TEDxSeattle
Chuck Murry: Can we regenerate heart muscle with stem cells?
查克·穆瑞: 我们可以用干细胞来再生心肌吗？
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Readability: 4.1
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心脏是人体中最难再生的器官之一——这是致使心脏衰竭成为全球头号杀手的重要因素。如果我们可以让心肌在受损后再生，那会怎样？医师兼科学家查克·穆瑞分享了他开创性的研究，利用干细胞来生成新的心脏细胞——这是实现干细胞药用的令人激动的一步。
Chuck Murry - Physician, scientist
Chuck Murry founded and currently directs the Institute for Stem Cell and Regenerative Medicine at the University of Washington. Full bio
Chuck Murry founded and currently directs the Institute for Stem Cell and Regenerative Medicine at the University of Washington. Full bio
Double-click the English transcript below to play the video.
00:12
I'd like to tell you
about a patient named Donna.
about a patient named Donna.
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我想和你们讲讲一个
叫唐娜的病人。
叫唐娜的病人。
00:16
In this photograph,
Donna was in her mid-70s,
Donna was in her mid-70s,
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在这张照片中，唐娜70多岁，
00:18
a vigorous, healthy woman,
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一个精力充沛、健康的女人，
00:20
the matriarch of a large clan.
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也是一个大家族的领袖。
00:22
She had a family history
of heart disease, however,
of heart disease, however,
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但她有心脏病家族史，
00:25
and one day, she had the sudden onset
of crushing chest pain.
of crushing chest pain.
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有一天，她突然感到胸痛。
00:28
Now unfortunately, rather than
seeking medical attention,
seeking medical attention,
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不幸的是，唐娜没有
寻求医疗救助，
寻求医疗救助，
00:31
Donna took to her bed for about 12 hours
until the pain passed.
until the pain passed.
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而是在床上躺了大约12个小时，
直到疼痛过去。
直到疼痛过去。
00:35
The next time she went
to see her physician,
to see her physician,
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下次她去看医生时，
00:37
he performed an electrocardiogram,
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医生做了心电图，
00:39
and this showed that she'd had
a large heart attack,
a large heart attack,
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这表明她心脏病发了，
00:41
or a "myocardial infarction"
in medical parlance.
in medical parlance.
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或者医学术语中的“心肌梗塞”。
00:45
After this heart attack,
Donna was never quite the same.
Donna was never quite the same.
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在这次心脏病发作之后，
唐娜就再也不一样了。
唐娜就再也不一样了。
00:48
Her energy levels progressively waned,
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她的体能逐渐下降，
00:51
she couldn't do a lot of the physical
activities she'd previously enjoyed.
activities she'd previously enjoyed.
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她不能做很多以前
喜欢的体育活动。
喜欢的体育活动。
00:54
It got to the point where she couldn't
keep up with her grandkids,
keep up with her grandkids,
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逐渐到了她不能跟上
孙子孙女的地步，
孙子孙女的地步，
00:58
and it was even too much work
to go out to the end of the driveway
to go out to the end of the driveway
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而且要走到楼道尽头
去拿邮件也变得费劲了。
去拿邮件也变得费劲了。
01:01
to pick up the mail.
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01:02
One day, her granddaughter
came by to walk the dog,
came by to walk the dog,
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一天，她的孙女过来遛狗，
01:05
and she found her grandmother
dead in the chair.
dead in the chair.
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她发现奶奶死在椅子上。
01:08
Doctors said it was a cardiac arrhythmia
that was secondary to heart failure.
that was secondary to heart failure.
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医生说这是一种
继发于心力衰竭的心律失常。
继发于心力衰竭的心律失常。
01:13
But the last thing that I should tell you
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但我最后要告诉你们的是
01:16
is that Donna was not just
an ordinary patient.
an ordinary patient.
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唐娜不仅仅是个普通病人。
01:18
Donna was my mother.
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唐娜是我母亲。
01:21
Stories like ours are,
unfortunately, far too common.
unfortunately, far too common.
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不幸的是，像我们
这样的故事太普遍了。
这样的故事太普遍了。
01:24
Heart disease is the number one killer
in the entire world.
in the entire world.
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心脏病是全世界头号杀手。
01:27
In the United States,
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在美国，
01:29
it's the most common reason
patients are admitted to the hospital,
patients are admitted to the hospital,
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这是病人入院的最常见原因，
01:32
and it's our number one
health care expense.
health care expense.
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这是我们最大的医疗费用。
01:34
We spend over a 100 billion dollars --
billion with a "B" --
billion with a "B" --
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我们花了1000多亿美元——
1000多亿美元——
1000多亿美元——
01:37
in this country every year
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在这个国家每年
01:38
on the treatment of heart disease.
