TED2010
Kevin Stone: The bio-future of joint replacement
Kevin Stoun (Kevin Stone): biološka budućnost operacija zglobova
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Artritis i povrede unište milione zglobova i samo nekoliko dobije pravi lek - pravo biološko tkivo. Kevin Stoun predstavlja tretman lečenja koji bi mogao da reši problem visokih cena i malog broja donora za alogene transplantacije uz pomoć novih načina primene životinjskog tkiva.
Kevin Stone - Surgeon, inventor
Kevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament. Full bio
Kevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament. Full bio
Double-click the English transcript below to play the video.
00:16
So let me just start with my story.
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Počeo bih sa svojom ličnom pričom.
00:18
So I tore my knee joint meniscus cartilage
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Igrajući fudbal na fakultetu, povredio sam
00:20
playing soccer in college.
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hrskavicu meniskusa.
00:23
Then I went on to tear my ACL, the ligament in my knee,
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Potom sam povredio svoj ACL, ligament kolena
00:26
and then developed an arthritic knee.
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i razvilo mi se artritisno koleno.
00:28
And I'm sure that many of you in this audience have that same story,
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Siguran sam da mnogi od vas u publici dele istu priču.
00:31
and, by the way, I married a woman
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Uzgred, moja žena
00:33
who has exactly the same story.
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je doživela istu stvar. Sve ovo me je motivisalo
00:36
So this motivated me to become an orthopedic surgeon
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da postanem ortoped i da proverim da li bih mogao da se
00:39
and to see if I couldn't focus on solutions for those problems
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skoncetrišem na traženje rešenja za ove probleme
00:42
that would keep me playing sports and not limit me.
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koji bi mi omogućili da igram fudbal i ne bi me ograničavali.
00:46
So with that, let me just show you a quick video
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Imajući to u vidu, sada bih vam pustio kratak snimak
00:49
to get you in the mood of what we're trying to explain.
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kako bih vam približio šta želim da objasnim.
00:52
Narrator: We are all aware of the risk of cancer,
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Pripovedač: "Svi smo svesni rizika za oboljenje od raka,
00:54
but there's another disease
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ali postoji još jedna bolest od koje će
00:56
that's destined to affect even more of us: arthritis.
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zasigurno oboleti još više ljudi: artritis.
00:59
Cancer may kill you, but when you look at the numbers,
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Rak može da vas ubije, ali kada analizirate brojke shvatite
01:01
arthritis ruins more lives.
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da artritis uništava više života. Ukoliko pretpostavimo
01:03
Assuming you live a long life, there's a 50 percent chance
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da ćete dugo živeti, imate 50% šanse
01:05
you'll develop arthritis.
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da obolite od artritisa.
01:08
And it's not just aging that causes arthritis.
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Starenje nije jedini uzrok artritisa. Regularne povrede
01:10
Common injuries can lead to decades of pain,
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mogu uzrokovati decenije bola, do momenta
01:13
until our joints quite literally grind to a halt.
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kada naši zglobovi bukvalno postanu nefunkcionalni.
01:16
Desperate for a solution, we've turned to engineering
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Očajnički tražeći rešenje, okrenuli smo se pravljenju
01:18
to design artificial components
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i dizajniranju veštačkih delova kojima bismo
01:20
to replace our worn-out body parts,
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zamenili istrošene delove naših tela,
01:22
but in the midst of the modern buzz
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ali usred ove moderne popularizacije
01:24
around the promises of a bionic body,
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potencijala bioničkog tela, zar ne bi trebalo
01:26
shouldn't we stop and ask if there's a better, more natural way?
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da zastanemo i da se upitamo da li postoji bolji, prirodniji način?
01:31
Let's consider an alternative path.
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Hajde da analiziramo alternativno rešenje.
01:33
What if all the replacements our bodies need
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Šta ako rezervni delovi koji su neophodni našim telima
01:36
already exist in nature,
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već postoje u priordi,
01:38
or within our own stem cells?
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ili se nalaze u našim matičnim ćelijama?
01:40
This is the field of biologic replacements,
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Ovde govorimo o biološkim zamenama,
01:42
where we replace worn-out parts with new, natural ones.
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gde zamenjujemo istrošene delove novim, prirodnim delovima."
01:45
Kevin Stone: And so, the mission is:
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Kevin Stoun: Tako da je naša misija sledeća:
01:47
how do I treat these things biologically?
