TEDMED 2009
Anthony Atala: Growing new organs
Entoni Atala (Anthony Atala) o uzgoju novih organa
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1,913,459 views
Napredna laboratorija Entonija Atale uzgaja ljudske organe -- od mišića, preko krvnih sudova, do bešika i više. Na TEDMED događaju, on nam pokazuje snimak njegovih bio-inženjera koji rade sa naučno-fantastičnom opremom, koja uključuje bioreaktor nalik rerni (prethodno zagrejan na 37°C) i mašinu koja "štampa" ljudska tkiva.
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 jedna slika
00:18
that hangs at the Countway Library at Harvard Medical School.
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koja je okačena u Kauntvej biblioteci Medicinskog fakulteta na Harvardu.
00:21
And it shows the first time an organ was ever transplanted.
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Pokazuje prvo presađivanje organa koje je ikada izvedeno.
00:25
In the front, you see, actually, Joe Murray
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U prvom planu vidite Džoija Merija
00:28
getting the patient ready for the transplant,
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koji priprema pacijenta za transplantaciju,
00:30
while in the back room you see Hartwell Harrison,
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dok u zadnjoj sobi vidite Hartvela Herisona,
00:32
the Chief of Urology at Harvard,
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načelnika Urologije na Harvardu,
00:35
actually harvesting the kidney.
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kako zapravo vadi bubreg.
00:37
The kidney was indeed the first organ
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I zaista, bubreg je bio prvi organ
00:39
ever to be transplanted to the human.
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koji je ikada presađen čoveku.
00:41
That was back in 1954,
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To je bilo još davne 1954.,
00:44
55 years ago.
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pre 55 godina.
00:46
Yet we're still dealing with a lot of the same challenges
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Ipak, mi se i dalje suočavamo sa mnoštvom istih izazova
00:49
as many decades ago.
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kao i pre mnogo decenija.
00:51
Certainly many advances, many lives saved.
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Svakako je bilo mnogo unapredjenja, mnogo spašenih života.
00:54
But we have a major shortage of organs.
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Međutim, imamo veliki manjak organa.
00:58
In the last decade the number of patients
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Tokom poslednje decenije, broj pacijenata
01:01
waiting for a transplant has doubled.
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koji čekaju na organ se udvostručio.
01:04
While, at the same time, the actual number of transplants
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U isto vreme, broj transplanta
01:06
has remained almost entirely flat.
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je ostao gotovo potpuno isti.
01:09
That really has to do with our aging population.
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To zapravo ima veze sa našom starećom populacijom.
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 je uspešnija
01:16
of keeping us alive.
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u održavanju ljudi u životu.
01:18
But as we age, our organs tend to fail more.
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Ali kako starimo, naši organi teže da propadaju više.
01:21
So, that's a challenge,
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Dakle, to je izazov,
01:23
not just for organs but also for tissues.
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ne samo za organe, već i za tkiva.
01:25
Trying to replace pancreas,
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Pokušaji da zamenimo pankreas,
01:28
trying to replace nerves that can help us with Parkinson's.
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pokušaji da zamenimo nerve koji nam mogu pomoći sa Parkinsonovom bolešću.
01:33
These are major issues.
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Ovo su glavni problemi.
01:35
This is actually a very stunning statistic.
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Ovo je zapravo veoma iznenađujuća 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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koje se mogu tretirati regeneracijom ili zamenom tkiva.
01:48
So, what can we do about it?
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Šta možemo učiniti povodom toga?
01:51
We've talked about stem cells tonight.
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Tokom večeri smo već govorili o matičnim ćelijama.
01:53
That's a way to do it.
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To je jedan način da to uradimo.
01:55
But still ways to go to get stem cells into patients,
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Međutim i dalje smo daleko od ubacivanja matičnih ćelija u pacijente,
02:00
in terms of actual therapies for organs.
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zarad stvarne terapije organa.
02:03
Wouldn't it be great if our bodies could regenerate?
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Zar ne bi bilo odlično kada bi naša tela mogla da se regenerišu?
02:06
Wouldn't it be great if we could actually harness the power
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Zar ne bi bilo odlično kada bismo mogli da upregnemo moć
02:09
of our bodies, to actually heal ourselves?
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naših tela, da se zapravo samoizlečimo?
02:14
It's not really that foreign of a concept, actually;
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To, zapravo, i nije tako stran koncept;
02:17
it happens on the Earth every day.
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svakodnevno se dešava na Zemlji.
02:21
This is actually a picture of a salamander.
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Ovo je slika daždevnjaka.
02:24
Salamanders have this amazing capacity to regenerate.
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Daždevnjaci imaju ovu neverovatnu sposobnost regeneracije.
