TED2015
Siddhartha Mukherjee: Soon we'll cure diseases with a cell, not a pill
Siddhartha Mukherjee: Kmalu bomo zdravili s celicami, ne s tabletami
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Današnja zdravljenja lahko povzamemo v šestih besedah: biti bolan, vzeti tableto, nekaj ubiti. Ampak zdravnik Siddhartha Mukherjee nam pokaže bodočnost medicine, ki bo spremenila način zdravljenja.
Siddhartha Mukherjee - Cancer physician and writer
When he’s not ferreting out the links between stem cells and malignant blood disease, Siddhartha Mukherjee writes and lectures on the history (and future) of medicine. Full bio
When he’s not ferreting out the links between stem cells and malignant blood disease, Siddhartha Mukherjee writes and lectures on the history (and future) of medicine. Full bio
Double-click the English transcript below to play the video.
00:12
I want to talk to you
about the future of medicine.
about the future of medicine.
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Rad bi vam govoril o prihodnosti medicine.
00:16
But before I do that, I want to talk
a little bit about the past.
a little bit about the past.
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Ampak prej bi rad govoril
malo o preteklosti.
malo o preteklosti.
00:21
Now, throughout much
of the recent history of medicine,
of the recent history of medicine,
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Skozi večji del nedavne zgodovine medicine
00:24
we've thought about illness and treatment
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smo o bolezni in zdravljenju
00:28
in terms of a profoundly simple model.
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razmišljali na zelo preprost način.
00:31
In fact, the model is so simple
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Dejansko, tako preprosto
00:34
that you could summarize it in six words:
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da lahko povzamemo v šestih besedah:
00:37
have disease, take pill, kill something.
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biti bolan, vzeti tableto, nekaj ubiti.
00:43
Now, the reason
for the dominance of this model
for the dominance of this model
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Razlog za prevlado tega modela
00:47
is of course the antibiotic revolution.
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je seveda antibiotska revolucija.
00:50
Many of you might not know this,
but we happen to be celebrating
but we happen to be celebrating
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Veliko vas najbrž ne ve,
ampak slučajno praznujemo
ampak slučajno praznujemo
00:53
the hundredth year of the introduction
of antibiotics into the United States.
of antibiotics into the United States.
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stoletnico uvedbe antibiotikov
v Združenih Državah.
v Združenih Državah.
00:57
But what you do know
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A kar veste je,
00:59
is that that introduction
was nothing short of transformative.
was nothing short of transformative.
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da je ta uvedba pomenila
pravo preobrazbo.
pravo preobrazbo.
01:04
Here you had a chemical,
either from the natural world
either from the natural world
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Imeli smo kemikalijo, naravno
01:08
or artificially synthesized
in the laboratory,
in the laboratory,
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ali umetno sintetizirano v laboratoriju,
01:11
and it would course through your body,
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in ta bi potovala po vašem telesu,
našla svoj cilj
01:14
it would find its target,
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01:17
lock into its target --
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se nanj pritrdila--
01:19
a microbe or some part of a microbe --
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neki mikrob ali delec mikroba--
01:21
and then turn off a lock and a key
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in potem bi zaklenila
ključavnico s ključem
ključavnico s ključem
01:25
with exquisite deftness,
exquisite specificity.
exquisite specificity.
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zelo spretno, zelo točno.
01:29
And you would end up taking
a previously fatal, lethal disease --
a previously fatal, lethal disease --
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Tako smo imeli neko prej smrtno bolezen
01:33
a pneumonia, syphilis, tuberculosis --
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--pljučnico, sifilis, tuberkulozo--
01:37
and transforming that
into a curable, or treatable illness.
into a curable, or treatable illness.
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in jo spremenili v ozdravljivo bolezen.
01:42
You have a pneumonia,
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Imaš pljučnico,
01:44
you take penicillin,
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vzameš penicilin,
01:45
you kill the microbe
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ubiješ mikrobe
01:47
and you cure the disease.
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in pozdraviš to bolezen.
01:49
So seductive was this idea,
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Tako zapeljiva je bila ta ideja,
01:52
so potent the metaphor of lock and key
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tako močna metafora ključavnice in ključa,
01:56
and killing something,
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in nekaj ubiti,
01:58
that it really swept through biology.
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da je prišla v biologijo.
02:00
It was a transformation like no other.
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Je bila sprememba brez primere.
02:04
And we've really spent the last 100 years
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Tako smo preživeli zadnjih 100 let,
02:07
trying to replicate that model
over and over again
over and over again
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da smo skušali replicirati
ta model vedno znova
ta model vedno znova
pri nenalezljivih boleznih,
02:10
in noninfectious diseases,
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02:12
in chronic diseases like diabetes
and hypertension and heart disease.
and hypertension and heart disease.
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pri kroničnih boleznih, kot so diabetes,
hipertenzija in srčna bolezen.
hipertenzija in srčna bolezen.
02:17
And it's worked,
but it's only worked partly.
but it's only worked partly.
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In delovalo je, a samo delno.
02:21
Let me show you.
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Vam bom pokazal.
02:22
You know, if you take the entire universe
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Veste, če vzamemo celoto
02:25
of all chemical reactions
in the human body,
in the human body,
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vseh kemičnih reakcij v človeškem telesu,
02:29
every chemical reaction
that your body is capable of,
that your body is capable of,
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vsako možno kemično reakcijo
v človeškem telesu,
v človeškem telesu,
02:32
most people think that that number
is on the order of a million.
is on the order of a million.
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večina ljudi misli, da ta številka
je okoli en milijon.
je okoli en milijon.
Recimo da je en milijon.
02:35
Let's call it a million.
