TED2006
Alan Russell: The potential of regenerative medicine
Alan Rasel o regeneraciji naših tela
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Alan Rasel proučava regenerativnu medicinu, revolucionaran način razmišljenja o bolesti i povredi, koji koristi proces koji signalizira telu da se samo popravi.
Alan Russell - Medical futurist
In the fight against disease, defect and injury, Alan Russell has a novel argument: Why not engineer new tissue and organs to replace sick ones? Full bio
In the fight against disease, defect and injury, Alan Russell has a novel argument: Why not engineer new tissue and organs to replace sick ones? Full bio
Double-click the English transcript below to play the video.
00:26
I'm going to talk to you today about
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Danas ću vam pričati
00:28
hopefully converting fear into hope.
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u nadi da ću preobraziti strah u nadu.
00:31
When we go to the physician today --
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Kada idemo kod lekara danas,
00:34
when we go to the doctor's office and we walk in,
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kada uđemo u doktorsku ordinaciju,
00:36
there are words that we just don't want to hear.
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ima reči koje jednostavno ne želimo da čujemo.
00:39
There are words that we're truly afraid of.
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Ima reči kojih se istinski plašimo.
00:41
Diabetes, cancer, Parkinson's, Alzheimer's,
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Dijabetes, rak, Parkinsonova bolest, Alchajmerova bolest.
00:45
heart failure, lung failure --
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otkazivanje srca, otkazivanje pluća.
00:47
things that we know are debilitating diseases,
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Stvari za koje znamo da su onesposobljavajuće bolesti,
00:50
for which there's relatively little that can be done.
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za koje ima relativno malo toga što može da se uradi.
00:55
And what I want to lay out for you today is
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I ono što želim danas da vam predstavim
00:57
a different way of thinking about how to treat debilitating disease,
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je drugačiji način razmišljanja o tome kako da lečimo onesposobljavajuće bolesti,
01:01
why it's important,
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zašto je to važno.
01:03
why without it perhaps our health care system will melt down
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Zašto će se bez njega, možda, naš zdravstveni sistem raspasti,
01:06
if you think it already hasn't,
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ako mislite da već nije.
01:08
and where we are clinically today, and where we might go tomorrow,
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Gde smo klinički sada i gde bismo mogli biti sutra
01:11
and what some of the hurdles are.
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i koje su neke od prepreka.
01:13
And we're going to do all of that in 18 minutes, I promise.
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I to ćemo sve uraditi za 18 minuta, obećavam.
01:16
I want to start with this slide,
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Želim da počnem sa ovim slajdom,
01:18
because this slide sort of tells the story the way Science Magazine thinks of it.
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jer ovaj slajd nekako priča priču na način na koji o njoj misli "Sajens" magazin.
01:23
This was an issue from 2002
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Ovo je izdanje iz 2002.
01:25
that they published with a lot of different articles on the bionic human.
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koje su izdali sa puno različitih članaka o bionskom čoveku.
01:29
It was basically a regenerative medicine issue.
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Ovo je, u suštini, broj o regenerativnoj medicini.
01:32
Regenerative medicine is an extraordinarily simple concept
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Regenerativna medicina je izuzetno jednostavan koncept
01:36
that everybody can understand.
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koji svako moze da razume.
01:38
It's simply accelerating the pace at which the body heals itself
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To je jednostavno ubrzavanje procesa kojim se telo samo leči
01:42
to a clinically relevant timescale.
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do klinički značajne brzine.
01:46
So we know how to do this in many of the ways that are up there.
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Mi to znamo da radimo na mnogo načina koji su tu.
01:49
We know that if we have a damaged hip, you can put an artificial hip in.
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Mi znamo da ako imamo oštećen kuk, možemo ugraditi veštački kuk.
01:53
And this is the idea that Science Magazine used on their front cover.
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I to je ideja koju je "Sajens" magazin koristio na svojoj naslovnoj strani.
01:57
This is the complete antithesis of regenerative medicine.
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To je potpuna antiteza regenerativne medicine.
02:01
This is not regenerative medicine.
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To nije regenerativna medicina.
02:03
Regenerative medicine is what Business Week put up
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Regenerativna medicina je ono što je "Biznis vik" stavio
02:06
when they did a story about regenerative medicine not too long ago.
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kada je, ne tako davno,radio priču o regenerativnoj medicini.
02:09
The idea is that instead of figuring out how to ameliorate symptoms
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Ideja je da umesto da pokušavamo da ublažimo simptome
02:14
with devices and drugs and the like --
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sa spravama i lekovima i slično -
02:16
and I'll come back to that theme a few times --
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i vratiću se na tu temu nekoliko puta -
02:19
instead of doing that, we will regenerate lost function of the body
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umesto da to radimo, mi ćemo regenerisati izgubljenu funkciju tela
02:23
by regenerating the function of organs and damaged tissue.
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tako što ćemo regenerisati funkciju organa ili oštećenog tkiva.
02:27
So that at the end of the treatment,
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Tako da ste na kraju tretmana
02:29
you are the same as you were at the beginning of the treatment.
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isti kao što ste bili na početku.
02:34
Very few good ideas -- if you agree that this is a good idea --
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Veoma malo dobrih ideja - ako se slažete da je ovo dobra ideja-
02:37
very few good ideas are truly novel.
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veoma malo dobrih ideja je zaista inovativno.
