TED2010
Kevin Stone: The bio-future of joint replacement
Kevin Stone：生物性關節置換的未來
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關節炎和運動傷害磨損了數以百萬計的關節，但是少有人接受到最好的治療 — 真正生物組織的置換。Kevin Stone 揭露了一種使用動物組織的創新療法，可能可以避開人類對人類關節移植中捐贈者短缺和成本過高的難題。
Kevin Stone - Surgeon, inventor
Kevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament. Full bio
Kevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament. Full bio
Double-click the English transcript below to play the video.
00:16
So let me just start with my story.
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那麼，讓我直接開始講我的故事。
00:18
So I tore my knee joint meniscus cartilage
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我大學時代踢足球的時候，
00:20
playing soccer in college.
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撕傷了我膝關節的半月軟骨。
00:23
Then I went on to tear my ACL, the ligament in my knee,
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然後我又撕傷了我膝關節上的前交叉韌帶，
00:26
and then developed an arthritic knee.
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因此病情惡化成為膝關節炎。
00:28
And I'm sure that many of you in this audience have that same story,
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而且我確定在座的各位當中，有許多人跟我有著同樣的故事。
00:31
and, by the way, I married a woman
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順帶一提，我娶到了一個
00:33
who has exactly the same story.
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跟我有著完全一樣經歷的妻子。
00:36
So this motivated me to become an orthopedic surgeon
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因此這激勵了我成為一名骨外科醫生，
00:39
and to see if I couldn't focus on solutions for those problems
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看看我是否能夠專注於找出讓這些使我不能運動的毛病
00:42
that would keep me playing sports and not limit me.
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不再限制我的解決方法。
00:46
So with that, let me just show you a quick video
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以此為楔子，讓我很快地放一段影片給大家看，
00:49
to get you in the mood of what we're trying to explain.
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讓你們對於我將要解釋的東西，有個大概的了解。
00:52
Narrator: We are all aware of the risk of cancer,
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旁白：我們都清楚地明白癌症的風險，
00:54
but there's another disease
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但是另外有一種疾病，
00:56
that's destined to affect even more of us: arthritis.
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其影響的人甚至比癌症還要多，那就是關節炎。
00:59
Cancer may kill you, but when you look at the numbers,
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癌症也許是致命的，但是如果你看看統計數字，
01:01
arthritis ruins more lives.
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更多的性命毀在關節炎手上。
01:03
Assuming you live a long life, there's a 50 percent chance
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假設你能活到高齡，你患有關節炎的機率
01:05
you'll develop arthritis.
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高達百分之五十。
01:08
And it's not just aging that causes arthritis.
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導致關節炎的原因並不是因為老化。
01:10
Common injuries can lead to decades of pain,
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常見的運動傷害能導致數十年的疼痛，
01:13
until our joints quite literally grind to a halt.
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直到我們的關節磨損到不能再使用為止。
01:16
Desperate for a solution, we've turned to engineering
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亟需解決方案，我們已朝向設計製造
01:18
to design artificial components
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人工關節組件
01:20
to replace our worn-out body parts,
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來替換我們耗盡的身體部件。
01:22
but in the midst of the modern buzz
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但是在圍繞著仿生機械身體美好前景
01:24
around the promises of a bionic body,
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的摩登炒作中，
01:26
shouldn't we stop and ask if there's a better, more natural way?
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我們是否該停下來問問，有沒有其他更好、更自然的方法？
01:31
Let's consider an alternative path.
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讓我們考慮另一個替代方案。
01:33
What if all the replacements our bodies need
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如果我們身體所需求的所有替代品
01:36
already exist in nature,
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都已經存在於自然界，
01:38
or within our own stem cells?
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或者存在於我們自身的幹細胞中，那將如何？
01:40
This is the field of biologic replacements,
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這就是生物性替換的領域，
01:42
where we replace worn-out parts with new, natural ones.
