New nanotech to detect cancer early | Joshua Smith

譯者: Helen Chang 審譯者: S Sung

"You have cancer."

「你得了癌症。」

Sadly, about 40 percent of us will hear those three words within our lifetime,

很不幸，約有 40% 的人 會在活著時聽到這幾個字，

and half will not survive.

其中半數終將不治。

This means that two out of five of your closest friends and relatives

意味著我們每五個親友當中

will be diagnosed with some form of cancer,

有兩個會被診斷出罹患某種癌症，

and one will die.

而一個會病故。

Beyond the physical hardships,

除了身心受苦，

roughly one-third of cancer survivors here in the US

大約三分之一的美國癌症倖存者

will go into debt from treatment.

會因為醫療而負債累累；

And they're at least two and a half times more likely to declare bankruptcy

他們破產的機率

至少是未罹癌者的 2.5 倍。

than those without cancer.

This disease is pervasive.

癌症無所不在，

It's emotionally draining

它損耗人的情感，

and, for many,

使許多人

financially destructive.

散盡家財。

But a cancer diagnosis doesn't have to be a death sentence.

但是被診斷出罹癌不等於被宣判死刑。

Finding cancer early,

及早發現

closer its genesis,

和貼近找出它的成因，

is one of the critical factors to improving treatment options,

對於提高存活率、

reducing its emotional impact

減低情緒影響，

and minimizing financial burdens.

和降低財務負擔至關重要。

Most importantly,

最關鍵的是要儘早發現癌症，

finding cancer early --

which is one of the primary aims of my research --

這也是我主要的研究目標之一，

greatly enhances your odds of survival.

能夠大大提高存活率。

If we just look at the case of breast cancer for example,

舉乳癌為例，

we find that those who are diagnosed and treated at stage one

在第一期就診斷且治療的患者

have a five-year survival rate of nearly 100 percent --

五年的存活率幾近百分之百，

odds that decrease to just 22 percent if treated at stage four.

如果到第四期才治療就只剩 22%。

And similar trends are found for colorectal and ovarian cancer.

大腸直腸癌和卵巢癌的情況類似。

Now, we're all aware that an early diagnosis that is accurate

大家都知道，早期的準確診斷

is critical for survival.

是存活與否的關鍵。

The problem is that many cancer diagnostic tools are invasive,

問題是很多癌症篩檢具有侵入性，

costly,

價格昂貴，

often inaccurate

常常不準確，

and they can take an agonizing amount of time to get the results back.

並且等待結果既焦慮又曠日費時。

Still worse, when it comes to some forms of cancer,

更糟的是若干癌症，

such as ovarian, liver or pancreatic cancer,

例如卵巢癌、肝癌、胰臟癌，

good screening methods simply don't exist,

根本沒有好的檢驗方式，

meaning that often people wait until physical symptoms surface,

意味著等到出現症狀時

which are themselves already indicators of late-stage progression.

已經到了癌症擴散的晚期。

Like a tornado strike in an area without an early warning system,

就好像在沒有龍捲風預警的地區

there is no alarm to warn,

沒有警報，

for the danger is already at your doorstep

一旦龍捲風到了家門口，

when your odds of survival are greatly reduced.

存活的機會就大大減少了。

Having the convenience and accessibility of regular screening options

方便、易取得、

that are affordable, noninvasive and could provide results much sooner,

便宜、非侵入性

和快篩的定期檢驗方式

would provide us with a formidable weapon in the fight against cancer.

將會是我們對抗癌症的強大利器。

An early warning would allow us to get out ahead of the disease

及早發現讓我們能搶得治療先機，

instead of merely following in its relentless wake.

而非只苦追在它殘酷無情的腳步後面。

And this is exactly what I've been doing.

這正是我的工作。

For the past three years, I've been developing technologies

過去三年來，

我一直在研發能夠幫助臨床醫生

that could ultimately aid clinicians

with rapid, early-stage cancer diagnostics.

快速、早期診斷癌症的科技。

And I've been fueled by a deep scientific curiosity,

強烈的科學好奇心與熱情

and a passion to change these statistics.

推動我要改變那些癌症的統計數據。

Last year however,

去年

this fight became much more personal

我的妻子被診斷出罹患乳癌，

when my wife was diagnosed with breast cancer.