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用于心脏病的治疗。
01:40
Just for reference, that's more than
twice the annual budget
twice the annual budget
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顺便说下，这是
华盛顿州年度预算的
华盛顿州年度预算的
01:43
of the state of Washington.
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两倍多。
01:45
What makes this disease so deadly?
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是什么使这种疾病如此致命？
01:47
Well, it all starts with the fact that
the heart is the least regenerative organ
the heart is the least regenerative organ
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这一切都是因为心脏是在人体内
01:51
in the human body.
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再生能力最小的器官。
01:53
Now, a heart attack happens when
a blood clot forms in a coronary artery
a blood clot forms in a coronary artery
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当将血液注入心脏壁的
冠状动脉中形成血液凝块时，
冠状动脉中形成血液凝块时，
01:57
that feeds blood to the wall of the heart.
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心脏病就会发作。
02:00
This plugs the blood flow,
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这会堵塞血流，
02:02
and the heart muscle
is very metabolically active,
is very metabolically active,
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心脏肌肉的新陈代谢非常活跃，
02:04
and so it dies very quickly,
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所以在血液流动
02:05
within just a few hours
of having its blood flow interrupted.
of having its blood flow interrupted.
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中断后的几个小时内，
心脏很快就死了。
心脏很快就死了。
02:10
Since the heart can't
grow back new muscle,
grow back new muscle,
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因为心脏不能长出新的心肌，
02:12
it heals by scar formation.
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它通过形成疤痕而愈合。
02:15
This leaves the patient with a deficit
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这使病人在
02:18
in the amount of heart
muscle that they have.
muscle that they have.
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心肌数量上形成了短缺。
02:20
And in too many people,
their illness progresses to the point
their illness progresses to the point
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在太多的人身上，
他们的病情已经坏到
他们的病情已经坏到
02:23
where the heart can no longer keep up
with the body's demand for blood flow.
with the body's demand for blood flow.
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心脏无法满足身体对
血液流动的需求。
血液流动的需求。
02:27
This imbalance between supply and demand
is the crux of heart failure.
is the crux of heart failure.
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供求失衡是心力衰竭的
症结所在。
症结所在。
02:34
So when I talk to people
about this problem,
about this problem,
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所以当我和人们
谈论这个问题时，
谈论这个问题时，
02:38
I often get a shrug
and a statement to the effect of,
and a statement to the effect of,
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我经常会耸耸肩，
然后说一句话，
然后说一句话，
02:42
"Well, you know, Chuck,
we've got to die of something."
we've got to die of something."
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“好吧，你知道，查克，
我们总会为某件事而死。”
我们总会为某件事而死。”
02:44
(Laughter)
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（笑声）
02:48
And yeah, but what this also tells me
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是的，但这也告诉了我
02:51
is that we've resigned ourselves to this
as the status quo because we have to.
as the status quo because we have to.
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我们已经对这个
现状自我放弃了。
现状自我放弃了。
02:58
Or do we?
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真是这样吗？
03:00
I think there's a better way,
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我觉得有更好的方法，
03:02
and this better way involves the use
of stem cells as medicines.
of stem cells as medicines.
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这种更好的方法包括
使用干细胞作为药物。
使用干细胞作为药物。
03:06
So what, exactly, are stem cells?
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那么，究竟什么是干细胞？
03:08
If you look at them under the microscope,
there's not much going on.
there's not much going on.
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如果你在显微镜下
观察它们，太简单了。
观察它们，太简单了。
03:12
They're just simple little round cells.
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它们只是简单的小圆形细胞。
03:13
But that belies two remarkable attributes.
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但这掩盖了两个显著的特征。
03:16
The first is they can divide like crazy.
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首先，它们可以疯狂地分裂。
03:19
So I can take a single cell,
and in a month's time,
and in a month's time,
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所以我只需要一个
细胞，一个月后，
细胞，一个月后，
03:22
I can grow this up to billions of cells.
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我可以把它长到数十亿个细胞。
03:24
The second is they can differentiate
or become more specialized,
or become more specialized,
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第二，它们可以分化或
变得更具指向性，
变得更具指向性，
03:29
so these simple little round cells
can turn into skin, can turn into brain,
can turn into skin, can turn into brain,
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所以这些简单的圆形细胞
可以变成皮肤，可以变成大脑，
可以变成皮肤，可以变成大脑，
03:33
can turn into kidney and so forth.
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可以变成肾脏等等。
03:36
Now, some tissues in our bodies
are chock-full of stem cells.
are chock-full of stem cells.
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现在，我们体内的一些
组织充满了干细胞。
组织充满了干细胞。
03:39
Our bone marrow, for example, cranks out
billions of blood cells every day.
billions of blood cells every day.
