ABOUT THE SPEAKER
Jocelyne Bloch - Functional neurosurgeon
Jocelyne 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).

More profile about the speaker
Jocelyne Bloch | Speaker | TED.com
TEDGlobal>Geneva

Jocelyne Bloch: The brain may be able to repair itself -- with help

Jocelyne Bloch: Pode que o cerebro sexa quen de repararse a si mesmo... con axuda.

Filmed:
3,127,181 views

A través do tratamento de todo tipo de lesións, desde as provocadas por embolias cerebrais ata as causadas por accidentes de automóbil, a neurocirurxiá Jocelyne Bloch coñece moi ben a incapacidade do cerebro para repararse a si mesmo. Pero agora, ela suxire que, xunto cos seus colegas, quizais atoparon a clave da neurorreparación: as células positivas á doblecortina. Parecidas ás células nai, son extremadamente adaptables e, cando se extraen do cerebro, se cultivan e se reimplantan nunha área lesionada do mesmo cerebro, poden axudar a reparalo e reconstruílo. "Cunha pouca axuda", afirma Bloch, "o cerebro podería ser capaz de repararse a si mesmo".
- Functional neurosurgeon
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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Son neurocirurxiá
00:15
And like most of my colleagues,
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e coma moitos dos meus colegas
00:17
I have to deal, every day,
with human tragedies.
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teño que tratar a cotío
con traxedias humanas.
00:22
I realize how your life can change
from one second to the other
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Doume conta de como a túa vida
pode cambiar nun segundo
00:27
after a major stroke
or after a car accident.
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tras unha embolia cerebral
ou un accidente de coche.
00:32
And what is very frustrating
for us neurosurgeons
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Faise moi frustrante para nós
como neurocirurxiáns
00:35
is to realize that unlike
other organs of the body,
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constatar que ao contrario
que outros órganos do corpo,
00:40
the brain has very little
ability for self-repair.
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o cerebro ten moi pouca
capacidade para autorrepararse.
00:45
And after a major injury
of your central nervous system,
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Despois dunha lesión grave
do sistema nervioso central
00:50
the patients often remain
with a severe handicap.
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os pacientes polo xeral fican
con secuelas graves.
00:55
And that's probably
the reason why I've chosen
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Esa é probablemente
a razón pola que decidín
00:57
to be a functional neurosurgeon.
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ser neurociruxián funcional.
01:01
What is a functional neurosurgeon?
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Que é un neurocirurxián funcional?
01:03
It's a doctor who is trying to improve
a neurological function
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É un doutor que intenta mellorar
unha función neurolóxica
01:08
through different surgical strategies.
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ao través de diferentes
técnicas cirúrxicas.
01:12
You've certainly heard of
one of the famous ones
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Seguramente escoitaron falar
dunha moi coñecida
01:14
called deep brain stimulation,
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chamada estimulación cerebral profunda,
01:17
where you implant an electrode
in the depths of the brain
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na cal implantamos un eléctrodo
no interior do cerebro
01:21
in order to modulate a circuit of neurons
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para modular un circuíto neuronal
01:24
to improve a neurological function.
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que mellore unha función neurolóxica.
01:27
It's really an amazing technology
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É unha tecnoloxía asombrosa
01:29
in that it has improved
the destiny of patients
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que está a mellorar
as probabilidades dos pacientes
01:32
with Parkinson's disease,
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coa enfermidade de Párkinson,
01:34
with severe tremor, with severe pain.
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con fortes tremores, con moita dor.
01:38
However, neuromodulation
does not mean neuro-repair.
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De calquera xeito, a neuromodulación
non quere dicir neurorreparación.
01:45
And the dream of functional neurosurgeons
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O soño dos neurocirurxiáns funcionais
01:47
is to repair the brain.
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e reparar o cerebro.
01:51
I think
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Penso
01:52
that we are approaching this dream.
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que estamos achegándonos a este soño.
01:54
And I would like to show you
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Gustaríame mostrarvos
01:57
that we are very close to this.
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que estamos moi preto disto.
02:00
And that with a little bit of help,
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Como cunha pequena axuda,
02:03
the brain is able to help itself.
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o cerebro é quen de repararse a si mesmo.
02:08
So the story started 15 years ago.
