ABOUT THE SPEAKER
Jocelyne Bloch - Functional neurosurgeon
Jocelyne 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).

More profile about the speaker
Jocelyne Bloch | Speaker | TED.com
TEDGlobal>Geneva

Jocelyne Bloch: The brain may be able to repair itself -- with help

Jocelyne Bloch: 只需要一點幫忙,腦部或許能自我修復。

Filmed:
3,127,181 views

Jocelyne Bloch 是一位神經外科醫生,治療無數腦創傷病人,無論因為中風以至交通意外而入院,令她認識到腦部自我修復能力不足。但是如今,她認為她跟同事已經找到神經修復的關鍵--微管相關蛋白正向細胞。它跟幹細胞很相似,適應能力很強。當它從腦部被抽取出來,培養後再重新注射入原來腦損傷的位置。這些細胞就能幫助腦部修復,完全康復過來。Bloch 說:「只要一點的幫忙,或許腦部就能自我康復。」
- Functional neurosurgeon
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神經外科醫生.
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我是一位神經㚈科醫生。
00:15
And like most of my colleagues同事,
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就像我的大部分同事一樣,
00:17
I have to deal合同, every一切 day,
with human人的 tragedies悲劇.
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我每天要面對很多人間悲剧。
00:22
I realize實現 how your life can change更改
from one second第二 to the other
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使我明白到人可能因為一次
嚴重中風或車禍,
00:27
after a major重大的 stroke行程
or after a car汽車 accident事故.
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而瞬間改變一生的命運。
00:32
And what is very frustrating洩氣
for us neurosurgeons神經外科醫生
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最令我們這些神經學家苦惱的,
00:35
is to realize實現 that unlike不像
other organs器官 of the body身體,
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就是知道腦部不似其他器官,
00:40
the brain has very little
ability能力 for self-repair自我修復.
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很難自我修復。
00:45
And after a major重大的 injury
of your central中央 nervous緊張 system系統,
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病人的中央神經系統
受到嚴重受創後,
00:50
the patients耐心 often經常 remain
with a severe嚴重 handicap阻礙.
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最後常常變成嚴重殘障。
00:55
And that's probably大概
the reason原因 why I've chosen選擇
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可能因為這樣,
00:57
to be a functional實用 neurosurgeon神經外科醫生.
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我決定成為功能性神經㚈科醫生。
01:01
What is a functional實用 neurosurgeon神經外科醫生?
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功能性神經㚈科醫生
做什麼工作呢?
01:03
It's a doctor醫生 who is trying to improve提高
a neurological神經 function功能
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這些醫生採用不同的㚈科方法,
01:08
through通過 different不同 surgical外科 strategies策略.
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致力改善神經功能。
01:12
You've certainly當然 heard聽說 of
one of the famous著名 ones那些
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各位一定聽過其中一個著名的方法
01:14
called deep brain stimulation促進,
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叫做腦部深層刺激手術。
01:17
where you implant注入 an electrode電極
in the depths深處 of the brain
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就是植入一種電極在腦部深層,
01:21
in order訂購 to modulate調製 a circuit電路 of neurons神經元
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改變神經元的迴路,
01:24
to improve提高 a neurological神經 function功能.
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繼而改善神經系統的功能。
01:27
It's really an amazing驚人 technology技術
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這種科技實在神奇,
01:29
in that it has improved改善
the destiny命運 of patients耐心
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因為它已經改變一些病人的命運,
01:32
with Parkinson's帕金森氏 disease疾病,
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例如柏金遜症、
01:34
with severe嚴重 tremor, with severe嚴重 pain疼痛.
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嚴重腦震盪和痛症。
01:38
However然而, neuromodulation神經調節
does not mean neuro-repair神經修復.
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但是神經調節並不是修復神經。
01:45
And the dream夢想 of functional實用 neurosurgeons神經外科醫生
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功能性㚈科醫生的夢想
01:47
is to repair修理 the brain.