使這努力成了與自身息息相關的戰鬥，

It was an experience that added a strong and unexpected emotional dimension

參雜了我始料未及的情感層面。

to these efforts.

I know firsthand how life-altering treatment can be,

我親身體驗到

治療對生活所造成的巨大衝擊，

and I'm keenly aware of the emotional havoc

十分清楚它帶來的精神浩劫，

that cancer can wreak on a family,

癌症可能會毀滅我們的家庭，

which in our case included our two young daughters.

包括我們兩個年幼的女兒。

Because we found it early during a routine mammogram,

經由定期乳房攝影檢查及早發現，

we were able to focus primarily on treatment options

我們得以專注治療仍限於局部的腫瘤，

for the localized tumor,

reaffirming to me how important an early diagnosis is.

使得我再次確認早期診斷極其重要。

Unlike other forms of cancer,

不同於其他的癌症，

mammograms do offer an early-stage screening option for breast cancer.

乳房攝影檢查能有效偵測早期乳癌。

Still, not everyone has this done,

儘管如此，仍有人沒定期做檢查，

or they may develop breast cancer

也有人未達建議該接受乳房攝影 檢查的年齡之前就已罹患乳癌。

before the middle age recommendation for having a mammogram.

So, there's still a lot of room for improvement,

因此，即便已有篩檢方式的癌症 仍有很大的改善空間。

even for cancers that do have screening options,

and, of course, considerable benefits for those that don't.

而那些尚未有篩檢法的癌症 更將會大大受益。

A key challenge then for cancer researchers

癌症研究者的關鍵挑戰在於

is to develop methods

開發出一種用於定期體檢，

that make regular screening for many types of cancers

能夠更容易查出多種癌症的方法。

much more accessible.

Imagine a scenario where during your regular checkup,

想像這情境：

醫生在定期體檢時能採取 簡單、非侵入性的尿液樣本

your doctor can take a simple, noninvasive urine sample,

or other liquid biopsy,

或是其他的液狀活檢體，

and present you with the results before you even leave the doctor's office.

在你離開診所之前就告訴你結果。

Such a technology could dramatically reduce the number of people

這樣的科技能夠大量減少

早期癌症篩檢所漏掉的人數。

who slip through the net of an early-stage cancer diagnosis.

My research team of engineers and biochemists

我的工程與生化研究團隊面對這挑戰，

is working on exactly this challenge.

We're working on ways to frequently activate an early-stage cancer alarm

正試圖找出一種能在人們仍健康時

就會觸發應該去做定期體檢的警示，

by enabling regular screenings that would start when a person is healthy

so that action could be taken to stop cancer the moment it emerges,

一旦出現癌症徵兆，馬上採取行動，

and before it can progress beyond its infancy.

不讓它有機會擴展到中、後期。

The silver bullet in this case are tiny vesicles,

此處的殺手鐧被稱為「胞外染色體」，

little escape pods regularly shed by cells called exosomes.

是細胞經常脫落的小小逃生艙。

Exosomes are important biomarkers

胞外染色體

是能在癌症早期預警的重要生物標記。

that provide an early-warning system for the development of cancer.

And because they're abundantly present in just about every bodily fluid,

這些標記大量而廣泛存在體液裡，

including blood, urine and saliva,

包括血液、尿液和唾液中，

they're extremely attractive for noninvasive liquid biopsies.

不具侵入性，極具液體活檢的優勢。

There's just one problem.

但這裡仍然有個問題，

An automated system for rapidly sorting these important biomarkers

能夠自動快篩這些生物標記的機制

is not currently available.

目前並不存在。

We've created a technology that we call nano-DLD

我們建立了稱作「奈米 DLD」的科技

that is capable of precisely this:

能夠精準做到

automated exosome isolation

自動分離出胞外染色體

to aid rapid cancer diagnostics.

以快速癌症篩檢。

Exosomes are the newest early-warning weapon, if you will,

胞外染色體是出現在液體活檢陣線的

to emerge on the liquid biopsy front.

最新早期預警利器。

And they're really, really small.

它們非常微小，

They measure just 30 to 150 nanometers in diameter.

直徑僅有 30 到 150 奈米，

This is so tiny

小到

that you could fit about a million of them into a single red blood cell.

