TEDMED 2009
Anthony Atala: Growing new organs
Anthony Atala 培養新器官
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Anthony Atala 極為先進的實驗室能夠培養人類器官，從肌肉、血管到膀胱，而且還不只這些。在 TEDMED 研討會上，他展示了一個他實驗室中的生物工程學家操作這些看似科幻新奇玩意的影片，包括了一個像烤箱的生物反應器（預熱到攝氏 37 度），還有能「印出」人類組織的印表機。
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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這是一幅
00:18
that hangs at the Countway Library at Harvard Medical School.
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掛在哈佛醫學院 Countway 圖書館的畫。
00:21
And it shows the first time an organ was ever transplanted.
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它描繪著史上第一次的器官移植。
00:25
In the front, you see, actually, Joe Murray
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在前排，你可以看到 Joe Murray
00:28
getting the patient ready for the transplant,
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正在調整病人狀況，使其適合器官移植。
00:30
while in the back room you see Hartwell Harrison,
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在房間的後面，你可以看到 Hartwell Harrison，
00:32
the Chief of Urology at Harvard,
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哈佛泌尿科主任，
00:35
actually harvesting the kidney.
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正在採集腎臟。
00:37
The kidney was indeed the first organ
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腎臟是第一個
00:39
ever to be transplanted to the human.
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成功移植到人類身上的器官。
00:41
That was back in 1954,
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那發生在 1954 年，
00:44
55 years ago.
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55 年前，
00:46
Yet we're still dealing with a lot of the same challenges
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他們仍然面對著許多跟數十年前
00:49
as many decades ago.
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相同的挑戰。
00:51
Certainly many advances, many lives saved.
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當然進步了許多，救了很多生命。
00:54
But we have a major shortage of organs.
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但是可供移植的器官數量極為短缺。
00:58
In the last decade the number of patients
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過去十年間
01:01
waiting for a transplant has doubled.
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等待器官移植的病人數量倍增。
01:04
While, at the same time, the actual number of transplants
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在此同時，器官移植的術例
01:06
has remained almost entirely flat.
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幾乎完全沒有增加。
01:09
That really has to do with our aging population.
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這是因為我們的平均壽命延長了，
01:11
We're just getting older.
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我們變老了。
01:13
Medicine is doing a better job
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醫學使我們的壽命
01:16
of keeping us alive.
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延長了。
01:18
But as we age, our organs tend to fail more.
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但是在我們變老的同時，器官也更容易衰竭。
01:21
So, that's a challenge,
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因此，這是一個挑戰，
01:23
not just for organs but also for tissues.
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不只是器官，人體組織也一樣。
01:25
Trying to replace pancreas,
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嘗試移植胰臟，
01:28
trying to replace nerves that can help us with Parkinson's.
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嘗試移植可以幫助帕金森氏症病人的神經組織。
01:33
These are major issues.
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這些是重大的問題。
01:35
This is actually a very stunning statistic.
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這邊有個非常令人震驚的統計數據，
01:39
Every 30 seconds
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每卅秒，
01:41
a patient dies from diseases
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就有一個病人因為疾病死亡，
01:44
that could be treated with tissue regeneration or replacement.
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但其實這個疾並可以藉由組織再生或更換來醫治。
01:48
So, what can we do about it?
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那麼，我們又能夠做些什麼？
01:51
We've talked about stem cells tonight.
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我們今晚已經聽過了關於幹細胞的演講，
01:53
That's a way to do it.
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那是方法之一。
01:55
But still ways to go to get stem cells into patients,
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但是從將幹細胞注入病人體內，
02:00
in terms of actual therapies for organs.
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直到真的對器官層次發生療效，這路途還很遙遠。
02:03
Wouldn't it be great if our bodies could regenerate?
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如果我們的身體能夠自行再生，那該多好？
02:06
Wouldn't it be great if we could actually harness the power
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如果我們能夠掌握身體自我治癒的能力，
02:09
of our bodies, to actually heal ourselves?
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那該多好？
02:14
It's not really that foreign of a concept, actually;
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這其實不是個什麼新奇的概念，事實上，
02:17
it happens on the Earth every day.
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在地球上，這類的事的每天都在發生著。
02:21
This is actually a picture of a salamander.
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這是一張蠑螈的照片，
02:24
Salamanders have this amazing capacity to regenerate.
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蠑螈擁有不可思議的再生能力。
02:28
You see here a little video.