02:28
You see here a little video.
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Ovde vidite kratak video snimak.
02:30
This is actually a limb injury in this salamander.
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Ovo je zapravo povreda ekstremiteta kod ovog daždevnjaka.
02:34
And this is actually real photography,
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Ovo je prava fotografija,
02:36
timed photography, showing how that limb regenerates
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tempirana fotografija, koja pokazuje kako se ekstremitet regeneriše
02:39
in a period of days.
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u periodu od nekoliko dana.
02:41
You see the scar form.
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Vidite formu ožiljka.
02:43
And that scar actually grows out
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Taj ožiljak zapravo izrasta
02:46
a new limb.
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novi ekstremitet.
02:48
So, salamanders can do it.
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Dakle, daždevnjaci to mogu da urade.
02:50
Why can't we? Why can't humans regenerate?
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Zašto mi to ne možemo? Zašto ljudi ne mogu da se regenerišu?
02:53
Actually, we can regenerate.
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Mi, zapravo, možemo da se regenerišemo.
02:57
Your body has many organs
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Vaše telo ima mnogo organa
03:01
and every single organ in your body
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i svaki organ u vašem telu
03:03
has a cell population
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ima populaciju ćelija
03:05
that's ready to take over at the time of injury. It happens every day.
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koje su spremne da priskoče tokom povrede. To se dešava svakog dana.
03:10
As you age, as you get older.
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Kako starite, kako postajete stariji.
03:13
Your bones regenerate every 10 years.
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Vaše kosti se regenerišu svakih deset godina.
03:16
Your skin regenerates every two weeks.
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Vaša koža se regeneriše svake dve nedelje.
03:19
So, your body is constantly regenerating.
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Dakle, vaše telo se konstantno regeneriše.
03:21
The challenge occurs when there is an injury.
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Izazov nastaje kada postoji povreda.
03:23
At the time of injury or disease,
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Tokom perioda povrede ili bolesti,
03:26
the body's first reaction
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prva reakcija tela
03:29
is to seal itself off from the rest of the body.
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jeste da se zapečati u odnosu na ostatak tela.
03:32
It basically wants to fight off infection,
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Ono zapravo želi da se odbrani od infekcije,
03:34
and seal itself, whether it's organs inside your body,
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i zapečati sebe, bilo da su u pitanju organi u vašem telu,
03:38
or your skin, the first reaction
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ili vaša koža, prva reakcija
03:41
is for scar tissue to move in,
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je nastanak ožiljka,
03:43
to seal itself off from the outside.
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da bi se zapečatilo od spoljašnjosti.
03:47
So, how can we harness that power?
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Kako mi možemo da upregnemo ovu moć?
03:49
One of the ways that we do that
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Jedan od načina na koje to činimo
03:51
is actually by using smart biomaterials.
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je upotreba pametnih biomaterijala.
03:56
How does this work? Well, on the left side here
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Kako ovo radi? Ovde, na levoj strani
03:59
you see a urethra which was injured.
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vidite uretru koja je povređena.
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 bešiku sa sredinom van tela.
04:05
And you see that it is injured.
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Možete videti da je povređena.
04:07
We basically found out that you can use these smart biomaterials
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Otkrili smo da zapravo možete koristiti ove pametne biomaterijale,
04:11
that you can actually use as a bridge.
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da ih možete koristiti kao most.
04:14
If you build that bridge, and you close off
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Ukoliko izgradite taj most, i zatvorite se
04:17
from the outside environment,
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od spoljne sredine,
04:19
then you can create that bridge, and cells
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onda možete napraviti taj most, a ćelije
04:22
that regenerate in your body,
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koje regenerišu vaše telo
04:24
can then cross that bridge, and take that path.
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onda mogu preći taj most i preuzeti taj put.
04:28
That's exactly what you see here.
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To je upravo ono što vidite ovde.
04:30
It's actually a smart biomaterial
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To je zapravo pametni biomaterijal
04:32
that we used, to actually treat this patient.
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koji smo iskoristili da tretiramo ovog pacijenta.
04:34
This was an injured urethra on the left side.
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Ovo je bila povređena uretra sa leve strane.
04:37
We used that biomaterial in the middle.
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Koristili smo taj biomaterijal u sredini.
04:39
And then, six months later on the right-hand side
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A onda, šest meseci kasnije, sa desne strane
04:42
you see this reengineered urethra.
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vidite ovu redizajniranu uretru.
04:44
Turns out your body can regenerate,
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Ispostavilo se da vaše telo može da se regeneriše,
04:46
but only for small distances.
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ali samo na malim razdaljinama.
04:49
The maximum efficient distance for regeneration
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Maksimalna efikasna razdaljina za regeneraciju
04:52
is only about one centimeter.