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就是修復腦部。
01:51
I think
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我想
01:52
that we are approaching接近 this dream夢想.
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我們正朝著這個夢想前進。
01:54
And I would like to show顯示 you
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而且我想告訴大家
01:57
that we are very close to this.
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我們很快實現夢想。
02:00
And that with a little bit of help,
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只需要一點的幫忙,
02:03
the brain is able能夠 to help itself本身.
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腦部就能自我修復。
02:08
So the story故事 started開始 15 years年份 ago.
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這件事源自15年前,
02:11
At that time, I was a chief首席 resident居民
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那時我是駐院總醫師,
02:13
working加工 days and nights
in the emergency room房間.
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在急診室日夜不停工作。
02:16
I often經常 had to take care關心
of patients耐心 with head trauma外傷.
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常常要照顧腦創傷病人。
02:21
You have to imagine想像 that when a patient患者
comes in with a severe嚴重 head trauma外傷,
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可以想像當一個病人頭部
受到重創入院,
02:25
his brain is swelling腫脹
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他的腦部不斷腫脹,
02:28
and he's increasing增加
his intracranial顱內 pressure壓力.
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顱內壓增加,
02:31
And in order訂購 to save保存 his life,
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為了拯救他的生命,
02:33
you have to decrease減少
this intracranial顱內 pressure壓力.
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一定要降低顱內壓。
02:36
And to do that,
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因此
02:37
you sometimes有時 have to remove去掉
a piece of swollen brain.
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有時需要替病人移除一塊
腫脹的腦組織。
02:42
So instead代替 of throwing投擲 away
these pieces of swollen brain,
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我們沒有把那塊腦組織丟棄,
02:46
we decided決定 with Jean-Fran讓 - 弗朗索瓦çoisOIS Brunet布呂內,
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反而決定跟我的一位同事,
02:49
who is a colleague同事 of mine, a biologist生物學家,
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那是生物學家Jean-Francois Brunet
02:51
to study研究 them.
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一同硏究。
02:53
What do I mean by that?
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我那樣說是什麼意思呢?
02:55
We wanted to grow增長 cells細胞
from these pieces of tissue組織.
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那時我們想從這些腦組織
培育細胞。
03:00
It's not an easy簡單 task任務.
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但這是並非容易的事。
03:02
Growing生長 cells細胞 from a piece of tissue組織
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從一塊腦組織培育細胞
03:04
is a bit the same相同 as growing生長
very small children孩子
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就像把一個幼童跟家人分開,
03:08
out from their family家庭.
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由我們養育一樣。
03:11
So you need to find the right nutrients營養成分,
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所以一定要找到適合的營養食物、
03:14
the warmth熱情, the humidity濕度
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溫暖和濕度的環境,
03:15
and all the nice不錯 environments環境
to make them thrive興旺.
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和所有良好的外圍
使他們茁壯成長。
03:19
So that's exactly究竟 what we had
to do with these cells細胞.
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這正是我們培養
這些細胞的想法。
03:22
And after many許多 attempts嘗試,
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經過多次嘗試,
03:24
Jean-Fran讓 - 弗朗索瓦çoisOIS did it.
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Jean-Francois 終於成功。
03:27
And that's what he saw
under his microscope顯微鏡.
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這是他在顯微鏡下看到的東西。
03:31
And that was, for us, a major重大的 surprise.
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我們知道結果後,感到很驚訝。
03:34
Why?
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為什麼?
03:35
Because this looks容貌 exactly究竟 the same相同
as a stem cell細胞 culture文化,
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因為這個情況就跟培養
幹細胞一樣,
03:40
with large green綠色 cells細胞
surrounding周圍 small, immature未成熟的 cells細胞.
