TEDGlobal 2013
Siddharthan Chandran: Can the damaged brain repair itself?
席達贊．坎卓然: 受損的大腦能自癒嗎？
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受到創傷性的大腦受傷後，偶爾可以自癒，長出新的腦細胞來替代受損的腦細胞。但自癒啟動的時間還尚未快到能從有退化狀況下像是運動神經疾病（也被稱做「盧．賈里格氏症」，或是「肌萎縮脊髓側索硬化症」，俗稱漸凍人）恢復原狀，席達贊．坎卓然（音譯）詳細解說一些利用特定幹細胞的新技術，能夠讓受損的腦部重建得更快速。
Siddharthan Chandran - Regenerative neurologist
Siddharthan Chandran explores how to heal damage from degenerative disorders such as MS and motor neuron disease (ALS). Full bio
Siddharthan Chandran explores how to heal damage from degenerative disorders such as MS and motor neuron disease (ALS). Full bio
Double-click the English transcript below to play the video.
00:12
I'm very pleased to be here today
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今天我感到非常開心來這裡，
00:14
to talk to you all about how we might repair
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要跟你們大家談：
「如何我們有可能修復
「如何我們有可能修復
00:16
the damaged brain,
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受損的大腦」
00:18
and I'm particularly excited by this field,
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這方面使我特別地感到振奮，
00:21
because as a neurologist myself,
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因為我身為一個神經學專家，
00:23
I believe that this offers one of the great ways
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我相信這提供了
一個最棒的辦法，
一個最棒的辦法，
00:25
that we might be able to offer hope
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讓我們也許有能力送上希望
給病人們，
那些今天活著帶有造成損傷、
那些今天活著帶有造成損傷、
00:27
for patients who today live with devastating
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尚未能治癒的大腦病變的人。
00:30
and yet untreatable diseases of the brain.
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問題就在這裡，
00:33
So here's the problem.
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00:36
You can see here the picture of somebody's brain
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你可以看到這是某人大腦的圖片，
00:38
with Alzheimer's disease
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是患有阿滋海默症的人。
00:40
next to a healthy brain,
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旁邊還有健康的大腦圖片，
00:42
and what's obvious is, in the Alzheimer's brain,
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很明顯的是在患有
阿滋海默症的大腦中
阿滋海默症的大腦中
00:44
ringed red, there's obvious
damage -- atrophy, scarring.
damage -- atrophy, scarring.
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被紅線圈起來的是明顯的損傷---
萎縮和傷疤。
00:49
And I could show you equivalent pictures
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我還可以讓你看更多同性質的照片，
00:51
from other disease: multiple sclerosis,
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來自其他大腦病變：多發性硬化症、
00:53
motor neuron disease, Parkinson's disease,
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運動神經疾病、巴金森氏症、
00:56
even Huntington's disease,
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甚至還有亨丁頓氏症，
00:58
and they would all tell a similar story.
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而且它們都訴說著相似的故事，
還有這些大腦失常集合性地代表
01:01
And collectively these brain disorders represent
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01:03
one of the major public health threats of our time.
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我們此生主要的一個公眾健康威脅。
01:06
And the numbers here are really rather staggering.
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況且這人數真的讓人傻眼，
以今天而言有三千五百萬人，
01:11
At any one time, there are 35 million people today
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01:14
living with one of these brain diseases,
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患有這些病變的其中一種，
01:17
and the annual cost globally
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而且年度的花費全球性來說
01:19
is 700 billion dollars.
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是七千億美金。
01:21
I mean, just think about that.
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就單單想一下那個金額，
01:23
That's greater than one percent
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那是遠大於百分之１
01:25
of the global GDP.
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的全球國內生產毛額。
01:27
And it gets worse,
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而且還會變糟，
01:29
because all these numbers are rising
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因為人數、花費等所有的數據
一直在上升中，
一直在上升中，
01:32
because these are by and large
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因為這些絕大部分是
01:33
age-related diseases, and we're living longer.
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年齡相關疾病而我們正活得更長壽。
01:36
So the question we really need to ask ourselves is,
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所以我們真正需要問我們自己的問題是
01:39
why, given the devastating impact of these diseases
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什麼原因使得破壞性影響的
這些大腦病變
這些大腦病變
發生在個人身上？
01:43
to the individual,
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01:44
never mind the scale of the societal problem,
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先不要關心到後續
造成的社會問題的規模。
造成的社會問題的規模。
01:47
why are there no effective treatments?
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為什麼沒有能成功的療法？
01:50
Now in order to consider this,
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現在為了要認真思考這問題，
01:52
I first need to give you a crash course
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我必須先給你們上一堂速成課，
01:55
in how the brain works.
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有關大腦是如何運作。
01:57
So in other words, I need to tell you
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所以換句話說我必須告訴你們
01:59
everything I learned at medical school.