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iznosi oko jedan centimetar.
04:54
So, we can use these smart biomaterials
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Možemo koristiti ove pametne biomaterijale
04:57
but only for about one centimeter
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ali samo za oko jedan centimetar,
05:00
to bridge those gaps.
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da premostimo taj međuprostor.
05:02
So, we do regenerate, but for limited distances.
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Dakle, mi se regenerišemo, ali samo na malim razdaljinama.
05:05
What do we do now,
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Šta da radimo,
05:07
if you have injury for larger organs?
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ako imate povredu nekog većeg organa?
05:10
What do we do when we have injuries
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Šta da radimo ako imamo povrede
05:12
for structures which are much larger
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struktura koje su mnogo veće
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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Onda možemo početi da koristimo ćelije.
05:19
The strategy here, is if a patient comes in to us
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Strategija koja se ovde koristi je da, ukoliko nam dođe pacijent
05:22
with a diseased or injured organ,
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sa obolelim ili povređenim organom,
05:24
you can take a very small piece of tissue from that organ,
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možete uzeti jako malo parče tkiva tog organa,
05:27
less than half the size of a postage stamp,
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koje je više nego duplo manje od poštanske marke,
05:30
you can then tease that tissue apart,
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onda možete podeliti to tkivo na delove,
05:33
and look at its basic components,
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pogledati njegove osnovne komponente,
05:35
the patient's own cells,
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pacijentove sopstvene ćelije,
05:37
you take those cells out,
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izvadite te ćelije,
05:39
grow and expand those cells outside the body in large quantities,
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razmnožite i razvijete te ćelije izvan tela u velikim količinama,
05:43
and then we then use scaffold materials.
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a onda koristite materijale za skelu.
05:46
To the naked eye they look like a piece of your blouse,
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Golom oku oni izgledaju kao parče vaše bluze,
05:49
or your shirt, but actually
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ili vaše košulje, ali zapravo
05:51
these materials are fairly complex
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ovi materijali su sasvim kompleksni
05:54
and they are designed to degrade once inside the body.
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i oni su dizajnirani da degradiraju jednom kada se nađu unutar tela.
05:57
It disintegrates a few months later.
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Dezintegrišu se nekoliko meseci kasnije.
05:59
It's acting only as a cell delivery vehicle.
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Ponaša se kao vozilo koje dostavlja ćelije.
06:02
It's bringing the cells into the body. It's allowing
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Unosi ćelije u telo. Dozvoljava ćelijama
06:04
the cells to regenerate new tissue,
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da regenerišu nova tkiva
06:06
and once the tissue is regenerated the scaffold goes away.
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i jednom kada su tkiva regenerisana skela nestaje.
06:10
And that's what we did for this piece of muscle.
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To je ono što smo uradili sa ovim parčetom mišića.
06:13
This is actually showing a piece of muscle and how we go through
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Ovo zapravo pokazuje parče mišića i kako prolazimo
06:15
the structures to actually engineer the muscle.
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kroz strukture da bi izgradili mišić.
06:18
We take the cells, we expand them,
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Uzimamo ćelije, razvijamo ih,
06:20
we place the cells on the scaffold,
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stavljamo ćelije na skelu,
06:22
and we then place the scaffold back into the patient.
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i skelu stavljamo nazad u pacijenta.
06:25
But actually, before placing the scaffold into the patient,
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Međutim, pre nego stavimo skelu u pacijenta,
06:28
we actually exercise it.
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mi je vežbamo.
06:31
We want to make sure that we condition
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Želimo da budemo sigurni da smo uzgajili
06:33
this muscle, so that it knows what to do
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ovaj mišić, tako da zna šta da radi
06:35
once we put it into the patient.
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kada ga stavimo u pacijenta.
06:37
That's what you're seeing here. You're seeing
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To je ono što vidite ovde. 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 zapravo vežba mišić, rastežući ga i skupljajući.
06:45
Okay. These are flat structures that we see here,
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Okej. Ono što vidimo ovde su ravne strukture,
06:49
the muscle.
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mišić.
06:51
What about other structures?
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Šta je sa drugim strukturama?
06:53
This is actually an engineered blood vessel.
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Ovo je zapravo jedan projektovan krvni sud.
06:56
Very similar to what we just did, but a little bit more complex.
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Veoma nalik onome što smo upravo uradili, samo neznatno složenije.
06:59
Here we take a scaffold,
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Ovde uzmemo skelu,
07:01
and we basically -- scaffold can be like a piece of paper here.
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skela može biti kao ovo parče papira ovde.
07:05
And we can then tubularize this scaffold.
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Onda možemo da ga savijemo u oblik cevi.