一粒紅血球的體積裡能裝下一百萬個，

That's roughly the difference between a golf ball

比例相當於一顆高爾夫球

and a fine grain piece of sand.

對應於一粒沙子。

Once thought to be little bins for unwanted cellular waste,

它雖曾被認為是細胞廢物的垃圾桶，

it has been found that cells actually communicate

後來卻發現，事實上細胞經由

by producing and absorbing these exosomes

產生和吸收胞外染色體來互相溝通，

which contain surface receptors,

因為它們具有表面接收器、蛋白質

proteins and other genetic material collected from their cell of origin.

以及母細胞所給予的基因。

When absorbed by a neighboring cell,

一旦被臨近的細胞所吸收，

exosomes release their contents into the receiving cell,

胞外染色體就會釋放內含的物質，

and can set in motion fundamental changes in gene expression --

大幅改變接收細胞的基因表現。

some good,

有些是好的改變；

and this is where cancer comes in,

但在癌症的情況下

some bad.

則是不好的改變。

Because they are clothed in the material of the mother cell,

因為它們被母細胞的物質包覆著，

and contain a sample of its environment,

裡頭含有環境的樣本，

they provide a genetic snapshot of that cell's health and its origin.

可以提供來源細胞的健康情況。

All of these qualities make exosomes invaluable messengers

胞外染色體具有這些無價的特質

that potentially allow physicians

使得醫生能從細胞層面

to eavesdrop on your health at the cellular level.

監測你的健康水平。

To catch cancer early, however,

但想要儘早發現癌症

you have to frequently intercept these messages

就必須頻繁截取這些訊息，

to determine when cancer-causing troublemakers within your body

看體內潛伏的鬧事份子

decide to start staging a coup,

是不是要滋事了。

which is why regular screening is so critical

這就是為什麼定期檢查非常重要，

and why we're developing technologies to make this possible.

以及我們為什麼要發展這科技。

While the first exosome-based diagnostics emerged on the market just this year,

儘管今年市場上出現了 首宗胞外染色體檢驗機制，

they are not yet part of mainstream healthcare options.

它們還不是主流的篩檢選項。

In addition to their recent emergence,

除了上市的時間很短，

another factor that's limiting their widespread adoption

另一個影響普及的因素

is that currently, no automated exosome isolation system exists

是目前尚無法自動分離出胞外染色體，

to make regular screening economically accessible.

所以用於定期體檢仍不夠便宜。

The current gold standard for exosome isolation

當下隔絕胞外染色體的標準做法，

includes ultracentrifugation,

包括超速離心法，

a process requiring expensive laboratory equipment,

必須使用昂貴的實驗器材，

a trained lab tech

由專業培訓過的技師操作，

and about 30 hours of time to process a sample.

耗費三十小時來處理一份樣本。

We've come up with a different approach for achieving automated exosome isolation

我們想出另一種方法，

從尿液之類的液體樣本

自動分離出胞外染色體。

from a sample such as urine.

We use a chip-based, continuous flow separation technique

我們用基於晶片的持續流動分離技術，

called deterministic lateral displacement.

這方法稱為「確定性側向位移」。

And we have done with it

藉由過去五十年來半導體產業

what the semiconductor industry has done so successfully for the past 50 years.

非常成功的晶片微縮技術，

We shrunk the dimensions of this technology

我們把這技術

from the micron scale to the true nanoscale.

從微米縮小到了真正的奈米等級。

So how does it work?

原理是什麼呢？

In a nutshell,

簡單來說，

a set of tiny pillars separated by nanoscopic gaps

把許多有奈米級間隙的細小柱子

are arranged in such a way

排成能讓液體細細分流的形式，

that the system divides the fluid into streamlines,

with the larger cancer-related nanoparticles being separated

較大的癌症奈米粒子會改道，

through a process of redirection from the smaller, healthier ones,

與較小的健康粒子分流；

which can in contrast

另一方面，

move around the pillars in a zigzag-type motion

體積較小的健康粒子 會沿著之字形的方向移動。

in the direction of fluid flow.

The net result is a complete separation of these two particle populations.

