This tiny particle could roam your body to find tumors | Sangeeta Bhatia

譯者: 易帆 余 審譯者: Max Chern

In the space that used to house one transistor,

過去可容納一個電晶體的空間，

we can now fit one billion.

我們現在可以放進 10 億個。

That made it so that a computer the size of an entire room

這使得過去一個房間大小的電腦

now fits in your pocket.

現在可以放進你的口袋裡了。

You might say the future is small.

你可能會說，未來的東西會是小的。

As an engineer,

身為一位工程師，

I'm inspired by this miniaturization revolution in computers.

我被這個電腦的 微型化革命所啟發。

As a physician,

而身為一位醫師，

I wonder whether we could use it to reduce the number of lives lost

我在想，我們是否可以利用它來降低

due to one of the fastest-growing diseases on Earth:

癌症 ─ 地球上成長最快速的疾病之一 的死亡人數。

cancer.

Now when I say that,

現在，當我這樣說時，

what most people hear me say is that we're working on curing cancer.

大部份聽到的人會說， 我們是研究癌症治療的。

And we are.

的確是！

But it turns out

但事實上，

that there's an incredible opportunity to save lives

有一個不可思議的機會 可以拯救生命，

through the early detection and prevention of cancer.

就是藉由癌症的早期發現與預防。

Worldwide, over two-thirds of deaths due to cancer are fully preventable

全球因癌症死亡的病例 超過 2/3 是可預防的 ，

using methods that we already have in hand today.

經由使用我們現今已有的方法，

Things like vaccination, timely screening

像是接種疫苗、定期篩檢，

and of course, stopping smoking.

當然，戒菸也是。

But even with the best tools and technologies that we have today,

但即使現在我們已經有 最好的工具與科技，

some tumors can't be detected

某些腫瘤要開始成長十年後 才能被偵測出來，

until 10 years after they've started growing,

when they are 50 million cancer cells strong.

那時的癌細胞已多達 5 千萬個了。

What if we had better technologies

要是我們有更好的科技，

to detect some of these more deadly cancers sooner,

可以更早偵測到更多這些致命的癌症，

when they could be removed,

也就是在它們可以被移除

when they were just getting started?

或剛長出時，那該有多好？

Let me tell you about how miniaturization might get us there.

讓我向各位說明 微型化科技將如何讓我們做到。

This is a microscope in a typical lab

這是一般實驗室裡的一台顯微鏡，

that a pathologist would use for looking at a tissue specimen,

病理學家用它來觀察組織的樣本，

like a biopsy or a pap smear.

例如活體切片或子宮頸抹片檢查。

This $7,000 microscope

這台 $7000 美金的顯微鏡 ，

would be used by somebody with years of specialized training

會被某些受多年專業訓練的人

to spot cancer cells.

用來找出癌細胞。

This is an image from a colleague of mine at Rice University,

這一張圖是來自我的 一位萊斯大學的同事

Rebecca Richards-Kortum.

麗貝卡·理查茲卡頓，

What she and her team have done is miniaturize that whole microscope

她和她的團隊所做的 就是把顯微鏡縮小成為一個

into this $10 part,

價值十元的零件，

and it fits on the end of an optical fiber.

並且可以裝在光纖的末端上。

Now what that means is instead of taking a sample from a patient

意思是，不需要從病人身上取出檢體，

and sending it to the microscope,

送到顯微鏡下觀察，

you can bring the microscope to the patient.

而是你可以把顯微鏡放到病人體內。

And then, instead of requiring a specialist to look at the images,

並且，不需要專家來檢視影像，

you can train the computer to score normal versus cancerous cells.

你可以訓練電腦區分 正常細胞與癌症細胞。

Now this is important,

這很重要，

because what they found working in rural communities,

因為他們發現在郊區工作，

is that even when they have a mobile screening van

即使有一台行動篩檢箱型車，

that can go out into the community and perform exams

可以開到社區裡進行檢查，

and collect samples

及收集檢體

and send them to the central hospital for analysis,

並把它們送回醫院做分析，

that days later,

過幾天後，

women get a call with an abnormal test result

受測女士們接到 檢查結果不正常的電話，

and they're asked to come in.

