TED2010
Kevin Stone: The bio-future of joint replacement
Kevin Stone：关节置换术的生物未来
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关节炎和关节磨损困扰着数以百万的人，但是很少有人能够得到最好的治疗。Kevin Stone为我们展示了一个新颖治疗的方法，它可以取代高昂医疗费用和人体器官捐助。这就是用动物的关节进行置换。
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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现在开始讲述我的故事
00:18
So I tore my knee joint meniscus cartilage
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在大学踢足球时
00:20
playing soccer in college.
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我将我的半月板软骨撕裂
00:23
Then I went on to tear my ACL, the ligament in my knee,
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随后，我的前十字韧带也被撕裂了
00:26
and then developed an arthritic knee.
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但不久之后，人工膝盖出现了
00:28
And I'm sure that many of you in this audience have that same story,
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我确信在座的很多听众都经历过此类的事情
00:31
and, by the way, I married a woman
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顺便说一句，我结婚了
00:33
who has exactly the same story.
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我的妻子也经历过同样的事情
00:36
So this motivated me to become an orthopedic surgeon
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这些事情促使我成为一名整形外科医生
00:39
and to see if I couldn't focus on solutions for those problems
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我希望能够解决如何让我们
00:42
that would keep me playing sports and not limit me.
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如何可以无拘束的运动问题
00:46
So with that, let me just show you a quick video
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带着这个问题，我先让我们看一个简短的视频
00:49
to get you in the mood of what we're trying to explain.
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让它带着你们了解我们所希望解决的问题
00:52
Narrator: We are all aware of the risk of cancer,
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视频旁白：我们都很关注癌症的风险
00:54
but there's another disease
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但是还有另一种疾病
00:56
that's destined to affect even more of us: arthritis.
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能够比癌症还要影响更多的人—关节炎
00:59
Cancer may kill you, but when you look at the numbers,
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癌症也许会让你死亡，但关节炎
01:01
arthritis ruins more lives.
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会毁掉更多人的生活
01:03
Assuming you live a long life, there's a 50 percent chance
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假设你可活得很长命，你将有50%的概率
01:05
you'll develop arthritis.
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患上关节炎
01:08
And it's not just aging that causes arthritis.
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这并不是因为年老而引起的疾病
01:10
Common injuries can lead to decades of pain,
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常见的损伤可以导致数十年的伤痛
01:13
until our joints quite literally grind to a halt.
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直到关节经过长时间磨损而停止工作
01:16
Desperate for a solution, we've turned to engineering
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我们迫切地想得到解决的方法，随之我们转向工程学
01:18
to design artificial components
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以来设计人造关节
01:20
to replace our worn-out body parts,
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来替代我们早已磨损且不堪重负的身体器官
01:22
but in the midst of the modern buzz
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但在研究新方法时
01:24
around the promises of a bionic body,
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都是围绕着仿生学这一前提
01:26
shouldn't we stop and ask if there's a better, more natural way?
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我们是否应该暂时停下脚步看看有没有更好、更自然的方法
01:31
Let's consider an alternative path.
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让我们一起考虑一个替代方法
01:33
What if all the replacements our bodies need
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如果我们将我们身体某一部分的需要替换为
01:36
already exist in nature,
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已经存在的生物器官
01:38
or within our own stem cells?
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又或者用我们自己的干细胞培养会怎么样
01:40
This is the field of biologic replacements,
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这就是生物置换领域
01:42
where we replace worn-out parts with new, natural ones.
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它将我们已磨损的器官替换为新的、自然的器官
01:45
Kevin Stone: And so, the mission is:
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Kevin Stone：任务就是
01:47
how do I treat these things biologically?
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我们如何用生物学知识处理这类事情
01:49
And let's talk about both what I did for my wife,
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下面然我们谈谈，我对我的妻子
01:51
and what I've done for hundreds of other patients.
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以及数以百计的病人的治疗方法
01:53
First thing for my wife,
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这是从我的妻子那里最先听到的
01:55
and the most common thing I hear from my patients,
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以及从我的患者口中
01:57
particularly in the 40- to 80-year-old age group, 70-year-old age group,
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尤其是那些40-80岁年龄组中的70岁年龄组
02:00
is they come in and say,
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最常听到的是
02:02
"Hey, Doc, isn't there just a shock absorber you can put in my knee?
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嘿，医生，我的膝盖中的放得只是一个减震器对吗
02:04
I'm not ready for joint replacement."
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我并没有做好换关节的准备
02:06
And so for her, I put in a human meniscus allograft donor
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对我的妻子来说我对她进了半月板手术
02:09
right into that [knee] joint space.
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在膝盖连接处行了同种异体的植入
02:11
And [the allograft] replaces [the missing meniscus].