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例如，我们的骨髓每天
产生数十亿个血细胞。
产生数十亿个血细胞。
03:43
Other tissues like the heart
are quite stable,
are quite stable,
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心脏等其他组织相当稳定，
03:46
and as far as we can tell,
the heart lacks stem cells entirely.
the heart lacks stem cells entirely.
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据我们所知，心脏
完全缺乏干细胞。
完全缺乏干细胞。
03:50
So for the heart, we're going to have
to bring stem cells in from the outside,
to bring stem cells in from the outside,
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所以对于心脏来说，
我们必须从外部引进干细胞，
我们必须从外部引进干细胞，
03:54
and for this, we turn to
the most potent stem cell type,
the most potent stem cell type,
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为此，我们转向最
有效的干细胞类型，
有效的干细胞类型，
03:57
the pluripotent stem cell.
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多能干细胞。
03:59
Pluripotent stem cells are so named
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多能干细胞就是这样命名的，
04:01
because they can turn into
any of the 240-some cell types
any of the 240-some cell types
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因为它们可以变成构成人体的
240种细胞类型中的
240种细胞类型中的
04:04
that make up the human body.
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任何一种。
04:06
So this is my big idea:
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这是我的想法：
04:08
I want to take human
pluripotent stem cells,
pluripotent stem cells,
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我想培养人类多能干细胞，
04:11
grow them up in large numbers,
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让它们大量分裂，
04:13
differentiate them
into cardiac muscle cells
into cardiac muscle cells
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进而分化为心肌细胞，
04:16
and then take them out of the dish
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然后把它们从培养皿中拿出来，
04:18
and transplant them into the hearts
of patients who have had heart attacks.
of patients who have had heart attacks.
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再把它们移植到
心脏病患者的心脏上。
心脏病患者的心脏上。
04:22
I think this is going to reseed the wall
with new muscle tissue,
with new muscle tissue,
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我认为新的心肌细胞会
缝合心脏上的伤口，
缝合心脏上的伤口，
04:25
and this will restore
contractile function to the heart.
contractile function to the heart.
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进而会恢复心脏的收缩功能。
04:29
(Applause)
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（掌声，欢呼）
04:36
Now, before you applaud too much,
this was my idea 20 years ago.
this was my idea 20 years ago.
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在你们鼓太多掌之前，
我想说这是我20年前的想法。
我想说这是我20年前的想法。
04:39
(Laughter)
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（笑声）
04:41
And I was young,
I was full of it, and I thought,
I was full of it, and I thought,
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我很年轻，我充满了
这种想法，我想，
这种想法，我想，
04:45
five years in the lab,
and we'll crank this out,
and we'll crank this out,
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在实验室里呆五年，
我们会解决这个问题的，
我们会解决这个问题的，
04:48
and we'll have this into the clinic.
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我们会把这个想法
在临床上变成现实。
在临床上变成现实。
04:50
Let me tell you what really happened.
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我来告诉你们到底发生了什么。
04:52
(Laughter)
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（笑声）
04:53
We began with the quest to turn these
pluripotent stem cells into heart muscle.
pluripotent stem cells into heart muscle.
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我们开始探索将这些
多能干细胞转化为心肌细胞。
多能干细胞转化为心肌细胞。
04:58
And our first experiments worked, sort of.
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我们的第一个实验
差不多算成功了。
差不多算成功了。
05:01
We got these little clumps of beating
human heart muscle in the dish,
human heart muscle in the dish,
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我们在培养皿中放了
一些跳动的人体心脏肌肉，
一些跳动的人体心脏肌肉，
05:05
and that was cool,
because it said, in principle,
because it said, in principle,
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这很酷，因为它表明，原则上
05:07
this should be able to be done.
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我的想法应该可以做到。
05:09
But when we got around
to doing the cell counts,
to doing the cell counts,
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但当我们开始做细胞计数时，
05:12
we found that only one
out of 1,000 of our stem cells
out of 1,000 of our stem cells
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我们发现1000个
干细胞中只有一个
干细胞中只有一个
05:15
were actually turning into heart muscle.
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实际上变成了心肌细胞。
05:17
The rest was just a gemisch
of brain and skin and cartilage
of brain and skin and cartilage
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其余的只是大脑细胞、皮肤细胞、
软骨细胞和肠道细胞的混合。
软骨细胞和肠道细胞的混合。
05:23
and intestine.
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05:25
So how do you coax a cell
that can become anything
that can become anything
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那么你如何让一个能
变成任何东西的细胞
变成任何东西的细胞
05:29
into becoming just a heart muscle cell?
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只变成心肌细胞呢？
05:32
Well, for this we turned
to the world of embryology.
to the world of embryology.
