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Jocelyne Bloch: The brain may be able to repair itself -- with help
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Through treating everything from strokes to car accident traumas, neurosurgeon Jocelyne Bloch knows the brain's inability to repair itself all too well. But now, she suggests, she and her colleagues may have found the key to neural repair: Doublecortin-positive cells. Similar to stem cells, they are extremely adaptable and, when extracted from a brain, cultured and then re-injected in a lesioned area of the same brain, they can help repair and rebuild it. "With a little help," Bloch says, "the brain may be able to help itself."
Jocelyne Bloch - Functional neurosurgeon
Jocelyne Bloch is helping to unlock potential self-healing capacities of the human brain. Full bio
Jocelyne Bloch is helping to unlock potential self-healing capacities of the human brain. Full bio
Double-click the English transcript below to play the video.
00:12
So I'm a neurosurgeon.
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And like most of my colleagues,
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I have to deal, every day,
with human tragedies.
with human tragedies.
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I realize how your life can change
from one second to the other
from one second to the other
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after a major stroke
or after a car accident.
or after a car accident.
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And what is very frustrating
for us neurosurgeons
for us neurosurgeons
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is to realize that unlike
other organs of the body,
other organs of the body,
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the brain has very little
ability for self-repair.
ability for self-repair.
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And after a major injury
of your central nervous system,
of your central nervous system,
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the patients often remain
with a severe handicap.
with a severe handicap.
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And that's probably
the reason why I've chosen
the reason why I've chosen
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to be a functional neurosurgeon.
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What is a functional neurosurgeon?
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It's a doctor who is trying to improve
a neurological function
a neurological function
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through different surgical strategies.
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You've certainly heard of
one of the famous ones
one of the famous ones
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called deep brain stimulation,
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where you implant an electrode
in the depths of the brain
in the depths of the brain
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in order to modulate a circuit of neurons
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to improve a neurological function.
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It's really an amazing technology
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in that it has improved
the destiny of patients
the destiny of patients
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with Parkinson's disease,
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with severe tremor, with severe pain.
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However, neuromodulation
does not mean neuro-repair.
does not mean neuro-repair.
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And the dream of functional neurosurgeons
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is to repair the brain.
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I think
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that we are approaching this dream.
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And I would like to show you
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that we are very close to this.
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And that with a little bit of help,
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the brain is able to help itself.
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So the story started 15 years ago.
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At that time, I was a chief resident
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working days and nights
in the emergency room.
in the emergency room.
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I often had to take care
of patients with head trauma.
of patients with head trauma.
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You have to imagine that when a patient
comes in with a severe head trauma,
comes in with a severe head trauma,
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his brain is swelling
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and he's increasing
his intracranial pressure.
his intracranial pressure.
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And in order to save his life,
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you have to decrease
this intracranial pressure.
this intracranial pressure.
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And to do that,
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you sometimes have to remove
a piece of swollen brain.
a piece of swollen brain.
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So instead of throwing away
these pieces of swollen brain,
these pieces of swollen brain,
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we decided with Jean-François Brunet,
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who is a colleague of mine, a biologist,
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to study them.
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What do I mean by that?
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We wanted to grow cells
from these pieces of tissue.
from these pieces of tissue.
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It's not an easy task.
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Growing cells from a piece of tissue
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is a bit the same as growing
very small children
very small children
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out from their family.
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So you need to find the right nutrients,
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the warmth, the humidity
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and all the nice environments
to make them thrive.
to make them thrive.
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So that's exactly what we had
to do with these cells.
to do with these cells.
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And after many attempts,
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Jean-François did it.
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And that's what he saw
under his microscope.
under his microscope.
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And that was, for us, a major surprise.
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Why?
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Because this looks exactly the same
as a stem cell culture,
as a stem cell culture,
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with large green cells
surrounding small, immature cells.
surrounding small, immature cells.
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And you may remember from biology class
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that stem cells are immature cells,
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able to turn into any type
of cell of the body.
of cell of the body.
