TEDGlobal>Geneva
Jocelyne Bloch: The brain may be able to repair itself -- with help
Jocelyne Bloch: 大脑也许可以在辅助下进行自我修复
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通过对中风和在车祸中大脑受到损伤的患者进行细致的治疗，神经外科医生 Jocelyne Bloch了解到大脑并不能彻底实现自我修复。但是现在，她提出，她和同事们可能已经找到了神经修复的关键所在：DCX阳性细胞。与干细胞类似，它们的可塑性很强，而且从大脑中被提取出之后，经过培养，再重新植入同一大脑的受损区域，它们就能够帮助大脑进行修复和重构。“只需要一点点的辅助，”Bloch说，“大脑也许就能自我复原。”
Jocelyne Bloch - Functional neurosurgeon
Jocelyne Bloch is helping to unlock potential self-healing capacities of the human brain. Full bio
Jocelyne Bloch is helping to unlock potential self-healing capacities of the human brain. Full bio
Double-click the English transcript below to play the video.
00:12
So I'm a neurosurgeon.
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我是一名神经外科医生。
00:15
And like most of my colleagues,
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跟我的大多数同事一样，
我每天都要面对各种人世间的悲剧。
00:17
I have to deal, every day,
with human tragedies.
with human tragedies.
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00:22
I realize how your life can change
from one second to the other
from one second to the other
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我认识到一次严重的中风
或者一次车祸，
或者一次车祸，
就足以在下一秒改变一个人的命运。
00:27
after a major stroke
or after a car accident.
or after a car accident.
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00:32
And what is very frustrating
for us neurosurgeons
for us neurosurgeons
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对我们这些神经外科医生来说，
最难过的事情就是意识到
最难过的事情就是意识到
与其他身体器官不同，
00:35
is to realize that unlike
other organs of the body,
other organs of the body,
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大脑几乎不能进行自我修复。
00:40
the brain has very little
ability for self-repair.
ability for self-repair.
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00:45
And after a major injury
of your central nervous system,
of your central nervous system,
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在中枢神经系统受到一次严重损伤后，
00:50
the patients often remain
with a severe handicap.
with a severe handicap.
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患者将会终身面对严重的残疾。
00:55
And that's probably
the reason why I've chosen
the reason why I've chosen
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这可能也是我想要成为一名
功能性神经外科医生的原因。
00:57
to be a functional neurosurgeon.
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01:01
What is a functional neurosurgeon?
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功能性神经外科医生是做什么的？
01:03
It's a doctor who is trying to improve
a neurological function
a neurological function
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他们主要通过各种不同的手术方法
来改善神经功能。
01:08
through different surgical strategies.
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01:12
You've certainly heard of
one of the famous ones
one of the famous ones
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你们一定听说过
很多主流方法中的一个，
很多主流方法中的一个，
叫做深度脑电刺激，
01:14
called deep brain stimulation,
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01:17
where you implant an electrode
in the depths of the brain
in the depths of the brain
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通常是把一个电极植入大脑深处，
通过调控神经元电流
01:21
in order to modulate a circuit of neurons
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来改善神经功能。
01:24
to improve a neurological function.
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01:27
It's really an amazing technology
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这项技术不可思议地
扭转了患有帕金森，
01:29
in that it has improved
the destiny of patients
the destiny of patients
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和被颤抖及疼痛困扰的
01:32
with Parkinson's disease,
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患者的命运。
01:34
with severe tremor, with severe pain.
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01:38
However, neuromodulation
does not mean neuro-repair.
does not mean neuro-repair.
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但是，神经调控并不意味着
神经元的修复。
神经元的修复。
01:45
And the dream of functional neurosurgeons
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而功能性神经外科医生希望有朝一日
能够修复受损的大脑。
01:47
is to repair the brain.
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01:51
I think
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我认为
我们正在一步步接近这个目标。
01:52
that we are approaching this dream.
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我想让大家看看
01:54
And I would like to show you
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01:57
that we are very close to this.