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为了这个，我们转向
胚胎学的世界。
胚胎学的世界。
05:34
For over a century, the embryologists
had been pondering
had been pondering
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一个多世纪以来，
胚胎学家一直在思考
胚胎学家一直在思考
05:37
the mysteries of heart development.
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心脏发育的奥秘。
05:39
And they had given us
what was essentially a Google Map
what was essentially a Google Map
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他们给了我们一张
类似谷歌地图的东西，
类似谷歌地图的东西，
05:42
for how to go from a single fertilized egg
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这指示如何从一个受精卵
05:45
all the way over to a human
cardiovascular system.
cardiovascular system.
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一直发展到人类心血管系统。
05:48
So we shamelessly absconded
all of this information
all of this information
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所以我们贪婪地
使用了所有这些信息，
使用了所有这些信息，
05:52
and tried to make human cardiovascular
development happen in a dish.
development happen in a dish.
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并试图使人的心血管发育
发生在一个培养皿里。
发生在一个培养皿里。
05:57
It took us about five years, but nowadays,
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我们花了五年时间，但现在，
05:59
we can get 90 percent of our stem cells
to turn into cardiac muscle --
to turn into cardiac muscle --
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我们可以让90%的干细胞
变成心肌细胞——
变成心肌细胞——
06:03
a 900-fold improvement.
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提高了900倍。
06:05
So this was quite exciting.
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所以这很令人兴奋。
06:08
This slide shows you
our current cellular product.
our current cellular product.
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这张幻灯片向你们展示
我们当前的细胞产物。
我们当前的细胞产物。
06:11
We grow our heart muscle cells
in little three-dimensional clumps
in little three-dimensional clumps
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我们的心肌细胞在
被称为心脏类器官的
被称为心脏类器官的
06:14
called cardiac organoids.
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三维结构中发育。
06:16
Each of them has 500 to 1,000
heart muscle cells in it.
heart muscle cells in it.
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它们每个都有500到
1000个心肌细胞。
1000个心肌细胞。
06:20
If you look closely, you can see these
little organoids are actually twitching;
little organoids are actually twitching;
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如果你仔细观察，你会发现
这些小的类器官实际上在运动；
这些小的类器官实际上在运动；
06:23
each one is beating independently.
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每个类器官都在独立地跳动。
06:26
But they've got another trick
up their sleeve.
up their sleeve.
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但它们还有另一个小奥秘。
06:28
We took a gene from jellyfish
that live in the Pacific Northwest,
that live in the Pacific Northwest,
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我们从太平洋西北部的水母身上
提取了一个基因，
提取了一个基因，
06:31
and we used a technique
called genome editing
called genome editing
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我们使用了一种叫做
基因组编辑的技术
基因组编辑的技术
06:34
to splice this gene into the stem cells.
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把这个基因拼接到干细胞中。
06:37
And this makes our heart muscle cells
flash green every time they beat.
flash green every time they beat.
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这使得我们的心肌细胞
每跳动一次都会闪烁绿色。
每跳动一次都会闪烁绿色。
06:41
OK, so now we were finally ready
to begin animal experiments.
to begin animal experiments.
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现在，我们终于准备好
开始动物实验了。
开始动物实验了。
06:45
We took our cardiac muscle cells
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我们取了我们的心肌细胞，
06:47
and we transplanted them
into the hearts of rats
into the hearts of rats
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把它们移植到有
实验性心脏病发作的
实验性心脏病发作的
06:50
that had been given
experimental heart attacks.
experimental heart attacks.
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老鼠的心脏里。
06:52
A month later, I peered anxiously
down through my microscope
down through my microscope
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一个月后，我焦急地
透过显微镜观察，
透过显微镜观察，
06:56
to see what we had grown,
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看看我们长出了什么，
06:58
and I saw ...
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我看到…
06:59
nothing.
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没有什么。
07:01
Everything had died.
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一切都死了。
07:03
But we persevered on this,
and we came up with a biochemical cocktail
and we came up with a biochemical cocktail
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但我们坚持不懈，
想出了一种生化鸡尾酒，
想出了一种生化鸡尾酒，
07:07
that we called
our "pro-survival cocktail,"
our "pro-survival cocktail,"
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我们称之为“助生鸡尾酒”，
07:09
and this was enough to allow
our cells to survive
our cells to survive
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这足以通过移植的压力，
07:12
through the stressful process
of transplantation.
of transplantation.
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让我们的细胞存活下来。
07:15
And now when I looked
through the microscope,
through the microscope,
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现在当我通过显微镜看的时候，
07:17
I could see this fresh, young,
human heart muscle
human heart muscle
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我能看到这些新鲜的、
年轻的人类心肌
年轻的人类心肌
07:20
growing back in the injured wall
of this rat's heart.
of this rat's heart.