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以自然的、新的部件來替換我們耗盡的部件。
01:45
Kevin Stone: And so, the mission is:
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Kevin Stone: 所以任務是：
01:47
how do I treat these things biologically?
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我要如何利用生物性的方法來治療這些疾病？
01:49
And let's talk about both what I did for my wife,
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讓我們來談談，我為我妻子所做的事，
01:51
and what I've done for hundreds of other patients.
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和我已經為其他數百名病患所做的事。
01:53
First thing for my wife,
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首先是為我妻子所做的，
01:55
and the most common thing I hear from my patients,
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也是我從病人那最常聽到的事，
01:57
particularly in the 40- to 80-year-old age group, 70-year-old age group,
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特別是介於 40~80 歲的族群、70 歲的族群，
02:00
is they come in and say,
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他們通常進來後會說，
02:02
"Hey, Doc, isn't there just a shock absorber you can put in my knee?
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「醫生，難道沒有可以吸震的東西放到我的膝蓋裡嗎？
02:04
I'm not ready for joint replacement."
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我還沒有準備好做關節置換手術。」
02:06
And so for her, I put in a human meniscus allograft donor
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因此，在我妻子身上，我將人類半月板移植供應體
02:09
right into that [knee] joint space.
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置入她膝關節的空間內。
02:11
And [the allograft] replaces [the missing meniscus].
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這個 [移植] 取代了 [缺失的半月板] 。
02:13
And then for that unstable ligament,
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而對於那個不穩定的韌帶，
02:15
we put in a human donor ligament
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我們也放入了一個人類捐贈的韌帶
02:17
to stabilize the knee.
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來穩定住膝蓋。
02:19
And then for the damaged arthritis on the surface,
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而那些因為關節炎而受損的表面，
02:22
we did a stem cell paste graft,
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我們使用了幹細胞黏貼移植法，
02:24
which we designed in 1991,
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這方法是我們於 1991 年設計出來的，
02:26
to regrow that articular cartilage surface
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能夠重新長出關節軟骨表面，
02:29
and give it back a smooth surface there.
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因此重回原本滑順的表面。
02:32
So here's my wife's bad knee on the left,
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在這邊，左邊是我妻子的爛膝蓋，
02:34
and her just hiking now
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而如今她剛剛能夠登山健行，
02:36
four months later in Aspen, and doing well.
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手術完成的四個月後，她去阿斯彭參加健行，反應良好。
02:39
And it works, not just for my wife, but certainly for other patients.
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手術很成功，不僅對我妻子是這樣，對其他病人一定也是一樣。
02:42
The girl on the video, Jen Hudak,
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影片中的女孩，Jen Hudak，
02:44
just won the Superpipe in Aspen
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剛在阿斯彭贏得 Superpipe 極限滑雪大賽，
02:46
just nine months after having destroyed her knee,
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僅僅在毀了她膝蓋的九個月後，
02:49
as you see in the other image --
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如同你在其他照片所看到的一般 —
02:51
and having a paste graft to that knee.
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她的膝蓋進行了黏貼移植。
02:53
And so we can regrow these surfaces biologically.
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因此我們可以生物性的重新長出這些表面。
02:57
So with all this success,
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即使有了這些成功，
02:59
why isn't that good enough, you might ask.
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你可能會問，這樣還不夠好嗎？
03:02
Well the reason is because there's not enough donor cycles.
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因為沒有足夠的捐贈者，
03:05
There's not enough young, healthy people
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沒有足夠的年輕、健康的人們
03:07
falling off their motorcycle
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從摩托車上摔下來，
03:09
and donating that tissue to us.
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然後捐贈那些組織給我們。
03:12
And the tissue's very expensive.
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也因此，這些組織非常的昂貴。
03:15
And so that's not going to be a solution
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因此，這不會是個能夠
03:17
that's going to get us global with biologic tissue.
