TED2010
Kevin Stone: The bio-future of joint replacement
Kevin Stone: Bio-budućnost zamjenskih zglobova
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Artritis i ozljede ribaju milijune zglobova, ali rijetki dobiju najbolji lijek – pravo biološko tkivo. Kevin Stone pokazuje tretman koji bi mogao zaobići visoke cijene i manjak donora za transplantate s čovjeka na čovjeka s novom upotrebom životinjskih tkiva.
Kevin Stone - Surgeon, inventor
Kevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament. Full bio
Kevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament. Full bio
Double-click the English transcript below to play the video.
00:16
So let me just start with my story.
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Započeo bih sa svojom pričom.
00:18
So I tore my knee joint meniscus cartilage
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Pokidao sam menisk u koljenu
00:20
playing soccer in college.
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igrajući nogomet na fakultetu.
00:23
Then I went on to tear my ACL, the ligament in my knee,
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Zatim sam pokidao svoj prednji ukriženi ligament, ligament u svom koljenu,
00:26
and then developed an arthritic knee.
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a zatim sam razvio artritično koljeno.
00:28
And I'm sure that many of you in this audience have that same story,
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Siguran sam da mnogi od vas u publici imate istu priču.
00:31
and, by the way, I married a woman
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Inače, oženio sam ženu
00:33
who has exactly the same story.
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koja ima potpuno istu priču.
00:36
So this motivated me to become an orthopedic surgeon
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To me potaklo da postanem ortopedski kirurg
00:39
and to see if I couldn't focus on solutions for those problems
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i vidim mogu li se usmjeriti na rješenja za te probleme
00:42
that would keep me playing sports and not limit me.
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koja bi mi omogućila da se bavim sportom i ne bi me ograničavala.
00:46
So with that, let me just show you a quick video
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Uz to, pokazao bih vam kratku snimku
00:49
to get you in the mood of what we're trying to explain.
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da vas uvedem u raspoloženje onoga što želimo objasniti.
00:52
Narrator: We are all aware of the risk of cancer,
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Voditelj: Svi smo svjesni rizika za rak,
00:54
but there's another disease
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ali postoji druga bolest
00:56
that's destined to affect even more of us: arthritis.
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koja će zahvatiti još više nas, artritis.
00:59
Cancer may kill you, but when you look at the numbers,
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Rak vas može ubiti, ali ako pogledate brojeve,
01:01
arthritis ruins more lives.
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artritis uništi više života.
01:03
Assuming you live a long life, there's a 50 percent chance
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Pod pretpostavkom da živite dug život, postoji 50 postotna šansa
01:05
you'll develop arthritis.
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da ćete razviti artritis.
01:08
And it's not just aging that causes arthritis.
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A starenje nije uzrok artritisa.
01:10
Common injuries can lead to decades of pain,
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Obične ozljede mogu dovesti do desetljeća boli,
01:13
until our joints quite literally grind to a halt.
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dok nam se zglobovi doslovno ne samelju i stanu.
01:16
Desperate for a solution, we've turned to engineering
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Očajnički tražeći rješenje, okrenuli smo se inžinjerstvu
01:18
to design artificial components
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ne bismo li dizajnirali umjetne komponente
01:20
to replace our worn-out body parts,
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koje bi zamjenile naše istrošene dijelove tijela.
01:22
but in the midst of the modern buzz
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Ali usred modernog ushita
01:24
around the promises of a bionic body,
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oko obećavajućih bioničkih tijela
01:26
shouldn't we stop and ask if there's a better, more natural way?
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ne bismo li trebali stati i zapitati se postoji li bolji, prirodniji način?
01:31
Let's consider an alternative path.
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Razmotrimo alternativni put.
01:33
What if all the replacements our bodies need
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Što ako svi nadomjestci koje naše tijelo treba
01:36
already exist in nature,
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već postoje u prirodi,
01:38
or within our own stem cells?
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ili u našim vlastitim matičnim stanicama?
01:40
This is the field of biologic replacements,
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Ovo je polje bioloških nadomjestaka,
01:42
where we replace worn-out parts with new, natural ones.
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gdje istrošene dijelove zamjenjujemo novim, prirodnim dijelovima.