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在受伤的老鼠心脏壁上生长。
07:23
So this was getting quite exciting.
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这变得非常令人兴奋。
07:25
The next question was:
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下一个问题是：
07:27
Will this new muscle beat in synchrony
with the rest of the heart?
with the rest of the heart?
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这种新的肌肉会与心脏的
其他部分同步跳动吗？
其他部分同步跳动吗？
07:31
So to answer that,
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要回答这个问题，
07:32
we returned to the cells that had
that jellyfish gene in them.
that jellyfish gene in them.
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我们回到了含有
水母基因的细胞。
水母基因的细胞。
07:37
We used these cells essentially
like a space probe
like a space probe
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我们基本上就把这些细胞
当做太空探测器一样来使用，
当做太空探测器一样来使用，
07:40
that we could launch
into a foreign environment
into a foreign environment
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我们把它们放到一个
陌生的环境中，
陌生的环境中，
07:42
and then have that flashing
report back to us
report back to us
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然后我们通过返还给
我们的闪烁信号，
我们的闪烁信号，
07:45
about their biological activity.
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来了解它们的生物活性。
07:47
What you're seeing here
is a zoomed-in view,
is a zoomed-in view,
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你们现在看到的是一个放大的
07:49
a black-and-white image
of a guinea pig's heart
of a guinea pig's heart
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豚鼠心脏的黑白图像，
07:51
that was injured and then received
three grafts of our human cardiac muscle.
three grafts of our human cardiac muscle.
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这颗心脏受了伤，
然后接受了三轮的人体心肌移植。
然后接受了三轮的人体心肌移植。
07:55
So you see those sort of diagonally
running white lines.
running white lines.
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你们可以看到那些斜行的白线。
07:57
Each of those is a needle track
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每个都是针线，
07:59
that contains a couple of million
human cardiac muscle cells in it.
human cardiac muscle cells in it.
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里面有几百万人类心肌细胞。
08:03
And when I start the video,
you can see what we saw
you can see what we saw
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当我开始放视频的时候，
你们就可以看到我们透过显微镜时
你们就可以看到我们透过显微镜时
08:06
when we looked through the microscope.
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看到的景象。
08:09
Our cells are flashing,
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细胞在闪烁，
08:10
and they're flashing in synchrony,
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2025
而且它们在同步闪烁，
08:12
back through the walls
of the injured heart.
of the injured heart.
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透过受伤的心脏壁传回来。
08:15
What does this mean?
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这是什么意思？
08:16
It means the cells are alive,
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这意味着细胞是活的，
08:17
they're well, they're beating,
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2148
它们很好，它们在跳动，
08:19
and they've managed
to connect with one another
to connect with one another
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它们已经成功的融为一体了，
08:22
so that they're beating in synchrony.
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所以它们在同步跳动。
08:24
But it gets even more
interesting than this.
interesting than this.
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但还有更有意思的事情。
08:26
If you look at that tracing
that's along the bottom,
that's along the bottom,
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如果你看底部的线条，
08:28
that's the electrocardiogram
from the guinea pig's own heart.
from the guinea pig's own heart.
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这是豚鼠心脏的心电图。
08:32
And if you line up the flashing
with the heartbeat
with the heartbeat
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如果你把闪光和心跳排成一行
08:35
that's shown on the bottom,
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如图所示，
08:36
what you can see is there's a perfect
one-to-one correspondence.
one-to-one correspondence.
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你看到的是一对一的完美对应。
08:40
In other words, the guinea pig's
natural pacemaker is calling the shots,
natural pacemaker is calling the shots,
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换言之，豚鼠自身的
心脏正在主导，
心脏正在主导，
08:44
and the human heart muscle cells
are following in lockstep
are following in lockstep
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而人体心肌细胞则是
亦步亦趋的跟随着，
亦步亦趋的跟随着，
08:47
like good soldiers.
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就像好士兵一样。
08:49
(Applause)
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（掌声，欢呼）
08:56
Our current studies have moved into
what I think is going to be
what I think is going to be
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我们目前的研究已经
进入了我所认为的
进入了我所认为的
08:59
the best possible predictor
of a human patient,
of a human patient,
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和人类最相近的动物实验阶段，
09:01
and that's into macaque monkeys.
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那就是猕猴实验。
09:05
This next slide shows you
a microscopic image
a microscopic image
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下一张幻灯片是一幅显微图像，
09:08
from the heart of a macaque that was given
an experimental heart attack
an experimental heart attack
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4442
展示了一只实验性心脏病
发作的猕猴心脏，
发作的猕猴心脏，
09:12
and then treated with a saline injection.
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2079
然后被注射了盐水。
09:15
This is essentially like
a placebo treatment
a placebo treatment
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2233
这基本上就像安慰剂治疗，
09:17
to show the natural history
of the disease.
of the disease.
