TEDxSeattle
Chuck Murry: Can we regenerate heart muscle with stem cells?
查克莫瑞: 我們能用幹細胞來重新生成心肌嗎？
Filmed:
Readability: 4.1
1,853,632 views
心臟是人體中再生功能最差的組織之一——這是導致心臟衰竭成爲世界第一殺手的重要原因之一。如果我們能在心臟肌肉受傷之後協助它再生呢？醫生兼科學家查克莫瑞分享了他的開創性研究，使用幹細胞來生成新的心臟細胞——這是實現幹細胞藥用令人振奮的一步。
Chuck Murry - Physician, scientist
Chuck Murry founded and currently directs the Institute for Stem Cell and Regenerative Medicine at the University of Washington. Full bio
Chuck Murry founded and currently directs the Institute for Stem Cell and Regenerative Medicine at the University of Washington. Full bio
Double-click the English transcript below to play the video.
00:12
I'd like to tell you
about a patient named Donna.
about a patient named Donna.
0
562
2945
我想要跟各位聊聊
一位叫做唐娜的病人。
一位叫做唐娜的病人。
00:16
In this photograph,
Donna was in her mid-70s,
Donna was in her mid-70s,
1
4239
2465
在這張照片中，
唐娜大約七十五歲，
唐娜大約七十五歲，
00:18
a vigorous, healthy woman,
2
6728
1375
精力充沛又健康，
00:20
the matriarch of a large clan.
3
8127
1941
是個大家族的家長。
00:22
She had a family history
of heart disease, however,
of heart disease, however,
4
10586
2405
不過，她的家庭有心臟病史，
00:25
and one day, she had the sudden onset
of crushing chest pain.
of crushing chest pain.
5
13015
3339
有一天，她的胸口
突然痛到讓她站不起來。
突然痛到讓她站不起來。
00:28
Now unfortunately, rather than
seeking medical attention,
seeking medical attention,
6
16742
2668
不幸的是，唐娜沒有
尋求醫療協助，
尋求醫療協助，
00:31
Donna took to her bed for about 12 hours
until the pain passed.
until the pain passed.
7
19434
3916
而是選擇在她的床上躺了
十二小時，直到胸痛過去。
十二小時，直到胸痛過去。
00:35
The next time she went
to see her physician,
to see her physician,
8
23374
2060
後來她去看她的醫生時，
00:37
he performed an electrocardiogram,
9
25458
1637
醫生幫她做了心電圖，
00:39
and this showed that she'd had
a large heart attack,
a large heart attack,
10
27119
2444
結果顯示她之前的狀況是
重大的心臟病發作，
重大的心臟病發作，
00:41
or a "myocardial infarction"
in medical parlance.
in medical parlance.
11
29587
2964
用醫學用語來說，
就是「心肌梗塞」。
就是「心肌梗塞」。
00:45
After this heart attack,
Donna was never quite the same.
Donna was never quite the same.
12
33496
3050
在這次心臟病發作之後，
唐娜變得不一樣了。
唐娜變得不一樣了。
00:48
Her energy levels progressively waned,
13
36570
2622
她的精神日漸萎靡，
00:51
she couldn't do a lot of the physical
activities she'd previously enjoyed.
activities she'd previously enjoyed.
14
39216
3658
她無法繼續做很多
她以前很享受的身體活動。
她以前很享受的身體活動。
00:54
It got to the point where she couldn't
keep up with her grandkids,
keep up with her grandkids,
15
42898
3114
後來到了她追不上
孫子孫女的程度，
孫子孫女的程度，
就連走到家門口的車道前
去取郵件都是件費勁的事情。
去取郵件都是件費勁的事情。
00:58
and it was even too much work
to go out to the end of the driveway
to go out to the end of the driveway
16
46036
3141
01:01
to pick up the mail.
17
49201
1151
01:02
One day, her granddaughter
came by to walk the dog,
came by to walk the dog,
18
50376
3053
有一天，她的孫女正出去遛狗時，
01:05
and she found her grandmother
dead in the chair.
dead in the chair.
19
53453
2423
發現她的祖母在椅子上過世了。
01:08
Doctors said it was a cardiac arrhythmia
that was secondary to heart failure.
that was secondary to heart failure.
20
56673
4347
醫生說（死因）是心臟衰竭
所伴隨的心律不整。
所伴隨的心律不整。
01:13
But the last thing that I should tell you
21
61980
2004
但，在最後我想告訴各位一件事，
01:16
is that Donna was not just
an ordinary patient.
an ordinary patient.
22
64008
2870
唐娜不是一般的病人。
01:18
Donna was my mother.
23
66902
1556
唐娜是我母親。
01:21
Stories like ours are,
unfortunately, far too common.
unfortunately, far too common.
24
69445
3444
很不幸的是，
像這樣的故事其實很常見。
像這樣的故事其實很常見。
01:24
Heart disease is the number one killer
in the entire world.
in the entire world.