07:07
And what we do is we, to make a blood vessel, same strategy.
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I ono što uradimo, da bi napravili krvni sud, jeste da primenimo istu strategiju.
07:11
A blood vessel is made up of two different cell types.
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Krvni sud je sačinjen od dve različite vrste ćelija.
07:15
We take muscle cells, we paste,
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Uzmemo mišićne ćelije, nalepimo
07:18
or coat the outside with these muscle cells,
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ili pokrijemo spoljni deo ovim mišićnim ćelijama,
07:20
very much like baking a layer cake, if you will.
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veoma nalik pečenju kore za tortu, ako vam se tako dopada.
07:23
You place the muscle cells on the outside.
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Smestite mišićne ćelije napolje.
07:26
You place the vascular blood vessel lining cells on the inside.
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Postavite vaskularne ćelije koje oblažu krvne sudove iznutra.
07:31
You now have your fully seeded scaffold.
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Sada imate u potpunosti zasejanu skelu.
07:33
You're going to place this in an oven-like device.
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Ovo ćete smestiti u jedan aparat nalik rerni.
07:36
It has the same conditions as a human body,
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U njoj su isti uslovi kao i u ljudskom telu,
07:38
37 degrees centigrade,
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37 stepeni Celzijusa,
07:40
95 percent oxygen.
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95 procenata kiseonika.
07:42
You then exercise it, as what you saw on that tape.
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Onda ga vežbate, kao što ste videli na snimku.
07:46
And on the right you actually see a carotid artery that was engineered.
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Desno zapravo vidite karotidnu arteriju koja je napravljena.
07:49
This is actually the artery that goes from your neck to your brain.
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Ovo je u stvari 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 jedan rendgen snimak koji vam pokazuje
07:55
the patent, functional blood vessel.
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prohodan, funkcionalni krvni sud.
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 krvni sudovi, uretre, koje sam vam pokazao,
08:03
they're definitely more complex
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oni su definitivno komplikovaniji
08:05
because you're introducing two different cell types.
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zato što koristite dva različita tipa ćelija.
08:07
But they are really acting mostly as conduits.
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Ali se oni zaista pretežno ponašaju kao kanali.
08:09
You're allowing fluid or air to go through
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Dozvoljavate tečnosti ili vazduhu da prolazi kroz njih
08:11
at steady states.
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stabilnim tempom.
08:13
They are not nearly as complex as hollow organs.
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Oni nisu ni približno složeni kao šuplji organi.
08:15
Hollow organs have a much higher degree of complexity,
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Šuplji organi imaju mnogo veći stepen složenosti,
08:18
because you're asking these organs to act on demand.
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zato što od ovih organa tražite da rade po potrebi.
08:21
So, the bladder is one such organ.
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Dakle, bešika je jedan takav organ.
08:24
Same strategy, we take a very small piece of the bladder,
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Ista strategija, uzimamo veoma malo parče bešike,
08:27
less than half the size of a postage stamp.
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manje od polovine poštanske markice.
08:29
We then tease the tissue apart
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Onda razdvajamo tkivo na delove,
08:31
into its two individual cell components,
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na njegove dve ćelijske komponente,
08:33
muscle, and these bladder specialized cells.
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mišić i ove specijalizovane ćelije bešike.
08:36
We grow the cells outside the body in large quantities.
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Uzgajamo ćelije van tela u velikim količinama.
08:39
It takes about four weeks to grow these cells from the organ.
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Potrebno je oko četiri nedelje da uzgojite ove ćelije iz organa.
08:42
We then take a scaffold that we shape like a bladder.
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Onda uzimamo skelu koju oblikujemo kao bešiku.
08:45
We coat the inside with these bladder lining cells.
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Odevamo unutrašnjost ovim ćelijama koje oblažu bešiku.
08:49
We coat the outside with these muscle cells.
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Spoljašnost oblažemo ovim mišićnim ćelijama.
08:52
We place it back into this oven-like device.
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Sve ovo smeštamo natrag u ovaj aparat nalik rerni.
08:55
From the time you take that piece of tissue, six to eight weeks later
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Od trenutka kada uzmete to parče tkiva, šest to osam nedelja kasnije
08:58
you can put the organ right back into the patient.
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možete da vratite organ pravo u pacijenta.
09:01
This actually shows the scaffold.
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Ovo pokazuje skelu.
09:04
The material is actually being coated with the cells.
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Materijal se upravo oblaže ćelijama.
09:08
When we did the first clinical trial for these patients
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Kada smo uradili prvo kliničko ispitivanje za ove pacijente
09:11
we actually created the scaffold specifically for each patient.
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napravili smo zasebnu bešiku za svakog pacijenta.