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2165
显示疾病的自然发生过程。
09:19
The macaque heart muscle is shown in red,
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2268
猕猴的心肌呈红色，
09:21
and in blue, you see the scar tissue
that results from the heart attack.
that results from the heart attack.
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549777
3504
蓝色部分，你可以看到
心脏病引起的疤痕组织。
心脏病引起的疤痕组织。
09:25
So as you look as this, you can see how
there's a big deficiency in the muscle
there's a big deficiency in the muscle
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当你看着这张图时，
你会发现心室壁的一部分
你会发现心室壁的一部分
09:29
in part of the wall of the heart.
192
557211
1918
肌肉有很大的缺陷。
09:31
And it's not hard to imagine
how this heart would have a tough time
how this heart would have a tough time
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3243
不难想象这颗心脏在起搏时
09:34
generating much force.
194
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会有多么大的阻碍。
09:37
Now in contrast, this is one
of the stem-cell-treated hearts.
of the stem-cell-treated hearts.
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3376
相反，这是颗接受
干细胞治疗的心脏。
干细胞治疗的心脏。
09:41
Again, you can see
the monkey's heart muscle in red,
the monkey's heart muscle in red,
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3935
同样的，你可以看到
猴子的心肌是红色的，
猴子的心肌是红色的，
09:45
but it's very hard to even see
the blue scar tissue,
the blue scar tissue,
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2707
但是很难看到蓝色的疤痕组织，
09:47
and that's because we've
been able to repopulate it
been able to repopulate it
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3120
那是因为我们用了人类的心肌
09:51
with the human heart muscle,
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1864
去恢复了它，
09:53
and so we've got this nice, plump wall.
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2182
所以我们重新有了一扇
漂亮丰满的心室壁。
漂亮丰满的心室壁。
09:55
OK, let's just take a second and recap.
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好吧，让我们花点
时间回顾一下。
时间回顾一下。
09:57
I've showed you
that we can take our stem cells
that we can take our stem cells
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2534
我已经向你展示了
我们的干细胞
我们的干细胞
10:00
and differentiate them
into cardiac muscle.
into cardiac muscle.
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2512
以及它们分化成心肌细胞的过程。
10:02
We've learned how to keep them alive
after transplantation,
after transplantation,
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3200
我们已经学会了如何在
移植后保持它们的活力，
移植后保持它们的活力，
10:05
we've showed that they beat
in synchrony with the rest of the heart,
in synchrony with the rest of the heart,
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3255
我们已经证明它们与心脏的
其他部分同步跳动，
其他部分同步跳动，
10:09
and we've shown that we can scale them up
206
597275
1995
我们已经证明我们可以在
10:11
into an animal that is the best possible
predictor of a human's response.
predictor of a human's response.
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4350
成为最能预测人类反应的
动物身上进行实验。
动物身上进行实验。
10:16
You'd think that we hit all the roadblocks
that lay in our path, right?
that lay in our path, right?
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你们会认为我们清除了
所有阻碍我们前进的路障，对吧？
所有阻碍我们前进的路障，对吧？
10:23
Turns out, not.
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1190
事实证明，不是这样。
10:24
These macaque studies also taught us
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2395
这些猕猴的研究也教会了我们
10:27
that our human heart muscle cells created
a period of electrical instability.
a period of electrical instability.
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4703
我们人类的心肌细胞造成了
一段时间的心电不稳。
一段时间的心电不稳。
10:32
They caused ventricular arrhythmias,
or irregular heartbeats,
or irregular heartbeats,
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3581
它们引起了室性心律失常
或不规则的心跳，
或不规则的心跳，
10:35
for several weeks after
we transplanted them.
we transplanted them.
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2264
长达移植后几个星期之久。
10:39
This was quite unexpected, because
we hadn't seen this in smaller animals.
we hadn't seen this in smaller animals.
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3577
这完全出乎意料，因为我们
在小动物身上没有看到过。
在小动物身上没有看到过。
10:43
We've studied it extensively,
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1787
我们对这进行了广泛的研究，
10:45
and it turns out that it results
from the fact that our cellular graphs
from the fact that our cellular graphs
216
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3988
结果发现，发生的原因是
我们的细胞图
我们的细胞图
10:49
are quite immature,
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1538
很不成熟，
10:50
and immature heart muscle cells
all act like pacemakers.
all act like pacemakers.
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3582
未成熟的心肌细胞都像起搏器。
10:54
So what happens is,
we put them into the heart,
we put them into the heart,
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2395
所以当我们把它们放进心脏，
10:56
and there starts to be a competition
with the heart's natural pacemaker
with the heart's natural pacemaker
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644676
3445
它们便开始与心脏的
自然起搏竞争
自然起搏竞争
11:00
over who gets to call the shots.