01:45
Kevin Stone: And so, the mission is:
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Kevin Stone: Dakle, misija je:
01:47
how do I treat these things biologically?
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kako liječiti ove probleme na biološki način?
01:49
And let's talk about both what I did for my wife,
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Pričajmo o tome što sam učinio, kako za svoju ženu,
01:51
and what I've done for hundreds of other patients.
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tako i za stotine drugih pacijenata.
01:53
First thing for my wife,
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Prvo za svoju ženu,
01:55
and the most common thing I hear from my patients,
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i najčešća stvar koju čujem od svojih pacijenata,
01:57
particularly in the 40- to 80-year-old age group, 70-year-old age group,
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osobito u dobnoj skupini od 40 do 80 godina, skupini od sedamdesetogodišnjaka,
02:00
is they come in and say,
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jest ta da dođu i kažu,
02:02
"Hey, Doc, isn't there just a shock absorber you can put in my knee?
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"Hej, doktore, ne postoji li amortizer koji možeš staviti u moje koljeno?
02:04
I'm not ready for joint replacement."
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Nisam spreman za zamjenski zglob."
02:06
And so for her, I put in a human meniscus allograft donor
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Tako sam joj stavio čovječji menisk nesrodnog donora
02:09
right into that [knee] joint space.
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izravno u zglobni prostor njenog koljena.
02:11
And [the allograft] replaces [the missing meniscus].
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I taj presadak zamjenjuje menisk koji nedostaje.
02:13
And then for that unstable ligament,
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A što se tiče onog nestabilnog ligamenta,
02:15
we put in a human donor ligament
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stavimo ligament čovječjeg donora
02:17
to stabilize the knee.
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da stabiliziramo koljeno.
02:19
And then for the damaged arthritis on the surface,
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A zatim za oštećeni artritis na površini,
02:22
we did a stem cell paste graft,
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napravili smo pastozni presadak matičnih stanica,
02:24
which we designed in 1991,
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koji smo dizajnirali 1991.,
02:26
to regrow that articular cartilage surface
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da obnovi površinu zglobne hrskavice
02:29
and give it back a smooth surface there.
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i ponovno joj da glatku površinu.
02:32
So here's my wife's bad knee on the left,
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Evo oštećenog koljena moje žene nalijevo,
02:34
and her just hiking now
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i nje kako sada planinari
02:36
four months later in Aspen, and doing well.
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četiri mjeseca kasnije u Aspenu i dobro napreduje.
02:39
And it works, not just for my wife, but certainly for other patients.
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I to funkcionira, ne samo za moju ženu, već sigurno i za druge pacijente.
02:42
The girl on the video, Jen Hudak,
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Djevojka na videu, Jen Hudak,
02:44
just won the Superpipe in Aspen
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upravo je osvojila Superpipe u Aspenu
02:46
just nine months after having destroyed her knee,
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samo devet mjeseci nakon što je uništila svoje koljeno
02:49
as you see in the other image --
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kao što vidite na drugoj slici --
02:51
and having a paste graft to that knee.
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dobiva pastozni presadak na tom koljenu.
02:53
And so we can regrow these surfaces biologically.
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Tako da možemo obnoviti ove površine biološki.
02:57
So with all this success,
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A sa svim ovim uspjesima,
02:59
why isn't that good enough, you might ask.
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zašto to nije dovoljno dobro, mogli biste pitati.
03:02
Well the reason is because there's not enough donor cycles.
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Razlog je taj što nema dovoljno donora.
03:05
There's not enough young, healthy people
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Nema dovoljno mladih zdravih ljudi
03:07
falling off their motorcycle
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koji padaju sa svojih motocikala
03:09
and donating that tissue to us.
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i doniraju to tkivo nama.
03:12
And the tissue's very expensive.
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A tkivo je vrlo skupo.
03:15
And so that's not going to be a solution
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Tako da to neće biti rješenje
03:17
that's going to get us global with biologic tissue.
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koje će nas globalno dovesti s biološkim tkivima.
03:20
But the solution is animal tissue
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Ali rješenje su životinjska tkiva
03:22
because it's plentiful, it's cheap,
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zato što ih ima mnogo, jeftina su.
