TEDMED 2009
Anthony Atala: Growing new organs
Anthony Atala o uzgoju novih organa
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1,913,459 views
Najsuvremeniji laboratorij Anthony Atale uzgaja ljudske organe - od mišića, krvnih žila, mjehura, pa i više. Na TEDMED-u pokazuje snimke svojih bio-inženjera kako koriste neke od svojih znanstveno-fantastičnih spravica, uključujući i bioreaktor nalik pećnici (zagrijavanje do 37 ˚C), i stroj koji "printa" ljudsko tkivo.
Anthony Atala - Surgeon
Anthony Atala asks, "Can we grow organs instead of transplanting them?" His lab at the Wake Forest Institute for Regenerative Medicine is doing just that -- engineering over 30 tissues and whole organs. Full bio
Anthony Atala asks, "Can we grow organs instead of transplanting them?" His lab at the Wake Forest Institute for Regenerative Medicine is doing just that -- engineering over 30 tissues and whole organs. Full bio
Double-click the English transcript below to play the video.
00:15
This is actually a painting
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Ovo je, u stvari, slika
00:18
that hangs at the Countway Library at Harvard Medical School.
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koja visi u Countway knjižnici u medicinskoj školi na Harvardu.
00:21
And it shows the first time an organ was ever transplanted.
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A ona pokazuje kad je prvi puta neki organ uopće bio transplatiran.
00:25
In the front, you see, actually, Joe Murray
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Sprijeda, vidite, zapravo, Joa Murreya
00:28
getting the patient ready for the transplant,
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kako priprema pacijenta za transplataciju,
00:30
while in the back room you see Hartwell Harrison,
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dok u sporednoj sobi vidite Hartwell Harrison,
00:32
the Chief of Urology at Harvard,
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šefa urologije na Harvardu,
00:35
actually harvesting the kidney.
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koji u stvari vadi bubreg.
00:37
The kidney was indeed the first organ
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Bubreg je doista bio prvi organ
00:39
ever to be transplanted to the human.
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koji je ikad transplatiran čovjeku.
00:41
That was back in 1954,
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To je bilo 1954.g
00:44
55 years ago.
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Prije 55 godina
00:46
Yet we're still dealing with a lot of the same challenges
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još uvijek su se bavili istim izazovima
00:49
as many decades ago.
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kao i mnogo desetljeća prije.
00:51
Certainly many advances, many lives saved.
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Naravno, mnoga poboljšanja, mnogi životi su spašeni.
00:54
But we have a major shortage of organs.
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Međutim, postojala je ogromna nestašica organa.
00:58
In the last decade the number of patients
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U poslednjem desetljeću, broj pacijenata
01:01
waiting for a transplant has doubled.
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koji čekaju transplataciju se udvostručio.
01:04
While, at the same time, the actual number of transplants
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Dok je, istovremeno, stvaran broj transplantata
01:06
has remained almost entirely flat.
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ostao na istoj razini.
01:09
That really has to do with our aging population.
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To je usko povezano s našom populacijom koja stari.
01:11
We're just getting older.
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Jednostavno, postajemo stariji.
01:13
Medicine is doing a better job
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Medicina bolje uspijeva
01:16
of keeping us alive.
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održavati nas na životu.
01:18
But as we age, our organs tend to fail more.
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No, kako starimo, naši organi su skloniji sve više zakazivati.
01:21
So, that's a challenge,
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Prema tome, to je izazov,
01:23
not just for organs but also for tissues.
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ne samo za organe, već isto tako i za tkiva.
01:25
Trying to replace pancreas,
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Nastoji se zamijeniti gušteraču,
01:28
trying to replace nerves that can help us with Parkinson's.
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nastoje se zamijeniti živci što bi nam pomoglo kod liječenja Parkinsonove bolesti.
01:33
These are major issues.
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To su glavna pitanja.
01:35
This is actually a very stunning statistic.
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Ovo je u stvari veoma zaprepašćujuća statistika.
01:39
Every 30 seconds
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Svakih 30 sekundi
01:41
a patient dies from diseases
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jedan pacijent umre od bolesti
01:44
that could be treated with tissue regeneration or replacement.
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koja bi se mogla liječiti regeneracijom ili zamjenom tkiva.
01:48
So, what can we do about it?
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Pa onda, što možemo učiniti u vezi toga?
01:51
We've talked about stem cells tonight.
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Večeras smo govorili o matičnim stanicama.
01:53
That's a way to do it.
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To je jedan od načina kako ovo riješiti.
01:55
But still ways to go to get stem cells into patients,
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No, još predstoji put kako usaditi matične stanice u pacijenta,
02:00
in terms of actual therapies for organs.
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u smislu stvarne terapije organa.
02:03
Wouldn't it be great if our bodies could regenerate?
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Ne bi li bilo fantastično kad bi se naša tijela mogla regenerirati?
02:06
Wouldn't it be great if we could actually harness the power
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Zar ne bi bilo značajno kad bi stvarno mogli koristiti snagu
02:09
of our bodies, to actually heal ourselves?