02:40
And this is just the same.
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I ovo je isto.
02:42
If you look back in history,
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Ako pogledate unazad kroz istoriju,
02:44
Charles Lindbergh, who was better known for flying airplanes,
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Čarls Lindberg koji je bio poznat po letenju avionima je,
02:48
was actually one of the first people
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u stvari bio jedan od prvih ljudi,
02:49
along with Alexis Carrel, one of the Nobel Laureates from Rockefeller,
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zajedno sa Aleksis Karnel-om, jednim od Nobelovih laureata od Rokfelera,
02:53
to begin to think about, could you culture organs?
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koji su počeli da razmišljaju o mogućnosti uzgajaja organa.
02:57
And they published this book in 1937,
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I objavili su ovu knjigu 1937.,
02:59
where they actually began to think about,
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u kojoj su počeli da razmišljaju
03:01
what could you do in bio-reactors to grow whole organs?
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o tome šta bi se moglo uraditi u bio-reaktorima da bi se uzgajili celi organi?
03:07
We've come a long way since then.
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Od tada smo prešli dugačak put.
03:08
I'm going to share with you some of the exciting work that's going on.
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Podeliću sa vama nešto od uzbudljivog rada koji se odvija.
03:11
But before doing that, what I'd like to do
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Ali pre toga, ono što bih želeo da uradim
03:13
is share my depression about the health care system
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je da sa vama podelim moju tugu u vezi sa
03:16
and the need for this with you.
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sistemom zdravstvene zaštite i potrebe za njim.
03:18
Many of the talks yesterday talked about
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Mnogi govori juče su pričali o
03:20
improving the quality of life, and reducing poverty,
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popravljanju kvaliteta života i smanjenju siromaštva.
03:23
and essentially increasing life expectancy all around the globe.
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I suštinski o produženju životnog veka svuda na svetu.
03:28
One of the challenges is that the richer we are, the longer we live.
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Jedan od izazova je da što smo bogatiji, duže živimo.
03:33
And the longer we live, the more expensive it is
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I što duže živimo, to je skuplje
03:36
to take care of our diseases as we get older.
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da se lečimo kako starimo.
03:39
This is simply the wealth of a country
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To je jednostavno bogatstvo zemlje
03:42
versus the percent of population over the age of 65.
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naspram procenta stanovništva preko 65 godina.
03:46
And you can basically see that the richer a country is,
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I u stvari vidite da što je zemlja bogatija,
03:49
the older the people are within it.
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to su ljudi u njoj stariji.
03:51
Why is this important?
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Zašto je to važno?
03:53
And why is this a particularly dramatic challenge right now?
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I zašto je to sada posebno dramatičan izazov?
03:57
If the average age of your population is 30,
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Ako je prosečna starost našeg stanovništva 30,
03:59
then the average kind of disease that you have to treat
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onda je prosečna vrsta bolesti koju treba lečiti
04:03
is maybe a broken ankle every now and again,
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možda polomljen zglob s vremena na vreme,
04:05
maybe a little bit of asthma.
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možda malo astme.
04:06
If the average age in your country is 45 to 55,
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Ako je prosečna starost stanovništva 45 do 55,
04:10
now the average person is looking at diabetes,
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sada prosečnu osobu čekaju dijabetes,
04:13
early-onset diabetes, heart failure, coronary artery disease --
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pred-dijabetes, otkazivanje srca, bolest koronarnih arterija.
04:16
things that are inherently more difficult to treat,
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Stvari koje se mnogo teže leče,
04:19
and much more expensive to treat.
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i koje je skuplje lečiti.
04:21
Just have a look at the demographics in the U.S. here.
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Samo pogledajte demografiju SAD-a.
04:24
This is from "The Untied States of America."
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Ovo je iz "Sjedinjenih američkih država".
04:26
In 1930, there were 41 workers per retiree.
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1930. je bio 41 radnik po penzioneru.
04:30
41 people who were basically outside of being really sick,
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41 čovek koji nije bio bolestan,
04:35
paying for the one retiree who was experiencing debilitating disease.
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i koji je plaćao za jednog penzionera koji je bolovao od onesposobljavajuće bolesti.
04:41
In 2010, two workers per retiree in the U.S.
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U 2010. ima dva radnika po penzioneru u SAD-u.
04:44
And this is matched in every industrialized, wealthy country in the world.
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I to je tako u svakoj industrijalizovanoj, bogatoj zemlji na svetu.
04:50
How can you actually afford to treat patients
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Kako možemo zaista da priuštimo da lečimo pacijente,
04:53
when the reality of getting old looks like this?
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kada ovako izgleda realnost starenja?
04:56
This is age versus cost of health care.
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Ovo je starost naspram troškova zdravstvene nege.
04:59
And you can see that right around age 45, 40 to 45,
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I može se videti da upravo oko 45. godine, od 40. do 45.,
05:05
there's a sudden spike in the cost of health care.
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nastaje iznenadni porast troškova zdravstvene nege.
05:10
It's actually quite interesting. If you do the right studies,
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U stvari je veoma interesantno - ako uradite prave studije,
05:13
you can look at how much you as an individual spend on your own health care,
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možete videti koliko vi, kao individua, trošite na sopstveno zdravstveno osiguranje,
05:17
plotted over your lifetime.
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tokom vašeg životnog veka.