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02:36
And now you ask the question,
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Sedaj vprašate
02:38
what number or fraction of reactions
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kakšno je število teh reakcij,
02:41
can actually be targeted
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ki res lahko postanejo cilj
02:43
by the entire pharmacopoeia,
all of medicinal chemistry?
all of medicinal chemistry?
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v vsej farmakopeji,
vsej farmacevtski kemiji?
vsej farmacevtski kemiji?
02:48
That number is 250.
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To število je 250.
02:51
The rest is chemical darkness.
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Ostalo je kemična tema.
02:54
In other words, 0.025 percent
of all chemical reactions in your body
of all chemical reactions in your body
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Z drugimi besedami, 0,025 % vseh
kemičnih reakcij v vašem telesu
kemičnih reakcij v vašem telesu
03:00
are actually targetable
by this lock and key mechanism.
by this lock and key mechanism.
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lahko postane tarča tega
mehanizma ključavnice in ključa.
mehanizma ključavnice in ključa.
03:05
You know, if you think
about human physiology
about human physiology
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Če razmišljate o človeški fiziologiji
03:08
as a vast global telephone network
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kot o nekem velikem telefonskem omrežju
03:12
with interacting nodes
and interacting pieces,
and interacting pieces,
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s povezanimi vozliči in kosi
03:16
then all of our medicinal chemistry
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potem vsa naša farmacevtska kemija
03:19
is operating on one tiny corner
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deluje v majhnem kotu
03:22
at the edge, the outer edge,
of that network.
of that network.
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na robu, zunanjem robu tega omrežja.
03:24
It's like all of our
pharmaceutical chemistry
pharmaceutical chemistry
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Kot, da je vsa naša farmacevtska kemija
03:28
is a pole operator in Wichita, Kansas
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neki delavec v Wichita, Kansasu
03:32
who is tinkering with about
10 or 15 telephone lines.
10 or 15 telephone lines.
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in nadzoruje 10 ali 15 telefonskih linij.
03:36
So what do we do about this idea?
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Kaj naredimo s to idejo?
03:40
What if we reorganized this approach?
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Kaj, če preuredimo ta pristop?
03:44
In fact, it turns out
that the natural world
that the natural world
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Izkaže se, da nam narava
03:47
gives us a sense of how one
might think about illness
might think about illness
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pokaže smer, kako bi lahko
premišljevali o bolezni
premišljevali o bolezni
03:52
in a radically different way,
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na zelo drugačen način,
03:54
rather than disease, medicine, target.
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namesto bolezen-zdravilo- tarča.
03:59
In fact, the natural world
is organized hierarchically upwards,
is organized hierarchically upwards,
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Narava je urejena hierarhično navzgor,
04:02
not downwards, but upwards,
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ne navzdol, ampak navzgor.
04:04
and we begin with a self-regulating,
semi-autonomous unit called a cell.
semi-autonomous unit called a cell.
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in začnemo s samoregulativno,
deloma neodvisno enoto, imenovano celica.
deloma neodvisno enoto, imenovano celica.
04:11
These self-regulating,
semi-autonomous units
semi-autonomous units
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Te samoregulativne,
deloma samostojne enote
deloma samostojne enote
04:14
give rise to self-regulating,
semi-autonomous units called organs,
semi-autonomous units called organs,
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naredijo samoregulativne,
deloma samostojne enote -- organe,
deloma samostojne enote -- organe,
04:19
and these organs coalesce
to form things called humans,
to form things called humans,
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in ti se združijo in naredijo človeka,
04:23
and these organisms
ultimately live in environments,
ultimately live in environments,
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in ti organizmi konec koncev
živijo v okolju,
živijo v okolju,
04:27
which are partly self-regulating
and partly semi-autonomous.
and partly semi-autonomous.
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ki so deloma samoregulativni
in deloma samostojni.
in deloma samostojni.
04:32
What's nice about this scheme,
this hierarchical scheme
this hierarchical scheme
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Kar je lepo pri tej shemi,
hierarhični shemi,
hierarhični shemi,
04:35
building upwards rather than downwards,
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ki gradi raje navzgor kot navzdol,
04:38
is that it allows us
to think about illness as well
to think about illness as well
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je, da nam dovoli misliti tudi o bolezni
04:41
in a somewhat different way.
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na nekako drugačen način.
04:44
Take a disease like cancer.
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Vzemimo neko bolezen, na primer rak.
04:48
Since the 1950s,
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Od 1950ih naprej
04:49
we've tried rather desperately to apply
this lock and key model to cancer.
this lock and key model to cancer.
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smo skušali na vse načine uporabiti
ta model ključavnice in ključa pri raku.
ta model ključavnice in ključa pri raku.
04:54
We've tried to kill cells
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Skušali smo ubiti celice
04:57
using a variety of chemotherapies
or targeted therapies,
or targeted therapies,
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z raznimi kemoterapijami in
usmerjenim terapijami,
usmerjenim terapijami,
05:02
and as most of us know, that's worked.
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in tako kot nas ve večina, je učinkovalo.
05:04
It's worked for diseases like leukemia.
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Je delovalo za bolezni kot je levkemija.
05:06
It's worked for some forms
of breast cancer,
of breast cancer,
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Tudi za nekaj vrst raka dojke,
05:09
but eventually you run
to the ceiling of that approach.
to the ceiling of that approach.
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ampak konec koncev pridemo
do meje tega pristopa.
do meje tega pristopa.
05:12
And it's only in the last 10 years or so
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In šele v zadnjih 10 letih smo
05:15
that we've begun to think
about using the immune system,
about using the immune system,
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začeli razmišljato o uporabi
imunskega sistema,
imunskega sistema,
05:18
remembering that in fact the cancer cell
doesn't grow in a vacuum.
doesn't grow in a vacuum.