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naših tijela, da liječe sama sebe.
02:14
It's not really that foreign of a concept, actually;
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Ovo i nije tako stran koncept, jer zapravo;
02:17
it happens on the Earth every day.
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to se događa na Zemlji svaki dan.
02:21
This is actually a picture of a salamander.
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Ovdje je slika guštera.
02:24
Salamanders have this amazing capacity to regenerate.
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Gušteri posjeduju tu čudesnu sposobnost regeneracije.
02:28
You see here a little video.
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Vidite ovdje kratki video.
02:30
This is actually a limb injury in this salamander.
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Kod ovog guštera nastala je ozljeda uda
02:34
And this is actually real photography,
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A ovo je, u stvari stvarna slika,
02:36
timed photography, showing how that limb regenerates
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ubrzani snimak, koji pokazuje kako se taj ud regenerira
02:39
in a period of days.
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tijekom nekoliko dana.
02:41
You see the scar form.
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Vidi se ožiljak.
02:43
And that scar actually grows out
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I u stvari taj ožiljak izrasta
02:46
a new limb.
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u novi ud.
02:48
So, salamanders can do it.
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Znači, gušteru to uspijeva.
02:50
Why can't we? Why can't humans regenerate?
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Zašto ne bi i nama? Zašto kod ljudi nema regeneracije?
02:53
Actually, we can regenerate.
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Zapravo, mi se možemo regenerirati.
02:57
Your body has many organs
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Vaše tijelo ima mnoge organe
03:01
and every single organ in your body
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i svaki pojedini organ u vašem tijelu
03:03
has a cell population
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posjeduje stanice
03:05
that's ready to take over at the time of injury. It happens every day.
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koje su spremne preuzeti tu zadaću za vrijeme ozljede. To se događa svaki dan.
03:10
As you age, as you get older.
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Kako starite, kako postajete sve stariji.
03:13
Your bones regenerate every 10 years.
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Vaše kosti se regeneriraju svakih 10 godina.
03:16
Your skin regenerates every two weeks.
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Vaša koža se regenerira svaka dva tjedna.
03:19
So, your body is constantly regenerating.
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Prema tome, vaše tijelo se stalno regenerira.
03:21
The challenge occurs when there is an injury.
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Izazov nastaje kad dođe do ozljede.
03:23
At the time of injury or disease,
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U vrijeme ozljede ili bolesti,
03:26
the body's first reaction
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prva reakcija tijela
03:29
is to seal itself off from the rest of the body.
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je da sebe izolira od ostatka tijela.
03:32
It basically wants to fight off infection,
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U osnovi, ono želi odbaciti infekciju,
03:34
and seal itself, whether it's organs inside your body,
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te sebe izolirati, bilo da se radi o organima unutar vašeg tijela,
03:38
or your skin, the first reaction
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ili vašoj koži, prva reakcija
03:41
is for scar tissue to move in,
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za tkiva ožiljka da se usele,
03:43
to seal itself off from the outside.
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kako bi sebe izolirala od izvanjskog utjecaja.
03:47
So, how can we harness that power?
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Prema tome, kako možemo ojačati tu moć?
03:49
One of the ways that we do that
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Jedan od načina kojeg mi koristimo
03:51
is actually by using smart biomaterials.
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je u stvari, uporaba pametnih bio-tvari.
03:56
How does this work? Well, on the left side here
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kako ovo funkcionira? Pa, ovdje na lijevoj strani
03:59
you see a urethra which was injured.
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vidite mokraćnu cijev koja je oštećena.
04:01
This is the channel that connects the bladder to the outside of the body.
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Ovo je kanal koji povezuje mjehur s vanjskom stranom tijela.
04:05
And you see that it is injured.
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Možete vidjeti kako je cijev oštećena.
04:07
We basically found out that you can use these smart biomaterials
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U biti, otkrili smo da se mogu upotrijebiti ove bio-tvari,
04:11
that you can actually use as a bridge.
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koje se mogu koristiti kao most.
04:14
If you build that bridge, and you close off
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Ako načinite takvu premosnicu, i zatvorite je
04:17
from the outside environment,
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od vanjskog okruženja,
04:19
then you can create that bridge, and cells
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tada možete stvoriti takav most, i stanice
04:22
that regenerate in your body,
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koje se regeneriraju u vašem tijelu,
04:24
can then cross that bridge, and take that path.
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tada mogu prijeći tim mostom, i krenuti tim putem.
04:28
That's exactly what you see here.
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To je točno ono što se vidi ovdje.
04:30
It's actually a smart biomaterial
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U biti, to je pametna bio-tvar
04:32
that we used, to actually treat this patient.
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koju koristimo, da bi se liječio pacijent.
04:34
This was an injured urethra on the left side.
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Ovdje na lijevoj strani je oštećeni mokraćni kanal.
04:37
We used that biomaterial in the middle.
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U sredini je bio-tvar koju koristimo.
04:39
And then, six months later on the right-hand side
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I zatim, šest mjeseci kasnije na desnoj strani
04:42
you see this reengineered urethra.