05:19
And about seven years before you're about to die, there's a spike.
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I sedam godina pre vaše smrti dešava se nagli porast.
05:23
And you can actually --
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I možete u stvari -
05:24
(Laughter)
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(smeh)
05:26
-- we won't get into that.
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- nećemo ulaziti u to.
05:27
(Laughter)
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(smeh)
05:31
There are very few things, very few things that you can really do
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Ima malo stvari, vrlo malo stvari koje stvarno možete uraditi
05:36
that will change the way that you can treat these kinds of diseases
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koje će promeniti način na koji se tretiraju ove bolesti
05:41
and experience what I would call healthy aging.
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i iskusiti ono što bih ja nazvao, zdravo starenje.
05:45
I'd suggest there are four things,
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Predložio bih da postoje četiri stvari.
05:47
and none of these things include an insurance system or a legal system.
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I nijedna od njih ne uključuje sistem osiguranja ili pravni sistem.
05:51
All those things do is change who pays.
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Sve što te stvari rade je menjaju ko plaća.
05:53
They don't actually change what the actual cost of the treatment is.
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One zapravo ne menjaju cenu lečenja.
05:57
One thing you can do is not treat. You can ration health care.
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Jedna stvar koju mozete uraditi je da se ne lečite. Možete podeliti zdravstvenu negu.
06:01
We won't talk about that anymore. It's too depressing.
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O tome nećemo dalje pričati.Suviše je deprimirajuće.
06:04
You can prevent.
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Možete vršiti prevenciju.
06:05
Obviously a lot of monies should be put into prevention.
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Očigledno dosta novca treba uložiti u prevenciju.
06:09
But perhaps most interesting, to me anyway, and most important,
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Ali možda najinteresantnije, za mene bar, i najvažnije,
06:12
is the idea of diagnosing a disease much earlier on in the progression,
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je ideja o uspostavljanju dijagnoze bolesti u početnom stadijumu,
06:17
and then treating the disease to cure the disease
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a onda lečenju bolesti da bi se bolest potpuno izlečila,
06:20
instead of treating a symptom.
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umesto lečenja simptoma.
06:22
Think of it in terms of diabetes, for instance.
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Razmišljajte o tome na primeru dijabetesa.
06:26
Today, with diabetes, what do we do?
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Šta danas radimo sa dijabetesom?
06:28
We diagnose the disease eventually, once it becomes symptomatic,
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Dijagnoziramo bolest tek kada se ispolje simptomi,
06:31
and then we treat the symptom for 10, 20, 30, 40 years.
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a onda lečimo simptome 10, 20, 30, 40 godina.
06:35
And we do OK. Insulin's a pretty good therapy.
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I to radimo dobro. Insulin je prilično dobra terapija.
06:39
But eventually it stops working,
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Ali to na kraju prestane da deluje
06:40
and diabetes leads to a predictable onset of debilitating disease.
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i dijabetes vodi predvidljivom početku onesposobljavajuće bolesti.
06:48
Why couldn't we just inject the pancreas with something
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Zašto ne bismo mogli ubrizgati u pankreas nešto
06:51
to regenerate the pancreas early on in the disease,
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što bi regenerisalo pankreas na početku bolesti
06:54
perhaps even before it was symptomatic?
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možda još pre nego što se ispolje simptomi?
06:57
And it might be a little bit expensive at the time that we did it,
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I možda bi to bilo malo skuplje u vreme kada bismo ga radili,
07:00
but if it worked, we would truly be able to do something different.
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ali ako bi uspelo, mogli bismo stvarno da uradimo nešto drugačije.
07:04
This video, I think, gets across the concept that I'm talking about quite dramatically.
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Mislim da ovaj video, prilično dramatično prenosi koncept o kome pričam .
07:09
This is a newt re-growing its limb.
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Ovo je gušter, kome ponovo raste noga.
07:13
If a newt can do this kind of thing, why can't we?
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Ako gušter može to da uradi zašto mi ne možemo?
07:16
I'll actually show you some more important features
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Pokazaću vam, u stvari, neke važnije odlike
07:19
about limb regeneration in a moment.
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regeneracije uda za koji trenutak.
07:21
But what we're talking about in regenerative medicine
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Ali ono o čemu pričamo u regenerativnoj medicini
07:24
is doing this in every organ system of the body,
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je da ovo uradimo u svakom sistemu organa u telu,
07:27
for tissues and for organs themselves.
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za tkiva i same organe.
07:34
So today's reality is that if we get sick,
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Tako da je današnja stvarnost ako se razbolimo,
07:37
the message is we will treat your symptoms,
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poruka je da će nam lečiti simptome,
07:40
and you need to adjust to a new way of life.
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i mi ćemo se morati navići na nov način života.
07:43
I would pose to you that tomorrow --
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Zaintrigiraću vas sa činjenicom da ćemo sutra -
07:45
and when tomorrow is we could debate,
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a kada je sutra, o tome možemo diskutovati,
07:47
but it's within the foreseeable future --
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ali je u doglednoj budućnosti -
07:49
we will talk about regenerative rehabilitation.
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razgovarati o regenerativnoj rehabilitaciji.
07:53
There's a limb prosthetic up here,
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Ovde je proteza za nogu,
07:54
similar actually one on the soldier
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slična onoj koju vojnik
07:57
that's come back from Iraq.