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有大的綠色細胞包圍著
未長成的小細胞。
03:47
And you may可能 remember記得 from biology生物學 class
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或許你會記得上生物課,
03:50
that stem cells細胞 are immature未成熟的 cells細胞,
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學過幹細胞是未成熟的細胞,
03:53
able能夠 to turn into any type類型
of cell細胞 of the body身體.
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可以變成身體任何一種細胞。
03:59
The adult成人 brain has stem cells細胞,
but they're very rare罕見
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成人的腦部也有幹細胞,
但十分稀少。
04:04
and they're located位於
in deep and small niches壁龕
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這些細胞存在於腦部低層
04:08
in the depths深處 of the brain.
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深處小小的位置。
04:10
So it was surprising奇怪 to get
this kind of stem cell細胞 culture文化
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所以能夠從手術室病人
腫脹的腦部表面,
04:14
from the superficial part部分
of swollen brain we had
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得到這些幹細胞培養組織,
04:16
in the operating操作 theater劇院.
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實在令人感到意外。
04:18
And there was another另一個
intriguing奇妙 observation意見:
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還有另一個有趣的觀測結果:
04:21
Regular定期 stem cells細胞
are very active活性 cells細胞 --
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正常的幹細胞非常活躍-
04:26
cells細胞 that divide劃分, divide劃分,
divide劃分 very quickly很快.
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它們不停分裂,非常迅速。
04:30
And they never die,
they're immortal不朽 cells細胞.
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永遠不會死亡,是一種不死細胞。
04:33
But these cells細胞 behave表現 differently不同.
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但是這些細胞行為不一樣。
04:36
They divide劃分 slowly慢慢地,
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它們緩慢地分裂,
04:38
and after a few少數 weeks of culture文化,
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經過數星期的培養,
04:40
they even died死亡.
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它們甚至死亡。
04:43
So we were in front面前 of a strange奇怪
new cell細胞 population人口
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所以我們面對了一群
奇怪的新細胞,
04:46
that looked看著 like stem cells細胞
but behaved differently不同.
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它們貌似幹細胞,但行為有分別。
04:51
And it took us a long time
to understand理解 where they came來了 from.
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我們花了很長時間,
才知道它們從那
04:55
They come from these cells細胞.
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就是來自這些細胞,
04:58
These blue藍色 and red cells細胞 are called
doublecortin-positivedoublecortin陽性 cells細胞.
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這些藍色、紅色細胞叫做
微管相關蛋白正向細胞。
05:04
All of you have them in your brain.
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在座各位的腦部都有這些細胞。
05:07
They represent代表 four percent百分
of your cortical皮質 brain cells細胞.
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它們佔了腦部皮質細胞的4%。
05:11
They have a very important重要 role角色
during the development發展 stage階段.
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對人類的成長期很重要。
05:15
When you were fetuses胎兒,
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在胚胎期,
05:18
they helped幫助 your brain to fold itself本身.
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它們幫助腦部摺疊起來。
05:22
But why do they stay in your head?
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但為什麼它們仍然留在
大家的腦部呢?
05:25
This, we don't know.
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這個我們不知道。
05:27
We think that they may可能
participate參加 in brain repair修理
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或許它們要參與腦部的修復,
05:30
because we find them
in higher更高 concentration濃度
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因為我們發現它們
在腦損傷的附近
05:34
close to brain lesions病變.
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比較高度聚集。
05:35
But it's not so sure.
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但我們仍然不能確定。
05:37
But there is one clear明確 thing --
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但是有一件事實很清楚-
05:40
that from these cells細胞,
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我們從這些細胞,
05:41
we got our stem cell細胞 culture文化.
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可以培養幹細胞。
05:45
And we were in front面前
of a potential潛在 new source資源 of cells細胞
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這些具有潛力的新細胞
就在我們面前,
05:48
to repair修理 the brain.
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它們能夠修復腦部。
05:50
And we had to prove證明 this.
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我們一定要證實這個論點。
05:51
So to prove證明 it,
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為了證實它,
05:52
we decided決定 to design設計
an experimental試驗 paradigm範例.
