Which is understandable, the brain is delicate, etc.

BG：這是可以理解，因為腦部是那麼纖細脆弱等等。

JB: Yes, it is, but it takes a long time

JB: 對的，但是需要很長的時間，

and a lot of patience and almost a professional team to do it, you know?

需要耐力和一个專業的團隊。

BG: If you project yourself --

BG: 如果你自己預測

having done the research

完成研究

and having tried to get permission to start the trials,

和獲准開始試驗後，

if you project yourself out in time,

假如妳可以預計需要多少時間，

how many years before somebody gets into a hospital

病人要入院接受這種治療，

and this therapy is available?

需要等多少年呢？

JB: So, it's very difficult to say.

JB : 這樣很難說。

It depends, first, on the approval of the trial.

首先要看做實驗可否獲批。

Will the regulation allow us to do it soon?

那些規條會否讓我們 盡快做試驗呢？

And then, you have to perform this kind of study

然後要替一小撮病人

in a small group of patients.

進行硏究。

So it takes, already, a long time to select the patients,

那又要花長時間挑選病人

do the treatment

接受治療，

and evaluate if it's useful to do this kind of treatment.

然後評估這類治療是否有效。

And then you have to deploy this to a multicentric trial.

繼而要展開多核心試驗。

You have to really prove first that it's useful

一定先要證實那是對病人有作用，

before offering this treatment up for everybody.

才能給大眾接受治療。

BG: And safe, of course. JB: Of course.

BG：當然要安全可靠。 JB：一定。

BG: Jocelyne, thank you for coming to TED and sharing this.

BG：Jocelyne，謝謝妳來到Ted 跟我們分享這些見解。

BG: Thank you.

BG：謝謝。

(Applause)

（鼓掌聲)