TED2015
Siddhartha Mukherjee: Soon we'll cure diseases with a cell, not a pill
Sidarta Makhardži (Siddhartha Mukherjee): Uskoro ćemo lečiti bolesti ćelijama, a ne pilulama
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Današnji medicinski tretmani svode se na šest reči: imate bolest, uzmite pilulu, ubijte nešto. Međutim, lekar Sidarta Makhardži ukazuje na budućnost medicine koja će transformisati način na koji se lečimo.
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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Želim da vam govorim
o budućnosti medicine,
o budućnosti 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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a pre nego što to uradim,
želeo bih da malo govorim o prošlosti.
želeo bih da malo govorim o prošlosti.
00:21
Now, throughout much
of the recent history of medicine,
of the recent history of medicine,
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Većim delom skorije istorije medicine,
00:24
we've thought about illness and treatment
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razmišljali smo o bolestima i lečenju
00:28
in terms of a profoundly simple model.
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u okvirima jako jednostavnog modela.
00:31
In fact, the model is so simple
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Zapravo, model je tako jednostavan
00:34
that you could summarize it in six words:
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da ga možete rezimirati u šest reči:
00:37
have disease, take pill, kill something.
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imate bolest, uzmite pilulu, ubijte nešto.
00:43
Now, the reason
for the dominance of this model
for the dominance of this model
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E, sad, razlog dominantnosti ovog modela,
00:47
is of course the antibiotic revolution.
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naravno, predstavlja
revolucija antibiotika.
revolucija antibiotika.
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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Mnogi od vas možda ovo ne znaju,
ali upravo slavimo
ali upravo slavimo
00:53
the hundredth year of the introduction
of antibiotics into the United States.
of antibiotics into the United States.
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stotu godinu od uvođenja antibiotika
u Sjedinjene Države.
u Sjedinjene Države.
00:57
But what you do know
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Ipak, ono što znate
00:59
is that that introduction
was nothing short of transformative.
was nothing short of transformative.
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jeste da to uvođenje
nije bilo ništa manje nego transformišuće.
nije bilo ništa manje nego transformišuće.
01:04
Here you had a chemical,
either from the natural world
either from the natural world
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Imali ste hemikaliju,
bilo iz sveta prirode
bilo iz sveta prirode
01:08
or artificially synthesized
in the laboratory,
in the laboratory,
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ili veštački sintetizovanu u laboratoriji,
01:11
and it would course through your body,
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ona bi prolazila kroz vaše telo,
01:14
it would find its target,
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našla bi svoju metu,
01:17
lock into its target --
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naciljala bi svoju metu -
01:19
a microbe or some part of a microbe --
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mikrob ili deo mikroba -
01:21
and then turn off a lock and a key
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a zatim onesposobila i bravu i ključ
01:25
with exquisite deftness,
exquisite specificity.
exquisite specificity.
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sa izuzetnom spretnošću,
izuzetnom specifičnošću.
izuzetnom specifičnošću.
01:29
And you would end up taking
a previously fatal, lethal disease --
a previously fatal, lethal disease --
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Na kraju biste uzeli
prethodno fatalnu, smrtonosnu bolest -
prethodno fatalnu, smrtonosnu bolest -
01:33
a pneumonia, syphilis, tuberculosis --
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upalu pluća, sifilis, tuberkulozu -
01:37
and transforming that
into a curable, or treatable illness.
into a curable, or treatable illness.
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i pretvorili je u izlečivu bolest
ili bolest za koju postoji tretman.
ili bolest za koju postoji tretman.
01:42
You have a pneumonia,
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Imate upalu pluća,
01:44
you take penicillin,
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uzmete penicilin,
01:45
you kill the microbe
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ubijete mikrobe
01:47
and you cure the disease.
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i izlečite bolest.
01:49
So seductive was this idea,
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Toliko je bila zavodljiva ta ideja,
01:52
so potent the metaphor of lock and key
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tako moćna metafora o bravi i ključu
01:56
and killing something,
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i ubijanju nečega,
01:58
that it really swept through biology.
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da se brzo probila kroz biologiju.
02:00
It was a transformation like no other.
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Bila je to transformacija
kao nijedna druga.
kao nijedna druga.
02:04
And we've really spent the last 100 years
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Zaista smo proveli poslednjih sto godina
02:07
trying to replicate that model
over and over again
over and over again
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pokušavajući da iznova i iznova
ponovimo taj model
ponovimo taj model
02:10
in noninfectious diseases,
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kod neinfektivnih bolesti,
02:12
in chronic diseases like diabetes
and hypertension and heart disease.
and hypertension and heart disease.
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kod hroničnih bolesti poput dijabetesa,
hipertenzije i srčanih oboljenja.
hipertenzije i srčanih oboljenja.
02:17
And it's worked,
but it's only worked partly.
but it's only worked partly.
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Uspelo je, ali samo delimično.
02:21
Let me show you.
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Dozvolite da vam pokažem.
02:22
You know, if you take the entire universe
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Znate, ako uzmete čitav univerzum
02:25
of all chemical reactions
in the human body,
in the human body,
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hemijskih reakcija u ljudskom telu,
02:29
every chemical reaction
that your body is capable of,
that your body is capable of,
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svaku hemijsku reakciju
za koju je vaše telo sposobno,
za koju je vaše telo sposobno,
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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većina ljudi misli
da je taj broj blizu miliona.
da je taj broj blizu miliona.