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kako se biološkim putem mogu lečiti ove stvari?
01:49
And let's talk about both what I did for my wife,
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Sada ću vam ispričati šta sam uradio za svoju ženu
01:51
and what I've done for hundreds of other patients.
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i stotine drugih pacijenata. Pa prva stvar
01:53
First thing for my wife,
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koju bih spomenuo i u slučaju moje žene,
01:55
and the most common thing I hear from my patients,
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a i generalno najčešće to čujem od pacijenata
01:57
particularly in the 40- to 80-year-old age group, 70-year-old age group,
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naročito onih koji imaju između 40 i 80 godina, kod sedamdesetogodišnjaka,
02:00
is they come in and say,
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je to da oni dođu i pitaju: " Doktore, da li postoji
02:02
"Hey, Doc, isn't there just a shock absorber you can put in my knee?
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neki "amortizer" koji biste stavili u moje koleno?
02:04
I'm not ready for joint replacement."
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Nisam spreman za zamenu zgloba." Njoj sam uradio
02:06
And so for her, I put in a human meniscus allograft donor
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alograft transplantaciju i stavio ljudski meniskus
02:09
right into that [knee] joint space.
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pravo u predeo zgloba kolena.
02:11
And [the allograft] replaces [the missing meniscus].
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To zamenjuje meniskus koji nedostaje.
02:13
And then for that unstable ligament,
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Za rešenje problema nestabilnog ligamenta,
02:15
we put in a human donor ligament
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implantirali smo humani ligament donora
02:17
to stabilize the knee.
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kako bismo stabilizovali koleno.
02:19
And then for the damaged arthritis on the surface,
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Kako bismo rešili problem artritisa na površini,
02:22
we did a stem cell paste graft,
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odradili smo transplant matičnim ćelijama,
02:24
which we designed in 1991,
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koji smo dizajnirali 1991.
02:26
to regrow that articular cartilage surface
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kako bismo regenerisali hrskavicu na površini zgloba
02:29
and give it back a smooth surface there.
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i ponovo uspostavili glatku površinu.
02:32
So here's my wife's bad knee on the left,
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Sa leve strane možete videti povređeno koleno moje žene,
02:34
and her just hiking now
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a ovde je vidite na planinarenju četiri meseca
02:36
four months later in Aspen, and doing well.
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nakon toga u Aspenu, gde se oseća dobro.
02:39
And it works, not just for my wife, but certainly for other patients.
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Ovo funkcioniše, ne samo u slučaju moje žene, već sigurno i za druge pacijente.
02:42
The girl on the video, Jen Hudak,
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Devojka sa ovog snimka, Džen Hudak,
02:44
just won the Superpipe in Aspen
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je upravo osvojila "Superpipe" u Aspenu
02:46
just nine months after having destroyed her knee,
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samo devet meseci nakon što je uništila svoje koleno,
02:49
as you see in the other image --
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kao što vidite na drugoj fotografiji,
02:51
and having a paste graft to that knee.
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a potom joj je stavljen implant u to koleno,
02:53
And so we can regrow these surfaces biologically.
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tako da možemo biološki da regenerišemo tu površinu.
02:57
So with all this success,
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S obzirom na ovoliki uspeh,
02:59
why isn't that good enough, you might ask.
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možda se pitate zašto to nije dovoljno.
03:02
Well the reason is because there's not enough donor cycles.
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Razlog je što ne postoji dovoljno donora tih organa.
03:05
There's not enough young, healthy people
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Nema dovoljno mladih, zdravih ljudi
03:07
falling off their motorcycle
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koji doživljavaju saobraćajne nesreće
03:09
and donating that tissue to us.
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i potom doniraju to tkivo nama.
03:12
And the tissue's very expensive.
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To tkivo je veoma skupo.
03:15
And so that's not going to be a solution
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Tako da to neće biti rešenje koje će dovesti
03:17
that's going to get us global with biologic tissue.
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do globalne upotrebe bioloških tkiva.
03:20
But the solution is animal tissue
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Rešenje leži u tkivu životinja,
03:22
because it's plentiful, it's cheap,
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jer ga ima u izobilju, jeftino je,
03:24
you can get it from young, healthy tissues,
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možete ga izolovati iz mladog, zdravog tkiva,
03:27
but the barrier is immunology.