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这种异基因移植物替换了缺失的半月板
02:13
And then for that unstable ligament,
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随后对原来的韧带进行替换
02:15
we put in a human donor ligament
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我们放入了其他人捐赠的韧带
02:17
to stabilize the knee.
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以使她的膝盖得到稳定的支撑
02:19
And then for the damaged arthritis on the surface,
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第三，则是对关节表面的损坏
02:22
we did a stem cell paste graft,
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我们进行了干细胞黏贴移植
02:24
which we designed in 1991,
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这个则是我们在1991年设计出来的
02:26
to regrow that articular cartilage surface
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可以使得关节软骨组织再生
02:29
and give it back a smooth surface there.
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使他们还原为光滑的表面
02:32
So here's my wife's bad knee on the left,
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左边这个是我爱人原已损坏的膝盖
02:34
and her just hiking now
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但是看右边，她在四个月后的Aspen
02:36
four months later in Aspen, and doing well.
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已经可以徒步旅行了，并且一切都很好
02:39
And it works, not just for my wife, but certainly for other patients.
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手术成功了，但并这个成功并不仅仅局限于我的爱人，其他患者也同样受益
02:42
The girl on the video, Jen Hudak,
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视频中的女孩，Jen Hudak
02:44
just won the Superpipe in Aspen
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刚刚在Aspen赢得了雪道滑雪
02:46
just nine months after having destroyed her knee,
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而这发生在她膝盖损坏后的九个月
02:49
as you see in the other image --
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正如你们看到视频
02:51
and having a paste graft to that knee.
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她有着经过干细胞修复过的膝盖
02:53
And so we can regrow these surfaces biologically.
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所以我们从生物学的角度将是可以修复关节表面的
02:57
So with all this success,
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所以经过了这些的成功
02:59
why isn't that good enough, you might ask.
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你们也许会问为什么还不够好呢
03:02
Well the reason is because there's not enough donor cycles.
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这是因为还没有足够的数据来支撑这个实践
03:05
There's not enough young, healthy people
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没有足够健康的年轻人
03:07
falling off their motorcycle
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从他们的模特车上摔倒
03:09
and donating that tissue to us.
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并且将他们的器官捐赠给我们
03:12
And the tissue's very expensive.
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并且这个手术十分昂贵
03:15
And so that's not going to be a solution
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这就是这个办法没有得到普及的原因
03:17
that's going to get us global with biologic tissue.
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也使得我们将事业放眼于全球去寻找合适的生物组织
03:20
But the solution is animal tissue
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随后我们用动物组织进行替代
03:22
because it's plentiful, it's cheap,
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因为生物组织可以随处找到，并且价格也不高
03:24
you can get it from young, healthy tissues,
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并且可以得到年轻、健康的生物组织
03:27
but the barrier is immunology.
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但是，该种方法的障碍就是免疫问题
03:29
And the specific barrier
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这种特别的障碍是由
03:31
is a specific epitope
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特殊的抗原决定基所导致
03:33
called the galactosyl, or gal epitope.
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这种抗原决定基就是”半乳糖基“
03:35
So if we're going to transplant animal tissues to people,
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所以，如果我们想将动物组织移植到人类的身体上
03:37
we have to figure out a way to get rid of that epitope.
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则必须找到一种方法去除掉半乳糖基
03:40
So my story in working with animal tissues
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所以我的工作
03:42
starts in 1984.
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从1984年开始研究动物组织
03:44
And I started first
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我首先从
03:46
with cow Achilles tendon,
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牛的跟腱开始
03:48
where we would take the cow Achilles tendon,
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我们可以将牛的跟腱中的
03:50
which is type-I collagen,
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一种胶原质
03:52
strip it of its antigens
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从其抗原中分离
03:54
by degrading it with an acid and detergent wash
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进过一种酸和清洁剂的冲洗降解
03:57
and forming it into a regeneration template.
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使其成为一种再生模板
04:00
We would then take that regeneration template
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我们随后可以将这个再生模板
04:02
and insert it into the missing meniscus cartilage
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插入半月板软骨撕裂处
04:05
to regrow that in a patient's knee.
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让其在患者的膝盖再生
04:08
We've now done that procedure,
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直到现在，通过使用这种方法
04:10
and it's been done worldwide in over 4,000 cases,
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我们已经在全球范围内治愈了逾4000位患者
04:12
so it's an FDA-approved and worldwide-accepted way
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所以这是一个可以被美国食品及药物管理局以及全世界所接受的
04:15
to regrow the meniscus.
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膝盖半月板再生法
04:17
And that's great when I can degrade the tissue.
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而且当我们能够降解生物组织时将会更好
04:20
But what happens for your ligament when I need an intact ligament?