Recimo da je milion.
02:35
Let's call it a million.
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02:36
And now you ask the question,
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Da vas sada pitam,
02:38
what number or fraction of reactions
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koji broj ili deo reakcija
02:41
can actually be targeted
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zaista može biti meta
02:43
by the entire pharmacopoeia,
all of medicinal chemistry?
all of medicinal chemistry?
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čitave farmakopeje,
cele medicinske hemije?
cele medicinske hemije?
02:48
That number is 250.
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Taj broj je 250.
02:51
The rest is chemical darkness.
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Ostatak je u hemijskoj tami.
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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Drugim rečima, 0,025 posto
svih hemijskih reakcija u vašem telu
svih hemijskih reakcija u vašem telu
03:00
are actually targetable
by this lock and key mechanism.
by this lock and key mechanism.
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mogu postati meta
ovog mehanizma ključa i brave.
ovog mehanizma ključa i brave.
03:05
You know, if you think
about human physiology
about human physiology
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Znate, ako razmišljate
o ljudskoj fiziologiji
o ljudskoj fiziologiji
03:08
as a vast global telephone network
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kao o ogromnoj globalnoj telefonskoj mreži
03:12
with interacting nodes
and interacting pieces,
and interacting pieces,
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sa čvorovima i delovima u interakciji,
03:16
then all of our medicinal chemistry
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tada celokupna naša medicinska hemija
03:19
is operating on one tiny corner
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funkcioniše u jednom malom uglu
03:22
at the edge, the outer edge,
of that network.
of that network.
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na ivici, spoljnoj ivici te mreže.
03:24
It's like all of our
pharmaceutical chemistry
pharmaceutical chemistry
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To bi bilo kao da je
čitava naša farmaceutska hemija
čitava naša farmaceutska hemija
03:28
is a pole operator in Wichita, Kansas
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potporni operater u Vičiti, u Kanzasu,
koji petlja sa oko deset
ili petnaest telefonskih linija.
ili petnaest telefonskih linija.
03:32
who is tinkering with about
10 or 15 telephone lines.
10 or 15 telephone lines.
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03:36
So what do we do about this idea?
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Pa, šta da radimo u vezi sa ovom idejom?
03:40
What if we reorganized this approach?
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Šta ako bismo reorganizovali ovaj pristup?
03:44
In fact, it turns out
that the natural world
that the natural world
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U stvari, ispostavilo se
da nam svet prirode
da nam svet prirode
03:47
gives us a sense of how one
might think about illness
might think about illness
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daje nagoveštaj kako bismo mogli
razmišljati o bolestima
razmišljati o bolestima
03:52
in a radically different way,
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na potpuno drugačiji način,
03:54
rather than disease, medicine, target.
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umesto zaraze, lekova, meta.
03:59
In fact, the natural world
is organized hierarchically upwards,
is organized hierarchically upwards,
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Zapravo, svet prirode je organizovan
hijerarhijski prema gore,
hijerarhijski prema gore,
04:02
not downwards, but upwards,
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nije usmeren nadole, već nagore,
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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a započinjemo samoregulišućom,
poluautonomnom jedinicom zvanom ćelija.
poluautonomnom jedinicom zvanom ćelija.
04:11
These self-regulating,
semi-autonomous units
semi-autonomous units
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Te samoregulišuće, poluautonomne jedinice
04:14
give rise to self-regulating,
semi-autonomous units called organs,
semi-autonomous units called organs,
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dovode do samoregulišućih,
poluautonomnih jedinica zvanih organi,
poluautonomnih jedinica zvanih organi,
04:19
and these organs coalesce
to form things called humans,
to form things called humans,
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a ti organi se sjedinjuju
da bi formirali ono što se zovu ljudi,
da bi formirali ono što se zovu ljudi,
04:23
and these organisms
ultimately live in environments,
ultimately live in environments,
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a ti organizmi na kraju žive u sredinama
04:27
which are partly self-regulating
and partly semi-autonomous.
and partly semi-autonomous.
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koje su delom samoregulišuće,
a delom poluautonomne.
a delom poluautonomne.
Ono što je fino u vezi sa ovom šemom,
ovom hijerarhijskom šemom
ovom hijerarhijskom šemom
04:32
What's nice about this scheme,
this hierarchical scheme
this hierarchical scheme
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04:35
building upwards rather than downwards,
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koja se izgrađuje nagore umesto nadole,
04:38
is that it allows us
to think about illness as well
to think about illness as well
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je to što nam omogućava
da razmišljamo o bolestima
da razmišljamo o bolestima
04:41
in a somewhat different way.
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na donekle drugačiji način.
04:44
Take a disease like cancer.
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Uzmite bolest poput raka.
04:48
Since the 1950s,
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Od 1950-ih godina,
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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pokušavali smo zaista očajnički
da model ključa i brave primenimo na raku.
da model ključa i brave primenimo na raku.
04:54
We've tried to kill cells
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Pokušavali smo da ubijemo ćelije
04:57
using a variety of chemotherapies
or targeted therapies,
or targeted therapies,
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koristeći mnoštvo hemoterapija
ili usmerenih terapija,
ili usmerenih terapija,
05:02
and as most of us know, that's worked.
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i kao što je većini poznato,
to je uspelo.
to je uspelo.
Uspelo je kod bolesti
kao što je leukemija.
kao što je leukemija.