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我在醫學院裡學到的所有一切。
02:01
(Laughter)
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(笑聲)
不過相信我！
這預計不會花太久，
這預計不會花太久，
02:03
But believe me, this isn't going to take very long.
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02:05
Okay? (Laughter)
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可以吧？
02:08
So the brain is terribly simple:
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大腦組織真的再簡單不過，
02:10
it's made up of four cells,
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它是由四種細胞組成的，
02:13
and two of them are shown here.
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這邊展示了其中的兩種，
02:14
There's the nerve cell,
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有神經細胞、
02:16
and then there's the myelinating cell,
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再來是髓鞘細胞，
02:18
or the insulating cell.
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或叫絕緣細胞。
02:19
It's called oligodendrocyte.
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這叫寡突膠細胞。
02:22
And when these four cells work together
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當四種細胞一起運作，
02:23
in health and harmony,
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是在健康跟和諧之下，
02:25
they create an extraordinary
symphony of electrical activity,
symphony of electrical activity,
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它們像電流般的傳輸行為
譜了出色的交響曲，
譜了出色的交響曲，
02:29
and it is this electrical activity
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而且正是這些像電流般
的傳輸行為，
的傳輸行為，
02:31
that underpins our ability to think, to emote,
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支持我們去思考、表達情緒、
記住、學習、移動、
感知等等的能力。
感知等等的能力。
02:35
to remember, to learn, move, feel and so on.
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02:38
But equally, each of these individual four cells
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但同等地每一個這四種細胞
單獨或一起可能不受控制或者死掉，
02:41
alone or together, can go rogue or die,
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02:47
and when that happens, you get damage.
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當這情況發生時你就會受到傷害，
02:49
You get damaged wiring.
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你會發生大腦網絡損壞、
02:50
You get disrupted connections.
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你會發生大腦連結中斷，
02:53
And that's evident here with the slower conduction.
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這邊就是證據，
有著較慢的大腦傳輸。
有著較慢的大腦傳輸。
02:57
But ultimately, this damage will manifest
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最終這種損壞將肯定地表示
03:00
as disease, clearly.
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是大腦病變。
03:02
And if the starting dying nerve cell
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如果最先開始死掉的神經細胞，
03:05
is a motor nerve, for example,
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例如是運動神經細胞
03:07
you'll get motor neuron disease.
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你就會有運動神經細胞病變。
03:09
So I'd like to give you a real-life illustration
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因此，我想要給你們
看一個真人實例，
看一個真人實例，
03:12
of what happens with motor neuron disease.
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患有運動神經細胞病變
會有甚麼事發生？
會有甚麼事發生？
03:16
So this is a patient of mine called John.
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這位是我的一位病人叫約翰
03:18
John I saw just last week in the clinic.
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我才在上個星期的門診看過約翰，
03:21
And I've asked John to tell us something
about what were his problems
about what were his problems
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我請約翰來告訴我們
有關他當時有甚麼毛病，
有關他當時有甚麼毛病，
03:25
that led to the initial diagnosis
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造成之後首次診斷
是運動神經細胞病變。
是運動神經細胞病變。
03:27
of motor neuron disease.
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03:28
John: I was diagnosed in October in 2011,
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我在2011年十月時就診的，
(吃力呼吸)
03:33
and the main problem was a breathing problem,
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當時主要的問題是有關呼吸方面，
呼吸困難。
03:37
difficulty breathing.
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我不知道你是否全部聽清楚了，
約翰想告訴我們
約翰想告訴我們
03:38
Siddharthan Chandran: I don't know if you
caught all of that, but what John was telling us
caught all of that, but what John was telling us
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03:41
was that difficulty with breathing
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是呼吸的時候會有困難，
03:43
led eventually to the diagnosis
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導致最後的診斷出
運動神經細胞病變。
03:45
of motor neuron disease.
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約翰從那次診斷到現在
已過了18個月，
已過了18個月，
03:48
So John's now 18 months
further down in that journey,
further down in that journey,
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03:51
and I've now asked him to tell us something about
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我現在請他來告訴我們關於
他目前的困境。
03:54
his current predicament.
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我現在變得呼吸更吃力、
03:56
John: What I've got now is
the breathing's gotten worse.
the breathing's gotten worse.
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我的手、上肢、下肢變得無力，
03:59
I've got weakness in my hands,
my arms and my legs.
my arms and my legs.
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所以基本上我大部分時間都
坐在輪椅裡。
坐在輪椅裡。
04:05
So basically I'm in a wheelchair most of the time.
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04:09
SC: John's just told us he's in a wheelchair
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約翰告訴我們他是坐著輪椅
04:12
most of the time.