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提供我們全球性生物組織來源的解決方案。
03:20
But the solution is animal tissue
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但是，解決方案就是動物組織，
03:22
because it's plentiful, it's cheap,
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因為它們不虞匱乏，並且便宜。
03:24
you can get it from young, healthy tissues,
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你可以很容易取得年輕、健康的組織，
03:27
but the barrier is immunology.
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但是障礙就是免疫反應。
03:29
And the specific barrier
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這個專一性的障礙是
03:31
is a specific epitope
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有一種特別的蛋白免疫表位
03:33
called the galactosyl, or gal epitope.
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稱作半乳糖基或是 gal 表位。
03:35
So if we're going to transplant animal tissues to people,
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因此，如果我們要移植動物性組織到人類身上，
03:37
we have to figure out a way to get rid of that epitope.
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我們就必須找出一種方法，移除這個免疫表位。
03:40
So my story in working with animal tissues
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因此，我與動物組織一起工作的故事
03:42
starts in 1984.
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始於 1984。
03:44
And I started first
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我首先從
03:46
with cow Achilles tendon,
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牛的跟（阿基里斯）腱開始，
03:48
where we would take the cow Achilles tendon,
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我們使用牛的跟腱，
03:50
which is type-I collagen,
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它是甲型膠原蛋白，
03:52
strip it of its antigens
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以酸性溶劑與清潔劑清洗
03:54
by degrading it with an acid and detergent wash
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來移除它的抗原，
03:57
and forming it into a regeneration template.
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再將它塑型成可供再生的模板。
04:00
We would then take that regeneration template
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然後我們利用這個再生模板，
04:02
and insert it into the missing meniscus cartilage
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將之置入缺失的半月軟骨處，
04:05
to regrow that in a patient's knee.
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在病人的膝蓋內重新生長出來。
04:08
We've now done that procedure,
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這樣我們就完成了這項手術，
04:10
and it's been done worldwide in over 4,000 cases,
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這手術在全球已經有超過四千起成功的術例，
04:12
so it's an FDA-approved and worldwide-accepted way
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因此它已經是 FDA 核准並被世界所接受
04:15
to regrow the meniscus.
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重新生長半月軟骨的方法。
04:17
And that's great when I can degrade the tissue.
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這方法在我能夠降解組織的時候，一切都很好。
04:20
But what happens for your ligament when I need an intact ligament?
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但是當我需要一個完整的韌帶組織時，你的韌帶又將會如何？
04:23
I can't grind it up in a blender.
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我不能再用攪拌器將組織打碎。
04:25
So in that case,
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因此，
04:27
I have to design -- and we designed with Uri Galili and Tom Turek --
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我們與 Uri Galili 和 Tom Turek 一同設計了 —
04:30
an enzyme wash
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一種酵素洗劑
04:32
to wash away, or strip,
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來洗掉，或脫除
04:34
those galactosyl epitopes
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這些半乳糖基免疫表位，
04:36
with a specific enzyme.
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藉由一種特殊的酵素。
04:38
And we call that a "gal stripping" technique.
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我們稱之為「gal 脫除法」。
04:41
What we do is humanize the tissue.
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我們所做的是將這組織「人類」化。
04:43
It's by gal stripping that tissue
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藉由脫除組織上的 gal 基
04:45
we humanize it (Laughter),
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我們就使其「人類」化了，
04:47
and then we can put it back
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然後我們將之放回
04:49
into a patient's knee.
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到病人的膝蓋內。
04:53
And we've done that. Now we've taken pig ligament --
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因為手術的成功，現在我們能用豬的韌帶 —
04:55
young, healthy, big tissue,
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年輕、健康、大組織，
04:57
put it into 10 patients in an FDA-approved trial --
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在一個 FDA 核准的實驗性療法中，將之置入十個病人身上 —
05:00
and then one of our patients went on to have
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然後我們其中一位病人獲得了
05:02
three Canadian Masters Downhill championships --
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三項加拿大大師級下坡滑雪競賽大獎 —
05:05
on his "pig-lig," as he calls it. So we know it can work.