221
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1619
决定谁来占主导地位。
11:02
It would be sort of like
222
650502
1163
这就有点像
11:03
if you brought a whole gaggle of teenagers
into your orderly household all at once,
into your orderly household all at once,
223
651689
4617
如果你一下子把一群傻乎乎的青少年
带到你井然有序的家里，
带到你井然有序的家里，
11:08
and they don't want to follow the rules
and the rhythms of the way you run things,
and the rhythms of the way you run things,
224
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4137
他们不想遵守你的规则和节奏，
11:12
and it takes a while to rein everybody in
225
660491
1972
需要一段时间来控制所有人，
11:14
and get people working
in a coordinated fashion.
in a coordinated fashion.
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2477
让人们以协调一致的方式工作。
11:17
So our plans at the moment
227
665471
1249
所以我们现在的计划
11:18
are to make the cells go through
this troubled adolescence period
this troubled adolescence period
228
666744
3143
是当细胞还在培养皿里的时候，
11:21
while they're still in the dish,
229
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1982
让它们经历这个麻烦的“青春期”，
11:23
and then we'll transplant them in
in the post-adolescent phase,
in the post-adolescent phase,
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671917
4421
然后我们在“青春期”后移植它们，
11:28
where they should be much more orderly
231
676362
1970
那时它们会更加的有序，
11:30
and be ready to listen
to their marching orders.
to their marching orders.
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2730
准备好遵守它们的行军命令。
11:33
In the meantime, it turns out
we can actually do quite well
we can actually do quite well
233
681110
2804
同时，事实证明当这种方法和
抗心律失常药物结合时，
抗心律失常药物结合时，
11:35
by treating with
anti-arrhythmia drugs as well.
anti-arrhythmia drugs as well.
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2404
我们做的相当不错。
11:39
So one big question still remains,
235
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2590
还有一个大问题，
11:41
and that is, of course, the whole purpose
that we set out to do this:
that we set out to do this:
236
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3289
当然，这就是我们开始
做这件事的全部目的：
做这件事的全部目的：
11:44
Can we actually restore function
to the injured heart?
to the injured heart?
237
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3322
我们真的能恢复
受伤心脏的功能吗？
受伤心脏的功能吗？
11:49
To answer this question,
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1260
要回答这个问题，
11:50
we went to something that's called
"left ventricular ejection fraction."
"left ventricular ejection fraction."
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3766
我们研究了所谓的
“左心室射出分率”。
“左心室射出分率”。
11:54
Ejection fraction is simply
the amount of blood
the amount of blood
240
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2330
射出分率是每一次起搏时
11:56
that is squeezed
out of the chamber of the heart
out of the chamber of the heart
241
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2366
从心腔中挤出来的
11:59
with each beat.
242
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1172
血液量。
12:00
Now, in healthy macaques,
like in healthy people,
like in healthy people,
243
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2459
健康的猕猴，就像健康人一样，
12:02
ejection fractions are about 65 percent.
244
710715
2470
射出分率约为65%。
12:05
After a heart attack, ejection fraction
drops down to about 40 percent,
drops down to about 40 percent,
245
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4120
心脏病发作后，射出分率
下降到40%左右，
下降到40%左右，
12:09
so these animals are
well on their way to heart failure.
well on their way to heart failure.
246
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2834
所以这些动物很快
就会患上心力衰竭。
就会患上心力衰竭。
12:12
In the animals that receive
a placebo injection,
a placebo injection,
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2275
在接受安慰剂注射的动物中，
12:15
when we scan them a month later,
248
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1575
一个月后当我们扫描它们时，
12:16
we see that ejection
fraction is unchanged,
fraction is unchanged,
249
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2289
我们看到射出分率不变，
12:18
because the heart, of course,
doesn't spontaneously recover.
doesn't spontaneously recover.
250
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2861
因为心脏不会自动恢复。
12:22
But in every one of the animals
that received a graft
that received a graft
251
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2783
但是在每只接受人体
心肌细胞移植的
心肌细胞移植的
12:25
of human cardiac muscle cells,
252
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1711
动物身上，
12:27
we see a substantial improvement
in cardiac function.
in cardiac function.
253
735031
2998
我们看到心脏功能
有了实质性的改善。
有了实质性的改善。
12:30
This averaged eight points,
so from 40 to 48 percent.
so from 40 to 48 percent.
254
738053
3934
从40%到48%，平均
有8个点的提升。
有8个点的提升。
12:34
What I can tell you
is that eight points is better
is that eight points is better
255
742011
3056
我能告诉你的是8个点
12:37
than anything that's
on the market right now
on the market right now
256
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2328
比现在市场上的任何
12:39
for treating patients with heart attacks.