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ali tu postoji imunološka prepreka.
03:29
And the specific barrier
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Specifična prepreka je
03:31
is a specific epitope
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određeni epitop koji nazivamo
03:33
called the galactosyl, or gal epitope.
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galaktozil ili gal-epitop.
03:35
So if we're going to transplant animal tissues to people,
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Ako želimo da transplantiramo životinjsko tkivo ljudima,
03:37
we have to figure out a way to get rid of that epitope.
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moramo da smislimo način kako da uklonimo taj epitop.
03:40
So my story in working with animal tissues
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Moja priča o radu sa životinjskim tkivima
03:42
starts in 1984.
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je počela 1984. godine.
03:44
And I started first
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Počeo sam rad koristeći
03:46
with cow Achilles tendon,
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Ahilovu tetivu krave,
03:48
where we would take the cow Achilles tendon,
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pri čemu bismo izolovali Ahilovu tetivu krave,
03:50
which is type-I collagen,
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a to je čist kolagen tipa I,
03:52
strip it of its antigens
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potom bismo uklonili antigene tako što smo
03:54
by degrading it with an acid and detergent wash
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ih razgrađivali pranjem u kiselinama i deterdžentima
03:57
and forming it into a regeneration template.
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i uspostavili smo uzorak za regeneraciju.
04:00
We would then take that regeneration template
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Onda bismo iskoristili tu regenerativnu osnovu
04:02
and insert it into the missing meniscus cartilage
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i implantirali bismo je u istrošenu hrskavicu meniskusa
04:05
to regrow that in a patient's knee.
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kako bi došlo do obnavljanja pacijentovog kolena.
04:08
We've now done that procedure,
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Odradili smo tu proceduru,
04:10
and it's been done worldwide in over 4,000 cases,
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i odrađeno je širom sveta 4.000 operacija,
04:12
so it's an FDA-approved and worldwide-accepted way
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to je FDA odobrena (Food and Drug Administration) i širom sveta
04:15
to regrow the meniscus.
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prihvaćena metoda za obnavljanje meniskusa.
04:17
And that's great when I can degrade the tissue.
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To je odlično kada sam u stanju da razgradim tkivo.
04:20
But what happens for your ligament when I need an intact ligament?
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Ali šta se dešava sa vašim ligamentom kada je meni neophodan netaknut ligament?
04:23
I can't grind it up in a blender.
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Ne mogu da ga sameljem u blenderu.
04:25
So in that case,
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U tom slučaju, moram da dizajniram
04:27
I have to design -- and we designed with Uri Galili and Tom Turek --
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i zajedno sa Urijem Galilijem i Tomom Turekom smo to uradili,
04:30
an enzyme wash
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enzimatski tretman
04:32
to wash away, or strip,
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da operemo ili skinemo,
04:34
those galactosyl epitopes
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te galaktozil-epitope
04:36
with a specific enzyme.
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pomoću posebnog enzima.
04:38
And we call that a "gal stripping" technique.
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Ovo zovemo tehnikom uklanjanja gala.
04:41
What we do is humanize the tissue.
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Ono što radimo je dodavanje tkivu humanih svojstava.
04:43
It's by gal stripping that tissue
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Pomoću enzimskog tretmana,
04:45
we humanize it (Laughter),
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mi ga činimo humanim (smeh),
04:47
and then we can put it back
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a potom deo tog organa možemo da
04:49
into a patient's knee.
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implantiramo u koleno pacijenta.
04:53
And we've done that. Now we've taken pig ligament --
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To smo i uradili. Uzeli smo ligament svinje,
04:55
young, healthy, big tissue,
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mlado, zdravo, veliko tkivo,
04:57
put it into 10 patients in an FDA-approved trial --
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i implantirali u 10 pacijenata u istraživanju koje je FDA odobreno,
05:00
and then one of our patients went on to have
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nakon toga je jedan od naših pacijenata osvojio
05:02
three Canadian Masters Downhill championships --
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tri "Masters Downhill" prvenstva u Kanadi pomoću svog
05:05
on his "pig-lig," as he calls it. So we know it can work.
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"prasećeg ligamenta", kako ga on zove. Tako da znamo da to radi.
05:07
And there's a wide clinical trial of this tissue now pending.