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在大部分時間裡。
所以這兩段短片所要表達的
04:14
So what these two clips show
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不只是有關大腦病變的
嚴重傷害性的後果，
嚴重傷害性的後果，
04:17
is not just the devastating
consequence of the disease,
consequence of the disease,
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04:19
but they also tell us something about
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而它們也告訴我們有關
04:21
the shocking pace of the disease,
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病變驚人的惡化速度，
因為只是在18個月之內，
04:23
because in just 18 months,
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一個健全的成年男人已經給送上
04:26
a fit adult man has been rendered
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了輪椅而且要依靠呼吸器。
04:29
wheelchair- and respirator-dependent.
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讓我們正視它，
約翰有可能是任何人的父親、
約翰有可能是任何人的父親、
04:32
And let's face it, John could be anybody's father,
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兄弟或朋友。
04:35
brother or friend.
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04:37
So that's what happens when the motor nerve dies.
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這就是當運動神經細胞
死亡時會發生的事。
死亡時會發生的事。
04:39
But what happens when that myelin cell dies?
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那髓鞘細胞死亡時又會如何？
04:44
You get multiple sclerosis.
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你將患有多發性硬化症。
04:46
So the scan on your left
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所以在你左手邊的掃描
04:48
is an illustration of the brain,
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正是一張大腦的圖片，
04:51
and it's a map of the connections of the brain,
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而且它也是大腦連結路徑的地圖，
04:53
and superimposed upon which
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上面又被標記出的是
大腦受損的地方，
04:55
are areas of damage.
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我們稱作「去髓鞘損傷」，
04:57
We call them lesions of demyelination.
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04:59
But they're damage, and they're white.
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不過它們壞掉了、還有是白色的。
05:02
So I know what you're thinking here.
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我知道你在想什麼，
05:03
You're thinking, "My God, this bloke came up
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你正在想，「我的天哪！
這傢伙上台來，
這傢伙上台來，
說他想談的是希望，
05:06
and said he's going to talk about hope,
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05:08
and all he's done is give a really rather bleak
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所有他做的事就是說了再無望不過
以及令人沮喪的故事。」
05:10
and depressing tale."
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05:12
I've told you these diseases are terrible.
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我剛跟你說過這些病變是可怕的。
05:13
They're devastating, numbers are rising,
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它們是傷害性的、數字一直上升中的、
費用是太離譜的，且最糟糕的是
05:16
the costs are ridiculous, and worst of all,
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我們沒有治療方法，希望在哪裡呢？
05:18
we have no treatment. Where's the hope?
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你們知道嗎我認為是有希望的，
05:20
Well, you know what? I think there is hope.
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而且希望就在旁邊那張剖面圖裡，
05:23
And there's hope in this next section,
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是某位患有多發性硬化症病人
的大腦剖面圖，
的大腦剖面圖，
05:25
of this brain section of somebody else with M.S.,
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因為令人驚訝地是它說明了，
05:28
because what it illustrates
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大腦能夠自癒，
05:29
is, amazingly, the brain can repair itself.
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它只是自癒做得還不夠好。
05:32
It just doesn't do it well enough.
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05:34
And so again, there are two
things I want to show you.
things I want to show you.
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有兩件事我要告訴你。
05:36
First of all is the damage of this patient with M.S.
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首先，是患有多發性硬化症的
這個病人大腦有損傷。
這個病人大腦有損傷。
05:40
And again, it's another one of these white masses.
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再來一次就是這些白色區塊的一塊。
但很重要地，是這個被紅色圈起來的地方
05:43
But crucially, the area that's ringed red
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05:47
highlights an area that is pale blue.
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註記了一個淡藍色的區域，
05:49
But that area that is pale blue was once white.
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但是那個淡藍色的區域原本是白色的。
05:52
So it was damaged. It's now repaired.
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就是說它曾經是受損的，
現在已經修復了。
現在已經修復了。
再澄清一些，這不是醫生們造成的。
05:55
Just to be clear: It's not because of doctors.
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這是醫生以外的因素，
不是醫生們造成的。
不是醫生們造成的。
05:58
It's in spite of doctors, not because of doctors.
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06:01
This is spontaneous repair.
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這是自主性的修復。
06:03
It's amazing and it's occurred
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這很令人驚奇的而且它發生了
06:04
because there are stem cells in the brain, even,
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就是因為大腦中有幹細胞，
06:07
which can enable new myelin, new insulation,
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甚至可以使新的髓鞘細胞、絕緣體
06:11
to be laid down over the damaged nerves.
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包覆在受損的神經上。
這個觀察之所以重要有兩個原因，
06:13
And this observation is important for two reasons.
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第一、是它質疑了一個正統學說
06:17
The first is it challenges one of the orthodoxies
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就是我們當初在醫學院裡學到的，
06:21
that we learnt at medical school,
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06:22
or at least I did, admittedly last century,
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起碼是我曾學習到，
誠然地是在上個世紀時，
誠然地是在上個世紀時，
就是大腦不能自癒，
06:26
which is that the brain doesn't repair itself,
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06:28
unlike, say, the bone or the liver.
