Aaron Morris: How your body could become its own diagnostic lab | TED Fellows

譯者: Pilon Lin 審譯者: Amanda Zhu

[SHAPE YOUR FUTURE]

［塑造你的未來］

(Slam) Ow!

(撞擊聲) 噢!

As anyone who’s stubbed a toe in the dark

任何曾在黑暗中撞到腳趾

or spent an hour searching for their keys knows

或是花一個小時找鑰匙的人都知道，

we're often limited by what we can or cannot see.

我們常常被那些 看得到或看不到的東西限制住。

In fact, even our own bodies can be black boxes.

事實上，我們自己的身體像是黑盒子。

Today, I want to take you through a vision of health care

今天，我想帶你了解 包括我自己在內的一些科學家和工程師

that scientists and engineers, myself included, are building.

所一起建設的醫療保健願景。

We are creating a diagnostic lab inside your body

我們要在你體內建造一座診斷實驗室，

that can provide a continuous analysis of your health

它可以持續分析您的健康狀況，

so that we can better see what's happening in patients.

這樣我們就可以更清楚地觀察 患者的身體狀況。

Currently, if someone is sick,

現在，如果有人生病了，

we may diagnose them by using a biopsy

我們可能會透過組織切片去診斷他們，

to bring disease tissue outside the body where we can see it.

這是方法是將病變組織帶出體外， 讓我們可以看到它。

We do this if we suspect, for instance, that a growth might be cancerous.

例如，我們懷疑腫瘤 可能會癌變時就會這樣做。

Unfortunately, this approach can't work all the time

不幸的是，這個方法 有兩個很大的問題，

because of two major problems.

所以在有些狀況下無法使用。

First, some tissues, like brains or spinal cords,

首先，有些組織，像是大腦或脊隨，

can't be routinely biopsied.

不能做一般的切片檢查。

And second, doctors often don't know which tissue is causing the problem,

其次，醫生通常不知道 是哪些組織出了問題，

so they don't know what to biopsy.

所以也不知道該採檢什麼組織。

So far, we've dealt with these issues using external medical tests,

迄今，我們處理這些問題時，

運用的是核磁共振 和抽血檢查體等體外的醫學測試。

like MRIs or blood tests.

These provide a broad overview of the health of a patient,

這些方法為患者的健康 提供了一個廣泛的概括了解，

but they can't see the molecular and cellular changes

但無法看到組織裡分子和細胞的變化，

that occur within tissues,

and they certainly can't provide enough information

當然也無法提供足夠的資訊

to proactively treat patients before symptoms develop.

為患者在症狀出現之前積極治療。

This is unfortunate

這很不幸，

because it's these invisible changes that ultimately cause disease.

因為最終就是這些 看不見的身體變化導致疾病。

Our inability to measure these changes

我們無法衡量這些變化，

results in a disparity between what we can see on a test

使得我們在檢驗結果看到的狀況

and what we know is happening in patients.

和患者體內實際發生的事 有很大的差異。

Let's take multiple sclerosis as an example.

以 MS，也就是多發性硬化症為例。

In MS, which is an autoimmune disease,

這是一種自身免疫性疾病，

the immune system attacks two specific tissues:

免疫系統攻擊兩種特定組織 :

the brain and the spinal cord,

大腦和脊隨；

resulting in damage and in some cases, paralysis.

造成腦和脊隨的損害， 有時候甚至導致癱瘓。

Now, we obviously can't catch MS by routinely biopsying people's brains,

我們顯然不能定期做腦組織切片 來診斷病人是否患有 MS，

where there would be abundant and active disease-inducing cells.

但患有 MS 的腦部必然有 大量活耀的疾病誘導細胞。

And we can't catch it using a blood test

驗血也無法發現 MS，

because the MS-inducing cells are so rare and inactive in the blood

因為 MS 誘導細胞在血液中 很罕見也沒有活性，

that we simply can't see them.

以至於我們根本無法看到它們。

Even brain imaging technologies like MRI can't provide the information we need

即便是腦成像技術，像是核磁共振，

也無法提供我們所需要的資訊 去積極應對 MS。

to be proactive about MS.

So we need to rethink how we see.

所以我們必須要重新思考 我們「看」的方式。

My coworkers at the University of Michigan and I decided to do just that.

這正是我跟密西根大學的 同事決定的做法，

Instead of taking an outside-in approach to diagnostics,

我們用由內而顯於外的診斷方法

we're taking an inside-out approach.