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vidite ovaj regenerirani mokraćni kanal.
04:44
Turns out your body can regenerate,
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Ispada da se vaše tijelo može regenerirati,
04:46
but only for small distances.
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ali samo unutar kratkih dužina.
04:49
The maximum efficient distance for regeneration
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Najveća efikasna dužina za regeneraciju
04:52
is only about one centimeter.
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iznosi samo oko jedan centimetar.
04:54
So, we can use these smart biomaterials
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Prema tome, možemo koristiti ove pametne bio-tvari
04:57
but only for about one centimeter
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ali samo za otprilike jedan centimetar
05:00
to bridge those gaps.
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kako bismo premostili takve prekide.
05:02
So, we do regenerate, but for limited distances.
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Znači, stvarno se regeneriramo, no samo za ograničene udaljenosti.
05:05
What do we do now,
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Što onda radimo
05:07
if you have injury for larger organs?
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ako imate oštećenje većih organa?
05:10
What do we do when we have injuries
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Što radimo kada imamo oštećenja
05:12
for structures which are much larger
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struktura koja su mnogo veća
05:14
than one centimeter?
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od jednog centimetra?
05:16
Then we can start to use cells.
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Tada možemo početi upotrebljavati stanice.
05:19
The strategy here, is if a patient comes in to us
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Ovdje je strategija, ako pacijent dođe k nama
05:22
with a diseased or injured organ,
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s oboljelim ili oštećenim organom,
05:24
you can take a very small piece of tissue from that organ,
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možete uzeti veoma mali dio tkiva iz tog organa,
05:27
less than half the size of a postage stamp,
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upola manji od poštanske marke,
05:30
you can then tease that tissue apart,
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onda možete to tkivo razdvojiti na dijelove,
05:33
and look at its basic components,
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i pogledati njegove osnovne komponente,
05:35
the patient's own cells,
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pacijentove vlastite stanice,
05:37
you take those cells out,
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izvadite te stanice van,
05:39
grow and expand those cells outside the body in large quantities,
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uzgojite i povećate te stanice u velikim količinama van tijela,
05:43
and then we then use scaffold materials.
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a zatim upotrebljavamo skelne materijale.
05:46
To the naked eye they look like a piece of your blouse,
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Za golo oko oni izgledaju kao dijelovi vaše košulje,
05:49
or your shirt, but actually
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ili majice, no u stvari
05:51
these materials are fairly complex
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ovi materijali su prilično složeni
05:54
and they are designed to degrade once inside the body.
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i dizajnirani su tako da se razgrade kad se nađu unutar vašeg tijela.
05:57
It disintegrates a few months later.
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Nestanu nakon nekoliko mjeseci.
05:59
It's acting only as a cell delivery vehicle.
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Služe jedino kao vozilo za dostavu stanice.
06:02
It's bringing the cells into the body. It's allowing
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Oni dovode stanicu u tijelo. Dopuštaju
06:04
the cells to regenerate new tissue,
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stanicama da regeneriraju novo tkivo,
06:06
and once the tissue is regenerated the scaffold goes away.
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i jednom kad je tkivo regenerirano skela nestaje.
06:10
And that's what we did for this piece of muscle.
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I to je ono što mi činimo za ovaj dio mišića.
06:13
This is actually showing a piece of muscle and how we go through
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Ovo je prikaz komada mišića i kako ulazimo kroz
06:15
the structures to actually engineer the muscle.
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strukture kako bi u stvari konstruirali mišić.
06:18
We take the cells, we expand them,
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Uzimamo stanice, rastežemo ih,
06:20
we place the cells on the scaffold,
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smjestimo stanice na skelu,
06:22
and we then place the scaffold back into the patient.
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a zatim umetnemo skelu natrag u pacijenta.
06:25
But actually, before placing the scaffold into the patient,
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Zapravo, prije no što smjestimo skelu unutar pacijenta,
06:28
we actually exercise it.
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mi je uvježbamo.
06:31
We want to make sure that we condition
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Želimo se uvjeriti te kondicioniramo
06:33
this muscle, so that it knows what to do
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ovaj mišić, tako da on zna što činiti
06:35
once we put it into the patient.
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jednom kad ga stavimo unutar pacijenta.
06:37
That's what you're seeing here. You're seeing
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To je ono što ovde vidite. Vidite
06:39
this muscle bio-reactor
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ovaj mišićni bio-reaktor
06:41
actually exercising the muscle back and forth.
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koji u stvari rasteže mišić natrag i naprijed.
06:45
Okay. These are flat structures that we see here,
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Dobro. Ovo su ravne strukture što ih ovdje vidimo,
06:49
the muscle.
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mišić
06:51
What about other structures?
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Šta je s drugim strukturama?
06:53
This is actually an engineered blood vessel.
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Ovo je zapravo konstruirana krvna žila.
06:56
Very similar to what we just did, but a little bit more complex.
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Vrlo slično onome što smo maločas napravili, no malo složenije.
06:59
Here we take a scaffold,
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Ovdje uzimamo skelu,
07:01
and we basically -- scaffold can be like a piece of paper here.