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不像好比說是骨頭或肝臟。
不過實際上它可以自癒，
只是它自癒得還不夠好。
只是它自癒得還不夠好。
06:32
But actually it does, but it
just doesn't do it well enough.
just doesn't do it well enough.
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06:35
And the second thing it does,
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它做的第二件事，
06:37
and it gives us a very clear direction
of travel for new therapies --
of travel for new therapies --
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它給了我們一個清楚的方向
去找出新的療法，
去找出新的療法，
06:41
I mean, you don't need to be a rocket scientist
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我說的是你不必是極聰明的人，
去知道這裡要做甚麼。
06:42
to know what to do here.
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06:44
You simply need to find ways of promoting
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你僅需要找出方法來促使
內生性、自主性的修復
無論如何都能啟動。
無論如何都能啟動。
06:47
the endogenous, spontaneous
repair that occurs anyway.
repair that occurs anyway.
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06:51
So the question is, why, if we've known that
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問題是如果我們已經知道這些
06:54
for some time, as we have,
155
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有一段時間了，
為什麼我們還沒有治療那
些大腦損傷的方法？
些大腦損傷的方法？
06:56
why do we not have those treatments?
156
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07:00
And that in part reflects the complexity
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那有一部分原因反映出藥品開發
07:02
of drug development.
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的複雜性。
07:05
Now, drug development you might think of
159
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現在藥品開發你可能會想到
既昂貴又有風險的賭博，
07:07
as a rather expensive but risky bet,
160
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2724
07:10
and the odds of this bet are roughly this:
161
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而這賭博的實現機率大概是
07:12
they're 10,000 to one against,
162
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萬分之一，
07:14
because you need to screen
about 10,000 compounds
about 10,000 compounds
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2805
因為你需要測試約ㄧ萬種配方，
去找出那一個有可能成功的正解。
07:17
to find that one potential winner.
164
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07:19
And then you need to spend 15 years
165
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接著你需要花15年的時間，
07:21
and spend over a billion dollars,
166
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以及支出超過10億美元，
07:22
and even then, you may not have a winner.
167
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甚至到後來你並沒有正解。
07:26
So the question for us is,
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所以我們該問的問題是，
07:27
can you change the rules of the game
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你可以改變遊戲規則嗎？
07:29
and can you shorten the odds?
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你可以縮短找到正解的時間嗎？
07:31
And in order to do that, you have to think,
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為了達到這個目的你必須去想，
07:33
where is the bottleneck in this drug discovery?
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藥品開發的瓶頸在哪？
07:36
And one of the bottlenecks is
early in drug discovery.
early in drug discovery.
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其中一個瓶頸在藥品開發的初期，
07:39
All that screening occurs in animal models.
174
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所有的測試都發生在動物實驗體上。
07:43
But we know that the proper
study of mankind is man,
study of mankind is man,
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不過我們知道
正確的研究人類要用真人，
正確的研究人類要用真人，
07:47
to borrow from Alexander Pope.
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我借用亞歷山大．波普的話。
07:49
So the question is, can we study these diseases
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所以問題是：我們能否研究這些疾病
07:51
using human material?
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使用真人？
當然，我們絕對可以。
07:54
And of course, absolutely we can.
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07:56
We can use stem cells,
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我們可以用幹細胞，
07:57
and specifically we can use human stem cells.
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2800
尤其是人類的幹細胞，
08:00
And human stem cells are these extraordinary
182
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2104
人類的幹細胞是很不一樣
08:02
but simple cells that can do two things:
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2402
但又簡單的細胞，可以做到兩件事情：
08:05
they can self-renew or make more of themselves,
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2794
它們懂得再生
或是製造出更多幹細胞，
或是製造出更多幹細胞，
08:07
but they can also become specialized
185
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它們可以特化為
08:09
to make bone, liver or, crucially, nerve cells,
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477949
2599
骨頭、肝臟，或者很關鍵地
－神經的細胞，
－神經的細胞，
08:12
maybe even the motor nerve cell
187
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可能甚至是運動神經細胞，
08:14
or the myelin cell.
188
482388
2160
或是髓鞘細胞。
而存在了很久的挑戰是
08:16
And the challenge has long been,
189
484548
1521
08:18
can we harness the power,
190
486069
1972
我們是否能獲取這份力量，
08:20
the undoubted power of these stem cells
191
488041
2285
這些幹細胞無庸置疑的力量，
08:22
in order to realize their promise
192
490326
2018
來實現它們為
08:24
for regenerative neurology?
193
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1627
再生神經學帶來的好消息？
08:25
And I think we can now, and the reason we can
194
493971
2929
我想我們現在可以，
而我們可以的理由
而我們可以的理由
08:28
is because there have been
several major discoveries
several major discoveries
195
496900
2908
是因為在過去的10~20年間
有很多重大的發現。
08:31
in the last 10, 20 years.