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但是，当你需要一个完整的韧带时
04:23
I can't grind it up in a blender.
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我不能将其在搅拌机里将其磨碎
04:25
So in that case,
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所以，这种情况下
04:27
I have to design -- and we designed with Uri Galili and Tom Turek --
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我必须进行研究设计，与我一起设计的还有Uri Galili和Tom Turek
04:30
an enzyme wash
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我们一起设计一种酶洗之法
04:32
to wash away, or strip,
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用一种特殊的酶
04:34
those galactosyl epitopes
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以洗掉或脱离掉
04:36
with a specific enzyme.
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那些半乳糖抗原决定基
04:38
And we call that a "gal stripping" technique.
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这种酶素洗法我们称之为“半乳糖脱离”技术
04:41
What we do is humanize the tissue.
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我们所做的就是将组织做的更加人性化
04:43
It's by gal stripping that tissue
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用半乳糖脱离法
04:45
we humanize it (Laughter),
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我们可以将其处理的更加接近人的组织
04:47
and then we can put it back
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然后我们就可以
04:49
into a patient's knee.
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将这个组织放回患者的膝盖处
04:53
And we've done that. Now we've taken pig ligament --
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我们已经做过这个实验，现在我们采用猪的韧带
04:55
young, healthy, big tissue,
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年轻的、健康的、大的组织
04:57
put it into 10 patients in an FDA-approved trial --
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将其放入是为患者的体内，当然这个实验是经过美国食品药品监督管理局的批准
05:00
and then one of our patients went on to have
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不久，其中一位患者就继续参加了
05:02
three Canadian Masters Downhill championships --
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三个加拿大斜坡大师冠军赛
05:05
on his "pig-lig," as he calls it. So we know it can work.
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当然，这都是经过他自己称之为“猪膝盖”的做功。这让我们了解到这种方法管用
05:07
And there's a wide clinical trial of this tissue now pending.
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而且，一个更大规模的临床试验将要进行
05:12
So what about the next step?
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那么我们的下一步将会做什么
05:14
What about getting to a total biologic knee replacement,
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做一个整体生物膝盖置换怎么样
05:16
not just the parts?
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不再局限于一个部分
05:18
How are we going to revolutionize artificial joint replacement?
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我们如何对人在关节置换进行革命性改变
05:21
Well here's how we're going to do it.
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这就是我们如何做这件事情
05:23
So what we're going to do is take
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我们将会用一个
05:25
an articular cartilage
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来自年轻、健康的猪的
05:27
from a young, healthy pig,
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关节软骨
05:29
strip it of its antigens,
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剥离掉它的抗原
05:31
load it with your stem cells,
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载上你自己的干细胞
05:34
then put it back on to that
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然后将其放回
05:36
arthritic surface in your knee,
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你自己膝盖处的关节
05:39
tack it on there, have you heal that surface
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将其固定，让你自己治愈破损的表面
05:42
and then create a new biologic surface for your knee.
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并让其自己为你的膝盖生长一个新的生物表面
05:48
So that's our biologic approach right now.
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这就是我们现在的生物方法
05:52
We're going to rebuild your knee with the parts.
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我们可以用部分组织让你的膝盖得以重生
05:54
We're going to resurface it with a completely new surface.
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我们将原组织表面生成一个全新的表面
05:57
But we have other advantages from the animal kingdom.
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但是，我们可以从动物王国哪里得到其他的利益
06:00
There's a benefit of 400 million years
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这个利益是他们有四亿年的
06:02
of ambulation.
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移动历史
06:04
We can harness those benefits.
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我们可以利用那些有事
06:06
We can use thicker, younger, better tissues
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我们可以利用那些更加厚实、年轻
06:09
than you might have injured in your knee,
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比你自身更好的组织
06:11
or that you might have when you're 40, 50 or 60.
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或比你40、50、60岁时更好的组织
06:13
We can do it as an outpatient procedure.
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我们可以将其发展为门诊式的程序
06:15
We can strip that tissue very economically,
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我们还可以将脱离技术发展为更为经济的方法
06:18
and so this is how we can get biologic knee replacement
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这就是我们如何在全球范围内
06:21
to go global.
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获得生物膝盖置换的方法
06:23
And so welcome to super biologics.
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欢迎进入生物学的世界
06:25
It's not hardware.
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他不是硬件
06:27
It's not software.
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也不是软件
06:30
It's bioware.
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是生物部件
06:32
It's version 2.0 of you.
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是你身体部件的第二代
06:35
And so with that, coming to a --
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我深信不久人们将会在
06:37
(Laughter)
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（笑声）
06:39
coming to an operating theater near you soon, I believe.
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各个医院中见到它的使用
06:41
Thank you very much.
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谢谢
06:43
(Applause)
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（掌声）
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