05:04
It's worked for diseases like leukemia.
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Uspelo je kod nekih oblika raka dojke,
05:06
It's worked for some forms
of breast cancer,
of breast cancer,
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05:09
but eventually you run
to the ceiling of that approach.
to the ceiling of that approach.
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ali na kraju stignete
do gornje granice tog pristupa.
do gornje granice tog pristupa.
05:12
And it's only in the last 10 years or so
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Tek smo poslednjih desetak godina
05:15
that we've begun to think
about using the immune system,
about using the immune system,
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počeli da razmišljamo
o korišćenju imunog sistema,
o korišćenju imunog 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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setivši se da ćelije raka
u stvari ne rastu u vakuumu.
u stvari ne rastu u vakuumu.
05:21
It actually grows in a human organism.
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Zapravo rastu u ljudskom organizmu.
05:23
And could you use the organismal capacity,
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A da li možete koristiti
organizmički kapacitet,
organizmički kapacitet,
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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činjenicu da ljudska bića imaju
imuni sistem, da biste napali rak?
imuni sistem, da biste napali rak?
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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Naime, to je dovelo
do nekih od najspektakularnijih
novih lekova protiv raka.
novih lekova protiv 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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Konačno, tu je nivo okruženja, zar ne?
05:38
You know, we don't think of cancer
as altering the environment.
as altering the environment.
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Znate, mi ne mislimo o raku
kao o menjanju sredine.
kao o menjanju sredine.
05:41
But let me give you an example
of a profoundly carcinogenic environment.
of a profoundly carcinogenic environment.
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Dozvolite da vam dam primer
duboko karcinogenog okruženja.
duboko karcinogenog okruženja.
05:46
It's called a prison.
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Zove se zatvor.
05:48
You take loneliness, you take depression,
you take confinement,
you take confinement,
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Uzmite usamljenost, uzmite depresiju,
uzmite pritvaranje,
uzmite pritvaranje,
05:53
and you add to that,
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i tome dodajte,
05:55
rolled up in a little
white sheet of paper,
white sheet of paper,
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urolan u malo belo parče papira,
05:59
one of the most potent neurostimulants
that we know, called nicotine,
that we know, called nicotine,
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jedan od najsnažnijih neurostimulansa
za koje znamo, zvani nikotin,
za koje znamo, zvani 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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i tome dodate jednu od najjačih
zavisničkih supstanci za koje znate,
zavisničkih supstanci za koje znate,
06:07
and you have
a pro-carcinogenic environment.
a pro-carcinogenic environment.
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i imate prokancerogeno okruženje.
06:11
But you can have anti-carcinogenic
environments too.
environments too.
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Možete imati i antikarcinogena okruženja.
06:14
There are attempts to create milieus,
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Postoje pokušaji stvaranja sredina,
06:16
change the hormonal milieu
for breast cancer, for instance.
for breast cancer, for instance.
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menjanja hormonalne sredine
za rak dojke, na primer.
za rak dojke, na primer.
Pokušavamo da menjamo
metaboličko okruženje
metaboličko okruženje
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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kod drugih oblika raka.
06:23
Or take another disease, like depression.
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Ili uzmite drugu bolest,
kao što je depresija.
kao što je depresija.
06:26
Again, working upwards,
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Opet, radeći nagore,
06:29
since the 1960s and 1970s,
we've tried, again, desperately
we've tried, again, desperately
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od 60-ih i 70-ih godina smo pokušavali,
takođe očajnički,
takođe očajnički,
06:33
to turn off molecules
that operate between nerve cells --
that operate between nerve cells --
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da isključimo molekule
koji deluju između nervnih ćelija -
koji deluju između nervnih ćelija -
06:37
serotonin, dopamine --
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serotonin, dopamin -
06:39
and tried to cure depression that way,
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i pokušavali da tako izlečimo depresiju,
i to je uspevalo,
i to je uspevalo,
06:41
and that's worked,
but then that reached the limit.
but then that reached the limit.
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ali je onda doseglo granicu.
06:45
And we now know that what you
really probably need to do
really probably need to do
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Sada znamo da je verovatno
ono što mora da se uradi -
ono što mora da se uradi -
06:47
is to change the physiology
of the organ, the brain,
of the organ, the brain,
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promeniti fiziologiju organa, mozga,
06:50
rewire it, remodel it,
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prespojiti ga, preoblikovati ga,
i to, naravno, znamo
jer je studija za studijom pokazala
jer je studija za studijom pokazala
06:52
and that, of course,
we know study upon study has shown
we know study upon study has shown
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da terapija razgovorom upravo to čini,
06:55
that talk therapy does exactly that,
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06:57
and study upon study
has shown that talk therapy
has shown that talk therapy
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i studija za studijom je pokazala
da je terapija razgovorom
u kombinaciji sa lekovima, pilulama,
u kombinaciji sa lekovima, pilulama,
06:59
combined with medicines, pills,
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zapravo mnogo delotvornija
nego bilo koje od ta dva zasebno.
nego bilo koje od ta dva zasebno.
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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Možemo li zamisliti obuhvatnije okruženje
koje će promeniti depresiju?
koje će promeniti depresiju?
07:09
Can you lock out the signals
that elicit depression?
that elicit depression?
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Možete li da blokirate signale
koji izazivaju depresiju?
koji izazivaju depresiju?