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這邊有一小段影片，
02:30
This is actually a limb injury in this salamander.
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這是那蠑螈的腳受傷
02:34
And this is actually real photography,
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的真實照片，
02:36
timed photography, showing how that limb regenerates
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定時攝像，顯示那隻腳如何在
02:39
in a period of days.
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數天內再生回來。
02:41
You see the scar form.
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你看到痂的產生，
02:43
And that scar actually grows out
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然而這個痂事實上向外
02:46
a new limb.
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長成了一隻新的腳。
02:48
So, salamanders can do it.
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因此，蠑螈能夠做到，
02:50
Why can't we? Why can't humans regenerate?
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我們為什麼不能？人類為什麼無法自行再生？
02:53
Actually, we can regenerate.
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事實上，我們可以的。
02:57
Your body has many organs
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你的身體擁有許多器官，
03:01
and every single organ in your body
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而你體內的每一個器官
03:03
has a cell population
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都有一個細胞的群體，
03:05
that's ready to take over at the time of injury. It happens every day.
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準備好當受傷時能夠立即反應，這樣的戲碼每天都在上演。
03:10
As you age, as you get older.
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當你變老，
03:13
Your bones regenerate every 10 years.
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每十年，你的骨骼就會全部再生一次。
03:16
Your skin regenerates every two weeks.
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你的皮膚每兩星期再生一次。
03:19
So, your body is constantly regenerating.
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因此，你的身體其實是不斷地在更新的。
03:21
The challenge occurs when there is an injury.
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困難之處在於，當受傷時，
03:23
At the time of injury or disease,
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在受傷或生病的時候，
03:26
the body's first reaction
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你身體的第一個反應
03:29
is to seal itself off from the rest of the body.
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是將它與身體其他部份隔絕。
03:32
It basically wants to fight off infection,
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基本上，它想與感染作戰，
03:34
and seal itself, whether it's organs inside your body,
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並將戰場侷限住，不管那是在你身體的器官裡面，
03:38
or your skin, the first reaction
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或是你的皮膚，第一個反應都是
03:41
is for scar tissue to move in,
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讓結痂組織移入，
03:43
to seal itself off from the outside.
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將之與外界隔離。
03:47
So, how can we harness that power?
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那麼，我們要怎樣才能重拾那樣的能力呢？
03:49
One of the ways that we do that
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其中一個辦法是，
03:51
is actually by using smart biomaterials.
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使用智慧型生物材料。
03:56
How does this work? Well, on the left side here
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這其中原理是什麼呢？在畫面左邊
03:59
you see a urethra which was injured.
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你可以看到一個損傷的尿道。
04:01
This is the channel that connects the bladder to the outside of the body.
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這是將膀胱的尿液排出體外的渠道，
04:05
And you see that it is injured.
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你可以看到它受傷了。
04:07
We basically found out that you can use these smart biomaterials
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我們基本上發現使用這些智慧型生物材料，
04:11
that you can actually use as a bridge.
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你可以使用其作為橋樑跨接，
04:14
If you build that bridge, and you close off
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如果你建造那座橋，然後你將其與
04:17
from the outside environment,
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外在環境隔絕，
04:19
then you can create that bridge, and cells
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那麼，你建造的這座橋，可以讓
04:22
that regenerate in your body,
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那些能夠另你身體再生的細胞
04:24
can then cross that bridge, and take that path.
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通過，並使用這座橋來聯絡。
04:28
That's exactly what you see here.
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這就是你在這邊看到的。
04:30
It's actually a smart biomaterial
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這就是我們使用的
04:32
that we used, to actually treat this patient.
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智慧型生物材料，醫治這個病人的情形。
04:34
This was an injured urethra on the left side.
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左邊是受損的尿道，
04:37
We used that biomaterial in the middle.
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我們在中間使用了生物材料，
04:39
And then, six months later on the right-hand side
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然後，右邊是六個月後的復原情形，
04:42
you see this reengineered urethra.
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你看到尿道被重建了。
04:44
Turns out your body can regenerate,
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這證實了你的身體可以再生，
04:46
but only for small distances.
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但是僅限於非常短的距離，
04:49
The maximum efficient distance for regeneration
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能夠再生的最大範圍
04:52
is only about one centimeter.
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只有大約一公分。
04:54
So, we can use these smart biomaterials
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所以就算我們使用這些智慧型生物材料，
04:57
but only for about one centimeter
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也只能跨接並治癒
05:00
to bridge those gaps.
