TEDMED 2009
Anthony Atala: Growing new organs
Anthony Atala om at dyrke nye organer
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Readability: 4
1,913,459 views
Anthony Atala's state-of-the-art laboratorium dyrker menneskelige organer -- fra muskler, til blodkar, til blære og mere. Ved TEDMED viser han optagelser af hans bio-ingeniører der arbejder med nogle af dens sci-fi dimser, inklusive en oven lignende bioreactor (forvarm til 37 grader C) og en maskine der "printer" menneskeligt væv.
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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Dette er faktisk et maleri
00:18
that hangs at the Countway Library at Harvard Medical School.
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der hænger i Countway Library ved Harvard Medical School.
00:21
And it shows the first time an organ was ever transplanted.
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Og det viser den første gang et organ nogensinde blev transplanteret.
00:25
In the front, you see, actually, Joe Murray
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Foran kan man se, faktisk, Joe Murray
00:28
getting the patient ready for the transplant,
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der gør en patient klar til transplantationen,
00:30
while in the back room you see Hartwell Harrison,
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mens man bagerst i lokalet kan se Hartwell Harrison,
00:32
the Chief of Urology at Harvard,
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lederen af urologisk afdeling ved Harvard,
00:35
actually harvesting the kidney.
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der faktisk høstede nyren.
00:37
The kidney was indeed the first organ
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Nyren var netop det første organ
00:39
ever to be transplanted to the human.
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nogensinde til at blive transplanteret til et menneske.
00:41
That was back in 1954,
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Det var tilbage i 1954,
00:44
55 years ago.
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55 år siden.
00:46
Yet we're still dealing with a lot of the same challenges
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Alligevel har vi stadig mange af de samme udfordringer
00:49
as many decades ago.
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som mange årtier siden.
00:51
Certainly many advances, many lives saved.
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Bestemt mange fremskridt, mange reddede liv.
00:54
But we have a major shortage of organs.
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Men vi har en kæmpe mangel på organer.
00:58
In the last decade the number of patients
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I det sidste årti er antallet af patienter
01:01
waiting for a transplant has doubled.
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der venter på en transplantation fordoblet.
01:04
While, at the same time, the actual number of transplants
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Mens, samtidig, det faktiske antal af transplantationer
01:06
has remained almost entirely flat.
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er forblevet næsten præcis det samme.
01:09
That really has to do with our aging population.
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Det har virkelig noget at gøre med vores aldrende befolkning.
01:11
We're just getting older.
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Vi bliver bare ældre.
01:13
Medicine is doing a better job
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Medicin gør et bedre stykke arbejde
01:16
of keeping us alive.
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med at holde os i live.
01:18
But as we age, our organs tend to fail more.
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Men som vi bliver ældre, har vores organer en tendens til at svigte oftere.
01:21
So, that's a challenge,
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Så, det er en udfordring,
01:23
not just for organs but also for tissues.
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ikke kun for organerne men også for vævet.
01:25
Trying to replace pancreas,
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At prøve at erstatte bugspytkirtlen,
01:28
trying to replace nerves that can help us with Parkinson's.
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at prøve at erstatte nerver der kan hjælpe os med Parkinson.
01:33
These are major issues.
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Dette er kæmpe problemstillinger.
01:35
This is actually a very stunning statistic.
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Dette er faktisk en meget lamslående statistik.
01:39
Every 30 seconds
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Hver 30. sekund
01:41
a patient dies from diseases
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dør en patient af sygdomme
01:44
that could be treated with tissue regeneration or replacement.
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der kunne være bleve behandlet med væv regeneration eller erstatning.
01:48
So, what can we do about it?
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Så, hvad kan vi gøre ved det?
01:51
We've talked about stem cells tonight.
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Vi har talt om stamceller i aften.
01:53
That's a way to do it.
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Det er en måde at gøre det på.
01:55
But still ways to go to get stem cells into patients,
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Men der mangler stadig noget for at få stamcellerne ind i patienterne,
02:00
in terms of actual therapies for organs.
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med hensyn til faktiske behandlinger for organer.
02:03
Wouldn't it be great if our bodies could regenerate?
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Ville det ikke være fedt hvis vore kroppe kunne regenerere?
02:06
Wouldn't it be great if we could actually harness the power
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Ville det ikke være mægtigt hvis vi faktisk kunne udnytte den kraft
02:09
of our bodies, to actually heal ourselves?
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fra vores kroppe, til faktisk at heale os selv?
02:14
It's not really that foreign of a concept, actually;
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Det er faktisk ikke så fremmed et koncept, faktisk;
02:17
it happens on the Earth every day.
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det sker på Jorden hver dag.
02:21
This is actually a picture of a salamander.