03:24
you can get it from young, healthy tissues,
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Možete ih dobiti iz mladih, zdravih tkiva,
03:27
but the barrier is immunology.
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ali prepreka je imunologija.
03:29
And the specific barrier
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A specifična prepreka
03:31
is a specific epitope
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je specifični epitop
03:33
called the galactosyl, or gal epitope.
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koji se zove galaktozil, ili gal epitop.
03:35
So if we're going to transplant animal tissues to people,
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Ako ćemo presađivati životinjska tkiva na ljude,
03:37
we have to figure out a way to get rid of that epitope.
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moramo smisliti način kako se riješiti tog epitopa.
03:40
So my story in working with animal tissues
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Moja priča o radu sa životinjskim tkivima
03:42
starts in 1984.
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počinje 1984.
03:44
And I started first
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Počeo sam
03:46
with cow Achilles tendon,
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s goveđom ahilovom tetivom,
03:48
where we would take the cow Achilles tendon,
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gdje bismo uzeli goveđu ahilovu tetivu,
03:50
which is type-I collagen,
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koja je kolagen tipa 1,
03:52
strip it of its antigens
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uklonili bismo njene antigene
03:54
by degrading it with an acid and detergent wash
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tako što bismo ih razgradili pranjem kiselinom i deterdžentima
03:57
and forming it into a regeneration template.
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i oblikovali bismo je u regeneracijsku šablonu.
04:00
We would then take that regeneration template
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Zatim bismo uzeli tu regeneracijsku šablonu
04:02
and insert it into the missing meniscus cartilage
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i unijeli je na mjesto nedostajućeg meniska
04:05
to regrow that in a patient's knee.
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da ponovno izraste u pacijentovu koljenu.
04:08
We've now done that procedure,
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Sada smo napravili tu proceduru,
04:10
and it's been done worldwide in over 4,000 cases,
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i napravljena je širom svijeta u preko 4.000 slučajeva,
04:12
so it's an FDA-approved and worldwide-accepted way
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to je odobrila FDA i međunarodno je prihvaćen način
04:15
to regrow the meniscus.
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obnove meniska.
04:17
And that's great when I can degrade the tissue.
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I to je odlično kada mogu degradirati tkivo.
04:20
But what happens for your ligament when I need an intact ligament?
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Ali što se dogodi s vašim ligamentom kad trebam netaknut ligament?
04:23
I can't grind it up in a blender.
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Ne mogu ga samljeti u mikseru.
04:25
So in that case,
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U tom slučaju
04:27
I have to design -- and we designed with Uri Galili and Tom Turek --
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moram dizajnirati -- i dizajnirali smo s Urijem Galilijem i Tomom Turekom --
04:30
an enzyme wash
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enzimsko pranje
04:32
to wash away, or strip,
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koje ispire, ili skida,
04:34
those galactosyl epitopes
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one galaktozilne epitope
04:36
with a specific enzyme.
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specifičnim enzimom.
04:38
And we call that a "gal stripping" technique.
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I to zovemo "gal skidajuća" tehnika .
04:41
What we do is humanize the tissue.
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Činimo to tako što humaniziramo to tkivo.
04:43
It's by gal stripping that tissue
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To činimo skidajući galaktozile s tog tkiva
04:45
we humanize it (Laughter),
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humaniziramo ga,
04:47
and then we can put it back
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i zatim ga vratimo
04:49
into a patient's knee.
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u pacijentovo koljeno.
04:53
And we've done that. Now we've taken pig ligament --
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I to smo i učinili. Sad smo uzeli svinjski ligament --
04:55
young, healthy, big tissue,
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mlado, zdravo, veliko tkivo,
04:57
put it into 10 patients in an FDA-approved trial --
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stavili ga u 10 pacijenata u studiji koju je odobrila FDA --
05:00
and then one of our patients went on to have
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a zatim je jedan od pacijenata otišao
05:02
three Canadian Masters Downhill championships --
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i osvojio tri Canadian Masters Downhill prvenstva --
05:05
on his "pig-lig," as he calls it. So we know it can work.
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na svom "pig-ligu," kako ga on voli zvati. Tako da znamo da to može funkcionirati.