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i u osnovi - skela može izgledati kao komad papira.
07:05
And we can then tubularize this scaffold.
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I tada možemo načiniti cjevčice unutar skele.
07:07
And what we do is we, to make a blood vessel, same strategy.
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I ono što činimo, pravimo krvnu žilu, ista strategija.
07:11
A blood vessel is made up of two different cell types.
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Krvna žila se sastoji od dvije različite vrste stanica.
07:15
We take muscle cells, we paste,
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Uzimamo mišićne stanice, lijepimo ih,
07:18
or coat the outside with these muscle cells,
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odnosno oblažemo vanjski dio s ovim mišićnim stanicama,
07:20
very much like baking a layer cake, if you will.
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poput pečenja slojevitog kolača, ako hoćete.
07:23
You place the muscle cells on the outside.
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Stavite mišićne stanice na vanjsku stranu.
07:26
You place the vascular blood vessel lining cells on the inside.
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Podstavimo iznutra stanice krvnih žila.
07:31
You now have your fully seeded scaffold.
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Sada imate potpuno zasađenu skelu.
07:33
You're going to place this in an oven-like device.
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Stavit ćete ovo u uređaj nalik pećnici.
07:36
It has the same conditions as a human body,
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On ima iste uvjete kao ljudsko tijelo.
07:38
37 degrees centigrade,
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37 stupnjeva Celziusa.
07:40
95 percent oxygen.
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95 posto kisika.
07:42
You then exercise it, as what you saw on that tape.
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Zatim ga uvježbavate, kao što ste vidjeli na snimci.
07:46
And on the right you actually see a carotid artery that was engineered.
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Na desnoj strani, zapravo, vidite karotidnu arteriju koja je konstruirana.
07:49
This is actually the artery that goes from your neck to your brain.
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Ovo je arterija koja ide od vašeg vrata do vašeg mozga.
07:52
And this is an X-ray showing you
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A ovo je rendgenska snimka koja pokazuje
07:55
the patent, functional blood vessel.
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patent, funkcionalnu krvnu žilu.
07:58
More complex structures
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Složenije strukture
08:00
such as blood vessels, urethras, which I showed you,
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kao što su krvne žile, mokraćne cijevi, koje sam vam pokazao,
08:03
they're definitely more complex
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oni su neosporno mnogo složeniji
08:05
because you're introducing two different cell types.
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jer su u igri dvije različite vrste stanica.
08:07
But they are really acting mostly as conduits.
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Ali oni u stvarnosti djeluju većinom kao cjevovodi.
08:09
You're allowing fluid or air to go through
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Dopuštate tekućini ili zraku da idu kroz njih
08:11
at steady states.
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pod stabilnim stanjima.
08:13
They are not nearly as complex as hollow organs.
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Niti približno nisu složeni kao šuplji organi.
08:15
Hollow organs have a much higher degree of complexity,
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Šuplji organi imaju mnogo veći stupanj složenosti,
08:18
because you're asking these organs to act on demand.
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zato što se traži od ovih organa da djeluju na zahtjev.
08:21
So, the bladder is one such organ.
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Mokraćni mjehur je jedan takav organ.
08:24
Same strategy, we take a very small piece of the bladder,
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Ista strategija, uzmemo veoma mali dio mjehura,
08:27
less than half the size of a postage stamp.
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manji od polovice poštanske marke.
08:29
We then tease the tissue apart
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Zatim, razdvojimo tkivo
08:31
into its two individual cell components,
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na njegove dvije pojedinačne stanične komponente,
08:33
muscle, and these bladder specialized cells.
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mišić i ove specijalizirane stanice mjehura.
08:36
We grow the cells outside the body in large quantities.
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Uzgojimo stanice u velikim količinama van tijela.
08:39
It takes about four weeks to grow these cells from the organ.
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Uzgoj stanica iz organa traje negdje oko četiri tjedna.
08:42
We then take a scaffold that we shape like a bladder.
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Zatim uzimamo skelu koju smo oblikovali kao mjehur.
08:45
We coat the inside with these bladder lining cells.
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Obložimo unutrašnjost sa ovim stanicama sluznice mokraćnog mjehura.
08:49
We coat the outside with these muscle cells.
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Obložimo vanjski dio s mišićnim stanicama.
08:52
We place it back into this oven-like device.
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Smjestimo natrag sve u uređaj sličan pećnici.
08:55
From the time you take that piece of tissue, six to eight weeks later
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Od trenutka kad ste uzeli komadić tkiva, nakon šest do osam tjedana
08:58
you can put the organ right back into the patient.
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možete organ vratiti natrag u pacijenta.
09:01
This actually shows the scaffold.
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Ovo prikazuje skelnu platformu.
09:04
The material is actually being coated with the cells.
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Materijal se zapravo oblaže stanicama.
09:08
When we did the first clinical trial for these patients
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Kada smo provodili prvi klinički pokus za ove pacijente
09:11
we actually created the scaffold specifically for each patient.