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我們決定設計一個實驗範例。
05:56
The idea理念 was to biopsy活檢 a piece of brain
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方法是在腦部不重要的區域
05:59
in a non-eloquent非佞 area of the brain,
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做活體組織切片,
06:02
and then to culture文化 the cells細胞
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然後培殖這些細胞,
06:04
exactly究竟 the way Jean-Fran讓 - 弗朗索瓦çoisOIS
did it in his lab實驗室.
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就跟Jean-Francois在實驗室
試驗的方法一樣。
06:07
And then label標籤 them, to put color顏色 in them
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然後把它標籤再染上顏色,
06:10
in order訂購 to be able能夠
to track跟踪 them in the brain.
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方便追踨它在腦部的位置。
06:13
And the last step was to re-implant重新植入 them
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最後把它再次植入在
06:15
in the same相同 individual個人.
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同一個病人。
06:17
We call these
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我們稱這些是
06:18
autologous自體 grafts移植物 -- autografts自體移植.
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自體移植物。
06:21
So the first question we had,
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我們首先有一個疑問,
06:24
"What will happen發生 if we re-implant重新植入
these cells細胞 in a normal正常 brain,
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「如果我們再次植入這些細胞
在正常腦部,會有什麼事;
06:29
and what will happen發生
if we re-implant重新植入 the same相同 cells細胞
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又或者再次植入有創傷的腦部,
06:32
in a lesioned毀損 brain?"
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又會發生什麼事情呢?
06:33
Thanks謝謝 to the help
of professor教授 Eric埃里克 RouillerRouiller,
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很多謝Eric Rouiller 教授的幫忙,
06:36
we worked工作 with monkeys猴子.
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我們一同利用猴子做研究,
06:39
So in the first-case第一例 scenario腳本,
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第一個的方案,
06:41
we re-implanted再注入的 the cells細胞
in the normal正常 brain
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我們再次植入細胞
在正常的腦部,
06:45
and what we saw is that they completely全然
disappeared消失 after a few少數 weeks,
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數星期後,我們發現
這些細胞完全消失,
06:50
as if they were taken採取 from the brain,
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就如它們從腦部帶走,
06:53
they go back home,
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後來回到從前腦部的家,
06:54
the space空間 is already已經 busy,
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由於地方實在太擠擁,
06:56
they are not needed需要 there,
so they disappear消失.
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所以沒需要再逗留,
唯有自行消失。
06:59
In the second-case第二殼體 scenario腳本,
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第二個方案,
07:01
we performed執行 the lesion病變,
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我們替
07:03
we re-implanted再注入的 exactly究竟 the same相同 cells細胞,
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跟著再次植入完全一樣的細胞,
07:06
and in this case案件, the cells細胞 remained保持 --
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這一次細胞繼續留下來-
07:10
and they became成為 mature成熟 neurons神經元.
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而且變成成熟的神經元。
07:13
And that's the image圖片 of what
we could observe under the microscope顯微鏡.
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這是我們在顯微鏡下
觀察到的影像。
07:17
Those are the cells細胞
that were re-implanted再注入的.
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這是再次植入的細胞。
07:20
And the proof證明 they carry攜帶,
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它們帶了實證,
07:22
these little spots斑點, those
are the cells細胞 that we've我們已經 labeled標記
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這些小點就是我們培養細胞時,
07:26
in vitro體外, when they were in culture文化.
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在試管
07:29
But we could not stop here, of course課程.
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當然我們不會就此停下來。
07:32
Do these cells細胞 also help a monkey
to recover恢復 after a lesion病變?
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這些細胞是否可以幫助
有腦創傷的猴子恢復呢?
07:37
So for that, we trained熟練 monkeys猴子
to perform演出 a manual手冊 dexterity靈巧 task任務.
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因此我們訓練猴子做一些
手指靈巧的動作。
07:42
They had to retrieve取回
food餐飲 pellets小球 from a tray托盤.