196
499808
1737
08:33
One of them was here in Edinburgh,
197
501545
1612
其中之一就發生在愛丁堡這裡，
08:35
and it must be the only celebrity sheep, Dolly.
198
503157
4112
而牠必定是唯一的名羊
～桃麗。
～桃麗。
桃麗是在愛丁堡製造的，
08:39
So Dolly was made in Edinburgh,
199
507269
1625
桃麗也是一個例子
08:40
and Dolly was an example
200
508894
1683
第一個複製哺乳類
08:42
of the first cloning of a mammal
201
510577
3214
取樣自成羊細胞。
08:45
from an adult cell.
202
513791
1948
但我認為更重大的突破，
08:47
But I think the even more significant breakthrough
203
515739
2805
08:50
for the purposes of our discussion today
204
518544
2922
與我們今天的討論目的相關的
08:53
was made in 2006 by a Japanese scientist
205
521466
2489
是2006年由一位
日本的科學家做出的，
日本的科學家做出的，
08:55
called Yamanaka.
206
523955
1597
是山中伸彌 (Yamanaka) 。
08:57
And what Yamaka did,
207
525552
1304
而山中伸彌所做的，
08:58
in a fantastic form of scientific cookery,
208
526856
2432
在一個神奇的科學大熔爐，
09:01
was he showed that four ingredients,
209
529288
2038
是他指出四種成分，
09:03
just four ingredients,
210
531326
1863
只要四種成分，
09:05
could effectively convert any cell, adult cell,
211
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3187
能夠成功地轉換任何細胞、成人細胞
09:08
into a master stem cell.
212
536376
2242
成為主要的幹細胞。
09:10
And the significance of this is difficult to exaggerate,
213
538618
2984
而這個突破的重大性
高到不能再誇大，
高到不能再誇大，
09:13
because what it means that
from anybody in this room,
from anybody in this room,
214
541602
2240
因為它表示從在這房間的每個人
09:15
but particularly patients,
215
543842
1804
特別是病人，
09:17
you could now generate
216
545646
1331
你可以產生
09:18
a bespoke, personalized tissue repair kit.
217
546977
2726
客製化、個人化的細胞修復包。
09:21
Take a skin cell, make it a master pluripotent cell,
218
549703
2948
取下皮膚細胞把它變成
主要的多功能幹細胞，
主要的多功能幹細胞，
接著你可以用那些細胞，
09:24
so you could then make those cells
219
552651
1739
與大腦病變有關連的細胞
09:26
that are relevant to their disease,
220
554390
2439
09:28
both to study but potentially to treat.
221
556829
2642
既可用於研究，又可用於治療。
09:31
Now, the idea of that at medical school --
222
559471
2062
這個想法在醫學院
09:33
this is a recurring theme, isn't
it, me and medical school? —
it, me and medical school? —
223
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2625
不是一直不斷上演的主題嗎？
對我和醫學院而言
對我和醫學院而言
09:36
would have been ridiculous,
224
564158
1818
可以說是再荒唐不過的。
09:37
but it's an absolute reality today.
225
565976
2059
但在今天它絕對是事實。
09:40
And I see this as the cornerstone
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568035
2134
我則把它視為
重建、修復與希望的基礎。
09:42
of regeneration, repair and hope.
227
570169
3177
09:45
And whilst we're on the theme of hope,
228
573346
1950
既然我們在談"希望"這個主題，
09:47
for those of you who might have failed at school,
229
575296
2141
對你們也許曾在學校被當掉的人而言，
09:49
there's hope for you as well,
230
577437
2225
你們一樣是有希望的。
09:51
because this is the school report of John Gerdon.
231
579662
2496
因為這是約翰．格登的成績報告書：
09:54
["I believe he has ideas about becoming a scientist;
on his present showing this is quite ridiculous."]
on his present showing this is quite ridiculous."]
232
582158
1212
「我相信他有想要成為科學家這想法；
以他現在的表現來說是相當荒謬的。」
以他現在的表現來說是相當荒謬的。」
09:55
So they didn't think much of him then.
233
583370
1436
所以他們之後並不常想起他，
09:56
But what you may not know is that he
got the Nobel Prize for medicine
got the Nobel Prize for medicine
234
584806
2858
不過你可能不知道
他得了諾貝爾醫學獎
他得了諾貝爾醫學獎
就在三個月之前。
09:59
just three months ago.
235
587664
2552
10:02
So to return to the original problem,
236
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2566
讓我們回到原來的問題，
10:04
what is the opportunity of these stem cells,
237
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2143
這些幹細胞成功的機會在哪裡？
10:06
or this disruptive technology,
238
594925
1661
或者這顛覆性性科學
10:08
for repairing the damaged brain,
239
596586
1554
用來療癒受損的大腦，
10:10
which we call regenerative neurology?