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koji je došao iz Iraka...
07:59
There are 370 soldiers that have come back from Iraq that have lost limbs.
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ima 370 vojnika koji su došli iz Iraka bez udova.
08:03
Imagine if instead of facing that, they could actually
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Zamislite da umesto da se suočavaju sa tim, oni mogu, u stvari
08:06
face the regeneration of that limb.
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da se suoče sa regeneracijom uda.
08:08
It's a wild concept.
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To je neverovatan pojam.
08:10
I'll show you where we are at the moment in working towards that concept.
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Pokazaću vam gde se trenutno nalazimo sa radom na tom pojmu.
08:15
But it's applicable, again, to every organ system.
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Ali to se može primeniti, ponavljam, na svaki sistem organa.
08:17
How can we do that?
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Kako to možemo da uradimo?
08:18
The way to do that is to develop a conversation with the body.
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Način da to uradimo je da razvijemo komunikaciju sa telom.
08:22
We need to learn to speak the body's language.
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Moramo naučiti da pričamo jezik tela.
08:25
And to switch on processes that we knew how to do when we were a fetus.
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I da uključimo procese koje smo znali kako da radimo kada smo bili fetusi.
08:30
A mammalian fetus, if it loses a limb during the first trimester of pregnancy,
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Ako fetus sisara izgubi ud tokom prvog tromesečja trudnoće,
08:35
will re-grow that limb.
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ponovo će mu izrasti.
08:37
So our DNA has the capacity to do these kinds of wound-healing mechanisms.
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Tako da naša DNK ima kapacitet da aktivira te mehanizme lečenja rana.
08:43
It's a natural process,
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To je prirodan proces,
08:45
but it is lost as we age.
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ali nestaje kako starimo.
08:49
In a child, before the age of about six months,
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Ako dete starosti oko šest meseci
08:52
if they lose their fingertip in an accident,
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izgubi vrh prsta u nesreći,
08:54
they'll re-grow their fingertip.
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ponovo će mu izrasti taj vrh prsta.
08:56
By the time they're five, they won't be able to do that anymore.
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To više neće moći da urade kada budu imali pet godina.
08:59
So to engage in that conversation with the body,
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Tako, da bi se upustili u tu konverzaciju sa telom,
09:02
we need to speak the body's language.
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moramo da govorimo jezik tela.
09:04
And there are certain tools in our toolbox that allow us to do this today.
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I ima načina koji nam omogućavaju da to radimo danas.
09:09
I'm going to give you an example of three of these tools
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Daću vam primer tri takva načina
09:12
through which to converse with the body.
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putem kojih možemo pričati sa telom.
09:15
The first is cellular therapies.
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Prvi je ćelijska terapija.
09:17
Clearly, we heal ourselves in a natural process,
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Jasno je da se lečimo kroz prirodan proces,
09:20
using cells to do most of the work.
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koristeći ćelije da urade većinu posla.
09:23
Therefore, if we can find the right cells
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Tako da, ako možemo da pronađemo prave ćelije
09:25
and implant them in the body, they may do the healing.
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i ugradimo ih u telo, one mogu lečiti.
09:29
Secondly, we can use materials.
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Drugo, možemo koristiti materijale.
09:31
We heard yesterday about the importance of new materials.
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Juče smo slušali o važnosti novih materijala.
09:34
If we can invent materials, design materials,
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Ako možemo izmisliti nove materijale, dizajnirati ih,
09:37
or extract materials from a natural environment,
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ili ih izvući iz prirodne sredine,
09:40
then we might be able to have those materials induce the body to heal itself.
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onda bi ti materijali mogli biti u stanju da nateraju telo da se samo leči.
09:44
And finally, we may be able to use smart devices
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I na kraju, možemo biti u stanju da koristimo pametne sprave
09:47
that will offload the work of the body and allow it to heal.
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koje bi rasteretile telo i omogućile mu da se samo izleči.
09:52
I'm going to show you an example of each of these,
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Pokazaću vam primer svake od njih,
09:54
and I'm going to start with materials.
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i počeću sa materijalima.
09:56
Steve Badylak -- who's at the University of Pittsburgh --
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Stiv Bedilak, sa Pitsburškog univerziteta je,
09:58
about a decade ago had a remarkable idea.
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pre 10 godina imao neverovatnu ideju.
10:01
And that idea was that the small intestine of a pig,
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I ta ideja je bila da tanko crevo svinje,
10:05
if you threw away all the cells,
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ako bacite sve ćelije,
10:08
and if you did that in a way that allowed it to remain biologically active,
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i to uradite na način koji mu omogućava da ostane biološki aktivno,
10:12
may contain all of the necessary factors and signals
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može sadržati sve neophodne faktore i signale
10:15
that would signal the body to heal itself.
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koji bi signaliziral telu da se samo izleči.
10:17
And he asked a very important question.
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I on je postavio vrlo važno pitanje.
10:19
He asked the question,
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On je postavio pitanje,
10:20
if I take that material, which is a natural material
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"Ako uzmem materijal koji je prirodan
10:23
that usually induces healing in the small intestine,
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i koji obično izaziva zarastanje rana u tankom crevu,
10:26
and I place it somewhere else on a person's body,
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i stavim ga na naki drugi deo tela osobe,
10:30
would it give a tissue-specific response,
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da li ću dobiti odgovor specifičan za to tkivo,
10:33
or would it make small intestine if I tried to make a new ear?