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Dette er faktisk et billede af en salamander.
02:24
Salamanders have this amazing capacity to regenerate.
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Salamandere har denne fantastiske evne til at regenerere.
02:28
You see here a little video.
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Man ser en lille video her.
02:30
This is actually a limb injury in this salamander.
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Dette er faktisk en skade i et lem i denne salamander.
02:34
And this is actually real photography,
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Og dette er faktisk et rigtigt fotografi,
02:36
timed photography, showing how that limb regenerates
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planlagt fotografi, der viser hvordan lemmet regenererer
02:39
in a period of days.
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i løbet af et par dage.
02:41
You see the scar form.
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Man ser arret blive dannet her.
02:43
And that scar actually grows out
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Og ud af det ar vokser der faktisk
02:46
a new limb.
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et nyt lem.
02:48
So, salamanders can do it.
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Så, salamandere kan gøre det.
02:50
Why can't we? Why can't humans regenerate?
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Hvorfor kan vi ikke? Hvorfor kan mennesker ikke regenerere?
02:53
Actually, we can regenerate.
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Vi kan faktisk regenerere.
02:57
Your body has many organs
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Ens krop har mange organer
03:01
and every single organ in your body
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og hvert enkelt organ i ens krop
03:03
has a cell population
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har en celle bestand
03:05
that's ready to take over at the time of injury. It happens every day.
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der er klar til at tage over når der kommer en skade. Det sker hver dag.
03:10
As you age, as you get older.
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Som man ældes, som man bliver ældre.
03:13
Your bones regenerate every 10 years.
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Ens knogler regenererer hver 10 år.
03:16
Your skin regenerates every two weeks.
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Ens hud regenererer hver to uger.
03:19
So, your body is constantly regenerating.
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Så, ens krop regenererer konstant.
03:21
The challenge occurs when there is an injury.
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Udfordringen kommer når der er en skade.
03:23
At the time of injury or disease,
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Når der kommer en skade eller sygdom,
03:26
the body's first reaction
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kroppens første reaktion
03:29
is to seal itself off from the rest of the body.
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er at lukke sig inde fra resten af kroppen.
03:32
It basically wants to fight off infection,
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Den vil dybest set bekæmpe infektionen,
03:34
and seal itself, whether it's organs inside your body,
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og lukke sig selv inde, hvad enten det er organerne inden i ens krop,
03:38
or your skin, the first reaction
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eller ens hud, den første reaktion
03:41
is for scar tissue to move in,
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er at der kommer arvæv,
03:43
to seal itself off from the outside.
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for at lukke sig selv inde fra alt udefrakommende.
03:47
So, how can we harness that power?
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Så, hvordan kan vi udnytte den evne?
03:49
One of the ways that we do that
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En af måderne vi kan gøre det på
03:51
is actually by using smart biomaterials.
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er faktisk ved at bruge smarte biomaterialer.
03:56
How does this work? Well, on the left side here
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Hvordan virker dette? Jamen, på den venstre side her
03:59
you see a urethra which was injured.
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ser man et urinrør der var skadet.
04:01
This is the channel that connects the bladder to the outside of the body.
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Dette er kanalen der forbinder blæren med ydersiden af kroppen.
04:05
And you see that it is injured.
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Og man kan se den er skadet.
04:07
We basically found out that you can use these smart biomaterials
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Vi fandt dybest set ud af, at man kan bruge disse smarte materialer
04:11
that you can actually use as a bridge.
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som man faktisk kan bruge som en bro.
04:14
If you build that bridge, and you close off
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Hvis man bygger den bro, og man lukker det
04:17
from the outside environment,
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fra det udefrakommende miljø,
04:19
then you can create that bridge, and cells
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så kan man skabe den bro, og celler
04:22
that regenerate in your body,
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der regenererer i ens krop,
04:24
can then cross that bridge, and take that path.
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kan så krydse den bro, og tage den vej.
04:28
That's exactly what you see here.
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Det er faktisk det man kan se her.
04:30
It's actually a smart biomaterial
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Det er faktisk et smart biomateriale
04:32
that we used, to actually treat this patient.
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som vi brugte, til virkelig at behandle denne patient.
04:34
This was an injured urethra on the left side.
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Dette var et skadet urinrør på den venstre side.
04:37
We used that biomaterial in the middle.
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Vi brugte det biomateriale i midten.
04:39
And then, six months later on the right-hand side
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Og så, seks måneder senere på den højre side
04:42
you see this reengineered urethra.
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kan man se dette redesignede urinrør.
04:44
Turns out your body can regenerate,
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Det viser sig at kroppen kan regenerere,
04:46
but only for small distances.
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men kun på små afstande.