09:14
We brought patients in,
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Uveli smo pacijente,
09:16
six to eight weeks prior to their scheduled surgery, did X-rays,
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šest do osam nedelja pre njihove zakazane operacije, uradili rendgen snimke,
09:19
and we then composed a scaffold specifically for that patient's size
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napravili skelu po veličini karlične duplje
09:22
pelvic cavity.
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tog pacijenta.
09:24
For the second phase of the trials
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Tokom druge faze ispitivanja
09:26
we just had different sizes, small, medium, large and extra-large.
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imali smo različite veličine, malu, srednju, veliku i ekstra-veliku.
09:29
(Laughter)
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(Smeh)
09:32
It's true.
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Istina je.
09:34
And I'm sure everyone here wanted an extra-large. Right?
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Siguran sam da bi svako ovde želeo jednu ekstra-veliku. Je li tako?
09:37
(Laughter)
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(Smeh)
09:39
So, bladders are definitely a little bit more complex
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Dakle, bešike su definitivno malo složenije
09:42
than the other structures.
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od drugih struktura.
09:44
But there are other hollow organs that have added complexity to it.
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Međutim, postoje i drugi šuplji organi koji su dodatno kompleksni.
09:47
This is actually a heart valve, which we engineered.
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Ovo je zapravo srčani zalistak koji smo mi projektovali.
09:50
And the way you engineer this heart valve is the same strategy.
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Primenom iste tehnike smo napravili ovaj srčani zalistak.
09:53
We take the scaffold, we seed it with cells,
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Uzmemo skelu, zasejemo je ćelijama,
09:55
and you can now see here, the valve leaflets opening and closing.
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i sada možete videti ovde, listiće srčanog zalistka kako se otvaraju i zatvaraju.
09:59
We exercise these prior to implantation.
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Vežbamo ih pre same 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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Najsloženiji organi su čvrsti organi.
10:06
For solid organs, they're more complex
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Čvrsti organi su kompleksniji
10:08
because you're using a lot more cells per centimeter.
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zato što koristite mnogo veći broj ćelija po centimetru.
10:12
This is actually a simple solid organ like the ear.
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Ovo je zapravo jednostavan čvrsti organ poput uha.
10:14
It's now being seeded with cartilage.
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Sada biva zasejan hrskavicom.
10:16
That's the oven-like device;
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Ovo je uređaj nalik rerni;
10:19
once it's coated it gets placed there.
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jednom kada je obložena biva smeštena ovde.
10:21
And then a few weeks later we can take out the cartilage scaffold.
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Onda, nekoliko nedelja kasnije možemo da izvadimo hrskavičastu skelu.
10:26
This is actually digits that we're engineering.
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Ovo su zapravo prsti koje pravimo.
10:28
These are being layered, one layer at a time,
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Prave se sloj po sloj,
10:31
first the bone, we fill in the gaps with cartilage.
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prvo kost, onda se praznine popune hrskavicom.
10:34
We then start adding the muscle on top.
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Onda preko toga dodajemo mišiće.
10:36
And you start layering these solid structures.
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I onda postavljate slojeve ovih čvrstih struktura.
10:38
Again, fairly more complex organs,
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Ponovo, sasvim složeniji organi,
10:41
but by far, the most complex solid organs
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ali daleko najsloženiji organi
10:44
are actually the vascularized, highly vascularized,
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su vaskularizovani, visoko vaskularizovani,
10:48
a lot of blood vessel supply,
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sa mnoštvom krvnih sudova,
10:50
organs such as the heart,
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organi poput srca,
10:53
the liver, the kidneys.
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jetre, bubrega.
10:56
This is actually an example -- several strategies
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Ovo je zapravo jedan primer -- upošljeno je nekoliko strategija
10:58
to engineer solid organs.
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u projektovanju jednog organa.
11:00
This is actually one of the strategies. We use a printer.
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Ovo je jedna od strategija. Koristimo štampač.
11:02
And instead of using ink, we use -- you just saw an inkjet cartridge --
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Umesto mastila, koristimo -- upravo ste videli jedan ink-džet ketridž --
11:06
we just use cells.
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samo koristimo ćelije.
11:08
This is actually your typical desktop printer.
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Ovo je u stvari vaš običan stoni štampač.
11:10
It's actually printing this two chamber heart,
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Štampa srce sa dve 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 kako tamo izlazi srce. Potrebno je oko 40 minuta za štampanje,
11:19
and about four to six hours later
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i četiri do šest sati kasnije
11:21
you see the muscle cells contract.
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vidite mišićne ćelije kako se grče.
11:24
(Applause)
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(Aplauz)
11:30
This technology was developed by Tao Ju, who worked at our institute.