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The adult brain has stem cells,
but they're very rare
but they're very rare
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and they're located
in deep and small niches
in deep and small niches
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in the depths of the brain.
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So it was surprising to get
this kind of stem cell culture
this kind of stem cell culture
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from the superficial part
of swollen brain we had
of swollen brain we had
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in the operating theater.
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And there was another
intriguing observation:
intriguing observation:
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Regular stem cells
are very active cells --
are very active cells --
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cells that divide, divide,
divide very quickly.
divide very quickly.
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And they never die,
they're immortal cells.
they're immortal cells.
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But these cells behave differently.
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They divide slowly,
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and after a few weeks of culture,
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they even died.
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So we were in front of a strange
new cell population
new cell population
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that looked like stem cells
but behaved differently.
but behaved differently.
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And it took us a long time
to understand where they came from.
to understand where they came from.
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They come from these cells.
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These blue and red cells are called
doublecortin-positive cells.
doublecortin-positive cells.
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All of you have them in your brain.
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They represent four percent
of your cortical brain cells.
of your cortical brain cells.
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They have a very important role
during the development stage.
during the development stage.
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When you were fetuses,
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they helped your brain to fold itself.
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But why do they stay in your head?
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This, we don't know.
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We think that they may
participate in brain repair
participate in brain repair
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because we find them
in higher concentration
in higher concentration
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close to brain lesions.
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But it's not so sure.
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But there is one clear thing --
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that from these cells,
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we got our stem cell culture.
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And we were in front
of a potential new source of cells
of a potential new source of cells
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to repair the brain.
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And we had to prove this.
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So to prove it,
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we decided to design
an experimental paradigm.
an experimental paradigm.
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The idea was to biopsy a piece of brain
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in a non-eloquent area of the brain,
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and then to culture the cells
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exactly the way Jean-François
did it in his lab.
did it in his lab.
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And then label them, to put color in them
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in order to be able
to track them in the brain.
to track them in the brain.
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And the last step was to re-implant them
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in the same individual.
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We call these
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autologous grafts -- autografts.
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So the first question we had,
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"What will happen if we re-implant
these cells in a normal brain,
these cells in a normal brain,
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and what will happen
if we re-implant the same cells
if we re-implant the same cells
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in a lesioned brain?"
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Thanks to the help
of professor Eric Rouiller,
of professor Eric Rouiller,
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we worked with monkeys.
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So in the first-case scenario,
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we re-implanted the cells
in the normal brain
in the normal brain
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and what we saw is that they completely
disappeared after a few weeks,
disappeared after a few weeks,
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as if they were taken from the brain,
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they go back home,
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the space is already busy,
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they are not needed there,
so they disappear.
so they disappear.
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In the second-case scenario,
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we performed the lesion,
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we re-implanted exactly the same cells,
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and in this case, the cells remained --
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and they became mature neurons.
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And that's the image of what
we could observe under the microscope.
we could observe under the microscope.
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Those are the cells
that were re-implanted.
that were re-implanted.
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And the proof they carry,
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these little spots, those
are the cells that we've labeled
are the cells that we've labeled
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in vitro, when they were in culture.
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But we could not stop here, of course.
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Do these cells also help a monkey
to recover after a lesion?
to recover after a lesion?
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So for that, we trained monkeys
to perform a manual dexterity task.
to perform a manual dexterity task.
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They had to retrieve
food pellets from a tray.
food pellets from a tray.
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They were very good at it.
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And when they had reached
a plateau of performance,
a plateau of performance,
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we did a lesion in the motor cortex
corresponding to the hand motion.
corresponding to the hand motion.
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So the monkeys were plegic,
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they could not move their hand anymore.
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And exactly the same as humans would do,
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they spontaneously recovered
to a certain extent,
to a certain extent,
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exactly the same as after a stroke.