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大約一公分的距離。
05:02
So, we do regenerate, but for limited distances.
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因此，我們再生，但是距離有限。
05:05
What do we do now,
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接下來該怎麼做？
05:07
if you have injury for larger organs?
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如果你體內的大型器官受損了？
05:10
What do we do when we have injuries
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如果我們體內比一公分大得多
05:12
for structures which are much larger
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的構造受到了損傷，
05:14
than one centimeter?
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我們該怎麼辦？
05:16
Then we can start to use cells.
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這時候，我們可以開始使用細胞。
05:19
The strategy here, is if a patient comes in to us
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這裡的策略是，如果病人來向我們求助，
05:22
with a diseased or injured organ,
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而他們的器官受到了感染或是損傷，
05:24
you can take a very small piece of tissue from that organ,
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你可以從那器官上取下一塊非常小的組織，
05:27
less than half the size of a postage stamp,
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只要大約一半郵票的大小，
05:30
you can then tease that tissue apart,
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現在你可以將這組織分離，
05:33
and look at its basic components,
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分析其基本組成，
05:35
the patient's own cells,
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這是病人自身的細胞，
05:37
you take those cells out,
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你可以將這些細胞取出，
05:39
grow and expand those cells outside the body in large quantities,
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在體外大量培養並增殖這些細胞，
05:43
and then we then use scaffold materials.
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然後我們使用支持材料，
05:46
To the naked eye they look like a piece of your blouse,
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肉眼看起來這材料像是你罩衫
05:49
or your shirt, but actually
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或襯衫的布料，但事實上
05:51
these materials are fairly complex
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這些材料非常地複雜，
05:54
and they are designed to degrade once inside the body.
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而且它們被設計成可在體內被分解。
05:57
It disintegrates a few months later.
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它會於數個月之後被分解。
05:59
It's acting only as a cell delivery vehicle.
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它只是一個運送細胞的載體。
06:02
It's bringing the cells into the body. It's allowing
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它把細胞帶入體內，
06:04
the cells to regenerate new tissue,
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讓細胞再生成新組織，
06:06
and once the tissue is regenerated the scaffold goes away.
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一但組織再生完成，那些支架也就不見了。
06:10
And that's what we did for this piece of muscle.
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這就是我們在這塊肌肉上所做的事。
06:13
This is actually showing a piece of muscle and how we go through
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這裡顯示了一塊肌肉以及我們從
06:15
the structures to actually engineer the muscle.
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如何建立結構到真正的能夠做出這些肌肉。
06:18
We take the cells, we expand them,
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我們取出細胞，將細胞增殖，
06:20
we place the cells on the scaffold,
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並把細胞放到支架上，
06:22
and we then place the scaffold back into the patient.
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然後我們把支架放回病人體內。
06:25
But actually, before placing the scaffold into the patient,
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但事實上，在我們將支架放回病人體內之前，
06:28
we actually exercise it.
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我們必須讓它運動。
06:31
We want to make sure that we condition
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我們希望確定我們給這些肌肉
06:33
this muscle, so that it knows what to do
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足夠的訓練，因此等到我們將之放回病人體內後，
06:35
once we put it into the patient.
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它將知道該怎麼做。
06:37
That's what you're seeing here. You're seeing
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這就是你在這裡看到的。你正在觀看一個
06:39
this muscle bio-reactor
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肌肉生物反應槽，
06:41
actually exercising the muscle back and forth.
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在這反應槽內，我們不停的往復運動肌肉。
06:45
Okay. These are flat structures that we see here,
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直到現在，我們看到的都還只是平面的構造，
06:49
the muscle.
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例如肌肉。
06:51
What about other structures?
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那麼其他的構造呢？
06:53
This is actually an engineered blood vessel.
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這是一條人造血管，
06:56
Very similar to what we just did, but a little bit more complex.
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製作過程跟我們剛剛所提及的非常相似，但是更複雜。
06:59
Here we take a scaffold,
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在這邊我們用一個支架，
07:01
and we basically -- scaffold can be like a piece of paper here.
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這支架可以是這邊所顯示的一張紙。
07:05
And we can then tubularize this scaffold.
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然後我們將這個支架捲曲成管狀。
07:07
And what we do is we, to make a blood vessel, same strategy.
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然後我們就能以同樣的策略做出血管了。
07:11
A blood vessel is made up of two different cell types.