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用他的「豬腳」，他自己取的。所以我們知道這方法可行。
05:07
And there's a wide clinical trial of this tissue now pending.
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關於這組織療法的擴大臨床試驗計畫正在審查階段。
05:12
So what about the next step?
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那麼，下一步是什麼？
05:14
What about getting to a total biologic knee replacement,
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一個完全生物性的膝關節置換聽起來如何？
05:16
not just the parts?
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不只是零部件而已。
05:18
How are we going to revolutionize artificial joint replacement?
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我們要如何推動人工關節置換革命？
05:21
Well here's how we're going to do it.
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那麼，我就告訴你我們準備如何下手。
05:23
So what we're going to do is take
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我們所將要做的是，使用
05:25
an articular cartilage
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從年輕、健康的豬隻身上
05:27
from a young, healthy pig,
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所取得的關節軟骨，
05:29
strip it of its antigens,
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脫去它的抗原，
05:31
load it with your stem cells,
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裝載上你的幹細胞，
05:34
then put it back on to that
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然後把它放回
05:36
arthritic surface in your knee,
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你膝蓋的軟骨表面上，
05:39
tack it on there, have you heal that surface
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釘在那邊，直到你那邊的軟骨表面癒合為止，
05:42
and then create a new biologic surface for your knee.
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然後也就產生了你膝蓋新的生物性表面。
05:48
So that's our biologic approach right now.
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這就是現在我們的生物性策略。
05:52
We're going to rebuild your knee with the parts.
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我們將要用零部件來重新建造你的膝蓋。
05:54
We're going to resurface it with a completely new surface.
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我們將重鋪全新的軟骨關節表面。
05:57
But we have other advantages from the animal kingdom.
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但是，動物界提供了我們其他的優勢。
06:00
There's a benefit of 400 million years
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行走 40 億年
06:02
of ambulation.
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所提供的利基。
06:04
We can harness those benefits.
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我們可以利用這些優惠。
06:06
We can use thicker, younger, better tissues
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我們可以使用比你膝蓋受傷前，
06:09
than you might have injured in your knee,
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更厚，更年輕，更好的組織，
06:11
or that you might have when you're 40, 50 or 60.
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或者比起你 40, 50 或 60 歲時好的組織。
06:13
We can do it as an outpatient procedure.
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我們可以以門診手術來進行。
06:15
We can strip that tissue very economically,
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我們可以非常經濟地脫去組織上的抗原。
06:18
and so this is how we can get biologic knee replacement
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這就是我們如何可以讓生物性膝關節置換
06:21
to go global.
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拓展到全球的方法。
06:23
And so welcome to super biologics.
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歡迎來到超級生物工程學。
06:25
It's not hardware.
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不是硬體。
06:27
It's not software.
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不是軟體。
06:30
It's bioware.
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是生物體。
06:32
It's version 2.0 of you.
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是第二代的你。
06:35
And so with that, coming to a --
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最後～
06:37
(Laughter)
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（笑聲）
06:39
coming to an operating theater near you soon, I believe.
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我相信，很快地就會在你們附近的戲院上映。
06:41
Thank you very much.
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非常謝謝你們。
06:43
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Kevin Stone - Surgeon, inventorKevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament.
Why you should listen
Orthopedic surgeon Kevin Stone knows mobility means more than just where you go -- it's the foundation for a fulfilling daily life. (True whether you're an athlete or not.) His Stone Clinic specializes in "biologic knee replacement": replacing damaged joint parts, not with artificial components, but with lab-grown tissue and parts from human donors. He and team are spearheading new techniques that use animal tissue but avoid the complications associated with animal-to-human transplantations.
Stone has consulted publications such as The Wall Street Journal and Newsweek as a medical expert; he has contributed to TV programs such as ESPN's "Treating Athletes in the New Millennium" and The Discovery Channel.
Kevin Stone | Speaker | TED.com