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ko smo se spomnili,
da rakaste celice ne živijo v vakuumu.
da rakaste celice ne živijo v vakuumu.
05:21
It actually grows in a human organism.
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Živijo v človeškem organizmu
05:23
And could you use the organismal capacity,
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In lahko uporabimo te
organizmske sposobnosti,
organizmske sposobnosti,
05:25
the fact that human beings
have an immune system, to attack cancer?
have an immune system, to attack cancer?
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dejstvo, da ima človek imunski sistem
za napad raka?
za napad raka?
05:29
In fact, it's led to the some of the most
spectacular new medicines in cancer.
spectacular new medicines in cancer.
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To je privedlo do nekaj od najbolj
spektakularnih novih zdravil za raka.
spektakularnih novih zdravil za raka.
05:34
And finally there's the level
of the environment, isn't there?
of the environment, isn't there?
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In končno je tu raven okolja, kaj ne?
05:38
You know, we don't think of cancer
as altering the environment.
as altering the environment.
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Ne gledamo na rak kot na spremembo okolja.
05:41
But let me give you an example
of a profoundly carcinogenic environment.
of a profoundly carcinogenic environment.
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Ampak vam bom dal en primer
zelo rakotvornega okolja.
zelo rakotvornega okolja.
05:46
It's called a prison.
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Imenuje se ječa.
05:48
You take loneliness, you take depression,
you take confinement,
you take confinement,
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Imamo samoto, depresijo, odvzem prostosti,
05:53
and you add to that,
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in dodamo še enega
05:55
rolled up in a little
white sheet of paper,
white sheet of paper,
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v bel papir zavitega
05:59
one of the most potent neurostimulants
that we know, called nicotine,
that we know, called nicotine,
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najmočnejših nevrostimulantov
ki jih poznamo, nikotin,
ki jih poznamo, nikotin,
06:02
and you add to that one of the most potent
addictive substances that you know,
addictive substances that you know,
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in dodamo še eno najbolj zasvojljivih
snovi, ki jih poznamo
snovi, ki jih poznamo
06:07
and you have
a pro-carcinogenic environment.
a pro-carcinogenic environment.
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in dobimo pro-rakotvorno okolje.
06:11
But you can have anti-carcinogenic
environments too.
environments too.
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Ampak lahko imamo tudi
anti-rakotvorno okolje.
anti-rakotvorno okolje.
06:14
There are attempts to create milieus,
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Obstajajo poskusi, ki ustvarjajo okolje,
06:16
change the hormonal milieu
for breast cancer, for instance.
for breast cancer, for instance.
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spreminjajo hormonsko okolje
pri raku dojke, na primer.
pri raku dojke, na primer.
06:20
We're trying to change the metabolic
milieu for other forms of cancer.
milieu for other forms of cancer.
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Skušamo spremeniti metabolno okolje
pri drugih vrstah raka.
pri drugih vrstah raka.
06:23
Or take another disease, like depression.
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Ali pa vzemimo drugo bolezen,
na primer depresijo.
na primer depresijo.
06:26
Again, working upwards,
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Spet, če gradimo navzgor
06:29
since the 1960s and 1970s,
we've tried, again, desperately
we've tried, again, desperately
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od 1960ih, 1970ih
smo skušali na vse načine
smo skušali na vse načine
06:33
to turn off molecules
that operate between nerve cells --
that operate between nerve cells --
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ugasniti molekule, ki delujejo
med živčnimi celicami
med živčnimi celicami
06:37
serotonin, dopamine --
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--serotonin, dopamin--
06:39
and tried to cure depression that way,
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smo poskušali tako zdraviti depresijo,
06:41
and that's worked,
but then that reached the limit.
but then that reached the limit.
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in je delovalo, ampak samo do neke mere.
06:45
And we now know that what you
really probably need to do
really probably need to do
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In sedaj vemo, da kar moramo zares storiti,
06:47
is to change the physiology
of the organ, the brain,
of the organ, the brain,
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je spremeniti fiziologijo organa,
to je možganov
to je možganov
06:50
rewire it, remodel it,
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ga znova povezati, ga predelati,
06:52
and that, of course,
we know study upon study has shown
we know study upon study has shown
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in to seveda vidimo študijo za študijo,
06:55
that talk therapy does exactly that,
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da to stori prav terapevtski pogovor,
06:57
and study upon study
has shown that talk therapy
has shown that talk therapy
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in študija za študijo kaže,
da je terapevtski pogovor
da je terapevtski pogovor
06:59
combined with medicines, pills,
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skupaj z zdravili, tabletami,
res veliko bolj učinkovit kot
katerakoli od obeh sama.
katerakoli od obeh sama.
07:02
really is much more effective
than either one alone.
than either one alone.
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07:05
Can we imagine a more immersive
environment that will change depression?
environment that will change depression?
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Si predstavljamo bolj poglobljeno
okolje ki bi lahko spremenilo depresijo?
okolje ki bi lahko spremenilo depresijo?
07:09
Can you lock out the signals
that elicit depression?
that elicit depression?
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Lahko zaklenemo signale
ki izzovejo depresijo?
ki izzovejo depresijo?
07:13
Again, moving upwards along this
hierarchical chain of organization.
hierarchical chain of organization.
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Spet, če gradimo navzgor skozi to
hierarhično organizirano verigo.
hierarhično organizirano verigo.
07:19
What's really at stake perhaps here
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Kar je res v igri tukaj
07:22
is not the medicine itself but a metaphor.
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ni v bistvu zdravilo, ampak metafora.