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血管是由兩種不同種類的細胞所組成。
07:15
We take muscle cells, we paste,
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我們拿取肌肉細胞，
07:18
or coat the outside with these muscle cells,
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將之貼在管壁的外緣，
07:20
very much like baking a layer cake, if you will.
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就好像烘培千層糕一般，如果你這樣比喻。
07:23
You place the muscle cells on the outside.
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將肌肉細胞貼在管壁外緣，
07:26
You place the vascular blood vessel lining cells on the inside.
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將血管相關條狀細胞貼在管壁內側。
07:31
You now have your fully seeded scaffold.
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現在你的支架就已經植入好細胞了。
07:33
You're going to place this in an oven-like device.
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然後我們將這個東西放入一個類似烤箱的裝置，
07:36
It has the same conditions as a human body,
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這裝置的內部狀態調整到與人體相同，
07:38
37 degrees centigrade,
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攝氏 37 度，
07:40
95 percent oxygen.
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95% 的含氧量。
07:42
You then exercise it, as what you saw on that tape.
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然後我們給它運動，就像這影片中顯示的一樣。
07:46
And on the right you actually see a carotid artery that was engineered.
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在畫面右側，你看到的是人造的頸動脈，
07:49
This is actually the artery that goes from your neck to your brain.
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就是從你的頸部通往腦部的動脈。
07:52
And this is an X-ray showing you
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這 X 光影像可以讓你看到
07:55
the patent, functional blood vessel.
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明顯的，功能正常的血管。
07:58
More complex structures
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更多複雜的構造，
08:00
such as blood vessels, urethras, which I showed you,
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像是血管、尿道，這些我已經讓你們看過的例子，
08:03
they're definitely more complex
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它們很複雜，
08:05
because you're introducing two different cell types.
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因為你必須引入兩種不同種類的細胞。
08:07
But they are really acting mostly as conduits.
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但是它們最主要的功能只是個渠道。
08:09
You're allowing fluid or air to go through
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只要能夠讓液體或是空氣
08:11
at steady states.
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以穩定的狀態通過。
08:13
They are not nearly as complex as hollow organs.
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它們的複雜度跟空腔臟器比起來是小巫見大巫。
08:15
Hollow organs have a much higher degree of complexity,
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空腔臟器的複雜度要大得多，
08:18
because you're asking these organs to act on demand.
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因為你需要這些器官對於人體需求能正確的反應。
08:21
So, the bladder is one such organ.
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例如，膀胱就是一個這樣的例子。
08:24
Same strategy, we take a very small piece of the bladder,
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同樣的策略，我們取下一塊非常小的膀胱，
08:27
less than half the size of a postage stamp.
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比郵票的一半還小。
08:29
We then tease the tissue apart
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我們將這個組織拆解開來，
08:31
into its two individual cell components,
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分成兩種不同的細胞組成，
08:33
muscle, and these bladder specialized cells.
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那就是肌肉和這些膀胱特化細胞。
08:36
We grow the cells outside the body in large quantities.
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我們在體外大量的培養這些細胞。
08:39
It takes about four weeks to grow these cells from the organ.
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從器官取出這些細胞後，大約需要四星期的培養時間。
08:42
We then take a scaffold that we shape like a bladder.
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然後我們拿一個我們做成膀胱造型的支架。
08:45
We coat the inside with these bladder lining cells.
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我們將這些膀胱特化細胞放置在內部，
08:49
We coat the outside with these muscle cells.
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外部則披上肌肉細胞。
08:52
We place it back into this oven-like device.
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然後我們將其放回這個像烤箱的裝置。
08:55
From the time you take that piece of tissue, six to eight weeks later
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從你取出那塊組織的時候算起，六到八星期後，
08:58
you can put the organ right back into the patient.
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你就可以將這個器官放回病人體內。
09:01
This actually shows the scaffold.
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這是那支架的樣子。
09:04
The material is actually being coated with the cells.
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這材料上面其實覆滿了細胞。
09:08
When we did the first clinical trial for these patients
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當我們首次對這些病人做臨床試驗的時候，
09:11
we actually created the scaffold specifically for each patient.
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事實上我們針對每個病人量身訂做了這些支架。
09:14
We brought patients in,
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這些病患於
09:16
six to eight weeks prior to their scheduled surgery, did X-rays,
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他們手術預定時間的六到八星期前來照 X 光，
09:19
and we then composed a scaffold specifically for that patient's size
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然後我們就做了一個跟那個病人骨盆腔
09:22
pelvic cavity.