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u stvari smo stvorili skelnu platformu posebno za svakog pacijenta
09:14
We brought patients in,
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Doveli smo pacijente,
09:16
six to eight weeks prior to their scheduled surgery, did X-rays,
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šest do osam tjedana prije planirane operacije, načinili rendgenske snimke,
09:19
and we then composed a scaffold specifically for that patient's size
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i tada smo sastavili platformu prema veličinama pacijentove
09:22
pelvic cavity.
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zdjelične šupljine.
09:24
For the second phase of the trials
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Za drugu fazu ovoga pokusa
09:26
we just had different sizes, small, medium, large and extra-large.
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jednostavno smo imali različite veličine, malen, srednji, veliki i ekstra veliki.
09:29
(Laughter)
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(Smijeh)
09:32
It's true.
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To je istina.
09:34
And I'm sure everyone here wanted an extra-large. Right?
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A siguran sam da bi svatko ovdje prisutan želio ekstra veliki. Je li tako?
09:37
(Laughter)
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(Smijeh)
09:39
So, bladders are definitely a little bit more complex
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Prema tome, mjehur je neosporno malo složeniji
09:42
than the other structures.
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nego neke druge strukture.
09:44
But there are other hollow organs that have added complexity to it.
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Međutim, ima i drugih šupljih organa koji imaju dodatnu složenost.
09:47
This is actually a heart valve, which we engineered.
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To je u stvari srčani zalistak, kojeg smo konstruirali.
09:50
And the way you engineer this heart valve is the same strategy.
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I način na koji se sastavlja ovaj srčani zalistak je ista strategija.
09:53
We take the scaffold, we seed it with cells,
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Uzimamo skelnu platformu, zasadimo je stanicama,
09:55
and you can now see here, the valve leaflets opening and closing.
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i ovdje možete vidjeti kako se listići zaliska otvaraju i zatvaraju.
09:59
We exercise these prior to implantation.
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Uvježbavamo ih prije implantacije.
10:02
Same strategy.
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Ista strategija.
10:04
And then the most complex are the solid organs.
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Na kraju, najsloženiji su čvrsti organi.
10:06
For solid organs, they're more complex
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Što se tiče solidnih organa, oni su složeniji
10:08
because you're using a lot more cells per centimeter.
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jer koristite mnogo više stanica po četvornom centimetru.
10:12
This is actually a simple solid organ like the ear.
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Ovo je u stvari jednostavan solidni organ, uho.
10:14
It's now being seeded with cartilage.
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Sada je zasađen s hrskavicom.
10:16
That's the oven-like device;
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To je uređaj koji sliči pećnici.
10:19
once it's coated it gets placed there.
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Jednom kada se obloži ono se stavlja tamo.
10:21
And then a few weeks later we can take out the cartilage scaffold.
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A onda nakon nekoliko tjedana možemo uzeti platformu od hrskavice.
10:26
This is actually digits that we're engineering.
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Ovo su prsti koje konstruiramo.
10:28
These are being layered, one layer at a time,
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Na ove nanosimo sloj, i to jedan po jedan,
10:31
first the bone, we fill in the gaps with cartilage.
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prvo kost, ispunjavamo praznine hrskavicom.
10:34
We then start adding the muscle on top.
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Zatim počinjemo dodavati mišiće na vrh.
10:36
And you start layering these solid structures.
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A zatim se počinje nanositi sloj čvrste strukture.
10:38
Again, fairly more complex organs,
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Opet, poprilično složeniji organ.
10:41
but by far, the most complex solid organs
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do sada, najsloženiji čvrsti organi
10:44
are actually the vascularized, highly vascularized,
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su u stvari vaskularizirani, veoma vaskularizirani,
10:48
a lot of blood vessel supply,
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mnogo krvnih žila ih snabdijeva,
10:50
organs such as the heart,
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organi kao što su srce,
10:53
the liver, the kidneys.
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jetra, bubrezi.
10:56
This is actually an example -- several strategies
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Ovo je u stvari jedan primjer - nekoliko strategija
10:58
to engineer solid organs.
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kako bi se konstruirali čvrsti organi.
11:00
This is actually one of the strategies. We use a printer.
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Ovo je jedna od strategija. Koristimo printer.
11:02
And instead of using ink, we use -- you just saw an inkjet cartridge --
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I umjesto uporabe tinte, koristimo - upravo ste vidjeli uložak za tintu -
11:06
we just use cells.
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jednostavno koristimo stanice.
11:08
This is actually your typical desktop printer.
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Ovo je tipični stolni printer.
11:10
It's actually printing this two chamber heart,
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Upravo printa ove dvije srčane komore,
11:13
one layer at a time.
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jedan po jedan sloj.
11:15
You see the heart coming out there. It takes about 40 minutes to print,
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Vidite tamo se stvara srce. Za printanje treba oko 40 minuta,
11:19
and about four to six hours later
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i nakon otprilike četiri do šest sati
11:21
you see the muscle cells contract.
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vidite stanice mišića kako se stežu.
11:24
(Applause)
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(Pljesak)
11:30
This technology was developed by Tao Ju, who worked at our institute.