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Ovu tehnologiju razvio je Tao Žu, koji je radio na našem institutu.
11:34
And this is actually still, of course, experimental,
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Ovo je, naravno, još uvek, eksperimentalno,
11:36
not for use in patients.
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nije za upotrebu na pacijentima.
11:39
Another strategy that we have followed
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Druga strategija koju smo koristili
11:41
is actually to use decellularized organs.
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je zapravo korišćenje decelularizovanih organa.
11:43
We actually take donor organs,
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Uzmemo organe od 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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a onda koristimo jako blage deterdžente
11:50
to take all the cell elements out of these organs.
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da bi izvukli sve ćelijske elemente iz ovih organa.
11:53
So, for example on the left panel,
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Tako, na primer na levom panelu,
11:55
top panel, you see a liver.
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gornjem panelu, vidite jetru.
11:57
We actually take the donor liver,
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Uzmemo donatorovu jetru,
11:59
we use very mild detergents,
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koristimo blage deterdžente
12:01
and we, by using these mild detergents, we take all the cells
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i koristeći ove blage deterdžente, izvadimo sve ćelije
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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Dve nedelje kasnije, možemo podići ovaj organ,
12:10
it feels like a liver,
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oseća se kao jetra,
12:12
we can hold it like a liver,
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možemo ga držati kao jetru,
12:14
it looks like a liver, but it has no cells.
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izgleda kao jetra, ali nema ćelija.
12:17
All we are left with
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Sve što nam je preostalo
12:19
is the skeleton, if you will, of the liver,
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je skelet, ako tako želite, jetre,
12:22
all made up of collagen,
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u potpunosti sačinjen od kolagena,
12:24
a material that's in our bodies, that will not reject.
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materijala koji je u našim telima, koji neće biti odbačen.
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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Onda uzmemo ovu vaskularnu strukturu
12:30
and we can prove that we retain the blood vessel supply.
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i možemo da dokažemo da smo zadržali prokrvljenost.
12:34
You can see, actually that's a fluoroscopy.
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Možete da vidite, to je zapravo fluoroskopija.
12:36
We're actually injecting contrast into the organ.
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Ubacujemo kontrast u organ.
12:39
Now you can see it start. We're injecting the contrast into the organ
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Ovde možete videti kako počinje. Ubacujemo kontrast
12:43
into this decellularized liver.
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u ovaj decelularizovani organ.
12:45
And you can see the vascular tree that remains intact.
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Možete da vidite vaskularno stablo koje je ostalo netaknuto.
12:48
We then take the cells, the vascular cells,
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Onda uzimamo ćelije, vaskularne ćelije,
12:51
blood vessel cells, we perfuse the vascular tree
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ćelije krvnih sudova, polivamo vaskularno stablo
12:53
with the patient's own cells.
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pacijentovim sopstvenim ćelijama.
12:55
We perfuse the outside of the liver
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polivamo spoljašnjost jetre
12:57
with the patient's own liver cells.
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pacijentovim sopstvenim ćelijama jetre.
12:59
And we can then create functional livers.
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Onda možemo da napravimo funkcionalnu jetru.
13:01
And that's actually what you're seeing.
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I to je upravo ono što vidite.
13:03
This is still experimental. But we are able to actually reproduce the functionality
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Ovo je i dalje eksperimentalno. Mi zapravo možemo da reprodukujemo funkcionalnost
13:07
of the liver structure, experimentally.
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strukture jetre, eksperimentalno.
13:10
For the kidney,
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Kada se radi o bubrezima,
13:12
as I talked to you about the first painting that you saw,
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kao što sam vam pričao o prvoj slici koju ste videli,
13:16
the first slide I showed you,
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o prvom slajdu koji sam vam prikazao,
13:18
90 percent of the patients on the transplant wait list
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90 procenata pacijenata na listi za transplantaciju
13:21
are waiting for a kidney, 90 percent.
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čekaju na bubreg, 90 procenata.
13:23
So, another strategy we're following
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Dakle, druga strategija koju pratimo
13:25
is actually to create wafers
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je da napravimo listove
13:27
that we stack together, like an accordion, if you will.
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koje slažemo jedan na drugi, kao harmoniku, ako tako želite.
13:31
So, we stack these wafers together, using the kidney cells.
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Dakle, slažemo ove listove jedan na drugi, koristeći ćelije bubrega,
13:34
And then you can see these miniature kidneys that we've engineered.
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Onda možete da vidite ove minijaturne bubrege koje smo napravili.
13:37
They are actually making urine.
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Oni zapravo prave urin.
13:39
Again, small structures, our challenge is how to make them larger,
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Ponovo, sa malim strukturama je izazov kako ih učiniti većim
13:43
and that is something we're working on
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i to je nešto na čemu radimo
13:45
right now at the institute.