04:49
The maximum efficient distance for regeneration
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Den maksimale effektive afstand for regenerering
04:52
is only about one centimeter.
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er kun omkring en centimeter.
04:54
So, we can use these smart biomaterials
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Så, vi kan bruge disse smart materialer
04:57
but only for about one centimeter
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men kun til omkring en centimeter
05:00
to bridge those gaps.
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for at slå bro over de huller.
05:02
So, we do regenerate, but for limited distances.
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Så, vi regenererer, men kun på små afstande.
05:05
What do we do now,
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Hvad gør vi nu,
05:07
if you have injury for larger organs?
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hvis man har en skade på større organer?
05:10
What do we do when we have injuries
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Hvad gør vi, når vi har skader
05:12
for structures which are much larger
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på strukturer der er meget større
05:14
than one centimeter?
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end en centimeter?
05:16
Then we can start to use cells.
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Så kan vi begynde at bruge celler.
05:19
The strategy here, is if a patient comes in to us
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Strategien her er, at hvis en patient kommer ind til os
05:22
with a diseased or injured organ,
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med et dødt eller skadet organ,
05:24
you can take a very small piece of tissue from that organ,
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kan man tage et meget lille stykke væv fra det organ,
05:27
less than half the size of a postage stamp,
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mindre end halvdelen af et frimærke,
05:30
you can then tease that tissue apart,
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man kan så karte det væv fra hinanden,
05:33
and look at its basic components,
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og se på basiskomponenterne,
05:35
the patient's own cells,
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patientens egne celler,
05:37
you take those cells out,
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man tager de celler ud,
05:39
grow and expand those cells outside the body in large quantities,
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dyrker og udvider de celler uden for kroppen i store mængder,
05:43
and then we then use scaffold materials.
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og så bruger vi stillads materialer.
05:46
To the naked eye they look like a piece of your blouse,
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For det blotte øje ligner de et stykke af ens bluse,
05:49
or your shirt, but actually
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eller ens skjorte, men faktisk
05:51
these materials are fairly complex
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er disse materialer ret komplicerede
05:54
and they are designed to degrade once inside the body.
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og de er designet til at nedbrydes når de er inde i kroppen.
05:57
It disintegrates a few months later.
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Det nedbrydes i løbet af få måneder.
05:59
It's acting only as a cell delivery vehicle.
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Det virker kun som en aflevering for cellerne.
06:02
It's bringing the cells into the body. It's allowing
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Det bringer cellerne ind i kroppen. Det tillader
06:04
the cells to regenerate new tissue,
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cellerne at regenerere nyt væv,
06:06
and once the tissue is regenerated the scaffold goes away.
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og når først vævet er regenereret, forsvinder stilladset.
06:10
And that's what we did for this piece of muscle.
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Og det er det vi gjorde ved dette stykke muskel.
06:13
This is actually showing a piece of muscle and how we go through
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Dette viser faktisk et stykke muskel og hvordan vi går gennem
06:15
the structures to actually engineer the muscle.
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strukturerne til faktisk at designe musklen.
06:18
We take the cells, we expand them,
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Vi tager cellerne, vi udvider dem,
06:20
we place the cells on the scaffold,
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vi placerer cellerne på dette stillads,
06:22
and we then place the scaffold back into the patient.
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og så placerer vi stilladset tilbage i patienten.
06:25
But actually, before placing the scaffold into the patient,
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Men faktisk, før vi placerer stilladset i patienten,
06:28
we actually exercise it.
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træner vi det faktisk.
06:31
We want to make sure that we condition
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Vi vil være sikre på at vi træner
06:33
this muscle, so that it knows what to do
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denne muskel, så den ved hvad den skal gøre
06:35
once we put it into the patient.
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når vi først putter den ind i patienten.
06:37
That's what you're seeing here. You're seeing
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Det er det man ser her. Man ser
06:39
this muscle bio-reactor
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denne muskel bioreaktor
06:41
actually exercising the muscle back and forth.
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der faktisk træner musklen frem og tilbage.
06:45
Okay. These are flat structures that we see here,
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Okay. Dette er flade strukturer vi ser her,
06:49
the muscle.
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musklen.
06:51
What about other structures?
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Hvad med andre strukturer?
06:53
This is actually an engineered blood vessel.
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Dette er faktisk et designet blodkar.
06:56
Very similar to what we just did, but a little bit more complex.
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Meget lig det vi lige gjorde, men en lille smule mere kompleks.
06:59
Here we take a scaffold,
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Her tager vi et stillads,
07:01
and we basically -- scaffold can be like a piece of paper here.
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og vi dybest set -- stilladset kan være ligesom et stykke papir her.
07:05
And we can then tubularize this scaffold.