07:25
Rather than killing something,
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Namesto ubijati nekaj,
07:27
in the case of the great
chronic degenerative diseases --
chronic degenerative diseases --
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v primeru velikih kroničnih
degenerativnih bolezni--
degenerativnih bolezni--
07:31
kidney failure, diabetes,
hypertension, osteoarthritis --
hypertension, osteoarthritis --
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odpoved ledvic, sladkorna,
hipertenzija, osteoartritis
hipertenzija, osteoartritis
07:35
maybe what we really need to do is change
the metaphor to growing something.
the metaphor to growing something.
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je morda to, kar moramo res spremeniti,
metafora gojenja nečesa.
metafora gojenja nečesa.
07:38
And that's the key, perhaps,
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In to je ključno, morda,
07:40
to reframing our thinking about medicine.
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za spremebmo našega mišlenja v medicini.
07:43
Now, this idea of changing,
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Ta ideja o spremembi,
07:46
of creating a perceptual
shift, as it were,
shift, as it were,
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o ustvarjanju zaznavnega premika,
od tega kar je,
od tega kar je,
07:49
came home to me to roost in a very
personal manner about 10 years ago.
personal manner about 10 years ago.
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mi je prišla na misel na zelo
oseben način pred približno 10 leti.
oseben način pred približno 10 leti.
07:52
About 10 years ago --
I've been a runner most of my life --
I've been a runner most of my life --
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Pred 10 leti --
večino življenja sem bil tekač-
večino življenja sem bil tekač-
07:55
I went for a run, a Saturday morning run,
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sem šel na tek, sobotni jutranji tek,
07:57
I came back and woke up
and I basically couldn't move.
and I basically couldn't move.
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se vrnil, zbudil in se v bistvu
se nisem mogel premikati.
se nisem mogel premikati.
07:59
My right knee was swollen up,
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Moje desno koleno je bilo otečeno,
08:01
and you could hear that ominous crunch
of bone against bone.
of bone against bone.
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in si lahko slišal tisti strašen
zvok kosti proti kosti.
zvok kosti proti kosti.
08:06
And one of the perks of being a physician
is that you get to order your own MRIs.
is that you get to order your own MRIs.
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Dobra stran tega, da si zdravnik je,
da si lahko sam predpišeš MRI zase.
da si lahko sam predpišeš MRI zase.
08:11
And I had an MRI the next week,
and it looked like that.
and it looked like that.
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Imel sem MRI naslednji teden,
in izgledalo je tako:
in izgledalo je tako:
08:15
Essentially, the meniscus of cartilage
that is between bone
that is between bone
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V glavnem, hrustančni meniskus,
ki je med kostmi
ki je med kostmi
08:19
had been completely torn
and the bone itself had been shattered.
and the bone itself had been shattered.
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je bil popolnoma pretrgan in
kost se je zdrobila.
kost se je zdrobila.
08:22
Now, if you're looking at me
and feeling sorry,
and feeling sorry,
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Če me gledate in se vam smilim,
08:25
let me tell you a few facts.
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naj vam povem nekaj dejstev.
08:27
If I was to take an MRI
of every person in this audience,
of every person in this audience,
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Če bi naredili MRI vsakemu
poslušalcu tukaj
poslušalcu tukaj
08:31
60 percent of you would show signs
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60% bi pokazalo znake
08:33
of bone degeneration
and cartilage degeneration like this.
and cartilage degeneration like this.
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kostne obrabe in hrustančne
degeneracije kot je ta.
degeneracije kot je ta.
08:36
85 percent of all women by the age of 70
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85% žensk do 70 leta
08:40
would show moderate to severe
cartilage degeneration.
cartilage degeneration.
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bi imelo znake srednje do
resne obrabe hrustanca.
resne obrabe hrustanca.
08:43
50 to 60 percent
of the men in this audience
of the men in this audience
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50 do 60% moških tukaj
08:45
would also have such signs.
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bi imelo take znake.
08:47
So this is a very common disease.
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To je torej zelo pogosta bolezen.
08:48
Well, the second perk of being a physician
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Ta druga dobra plat tega, da ste zdravnik,
08:51
is that you can get
to experiment on your own ailments.
to experiment on your own ailments.
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je, da lahko eksperimentirate
na vaših lastnih obolenjih.
na vaših lastnih obolenjih.
08:54
So about 10 years ago we began,
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Torej približno 10 let nazaj smo začeli,
08:56
we brought this process
into the laboratory,
into the laboratory,
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privedli smo ta proces v laboratorij,
08:58
and we began to do simple experiments,
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in smo začeli z enostavnimi eksperimenti,
09:00
mechanically trying
to fix this degeneration.
to fix this degeneration.
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poskušali mehanično popraviti
to obrabo.
to obrabo.
09:03
We tried to inject chemicals
into the knee spaces of animals
into the knee spaces of animals
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Poskusili smo vzbrizgati kemikalije
v koleno živalim
v koleno živalim
09:08
to try to reverse cartilage degeneration,
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da bi obrnili proces obrabe hrustanca,
09:10
and to put a short summary
on a very long and painful process,
on a very long and painful process,
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in na kratko povedano,
ta dolgi in boleči postopek
ta dolgi in boleči postopek
09:15
essentially it came to naught.
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ni pripeljal nikamor.
09:17
Nothing happened.
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Nič se ni zgodilo.
09:18
And then about seven years ago,
we had a research student from Australia.
we had a research student from Australia.
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Pred približno sedmimi leti smo dobili
raziskavo avstralskega študenta.
raziskavo avstralskega študenta.