結果大小兩種粒子被完全分開了。

You can visualize this separation process

可以把分離的過程

similar to traffic on a highway that separates into two roads,

觀想成用有高度限制的穿山隧道

把車流一分為二：

with one road going into a low-clearance tunnel under a mountain,

一條進隧道，另一條繞山而過。

and the other road going around it.

Here, smaller cars can go through the tunnel

像這樣，小車可以進入隧道，

while larger trucks, carrying potentially hazardous material,

而載有危險物品的大卡車

are forced to take the detour route.

只能繞路。

Traffic is effectively separated by size and contents

由車輛的大小和載物的種類引導，

without impeding its flow.

不會阻礙車流。

And this is exactly how our system works on a much, much smaller scale.

我們建置的工作原理相同，

只是規模遠小得多。

The idea here is that the separation process for screening

用分離篩檢的理念來分析

簡易取得的尿液、血液或唾液樣本，

could be as simple as processing a sample of urine, blood or saliva,

which is a near-term possibility within the next few years.

近幾年內就可實行。

Ultimately, it could be used to isolate and detect target exosomes

最終，這方法能分離和偵測出

associated with a particular type of cancer,

與特定癌症相關的胞外染色體，

sensing and reporting their presence within minutes.

而且自偵測至結果僅需數分鐘，

This would make rapid diagnostics virtually painless.

使得篩檢的過程快速且無痛。

Broadly speaking,

廣泛說，

the ability to separate and enrich biomarkers

有了奈米級精準的自動化分離機制

with nanoscale precision in an automated way,

與濃縮的生物標記，

opens the door to better understanding diseases such as cancer,

使我們更能了解癌症等疾病；

with applications ranging from sample preparation to diagnostics,

它的應用廣泛，從準備樣品、診斷，

and from drug resistance monitoring to therapeutics.

至觀察抗藥性和治療都能做。

Even before my wife's bout with cancer,

即使在我的妻子罹癌之前，

it was a dream of mine to facilitate the automation of this process --

我​​已經夢想要自動化檢驗的過程，

to make regular screening more accessible,

要使定期檢查更容易，

similar to the way Henry Ford made the automobile accessible

就像亨利·福特自動化汽車的生產線，

to the general population

使得普羅大眾買得起汽車那樣。

through development of the assembly line.

Automation is the key to accessibility.

自動化是普及的關鍵。

And in the spirit of the Hoover dream,

就像胡佛選總統的逐夢精神口號：

"a chicken in every pot and a car in every garage,"

「每只鍋裡有雞肉，每間車庫有輛車。」

we're developing a technology

我們開發這技術

that could ultimately place an early-warning cancer detection system

為的是把早期的癌症預警系統

in every home.

最終普及於每個家庭。

This would allow every man, woman and child

讓每個男人、女人和小孩

the opportunity to be regularly tested while they're still healthy,

都能夠在仍然健康時就定期做檢查，

catching cancer when it first emerges.

在初發的早期就偵測到癌症。

It is my hope and dream

我希望，我夢想

to help people around the world avoid the high costs --

要幫助世人

避掉癌症患者所面對的昂貴開銷，

physical, financial and emotional --

免去身體、財務和精神層面的艱辛，

faced by today's cancer patients,

hardships that I'm well acquainted with.

那是我再熟悉也不過的艱辛。

I'm also happy to report that because we caught my wife's cancer early,

我也開心地告訴大家，

由於發現得早，

her treatment was successful,

我的妻子治癌成功，

and she is now, thankfully, cancer-free.

謝天謝地，現在她已肅清癌細胞。

(Applause)

（掌聲）

It is an outcome that I would like to see for everyone with a cancer diagnosis.

我希望每位罹癌者都能被治癒。

With the work that my team has already done

我團隊開發的奈米生物標記分離法

on separation of nanoscale biomarkers

for rapid, early-stage cancer diagnostics,

能快速、早期偵測出癌症。

I am optimistic that within the next decade,

我樂觀看待在未來十年內，

this type of technology will be available,

這技術會被用來

helping protect our friends, our family and future generations.

保護我們的朋友、家人和子孫後代。

Even if we are so unlucky as to be diagnosed with cancer,

即便我們不幸被診斷出癌症，

that early-stage alarm will provide a strong beacon of hope.

早期警示將會提供更大的治癒希望。

Thank you.

謝謝大家。

(Applause)

（掌聲）