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Og vi kan lave tuber med dette stillads.
07:07
And what we do is we, to make a blood vessel, same strategy.
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Og det vi gør er, for at lave et blodkar, samme strategi.
07:11
A blood vessel is made up of two different cell types.
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Et blodkar er lavet af to forskellige typer celler.
07:15
We take muscle cells, we paste,
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Vi tager muskel celler, vi limer,
07:18
or coat the outside with these muscle cells,
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eller coater ydersiden med disse muskel celler,
07:20
very much like baking a layer cake, if you will.
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meget lig det at bage en lagkage, om man vil.
07:23
You place the muscle cells on the outside.
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Man placerer muskel cellerne på ydersiden.
07:26
You place the vascular blood vessel lining cells on the inside.
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Man placerer de vaskulære blodkars forings celler inden i.
07:31
You now have your fully seeded scaffold.
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Nu har man sit fuldt podede stillads.
07:33
You're going to place this in an oven-like device.
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Man placerer dette i et ovn-lignende apparat.
07:36
It has the same conditions as a human body,
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Det har de samme betingelser som den menneskelige krop,
07:38
37 degrees centigrade,
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37 grader celsius,
07:40
95 percent oxygen.
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95 procent ilt.
07:42
You then exercise it, as what you saw on that tape.
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Så træner man det, ligesom det man så i videoen.
07:46
And on the right you actually see a carotid artery that was engineered.
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Og til højre kan man faktisk se en carotid vene der var designet.
07:49
This is actually the artery that goes from your neck to your brain.
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Dette er faktisk den vene der går fra ens nakke til ens hjerne.
07:52
And this is an X-ray showing you
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Og dette er et røntgenbillede der viser en
07:55
the patent, functional blood vessel.
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det tydelige, funktionelle blodkar.
07:58
More complex structures
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Mere komplekse strukturer
08:00
such as blood vessels, urethras, which I showed you,
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såsom blodkar, urinrør, som jeg viste jer,
08:03
they're definitely more complex
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de er afgjort mere komplekse
08:05
because you're introducing two different cell types.
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fordi man introducerer to forskellige celle typer.
08:07
But they are really acting mostly as conduits.
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Men de opfører sig i virkeligheden som rør.
08:09
You're allowing fluid or air to go through
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Man tillader væske eller luft at komme igennem
08:11
at steady states.
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ved jævn fart.
08:13
They are not nearly as complex as hollow organs.
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De er ikke nær så komplekse som hule organer.
08:15
Hollow organs have a much higher degree of complexity,
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Hule organer har en meget højere grad af kompleksitet,
08:18
because you're asking these organs to act on demand.
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fordi man beder disse organer om at
08:21
So, the bladder is one such organ.
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Så, blæren er et af den slags organer.
08:24
Same strategy, we take a very small piece of the bladder,
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Samme strategi, vi tager et meget lille stykke af blæren,
08:27
less than half the size of a postage stamp.
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mindre en halvdelen af et frimærke.
08:29
We then tease the tissue apart
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Når vi karter dette væv fra hinanden
08:31
into its two individual cell components,
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i dets to individuelle celle komponenter,
08:33
muscle, and these bladder specialized cells.
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muskel, og disse blære specialiserede celler.
08:36
We grow the cells outside the body in large quantities.
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Vi dyrker cellerne uden for kroppen i store mængder.
08:39
It takes about four weeks to grow these cells from the organ.
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Det tager omkring fire uger at dyrke disse celler fra organet.
08:42
We then take a scaffold that we shape like a bladder.
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Så tager vi stilladset som vi former som en blære.
08:45
We coat the inside with these bladder lining cells.
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Vi coater indersiden med disse blæreforeceller.
08:49
We coat the outside with these muscle cells.
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Vi dækker ydersiden med disse muskelceller.
08:52
We place it back into this oven-like device.
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Vi putter det tilbage ind i dette oven lignende apparat.
08:55
From the time you take that piece of tissue, six to eight weeks later
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Fra det tidspunkt man tager det stykke væv, seks til otte uger senere
08:58
you can put the organ right back into the patient.
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kan man putte organet tilbage i patienten.
09:01
This actually shows the scaffold.
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Dette viser faktisk stilladset.
09:04
The material is actually being coated with the cells.
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Materialet bliver faktisk dækket med cellerne.
09:08
When we did the first clinical trial for these patients
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Da vi udførte vores første kliniske forsøg for disse patienter
09:11
we actually created the scaffold specifically for each patient.
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lavede vi faktisk stilladset specifikt til hver patient.