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upravo sada, na institutu.
13:47
One of the things that I wanted to summarize for you then
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Jedna od stvari koje želim da rezimiram za vas
13:50
is what is a strategy that we're going for in regenerative medicine.
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jeste strategija kojoj stremimo u regenerativnoj medicini.
13:54
If at all possible,
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Ako je uopšte moguće,
13:56
we really would like to use smart biomaterials
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zaista bismo želeli da koristimo pametne biomaterijale
13:59
that we can just take off the shelf
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koje bismo prosto mogli da uzmemo sa police
14:01
and regenerate your organs.
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i regenerišemo vaše organe.
14:03
We are limited with distances right now,
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Trenutno smo ograničeni razdaljinama,
14:05
but our goal is actually to increase those distances over time.
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ali je naš cilj da sa vremenom povećamo te razdaljine.
14:09
If we cannot use smart biomaterials,
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Ako ne možemo da koristimo pametne biomaterijale,
14:11
then we'd rather use your very own cells.
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onda bi radije koristili vaše sopstvene ćelije.
14:13
Why? Because they will not reject.
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Zašto? Zato što one neće biti odbačene.
14:15
We can take cells from you,
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Možemo uzeti ćelije od vas,
14:17
create the structure, put it right back into you, they will not reject.
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napraviti strukturu, staviti je nazad u vas i ona neće biti odbačena.
14:20
And if possible, we'd rather use the cells from your very specific organ.
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I ukoliko je moguće, mi bismo radije koristili ćelije vašeg specifičnog organa.
14:24
If you present with a diseased wind pipe
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Ako vam je oboleo dušnik
14:27
we'd like to take cells from your windpipe.
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voleli bismo da iz vašeg dušnika uzmemo ćelije.
14:29
If you present with a diseased pancreas
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Ako vam je oboleo pankreas
14:32
we'd like to take cells from that organ.
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voleli bismo da uzmemo ćelije iz tog organa.
14:34
Why? Because we'd rather take those cells
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Zašto? Zato što bismo radije uzeli one ćelije
14:37
which already know that those are the cell types you want.
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koje već znaju da je to tip ćelija koji želite.
14:40
A windpipe cell already knows it's a windpipe cell.
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Ćelija dušnika već zna da je ćelija dušnika.
14:43
We don't need to teach it to become another cell type.
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Ne treba da je učimo da postane ćelija drugog tipa.
14:46
So, we prefer organ-specific cells.
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Zato preferiramo ćelije specifičnih organa.
14:48
And today we can obtain cells from most every organ in your body,
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Danas možemo dobiti ćelije iz gotovo svakog organa vašeg tela,
14:51
except for several which we still need stem cells for,
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osim nekoliko za koje nam još uvek trebaju matične ćelije,
14:54
like heart, liver, nerve and pancreas.
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poput ćelija srca, jetre, nervnih i ćelija pankreasa.
14:58
And for those we still need stem cells.
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Za te su nam još uvek potrebne matične ćelije.
15:01
If we cannot use stem cells from your body
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Ako ne možemo koristiti matične ćelije iz vašeg tela
15:04
then we'd like to use donor stem cells.
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onda bismo voleli da koristimo matične ćelije donatora.
15:07
And we prefer cells that will not reject
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Preferiramo ćelije koje neće biti odbačene
15:09
and will not form tumors.
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i koje neće formirati tumore.
15:11
And we're working a lot with the stem cells that we
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Puno radimo sa matičnim ćelijama o kojima
15:13
published on two years ago,
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smo publikovali pre dve godine,
15:15
stem cells from the amniotic fluid,
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matičnim ćelijama iz plodove vode
15:17
and the placenta, which have those properties.
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i posteljice, koje imaju ta svojstva.
15:21
So, at this point, I do want to tell you that
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Dakle, sada želim da vam pričam
15:24
some of the major challenges we have.
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o nekim od glavnih izazova sa kojima se suočavamo.
15:28
You know, I just showed you this presentation, everything looks so good,
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Znate, upravo sam vam prikazao ovu prezentaciju i sve izgleda tako dobro,
15:30
everything works. Actually no,
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sve radi. Zapravo ne,
15:32
these technologies really are not that easy.
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ove tehnologije zaista nisu tako lake.
15:34
Some of the work you saw today
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Neki od radova koje ste videli danas
15:36
was performed by over 700 researchers
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je vršilo preko 700 istraživača
15:39
at our institute across a 20-year time span.
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na našem institutu tokom 20 godina.
15:42
So, these are very tough technologies.
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Stoga, ovo su veoma teške tehnologije.
15:44
Once you get the formula right you can replicate it.