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ili će napraviti tanko crevo ako ja pokušam da napravim uvo?"
10:37
I wouldn't be telling you this story if it weren't compelling.
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Ne bih vam pričao ovu priču da nije ubedljiva.
10:42
The picture I'm about to show you
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Ova slika koju ću vam pokazati -
10:44
is a compelling picture.
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(smeh)
10:46
(Laughter)
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- je ubedljiva slika.
10:48
However, for those of you that are even the slightest bit squeamish --
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Međutim, za one koji su makar malkice gadljivi -
10:51
even though you may not like to admit it in front of your friends --
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iako možda ne želite to da priznate pred prijateljima -
10:54
the lights are down. This is a good time to look at your feet,
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svetla su ugašena. Ovo je dobro vreme da gledate u vaša stopala,
10:57
check your Blackberry, do anything other than look at the screen.
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pogledajte u vaš telefon, uradite bilo šta samo ne gledajte u ekran.
11:02
(Laughter)
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(smeh)
11:05
What I'm about to show you is a diabetic ulcer.
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Ono što ću vam pokazati je čir kod dijabetičara.
11:09
And although -- it's good to laugh before we look at this.
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I iako je dobro smejati se pre nego što pogledamo ovo.
11:12
This is the reality of diabetes.
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Ovo je stvarnost dijabetesa.
11:14
I think a lot of times we hear about diabetics, diabetic ulcers,
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Mislim da često kada slušamo o dijabetičarima i njihovim čirevima,
11:17
we just don't connect the ulcer with the eventual treatment,
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mi jednostavno ne povezujemo čir sa eventualnim lečenjem,
11:22
which is amputation, if you can't heal it.
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a to je amputacija, ako ga ne možete izlečiti.
11:24
So I'm going to put the slide up now. It won't be up for long.
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Sada ću pokazati slajd. Neće biti dugo.
11:27
This is a diabetic ulcer. It's tragic.
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To je čir kod dijabetičara. Tragično.
11:30
The treatment for this is amputation.
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Tretman za njega je amputacija.
11:32
This is an older lady. She has cancer of the liver as well as diabetes,
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Ovo je starija žena. Ona ima rak jetre kao i dijabetes
11:36
and has decided to die with what' s left of her body intact.
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i odlučila je da umre sa onim što je ostalo od njenog tela.
11:41
And this lady decided, after a year of attempted treatment of that ulcer,
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Posle godinu dana neuspešne terapije tog čira, ona je odlučila
11:46
that she would try this new therapy that Steve invented.
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da će probati novu terapiju koju je Stiv izmislio.
11:49
That's what the wound looked like 11 weeks later.
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Ovo je kako je rana izgledala 11 nedelja kasnije.
11:52
That material contained only natural signals.
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Ovaj materijal je sadržao samo prirodne signale.
11:56
And that material induced the body to switch back on a healing response
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I on je naveo telo da ponovo uključi mehanizam lečenja
12:00
that it didn't have before.
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koji ranije nije imao.
12:02
There's going to be a couple more distressing slides for those of you --
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Biće još nekoliko neprijatnih slajdova za one od vas -
12:05
I'll let you know when you can look again.
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rećiću vam kada možete ponovo da gledate.
12:07
This is a horse. The horse is not in pain.
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Ovo je konj. Njega ništa ne boli.
12:10
If the horse was in pain, I wouldn't show you this slide.
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Da ga nešto boli, ne bih vam pokazao ovaj slajd.
12:12
The horse just has another nostril that's developed
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Konj samo ima još jednu nozdrvu koja se razvila
12:15
because of a riding accident.
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zbog nezgode na jahanju.
12:17
Just a few weeks after treatment --
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Samo nekoliko nedelja posle lečenja -
12:18
in this case, taking that material, turning it into a gel,
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u ovom slučaju uzimanja i pretvaranja materijala u gel,
12:21
and packing that area, and then repeating the treatment a few times --
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i pakovanja te oblasti i onda ponavljanja tretmana nekoliko puta -
12:25
and the horse heals up.
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i konj je ozdravio.
12:27
And if you took an ultrasound of that area, it would look great.
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I ako bismo obavili ultrazvuk te oblasti, ona bi izgledala sjajno.
12:29
Here's a dolphin where the fin's been re-attached.
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Ovde je delfin kome je ponovo pričvršćeno peraje
12:32
There are now 400,000 patients around the world
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Ima 400,000 pacijenata širom sveta
12:35
who have used that material to heal their wounds.
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koji su koristili taj materijal da izleče svoje rane.
12:38
Could you regenerate a limb?
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Da li možete regenerisati ud?
12:41
DARPA just gave Steve 15 million dollars to lead an eight-institution project
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DARPA (Agencija za napredne programe odbrane) je dala Stivu 15 miliona dolara da vodi projekat
12:45
to begin the process of asking that question.
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koji obuhvata 8 institucija, da bi počeo proces postavljanja tog pitanja.
12:48
And I'll show you the 15 million dollar picture.
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I pokazaću vam sliku od 15 miliona dolara.
12:51
This is a 78 year-old man who's lost the end of his fingertip.
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Ovo je sedamdesetosmogodišnji čovek koji je izgubio vrh prsta.