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Esta historia comezou hai 15 anos.
02:11
At that time, I was a chief resident
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Daquela, eu era xefa de residentes
02:13
working days and nights
in the emergency room.
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e pasaba días e días
nas salas de urxencias
02:16
I often had to take care
of patients with head trauma.
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A miúdo tiña que ocuparme
de pacientes con traumas na cabeza
02:21
You have to imagine that when a patient
comes in with a severe head trauma,
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Podedes imaxinar que cando un paciente
vén cun trauma grave na cabeza,
02:25
his brain is swelling
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o seu cerebro inflámase
02:28
and he's increasing
his intracranial pressure.
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e auméntalle
a presión intracranial.
02:31
And in order to save his life,
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Para salvar a súa vida,
02:33
you have to decrease
this intracranial pressure.
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tes que diminuír
esa presión intracranial,
02:36
And to do that,
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e para facer iso,
02:37
you sometimes have to remove
a piece of swollen brain.
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ás veces tiñamos que extraer
un anaco de cerebro inflamado
02:42
So instead of throwing away
these pieces of swollen brain,
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No canto de tirar eses anacos
02:46
we decided with Jean-François Brunet,
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decidimos, xunto con Jean-François Brunet,
02:49
who is a colleague of mine, a biologist,
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que é un colega meu, biólogo,
02:51
to study them.
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estudalos.
02:53
What do I mean by that?
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Que quero dicir?
02:55
We wanted to grow cells
from these pieces of tissue.
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Quixemos cultivar células
obtidas deses anacos de tecido.
03:00
It's not an easy task.
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Non é unha tarefa sinxela.
03:02
Growing cells from a piece of tissue
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Cultivar células dun anaco de tecido
03:04
is a bit the same as growing
very small children
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é case coma criar meniños pequerrechos
03:08
out from their family.
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lonxe das súas familias.
03:11
So you need to find the right nutrients,
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Así que necesitas atopar
os nutrientes adecuados,
03:14
the warmth, the humidity
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a temperatura, a humidade
03:15
and all the nice environments
to make them thrive.
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e os ambientes adecuados
para que saian adiante.
03:19
So that's exactly what we had
to do with these cells.
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Iso foi exactamente o que
fixemos con esas células.
03:22
And after many attempts,
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Despois de moitos intentos,
03:24
Jean-François did it.
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Jean-François conseguiuno.
03:27
And that's what he saw
under his microscope.
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Isto foi o que vimos
baixo o seu microscopio.
03:31
And that was, for us, a major surprise.
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E foi, para nós, unha gran sorpresa.
03:34
Why?
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Por que?
03:35
Because this looks exactly the same
as a stem cell culture,
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Porque parecía o mesmiño
ca un cultivo de células nai,
03:40
with large green cells
surrounding small, immature cells.
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con células grandes e verdes, arredor
das células pequenas e inmaturas.
03:47
And you may remember from biology class
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Lembraredes da clase de bioloxía
03:50
that stem cells are immature cells,
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que esas células nai
son células inmaturas,
03:53
able to turn into any type
of cell of the body.
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capaces de transformarse en
calquera célula do corpo.
03:59
The adult brain has stem cells,
but they're very rare
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O cerebro adulto ten células nai,
pero son moi escasas
04:04
and they're located
in deep and small niches
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e atópanse en profundas
e pequenas áreas
04:08
in the depths of the brain.
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do interior do cerebro.
04:10
So it was surprising to get
this kind of stem cell culture
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Foi sorprendente obter
esta clase de cultivos de células nai
04:14
from the superficial part
of swollen brain we had
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provenientes de fragmentos
de cerebro que conseguimos
04:16
in the operating theater.
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no quirófano.
04:18
And there was another
intriguing observation:
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Alí había outro
achado intrigante:
04:21
Regular stem cells
are very active cells --
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polo xeral as células nai son
células moi activas--
04:26
cells that divide, divide,
divide very quickly.
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células que se dividen,
dividen e dividen moi rápido.
04:30
And they never die,
they're immortal cells.
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Elas nunca morren,
son células inmortais.
Pero estas células eran diferentes
04:33
But these cells behave differently.
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04:36
They divide slowly,
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Elas dividíanse de vagar,
04:38
and after a few weeks of culture,
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e despois dunhas
semanas de cultivo,
04:40
they even died.