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一樣大小的支架。
09:24
For the second phase of the trials
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臨床試驗的第二期，
09:26
we just had different sizes, small, medium, large and extra-large.
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我們就只分成幾種尺寸，小、中、大和特大。
09:29
(Laughter)
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（笑聲）
09:32
It's true.
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這是真的。
09:34
And I'm sure everyone here wanted an extra-large. Right?
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而且我相信這裡的每個人都想要特大號，對吧？
09:37
(Laughter)
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（笑聲）
09:39
So, bladders are definitely a little bit more complex
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因為這樣，膀胱比起其他的構造
09:42
than the other structures.
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又更複雜。
09:44
But there are other hollow organs that have added complexity to it.
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但是還有其他的空腔臟器比膀胱更複雜。
09:47
This is actually a heart valve, which we engineered.
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這是一個我們做出來的心臟辦膜。
09:50
And the way you engineer this heart valve is the same strategy.
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一樣的製作策略，
09:53
We take the scaffold, we seed it with cells,
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用支架，種細胞，
09:55
and you can now see here, the valve leaflets opening and closing.
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在這邊你們可以看到，辦膜的葉片不斷的開合著。
09:59
We exercise these prior to implantation.
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在植入人體前，我們給它運動。
10:02
Same strategy.
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一樣的策略。
10:04
And then the most complex are the solid organs.
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然而，最複雜的是實心器官。
10:06
For solid organs, they're more complex
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對於實心器官，他們的複雜度在於
10:08
because you're using a lot more cells per centimeter.
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每一公分你需要使用的細胞量大大的增加。
10:12
This is actually a simple solid organ like the ear.
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這是一個簡單的實心器官，耳朵。
10:14
It's now being seeded with cartilage.
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它現在被植上軟骨。
10:16
That's the oven-like device;
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這是像烤箱的裝置，
10:19
once it's coated it gets placed there.
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一旦它被覆上細胞，我們就把它放置在這邊。
10:21
And then a few weeks later we can take out the cartilage scaffold.
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然後數星期後，我們就可以把軟骨支架取出。
10:26
This is actually digits that we're engineering.
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這是我們做的指頭。
10:28
These are being layered, one layer at a time,
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它們是一層層製作出來的，每次一層，
10:31
first the bone, we fill in the gaps with cartilage.
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先是骨頭，然後用軟骨填充空隙。
10:34
We then start adding the muscle on top.
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最後再加上肌肉。
10:36
And you start layering these solid structures.
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就這樣，你開始將實心器官分成一層層的看待。
10:38
Again, fairly more complex organs,
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的確，相對來說非常複雜的器官。
10:41
but by far, the most complex solid organs
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但是到目前為止，最複雜的實心器官
10:44
are actually the vascularized, highly vascularized,
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是那些高度血管化，
10:48
a lot of blood vessel supply,
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需要很多血管供給的器官，
10:50
organs such as the heart,
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像是心臟、
10:53
the liver, the kidneys.
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肝臟和腎臟。
10:56
This is actually an example -- several strategies
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這邊有一個實例，製作實心臟器
10:58
to engineer solid organs.
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的數個策略。
11:00
This is actually one of the strategies. We use a printer.
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這是數個策略之一，我們使用印表機。
11:02
And instead of using ink, we use -- you just saw an inkjet cartridge --
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但是我們不使用墨水，我們使用，這是墨水夾，
11:06
we just use cells.
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我們使用細胞來列印。
11:08
This is actually your typical desktop printer.
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這就是一般典型的桌上型印表機。
11:10
It's actually printing this two chamber heart,
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它正在列印出心臟的兩個心室，
11:13
one layer at a time.
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一層層的列印出來。
11:15
You see the heart coming out there. It takes about 40 minutes to print,
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你看到心臟快要成型了。列印一次耗時大約 40 分鐘，
11:19
and about four to six hours later
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然後大約四到六小時後，
11:21
you see the muscle cells contract.
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你開始可以看到肌肉細胞收縮。
11:24
(Applause)
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（掌聲）
11:30
This technology was developed by Tao Ju, who worked at our institute.
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這是我們研究所的道儒（音譯）所發展出來的科技。
11:34
And this is actually still, of course, experimental,
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當然，這還只是實驗性的技術，
11:36
not for use in patients.