09:14
We brought patients in,
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Vi bragte patienter ind,
09:16
six to eight weeks prior to their scheduled surgery, did X-rays,
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seks til otte uger før deres planlagte operation, lavede røntgenbilleder,
09:19
and we then composed a scaffold specifically for that patient's size
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og så sammensatte vi et stillads specifikt til størrelsen på patientens
09:22
pelvic cavity.
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bækkenbund.
09:24
For the second phase of the trials
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I den anden fase af forsøgene
09:26
we just had different sizes, small, medium, large and extra-large.
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havde vi bare forskellige størrelser, small, medium, large og extra-large.
09:29
(Laughter)
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(Latter)
09:32
It's true.
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Det er sandt.
09:34
And I'm sure everyone here wanted an extra-large. Right?
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Og jeg er sikker på at alle her vil have extra-large. Ikke?
09:37
(Laughter)
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(Latter)
09:39
So, bladders are definitely a little bit more complex
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Så, blære er helt sikkert en lille smule mere komplicerede
09:42
than the other structures.
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end de andre strukturer.
09:44
But there are other hollow organs that have added complexity to it.
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Men der er andre hule organer der har tillagt kompleksitet.
09:47
This is actually a heart valve, which we engineered.
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Dette er faktisk en hjerteklap, som vi har designet.
09:50
And the way you engineer this heart valve is the same strategy.
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Og måden hvorpå man designer denne hjerteklap er den samme strategi.
09:53
We take the scaffold, we seed it with cells,
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Vi tager stilladset, vi dækker det med celler,
09:55
and you can now see here, the valve leaflets opening and closing.
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og man kan nu se her, at klappens blade åbner sig og lukker sig.
09:59
We exercise these prior to implantation.
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Vi træner disse inden implantationen.
10:02
Same strategy.
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Samme strategi.
10:04
And then the most complex are the solid organs.
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Og så er de mest komplekse de faste organer.
10:06
For solid organs, they're more complex
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Til faste organer, de er mere komplekse
10:08
because you're using a lot more cells per centimeter.
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fordi de bruger mange flere celler per centimeter.
10:12
This is actually a simple solid organ like the ear.
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Dette er faktisk et simpelt fast organ som øret.
10:14
It's now being seeded with cartilage.
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Det bliver nu dækket med brusk.
10:16
That's the oven-like device;
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Det er det ovnlignende apparat;
10:19
once it's coated it gets placed there.
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når det er dækket bliver det placeret her.
10:21
And then a few weeks later we can take out the cartilage scaffold.
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Og så et par uger senere kan vi tage brusk stilladset ud.
10:26
This is actually digits that we're engineering.
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Dette er faktisk fingre der blev udviklet.
10:28
These are being layered, one layer at a time,
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De bliver stakket, et lag af gangen,
10:31
first the bone, we fill in the gaps with cartilage.
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først knoglen, vi fylder hullerne med brusk.
10:34
We then start adding the muscle on top.
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Så begynder vi at lægge musklen oven på.
10:36
And you start layering these solid structures.
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Og man begynder at lægge disse faste strukturer i lag.
10:38
Again, fairly more complex organs,
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Igen, noget mere komplekse organer,
10:41
but by far, the most complex solid organs
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men helt sikkert, de mest komplekse solide organer
10:44
are actually the vascularized, highly vascularized,
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er faktisk de vaskulære, særdeles vaskulære,
10:48
a lot of blood vessel supply,
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en masse blodkar,
10:50
organs such as the heart,
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organer som eksempelvis hjertet,
10:53
the liver, the kidneys.
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leveren, nyrene.
10:56
This is actually an example -- several strategies
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Dette er faktisk et eksempel -- adskillige strategier
10:58
to engineer solid organs.
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til at designe faste organer.
11:00
This is actually one of the strategies. We use a printer.
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Dette er faktisk en af strategierne. Vi bruger en printer.
11:02
And instead of using ink, we use -- you just saw an inkjet cartridge --
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Og i stedet for at bruge blæk, bruger vi -- I så lige en blækpatron --
11:06
we just use cells.
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vi bruger bare celler.
11:08
This is actually your typical desktop printer.
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Dette er faktisk en typisk printer.
11:10
It's actually printing this two chamber heart,
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Den printer faktisk dette to kamrede hjerte,
11:13
one layer at a time.
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et lag af gangen.
11:15
You see the heart coming out there. It takes about 40 minutes to print,
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Men kan se hjertet komme ud der. Det tager cirka 40 minutter at printe,
11:19
and about four to six hours later
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og omkring fire til seks timer senere
11:21
you see the muscle cells contract.
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kan man se muskel cellerne trække sig sammen.
11:24
(Applause)
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(Bifald)
11:30
This technology was developed by Tao Ju, who worked at our institute.
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Denne teknologi blev udviklet af Tao Ju, der arbejdede på vores institut.