12:54
Remember that I mentioned before the children who lose their fingertips.
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Setite se da sam ranije pominjao decu koja izgube vrh prsta.
12:58
After treatment that's what it looks like.
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Ovo je kako izgleda posle lečenja.
13:01
This is happening today.
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Ovo se dešava danas.
13:03
This is clinically relevant today.
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Ovo je danas klinički relevantno.
13:06
There are materials that do this. Here are the heart patches.
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Postoje materijali koji to rade. Postoje materijali koji se ugrade u srce operacijom i regenerišu ga.
13:09
But could you go a little further?
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Ali da li bismo mogi ići malo dalje?
13:11
Could you, say, instead of using material,
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Da li bismo, recimo, umesto da koristimo materijal,
13:13
can I take some cells along with the material,
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mogli uzeti neke ćelije zajedno sa materijalom
13:15
and remove a damaged piece of tissue,
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i otkloniti oštećene delove tkiva
13:17
put a bio-degradable material on there?
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i tamo staviti biorazgradljiv materijal?
13:20
You can see here a little bit of heart muscle beating in a dish.
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Ovde možemo videti mali deo srčanog mišića kakoi kuca u posudi.
13:23
This was done by Teruo Okano at Tokyo Women's Hospital.
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Ovo je uradio Teruo Okano u Tokijskoj ženskoj bolnici.
13:28
He can actually grow beating tissue in a dish.
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On može stvarno da napravi tkivo koje kuca u posudi.
13:31
He chills the dish, it changes its properties
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On ohladi posudu, ona promeni svoja svojstva
13:33
and he peels it right out of the dish.
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i on ga oguli pravo iz posude.
13:35
It's the coolest stuff.
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To je kul stvar.
13:38
Now I'm going to show you cell-based regeneration.
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Sada ću vam pokazati regeneraciju na bazi ćelija.
13:40
And what I'm going to show you here
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I ono što ću vam ovde pokazati
13:42
is stem cells being removed from the hip of a patient.
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su matične ćelije koje se vade iz kuka pacijenta.
13:46
Again, if you're squeamish, you don't want to watch.
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Ponovo, ako ste gadljivi, ne želite da gledate.
13:48
But this one's kind of cool.
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Ali ova je nekako kul.
13:49
So this is a bypass operation, just like what Al Gore had,
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Ovo je bajpas operacija, ista kao ona koju je imao Al Gor,
13:55
with a difference.
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sa razlikom.
13:56
In this case, at the end of the bypass operation,
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U ovom slučaju, na kraju operacije,
13:59
you're going to see the stem cells from the patient
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videćete matične ćelije pacijenta
14:01
that were removed at the beginning of the procedure
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koje su izvađene na početku ovog postupka
14:03
being injected directly into the heart of the patient.
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kako se ubrizgavaju u srce pacijenta.
14:07
And I'm standing up here because at one point
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I ja ovde stojim jer ću vam u jednom trenutku
14:09
I'm going to show you just how early this technology is.
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pokazati koliko je ova tehnologija, zapravo, u začetku.
14:12
Here go the stem cells, right into the beating heart of the patient.
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Evo idu matične ćelije, pravo u lupajuće srce pacijenta.
14:15
And if you look really carefully,
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I ako pogledate zaista pažljivo,
14:16
it's going to be right around this point
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biće to otprilike u ovom momentu
14:18
you'll actually see a back-flush.
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videćete kako se vraćaju.
14:20
You see the cells coming back out.
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Videćete kako ćelije izlaze napolje.
14:24
We need all sorts of new technology, new devices,
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Potrebne su nam razne vrste novih tehnologija i sprava,
14:26
to get the cells to the right place at the right time.
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da bi ćelije stigle na pravo mesto u pravo vreme.
14:31
Just a little bit of data, a tiny bit of data.
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Samo malo podataka, veoma malo podataka.
14:33
This was a randomized trial.
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Ovo je bilo ispitivanje na slučajnom uzorku.
14:35
At this time this was an N of 20. Now there's an N of about 100.
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To je bio N od 20. Sada je N od 100.
14:39
Basically, if you take an extremely sick patient
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U suštini, ako uzmete izuzetno bolesnog pacijenta
14:41
and you give them a bypass, they get a little bit better.
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i ugradite mu bajpas, biće mu malo bolje.
14:43
If you give them stem cells as well as their bypass,
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Ako mu date i matične ćelije sa njim,
14:46
for these particular patients, they became asymptomatic.
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za ove određene pacijente, simptomi nestaju.
14:49
These are now two years out.
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Ovo je posle 2 godine.
14:53
The coolest thing would be is if you could diagnose the disease early,
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Najbolje bi bilo kada bi dijagnostifikovali bolest rano
14:56
and prevent the onset of the disease to a bad state.
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i sprečili njen napredak do lošeg stadijuma.
15:00
This is the same procedure, but now done minimally invasively,
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Ovo je ista procedura, ali sada urađena minimalno invazivno
15:04
with only three holes in the body where they're taking the heart
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sa samo tri rupe u telu, gde uzimaju srce
15:07
and simply injecting stem cells through a laparoscopic procedure.
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i ubrizgavaju matične ćelije kroz laparoskopsku proceduru.
15:11
There go the cells.
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Evo idu ćelije.