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sempre morrían.
04:43
So we were in front of a strange
new cell population
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Atopabámonos fronte a unha
estraña nova poboación celular
04:46
that looked like stem cells
but behaved differently.
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semellante ás células nai
pero cun comportamento distinto.
04:51
And it took us a long time
to understand where they came from.
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E levounos bastante tempo comprender
de onde proviñan.
04:55
They come from these cells.
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Proveñen destas células.
04:58
These blue and red cells are called
doublecortin-positive cells.
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Esas células azuis e encarnadas son
células positivas á doblecortina.
05:04
All of you have them in your brain.
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Todos vós as tedes no voso cerebro.
05:07
They represent four percent
of your cortical brain cells.
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Representan o catro por cento das vosas
células corticais cerebrais.
05:11
They have a very important role
during the development stage.
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Xogan un papel moi importante durante
o estadio de desenvolvemento.
05:15
When you were fetuses,
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Cando erades fetos,
05:18
they helped your brain to fold itself.
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axudáronlle ao voso cerebro
a formar as circunvolucións.
05:22
But why do they stay in your head?
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Pero por que seguen na vosa cabeza?
05:25
This, we don't know.
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Iso non o sabemos.
05:27
We think that they may
participate in brain repair
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Cremos que poden intervir
na reparación cerebral
05:30
because we find them
in higher concentration
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porque nós atopámolas
en concentracións máis altas
preto de lesións cerebrais.
05:34
close to brain lesions.
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05:35
But it's not so sure.
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Pero non é seguro.
05:37
But there is one clear thing --
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Porén, unha cousa está clara...
05:40
that from these cells,
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grazas a estas células,
05:41
we got our stem cell culture.
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nós tivemos o noso cultivo de células nai.
05:45
And we were in front
of a potential new source of cells
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Estabamos fronte a unha
posible fonte de células
05:48
to repair the brain.
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para reparar o cerebro.
05:50
And we had to prove this.
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e tiñamos que demostralo.
05:51
So to prove it,
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Así que para demostralo,
05:52
we decided to design
an experimental paradigm.
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decidimos deseñar
un paradigma experimental.
05:56
The idea was to biopsy a piece of brain
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A idea foi biopsiar un anaco de cerebro
05:59
in a non-eloquent area of the brain,
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nunha parte non esencial do cerebro,
06:02
and then to culture the cells
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e despois cultivar as células
06:04
exactly the way Jean-François
did it in his lab.
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do mesmo xeito que Jean-François
fixera no seu laboratorio.
06:07
And then label them, to put color in them
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E despois etiquetalas, colorealas
06:10
in order to be able
to track them in the brain.
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de xeito que fósemos capaces
de rastrexalas no cerebro.
06:13
And the last step was to re-implant them
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O derradeiro paso sería reimplantalas
06:15
in the same individual.
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no mesmo individuo.
06:17
We call these
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Nós chamámoslle a isto
06:18
autologous grafts -- autografts.
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enxertos autólogos -- autoenxertos.
06:21
So the first question we had,
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A primeira pregunta que nos fixemos foi:
06:24
"What will happen if we re-implant
these cells in a normal brain,
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"Que ocorrería se reimplantásemos
esas células nun cerebro normal,
06:29
and what will happen
if we re-implant the same cells
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e que ocorrería se as
reimplantásemos
06:32
in a lesioned brain?"
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nun cerebro lesionado?"
06:33
Thanks to the help
of professor Eric Rouiller,
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Grazas a axuda
do profesor Eric Rouiller,
06:36
we worked with monkeys.
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traballamos con monos.
06:39
So in the first-case scenario,
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No primeiro suposto,
06:41
we re-implanted the cells
in the normal brain
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reimplantamos as células
nun cerebro san
06:45
and what we saw is that they completely
disappeared after a few weeks,
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e o que vimos foi que desapareceran
por completo ás poucas semanas
06:50
as if they were taken from the brain,
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coma se fosen sacadas do cerebro,
06:53
they go back home,
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volveron á casa,
06:54
the space is already busy,
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o lugar xa estaba ocupado,
06:56
they are not needed there,
so they disappear.
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alí non eran necesarias,
así que desapareceron.