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我们离成功已经近在咫尺了。
02:00
And that with a little bit of help,
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只需要一点点的人工辅助，
大脑就可以进行自我修复。
02:03
the brain is able to help itself.
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02:08
So the story started 15 years ago.
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事情还要从15年前说起。
02:11
At that time, I was a chief resident
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那时候我还是一名住院总医师，
夜以继日地在急诊室忙碌。
02:13
working days and nights
in the emergency room.
in the emergency room.
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02:16
I often had to take care
of patients with head trauma.
of patients with head trauma.
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我经常要护理有大脑损伤的病患。
02:21
You have to imagine that when a patient
comes in with a severe head trauma,
comes in with a severe head trauma,
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你们可以想象一下，
带有严重脑外伤的患者被推进来，
带有严重脑外伤的患者被推进来，
他的大脑不断肿胀，
02:25
his brain is swelling
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颅内压越来越高。
02:28
and he's increasing
his intracranial pressure.
his intracranial pressure.
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02:31
And in order to save his life,
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要挽救他的生命，
就必须要降低颅内压。
02:33
you have to decrease
this intracranial pressure.
this intracranial pressure.
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要做到这一点，
02:36
And to do that,
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有时候就需要移除一部分肿胀的脑组织。
02:37
you sometimes have to remove
a piece of swollen brain.
a piece of swollen brain.
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02:42
So instead of throwing away
these pieces of swollen brain,
these pieces of swollen brain,
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不过我们并没有把这一部分
肿胀的大脑直接丢弃，
肿胀的大脑直接丢弃，
而是在与生物学家 ，
也是我的一位同事
也是我的一位同事
02:46
we decided with Jean-François Brunet,
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Jean-François Brunet商量之后，
02:49
who is a colleague of mine, a biologist,
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决定对这部分组织进行进一步研究。
02:51
to study them.
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02:53
What do I mean by that?
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具体要怎么研究呢？
我们想让这一部分组织长出细胞来。
02:55
We wanted to grow cells
from these pieces of tissue.
from these pieces of tissue.
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03:00
It's not an easy task.
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这可不是件容易的事儿。
03:02
Growing cells from a piece of tissue
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让组织生长出细胞，
就好比一个家庭开始
03:04
is a bit the same as growing
very small children
very small children
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养育一个小宝宝。
03:08
out from their family.
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03:11
So you need to find the right nutrients,
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需要找到合适的营养成分，
合适的温度和湿度，
03:14
the warmth, the humidity
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保证它们能够在适宜的环境下存活。
03:15
and all the nice environments
to make them thrive.
to make them thrive.
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我们就是要在这样的条件下
培养这些细胞。
培养这些细胞。
03:19
So that's exactly what we had
to do with these cells.
to do with these cells.
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03:22
And after many attempts,
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尝试过很多次之后，
03:24
Jean-François did it.
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Jean-François成功了。
03:27
And that's what he saw
under his microscope.
under his microscope.
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这就是他在显微镜下看到的一幕。
03:31
And that was, for us, a major surprise.
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对我们来说，这是个天大的惊喜。
03:34
Why?
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为什么呢？
因为这看起来跟干细胞群落
几乎一模一样，
几乎一模一样，
03:35
Because this looks exactly the same
as a stem cell culture,
as a stem cell culture,
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小的，尚未成熟的细胞被一大群
绿色，较大的细胞包围着。
绿色，较大的细胞包围着。
03:40
with large green cells
surrounding small, immature cells.
surrounding small, immature cells.
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03:47
And you may remember from biology class
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你们可能还记得生物课上讲过，
干细胞是未发育成熟的细胞，
03:50
that stem cells are immature cells,
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可以演变成人体的任何一种细胞。
03:53
able to turn into any type
of cell of the body.
of cell of the body.
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03:59
The adult brain has stem cells,
but they're very rare
but they're very rare
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成人的大脑也有干细胞，
但是数量很少，
但是数量很少，
而且分布于大脑深处
04:04
and they're located
in deep and small niches
in deep and small niches
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隐蔽的角落里。
04:08
in the depths of the brain.