240
598140
2131
我們現在稱做重建神經學。
10:12
I think there are two ways you can think about this:
241
600271
2427
我認為你有兩個方向來看它：
10:14
as a fantastic 21st-century drug discovery tool,
242
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3448
當它是神奇的21世紀藥品開發的工具
10:18
and/or as a form of therapy.
243
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2817
或者是一種治療手段。
10:20
So I want to tell you a little bit about both of those
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608963
2027
我想再多告訴你一些有關這兩者的事
就在接下來的幾分鐘，
10:22
in the next few moments.
245
610990
2449
10:25
Drug discovery in a dish is how people often
246
613439
2031
在培養皿裡做藥品研究是人們
10:27
talk about this.
247
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1230
最常想到的，
10:28
It's very simple: You take a patient with a disease,
248
616700
2927
這很簡單，你找一位病人
10:31
let's say motor neuron disease,
249
619627
1819
假定是患有運動神經疾病，
10:33
you take a skin sample,
250
621446
1757
你做一個皮膚的取樣，
10:35
you do the pluripotent reprogramming,
251
623203
3058
你把它重編為多功能幹細胞，
10:38
as I've already told you,
252
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2091
就像我已經跟你說過的，
10:40
and you generate live motor nerve cells.
253
628352
2517
你可以產生活的運動神經元細胞。
10:42
That's straightforward, because that's what
254
630869
1734
就是這麼直接，因為那就是
10:44
pluripotent cells can do.
255
632603
1737
多功能幹細胞可以做到的事。
10:46
But crucially, you can then compare their behavior
256
634340
2956
但很重要地，你可以把它們的活動
與相同的但健康的原生細胞作比較，
10:49
to their equivalent but healthy counterparts,
257
637296
2423
理想上是與未受到影響的
周邊細胞相比，
周邊細胞相比，
10:51
ideally from an unaffected relative.
258
639719
2030
10:53
That way, you're matching for genetic variation.
259
641749
3242
這麼做你就吻合了基因的差異性。
這正是我們這裡一直以來在做的事。
10:56
And that's exactly what we did here.
260
644991
2347
10:59
This was a collaboration with colleagues:
261
647338
1923
這是同事們之間共同合作的成果，
11:01
in London, Chris Shaw; in the U.S.,
Steve Finkbeiner and Tom Maniatis.
Steve Finkbeiner and Tom Maniatis.
262
649261
3523
有在倫敦的克力斯．修、
美國的史蒂夫．芬博納、
湯姆．曼尼亞提斯。
湯姆．曼尼亞提斯。
11:04
And what you're looking at, and this is amazing,
263
652784
2522
而你正看著的圖片是非常讓人驚訝的，
11:07
these are living, growing, motor nerve cells
264
655306
2800
這些是活的、一直在成長的
運動神經細胞，
運動神經細胞，
11:10
from a patient with motor neuron disease.
265
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2243
來自一個患運動神經疾病的病人。
11:12
It happens to be an inherited form.
266
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1925
它是遺傳造成的，
11:14
I mean, just imagine that.
267
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1699
就想像看看，
11:15
This would have been unimaginable 10 years ago.
268
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2481
這在十年前可還無法想像的。
11:18
So apart from seeing them
grow and put out processes,
grow and put out processes,
269
666454
3354
除了看著它們成長
以及死亡的過程之外，
以及死亡的過程之外，
我們還可以設計讓它們發出螢光，
11:21
we can also engineer them so that they fluoresce,
270
669808
2442
11:24
but crucially, we can then
track their individual health
track their individual health
271
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3059
但很重要地，我們能因此追蹤
它們各自的健康
它們各自的健康
11:27
and compare the diseased motor nerve cells
272
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2520
用來比較不健康的運動神經細胞
11:29
to the healthy ones.
273
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1872
和健康的（運動神經）細胞。
11:31
And when you do all that and put it together,
274
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3487
當你做這些事
以及把結果擺在一起時，
以及把結果擺在一起時，
11:35
you realize that the diseased ones,
275
683188
2099
你會明白不健康的細胞，
11:37
which is represented in the red line,
276
685287
1788
被紅線代表的這邊，
11:39
are two and a half times more likely to die
277
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3621
是2又1/2倍的機率會死
與健康的對照細胞相比。
11:42
than the healthy counterpart.
278
690696
2705
11:45
And the crucial point about this is that you then have
279
693401
2643
重點是你之後會有
非常棒的鑑定方法來找出藥品，
11:48
a fantastic assay to discover drugs,
280
696044
3589
11:51
because what would you ask of the drugs,
281
699633
1909
因為你想知道有關藥品的事情，
11:53
and you could do this through a high-throughput
282
701542
1761
你就可以經由大量看完
11:55
automated screening system,
283
703303
2409
自動播放影片系統。
11:57
you'd ask the drugs, give me one thing:
284
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2446
你只要藥物幫你做一件事：
12:00
find me a drug that will bring the red line
285
708158
2825
幫你找到一種藥可以帶紅線
12:02
closer to the blue line,
286
710983
1890
更靠近藍線，
12:04
because that drug will be a high-value candidate
287
712873
3219
因為那種藥將會是
有高度價值的候選者，
有高度價值的候選者，
12:08
that you could probably take direct to human trial
288
716092
2900
讓你可以高度可能地直接做人體試驗，
12:10
and almost bypass that bottleneck
289
718992
2587
幾乎可以越過瓶頸，
12:13
that I've told you about in drug discovery
290
721579
2401
也就是我剛跟你說會在藥物發明
12:15
with the animal models,
291
723980
1813
用動物實驗體的不足，
12:17
if that makes sense. It's fantastic.