11:34
And this is actually still, of course, experimental,
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Og dette er faktisk stadigvæk, selvfølgelig, på eksperimental stadiet,
11:36
not for use in patients.
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ikke til at bruge i patienter.
11:39
Another strategy that we have followed
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En anden strategi vi har fulgt
11:41
is actually to use decellularized organs.
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er faktisk at bruge organer hvor cellerne er fjernet.
11:43
We actually take donor organs,
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Vi tager egentlig donor organer,
11:46
organs that are discarded,
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organer der er kasseret,
11:48
and we then can use very mild detergents
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og så kan vi bruge milde rengøringsmidler
11:50
to take all the cell elements out of these organs.
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til at tage celle elementerne ud af disse organer.
11:53
So, for example on the left panel,
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Så, for eksempel på det venstre panel,
11:55
top panel, you see a liver.
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det øverste panel, kan man se en lever.
11:57
We actually take the donor liver,
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Vi tager faktisk donor leveren,
11:59
we use very mild detergents,
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vi bruger meget milde rengøringsmidler,
12:01
and we, by using these mild detergents, we take all the cells
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og vi, ved at bruge disse milde rengøringsmidler, tager vi alle cellerne
12:05
out of the liver.
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ud af leveren.
12:07
Two weeks later, we basically can lift this organ up,
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To uger senere, kan vi dybest set løfte dette organ,
12:10
it feels like a liver,
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det føles som en lever,
12:12
we can hold it like a liver,
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vi kan holde den som en lever,
12:14
it looks like a liver, but it has no cells.
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det ligner en lever, men den har ingen celler.
12:17
All we are left with
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Det eneste vi har tilbage
12:19
is the skeleton, if you will, of the liver,
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er skelettet, om man vil, af leveren,
12:22
all made up of collagen,
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kun lavet af collagen,
12:24
a material that's in our bodies, that will not reject.
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et materiale der er i vores kroppe, som den ikke vil afstøde.
12:26
We can use it from one patient to the next.
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Vi kan bruge det fra den ene patient til den næste.
12:28
We then take this vascular structure
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Så tager vi denne vaskulære struktur
12:30
and we can prove that we retain the blood vessel supply.
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og vi kan bevise at vi beholder forsyningen blodkar.
12:34
You can see, actually that's a fluoroscopy.
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Man kan se, egentlig at det er en gennemlysning.
12:36
We're actually injecting contrast into the organ.
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Vi sprøjter faktisk kontrast ind i organet.
12:39
Now you can see it start. We're injecting the contrast into the organ
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Nu kan man se den begynde. Vi sprøjter kontrasten ind i organet
12:43
into this decellularized liver.
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ind i denne lever hvor cellerne er fjernet.
12:45
And you can see the vascular tree that remains intact.
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Og man kan se at det vaskulære træ forbliver intakt.
12:48
We then take the cells, the vascular cells,
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Når vi tager cellerne, de vaskulære celler,
12:51
blood vessel cells, we perfuse the vascular tree
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cellerne fra blodkarene, overhælder vi det vaskulære træ
12:53
with the patient's own cells.
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med patientens egne celler.
12:55
We perfuse the outside of the liver
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Vi overhælder ydersiden af leveren
12:57
with the patient's own liver cells.
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med patientens egne lever celler.
12:59
And we can then create functional livers.
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Og vi kan så skabe en funktionsdygtig lever.
13:01
And that's actually what you're seeing.
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Og det er faktisk det man ser.
13:03
This is still experimental. But we are able to actually reproduce the functionality
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Dette er stadig på forsøgsbasis. Men vi er faktisk i stand til at reproducere funktionaliteten
13:07
of the liver structure, experimentally.
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af leverens struktur, på forsøgsbasis.
13:10
For the kidney,
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For nyren,
13:12
as I talked to you about the first painting that you saw,
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som jeg talte til jer om i det første maleri som I så,
13:16
the first slide I showed you,
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den første slide jeg viste jer,
13:18
90 percent of the patients on the transplant wait list
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90 procent af patienterne på transplantations ventelisten
13:21
are waiting for a kidney, 90 percent.
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venter på en nyre, 90 procent.
13:23
So, another strategy we're following
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Så, en anden strategi vi følger
13:25
is actually to create wafers
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er faktisk for at skabe wafere
13:27
that we stack together, like an accordion, if you will.
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som vi stabler sammen, ligesom en harmonika, om man vil.
13:31
So, we stack these wafers together, using the kidney cells.
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Så, vi stakker disse wafere sammen, ved at bruge nyre cellerne.
13:34
And then you can see these miniature kidneys that we've engineered.
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Og så kan man se disse miniature nyrer som vi har udviklet.