257
747443
2011
用于治疗心脏病患者的东西都要好。
12:41
It's better than everything
we have put together.
we have put together.
258
749478
2729
这和我们把所有的东西
放在一起比都要好。
放在一起比都要好。
12:44
So if we could do
eight points in the clinic,
eight points in the clinic,
259
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2153
如果我们能在临床上达到8个点，
12:46
I think this would be a big deal
that would make a large impact
that would make a large impact
260
754408
3011
我认为这将会对人类健康
12:49
on human health.
261
757443
1186
会产生很大的影响。
12:51
But it gets more exciting.
262
759137
3581
但是还有更令人兴奋的。
12:54
That was just four weeks
after transplantation.
after transplantation.
263
762742
2679
这只是移植后的四周。
12:57
If we extend these studies
out to three months,
out to three months,
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2900
如果我们把这些
研究延长到三个月，
研究延长到三个月，
13:00
we get a full 22-point gain
in ejection fraction.
in ejection fraction.
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射出分率会增长22个点。
13:04
(Applause)
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（掌声）
13:11
Function in these
treated hearts is so good
treated hearts is so good
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这些治疗过的心脏功能很好
13:14
that if we didn't know up front
that these animals had had a heart attack,
that these animals had had a heart attack,
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以至于如果我们事先不知道
这些动物有过心脏病发作，
这些动物有过心脏病发作，
13:18
we would never be able to tell
from their functional studies.
from their functional studies.
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我们永远无法
从功能研究中将它们辨别出来。
从功能研究中将它们辨别出来。
13:24
Going forward, our plan
is to start phase one,
is to start phase one,
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接下来，我们的计划
是开始第一阶段，
是开始第一阶段，
13:28
first in human trials here at
the University of Washington in 2020 --
the University of Washington in 2020 --
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2020年首次在华盛顿大学
进行人体试验——
进行人体试验——
13:32
two short years from now.
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两年后。
13:34
Presuming these studies
are safe and effective,
are safe and effective,
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假设这些研究是安全有效的，
13:37
which I think they're going to be,
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我觉得它们是这样的，
13:39
our plan is to scale this up
and ship these cells all around the world
and ship these cells all around the world
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我们的计划是扩大规模，
把这些细胞运到世界各地
把这些细胞运到世界各地
13:44
for the treatment of patients
with heart disease.
with heart disease.
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用于治疗心脏病患者。
13:46
Given the global burden of this illness,
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鉴于这种疾病的全球性负担，
13:48
I could easily imagine this treating
a million or more patients a year.
a million or more patients a year.
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我可以很容易地想象，
每年治疗一百万或更多的病人。
每年治疗一百万或更多的病人。
13:52
So I envision a time,
maybe a decade from now,
maybe a decade from now,
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我设想一个时间，也许十年后，
13:55
where a patient like my mother
will have actual treatments
will have actual treatments
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像我母亲这样的病人
会接受真正的治疗，
会接受真正的治疗，
13:58
that can address the root cause
and not just manage her symptoms.
and not just manage her symptoms.
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这可以解决根本原因，
而不仅仅是缓解她的症状。
而不仅仅是缓解她的症状。
14:02
This all comes from the fact
that stem cells give us the ability
that stem cells give us the ability
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这些都因为干细胞让我们有能力
14:06
to repair the human body
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可以从人类身体的组成部分
14:07
from its component parts.
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来修复自身。
14:10
In the not-too-distant future,
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在不久的将来，
14:12
repairing humans is going to go
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修复人类就要
14:16
from something that is
far-fetched science fiction
far-fetched science fiction
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从牵强附会的科幻小说中
14:19
into common medical practice.
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走进普通的医学实践。
14:22
And when this happens,
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当这发生时，
14:23
it's going to have
a transformational effect
a transformational effect
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它会产生一个颠覆性的效果，
14:25
that rivals the development
of vaccinations and antibiotics.
of vaccinations and antibiotics.
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可以比肩疫苗和
抗生素的发展。
抗生素的发展。
14:30
Thank you for your attention.
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谢谢你们的聆听。
14:31
(Applause)
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（掌声，欢呼）
ABOUT THE SPEAKER
Chuck Murry - Physician, scientistChuck Murry founded and currently directs the Institute for Stem Cell and Regenerative Medicine at the University of Washington.
Why you should listen
Heart failure -- now the number one cause of death worldwide -- is the motivation behind Dr. Chuck Murry's specialized research into innovative treatments. Murry believes that it's not enough simply to help patients who are plagued with chronic disease survive. Instead, his pioneering work seeks to harness the potential of human stem cells to eliminate the disease from the body.
Chuck Murry | Speaker | TED.com