292
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2653
如果這有道理，會是非常棒的。
12:20
But I want to come back
293
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1564
但我想回到
12:22
to how you might use stem cells directly
294
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2049
如何讓你能直接使用幹細胞
12:24
to repair damage.
295
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1775
來修復損傷。
12:25
And again there are two ways to think about this,
296
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1825
一樣的有兩個方向來思考這件事，
12:27
and they're not mutually exclusive.
297
735659
2015
它們不是完全不相容的。
12:29
The first, and I think in the long run
298
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2290
第一、我想長遠來看
12:31
the one that will give us the biggest dividend,
299
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2229
這會給我們最大的好處，
12:34
but it's not thought of that way just yet,
300
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2604
而且還沒有其他人這樣想過，
12:36
is to think about those stem cells that are already
301
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3256
是去思考那些已經在你
大腦中的幹細胞
大腦中的幹細胞
12:40
in your brain, and I've told you that.
302
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1840
就像我剛跟你說的那樣。
12:41
All of us have stem cells in the brain,
303
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1854
我們所有人的大腦都有幹細胞，
12:43
even the diseased brain,
304
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1635
甚至在發生病變的大腦，
12:45
and surely the smart way forward
305
753382
1618
當然往前進的聰明的方法是
12:47
is to find ways that you can promote and activate
306
755000
2497
找到讓你可以促進與活化
12:49
those stem cells in your brain already
307
757497
2036
這些已經在你大腦裡的幹細胞，
12:51
to react and respond appropriately to damage
308
759533
3187
適當地對損傷做反應、回應，
12:54
to repair it.
309
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1284
來修復它。
12:56
That will be the future.
310
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1432
這會是未來的前景。
12:57
There will be drugs that will do that.
311
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2873
將會有藥物能夠做這件事。
13:00
But the other way is to effectively parachute in cells,
312
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4263
而另外一個想法是
有效地空投進細胞，
有效地空投進細胞，
把它們移植進去，
13:04
transplant them in,
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13:06
to replace dying or lost cells, even in the brain.
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以取代正在死亡或逝去的細胞，
甚至是大腦裡面。
甚至是大腦裡面。
13:10
And I want to tell you now an experiment,
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我現在要告訴你一個實驗，
13:12
it's a clinical trial that we did,
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是一個我們做過的臨床試驗，
13:14
which recently completed,
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最近才剛做完的，
13:16
which is with colleagues in UCL,
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與我們在倫敦大學學院的同事們，
13:19
David Miller in particular.
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尤其是大衛．米勒。
13:21
So this study was very simple.
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這研究很簡單，
13:23
We took patients with multiple sclerosis
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我們找來了患有多發性硬化症的病人們，
13:26
and asked a simple question:
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想一個簡單的問題，
13:28
Would stem cells from the bone marrow
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會否從骨髓中取出的幹細胞，
13:30
be protective of their nerves?
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對他們的神經細胞是有保護的？
13:31
So what we did was we took this bone marrow,
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所以我們所做的是從取出骨髓，
在實驗室裡培養幹細胞，
13:35
grew up the stem cells in the lab,
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13:37
and then injected them back into the vein.
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再把它們重新注入靜脈。
13:40
I'm making this sound really simple.
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我試著讓這聽起來非常簡單，
13:42
It took five years off a lot of people, okay?
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這花我們五年的時間、很多人力，知道嗎？
13:45
And it put gray hair on me
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它也讓我有了灰頭髮，
13:46
and caused all kinds of issues.
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也引起了各種問題。
13:48
But conceptually, it's essentially simple.
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但概念上而言它是基礎地簡單。
13:52
So we've given them into the vein, right?
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所以我們已經把它們送進靜脈，對吧？
13:55
So in order to measure whether
this was successful or not,
this was successful or not,
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為了評量到底這個手段成不成功，
13:59
we measured the optic nerve
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我們評量視神經，
14:01
as our outcome measure.
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作為我們的評量結果。
14:02
And that's a good thing to measure in M.S.,
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對要來評量多發性硬化症病人
也是一件好事
也是一件好事
14:04
because patients with M.S. sadly suffer
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因為患有多發性硬化症的病人不幸地遭受
14:06
with problems with vision --
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與視力有關的問題，
14:08
loss of vision, unclear vision.