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Ovu tehnologiju je razvio Tao Ju, koji je radio u našem institutu.
11:34
And this is actually still, of course, experimental,
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Naravno, ovo je još uvijek u eksperimentalnoj fazi,
11:36
not for use in patients.
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nije za primjenu na pacijentima.
11:39
Another strategy that we have followed
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Sljedeća strategija koju smo slijedili
11:41
is actually to use decellularized organs.
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je uporaba decelulariziranih organa .
11:43
We actually take donor organs,
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Zapravo, uzimamo organe donora,
11:46
organs that are discarded,
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organe koji su odbačeni,
11:48
and we then can use very mild detergents
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i onda koristimo veoma blage deterdžente
11:50
to take all the cell elements out of these organs.
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kako bismo izvadili stanične elemente iz ovih organa.
11:53
So, for example on the left panel,
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Tako, na primjer na lijevoj ploči,
11:55
top panel, you see a liver.
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gornjoj ploči, vidite jetru.
11:57
We actually take the donor liver,
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Uzimamo zapravo jetru donora,
11:59
we use very mild detergents,
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koristimo vrlo blage deterdžente,
12:01
and we, by using these mild detergents, we take all the cells
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i koristeći te blage deterdžente vadimo sve stanice
12:05
out of the liver.
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iz jetre.
12:07
Two weeks later, we basically can lift this organ up,
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Dva tjedna kasnije, u osnovi vadimo ovaj organ,
12:10
it feels like a liver,
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osjećamo je kao jetru,
12:12
we can hold it like a liver,
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držimo je kao jetru,
12:14
it looks like a liver, but it has no cells.
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izgleda kao jetra, ali nema ni jedne stanice.
12:17
All we are left with
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Sve što je ostalo
12:19
is the skeleton, if you will, of the liver,
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je, ako hoćete, kostur jetre,
12:22
all made up of collagen,
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sav sačinjen od kolagena,
12:24
a material that's in our bodies, that will not reject.
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tvari koja je u našim tijelima, koju ono neće odbaciti.
12:26
We can use it from one patient to the next.
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Možemo ga koristiti od jednog do drugog pacijenta.
12:28
We then take this vascular structure
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Zatim uzimamo ovu prokrvljenu strukturu
12:30
and we can prove that we retain the blood vessel supply.
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i možemo dokazati da je održana opskrba krvnih žila.
12:34
You can see, actually that's a fluoroscopy.
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Ovo što vidite je fluoroskopija.
12:36
We're actually injecting contrast into the organ.
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Zapravo, ubrizgavamo kontrast u organ.
12:39
Now you can see it start. We're injecting the contrast into the organ
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Sada vidite kako počinje. Ubrizgavamo kontrast u organ
12:43
into this decellularized liver.
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u ovu jetru kojoj su odstranjene sve stanice.
12:45
And you can see the vascular tree that remains intact.
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I vidite da je krvožilno stablo ostalo netaknuto.
12:48
We then take the cells, the vascular cells,
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Zatim uzimamo stanice, vaskularne stanice,
12:51
blood vessel cells, we perfuse the vascular tree
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stanice krvnih žila, prokrvljavamo vaskularno stablo
12:53
with the patient's own cells.
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sa stanicama samog pacijenta.
12:55
We perfuse the outside of the liver
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Prokrvljujemo vanjštinu jetre
12:57
with the patient's own liver cells.
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s pacijentovim vlastitim stanicama jetre.
12:59
And we can then create functional livers.
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Zatim možemo stvoriti funkcionalnu jetru.
13:01
And that's actually what you're seeing.
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I to je u stvari to što vidite.
13:03
This is still experimental. But we are able to actually reproduce the functionality
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Ovo je još eksperiment. No, u biti smo sposobni stvoriti funkcionalnost
13:07
of the liver structure, experimentally.
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jetrene strukture, eksperimentalno.
13:10
For the kidney,
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Što se tiče bubrega,
13:12
as I talked to you about the first painting that you saw,
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kad sam govorio o onoj prvoj slici što ste je vidjeli,
13:16
the first slide I showed you,
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prvi slajd koji sam vam pokazao.
13:18
90 percent of the patients on the transplant wait list
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90 posto pacijenata na listi čekanja za transplataciju
13:21
are waiting for a kidney, 90 percent.
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čekaju bubreg, 90 posto.
13:23
So, another strategy we're following
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Prema tome, sljedeća strategija koju slijedimo
13:25
is actually to create wafers
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je da se stvore tipke
13:27
that we stack together, like an accordion, if you will.
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koje složimo zajedno, kao kod harmonike, ako hoćete.
13:31
So, we stack these wafers together, using the kidney cells.
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Znači, složimo ove tipke zajedno, koristeći bubrežne stanice.
13:34
And then you can see these miniature kidneys that we've engineered.
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Sada možete vidjeti ove minijaturne bubrege koje smo konstruirali.
13:37
They are actually making urine.
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One stvarno proizvode mokraću.
13:39
Again, small structures, our challenge is how to make them larger,
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Ponovno, male strukture, izazov nam je kako ih učiniti većima,
13:43
and that is something we're working on
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i to je nešto na čemu se radi
13:45
right now at the institute.