並被要求到醫院來，

Fully half of them don't turn up because they can't afford the trip.

但她們至少有一半不會來， 因為付不起旅費。

With the integrated microscope and computer analysis,

藉由整合顯微鏡與電腦分析，

Rebecca and her colleagues have been able to create a van

麗貝卡和她的同事 已經可以做出一台

that has both a diagnostic setup and a treatment setup.

同時具有診斷與治療設施的廂型車。

And what that means is that they can do a diagnosis

意思就是，他們可以直接在現場

and perform therapy on the spot,

做診斷與治療，

so no one is lost to follow up.

這樣就沒人會錯過追蹤了。

That's just one example of how miniaturization can save lives.

這僅是一個微型化科技 如何拯救人命的案例之一。

Now as engineers,

身為工程師，

we think of this as straight-up miniaturization.

我們認為這就是微型化，

You took a big thing and you made it little.

你把一個大的東西變小了。

But what I told you before about computers

但我稍早跟各位提到 有關於電腦

was that they transformed our lives

改變了我們的生活，

when they became small enough for us to take them everywhere.

當它們變得 小到可以讓我們帶到任何地方時。

So what is the transformational equivalent like that in medicine?

在醫學上， 有什麼東西是相對等的改變呢？

Well, what if you had a detector

如果你有一個偵測器，

that was so small that it could circulate in your body,

它小到可以在你的體內循環，

find the tumor all by itself

並靠它自己找到腫瘤，

and send a signal to the outside world?

而且還能把訊號傳到體外呢？

It sounds a little bit like science fiction.

這聽起來有點像科幻小說，

But actually, nanotechnology allows us to do just that.

但實際上，奈米科技 已經可以讓我們做到了。

Nanotechnology allows us to shrink the parts that make up the detector

奈米科技已經讓我們能夠 把製造偵測器的零件

from the width of a human hair,

從原本是頭髮寬度即100微米

which is 100 microns,

to a thousand times smaller,

縮更小到其 1/1000，

which is 100 nanometers.

也就是100奈米。

And that has profound implications.

這樣就有很大的影響了，

It turns out that materials actually change their properties

也就是說，材質實際上 以奈米規格改變其特性。

at the nanoscale.

You take a common material like gold,

就拿黃金這個普遍的材質來說，

and you grind it into dust, into gold nanoparticles,

當你把黃金磨到奈米粒子的大小，

and it changes from looking gold to looking red.

它會從金色變成紅色。

If you take a more exotic material like cadmium selenide --

如果你再拿一個更奇特的材質， 像是硒化鎘 ──

forms a big, black crystal --

一個大而黑的晶體，

if you make nanocrystals out of this material

若把它製成奈米大小，

and you put it in a liquid,

然後放進一種液體裡，

and you shine light on it,

並以光線照射它

they glow.

它們會發光。

And they glow blue, green, yellow, orange, red,

它們會發出藍色、綠色、 黃色、橘色、紅色的光，

depending only on their size.

僅依據它們的大小不同。

It's wild! Can you imagine an object like that in the macro world?

這太神奇了！你可想像 這樣一個在宏觀世界裡的物體嗎？

It would be like all the denim jeans in your closet are all made of cotton,

就好比你衣櫃裡那些 全都是棉製的牛仔褲，

but they are different colors depending only on their size.

會依它們的尺寸大小 而有不同的顏色。

(Laughter)

（笑聲）

So as a physician,

所以，身為一位醫師，

what's just as interesting to me

讓我感興趣的

is that it's not just the color of materials

不只是材質 會依奈米規格的大小而改變顏色；

that changes at the nanoscale;

the way they travel in your body also changes.