15:12
We don't have time to go into all of those details,
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Nemamo vremena da ulazimo u sve ove detalje,
15:15
but basically, that works too.
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ali, u osnovi, i ovo funkcioniše.
15:17
You can take patients who are less sick,
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Možemo uzeti manje bolesne pacijente
15:20
and bring them back to an almost asymptomatic state
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i vratiti ih u stanje koje je skoro bez simptoma
15:24
through that kind of therapy.
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kroz ovu vrstu terapije.
15:26
Here's another example of stem-cell therapy that isn't quite clinical yet,
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Evo još jednog primera terapije matičnim ćelijama koja još uvek nije klinička,
15:30
but I think very soon will be.
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ali mislim da će uskoro biti.
15:32
This is the work of Kacey Marra from Pittsburgh,
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Ovo je rad Kejsi Mare iz Pitsburga,
15:34
along with a number of colleagues around the world.
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zajedno sa brojnim kolegama iz celog sveta.
15:36
They've decided that liposuction fluid,
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Oni su odlučili da tečnost od liposukcije,
15:39
which -- in the United States, we have a lot of liposuction fluid.
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koje imamo mnogo u Sjedinjenim državama.
15:42
(Laughter)
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(smeh)
15:43
It's a great source of stem cells.
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Odličan je izvor matičnih ćelija.
15:45
Stem cells are packed in that liposuction fluid.
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Tečnost od liposukcije je prepuna matičnih ćelija.
15:48
So you could go in, you could get your tummy-tuck.
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Mozete doći i uraditi liposukciju stomaka.
15:51
Out comes the liposuction fluid,
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Tečnost od liposukcije izlazi napolje,
15:53
and in this case, the stem cells are isolated and turned into neurons.
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i u ovom slučaju, matične ćelije su izolovane i pretvorene u neurone.
15:58
All done in the lab.
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Sve se radi u laboratoriji.
15:59
And I think fairly soon, you will see patients being treated
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I mislim da ćete prilično skoro videti pacijente koji se leče na ovaj način
16:02
with their own fat-derived, or adipose-derived, stem cells.
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sa sopstvenim matičnim ćelijama iz masnog tkiva.
16:07
I talked before about the use of devices
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Prethodno sam pričao o korišćenju sprava
16:09
to dramatically change the way we treat disease.
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koje bi dramatično promenile način na koji lečimo bolest.
16:12
Here's just one example before I close up.
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Evo još jednog primera pre nego što završim.
16:14
This is equally tragic.
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Ovo je jednako tragično.
16:16
We have a very abiding and heartbreaking partnership
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Imamo veoma trajno i srceparajuće partnerstvo
16:19
with our colleagues at the Institute for Surgical Research in the US Army,
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sa našim kolegama sa Instituta za hiruško istraživanje pri vojsci SAD-a,
16:23
who have to treat the now 11,000 kids that have come back from Iraq.
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koji moraju sada da leče 11 000 mladića koji su se vratili iz Iraka.¼
16:28
Many of those patients are very severely burned.
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Mnogi od njih imaju ozbiljne opekotine.
16:30
And if there's anything that's been learned about burn,
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I ako smo nešto naučili o opekotinama,
16:32
it's that we don't know how to treat it.
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onda je to da ne znamo kako da ih lečimo.
16:34
Everything that is done to treat burn --
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Sve što radimo je
16:36
basically we do a sodding approach.
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u suštini, presađivanje.
16:39
We make something over here,
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Napravimo nešto ovde,
16:41
and then we transplant it onto the site of the wound,
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i onda ga presadimo na mesto rane
16:43
and we try and get the two to take.
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i potrudimo se da se primi.
16:45
In this case here, a new, wearable bio-reactor has been designed --
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U ovom slučaju je dizajniran novi bioreaktor koji možete da nosite -
16:49
it should be tested clinically later this year at ISR --
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kasnije ove godine treba da prođe kroz klinička testiranja na ISR-u -
16:52
by Joerg Gerlach in Pittsburgh.
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koga je napravio Jorg Gerlak u Pitsburgu.
16:54
And that bio-reactor will lay down in the wound bed.
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I taj bioreaktor će biti postavljen u ranu.
16:57
The gun that you see there sprays cells.
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Pištolj koji vidite prska ćelije.
17:00
That's going to spray cells over that area.
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To će poprskati ćelije po ovoj oblasti.
17:03
The reactor will serve to fertilize the environment,
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Reaktor će služiti tome da oploditi okolinu,
17:06
deliver other things as well at the same time,
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da istovremeno isporuči i druge stvari
17:09
and therefore we will seed that lawn,
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i tako ćemo zasaditi travnjak,
17:12
as opposed to try the sodding approach.
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umesto da ga presađujemo.
17:14
It's a completely different way of doing it.
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To je potpuno novi način da se to radi.
17:18
So my 18 minutes is up.
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Dakle, mojih osamnaest minuta je isteklo.
17:20
So let me finish up with some good news,
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Dozvolite mi da završim sa nekim dobrim vestima
17:22
and maybe a little bit of bad news.
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i možda malo loših vesti.
17:25
The good news is that this is happening today.
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Dobra vest je da se ovo dešava danas.
17:28
It's very powerful work.
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To je vrlo moćan rad.
17:30
Clearly the images kind of get that across.
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Jasno je da slike to prenose.
17:32
It's incredibly difficult because it's highly inter-disciplinary.