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牠們要從托盤拿起食物粒。
07:45
They were very good at it.
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猴子做得勝任有餘。
07:47
And when they had reached到達
a plateau高原 of performance性能,
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當訓練牠們到了穩定期時,
07:51
we did a lesion病變 in the motor發動機 cortex皮質
corresponding相應 to the hand motion運動.
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我們替牠們手部動作相應的腦部
皮質做了一個傷口。
07:57
So the monkeys猴子 were plegicplegic,
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於是猴子癱瘓了,
07:59
they could not move移動 their hand anymore.
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雙手不能移動,
08:02
And exactly究竟 the same相同 as humans人類 would do,
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就跟人類的情況一樣,
08:05
they spontaneously自發 recovered恢復
to a certain某些 extent程度,
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猴子中風後,
08:08
exactly究竟 the same相同 as after a stroke行程.
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身體自行恢復到某個程度。
08:10
Patients耐心 are completely全然 plegicplegic,
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病人完全癱瘓,
08:12
and then they try to recover恢復
due應有 to a brain plasticity可塑性 mechanism機制,
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病人希望康復,由於腦部的
可塑性機制,
08:17
they recover恢復 to a certain某些 extent程度,
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病人能夠恢復到某一程度,
08:19
exactly究竟 the same相同 for the monkey.
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就跟猴子的情況完全一樣。
08:21
So when we were sure that the monkey
had reached到達 his plateau高原
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當我們確定猴子已經完成
08:24
of spontaneous自發 recovery復甦,
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身體自行恢復的階段,
08:27
we implanted植入 his own擁有 cells細胞.
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我們便植入牠自己的細胞。
08:30
So on the left side, you see the monkey
that has spontaneously自發 recovered恢復.
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在左方,你可以見到猴子
已經自行恢復。
08:37
He's at about 40 to 50 percent百分
of his previous以前 performance性能
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牠跟未有腦損傷時的表現,
08:42
before the lesion病變.
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大概做到4至5成。
08:44
He's not so accurate準確, not so quick.
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牠的動作並不那麼準確和敏捷。
08:47
And look now, when we re-impant再impant the cells細胞:
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再看看,我們再次植入這些細胞:
08:50
Two months個月 after re-implantation再注入,
the same相同 individual個人.
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兩個月後,同一隻猴子。
08:57
(Applause掌聲)
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(鼓掌聲)
09:04
It was also very exciting扣人心弦 results結果
for us, I tell you.
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那是令人非常興奮的結果。
09:09
Since以來 that time, we've我們已經 understood了解
much more about these cells細胞.
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從此我們更加了解這些細胞。
09:13
We know that we can cryopreserve冷凍保存 them,
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也知道可以把細胞超低溫冷凍,
09:15
we can use them later後來 on.
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留待日後再用。
09:18
We know that we can apply應用 them
in other neuropathological神經病理學 models楷模,
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我們可以應用在其他
神經病理模式。
09:22
like Parkinson's帕金森氏 disease疾病, for example.
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例如柏金遜症。
09:24
But our dream夢想 is still
to implant注入 them in humans人類.
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但是我們的夢想仍是
把細胞植入人腦。
09:28
And I really hope希望 that I'll be able能夠
to show顯示 you soon不久
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我真的希望很快顯示各位面前,
09:33
that the human人的 brain is giving us
the tools工具 to repair修理 itself本身.
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我們可以利用人腦成為
人體自我修復的功具。
09:38
Thank you.
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謝謝。
09:39
(Applause掌聲)
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(鼓掌聲)
09:45
Bruno布魯諾 Giussani吉薩尼: Jocelyne主任Jocelyne, this is amazing驚人,
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Bruno Glussani: Jocelyne, 真是令人驚嘆呢,
09:49
and I'm sure that right now, there are
several一些 dozen people in the audience聽眾,
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我肯定在座有很多觀眾,
09:53
possibly或者 even a majority多數,
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甚至可能大部分人
09:54
who are thinking思維, "I know
somebody who can use this."