它們在你身體裡面的 運行方式也會改變。

And this is the kind of observation that we're going to use

而我們將運用這種觀察方式

to make a better cancer detector.

來製作更好的癌症偵測器。

So let me show you what I mean.

讓我向各位解釋一下，

This is a blood vessel in the body.

這是身體裡面的一條血管，

Surrounding the blood vessel is a tumor.

圍繞著血管的是一個腫瘤。

We're going to inject nanoparticles into the blood vessel

我們把奈米粒子注射到血管裡面，

and watch how they travel from the bloodstream into the tumor.

然後觀察它們如何從 血流中進到腫瘤裡面。

Now it turns out that the blood vessels of many tumors are leaky,

結果我們看到 許多腫瘤的血管有漏洞，

and so nanoparticles can leak out from the bloodstream into the tumor.

所以奈米粒子會從血流漏向腫瘤，

Whether they leak out depends on their size.

它們是否會漏出去 取決於它們的大小。

So in this image,

在這影像

the smaller, hundred-nanometer, blue nanoparticles are leaking out,

較小、100奈米的 藍色奈米粒子正在漏出去，

and the larger, 500-nanometer, red nanoparticles

較大、500奈米的紅色奈米粒子

are stuck in the bloodstream.

則留在血流當中。

So that means as an engineer,

所以身為一位工程師，

depending on how big or small I make a material,

依據我所製作的物質大小，

I can change where it goes in your body.

可改變它在你身體裡的去處。

In my lab, we recently made a cancer nanodetector

在我的實驗室，我們最近 作出一種癌症奈米偵測器，

that is so small that it could travel into the body and look for tumors.

它小到可以進入身體並找尋腫瘤，

We designed it to listen for tumor invasion:

我們設計它用來監聽腫瘤的侵犯：

the orchestra of chemical signals that tumors need to make to spread.

腫瘤需要製造這些 化學訊號的樂音來擴散。

For a tumor to break out of the tissue that it's born in,

腫瘤為了要從它長出來的 組織突破出去，

it has to make chemicals called enzymes

它必須製造一種 稱為「酵素」的化學物質，

to chew through the scaffolding of tissues.

來穿破組織架構而出。

We designed these nanoparticles to be activated by these enzymes.

我們設計這些奈米粒子 可被腫瘤酵素活化，

One enzyme can activate a thousand of these chemical reactions in an hour.

一個酵素一小時內 可活化一千個這種化學反應。

Now in engineering, we call that one-to-a-thousand ratio

用工程術語來說，我們稱這種 1:1000 比率為一種放大率，

a form of amplification,

and it makes something ultrasensitive.

它會變得超靈敏。

So we've made an ultrasensitive cancer detector.

所以我們製造出一種 超靈敏的癌症偵測器，

OK, but how do I get this activated signal to the outside world,

但我要如何把這個活化訊號傳到體外，

where I can act on it?

我要從那裡著手呢？

For this, we're going to use one more piece of nanoscale biology,

為此，我們要再利用另一個 奈米規格生物學，

and that has to do with the kidney.

而這與腎臟有關。

The kidney is a filter.

腎臟是一種過濾器，

Its job is to filter out the blood and put waste into the urine.

它的功能就是將廢物 從血液濾出並排入尿液，

It turns out that what the kidney filters

其實腎臟所過濾的物質

is also dependent on size.

也是根據大小而定。

So in this image, what you can see

所以在這影片，各位可以看到

is that everything smaller than five nanometers

任何小於 5 奈米的物質，

is going from the blood, through the kidney, into the urine,

會從血液通過腎臟而排入尿液，

and everything else that's bigger is retained.

其他比較大的物質會被留下來。

OK, so if I make a 100-nanometer cancer detector,

好，如果我做了一個 100 奈米的癌症偵測器，

I inject it in the bloodstream,

然後把它注射到血流裡面，

it can leak into the tumor where it's activated by tumor enzymes

它會漏入腫瘤裡面， 被腫瘤酵素活化，

to release a small signal

並釋放一種微小訊號，

that is small enough to be filtered out of the kidney

小到可以被腎臟過濾出來，

and put into the urine,

然後排到尿液裡面，

I have a signal in the outside world that I can detect.