07:13
Again, moving upwards along this
hierarchical chain of organization.
hierarchical chain of organization.
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Još jednom, krećući se nagore
ovim hijerahijskim lancem organizacije.
ovim hijerahijskim lancem organizacije.
07:19
What's really at stake perhaps here
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Možda ovde zapravo u pitanju
07:22
is not the medicine itself but a metaphor.
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nije lek sam po sebi, već metafora.
07:25
Rather than killing something,
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Umesto ubijanja nečega,
07:27
in the case of the great
chronic degenerative diseases --
chronic degenerative diseases --
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u slučaju velikih hroničnih
degenerativnih oboljenja -
degenerativnih oboljenja -
07:31
kidney failure, diabetes,
hypertension, osteoarthritis --
hypertension, osteoarthritis --
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otkazivanja bubrega, dijabetesa,
hipertenzija, artroze -
hipertenzija, artroze -
možda je ono što zaista treba da uradimo
promena metafore na uzgajanje nečega,
promena metafore na uzgajanje nečega,
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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07:38
And that's the key, perhaps,
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a to je ključ, možda,
07:40
to reframing our thinking about medicine.
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za preformulisanje
našeg razmišljaja o medicini.
našeg razmišljaja o medicini.
07:43
Now, this idea of changing,
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E, sad, ta ideja o menjanju,
07:46
of creating a perceptual
shift, as it were,
shift, as it were,
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stvaranju preokreta
u percepciji, takoreći,
u percepciji, takoreći,
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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ugnezdila se kod mene
na vrlo ličan način pre oko 10 godina.
na vrlo ličan način pre oko 10 godina.
Pre oko 10 godina -
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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bavio sam se trčanjem većim delom života -
07:55
I went for a run, a Saturday morning run,
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otišao sam na trčanje u subotu ujutu.
Vratio sam se i probudio se
i bukvalno nisam mogao da se pomerim.
i bukvalno nisam mogao da se pomerim.
07:57
I came back and woke up
and I basically couldn't move.
and I basically couldn't move.
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07:59
My right knee was swollen up,
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Moje desno koleno je bilo natečeno
08:01
and you could hear that ominous crunch
of bone against bone.
of bone against bone.
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i mogli ste da čujete
to zlokobno krckanje kost o kost.
to zlokobno krckanje kost o kost.
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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Jedna od privilegija lekara
je da ste možete da zatražite
svoju magnetnu rezonancu.
svoju magnetnu rezonancu.
08:11
And I had an MRI the next week,
and it looked like that.
and it looked like that.
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Sledeće nedelje sam otišao
na magnetnu rezonancu
na magnetnu rezonancu
i to je ovako izgledalo.
08:15
Essentially, the meniscus of cartilage
that is between bone
that is between bone
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U suštini, meniskus hrskavice
koji se nalazi između kostiju
koji se nalazi između kostiju
08:19
had been completely torn
and the bone itself had been shattered.
and the bone itself had been shattered.
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bio je potpuno iskidan,
a sama kost je bila oštećena.
a sama kost je bila oštećena.
08:22
Now, if you're looking at me
and feeling sorry,
and feeling sorry,
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Ako me gledate sa sažaljenjem,
08:25
let me tell you a few facts.
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da vam kažem nekoliko činjenica.
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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Ako bih odveo na magnetnu rezonancu
svaku osobu u ovoj publici,
svaku osobu u ovoj publici,
08:31
60 percent of you would show signs
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60 procenata vas bi pokazivalo znake
08:33
of bone degeneration
and cartilage degeneration like this.
and cartilage degeneration like this.
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ovakvog propadanja kostiju i hrskavice.
08:36
85 percent of all women by the age of 70
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Osamdeset pet posto
svih žena do 70. godine
svih žena do 70. godine
08:40
would show moderate to severe
cartilage degeneration.
cartilage degeneration.
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pokazuje znake umerene do ozbiljne
degeneracije hrskavice,
degeneracije hrskavice,
08:43
50 to 60 percent
of the men in this audience
of the men in this audience
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a 50 do 60 procenata muškaraca
u ovoj publici
u ovoj publici
takođe bi imalo takve simptome.
08:45
would also have such signs.
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08:47
So this is a very common disease.
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Dakle, ovo je veoma učestalo oboljenje.
08:48
Well, the second perk of being a physician
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Druga prednost koju imaju lekari
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 mogu da eksperimentišu
sa svojim tegobama.
sa svojim tegobama.
08:54
So about 10 years ago we began,
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Dakle, pre oko 10 godina smo započeli,
08:56
we brought this process
into the laboratory,
into the laboratory,
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doneli smo ovaj proces u laboratoriju
i započeli smo
sa jednostavnim eksperimentima,
sa jednostavnim eksperimentima,
08:58
and we began to do simple experiments,
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09:00
mechanically trying
to fix this degeneration.
to fix this degeneration.
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pokušavajući mehanički
da popravimo ovu degeneraciju.
da popravimo ovu degeneraciju.
09:03
We tried to inject chemicals
into the knee spaces of animals
into the knee spaces of animals
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Pokušali smo da ubrizgavamo hemikalije
u kolena životinja
u kolena životinja
09:08
to try to reverse cartilage degeneration,
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da bismo probali da preokrenemo
propadanje hrskavice,
propadanje hrskavice,
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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i da rezimiramo ukratko
veoma dug i bolan proces,
veoma dug i bolan proces,
09:15
essentially it came to naught.