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所以能够在操作室里从肿胀的
04:10
So it was surprising to get
this kind of stem cell culture
this kind of stem cell culture
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大脑表面获得这种干细胞群落，
04:14
from the superficial part
of swollen brain we had
of swollen brain we had
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真是太让人意外了。
04:16
in the operating theater.
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而我们还观察到了
另外一个有趣的现象：
另外一个有趣的现象：
04:18
And there was another
intriguing observation:
intriguing observation:
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04:21
Regular stem cells
are very active cells --
are very active cells --
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正常的干细胞非常活跃——
它们可以不断地进行快速分裂。
04:26
cells that divide, divide,
divide very quickly.
divide very quickly.
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04:30
And they never die,
they're immortal cells.
they're immortal cells.
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它们也不会凋亡，能够一直存活。
04:33
But these cells behave differently.
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但是这些细胞却有着不同的行为。
04:36
They divide slowly,
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它们分裂得很慢，
而且仅仅过了几个星期，
04:38
and after a few weeks of culture,
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就会慢慢死掉。
04:40
they even died.
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04:43
So we were in front of a strange
new cell population
new cell population
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于是我们面前就出现了
一个奇怪的新的细胞群落，
一个奇怪的新的细胞群落，
看起来像干细胞，
但其行为却又跟干细胞有着天壤之别。
但其行为却又跟干细胞有着天壤之别。
04:46
that looked like stem cells
but behaved differently.
but behaved differently.
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04:51
And it took us a long time
to understand where they came from.
to understand where they came from.
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我们花了好长时间
才搞清楚它们是从哪儿来的。
才搞清楚它们是从哪儿来的。
它们来自于这些细胞。
04:55
They come from these cells.
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04:58
These blue and red cells are called
doublecortin-positive cells.
doublecortin-positive cells.
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这些蓝色和红色的细胞称为
DCX（doublecortin-positive）阳性细胞。
DCX（doublecortin-positive）阳性细胞。
05:04
All of you have them in your brain.
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它们存在于我们每个人的大脑中，
05:07
They represent four percent
of your cortical brain cells.
of your cortical brain cells.
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组成了我们4%的大脑皮层细胞。
05:11
They have a very important role
during the development stage.
during the development stage.
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在大脑发育过程中，
这些细胞起着至关重要的作用。
这些细胞起着至关重要的作用。
在婴儿时期，
05:15
When you were fetuses,
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05:18
they helped your brain to fold itself.
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它们能帮助大脑产生褶皱。
05:22
But why do they stay in your head?
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但它们为什么会一直留在大脑中呢？
05:25
This, we don't know.
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这一点我们还不清楚。
05:27
We think that they may
participate in brain repair
participate in brain repair
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我们认为它们可能参与了大脑修复，
是因为我们发现在大脑损伤的部位
05:30
because we find them
in higher concentration
in higher concentration
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它们的浓度比较高。
05:34
close to brain lesions.
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但我们还不是非常确定。
05:35
But it's not so sure.
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05:37
But there is one clear thing --
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但有一点已经很清楚了——
也就是从这些细胞中，
05:40
that from these cells,
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我们得到了干细胞群落。
05:41
we got our stem cell culture.
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05:45
And we were in front
of a potential new source of cells
of a potential new source of cells
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我们面前正是一群有可能修复大脑的
细胞的新来源。
05:48
to repair the brain.
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05:50
And we had to prove this.
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我们需要证明这一点。
那么想要证明，
05:51
So to prove it,
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我们决定设计一组对照试实验。
05:52
we decided to design
an experimental paradigm.
an experimental paradigm.
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基本概念就是在大脑中一块
05:56
The idea was to biopsy a piece of brain
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功能尚不明确的区域进行活组织提取，
05:59
in a non-eloquent area of the brain,
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然后用Jean-François在实验室
06:02
and then to culture the cells
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尝试过的同样的方法培养细胞。
06:04
exactly the way Jean-François
did it in his lab.
did it in his lab.