09:23
The nice thing about Australians
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Pri Avstralcih je fino,
09:25
is that they're habitually used to
looking at the world upside down.
looking at the world upside down.
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je, da so že navajeni gledati na svet
od spodaj navzgor.
od spodaj navzgor.
09:28
(Laughter)
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(smeh)
09:29
And so Dan suggested to me, "You know,
maybe it isn't a mechanical problem.
maybe it isn't a mechanical problem.
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Torej Dan mi je predlagal: "Veš,
morda to ni mehaničen problem.
morda to ni mehaničen problem.
09:33
Maybe it isn't a chemical problem.
Maybe it's a stem cell problem."
Maybe it's a stem cell problem."
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Morda to ni kemičen problem.
Morda je problem matičnih celic."
Morda je problem matičnih celic."
09:39
In other words, he had two hypotheses.
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Drugače rečeno, imel je dve hipotezi.
09:41
Number one, there is such a thing
as a skeletal stem cell --
as a skeletal stem cell --
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Prvič, obstaja nekaj imenovano
skeletne izvorne celice--
skeletne izvorne celice--
09:45
a skeletal stem cell that builds up
the entire vertebrate skeleton,
the entire vertebrate skeleton,
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skeletne izvorne celice, ki naredijo
vse okostje vretenčarjev
vse okostje vretenčarjev
09:49
bone, cartilage and the fibrous
elements of skeleton,
elements of skeleton,
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kosti, hrustanec in fibrozne
elemente skeleta,
elemente skeleta,
09:51
just like there's a stem cell in blood,
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tako kot obstajajo krvne matične celice,
09:53
just like there's a stem cell
in the nervous system.
in the nervous system.
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tako kot so izvorne celice
v živčnem sistemu.
v živčnem sistemu.
09:55
And two, that maybe that, the degeneration
or dysfunction of this stem cell
or dysfunction of this stem cell
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Drugič, da je morda degeneracija
ali disfunkcija te izvorne celice
ali disfunkcija te izvorne celice
09:59
is what's causing osteochondral arthritis,
a very common ailment.
a very common ailment.
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to kar povzroča osteohondralni artritis,
zelo pogosto bolezen.
zelo pogosto bolezen.
10:03
So really the question was,
were we looking for a pill
were we looking for a pill
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Pravo vprašanje je torej bilo,
ali smo iskali tableto,
ali smo iskali tableto,
10:06
when we should have really
been looking for a cell.
been looking for a cell.
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ko bi morali iskati celico.
10:08
So we switched our models,
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Torej smo zamenjali model,
10:11
and now we began
to look for skeletal stem cells.
to look for skeletal stem cells.
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začeli iskati matične celice okostja.
10:15
And to cut again a long story short,
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In spet na kratko povedano,
10:18
about five years ago,
we found these cells.
we found these cells.
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pred približno petimi leti
smo našli te celice.
smo našli te celice.
10:21
They live inside the skeleton.
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Živijo v okostju.
10:24
Here's a schematic and then
a real photograph of one of them.
a real photograph of one of them.
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Tukaj je shema in potem
prava fotografija ene izmed njih.
prava fotografija ene izmed njih.
10:27
The white stuff is bone,
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Ta belo je kost,
10:29
and these red columns that you see
and the yellow cells
and the yellow cells
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in ti rdeči stebri, ki jih vidite
in rumene celice
in rumene celice
10:32
are cells that have arisen
from one single skeletal stem cell --
from one single skeletal stem cell --
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so celice ki so nastale iz
ene same matične celice--
ene same matične celice--
10:35
columns of cartilage, columns of bone
coming out of a single cell.
coming out of a single cell.
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hrustanec in kosti
iz ene same celice.
iz ene same celice.
10:38
These cells are fascinating.
They have four properties.
They have four properties.
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Te celice so zelo zanimive.
Imajo štiri lastnosti.
Imajo štiri lastnosti.
10:42
Number one is that they live
where they're expected to live.
where they're expected to live.
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Ena, živijo tam,
kjer pričakujemo da živijo.
kjer pričakujemo da živijo.
10:45
They live just underneath
the surface of the bone,
the surface of the bone,
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Živijo točno pod površino kosti,
10:48
underneath cartilage.
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pod hrustancem.
10:49
You know, in biology,
it's location, location, location.
it's location, location, location.
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Veste, pri biologiji je lokacija,
lokacija, lokacija.
lokacija, lokacija.
10:52
And they move into the appropriate areas
and form bone and cartilage.
and form bone and cartilage.
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In gredo v primerne prostore
in naredijo kost in hrustanec.
in naredijo kost in hrustanec.
10:56
That's one.
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To je ena.
10:58
Here's an interesting property.
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Tu je še ena zanimiva lastnost.
10:59
You can take them out
of the vertebrate skeleton,
of the vertebrate skeleton,
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lahko jih vzamete iz vretenčnega okostja,
11:02
you can culture them
in petri dishes in the laboratory,
in petri dishes in the laboratory,
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jih lahko gojite v petrijevkah
v laboratoriju
v laboratoriju
in rade bi izdelovale hrustančaste celice.
11:04
and they are dying to form cartilage.
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Se spomnite kako nismo mogli narediti
hrustanca za noben denar?
hrustanca za noben denar?
11:06
Remember how we couldn't
form cartilage for love or money?
form cartilage for love or money?
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11:09
These cells are dying to form cartilage.
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Te celice želijo izdelovati hrustanec.
11:11
They form their own furls
of cartilage around themselves.
of cartilage around themselves.
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Okrog sebe naredijo zvitke hrustanca.
11:14
They're also, number three,
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So tudi, številka tri,
11:16
the most efficient repairers
of fractures that we've ever encountered.
of fractures that we've ever encountered.