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u suštini se to svelo ni na šta.
09:17
Nothing happened.
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Ništa se nije dogodilo.
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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Zatim, pre oko sedam godina, imali smo
studenta istraživača iz Australije.
studenta istraživača iz Australije.
Dobra stvar kod Australijanaca
09:23
The nice thing about Australians
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je da su navikli
da posmatraju svet naopako.
da posmatraju svet naopako.
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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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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Tako mi je Den predložio: „Znaš,
možda nije u pitanju mehanički problem.
možda nije u pitanju mehanički 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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Možda nije hemijski problem.
Možda je problem matičnih ćelija.“
Možda je problem matičnih ćelija.“
09:39
In other words, he had two hypotheses.
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Drugim rečima, imali smo dve hipoteze.
09:41
Number one, there is such a thing
as a skeletal stem cell --
as a skeletal stem cell --
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Broj jedan, postoji tako nešto
kao skeletne matične ćelije -
kao skeletne matične ćelije -
09:45
a skeletal stem cell that builds up
the entire vertebrate skeleton,
the entire vertebrate skeleton,
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skeletne matične ćelije koje grade
čitav skelet kičmenjaka,
čitav skelet kičmenjaka,
09:49
bone, cartilage and the fibrous
elements of skeleton,
elements of skeleton,
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kosti, hrskavicu
i vlaknaste elemente skeleta,
i vlaknaste elemente skeleta,
baš kao što postoje matične ćelije u krvi,
09:51
just like there's a stem cell in blood,
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baš kao što postoje
matične ćelije u nervnom sistemu.
matične ćelije u nervnom sistemu.
09:53
just like there's a stem cell
in the nervous system.
in the nervous system.
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I pod dva, da možda je degeneracija
ili disfunkcija ovih matičnih ćelija
ili disfunkcija ovih matičnih ćelija
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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ono što izaziva kostohondralni artritis,
vrlo učestalu bolest.
vrlo učestalu bolest.
09:59
is what's causing osteochondral arthritis,
a very common ailment.
a very common ailment.
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10:03
So really the question was,
were we looking for a pill
were we looking for a pill
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Dakle, pitanje je zapravo,
da li smo tragali za pilulom
da li smo tragali za pilulom
10:06
when we should have really
been looking for a cell.
been looking for a cell.
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kada je u stvari trebalo
da tragamo za ćelijom.
da tragamo za ćelijom.
10:08
So we switched our models,
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Stoga smo preokrenuli naše modele
10:11
and now we began
to look for skeletal stem cells.
to look for skeletal stem cells.
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i počeli da tragamo
za skeletnim matičnim ćelijama.
za skeletnim matičnim ćelijama.
10:15
And to cut again a long story short,
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Da ponovo skratimo priču,
10:18
about five years ago,
we found these cells.
we found these cells.
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pre oko pet godina pronašli smo te ćelije.
10:21
They live inside the skeleton.
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One žive unutar skeleta.
Ovde je šematski prikaz,
a potom i prava fotografija jedne od njih.
a potom i prava fotografija jedne od njih.
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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10:27
The white stuff is bone,
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Belo na slici je kost, a te crvene kolone
koje vidite i žute ćelije
koje vidite i žute ćelije
10:29
and these red columns that you see
and the yellow cells
and the yellow cells
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10:32
are cells that have arisen
from one single skeletal stem cell --
from one single skeletal stem cell --
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su ćelije koje su nastale
iz samo jedne skeletne matične ćelije -
iz samo jedne skeletne matične ćelije -
10:35
columns of cartilage, columns of bone
coming out of a single cell.
coming out of a single cell.
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kolone hrskavice, kolone kostiju
koje proizilaze iz samo jedne ćelije.
koje proizilaze iz samo jedne ćelije.
10:38
These cells are fascinating.
They have four properties.
They have four properties.
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Ove ćelije su fascinantne.
Imaju četiri svojstva.
Imaju četiri svojstva.
10:42
Number one is that they live
where they're expected to live.
where they're expected to live.
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Prvo je da žive gde se to i očekuje.
10:45
They live just underneath
the surface of the bone,
the surface of the bone,
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Žive baš ispod površine kosti,
10:48
underneath cartilage.
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ispod hrskavice.
10:49
You know, in biology,
it's location, location, location.
it's location, location, location.
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Znate, u biologiji
se sve vrti oko lokacije.
se sve vrti oko lokacije.
10:52
And they move into the appropriate areas
and form bone and cartilage.
and form bone and cartilage.
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Pređu u odgovarajuća područja
i formiraju kost i hrskavicu.
i formiraju kost i hrskavicu.
10:56
That's one.
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To je prvo svojstvo.
10:58
Here's an interesting property.
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Evo zanimljivog svojstva.
Možete da ih izvadite
iz skeleta kičmenjaka,
iz skeleta kičmenjaka,
10:59
You can take them out
of the vertebrate skeleton,
of the vertebrate skeleton,
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možete da ih kultivišete
u petrijevoj šolji u laboratoriji,
u petrijevoj šolji u laboratoriji,
11:02
you can culture them
in petri dishes in the laboratory,
in petri dishes in the laboratory,
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a one strašno žele da formiraju hrskavicu.
11:04
and they are dying to form cartilage.