13:37
They are actually making urine.
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De laver faktisk urin.
13:39
Again, small structures, our challenge is how to make them larger,
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Igen, små strukturer, vores udfordring er hvordan man laver dem større,
13:43
and that is something we're working on
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og det er noget vi arbejder på
13:45
right now at the institute.
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lige nu på instituttet.
13:47
One of the things that I wanted to summarize for you then
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En af tingene som jeg ville opsummere for jer så,
13:50
is what is a strategy that we're going for in regenerative medicine.
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var hvilken strategi vi går efter inden for regenerativ medicin.
13:54
If at all possible,
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Hvis det overhovedet er muligt,
13:56
we really would like to use smart biomaterials
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vi vil virkelig gerne begynde at bruge smarte biomaterialer
13:59
that we can just take off the shelf
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som vi bare kan tage ned fra hylden
14:01
and regenerate your organs.
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og regenerere ens organer.
14:03
We are limited with distances right now,
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Vi er begrænset af afstande lige nu,
14:05
but our goal is actually to increase those distances over time.
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men vores mål er faktisk at forøge disse afstande med tiden.
14:09
If we cannot use smart biomaterials,
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Hvis vi ikke kan bruge smart materialer,
14:11
then we'd rather use your very own cells.
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så vil vi hellere bruge vores helt egne celler.
14:13
Why? Because they will not reject.
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Hvorfor? Fordi de ikke bliver afstødt.
14:15
We can take cells from you,
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Vi kan tage celler fra en,
14:17
create the structure, put it right back into you, they will not reject.
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skabe strukturer, sætte det tilbage i en, de vil ikke blive afstødt.
14:20
And if possible, we'd rather use the cells from your very specific organ.
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Og hvis det muligt, vil vi hellere bruge cellerne fra ens eget specifikke organ.
14:24
If you present with a diseased wind pipe
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Hvis man overbringer et dødt luftrør
14:27
we'd like to take cells from your windpipe.
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vil vi gerne tage cellerne fra ens luftrør.
14:29
If you present with a diseased pancreas
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Hvis man overbringer en død bugspytkirtel
14:32
we'd like to take cells from that organ.
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vil vi hellere tage cellerne fra det organ.
14:34
Why? Because we'd rather take those cells
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Hvorfor? Fordi vi hellere vil tage de celler
14:37
which already know that those are the cell types you want.
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der allerede ved, at det er den type celler man vil have.
14:40
A windpipe cell already knows it's a windpipe cell.
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En luftrørs celle ved allerede at det er en luftrørs celle.
14:43
We don't need to teach it to become another cell type.
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Vi behøver ikke at lære den at blive en anden type celle.
14:46
So, we prefer organ-specific cells.
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Så, vi foretrækker organ specifikke celler.
14:48
And today we can obtain cells from most every organ in your body,
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Og i dag kan vi skaffe cellerne fra næsten alle organer i ens krop,
14:51
except for several which we still need stem cells for,
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bortset fra adskillige som vi stadig har brug for stamceller til,
14:54
like heart, liver, nerve and pancreas.
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ligesom hjerte, lever, nerver og bugspytkirtel.
14:58
And for those we still need stem cells.
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Og til dem vi stadig har brug for stamceller til.
15:01
If we cannot use stem cells from your body
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Hvis vi ikke kan bruge stamceller fra ens krop
15:04
then we'd like to use donor stem cells.
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så vil vi gerne bruge donor stamceller.
15:07
And we prefer cells that will not reject
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Og vi foretrækker celler der ikke vil afstødes
15:09
and will not form tumors.
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og ikke vil danne nogen svulster.
15:11
And we're working a lot with the stem cells that we
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Og vi arbejder meget med de stamceller som vi
15:13
published on two years ago,
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udgav om for to år siden,
15:15
stem cells from the amniotic fluid,
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stamceller fra fostervand,
15:17
and the placenta, which have those properties.
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og moderkagen, der har disse egenskaber.
15:21
So, at this point, I do want to tell you that
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Så, på dette tidspunkt, vil jeg fortælle jer at
15:24
some of the major challenges we have.
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nogle af de alvorlige udfordringer vi har.
15:28
You know, I just showed you this presentation, everything looks so good,
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I ved, jeg viste jer denne præsentation, alt ser så godt ud,
15:30
everything works. Actually no,
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alt virker. Faktisk ikke,
15:32
these technologies really are not that easy.
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disse teknologier er virkelig ikke så nemme.
15:34
Some of the work you saw today
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Noget af det arbejde I så i dag
15:36
was performed by over 700 researchers
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var udført af over 700 forskere
15:39
at our institute across a 20-year time span.