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如失明、看不清楚，
14:10
And so we measured the size of the optic nerve
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所以我們評量視神經的大小
14:12
using the scans with David Miller
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與大衛．米勒一起用掃描器
14:14
three times -- 12 months, six months,
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三遍：１２個月前、６個月前、
14:16
and before the infusion --
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以及注射之前。
14:18
and you can see the gently declining red line.
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你可以看到那稍微降低的紅線。
14:21
And that's telling you that
the optic nerve is shrinking,
the optic nerve is shrinking,
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那是要告知你視神經正在萎縮中，
14:23
which makes sense, because their nerves are dying.
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那講得通的，因為他們的
神經細胞正在死亡中。
神經細胞正在死亡中。
14:25
We then gave the stem cell infusion
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接著我們做了幹細胞注射，
14:28
and repeated the measurement twice --
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又做了兩次評量，
14:30
three months and six months --
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３個月後和６個月後，
14:31
and to our surprise, almost,
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讓我們大部分人驚訝的是
14:33
the line's gone up.
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那條紅線往上爬升了。
14:36
That suggests that the intervention
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這表明了介入注射
14:38
has been protective.
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是有保護性的，
14:40
I don't think myself that what's happened
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我個人不認為
14:42
is that those stem cells have made new myelin
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是因為那些幹細胞
製造出新的髓鞘細胞，
製造出新的髓鞘細胞，
14:44
or new nerves.
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或是新的神經細胞，
14:45
What I think they've done is they've promoted
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我認為它們做到的是它們促使
14:48
the endogenous stem cells, or precursor cells,
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了內生性的幹細胞或者前身細胞
14:50
to do their job, wake up, lay down new myelin.
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去做它們的工作，
醒來、覆蓋上新的髓鞘，
醒來、覆蓋上新的髓鞘，
14:54
So this is a proof of concept.
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這是一個有證據的想法，
14:56
I'm very excited about that.
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我可是對這感到興奮的。
14:58
So I just want to end with the theme I began on,
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所以我就想要用
我剛開始談的主題做結束，
我剛開始談的主題做結束，
15:01
which was regeneration and hope.
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也就是再生與希望。
15:03
So here I've asked John
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我也問過了約翰
15:05
what his hopes are for the future.
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他對未來有什麼希望？
15:07
John: I would hope that
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我會希望
15:09
sometime in the future
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在未來的某個時點
15:11
through the research that you people are doing,
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經由你們現在在做的研究
15:13
we can come up with a cure
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我們能找出解藥，
15:15
so that people like me can lead a normal life.
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然後和我一樣的人
能夠過正常的生活。
能夠過正常的生活。
15:19
SC: I mean, that speaks volumes.
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我想，這很明確。
15:22
But I'd like to close by first of all thanking John --
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不過我想先謝謝約翰來作結尾，
15:24
thanking John for allowing me to share
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謝謝約翰同意我來分享
15:26
his insights and these clips with you all.
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他的想法和這些短片給你們大家。
15:29
But I'd also like to add to John and to others
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但我還想要做補充給約翰和其他人，
15:32
that my own view is, I'm hopeful for the future.
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我個人的觀點是
我對未來是有希望的。
我對未來是有希望的。
15:34
I do believe that the disruptive technologies
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我相信這些顛覆性的科技
15:37
like stem cells that I've tried to explain to you
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像是我試著解釋
給你們聽的幹細胞
給你們聽的幹細胞
15:39
do offer very real hope.
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的確帶來希望。
15:40
And I do think that the day that we might be able
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我認為那一天，
我們可能有能力
我們可能有能力
15:42
to repair the damaged brain
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修復受損的大腦的那天，
15:44
is sooner than we think.
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是比我們想像的來得快。
15:45
Thank you.
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謝謝。
15:47
(Applause)
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(掌聲)
ABOUT THE SPEAKER
Siddharthan Chandran - Regenerative neurologistSiddharthan Chandran explores how to heal damage from degenerative disorders such as MS and motor neuron disease (ALS).
Why you should listen
Multiple sclerosis (MS) affects the nervous system by chewing up the axons that connect neurons to one another, which slows, stops or simply randomizes the transmission of nerve impulses. At the Centre for clinical brain sciences at the University of Edinburgh, Siddharthan Chandran works in the emerging discipline of regenerative neurology -- exploring how injured or damaged neurons in the brain might actually be repaired.
His research strategy uses MS and motor neuron disease (ALS, or Lou Gehrig's diesease) as primary disease models, combining laboratory and clinical activity to study brain injury, neurodegeneration and repair, using stem cells to model and test. His work, he says, "reflects the complexity of the brain. You can replace a kidney, but not a brain. One must remain careful and humble in the face of current knowledge." He is also director of the Anne Rowling Regenerative Neurology Clinic.
Siddharthan Chandran | Speaker | TED.com