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upravo sada u institutu.
13:47
One of the things that I wanted to summarize for you then
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Jedna od stvari koju bih sada želio rezimirati za vas
13:50
is what is a strategy that we're going for in regenerative medicine.
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je koja je strategija kojoj težimo u regenerativnoj medicini.
13:54
If at all possible,
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Ako je uopće moguće
13:56
we really would like to use smart biomaterials
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mi bismo uistinu željeli koristiti pametne biomaterijale.
13:59
that we can just take off the shelf
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koje bismo jednostavno mogli pokupiti s police
14:01
and regenerate your organs.
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i regenerirati vaše organe.
14:03
We are limited with distances right now,
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Trenutno smo ograničeni udaljenostima,
14:05
but our goal is actually to increase those distances over time.
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međutim, naš cilj je vremenom povećati te udaljenosti.
14:09
If we cannot use smart biomaterials,
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Ako ne možemo koristiti pametne biomaterijale,
14:11
then we'd rather use your very own cells.
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onda bismo radije koristili vaše vlastite stanice.
14:13
Why? Because they will not reject.
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Zašto? Jer se one ne bi odbacile.
14:15
We can take cells from you,
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Možemo uzeti stanice od vas,
14:17
create the structure, put it right back into you, they will not reject.
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stvoriti strukturu, vratiti ih u vas, one se neće odbaciti.
14:20
And if possible, we'd rather use the cells from your very specific organ.
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I ako je moguće, radije bismo uzeli stanice iz vašeg određenog organa.
14:24
If you present with a diseased wind pipe
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Ako imate bolest dušnika
14:27
we'd like to take cells from your windpipe.
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željeli bismo uzeti stanice iz vašeg dušnika.
14:29
If you present with a diseased pancreas
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Ako imate bolest gušterače
14:32
we'd like to take cells from that organ.
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željeli bismo uzeti stanice iz tog organa.
14:34
Why? Because we'd rather take those cells
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Zašto? Jer radije bismo uzeli one stanice
14:37
which already know that those are the cell types you want.
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koje već znaju da su one onog tipa kojega vi želite.
14:40
A windpipe cell already knows it's a windpipe cell.
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Stanice dušnika već znaju da su one stanice dušnika.
14:43
We don't need to teach it to become another cell type.
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Ne moramo ih učiti da postanu neke stanice druge vrste.
14:46
So, we prefer organ-specific cells.
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Prema tome, mi smo skloniji stanicama specifičnih organa.
14:48
And today we can obtain cells from most every organ in your body,
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Danas možemo nabaviti stanice iz skoro svakog organa vašeg tijela,
14:51
except for several which we still need stem cells for,
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osim ponekih za koje još trebamo matične stanice
14:54
like heart, liver, nerve and pancreas.
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kao što su srce, jetra, živci i gušterača.
14:58
And for those we still need stem cells.
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Za njih još trebamo matične stanice.
15:01
If we cannot use stem cells from your body
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Ako se ne mogu koristiti matične stanice iz vašega tijela
15:04
then we'd like to use donor stem cells.
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onda bismo željeli rabiti matične stanice od donora.
15:07
And we prefer cells that will not reject
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I skloniji smo stanicama koje se neće odbaciti
15:09
and will not form tumors.
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i neće tvoriti tumore.
15:11
And we're working a lot with the stem cells that we
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Mnogo radimo s matičnim stanicama što smo
15:13
published on two years ago,
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objavili prije dvije godine,
15:15
stem cells from the amniotic fluid,
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matičnim stanicama iz plodne vode,
15:17
and the placenta, which have those properties.
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i posteljice, koje imaju takve osobine.
15:21
So, at this point, I do want to tell you that
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Prema tome, sada bih vam rekao o
15:24
some of the major challenges we have.
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nekim glavnim izazovima koje imamo.
15:28
You know, I just showed you this presentation, everything looks so good,
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Znate, upravo sam vam pokazao ovu prezentaciju, sve izgleda tako dobro,
15:30
everything works. Actually no,
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sve štima. U stvari nije,
15:32
these technologies really are not that easy.
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ove tehnologije uistinu i nisu tako lagane.
15:34
Some of the work you saw today
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Neke radove koje ste danas vidjeli
15:36
was performed by over 700 researchers
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je izvodilo preko 700 istraživača
15:39
at our institute across a 20-year time span.
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u našem institutu, tijekom razdoblja od 20 godina.
15:42
So, these are very tough technologies.
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Prema tome, ovo su veoma zahtjevne tehnologije.
15:44
Once you get the formula right you can replicate it.
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Jednom kad imate pravu formulu možete je ponoviti.
15:47
But it takes a lot to get there.
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Međutim, treba puno da bi se do toga došlo.
15:49
So, I always like to show this cartoon.
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Uvijek mi je drago pokazati ovaj crtić.
15:51
This is how to stop a runaway stage.
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Ovaj je o tome kako zaustaviti jureću kočiju.