去取代由外推測體內狀況的診斷方法。

We are creating implantable sites

我們在體表尋找可植入的部位，

that have similarities to other sites in the body,

這些部位必須與體內 特定部位有相似之處，

and will improve our vision by giving us real-time access

如此我們就能夠取得 即時的分子、細胞資訊

to molecular and cellular information about diseased tissues.

來改善我們可看到的範圍。

These insights will enable us to predict the onset of disease

這些觀察結果讓我們 能夠預測疾病的發生，

and even identify therapies likely to work in an individual patient.

甚至找出對個別患者 可能會起作用的療法。

So what does this inside-out approach look like?

那這個由內而顯於外的方法 是什麼樣子呢？

Step one is to engineer new tissues just under the skin.

第一步是在皮下製造新組織，

These tissues have similarities to other inaccessible sites in the body,

這些組織與身體其他難以觀察的部位，

比如說大腦或肺，

like the brain or the lungs.

有著相似之處，

By implanting a porous plastic disk made of FDA-approved biomaterials,

接著植入FDA 認可的生物材料 所做成的多孔塑膠盤，

I can harness the body's natural responses to allow cells to migrate into the disk,

我可以利用身體的自然反應， 讓細胞遷移到塑膠盤裡，

survive at the site and form a tissue.

在那兒存活下來並生成組織。

Eventually, we're left with an engineered tissue

最終，我們得到的

with integrated immune cells,

是具有整合免疫細胞的人造組織，

just the cells we need for diagnosis.

正是我們診斷所需要的細胞。

Although these tissues are complex and chronically inflamed,

即使這些組織很複雜 以及會長期發炎，

they're also innocuous

他們依舊是無害的。

and after a few weeks, nearly imperceptible.

幾週後就感覺不到它的存在。

Our engineered tissues contain information not present in the blood,

我們製造的組織 含有在血液中找不到的訊息，

and they can help bridge the gap

而且能幫助補足

between what we can see on a traditional test

在傳統測試中無法取得的資訊，

and cellular changes we know occur in disease.

也就是患部細胞實際發生的變化。

Step two is to read this signal.

第二步就是讀取這些訊號。

Currently, I could take a biopsy of my engineered site and analyze it

現在，我可以在人造的部位 做切片並加以分析，

because I made them accessible just under the skin.

因為位在皮下，易於採檢。

But it would certainly be better

但如果我們也能以非侵入性的方式 使用和讀取感應器

if we could incorporate and read a sensor noninvasively.

就更好了。

Within the next decade,

在未來十年內，

rapidly converging technologies could enable diagnosis at such an implant

技術的快速融合可能讓我們 透過操控簡單的探測器，

by harnessing simple detectors,

類似腕式血壓計或智能手錶，

like a blood pressure cuff or smartwatch does now.

在這種植入物上進行診斷。

The mechanisms for diagnosing and monitoring disease

這個診斷以及監測疾病的機制，

could be as simple as opening an app, like Candy Crush on your phone.

可以如同在手機上打開一個 像 Candy Crush 的 APP 一樣簡單。

Step three is to harness the huge array of knowledge

第三步是運用工程 和材料科學等領域的大量知識，

in fields like engineering and material science

to improve these implants and our ability to read their data.

去改善那些植入物 以及我們讀取那些數據的能力。

Eventually, tens, if not hundreds of individual engineered tissues

最後，數十種甚或數百種 帶有整合感應器的人造組織

with integrated sensors

may be implantable with a single application.

可以一次植入。

Now, this approach to diagnosis is unconventional, to be sure,

這種診斷方法是非傳統的，

but it is robust.

但很牢靠。

So far, my colleagues and I have used it

迄今，我和同事們曾運用它

to diagnose models of metastatic cancer,

來做轉移性癌症、 第 1 型糖尿病、多發性硬化症

type 1 diabetes, multiple sclerosis and organ transplant rejection.

以及移植器官排斥的診斷實驗。

But this is just the beginning of what we can see.

但這只是冰山的一角。

With continuous improvements,

經過持續的改善，

we will be able to truly create

我們將能夠真正地創造

a diagnostic lab inside your body

一個可以持續分析您健康狀況的 體內診斷實驗室。

that provides a continuous analysis of your health.

By changing how we see what's going wrong in patients,

藉由改變我們「看見」疾病的方法，

we will be able to diagnose and treat diseases better

我們能比以前更好、更快地 診斷和治療疾病。

and faster than ever before.

If you're willing to rethink how you see,

如果你願意重新思考｢看｣的方式，

you may be surprised what comes into view.

你或許會對你所看到的感到驚訝。

Thank you.

謝謝。