06:59
In the second-case scenario,
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No segundo suposto,
07:01
we performed the lesion,
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nós recreamos a lesión,
07:03
we re-implanted exactly the same cells,
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reimplantamos exactamente
as mesmas células,
07:06
and in this case, the cells remained --
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e neste caso, as células permaneceron...
07:10
and they became mature neurons.
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e convertéronse en neuronas maduras.
07:13
And that's the image of what
we could observe under the microscope.
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Esta foi a imaxe que nós
puidemos observar baixo o microscopio
07:17
Those are the cells
that were re-implanted.
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Estas son as células
que reimplantáramos.
07:20
And the proof they carry,
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A proba que portan,
07:22
these little spots, those
are the cells that we've labeled
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estas pequenas manchas, esas
son as células que nos etiquetamos
07:26
in vitro, when they were in culture.
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in vitro, cando elas estaban no cultivo.
07:29
But we could not stop here, of course.
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Non nos detivemos aí, por suposto.
07:32
Do these cells also help a monkey
to recover after a lesion?
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Poderían esas células tamén axudarlle a
un mono a recuperarse tras unha lesión?
07:37
So for that, we trained monkeys
to perform a manual dexterity task.
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Para isto, adestramos os monos
para dominar unha tarefa manual.
07:42
They had to retrieve
food pellets from a tray.
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Tiñan que tirar
boliñas de comida dunha bandexa.
07:45
They were very good at it.
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Facíano moi ben.
07:47
And when they had reached
a plateau of performance,
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Cando alcanzaron
unha certa habilidade,
07:51
we did a lesion in the motor cortex
corresponding to the hand motion.
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causámoslles unha lesión no córtex motor
correspondente ao control da man.
07:57
So the monkeys were plegic,
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De xeito que os monos quedaron eivados,
07:59
they could not move their hand anymore.
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xa non eran quen de mover a man.
08:02
And exactly the same as humans would do,
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Igual que ocorrería nos seres humanos,
08:05
they spontaneously recovered
to a certain extent,
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recuperáronse espontaneamente
ata certo nivel,
08:08
exactly the same as after a stroke.
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igualiño ca despois
dunha embolia cerebral.
08:10
Patients are completely plegic,
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Pacientes totalmente eivados,
08:12
and then they try to recover
due to a brain plasticity mechanism,
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que intentan recuperarse grazas
ao mecanismo de plasticidade cerebral,
08:17
they recover to a certain extent,
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facéndoo ata un certo nivel,
08:19
exactly the same for the monkey.
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exactamente o mesmo para os monos.
08:21
So when we were sure that the monkey
had reached his plateau
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Entón, cando nos aseguramos que os monos
alcanzaran o seu límite
08:24
of spontaneous recovery,
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de recuperación espontánea,
08:27
we implanted his own cells.
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reimplantámoslles as súas propias células,
08:30
So on the left side, you see the monkey
that has spontaneously recovered.
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No lado esquerdo, vese o mono
que se recuperou espontaneamente.
08:37
He's at about 40 to 50 percent
of his previous performance
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Isto é arredor do 40 ao 50 por cento
da súa destreza
08:42
before the lesion.
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previa á lesión.
Non é moi preciso, nin moi rápido.
08:44
He's not so accurate, not so quick.
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08:47
And look now, when we re-impant the cells:
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Mirade agora, ao reimplantar as células,
08:50
Two months after re-implantation,
the same individual.
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dous meses despois da reimplantación,
o mesmo individuo.
08:57
(Applause)
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(Aplausos)
09:04
It was also very exciting results
for us, I tell you.
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Foron uns resultados moi emocionantes
para nós, en serio.
09:09
Since that time, we've understood
much more about these cells.
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Dende ese intre, nós comprendemos
moito mellor estas células.
09:13
We know that we can cryopreserve them,
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Sabemos que podemos criopreservalas,
09:15
we can use them later on.
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para empregalas máis adiante.
09:18
We know that we can apply them
in other neuropathological models,
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Sabemos que podemos empregalas
noutros modelos neuropatolóxicos,
09:22
like Parkinson's disease, for example.
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coma a enfermidade de Párkinson.
09:24
But our dream is still
to implant them in humans.
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Pero o noso soño é aínda
implantalas nos humanos.