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都在想:「我知道某人可以
接受這個治療。」
09:57
I do, in any case案件.
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無論如何我也認同。
09:59
And of course課程 the question is,
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但問題是
10:01
what are the biggest最大 obstacles障礙
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什麼是你進行人體臨床試驗時,
10:03
before you can go
into human人的 clinical臨床 trials試驗?
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最大的阻力呢?
10:07
Jocelyne主任Jocelyne Bloch布洛赫: The biggest最大
obstacles障礙 are regulations法規. (Laughs)
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Jocelyne Bloch: 最大的阻力
就是規條。(笑聲)
10:13
So, from these exciting扣人心弦 results結果,
you need to fill out
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雖然有這些令人興奮的結果,
10:15
about two kilograms公斤 of papers文件 and forms形式
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但要填寫大約2公斤的表格,
10:19
to be able能夠 to go through通過 these
kind of trials試驗.
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才能獲准去做這些試驗。
10:22
BGBG: Which哪一個 is understandable可理解,
the brain is delicate精巧, etc等等.
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BG:這是可以理解,因為腦部是那麼纖細脆弱等等。
10:24
JBJB: Yes, it is, but it takes a long time
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JB: 對的,但是需要很長的時間,
10:27
and a lot of patience忍耐 and almost幾乎
a professional專業的 team球隊 to do it, you know?
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需要耐力和一个專業的團隊。
10:31
BGBG: If you project項目 yourself你自己 --
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BG: 如果你自己預測
10:33
having doneDONE the research研究
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完成研究
10:34
and having tried試著 to get
permission允許 to start開始 the trials試驗,
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和獲准開始試驗後,
10:38
if you project項目 yourself你自己 out in time,
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假如妳可以預計需要多少時間,
10:42
how many許多 years年份 before
somebody gets得到 into a hospital醫院
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病人要入院接受這種治療,
10:46
and this therapy治療 is available可得到?
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需要等多少年呢?
10:49
JBJB: So, it's very difficult to say.
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JB : 這樣很難說。
10:51
It depends依靠, first,
on the approval贊同 of the trial審訊.
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首先要看做實驗可否獲批。
10:55
Will the regulation allow允許 us
to do it soon不久?
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那些規條會否讓我們
盡快做試驗呢?
10:58
And then, you have to perform演出
this kind of study研究
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然後要替一小撮病人
11:01
in a small group of patients耐心.
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進行硏究。
11:04
So it takes, already已經, a long time
to select選擇 the patients耐心,
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那又要花長時間挑選病人
11:07
do the treatment治療
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接受治療,
11:09
and evaluate評估 if it's useful有用
to do this kind of treatment治療.
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然後評估這類治療是否有效。
11:13
And then you have to deploy部署
this to a multicentric多中心 trial審訊.
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繼而要展開多核心試驗。
11:17
You have to really prove證明
first that it's useful有用
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一定先要證實那是對病人有作用,
11:21
before offering this treatment治療
up for everybody每個人.
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才能給大眾接受治療。
11:24
BGBG: And safe安全, of course課程. JBJB: Of course課程.
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BG:當然要安全可靠。
JB:一定。
11:26
BGBG: Jocelyne主任Jocelyne, thank you for coming未來
to TEDTED and sharing分享 this.
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BG:Jocelyne,謝謝妳來到Ted
跟我們分享這些見解。
11:29
BGBG: Thank you.
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BG:謝謝。
11:30
(Applause掌聲)
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(鼓掌聲)
Translated by Wink Wong
Reviewed by Becky Yuan

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ABOUT THE SPEAKER
Jocelyne Bloch - Functional neurosurgeon
Jocelyne 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).

More profile about the speaker
Jocelyne Bloch | Speaker | TED.com

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