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還不能用來醫治病人。
11:39
Another strategy that we have followed
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我們使用的另一個策略是，
11:41
is actually to use decellularized organs.
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使用去細胞化的器官。
11:43
We actually take donor organs,
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我們使用捐贈者的器官，
11:46
organs that are discarded,
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被遺棄不要的器官，
11:48
and we then can use very mild detergents
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然後我們使用非常柔性的清潔劑
11:50
to take all the cell elements out of these organs.
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將所有的細胞元素從這些器官上移除。
11:53
So, for example on the left panel,
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因此，在左側，
11:55
top panel, you see a liver.
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上方，你看到一個肝臟。
11:57
We actually take the donor liver,
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我們使用捐贈者的肝臟，
11:59
we use very mild detergents,
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使用非常柔性的清潔劑，
12:01
and we, by using these mild detergents, we take all the cells
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藉由使用這些柔性的清潔劑，我們將所有的細胞
12:05
out of the liver.
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從這個肝臟上移除。
12:07
Two weeks later, we basically can lift this organ up,
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兩星期後，我們就可以將這個器官拿出，
12:10
it feels like a liver,
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它感覺就像個肝臟，
12:12
we can hold it like a liver,
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我們可以像握著一顆肝臟般握著它，
12:14
it looks like a liver, but it has no cells.
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它看起來像肝臟，但是它已經沒有細胞了。
12:17
All we are left with
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只剩下
12:19
is the skeleton, if you will, of the liver,
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它的「骨頭」，如果你這樣比喻的話，
12:22
all made up of collagen,
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由膠原蛋白構成的骨頭，
12:24
a material that's in our bodies, that will not reject.
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膠原蛋白我們體內都有，而且不具免疫排斥性。
12:26
We can use it from one patient to the next.
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我們可以從前一個病人身上取下，然後用在下一個病人身上。
12:28
We then take this vascular structure
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然後我們使用這個血管化的結構，
12:30
and we can prove that we retain the blood vessel supply.
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證明我們保存了血管供給的能力。
12:34
You can see, actually that's a fluoroscopy.
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你們可以看到，事實上，這是螢光鏡的影像。
12:36
We're actually injecting contrast into the organ.
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我們注入顯影劑到器官中。
12:39
Now you can see it start. We're injecting the contrast into the organ
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現在你們可以看到它開始了。我們剛剛注入顯影劑到器官裡，
12:43
into this decellularized liver.
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到這個去細胞化的肝臟裡。
12:45
And you can see the vascular tree that remains intact.
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你們可以看到這些樹狀的血管維持完整。
12:48
We then take the cells, the vascular cells,
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我們現在可以將細胞，管狀細胞，
12:51
blood vessel cells, we perfuse the vascular tree
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血管細胞，我們將這樹狀血管結構
12:53
with the patient's own cells.
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注滿病人自己的細胞。
12:55
We perfuse the outside of the liver
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我們將肝臟的外部注滿
12:57
with the patient's own liver cells.
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病人自己的肝臟細胞。
12:59
And we can then create functional livers.
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然後我們就可以做出能正常運作的肝臟。
13:01
And that's actually what you're seeing.
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這就是你們正在看的。
13:03
This is still experimental. But we are able to actually reproduce the functionality
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這仍是實驗性的技術。但是我們能夠重製具有功能的
13:07
of the liver structure, experimentally.
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肝臟結構，至少在實驗室裡能夠。
13:10
For the kidney,
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至於腎臟，
13:12
as I talked to you about the first painting that you saw,
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記得我剛剛給你們看列印器官的投影片嗎？
13:16
the first slide I showed you,
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就是第一張投影片，
13:18
90 percent of the patients on the transplant wait list
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90% 在器官移植等待名單上的病人，
13:21
are waiting for a kidney, 90 percent.
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是在等待腎臟，90%。
13:23
So, another strategy we're following
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因此，我們使用的另一個策略，
13:25
is actually to create wafers
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是製造千層酥，
13:27
that we stack together, like an accordion, if you will.
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然後我們將它們疊在一起，像個手風琴，如果你這樣想像的話。
13:31
So, we stack these wafers together, using the kidney cells.
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我們用腎臟細胞將這些千層酥疊在一起，
13:34
And then you can see these miniature kidneys that we've engineered.
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現在你就可以看到這些我們造的迷你腎臟了。
13:37
They are actually making urine.