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然后给它们做标记，染色，
06:07
And then label them, to put color in them
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这样就可以在大脑中追踪它们的活动。
06:10
in order to be able
to track them in the brain.
to track them in the brain.
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06:13
And the last step was to re-implant them
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最后一步就是把它们重新移植入
相同的个体中。
06:15
in the same individual.
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我们把这叫做
06:17
We call these
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自体同源嫁接——自嫁接。
06:18
autologous grafts -- autografts.
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06:21
So the first question we had,
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我们的第一个问题就是，
“如果我们把这些细胞
重新植入一个正常的大脑，
重新植入一个正常的大脑，
06:24
"What will happen if we re-implant
these cells in a normal brain,
these cells in a normal brain,
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或者一个受过损伤的大脑，
06:29
and what will happen
if we re-implant the same cells
if we re-implant the same cells
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会有什么区别呢？”
06:32
in a lesioned brain?"
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很幸运，在Eric Rouiller教授的帮助下，
06:33
Thanks to the help
of professor Eric Rouiller,
of professor Eric Rouiller,
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我们得以在猴子身上进行试验。
06:36
we worked with monkeys.
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06:39
So in the first-case scenario,
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在第一种情况中，
我们把这些细胞移植入了正常大脑中，
06:41
we re-implanted the cells
in the normal brain
in the normal brain
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发现它们在
仅仅几周后就完全消失了，
仅仅几周后就完全消失了，
06:45
and what we saw is that they completely
disappeared after a few weeks,
disappeared after a few weeks,
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就好像被从大脑中清除了一样，
06:50
as if they were taken from the brain,
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它们被驱赶出了这一区域，
06:53
they go back home,
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这里没有多余的空间了，
06:54
the space is already busy,
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它们发挥不了任何作用，于是就消失了。
06:56
they are not needed there,
so they disappear.
so they disappear.
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06:59
In the second-case scenario,
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在第二种情况中，
我们用了受损的大脑，
07:01
we performed the lesion,
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把一模一样的细胞移植了进去，
07:03
we re-implanted exactly the same cells,
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而这一次，细胞存活了下来——
07:06
and in this case, the cells remained --
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它们发育成了成熟的神经细胞。
07:10
and they became mature neurons.
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07:13
And that's the image of what
we could observe under the microscope.
we could observe under the microscope.
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这就是我们在显微镜下看到的图像。
这些是重新移植过的细胞。
07:17
Those are the cells
that were re-implanted.
that were re-implanted.
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07:20
And the proof they carry,
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证据表明，
这些小点就是我们在体外标记过的
07:22
these little spots, those
are the cells that we've labeled
are the cells that we've labeled
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还处在群落状态下的细胞。
07:26
in vitro, when they were in culture.
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07:29
But we could not stop here, of course.
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但这肯定还远远不够。
07:32
Do these cells also help a monkey
to recover after a lesion?
to recover after a lesion?
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那么这些细胞到底会不会
修复猴子的脑损伤呢？
修复猴子的脑损伤呢？
为了证明这一点，我们训练猴子
完成一些有关肢体敏捷性的任务。
完成一些有关肢体敏捷性的任务。
07:37
So for that, we trained monkeys
to perform a manual dexterity task.
to perform a manual dexterity task.
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它们需要从盘子里取出食物。
07:42
They had to retrieve
food pellets from a tray.
food pellets from a tray.
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它们一向很擅长这种事儿。
07:45
They were very good at it.
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07:47
And when they had reached
a plateau of performance,
a plateau of performance,
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当它们的表现稳定后，
我们在大脑的运动皮层管理手部动作的
区域人为制造了一些损伤。
区域人为制造了一些损伤。
07:51
we did a lesion in the motor cortex
corresponding to the hand motion.
corresponding to the hand motion.
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07:57
So the monkeys were plegic,
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于是猴子们失去了手部行动能力，
手再也不停使唤了。
07:59
they could not move their hand anymore.