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11:06
Remember how we couldn't
form cartilage for love or money?
form cartilage for love or money?
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Sećate se kako nikako nismo mogli
da formiramo hrskavicu?
da formiramo hrskavicu?
Ove ćelije užasno žele
da formiraju hrskavicu.
da formiraju hrskavicu.
11:09
These cells are dying to form cartilage.
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11:11
They form their own furls
of cartilage around themselves.
of cartilage around themselves.
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One formiraju naslage hrskavice oko sebe.
11:14
They're also, number three,
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One su takođe, broj 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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najefikasniji remonteri preloma
sa kojima smo se ikada susreli.
sa kojima smo se ikada susreli.
11:20
This is a little bone,
a mouse bone that we fractured
a mouse bone that we fractured
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Ovo je mala kost,
kost miša koju smo prelomili
kost miša koju smo prelomili
11:23
and then let it heal by itself.
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i zatim pustili da sama zaceli.
11:25
These stem cells have come in
and repaired, in yellow, the bone,
and repaired, in yellow, the bone,
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Ove matične ćelije su došle
i popravile kost, žuto na slici,
i popravile kost, žuto na slici,
11:28
in white, the cartilage,
almost completely.
almost completely.
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hrskavica je belo, skoro u potpunosti.
11:31
So much so that if you label them
with a fluorescent dye
with a fluorescent dye
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Toliko da, ako ih obeležite
fluorescentnom bojom,
fluorescentnom bojom,
11:34
you can see them like some kind
of peculiar cellular glue
of peculiar cellular glue
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možete da ih posmatrate
kao vrstu čudnog ćelijskog lepka
kao vrstu čudnog ćelijskog lepka
11:38
coming into the area of a fracture,
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koji dolazi u oblast preloma,
popravljajući ga lokalno
i zatim zaustavljajući njegovo dejstvo.
i zatim zaustavljajući njegovo dejstvo.
11:40
fixing it locally
and then stopping their work.
and then stopping their work.
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11:43
Now, the fourth one is the most ominous,
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E sad, četvrto je najkobnije,
11:45
and that is that their numbers
decline precipitously,
decline precipitously,
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a to je da njihov broj naglo opada,
11:49
precipitously, tenfold,
fiftyfold, as you age.
fiftyfold, as you age.
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strmoglavo, desetostruko,
pedesetostruko, dok starimo.
pedesetostruko, dok starimo.
11:54
And so what had happened, really,
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Dakle, ono što se zapravo desilo
11:56
is that we found ourselves
in a perceptual shift.
in a perceptual shift.
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je da smo pronašli perceptivni preokret.
11:59
We had gone hunting for pills
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Krenuli smo u potragu za pilulama
12:01
but we ended up finding theories.
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a završili s pronalaženjem teorija.
12:04
And in some ways
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Na neki način,
12:05
we had hooked ourselves
back onto this idea:
back onto this idea:
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upecali smo se ponovo na ovu ideju:
12:08
cells, organisms, environments,
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ćelije, organizmi, sredine,
jer kako smo sada razmišljali
o koštanim matičnim ćelijama,
o koštanim matičnim ćelijama,
12:11
because we were now thinking
about bone stem cells,
about bone stem cells,
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12:13
we were thinking about arthritis
in terms of a cellular disease.
in terms of a cellular disease.
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razmišljali smo o artritisu
u smislu ćelijske bolesti.
u smislu ćelijske bolesti.
Zatim je sledeće pitanje bilo
da li postoje organi?
da li postoje organi?
12:17
And then the next question was,
are there organs?
are there organs?
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Da li možete ovo da izgradite
kao organ izvan tela?
kao organ izvan tela?
12:20
Can you build this
as an organ outside the body?
as an organ outside the body?
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12:22
Can you implant cartilage
into areas of trauma?
into areas of trauma?
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Možete li da usadite hrskavicu
u oblast povrede?
u oblast povrede?
12:26
And perhaps most interestingly,
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I možda najinteresantnije,
12:28
can you ascend right up
and create environments?
and create environments?
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možete li da doprete iznad
i stvorite sredine?
i stvorite sredine?
12:30
You know, we know
that exercise remodels bone,
that exercise remodels bone,
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Znate, poznato nam je
da vežbanje preoblikuje kosti,
da vežbanje preoblikuje kosti,
12:33
but come on, none of us
is going to exercise.
is going to exercise.
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ali dajte, niko od nas neće da vežba.
12:36
So could you imagine ways of passively
loading and unloading bone
loading and unloading bone
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Možete li da zamislite načine
da se kosti pasivno pune i prazne
da se kosti pasivno pune i prazne
12:41
so that you can recreate
or regenerate degenerating cartilage?
or regenerate degenerating cartilage?
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tako da možete da iznova stvarate
ili regenerišete hrskavicu koja propada?
ili regenerišete hrskavicu koja propada?
12:46
And perhaps more interesting,
and more importantly,
and more importantly,
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Možda je zanimljivije i važnije
12:48
the question is, can you apply this model
more globally outside medicine?
more globally outside medicine?
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pitanje da li možete primeniti
ovaj model globalnije izvan medicine.
ovaj model globalnije izvan medicine.
12:52
What's at stake, as I said before,
is not killing something,
is not killing something,
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Nije u pitanju, kao što sam već rekao,
ubijanje nečega, već uzgajanje nečega.
12:56
but growing something.