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它們真的可以製造尿液。
13:39
Again, small structures, our challenge is how to make them larger,
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但是仍然太小，我們的挑戰是把它們做得大一點，
13:43
and that is something we're working on
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這就是我們現在正在
13:45
right now at the institute.
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我們的研究所裡面嘗試的。
13:47
One of the things that I wanted to summarize for you then
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我想要向你們總結的幾件事情之一，
13:50
is what is a strategy that we're going for in regenerative medicine.
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就是我們嘗試向再生醫療邁進的策略。
13:54
If at all possible,
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如果有可能，
13:56
we really would like to use smart biomaterials
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我們希望可以使用智慧型生物材料，
13:59
that we can just take off the shelf
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我們可以直接從藥物櫃上取得，
14:01
and regenerate your organs.
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然後開始製作你的器官。
14:03
We are limited with distances right now,
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現在我們仍然受到距離的限制，
14:05
but our goal is actually to increase those distances over time.
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但是我們的目標是隨著時間逐漸增加這個距離的限制。
14:09
If we cannot use smart biomaterials,
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如果我們不能使用智慧型生物材料，
14:11
then we'd rather use your very own cells.
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退而求其次，我們希望使用你自己的細胞。
14:13
Why? Because they will not reject.
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為什麼？因為它們不會受到排斥。
14:15
We can take cells from you,
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我們可以從你身上取得細胞，
14:17
create the structure, put it right back into you, they will not reject.
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做出它的構造，再將它放回你體內，它們不會受到排斥。
14:20
And if possible, we'd rather use the cells from your very specific organ.
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再來，如果可能的話，我們希望使用你身上同一個器官的細胞。
14:24
If you present with a diseased wind pipe
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如果你的氣管有問題，
14:27
we'd like to take cells from your windpipe.
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我們希望從你的氣管上取得細胞。
14:29
If you present with a diseased pancreas
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如果是你的胰臟有問題，
14:32
we'd like to take cells from that organ.
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我們希望從胰臟上取樣。
14:34
Why? Because we'd rather take those cells
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為什麼？因為我們寧願使用這些
14:37
which already know that those are the cell types you want.
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已經知道是你想要使用的細胞種類。
14:40
A windpipe cell already knows it's a windpipe cell.
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氣管細胞已經知道它是氣管細胞。
14:43
We don't need to teach it to become another cell type.
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我們不需要教它去變成另外一種細胞。
14:46
So, we prefer organ-specific cells.
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所以我們偏愛同一個器官的細胞。
14:48
And today we can obtain cells from most every organ in your body,
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今天，我們幾乎能從你體內的任何器官採樣，
14:51
except for several which we still need stem cells for,
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除了少數幾個我們仍然需要幹細胞的幫忙，
14:54
like heart, liver, nerve and pancreas.
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像是心臟、肝臟、神經和胰臟。
14:58
And for those we still need stem cells.
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這些器官或組織的問題，我們仍需使用幹細胞。
15:01
If we cannot use stem cells from your body
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如果我們無法使用你自身的幹細胞，
15:04
then we'd like to use donor stem cells.
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那麼我們將會使用捐贈者的幹細胞。
15:07
And we prefer cells that will not reject
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我們偏好不具有免疫排斥性，
15:09
and will not form tumors.
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且不會形成腫瘤的細胞。
15:11
And we're working a lot with the stem cells that we
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我們兩年前發表的研究，讓我們有很多
15:13
published on two years ago,
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幹細胞的研究經驗，
15:15
stem cells from the amniotic fluid,
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從羊水、胎盤取得的幹細胞，
15:17
and the placenta, which have those properties.
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它們具有這種特性。
15:21
So, at this point, I do want to tell you that
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因此，現在，我真的希望告訴你們
15:24
some of the major challenges we have.
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我們遇到的一些重大挑戰。
15:28
You know, I just showed you this presentation, everything looks so good,
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你知道的，我剛剛向你們所做的簡報，一切看起來是如此的美好，
15:30
everything works. Actually no,
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一切順利。事實上，並非如此，
15:32
these technologies really are not that easy.
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這些技術真的非常不簡單。
15:34
Some of the work you saw today
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一些你們今天看到的研究，
15:36
was performed by over 700 researchers
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是由超過 700 位研究者，
15:39
at our institute across a 20-year time span.
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在我們研究所，花了廿年研究的成果。
15:42
So, these are very tough technologies.