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Jednom kada dobijete pravu formulu možete da napravite njenu kopiju.
15:47
But it takes a lot to get there.
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Ali potrebno je mnogo da bi se dotle stiglo.
15:49
So, I always like to show this cartoon.
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Uvek volim da prikažem ovu karikaturu.
15:51
This is how to stop a runaway stage.
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Ovo je kako da zaustavite bežanje.
15:53
And there you see the stagecoach driver,
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Tamo vidite vozača poštanske kočije,
15:55
and he goes, on the top panel,
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onda on odlazi na gornji panel.
15:57
He goes A, B, C, D, E, F.
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Odatle ide na A, B, C, D, E, F.
15:59
He finally stops the runaway stage.
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I konačno zaustavlja beg.
16:01
And those are usually the basic scientists,
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I to su obično osnovni naučnici,
16:04
The bottom is usually the surgeons.
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na dnu su obično hirurzi.
16:06
(Laughter)
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(Smeh)
16:10
I'm a surgeon so that's not that funny.
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Ja sam hirurg, tako da to i nije tako smešno.
16:12
(Laughter)
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(Smeh)
16:13
But actually method A is the correct approach.
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Ali zapravo, metod A je pravilan pristup.
16:17
And what I mean by that is that anytime we've launched one of these technologies
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Ono što time želim da kažem jeste da svaki put kada pokrenemo jednu od ovih tehnologija
16:20
to the clinic,
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ka klinici,
16:22
we've made absolutely sure that we do everything we can
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apsolutno smo sigurni da radimo sve što možemo
16:25
in the laboratory before we ever
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u laboratoriji pre nego što uopšte
16:27
launch these technologies to patients.
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pokrenemo ove tehnologije ka pacijentima.
16:29
And when we launch these technologies to patients
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A kada pokrenemo ove tehnologije ka pacijentima
16:31
we want to make sure that we ask ourselves a very tough question.
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želimo da budemo sigurni da smo se zapitali jedno veoma teško pitanje.
16:36
Are you ready to place this in your own loved one, your own child,
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Da li ste spremni da ovo stavite u vaše voljeno, vaše sopstveno dete,
16:39
your own family member, and then we proceed.
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člana vaše porodice, a tek onda nastavimo.
16:42
Because our main goal, of course,
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Zato što je naš glavni cilj, naravno,
16:44
is first, to do no harm.
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da prvenstveno ne nanesemo nikakvo zlo.
16:47
I'm going to show you now, a very short clip,
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Sada ću vam pokazati veoma kratak snimak.
16:49
It's a five second clip of a patient
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To je snimak od pet sekundi, jednog našeg pacijenta,
16:52
who received one of the engineered organs.
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koji je primio jedan od ovih projektovanih organa.
16:54
We started implanting some of these structures
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Počeli smo sa usađivanjem nekih od ovih struktura
16:56
over 14 years ago.
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pre 14 godina.
16:58
So, we have patients now walking around with organs,
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Sada takođe imamo pacijente koji hodaju okolo, sa organima,
17:00
engineered organs, for over 10 years, as well.
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projektovanim organima, preko 10 godina.
17:04
I'm going to show a clip of one young lady.
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Pokazaću vam snimak jedne mlade dame.
17:06
She had a spina bifida defect, a spinal cord abnormality.
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Ona je imala spina bifida defekt, abnormalnost kičmene moždine.
17:09
She did not have a normal bladder. This is a segment from CNN.
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Ona nije imala normalnu bešiku. Ovo je odsečak sa Si-En-Ena.
17:12
We are just taking five seconds.
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Uzimamo samo pet sekundi.
17:14
This is a segment that Sanjay Gupta actually took care of.
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Ovo je odsečak za koji se Sandžaj Gupta postarao.
17:19
Video: Kaitlyn M: I'm happy. I was always afraid
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Video: Kejtlin M: Srećna sam. Uvek sam se bojala
17:21
that I was going to have like, an accident or something.
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da ću da doživim neku nesreću ili nešto slično.
17:24
And now I can just go and
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A sada mogu da idem i
17:27
go out with my friends,
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da izlazim sa prijateljima,
17:29
go do whatever I want.
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da radim šta god želim.
17:32
Anthony Atala: See, at the end of the day, the promise of regenerative medicine
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Entoni Atala: Vidite, na kraju dana, obećanje regenerativne medicine
17:35
is a single promise.
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je samo jedno.
17:37
And that is really very simple,
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A to je zaista veoma jednostavno,
17:40
to make our patients better.
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da našim pacijentima bude bolje.
17:42
Thank you for your attention.
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Hvala vam na vašoj pažnji.
17:44
(Applause)
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(Aplauz)
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