15:53
And there you see the stagecoach driver,
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Vidite vozača kočije,
15:55
and he goes, on the top panel,
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na gornjoj ploči,
15:57
He goes A, B, C, D, E, F.
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On ide A, B, C, D, E, F.
15:59
He finally stops the runaway stage.
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I na koncu zaustavlja jureću kočiju.
16:01
And those are usually the basic scientists,
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I to su obično temeljni znanstvenici.
16:04
The bottom is usually the surgeons.
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Donji su obično kirurzi.
16:06
(Laughter)
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(Smijeh)
16:10
I'm a surgeon so that's not that funny.
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Ja sam kirurg, prema tome ovo nije toliko smiješno.
16:12
(Laughter)
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(Smijeh)
16:13
But actually method A is the correct approach.
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Ali, zapravo A metoda je ispravan pristup.
16:17
And what I mean by that is that anytime we've launched one of these technologies
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A ono što sam mislio je da kad god lansiramo jednu od ovih tehnologija
16:20
to the clinic,
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u kliničku praksu,
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we've made absolutely sure that we do everything we can
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moramo biti u potpunosti sigurni da smo učinili sve što smo mogli
16:25
in the laboratory before we ever
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u laboratoriju prije nego što
16:27
launch these technologies to patients.
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primijenimo ove tehnologije na pacijente.
16:29
And when we launch these technologies to patients
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A kada uvedemo ove tehnologije kod pacijenata
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we want to make sure that we ask ourselves a very tough question.
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želimo biti sigurni da smo se zapitali veoma teško pitanje.
16:36
Are you ready to place this in your own loved one, your own child,
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jesmo li spremni primijeniti ovo na svoju voljenu osobu, na svoje vlastito dijete,
16:39
your own family member, and then we proceed.
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na članove svoje obitelj, i tek tada nastaviti.
16:42
Because our main goal, of course,
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Jer, naravno, naš glavni cilj
16:44
is first, to do no harm.
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je u prvom redu, ne naškoditi.
16:47
I'm going to show you now, a very short clip,
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Pokazat ću vam sada, veoma kratak isječak.
16:49
It's a five second clip of a patient
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Isječak od pet sekundi je o pacijentu
16:52
who received one of the engineered organs.
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koji je primio jedan od konstruiranih organa.
16:54
We started implanting some of these structures
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Već smo započeli s implantacijom ovih struktura
16:56
over 14 years ago.
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prije 14 godina.
16:58
So, we have patients now walking around with organs,
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Prema tome, imamo pacijente koji unaokolo hodaju s organima,
17:00
engineered organs, for over 10 years, as well.
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konstruiranim organima, već više od 10 godina.
17:04
I'm going to show a clip of one young lady.
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Pokazat ću vam isječak o jednoj mladoj dami.
17:06
She had a spina bifida defect, a spinal cord abnormality.
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Ona ima anomaliju spina bifidu, abnormalnost kralježničke moždine.
17:09
She did not have a normal bladder. This is a segment from CNN.
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Nije imala normalan mjehur. Ovo je dio sa CNN-a.
17:12
We are just taking five seconds.
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Treba nam samo pet sekundi.
17:14
This is a segment that Sanjay Gupta actually took care of.
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Ovo je dio za koji se pobrinuo Sanjay Gupta.
17:19
Video: Kaitlyn M: I'm happy. I was always afraid
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Video: Kaitlyn M: Sretna sam. Uvijek sam se bojala.
17:21
that I was going to have like, an accident or something.
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da ću doživjeti neku vrstu nesreće ili slično.
17:24
And now I can just go and
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A sada jednostavno mogu ići i
17:27
go out with my friends,
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izlaziti s mojim prijateljima.
17:29
go do whatever I want.
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činiti što god poželim.
17:32
Anthony Atala: See, at the end of the day, the promise of regenerative medicine
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Anthony Atala: Vidite, na kraju dana, obećanje regenerativne medicine
17:35
is a single promise.
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je obično obećanje.
17:37
And that is really very simple,
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A to je veoma jednostavno,
17:40
to make our patients better.
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učiniti da se naš pacijent osjeća bolje.
17:42
Thank you for your attention.
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Hvala na pažnji.
17:44
(Applause)
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(Pljesak)
ABOUT THE SPEAKER
Anthony Atala - SurgeonAnthony Atala asks, "Can we grow organs instead of transplanting them?" His lab at the Wake Forest Institute for Regenerative Medicine is doing just that -- engineering over 30 tissues and whole organs.
Why you should listen
Anthony Atala is the director of the Wake Forest Institute for Regenerative Medicine, where his work focuses on growing and regenerating tissues and organs. His team engineered the first lab-grown organ to be implanted into a human -- a bladder -- and is developing experimental fabrication technology that can "print" human tissue on demand.
In 2007, Atala and a team of Harvard University researchers showed that stem cells can be harvested from the amniotic fluid of pregnant women. This and other breakthroughs in the development of smart bio-materials and tissue fabrication technology promises to revolutionize the practice of medicine.
Anthony Atala | Speaker | TED.com