09:28
And I really hope that I'll be able
to show you soon
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Eu teño a esperanza de sermos quen
de mostrarvos axiña
09:33
that the human brain is giving us
the tools to repair itself.
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que o cerebro humano estanos a dar
as ferramentas para autorrepararse.
09:38
Thank you.
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Grazas.
09:39
(Applause)
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(Aplausos)
09:45
Bruno Giussani: Jocelyne, this is amazing,
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Bruno Giussani: Jocelyne,
isto é asombroso.
09:49
and I'm sure that right now, there are
several dozen people in the audience,
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Estou seguro de que agora mesmo,
hai ducias de persoas no público
09:53
possibly even a majority,
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posiblemente a maioría,
09:54
who are thinking, "I know
somebody who can use this."
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que están a pensar,"Eu sei de
alguén que pode usar isto."
09:57
I do, in any case.
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Eu estou, desde logo.
09:59
And of course the question is,
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E por suposto a pregunta é:
10:01
what are the biggest obstacles
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cales son os maiores obstáculos
10:03
before you can go
into human clinical trials?
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antes de que poidas facer
ensaios clínicos en humanos?
10:07
Jocelyne Bloch: The biggest
obstacles are regulations. (Laughs)
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Jocelyne Bloch: Os meirandes obstáculos
son as regulacións. (Risos)
10:13
So, from these exciting results,
you need to fill out
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Así que, a partir destes bos resultados,
necesitas obter
10:15
about two kilograms of papers and forms
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arredor de dous kg de papeis e formularios
10:19
to be able to go through these
kind of trials.
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para ser quen de desenvolver
este tipo de ensaios.
10:22
BG: Which is understandable,
the brain is delicate, etc.
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BG: O cal é comprensible,
o cerebro é delicado, etc.
10:24
JB: Yes, it is, but it takes a long time
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JB: Si, así é, pero cómpre moito tempo
10:27
and a lot of patience and almost
a professional team to do it, you know?
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e moita paciencia e case un equipo
profesional para facelo, sabes.
BG: Se te imaxinas a ti mesma...
10:31
BG: If you project yourself --
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despois da investigación,
10:33
having done the research
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10:34
and having tried to get
permission to start the trials,
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intentando obter os permisos
para comezar os ensaios,
10:38
if you project yourself out in time,
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se te proxectas a ti mesma no tempo,
10:42
how many years before
somebody gets into a hospital
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cantos anos pasarán antes de que
alguén chegue a un hospital
10:46
and this therapy is available?
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e dispoña desta terapia?
10:49
JB: So, it's very difficult to say.
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JB: Isto é moi difícil de dicir.
10:51
It depends, first,
on the approval of the trial.
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Depende, primeio,
da aprobación do ensaio.
10:55
Will the regulation allow us
to do it soon?
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Permitiránolo a regulación
de aquí a pouco?
10:58
And then, you have to perform
this kind of study
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Despois, tes que preparar
este tipo de estudo
11:01
in a small group of patients.
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nun pequeno grupo de pacientes.
11:04
So it takes, already, a long time
to select the patients,
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Vai levar, seguro, moito tempo
seleccionar os pacientes,
11:07
do the treatment
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facer o tratamento
11:09
and evaluate if it's useful
to do this kind of treatment.
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e avaliar se é axeitado
empregar esta clase de tratamento.
11:13
And then you have to deploy
this to a multicentric trial.
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E despois haberá que desenvolver isto
nun ensaio multicéntrico.
11:17
You have to really prove
first that it's useful
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Primeiro haberá que demostrar realmente
que é útil
11:21
before offering this treatment
up for everybody.
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antes de ofrecerlle este tratamento
para todo o mundo
BG: E seguro, por suposto.
JB: Por suposto.
11:24
BG: And safe, of course. JB: Of course.
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11:26
BG: Jocelyne, thank you for coming
to TED and sharing this.
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BG: Jocelyne, grazas por vir a TED
e contarnos isto.
JB: Grazas.
11:29
BG: Thank you.
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(Aplausos)
11:30
(Applause)
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ABOUT THE SPEAKER
Jocelyne Bloch - Functional neurosurgeon
Jocelyne 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).

More profile about the speaker
Jocelyne Bloch | Speaker | TED.com