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Opsežno kliničko istraživanje koje iziskuje ovo tkivo je sada
05:12
So what about the next step?
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na listi čekanja. Šta bi bio sledeći korak?
05:14
What about getting to a total biologic knee replacement,
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Da li bismo mogli potpuno da zamenimo biološko koleno,
05:16
not just the parts?
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a ne samo njegove delove?
05:18
How are we going to revolutionize artificial joint replacement?
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Kako ćemo dovesti do revolucije u zameni veštačkih zglobova?
05:21
Well here's how we're going to do it.
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Ovako ćemo to uraditi.
05:23
So what we're going to do is take
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Mi ćemo prosto uzeti
05:25
an articular cartilage
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hrskavicu zgloba
05:27
from a young, healthy pig,
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mlade, zdrave svinje,
05:29
strip it of its antigens,
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očistićemo je od antigena,
05:31
load it with your stem cells,
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natovariti je matičnim ćelijama,
05:34
then put it back on to that
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a onda bismo to implantirali
05:36
arthritic surface in your knee,
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na zglobnu površinu u Vašem kolenu,
05:39
tack it on there, have you heal that surface
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pričvrstili bismo je tu i ta površina bi se prvo zarasla
05:42
and then create a new biologic surface for your knee.
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i potom bi proizvela novu biološka površinu na vašem kolenu.
05:48
So that's our biologic approach right now.
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Trenutno je to naš biološki pristup.
05:52
We're going to rebuild your knee with the parts.
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Napravićemo ponovo Vaše koleno pomoću ovih delova.
05:54
We're going to resurface it with a completely new surface.
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I obložićemo ga potpuno novim slojem.
05:57
But we have other advantages from the animal kingdom.
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Postoje i druge prednosti koje nalazimo u svetu životinja.
06:00
There's a benefit of 400 million years
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Tu su i beneficije napretka
06:02
of ambulation.
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u poslednjih 400 miliona godina.
06:04
We can harness those benefits.
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Možemo iskoristiti sve prednosti.
06:06
We can use thicker, younger, better tissues
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Možemo koristiti jača, mlađa, bolja tkiva
06:09
than you might have injured in your knee,
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u odnosu na ona koje ste povredili u svom kolenu,
06:11
or that you might have when you're 40, 50 or 60.
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ili u odnosu na tkivo koje imate u 40-im, 50-im ili 60-im.
06:13
We can do it as an outpatient procedure.
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To možemo da uradimo bez hospitalizacije pacijenta.
06:15
We can strip that tissue very economically,
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Možemo veoma ekonomično da prečistimo to tkivo,
06:18
and so this is how we can get biologic knee replacement
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i tako bismo uspeli da biološku zamenu kolena
06:21
to go global.
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učinimo globalnim fenomenom.
06:23
And so welcome to super biologics.
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Dobrodošli u svet super biologa.
06:25
It's not hardware.
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To nije hardver.
06:27
It's not software.
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To nije softver.
06:30
It's bioware.
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To je biover.
06:32
It's version 2.0 of you.
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Ovo je napredna, 2.0 verzija vas samih.
06:35
And so with that, coming to a --
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I za kraj, uskoro u,
06:37
(Laughter)
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(smeh)
06:39
coming to an operating theater near you soon, I believe.
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verujem, uskoro u pozorištu za operacije u vašoj blizini.
06:41
Thank you very much.
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Mnogo vam hvala.
06:43
(Applause)
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(Aplauz).
ABOUT THE SPEAKER
Kevin Stone - Surgeon, inventorKevin Stone's clinic treats joint injury using the latest in bio-medicine: reconstructing damaged tissue, even replacing whole joint parts, with lab-grown cartilage and ligament.
Why you should listen
Orthopedic surgeon Kevin Stone knows mobility means more than just where you go -- it's the foundation for a fulfilling daily life. (True whether you're an athlete or not.) His Stone Clinic specializes in "biologic knee replacement": replacing damaged joint parts, not with artificial components, but with lab-grown tissue and parts from human donors. He and team are spearheading new techniques that use animal tissue but avoid the complications associated with animal-to-human transplantations.
Stone has consulted publications such as The Wall Street Journal and Newsweek as a medical expert; he has contributed to TV programs such as ESPN's "Treating Athletes in the New Millennium" and The Discovery Channel.
Kevin Stone | Speaker | TED.com