這樣在體外 就有我可以偵測到的訊號了。

OK, but there's one more problem.

好，但還有一個問題。

This is a tiny little signal,

這是一個很微小的訊號，

so how do I detect it?

我要如何偵測呢？

Well, the signal is just a molecule.

訊號其實只是一種分子，

They're molecules that we designed as engineers.

是我們工程師設計出來的分子。

They're completely synthetic, and we can design them

它們完全是合成的， 我們可以設計它們，

so they are compatible with our tool of choice.

讓它與我們選擇的工具完全相容。

If we want to use a really sensitive, fancy instrument

如果我們要用一種 相當靈敏的昂貴設備 ──

called a mass spectrometer,

叫做質譜儀，

then we make a molecule with a unique mass.

那麼我們會製造 一種特定質量的分子。

Or maybe we want make something that's more inexpensive and portable.

或許我們想讓它 不那麼昂貴且方便攜帶，

Then we make molecules that we can trap on paper,

那麼我們會製造 能被試紙抓住的分子，

like a pregnancy test.

就像驗孕一樣。

In fact, there's a whole world of paper tests

事實上，現在有很多的試紙測試方法，

that are becoming available in a field called paper diagnostics.

已廣泛應用在「試紙診斷」領域了。

Alright, where are we going with this?

好的，我們做這個有什麼用處呢？

What I'm going to tell you next,

接下來我要告訴各位的是

as a lifelong researcher,

身為一位終身研究員，

represents a dream of mine.

我想對各位訴說我的夢想。

I can't say that's it's a promise;

我不能說這是個承諾；

it's a dream.

但它至少是個夢想。

But I think we all have to have dreams to keep us pushing forward,

我認為我們都必須有夢想 來讓我們向前邁進，

even -- and maybe especially -- cancer researchers.

甚至，特別是癌症研究人員。

I'm going to tell you what I hope will happen with my technology,

我要告訴各位我期望 我的技術將來會有何進展，

that my team and I will put our hearts and souls

我的團隊和我都會盡心盡力地

讓這期望成真。

into making a reality.

OK, here goes.

好的，我要開始了。

I dream that one day,

我夢想有一天，

instead of going into an expensive screening facility

大家不用再使用昂貴的篩檢設備

to get a colonoscopy,

來做大腸鏡檢查

or a mammogram,

或乳房攝影檢查

or a pap smear,

或子宮頸抹片檢查，

that you could get a shot,

而是你可能扎一針，

wait an hour,

等一個小時，

and do a urine test on a paper strip.

然後在試紙上做尿液檢測即可。

I imagine that this could even happen

我想像這甚至

不需要穩定的電流 或專業醫療人士在檢驗室裡就可能做到。

without the need for steady electricity,

or a medical professional in the room.

Maybe they could be far away

或許他們可以遠隔千里

and connected only by the image on a smartphone.

僅用智能手機連結影像即可。

Now I know this sounds like a dream,

我知道這聽起來像是個夢想，

but in the lab we already have this working in mice,

但在實驗室， 我們已經用在老鼠身上了，

where it works better than existing methods

對於偵測肺癌、大腸癌及卵巢癌， 這比現行方法更有用。

for the detection of lung, colon and ovarian cancer.

And I hope that what this means

而這也意味著我期望

is that one day we can detect tumors in patients

有一天，在病人腫瘤開始成長的10年內， 我們就可以偵測到。

sooner than 10 years after they've started growing,

in all walks of life,

在各行各業、世界各地的人都能受惠，

all around the globe,

and that this would lead to earlier treatments,

這會促成早期治療，

and that we could save more lives than we can today,

藉由早期發現， 我們能比今日拯救更多人的性命。

with early detection.

Thank you.

謝謝！

(Applause)

（掌聲）