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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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To pokreće niz, rekao bih,
nekih od najzanimljivijih pitanja
nekih od najzanimljivijih pitanja
13:03
about how we think
about medicine in the future.
about medicine in the future.
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o tome kako ćemo razmišljati
o lekovima u budućnosti.
o lekovima u budućnosti.
13:07
Could your medicine
be a cell and not a pill?
be a cell and not a pill?
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Da li bi vaš lek
mogla biti ćelija, a ne pilula?
mogla biti ćelija, a ne pilula?
13:10
How would we grow these cells?
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Kako bismo uzgajali te ćelije?
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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Šta bismo uradili da zaustavimo
maligni rast ovih ćelija?
maligni rast ovih ćelija?
13:16
We heard about the problems
of unleashing growth.
of unleashing growth.
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Čuli smo za probleme neobuzdanog rasta.
13:20
Could we implant
suicide genes into these cells
suicide genes into these cells
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Da li bismo mogli da ugradimo
suicidne gene u te ćelije
suicidne gene u te ćelije
13:23
to stop them from growing?
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da ih sprečimo da rastu?
13:25
Could your medicine be an organ
that's created outside the body
that's created outside the body
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Da li bi vaš lek mogao biti organ
koji je stvoren izvan tela
koji je stvoren izvan tela
13:29
and then implanted into the body?
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i zatim ugrađen u telo?
13:30
Could that stop some of the degeneration?
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Da li bi to moglo da zaustavi
deo propadanja?
deo propadanja?
13:33
What if the organ needed to have memory?
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Šta ako organ mora da ima memoriju?
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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U slučajevima bolesti nervnog sistema,
neki od tih organa su imali memoriju.
neki od tih organa su imali memoriju.
13:40
How could we implant
those memories back in?
those memories back in?
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Kako bismo mogli
da ponovo ugradimo tu memoriju?
da ponovo ugradimo tu memoriju?
13:42
Could we store these organs?
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Možemo li da skladištimo 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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Da li bi svaki organ morao da bude stvoren
za pojedinačno ljudsko biće i vraćen?
za pojedinačno ljudsko biće i vraćen?
13:47
and put back?
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13:50
And perhaps most puzzlingly,
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I možda najzagonetnije,
da li bi vaš lek mogla da bude sredina?
13:53
could your medicine be an environment?
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Da li biste mogli da patentirate sredinu?
13:56
Could you patent an environment?
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13:57
You know, in every culture,
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Znate, u svakoj kulturi,
14:01
shamans have been using
environments as medicines.
environments as medicines.
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šamani su koristili okruženje kao lek.
14:04
Could we imagine that for our future?
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Da li možemo to da zamislimo
u našoj budućnosti?
u našoj budućnosti?
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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Dosta sam govorio o modelima.
Započeo sam ovaj govor modelima.
Započeo sam ovaj govor modelima.
14:11
So let me end with some thoughts
about model building.
about model building.
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Dopustite mi da završim mislima
o izgradnji modela.
o izgradnji modela.
14:14
That's what we do as scientists.
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To je ono što mi radimo kao naučnici.
14:16
You know, when an architect
builds a model,
builds a model,
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Znate, kada arhitekta napravi model,
14:19
he or she is trying to show you
a world in miniature.
a world in miniature.
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on ili ona pokušava
da vam pokaže svet u malom,
da vam pokaže svet u malom,
14:22
But when a scientist is building a model,
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a kada naučnik pravi model,
14:25
he or she is trying to show you
the world in metaphor.
the world in metaphor.
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on ili ona pokušava da vam pokaže
svet kroz metaforu.
svet kroz metaforu.
14:29
He or she is trying to create
a new way of seeing.
a new way of seeing.
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On ili ona pokušava da stvori
novi način sagledavanja stvari.
novi način sagledavanja stvari.
14:33
The former is a scale shift.
The latter is a perceptual shift.
The latter is a perceptual shift.
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Prvo je promena razmere.
Drugo je promena percepcije.
Drugo je promena percepcije.
14:38
Now, antibiotics created
such a perceptual shift
such a perceptual shift
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E, sad, antibiotici su stvorili
takvu perceptivnu promenu
takvu perceptivnu promenu
14:43
in our way of thinking about medicine
that it really colored, distorted,
that it really colored, distorted,
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u našem načinu razmišljanja o medicini
koji je zaista obojen, iskrivljen,
koji je zaista obojen, iskrivljen,
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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vrlo uspešno, tako smo razmišljali
o medicini poslednjih sto godina.
o medicini poslednjih sto godina.
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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Ipak, u budućnosti su nam potrebni
novi modeli za razmišljanje o medicini.
novi modeli za razmišljanje o medicini.
14:56
That's what's at stake.
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O tome se radi.
14:59
You know, there's
a popular trope out there
a popular trope out there
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Znate, prisutna je popularna fraza
15:02
that the reason we haven't had
the transformative impact
the transformative impact
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da je razlog zbog kojeg nismo ostvarili
transformišući uticaj
transformišući uticaj
15:06
on the treatment of illness
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u lečenju bolesti
15:08
is because we don't have
powerful-enough drugs,
powerful-enough drugs,
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taj da nemamo dovoljno jake lekove,
15:11
and that's partly true.
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i to je delom istina.
15:14
But perhaps the real reason is
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Ipak, možda 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 nemamo dovoljno jake
načine razmišljanja o lekovima.
načine razmišljanja o lekovima.