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najbolj efektivni popravljalci
zlomov, kar smo jih videli.
zlomov, kar smo jih videli.
11:20
This is a little bone,
a mouse bone that we fractured
a mouse bone that we fractured
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To je mala kost, mišja kost,
ki smo jo zlomili
ki smo jo zlomili
in potem pustili, da se sama pozdravi.
11:23
and then let it heal by itself.
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11:25
These stem cells have come in
and repaired, in yellow, the bone,
and repaired, in yellow, the bone,
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Te iste celice so prišle in popravile,
rumeno, kost,
rumeno, kost,
11:28
in white, the cartilage,
almost completely.
almost completely.
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belo, hrustanec, skoraj v celoti.
11:31
So much so that if you label them
with a fluorescent dye
with a fluorescent dye
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V tolikšni meri, da če jih označimo
s fluorescento barvo
s fluorescento barvo
11:34
you can see them like some kind
of peculiar cellular glue
of peculiar cellular glue
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jih lahko vidimo kot neke vrste
posebno lepilo za kosti
posebno lepilo za kosti
11:38
coming into the area of a fracture,
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ki pride v prostor zloma,
11:40
fixing it locally
and then stopping their work.
and then stopping their work.
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ga v popravi na mestu
in potem ustavi svoje delo.
in potem ustavi svoje delo.
11:43
Now, the fourth one is the most ominous,
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Ta četrta je ta najbolj nevarna,
11:45
and that is that their numbers
decline precipitously,
decline precipitously,
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in to je, da število upade zelo hitro,
11:49
precipitously, tenfold,
fiftyfold, as you age.
fiftyfold, as you age.
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strmo, desetkrat, petdesetkrat
ko se starate.
ko se starate.
11:54
And so what had happened, really,
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A kar se je v resnici zgodilo je,
11:56
is that we found ourselves
in a perceptual shift.
in a perceptual shift.
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da smo se znajdli v premiku percepcije.
11:59
We had gone hunting for pills
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Začeli smo tako, da smo iskali tablete
12:01
but we ended up finding theories.
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a smo končali z iznajdbo teorij.
12:04
And in some ways
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In na nek način
12:05
we had hooked ourselves
back onto this idea:
back onto this idea:
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smo spet zasvojeni s to idejo:
12:08
cells, organisms, environments,
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celice, organizmi, okolje,
12:11
because we were now thinking
about bone stem cells,
about bone stem cells,
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ker zdaj smo mislili na
kostne matične celice
kostne matične celice
12:13
we were thinking about arthritis
in terms of a cellular disease.
in terms of a cellular disease.
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smo mislili na artrozo kot
na neko celično bolezen.
na neko celično bolezen.
12:17
And then the next question was,
are there organs?
are there organs?
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In naslednje vprašanje je bilo:
obstajajo organi?
obstajajo organi?
12:20
Can you build this
as an organ outside the body?
as an organ outside the body?
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Lahko naredimo to kot organe,
izven telesa?
izven telesa?
12:22
Can you implant cartilage
into areas of trauma?
into areas of trauma?
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Lahko vsadimo hrustanec na
področja poškodbe?
področja poškodbe?
12:26
And perhaps most interestingly,
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In morda še bolj zanimivo,
12:28
can you ascend right up
and create environments?
and create environments?
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lahko se povzpnemo še višje
in naredimo nova okolja?
in naredimo nova okolja?
12:30
You know, we know
that exercise remodels bone,
that exercise remodels bone,
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Veste, vemo da trening preoblikuje kosti
12:33
but come on, none of us
is going to exercise.
is going to exercise.
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ampak noben
od nas noče trenirati.
od nas noče trenirati.
12:36
So could you imagine ways of passively
loading and unloading bone
loading and unloading bone
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Si predstavljate torej način za pasivno
obremenitiev in razbremenitev kosti,
obremenitiev in razbremenitev kosti,
12:41
so that you can recreate
or regenerate degenerating cartilage?
or regenerate degenerating cartilage?
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da lahko naredimo ali
obnovimo obrabljen hrustanec?
obnovimo obrabljen hrustanec?
12:46
And perhaps more interesting,
and more importantly,
and more importantly,
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In kar je morda še bolj
pomembno in zanimivo,
pomembno in zanimivo,
12:48
the question is, can you apply this model
more globally outside medicine?
more globally outside medicine?
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vprašanje je, lahko uporabimo
ta model izven medicine?
ta model izven medicine?
Kar je v igri, kot sem omenil,
ni nekaj ubiti,
ni nekaj ubiti,
12:52
What's at stake, as I said before,
is not killing something,
is not killing something,
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12:56
but growing something.
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ampak nekaj novega vzgojiti.
12:58
And it raises a series of, I think,
some of the most interesting questions
some of the most interesting questions
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Menim, da to nam postavi nekaj
najbolj zanimivih vprašanj
najbolj zanimivih vprašanj
13:03
about how we think
about medicine in the future.
about medicine in the future.
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o tem, kako razmišljamo o medicini
v prihodnosti.
v prihodnosti.
13:07
Could your medicine
be a cell and not a pill?
be a cell and not a pill?
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Je lahko tvoje zdravilo ena celica,
in ne ena tableta?
in ne ena tableta?
13:10
How would we grow these cells?
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Kako bi gojili te celice?
13:13
What we would we do to stop
the malignant growth of these cells?
the malignant growth of these cells?
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Kaj lahko naredimo, da ustavimo
maligno rast teh celic?
maligno rast teh celic?
13:16
We heard about the problems
of unleashing growth.
of unleashing growth.
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Slišali smo o problemih nebrzdane rasti.