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08:02
And exactly the same as humans would do,
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跟人类一样，
它们自动恢复到了某种水平，
08:05
they spontaneously recovered
to a certain extent,
to a certain extent,
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跟中风后的情形相同。
08:08
exactly the same as after a stroke.
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中风患者完全不具备行动能力，
08:10
Patients are completely plegic,
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他们会试图利用大脑的弹性机制，
08:12
and then they try to recover
due to a brain plasticity mechanism,
due to a brain plasticity mechanism,
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恢复到某种程度，
08:17
they recover to a certain extent,
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猴子也是一样。
08:19
exactly the same for the monkey.
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于是当我们很确定猴子的自我恢复能力
08:21
So when we were sure that the monkey
had reached his plateau
had reached his plateau
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已经到达极限时，
08:24
of spontaneous recovery,
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我们移植了它自身的细胞。
08:27
we implanted his own cells.
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08:30
So on the left side, you see the monkey
that has spontaneously recovered.
that has spontaneously recovered.
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在左边，你们可以看到
猴子自行恢复的状况。
猴子自行恢复的状况。
08:37
He's at about 40 to 50 percent
of his previous performance
of his previous performance
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与大脑受到损伤之前的状况相比，
它大概恢复了
它大概恢复了
40-50%的行动能力。
08:42
before the lesion.
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08:44
He's not so accurate, not so quick.
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它的动作不是很精准，也比较慢。
08:47
And look now, when we re-impant the cells:
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再看看现在，我们重新移植了细胞之后：
同样的个体，移植两个月后的状况。
08:50
Two months after re-implantation,
the same individual.
the same individual.
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08:57
(Applause)
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（掌声）
09:04
It was also very exciting results
for us, I tell you.
for us, I tell you.
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说实话，这样的结果
就连我们也感到很意外。
就连我们也感到很意外。
09:09
Since that time, we've understood
much more about these cells.
much more about these cells.
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从那时起，
我们对这些细胞就更加了解了。
我们对这些细胞就更加了解了。
09:13
We know that we can cryopreserve them,
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我们知道我们能对
它们进行加密保存，
它们进行加密保存，
以后也能用得到。
09:15
we can use them later on.
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09:18
We know that we can apply them
in other neuropathological models,
in other neuropathological models,
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我们也知道我们可以把它们应用到
其他神经病理学模型中，
其他神经病理学模型中，
比如帕金森。
09:22
like Parkinson's disease, for example.
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但我们始终梦想有一天
能把它们移植入人体中。
能把它们移植入人体中。
09:24
But our dream is still
to implant them in humans.
to implant them in humans.
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09:28
And I really hope that I'll be able
to show you soon
to show you soon
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我真的希望很快就能让你们看到
09:33
that the human brain is giving us
the tools to repair itself.
the tools to repair itself.
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人类大脑为我们提供了
让它进行自我修复的工具。
让它进行自我修复的工具。
谢谢大家。
09:38
Thank you.
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（掌声）
09:39
(Applause)
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Bruno Giussaini（BG）:
Jocelyne，这太精彩了，
Jocelyne，这太精彩了，
09:45
Bruno Giussani: Jocelyne, this is amazing,
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现在我很确定，在座的很多人，
09:49
and I'm sure that right now, there are
several dozen people in the audience,
several dozen people in the audience,
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甚至可能是大部分人，
09:53
possibly even a majority,
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都在想，“我知道什么人会需要这项技术。”
09:54
who are thinking, "I know
somebody who can use this."
somebody who can use this."
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总之我很确信。
09:57
I do, in any case.
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当然我还有个问题，
09:59
And of course the question is,
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在你们能够进行人体临床试验之前，
10:01
what are the biggest obstacles
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你们面临的最大障碍都有哪些呢？
10:03
before you can go
into human clinical trials?
into human clinical trials?