15:20
It's certainly true that
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Svakako je istina
15:23
it would be lovely to have new medicines.
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da bi bilo lepo imati nove lekove,
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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ali možda ono što je zaista u igri
leži na trima nedodirljivim M:
leži na trima nedodirljivim M:
15:31
mechanisms, models, metaphors.
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mehanizmima, modelima, metaforama.
15:35
Thank you.
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Hvala.
15:36
(Applause)
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(Aplauz)
15:45
Chris Anderson:
I really like this metaphor.
I really like this metaphor.
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Kris Anderson:
Baš mi se dopada ova metafora.
Baš mi se dopada ova metafora.
15:49
How does it link in?
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Kako se to povezuje?
15:50
There's a lot of talk in technologyland
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Dosta se priča u oblasti tehnologije
15:53
about the personalization of medicine,
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o personalizaciji lekova,
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 sve te podatke
i da će medicinski tretmani u budućnosti
i da će medicinski tretmani u budućnosti
15:59
will be for you specifically,
your genome, your current context.
your genome, your current context.
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biti posebno prilagođeni za vas,
za vaš genom, vaš aktuelni kontekst.
za vaš genom, vaš aktuelni kontekst.
16:03
Does that apply to this model
you've got here?
you've got here?
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Da li to važi za ovaj model koji vi imate?
16:07
Siddhartha Mukherjee:
It's a very interesting question.
It's a very interesting question.
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Sidarta Makhardži:
To je vrlo zanimljivo pitanje.
To je vrlo zanimljivo pitanje.
Dosta smo razmišljali
o personalizaciji medicine
o personalizaciji medicine
16:10
We've thought about
personalization of medicine
personalization of medicine
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16:12
very much in terms of genomics.
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u pogledu genomike.
16:14
That's because the gene
is such a dominant metaphor,
is such a dominant metaphor,
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Zato što je gen
tako dominantna metafora,
tako dominantna metafora,
16:16
again, to use that same word,
in medicine today,
in medicine today,
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opet, da upotrebim tu istu reč,
u današnjoj medicini,
u današnjoj medicini,
16:19
that we think the genome will drive
the personalization of medicine.
the personalization of medicine.
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3736
smatramo da će genom biti pokretač
personalizacije medicine.
personalizacije medicine.
16:23
But of course the genome
is just the bottom
is just the bottom
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Naravno, genom je samo kraj
16:26
of a long chain of being, as it were.
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dugog lanca bića, takoreći.
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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Prva organizovana jedinica
na tom lancu bića je ćelija.
na tom lancu bića je ćelija.
16:34
So, if we are really going to deliver
in medicine in this way,
in medicine in this way,
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Dakle, ako ćemo to zaista tako izneti
u medicini,
u medicini,
16:37
we have to think of personalizing
cellular therapies,
cellular therapies,
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moramo da razmišljamo
o personalizaciji ćelijskih terapija,
o personalizaciji ćelijskih terapija,
16:40
and then personalizing
organ or organismal therapies,
organ or organismal therapies,
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a zatim i personalizaciji
organskih ili organizmičkih terapija,
organskih ili organizmičkih terapija,
16:43
and ultimately personalizing
immersion therapies for the environment.
immersion therapies for the environment.
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na kraju personalizujući
terapije izlaganja za okruženje.
terapije izlaganja za okruženje.
16:47
So I think at every stage, you know --
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Dakle, ja mislim da u svakoj fazi, znate -
postoji ona metafora sa kornjačama
koje se pružaju sve do kraja.
koje se pružaju sve do kraja.
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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Pa, ovde to važi za personalizaciju.
16:55
CA: So when you say
medicine could be a cell
medicine could be a cell
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KA: Dakle, kada kažete
da ćelija može biti lek,
da ćelija može biti lek,
16:58
and not a pill,
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a ne pilula,
17:00
you're talking about
potentially your own cells.
potentially your own cells.
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govorite potencijalno
o sopstvenim ćelijama.
o sopstvenim ćelijama.
SM: Apsolutno.
KA: Dakle, preobraćene u matične ćelije,
KA: Dakle, preobraćene u matične ćelije,
17:02
SM: Absolutely.
CA: So converted to stem cells,
CA: So converted to stem cells,
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17:04
perhaps tested against all kinds
of drugs or something, and prepared.
of drugs or something, and prepared.
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možda testirane u odnosu na razne lekove
ili tako nešto, i pripremljene.
ili tako nešto, i pripremljene.
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: I nema možda. To je ono što radimo.
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 ono što se dešava, i zapravo,
polako se krećemo,
polako se krećemo,
17:15
not away from genomics,
but incorporating genomics
but incorporating genomics
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ne udaljavamo se od genomike
već je ugrađujemo
već je ugrađujemo
u ono što nazivamo
sistemima sa više poretka,
sistemima sa više poretka,
17:19
into what we call multi-order,
semi-autonomous, self-regulating systems,
semi-autonomous, self-regulating systems,
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poluautonomnim, samoregulišućim sistemima,
17:24
like cells, like organs,
like environments.
like environments.
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kao što su ćelije, organi, sredine.
17:26
CA: Thank you so much.
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KA: Mnogo vam hvala.
17:28
SM: Pleasure. Thanks.
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SM: Sa zadovoljstvom. Hvala.
(Aplauz)
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