Lahko vsadimo samomorilne
gene v te celice,
gene v te celice,
13:20
Could we implant
suicide genes into these cells
suicide genes into these cells
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13:23
to stop them from growing?
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da preprečimo njihovo rast?
13:25
Could your medicine be an organ
that's created outside the body
that's created outside the body
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Je lahko tvoje zdravilo
organ, ustvarjen izven telesa
organ, ustvarjen izven telesa
13:29
and then implanted into the body?
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in potem vsajen v telo?
13:30
Could that stop some of the degeneration?
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Lahko to prepreči kakšno degeneracijo?
13:33
What if the organ needed to have memory?
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Kaj če mora organ imeti spomin?
13:35
In cases of diseases of the nervous system
some of those organs had memory.
some of those organs had memory.
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V primerih bolezni živčevja so imeli
nekateri izmed teh organov spomin.
nekateri izmed teh organov spomin.
13:40
How could we implant
those memories back in?
those memories back in?
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Kako lahko vsadimo te spomine nazaj?
13:42
Could we store these organs?
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Lahko hranimo te organe?
13:44
Would each organ have to be developed
for an individual human being
for an individual human being
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Bo moral biti vsak organ oblikovan
za posameznika
za posameznika
13:47
and put back?
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in nato vrnjen?
13:50
And perhaps most puzzlingly,
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In morda še najbolj zapleteno,
13:53
could your medicine be an environment?
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je lahko tvoje zdravilo neko okolje?
13:56
Could you patent an environment?
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Lahko patentiramo neko okolje?
13:57
You know, in every culture,
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Veste, v vsaki kulturi,
14:01
shamans have been using
environments as medicines.
environments as medicines.
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šamani so uporabljali okolja kot zdravila.
14:04
Could we imagine that for our future?
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Si lahko predstavljamo to
kot našo prihodnost?
kot našo prihodnost?
14:08
I've talked a lot about models.
I began this talk with models.
I began this talk with models.
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Precej sem govoril o modelih,
to predavanje sem pričel z modeli.
to predavanje sem pričel z modeli.
14:11
So let me end with some thoughts
about model building.
about model building.
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Naj torej končam z mislimi
o gradnji modelov.
o gradnji modelov.
14:14
That's what we do as scientists.
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To je to, kar kot znanstveniki počnemo.
14:16
You know, when an architect
builds a model,
builds a model,
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Veste, ko arhitekt pripravi model,
14:19
he or she is trying to show you
a world in miniature.
a world in miniature.
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vam skuša pokazati svet v miniaturi.
14:22
But when a scientist is building a model,
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Ampak ko znanstvenik gradi model,
14:25
he or she is trying to show you
the world in metaphor.
the world in metaphor.
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vam skuša pokazati svet kot metaforo.
14:29
He or she is trying to create
a new way of seeing.
a new way of seeing.
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Skuša ustvariti novi način gledanja.
14:33
The former is a scale shift.
The latter is a perceptual shift.
The latter is a perceptual shift.
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Prvi je sprememba dimenzije.
Drugi je spremeba percepcije.
Drugi je spremeba percepcije.
14:38
Now, antibiotics created
such a perceptual shift
such a perceptual shift
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Antibiotiki so povzročili tako
spremembo percepcije
spremembo percepcije
14:43
in our way of thinking about medicine
that it really colored, distorted,
that it really colored, distorted,
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v našem načinu gledanja na medicino,
da je res pobarvala, popačila,
da je res pobarvala, popačila,
14:47
very successfully, the way we've thought
about medicine for the last hundred years.
about medicine for the last hundred years.
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na zelo učinkovit način, kako
premišljujemo o medicini zadnjih sto let.
premišljujemo o medicini zadnjih sto let.
14:52
But we need new models
to think about medicine in the future.
to think about medicine in the future.
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Ampak potrebujemo nove modele za
razmišljanje o medicini v prihodnosti.
razmišljanje o medicini v prihodnosti.
14:56
That's what's at stake.
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To je v igri.
14:59
You know, there's
a popular trope out there
a popular trope out there
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Obstaja neki popularen trop, ki pravi,
15:02
that the reason we haven't had
the transformative impact
the transformative impact
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da je razlog zakaj nismo imeli
transformativnega učinka
transformativnega učinka
15:06
on the treatment of illness
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na zdravljenje bolezni
15:08
is because we don't have
powerful-enough drugs,
powerful-enough drugs,
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pomanjkanje dovolj močnih zdravil,
15:11
and that's partly true.
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in to je v neki meri res.
15:14
But perhaps the real reason is
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Ampak morda je pravi razlog ,
15:15
that we don't have powerful-enough
ways of thinking about medicines.
ways of thinking about medicines.
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da nimamo dovolj močnih
pogledov na zdravila.
pogledov na zdravila.
15:20
It's certainly true that
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Brez dvoma je res, da
15:23
it would be lovely to have new medicines.
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bi bilo krasno imeti nova zdravila.
15:26
But perhaps what's really at stake
are three more intangible M's:
are three more intangible M's:
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Ampak morda so res v igri
trije neotipljivi pojmi:
trije neotipljivi pojmi:
15:31
mechanisms, models, metaphors.
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mahanizmi, modeli, metafore.
15:35
Thank you.
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Hvala lepa.
15:36
(Applause)
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(Aplavz)
15:45
Chris Anderson:
I really like this metaphor.
I really like this metaphor.
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Chris Andreson:
zelo mi je všeč ta metafora.
zelo mi je všeč ta metafora.
15:49
How does it link in?
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Kako se to poveže?
