Kevin Stone: The bio-future of joint replacement

譯者: Bill Hsiung 審譯者: Adrienne Lin

So let me just start with my story.

那麼，讓我直接開始講我的故事。

So I tore my knee joint meniscus cartilage

我大學時代踢足球的時候，

playing soccer in college.

撕傷了我膝關節的半月軟骨。

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

然後我又撕傷了我膝關節上的前交叉韌帶，

and then developed an arthritic knee.

因此病情惡化成為膝關節炎。

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

而且我確定在座的各位當中，有許多人跟我有著同樣的故事。

and, by the way, I married a woman

順帶一提，我娶到了一個

who has exactly the same story.

跟我有著完全一樣經歷的妻子。

So this motivated me to become an orthopedic surgeon

因此這激勵了我成為一名骨外科醫生，

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

看看我是否能夠專注於找出讓這些使我不能運動的毛病

that would keep me playing sports and not limit me.

不再限制我的解決方法。

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

以此為楔子，讓我很快地放一段影片給大家看，

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

讓你們對於我將要解釋的東西，有個大概的了解。

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

旁白：我們都清楚地明白癌症的風險，

but there's another disease

但是另外有一種疾病，

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

其影響的人甚至比癌症還要多，那就是關節炎。

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

癌症也許是致命的，但是如果你看看統計數字，

arthritis ruins more lives.

更多的性命毀在關節炎手上。

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

假設你能活到高齡，你患有關節炎的機率

you'll develop arthritis.

高達百分之五十。

And it's not just aging that causes arthritis.

導致關節炎的原因並不是因為老化。

Common injuries can lead to decades of pain,

常見的運動傷害能導致數十年的疼痛，

until our joints quite literally grind to a halt.

直到我們的關節磨損到不能再使用為止。

Desperate for a solution, we've turned to engineering

亟需解決方案，我們已朝向設計製造

to design artificial components

人工關節組件

to replace our worn-out body parts,

來替換我們耗盡的身體部件。

but in the midst of the modern buzz

但是在圍繞著仿生機械身體美好前景

around the promises of a bionic body,

的摩登炒作中，

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

我們是否該停下來問問，有沒有其他更好、更自然的方法？

Let's consider an alternative path.

讓我們考慮另一個替代方案。

What if all the replacements our bodies need

如果我們身體所需求的所有替代品

already exist in nature,

都已經存在於自然界，

or within our own stem cells?

或者存在於我們自身的幹細胞中，那將如何？

This is the field of biologic replacements,

這就是生物性替換的領域，

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

以自然的、新的部件來替換我們耗盡的部件。

Kevin Stone: And so, the mission is:

Kevin Stone: 所以任務是：

how do I treat these things biologically?

我要如何利用生物性的方法來治療這些疾病？

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

讓我們來談談，我為我妻子所做的事，

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

和我已經為其他數百名病患所做的事。

First thing for my wife,

首先是為我妻子所做的，

and the most common thing I hear from my patients,

也是我從病人那最常聽到的事，

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

特別是介於 40~80 歲的族群、70 歲的族群，

is they come in and say,

他們通常進來後會說，

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

「醫生，難道沒有可以吸震的東西放到我的膝蓋裡嗎？

I'm not ready for joint replacement."

我還沒有準備好做關節置換手術。」

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

因此，在我妻子身上，我將人類半月板移植供應體

right into that [knee] joint space.

置入她膝關節的空間內。

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

這個 [移植] 取代了 [缺失的半月板] 。

And then for that unstable ligament,

而對於那個不穩定的韌帶，

we put in a human donor ligament

我們也放入了一個人類捐贈的韌帶

to stabilize the knee.

來穩定住膝蓋。

And then for the damaged arthritis on the surface,

而那些因為關節炎而受損的表面，

we did a stem cell paste graft,

我們使用了幹細胞黏貼移植法，

which we designed in 1991,

這方法是我們於 1991 年設計出來的，

to regrow that articular cartilage surface

能夠重新長出關節軟骨表面，

and give it back a smooth surface there.

因此重回原本滑順的表面。

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

在這邊，左邊是我妻子的爛膝蓋，

and her just hiking now

而如今她剛剛能夠登山健行，

four months later in Aspen, and doing well.

手術完成的四個月後，她去阿斯彭參加健行，反應良好。

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

手術很成功，不僅對我妻子是這樣，對其他病人一定也是一樣。

The girl on the video, Jen Hudak,

影片中的女孩，Jen Hudak，

just won the Superpipe in Aspen

剛在阿斯彭贏得 Superpipe 極限滑雪大賽，

just nine months after having destroyed her knee,

僅僅在毀了她膝蓋的九個月後，

as you see in the other image --

如同你在其他照片所看到的一般 —

and having a paste graft to that knee.

她的膝蓋進行了黏貼移植。

And so we can regrow these surfaces biologically.

因此我們可以生物性的重新長出這些表面。

So with all this success,

即使有了這些成功，

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

你可能會問，這樣還不夠好嗎？

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

因為沒有足夠的捐贈者，

There's not enough young, healthy people

沒有足夠的年輕、健康的人們

falling off their motorcycle

從摩托車上摔下來，

and donating that tissue to us.

然後捐贈那些組織給我們。

And the tissue's very expensive.