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Neverovatno je teško jer je jako interdisciplinarno.
17:35
Almost every field of science engineering and clinical practice
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Skoro svaka oblast naučnog inženjeringa i kliničke prakse
17:39
is involved in trying to get this to happen.
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je uključena u pokušaj da se ovo izvede.
17:43
A number of governments, and a number of regions,
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Puno vlada i puno regiona
17:45
have recognized that this is a new way to treat disease.
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je priznalo da je ovo nov način za lečenje bolesti.
17:48
The Japanese government were perhaps the first,
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Japanska vlada je možda bila prva,
17:50
when they decided to invest first 3 billion,
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kada je odlučila da uloži prvo 3 milijarde,
17:53
later another 2 billion in this field.
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zatim još dve milijarde u ovo polje.
17:56
It's no coincidence.
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Nije slučajnost.
17:57
Japan is the oldest country on earth in terms of its average age.
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Japan je najstarija zemlja na svetu po prosečnoj starosti stanovništva.
18:00
They need this to work or their health system dies.
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Njima je potrebno da ovo uspe ili će im zdravstveni sistem umreti.
18:05
So they're putting a lot of strategic investment focused in this area.
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Tako da ulažu u puno strateških investicija koje se usredsređuju na ovu oblast.
18:09
The European Union, same thing.
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Evropska unija, ista stvar.
18:11
China, the same thing.
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Kina, ista stvar.
18:13
China just launched a national tissue-engineering center.
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Kina je upravo lansirala nacionalni centar za inženjering tkiva.
18:15
The first year budget was 250 million US dollars.
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Budžet za prvu godinu je 250 miliona dolara.
18:19
In the United States we've had a somewhat different approach.
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U SAD-u smo imali nešto drugačiji pristup. Mi -
18:23
(Laughter)
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(smeh)
18:26
Oh, for Al Gore to come and be in the real world as president.
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o, da je samo Al Gor predsednik u stvarnom svetu.
18:30
We've had a different approach.
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Mi smo imali drugačiji pristup.
18:31
And the approach has basically been to just sort of fund things as they come along.
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I pristup je bio da finansiramo stvari kako su nailazile.
18:35
But there's been no strategic investment
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Ali nije bilo strateških investicija
18:38
to bring all of the necessary things to bear and focus them in a careful way.
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da bi se sve potrebne stvari korisno primenile i usmerile na pažljiv način.
18:44
And I'm going to finish up with a quote, maybe a little cheap shot,
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I završiću citatom, mozda malo niskim udarcem,
18:47
at the director of the NIH, who's a very charming man.
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direktora NIH-a (Nacionalni institut za zdravlje SAD-a) koji je veoma šarmantan čovek.
18:53
Myself and Jay Vacanti from Harvard
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Ja i Džej Vakanti sa Harvarda
18:55
went to visit with him and a number of his directors of his institute
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smo otišli da posetimo njega i nekoliko njegovih direktora sa instituta
19:00
just a few months ago,
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pre samo nekoliko meseci,
19:03
to try and convince him that it was time to take just a little piece
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da pokušamo da ga ubedimo da je vreme da uzme samo mali deo
19:08
of that 27.5 billion dollars that he's going to get next year
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od tih 27,5 milijardi dolara koje će dobiti sledeće godine
19:12
and focus it, in a strategic way, to make sure we can accelerate the pace
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i usmeri ih, na strateški način, da obezbedi da možemo da ubrzamo korak
19:17
at which these things get to patients.
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kojim te stvari dolaze do pacijenata.
19:20
And at the end of a very testy meeting,
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I na kraju vrlo mrzovoljnog sastanka,
19:22
what the NIH director said was,
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ono što je direktor NIH-a rekao je,
19:24
"Your vision is larger than our appetite."
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"Vaša vizija je veća od našeg apetita."
19:26
I'd like to close by saying that no one's going to change our vision,
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Završiću sa rečima da niko neće promeniti našu viziju,
19:30
but together we can change his appetite.
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ali zajedno možemo promeniti njegov apetit.
19:32
Thank you.
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Hvala vam.
ABOUT THE SPEAKER
Alan Russell - Medical futuristIn the fight against disease, defect and injury, Alan Russell has a novel argument: Why not engineer new tissue and organs to replace sick ones?
Why you should listen
Alan Russell is a professor of surgery -- and of chemical engineering. In crossing the two fields, he is expanding our palette of treatments for disease, injury and congenital defects. We can treat symptoms, he says, or we can replace our damaged parts with bioengineered tissue. As he puts it: "If newts can regenerate a lost limb, why can't we?"
The founding director of the McGowan Institute for Regenerative Medicine, at the University of Pittsburgh, Russell leads an ambitious biomedicine program that explores tissue engineering, stem cell research, biosurgery and artificial and biohybrid organs. They've also started testing a new kind of heart pump, figured out that Botox can help with enlarged prostate, and identified human adipose cells as having the possibility to repair skeletal muscle. In his own Russell Lab, his team has studied antimicrobial surfaces and helping to develop a therapy to reduce scarring on muscle after injury. Lately, his lab is involved in biotechnology studies in relation to chemical and biological weapons defense.
He's also co-founder of Agentase, a company that makes an enzyme-based detector for chemical warfare agents.
Alan Russell | Speaker | TED.com