15:50
There's a lot of talk in technologyland
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Veliko se govori na področju tehnologije
15:53
about the personalization of medicine,
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o personalizaciji medicine,
15:55
that we have all this data
and that medical treatments of the future
and that medical treatments of the future
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da imamo vse te podatke in
da bo zdravljenje v prihodnosti
da bo zdravljenje v prihodnosti
15:59
will be for you specifically,
your genome, your current context.
your genome, your current context.
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specifično za vsakega, tvoj genom,
tvoj današnji položaj.
tvoj današnji položaj.
16:03
Does that apply to this model
you've got here?
you've got here?
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Velja to za te modele?
16:07
Siddhartha Mukherjee:
It's a very interesting question.
It's a very interesting question.
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Siddharta Mukherjee:
Zanimivo vprašanje.
Zanimivo vprašanje.
16:10
We've thought about
personalization of medicine
personalization of medicine
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O personalizaciji medicine smo razmišljali
16:12
very much in terms of genomics.
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v smislu genomike.
16:14
That's because the gene
is such a dominant metaphor,
is such a dominant metaphor,
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To je, ker je ta metafora o genih
tako prevladujoča
tako prevladujoča
16:16
again, to use that same word,
in medicine today,
in medicine today,
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spet, da uporabim isto besedo,
v današnji medicini,
v današnji medicini,
16:19
that we think the genome will drive
the personalization of medicine.
the personalization of medicine.
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da mislimo da bo genomika
pripeljala do personalizacije medicine.
pripeljala do personalizacije medicine.
16:23
But of course the genome
is just the bottom
is just the bottom
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Ampak genom je samo začetek
16:26
of a long chain of being, as it were.
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dolge verige.
16:30
That chain of being, really the first
organized unit of that, is the cell.
organized unit of that, is the cell.
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Ta veriga bitij, pravzaprav je ta prva
organizirana enota tega celica.
organizirana enota tega celica.
16:34
So, if we are really going to deliver
in medicine in this way,
in medicine in this way,
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Torej, če res mislimo izvajati
medicino na ta način,
medicino na ta način,
16:37
we have to think of personalizing
cellular therapies,
cellular therapies,
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moramo misliti na personalizacijo
celičnih terapij,
celičnih terapij,
16:40
and then personalizing
organ or organismal therapies,
organ or organismal therapies,
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in potem o personalizaciji terapij
za organe in organizme,
za organe in organizme,
16:43
and ultimately personalizing
immersion therapies for the environment.
immersion therapies for the environment.
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in končno o personalizaciji
imerzijskih terapij za okolje.
imerzijskih terapij za okolje.
16:47
So I think at every stage, you know --
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Torej mislim, da na vseh področjih
obstaja metafora,
ta pot se nikoli ne konča.
ta pot se nikoli ne konča.
16:50
there's that metaphor,
there's turtles all the way.
there's turtles all the way.
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16:52
Well, in this, there's
personalization all the way.
personalization all the way.
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Tako da, tudi personalizacija
se ne konča.
se ne konča.
16:55
CA: So when you say
medicine could be a cell
medicine could be a cell
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CA: Torej, ko pravite,
da je zdravilo lahko celica,
da je zdravilo lahko celica,
16:58
and not a pill,
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in ne tableta,
17:00
you're talking about
potentially your own cells.
potentially your own cells.
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govorite potencialno o vaših celicah.
17:02
SM: Absolutely.
CA: So converted to stem cells,
CA: So converted to stem cells,
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SM: Absolutno.
CA: Torej v terminih matičnih celic,
CA: Torej v terminih matičnih celic,
17:04
perhaps tested against all kinds
of drugs or something, and prepared.
of drugs or something, and prepared.
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morda testiranih za vse vrste zdravil
ipd., in pripravljene.
ipd., in pripravljene.
17:09
SM: And there's no perhaps.
This is what we're doing.
This is what we're doing.
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SM: In ni nobenega 'morda'.
To je kar delamo.
To je kar delamo.
17:11
This is what's happening,
and in fact, we're slowly moving,
and in fact, we're slowly moving,
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To je kar se dogaja, in dejansko,
se počasi premikamo,
se počasi premikamo,
17:15
not away from genomics,
but incorporating genomics
but incorporating genomics
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ne stran od genomike,
ampak uporabljamo genomiko
ampak uporabljamo genomiko
17:19
into what we call multi-order,
semi-autonomous, self-regulating systems,
semi-autonomous, self-regulating systems,
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za deloma samostojne,
samoregulativne sisteme v več redih,
samoregulativne sisteme v več redih,
17:24
like cells, like organs,
like environments.
like environments.
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kot so celice, organi, okolja.
17:26
CA: Thank you so much.
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CA: Najlepša hvala!
17:28
SM: Pleasure. Thanks.
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SM: V veselje mi je, hvala.
ABOUT THE SPEAKER
Siddhartha Mukherjee - Cancer physician and writerWhen he’s not ferreting out the links between stem cells and malignant blood disease, Siddhartha Mukherjee writes and lectures on the history (and future) of medicine.
Why you should listen
While discussing a diagnosis with a patient, Siddhartha Mukherjee realized that there were no easy answers to the question, “What is cancer?” Faced with his hesitation, Mukherjee decided to do something about it.
Over the next six years, Mukherjee wrote the influential, Pulitzer-winning The Emperor of All Maladies, a 4,000-year “biography” of cancer. He collaborated with Ken Burns on a six-hour documentary for PBS based on his book, updating the story with recent discoveries in oncology.
In his new TED Book, The Laws of Medicine, he examines the three principles that govern modern medicine -- and every profession that confronts uncertainty and wonder.
Siddhartha Mukherjee | Speaker | TED.com