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ved vores institut i løbet af 20 år.
15:42
So, these are very tough technologies.
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Så, dette er meget vanskelige teknologier.
15:44
Once you get the formula right you can replicate it.
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Når først man gør det rigtigt med formlen kan man reproducere den.
15:47
But it takes a lot to get there.
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Men det kræver meget at nå dertil.
15:49
So, I always like to show this cartoon.
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Så, jeg viser altid denne vittighedstegning.
15:51
This is how to stop a runaway stage.
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Dette er hvordan man stopper en løbsk diligence.
15:53
And there you see the stagecoach driver,
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Og der kan man se diligence føreren,
15:55
and he goes, on the top panel,
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og han siger, i det øverste panel,
15:57
He goes A, B, C, D, E, F.
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Han siger, A, B, C, D, E, F.
15:59
He finally stops the runaway stage.
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Han stopper langt om længe diligencen.
16:01
And those are usually the basic scientists,
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Og det er for det meste de sædvanlige basis forskere,
16:04
The bottom is usually the surgeons.
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I bunden er det for det meste kirurgerne.
16:06
(Laughter)
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(Latter)
16:10
I'm a surgeon so that's not that funny.
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Jeg er kirurg, så så sjovt er det ikke.
16:12
(Laughter)
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(Latter)
16:13
But actually method A is the correct approach.
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Men faktisk er metode A den korrekte fremgangsmåde.
16:17
And what I mean by that is that anytime we've launched one of these technologies
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Og det jeg mener med det er, at hver gang vi er kommet med en af disse teknologier
16:20
to the clinic,
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til klinikken,
16:22
we've made absolutely sure that we do everything we can
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er vi helt sikre på at vi har gjort alt hvad vi kan
16:25
in the laboratory before we ever
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i laboratoriet, før vi nogensinde
16:27
launch these technologies to patients.
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lancerer disse teknologier til patienter.
16:29
And when we launch these technologies to patients
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Og når vi lancerer disse teknologier til patienter
16:31
we want to make sure that we ask ourselves a very tough question.
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vil vi være sikre på at vi stiller os selv et meget hårdt spørgsmål.
16:36
Are you ready to place this in your own loved one, your own child,
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Er du klar til at sætte dette i dine kære, dit eget barn,
16:39
your own family member, and then we proceed.
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dit eget familiemedlem, og så fortsætter vi.
16:42
Because our main goal, of course,
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Fordi vores primære mål, selvfølgelig,
16:44
is first, to do no harm.
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er først, ikke at skade nogen.
16:47
I'm going to show you now, a very short clip,
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Jeg vil nu vise jer, et meget kort klip,
16:49
It's a five second clip of a patient
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det er et fem sekunders klip af en patient
16:52
who received one of the engineered organs.
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der modtog et af de udviklede organer.
16:54
We started implanting some of these structures
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Vi begyndte at implementere nogle af disse strukturer
16:56
over 14 years ago.
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for mere end 14 år siden.
16:58
So, we have patients now walking around with organs,
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Så, vi har patienter der nu går rundt med disse organer,
17:00
engineered organs, for over 10 years, as well.
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udviklede organer, i mere end 10 år også.
17:04
I'm going to show a clip of one young lady.
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Jeg vil vise jer et klip af en ung dame.
17:06
She had a spina bifida defect, a spinal cord abnormality.
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Hun havde spina bifida, en rygmarvs abnormitet.
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She did not have a normal bladder. This is a segment from CNN.
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Hun havde ikke nogen normal blære. Dette er et klip fra CNN.
17:12
We are just taking five seconds.
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Det tager kun fem sekunder.
17:14
This is a segment that Sanjay Gupta actually took care of.
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Dette er et segment som Sanjay Gupta faktisk tog sig af.
17:19
Video: Kaitlyn M: I'm happy. I was always afraid
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Video: Kaitlyn M: Jeg er lykkelig. Jeg var altid bange
17:21
that I was going to have like, an accident or something.
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for at jeg kommer ud for noget, som en ulykke eller noget.
17:24
And now I can just go and
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Og nu kan jeg bare
17:27
go out with my friends,
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gå ud med venner,
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go do whatever I want.
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og gøre hvad jeg har lyst til.
17:32
Anthony Atala: See, at the end of the day, the promise of regenerative medicine
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Anthony Atala: Så, når alt kommer til alt, er løftet om regenererende medicin
17:35
is a single promise.
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et enkelt løfte.
17:37
And that is really very simple,
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Og det er virkelig meget simpelt,
17:40
to make our patients better.
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til at gøre vores patienter bedre.
17:42
Thank you for your attention.
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Tak for jeres opmærksomhed.
17:44
(Applause)
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(Bifald)
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