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10:07
Jocelyne Bloch: The biggest
obstacles are regulations. (Laughs)
obstacles are regulations. (Laughs)
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Jocelyne Bloch （JB）：
最大的障碍就是监管制度。（笑声）
最大的障碍就是监管制度。（笑声）
就是说，有了这些不可思议的结果，
你就得开始处理
你就得开始处理
10:13
So, from these exciting results,
you need to fill out
you need to fill out
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10:15
about two kilograms of papers and forms
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大约两公斤的各种文件和表格，
然后才能开始临床试验。
10:19
to be able to go through these
kind of trials.
kind of trials.
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BG：这还算合理吧，毕竟大脑太复杂了，
还有其他种种需要考虑的问题。
还有其他种种需要考虑的问题。
10:22
BG: Which is understandable,
the brain is delicate, etc.
the brain is delicate, etc.
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JB：的确，但是这个过程太漫长了，
10:24
JB: Yes, it is, but it takes a long time
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需要极度的耐心，还有一个专业团队
来做这个事儿，对吧？
来做这个事儿，对吧？
10:27
and a lot of patience and almost
a professional team to do it, you know?
a professional team to do it, you know?
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BG：如果你们自己立项——
10:31
BG: If you project yourself --
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自己做研究，
10:33
having done the research
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然后试着拿到临床试验的许可，
10:34
and having tried to get
permission to start the trials,
permission to start the trials,
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如果能够按时完成这一系列过程，
10:38
if you project yourself out in time,
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10:42
how many years before
somebody gets into a hospital
somebody gets into a hospital
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一个普通人要去医院做这种治疗
还要等上几年呢？
10:46
and this therapy is available?
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10:49
JB: So, it's very difficult to say.
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JB：这很难说。
首先取决于临床试验的批准日期。
10:51
It depends, first,
on the approval of the trial.
on the approval of the trial.
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监管机构会让我们尽快开始吗？
10:55
Will the regulation allow us
to do it soon?
to do it soon?
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其次我们还得先在一小部分患者中间
10:58
And then, you have to perform
this kind of study
this kind of study
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进行预试验。
11:01
in a small group of patients.
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光是挑选合适的患者就要花上一阵子，
11:04
So it takes, already, a long time
to select the patients,
to select the patients,
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还得进行治疗，
11:07
do the treatment
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再评估这种治疗是否有效。
11:09
and evaluate if it's useful
to do this kind of treatment.
to do this kind of treatment.
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之后还要进行多中心治疗。
11:13
And then you have to deploy
this to a multicentric trial.
this to a multicentric trial.
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我们必须在把这种治疗推广到
11:17
You have to really prove
first that it's useful
first that it's useful
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普通大众身上之前确认它是有效的。
11:21
before offering this treatment
up for everybody.
up for everybody.
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BG：当然还要安全。
JB：肯定的。
JB：肯定的。
11:24
BG: And safe, of course. JB: Of course.
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BG：Jocelyne，
感谢你来TED分享这项研究。
感谢你来TED分享这项研究。
11:26
BG: Jocelyne, thank you for coming
to TED and sharing this.
to TED and sharing this.
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BG：谢谢。
（掌声）
11:29
BG: Thank you.
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11:30
(Applause)
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Reviewed by Yinchun Rui
ABOUT THE SPEAKER
Jocelyne Bloch - Functional neurosurgeonJocelyne Bloch is helping to unlock potential self-healing capacities of the human brain.
Why you should listen
Swiss neurosurgeon Jocelyne Bloch is an expert in deep brain stimulation and neuromodulation for movement disorders. Her recent work focuses on cortical cells, called doublecortin, related to neurogenesis and brain repair. In collaboration with Jean François Brunet and others, she is pioneering the development of adult brain cell transplantation for patients with stroke, using their own stem cells. She aims at gathering all these novel therapeutic strategies under a common umbrella that will optimize treatment options for patients suffering from neurological impairments. She is in charge of the functional neurosurgery unit at the Lausanne University Hospital (CHUV).
Jocelyne Bloch | Speaker | TED.com