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Patients are completely plegic,
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and then they try to recover
due to a brain plasticity mechanism,
due to a brain plasticity mechanism,
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they recover to a certain extent,
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exactly the same for the monkey.
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So when we were sure that the monkey
had reached his plateau
had reached his plateau
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of spontaneous recovery,
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we implanted his own cells.
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So on the left side, you see the monkey
that has spontaneously recovered.
that has spontaneously recovered.
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He's at about 40 to 50 percent
of his previous performance
of his previous performance
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before the lesion.
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He's not so accurate, not so quick.
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And look now, when we re-impant the cells:
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Two months after re-implantation,
the same individual.
the same individual.
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(Applause)
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It was also very exciting results
for us, I tell you.
for us, I tell you.
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Since that time, we've understood
much more about these cells.
much more about these cells.
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We know that we can cryopreserve them,
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we can use them later on.
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We know that we can apply them
in other neuropathological models,
in other neuropathological models,
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like Parkinson's disease, for example.
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But our dream is still
to implant them in humans.
to implant them in humans.
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And I really hope that I'll be able
to show you soon
to show you soon
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that the human brain is giving us
the tools to repair itself.
the tools to repair itself.
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Thank you.
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(Applause)
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Bruno Giussani: Jocelyne, this is amazing,
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and I'm sure that right now, there are
several dozen people in the audience,
several dozen people in the audience,
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possibly even a majority,
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who are thinking, "I know
somebody who can use this."
somebody who can use this."
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I do, in any case.
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And of course the question is,
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what are the biggest obstacles
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before you can go
into human clinical trials?
into human clinical trials?
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Jocelyne Bloch: The biggest
obstacles are regulations. (Laughs)
obstacles are regulations. (Laughs)
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So, from these exciting results,
you need to fill out
you need to fill out
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about two kilograms of papers and forms
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to be able to go through these
kind of trials.
kind of trials.
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BG: Which is understandable,
the brain is delicate, etc.
the brain is delicate, etc.
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JB: Yes, it is, but it takes a long time
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and a lot of patience and almost
a professional team to do it, you know?
a professional team to do it, you know?
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BG: If you project yourself --
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having done the research
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and having tried to get
permission to start the trials,
permission to start the trials,
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if you project yourself out in time,
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how many years before
somebody gets into a hospital
somebody gets into a hospital
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and this therapy is available?
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JB: So, it's very difficult to say.
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It depends, first,
on the approval of the trial.
on the approval of the trial.
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Will the regulation allow us
to do it soon?
to do it soon?
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And then, you have to perform
this kind of study
this kind of study
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in a small group of patients.
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So it takes, already, a long time
to select the patients,
to select the patients,
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do the treatment
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and evaluate if it's useful
to do this kind of treatment.
to do this kind of treatment.
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And then you have to deploy
this to a multicentric trial.
this to a multicentric trial.
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You have to really prove
first that it's useful
first that it's useful
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before offering this treatment
up for everybody.
up for everybody.
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BG: And safe, of course. JB: Of course.
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BG: Jocelyne, thank you for coming
to TED and sharing this.
to TED and sharing this.
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BG: Thank you.
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(Applause)
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ABOUT THE SPEAKER
Jocelyne Bloch - Functional neurosurgeonJocelyne Bloch is helping to unlock potential self-healing capacities of the human brain.
Why you should listen
Swiss neurosurgeon Jocelyne Bloch is an expert in deep brain stimulation and neuromodulation for movement disorders. Her recent work focuses on cortical cells, called doublecortin, related to neurogenesis and brain repair. In collaboration with Jean François Brunet and others, she is pioneering the development of adult brain cell transplantation for patients with stroke, using their own stem cells. She aims at gathering all these novel therapeutic strategies under a common umbrella that will optimize treatment options for patients suffering from neurological impairments. She is in charge of the functional neurosurgery unit at the Lausanne University Hospital (CHUV).
Jocelyne Bloch | Speaker | TED.com