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因此，這些是非常困難的技術。
15:44
Once you get the formula right you can replicate it.
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一旦你搞清楚怎麼做以後，你將能夠複製它。
15:47
But it takes a lot to get there.
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但是需要花上好大功夫才能抵達那個階段。
15:49
So, I always like to show this cartoon.
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因此，我總是喜歡放上這張漫畫。
15:51
This is how to stop a runaway stage.
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這是如何避免失控發生的階段。
15:53
And there you see the stagecoach driver,
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在這邊你看到那位馬車司機，
15:55
and he goes, on the top panel,
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他這麼做，從最上方開始，
15:57
He goes A, B, C, D, E, F.
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他做了 A, B, C, D, E, F.
15:59
He finally stops the runaway stage.
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然後他終於阻止了失控災難的發生。
16:01
And those are usually the basic scientists,
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通常這些馬車司機就是基礎科學家，
16:04
The bottom is usually the surgeons.
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下面的通常是外科醫生。
16:06
(Laughter)
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（笑聲）
16:10
I'm a surgeon so that's not that funny.
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我是一個外科醫師，所以這並不好笑。
16:12
(Laughter)
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（笑聲）
16:13
But actually method A is the correct approach.
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但是，事實上，方法 A 是正確的途徑。
16:17
And what I mean by that is that anytime we've launched one of these technologies
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我這樣說是想強調，不論何時，我們讓這些技術
16:20
to the clinic,
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走向臨床應用，
16:22
we've made absolutely sure that we do everything we can
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我們一定非常確定，我們已經在實驗室中
16:25
in the laboratory before we ever
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竭盡所能的試驗其安全性，
16:27
launch these technologies to patients.
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才會讓病人接觸到這些技術。
16:29
And when we launch these technologies to patients
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而當我們準備讓病人接觸這些技術時，
16:31
we want to make sure that we ask ourselves a very tough question.
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我們都會問自己一個非常難的問題。
16:36
Are you ready to place this in your own loved one, your own child,
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你已經準備好將這東西放到你心愛的人、你自己小孩，
16:39
your own family member, and then we proceed.
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和你的家人身上了嗎？然後我們才會進行。
16:42
Because our main goal, of course,
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因為我們主要的目標，當然，
16:44
is first, to do no harm.
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首先要講究不傷身體。
16:47
I'm going to show you now, a very short clip,
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現在我要播放一段非常短的影片，
16:49
It's a five second clip of a patient
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一段病人的五秒鐘影片，
16:52
who received one of the engineered organs.
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這病人接受了一個人工器官的移植。
16:54
We started implanting some of these structures
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我們從 14 年前就開始移植這些構造，
16:56
over 14 years ago.
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我們從 14 年前就開始移植這些構造，
16:58
So, we have patients now walking around with organs,
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所以現在我們有接受器官的病人活蹦亂跳的走來走去，
17:00
engineered organs, for over 10 years, as well.
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有些已經接受這些人造器官超過十年了。
17:04
I'm going to show a clip of one young lady.
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我將播放一段一個年輕女士的影片。
17:06
She had a spina bifida defect, a spinal cord abnormality.
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她有脊柱裂傷，一種脊椎骨異常症。
17:09
She did not have a normal bladder. This is a segment from CNN.
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她也沒有正常的膀胱。這是來自 CNN 的片段。
17:12
We are just taking five seconds.
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只要五秒鐘。
17:14
This is a segment that Sanjay Gupta actually took care of.
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這一個片段你們可以看到 Sanjay Gupta
17:19
Video: Kaitlyn M: I'm happy. I was always afraid
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影片：Kaitlyn M: 我很高興。之前我很害怕，
17:21
that I was going to have like, an accident or something.
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怕我會發生意外或什麼其他的事。
17:24
And now I can just go and
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但是現在我可以自由行動
17:27
go out with my friends,
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跟朋友們出去逛，
17:29
go do whatever I want.
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去任何我想去的地方。
17:32
Anthony Atala: See, at the end of the day, the promise of regenerative medicine
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Anthony Atala: 看到了嗎？在今天結束的時候，再生醫療向我們保證的
17:35
is a single promise.
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只有一件事。
17:37
And that is really very simple,
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一件非常簡單的事，
17:40
to make our patients better.
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讓我們的病人過得更好。
17:42
Thank you for your attention.
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非常謝謝你們。
17:44
(Applause)
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（掌聲）
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