也因此，這些組織非常的昂貴。

And so that's not going to be a solution

因此，這不會是個能夠

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

提供我們全球性生物組織來源的解決方案。

But the solution is animal tissue

但是，解決方案就是動物組織，

because it's plentiful, it's cheap,

因為它們不虞匱乏，並且便宜。

you can get it from young, healthy tissues,

你可以很容易取得年輕、健康的組織，

but the barrier is immunology.

但是障礙就是免疫反應。

And the specific barrier

這個專一性的障礙是

is a specific epitope

有一種特別的蛋白免疫表位

called the galactosyl, or gal epitope.

稱作半乳糖基或是 gal 表位。

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

因此，如果我們要移植動物性組織到人類身上，

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

我們就必須找出一種方法，移除這個免疫表位。

So my story in working with animal tissues

因此，我與動物組織一起工作的故事

starts in 1984.

始於 1984。

And I started first

我首先從

with cow Achilles tendon,

牛的跟（阿基里斯）腱開始，

where we would take the cow Achilles tendon,

我們使用牛的跟腱，

which is type-I collagen,

它是甲型膠原蛋白，

strip it of its antigens

以酸性溶劑與清潔劑清洗

by degrading it with an acid and detergent wash

來移除它的抗原，

and forming it into a regeneration template.

再將它塑型成可供再生的模板。

We would then take that regeneration template

然後我們利用這個再生模板，

and insert it into the missing meniscus cartilage

將之置入缺失的半月軟骨處，

to regrow that in a patient's knee.

在病人的膝蓋內重新生長出來。

We've now done that procedure,

這樣我們就完成了這項手術，

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

這手術在全球已經有超過四千起成功的術例，

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

因此它已經是 FDA 核准並被世界所接受

to regrow the meniscus.

重新生長半月軟骨的方法。

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

這方法在我能夠降解組織的時候，一切都很好。

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

但是當我需要一個完整的韌帶組織時，你的韌帶又將會如何？

I can't grind it up in a blender.

我不能再用攪拌器將組織打碎。

So in that case,

因此，

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

我們與 Uri Galili 和 Tom Turek 一同設計了 —

an enzyme wash

一種酵素洗劑

to wash away, or strip,

來洗掉，或脫除

those galactosyl epitopes

這些半乳糖基免疫表位，

with a specific enzyme.

藉由一種特殊的酵素。

And we call that a "gal stripping" technique.

我們稱之為「gal 脫除法」。

What we do is humanize the tissue.

我們所做的是將這組織「人類」化。

It's by gal stripping that tissue

藉由脫除組織上的 gal 基

we humanize it (Laughter),

我們就使其「人類」化了，

and then we can put it back

然後我們將之放回

into a patient's knee.

到病人的膝蓋內。

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

因為手術的成功，現在我們能用豬的韌帶 —

young, healthy, big tissue,

年輕、健康、大組織，

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

在一個 FDA 核准的實驗性療法中，將之置入十個病人身上 —

and then one of our patients went on to have

然後我們其中一位病人獲得了

three Canadian Masters Downhill championships --

三項加拿大大師級下坡滑雪競賽大獎 —

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

用他的「豬腳」，他自己取的。所以我們知道這方法可行。

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

關於這組織療法的擴大臨床試驗計畫正在審查階段。

So what about the next step?

那麼，下一步是什麼？

What about getting to a total biologic knee replacement,

一個完全生物性的膝關節置換聽起來如何？

not just the parts?

不只是零部件而已。

How are we going to revolutionize artificial joint replacement?

我們要如何推動人工關節置換革命？

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

那麼，我就告訴你我們準備如何下手。

So what we're going to do is take

我們所將要做的是，使用

an articular cartilage

從年輕、健康的豬隻身上

from a young, healthy pig,

所取得的關節軟骨，

strip it of its antigens,

脫去它的抗原，

load it with your stem cells,

裝載上你的幹細胞，

then put it back on to that

然後把它放回

arthritic surface in your knee,

你膝蓋的軟骨表面上，

tack it on there, have you heal that surface

釘在那邊，直到你那邊的軟骨表面癒合為止，

and then create a new biologic surface for your knee.

然後也就產生了你膝蓋新的生物性表面。

So that's our biologic approach right now.

這就是現在我們的生物性策略。

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

我們將要用零部件來重新建造你的膝蓋。

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

我們將重鋪全新的軟骨關節表面。

But we have other advantages from the animal kingdom.

但是，動物界提供了我們其他的優勢。

There's a benefit of 400 million years

行走 40 億年

of ambulation.

所提供的利基。

We can harness those benefits.

我們可以利用這些優惠。

We can use thicker, younger, better tissues

我們可以使用比你膝蓋受傷前，

than you might have injured in your knee,

更厚，更年輕，更好的組織，

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

或者比起你 40, 50 或 60 歲時好的組織。

We can do it as an outpatient procedure.

我們可以以門診手術來進行。

We can strip that tissue very economically,

我們可以非常經濟地脫去組織上的抗原。

and so this is how we can get biologic knee replacement

這就是我們如何可以讓生物性膝關節置換

to go global.

拓展到全球的方法。

And so welcome to super biologics.

歡迎來到超級生物工程學。

It's not hardware.

不是硬體。

It's not software.

不是軟體。

It's bioware.

是生物體。

It's version 2.0 of you.

是第二代的你。

And so with that, coming to a --

最後～

(Laughter)

（笑聲）

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

我相信，很快地就會在你們附近的戲院上映。

Thank you very much.

非常謝謝你們。

(Applause)

（掌聲）