05:07
And there's a wide clinical trial of this tissue now pending.
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Sada se provodi opsežna klinička studija o ovom tkivu.
05:12
So what about the next step?
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Što je sljedeći korak?
05:14
What about getting to a total biologic knee replacement,
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Što je s dobivanjem potpuno biološkog zamjenskog koljena,
05:16
not just the parts?
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a ne samo dijelova?
05:18
How are we going to revolutionize artificial joint replacement?
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Kako ćemo revolucionizirati umjetne zamjenske zglobove?
05:21
Well here's how we're going to do it.
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Evo kako ćemo to učiniti.
05:23
So what we're going to do is take
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Ono što ćemo učiniti je to da ćemo uzeti
05:25
an articular cartilage
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zglobnu hrskavicu
05:27
from a young, healthy pig,
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iz mlade, zdrave svinje,
05:29
strip it of its antigens,
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uklonit ćemo njene antigene,
05:31
load it with your stem cells,
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napuniti je s vašim matičnim stanicama,
05:34
then put it back on to that
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i vratiti je natrag na ono
05:36
arthritic surface in your knee,
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artritično mjesto u vašem koljenu,
05:39
tack it on there, have you heal that surface
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pričvrstiti je ondje, dopustiti da zacijeli tu površinu
05:42
and then create a new biologic surface for your knee.
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i onda stvoriti novu biološku površinu za vaše koljeno.
05:48
So that's our biologic approach right now.
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To je naš biološki pristup trenutno.
05:52
We're going to rebuild your knee with the parts.
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Ponovno ćemo izgraditi vaše koljeno s dijelovima.
05:54
We're going to resurface it with a completely new surface.
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Obložit ćemo ga s potpuno novom površinom.
05:57
But we have other advantages from the animal kingdom.
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Ali imamo druge prednosti iz životinjskog kraljevstva.
06:00
There's a benefit of 400 million years
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Imamo povlastice od 400 milijuna godina
06:02
of ambulation.
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hodanja.
06:04
We can harness those benefits.
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Možemo upregnuti te povlastice.
06:06
We can use thicker, younger, better tissues
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Možemo upotrijebiti deblja, mlađa, bolja tkiva
06:09
than you might have injured in your knee,
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od onih koja ste mogli ozlijediti u svom koljenu,
06:11
or that you might have when you're 40, 50 or 60.
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ili koja možete imati s 40, 50 ili 60 godina.
06:13
We can do it as an outpatient procedure.
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Možemo to učiniti kao ambulantni postupak.
06:15
We can strip that tissue very economically,
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Možemo to tkivo očistiti vrlo ekonomično.
06:18
and so this is how we can get biologic knee replacement
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I to je način kako možemo dobiti biološka zamjenska koljena
06:21
to go global.
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koja mogu ići globalno.
06:23
And so welcome to super biologics.
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Dobro došli u super biologiku.
06:25
It's not hardware.
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To nije hardver.
06:27
It's not software.
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To nije softver.
06:30
It's bioware.
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To je biover.
06:32
It's version 2.0 of you.
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To je 2.0 verzija vas.
06:35
And so with that, coming to a --
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S tim, dolazimo do --
06:37
(Laughter)
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(Smijeh)
06:39
coming to an operating theater near you soon, I believe.
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vjerujem da dolazimo do kirurške sale blizu vas uskoro.
06:41
Thank you very much.
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Puno vam hvala.
06:43
(Applause)
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(Pljesak)
ABOUT THE SPEAKER
Kevin Stone - Surgeon, inventorKevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament.
Why you should listen
Orthopedic surgeon Kevin Stone knows mobility means more than just where you go -- it's the foundation for a fulfilling daily life. (True whether you're an athlete or not.) His Stone Clinic specializes in "biologic knee replacement": replacing damaged joint parts, not with artificial components, but with lab-grown tissue and parts from human donors. He and team are spearheading new techniques that use animal tissue but avoid the complications associated with animal-to-human transplantations.
Stone has consulted publications such as The Wall Street Journal and Newsweek as a medical expert; he has contributed to TV programs such as ESPN's "Treating Athletes in the New Millennium" and The Discovery Channel.
Kevin Stone | Speaker | TED.com