25
72913
2959
全世界排名第一的殺手
就是心臟疾病。
就是心臟疾病。
01:27
In the United States,
26
75896
1159
在美國，
01:29
it's the most common reason
patients are admitted to the hospital,
patients are admitted to the hospital,
27
77079
3128
心臟疾病是病人住院
最常見的原因，
最常見的原因，
且相關的醫療照護花費也最高。
01:32
and it's our number one
health care expense.
health care expense.
28
80231
2058
在美國，每年我們要花
超過一千億美元，是「億」喔，
超過一千億美元，是「億」喔，
01:34
We spend over a 100 billion dollars --
billion with a "B" --
billion with a "B" --
29
82313
2928
01:37
in this country every year
30
85265
1262
01:38
on the treatment of heart disease.
31
86551
1832
來治療心臟疾病。
01:40
Just for reference, that's more than
twice the annual budget
twice the annual budget
32
88407
2877
這個數字比華盛頓州
年度預算的兩倍還高。
年度預算的兩倍還高。
01:43
of the state of Washington.
33
91308
1317
01:45
What makes this disease so deadly?
34
93100
2157
這種疾病為什麼這麼致命？
01:47
Well, it all starts with the fact that
the heart is the least regenerative organ
the heart is the least regenerative organ
35
95757
3886
一切都始於，心臟是人類身體中
再生性最差的器官。
01:51
in the human body.
36
99667
1336
01:53
Now, a heart attack happens when
a blood clot forms in a coronary artery
a blood clot forms in a coronary artery
37
101502
3968
心臟病的發生是由於
給心室壁供血的冠狀動脈中
給心室壁供血的冠狀動脈中
01:57
that feeds blood to the wall of the heart.
38
105494
2495
形成了血凝塊。
02:00
This plugs the blood flow,
39
108013
2098
這會造成血流被阻塞，
而由於心肌的新陳代謝十分活躍，
02:02
and the heart muscle
is very metabolically active,
is very metabolically active,
40
110135
2415
02:04
and so it dies very quickly,
41
112574
1348
血流只要被中斷幾個小時
就足以致死。
就足以致死。
02:05
within just a few hours
of having its blood flow interrupted.
of having its blood flow interrupted.
42
113946
3788
02:10
Since the heart can't
grow back new muscle,
grow back new muscle,
43
118446
2399
因為心臟無法重新長出新肌肉，
02:12
it heals by scar formation.
44
120869
2424
它癒合的方式是形成疤痕，
02:15
This leaves the patient with a deficit
45
123999
2114
而這樣的結果會讓病人
沒有足量的心肌。
沒有足量的心肌。
02:18
in the amount of heart
muscle that they have.
muscle that they have.
46
126137
2306
02:20
And in too many people,
their illness progresses to the point
their illness progresses to the point
47
128467
2916
許多人的病發展到後期時，他們的
02:23
where the heart can no longer keep up
with the body's demand for blood flow.
with the body's demand for blood flow.
48
131407
3858
心臟無法及時供應身體需要的血流。
02:27
This imbalance between supply and demand
is the crux of heart failure.
is the crux of heart failure.
49
135289
5063
這種供需之間的不平衡
是心臟衰竭的關鍵所在。
02:34
So when I talk to people
about this problem,
about this problem,
50
142877
3369
而當我和別人談到這個問題時，
02:38
I often get a shrug
and a statement to the effect of,
and a statement to the effect of,
51
146270
3809
他們卻通常會聳聳肩，並告訴我：
02:42
"Well, you know, Chuck,
we've got to die of something."
we've got to die of something."
52
150103
2737
「查克，你知道的，
我們總會因為某種原因而死。」
我們總會因為某種原因而死。」
02:44
(Laughter)
53
152864
3423
（笑聲）
02:48
And yeah, but what this also tells me
54
156311
3357
是啊，但這也讓我知道，
02:51
is that we've resigned ourselves to this
as the status quo because we have to.
as the status quo because we have to.
55
159692
5594
我們對這件事聽天由命，
是因為我們沒有別的選擇。
是因為我們沒有別的選擇。
02:58
Or do we?
56
166801
1246
如果有呢？
03:00
I think there's a better way,
57
168459
1693
我認為有個更好的方法，
03:02
and this better way involves the use
of stem cells as medicines.
of stem cells as medicines.
58
170176
3503
這個方法是把幹細胞
拿來當醫藥用於治療。
拿來當醫藥用於治療。
03:06
So what, exactly, are stem cells?
59
174330
2021
所以，幹細胞到底是什麼？
03:08
If you look at them under the microscope,
there's not much going on.
there's not much going on.
60
176760
3237
如果用顯微鏡來看幹細胞，
我們看不出什麽所以然，
我們看不出什麽所以然，
它們看似只是簡單的小圓細胞。
03:12
They're just simple little round cells.
61
180021
1896
但它們其實還有有兩項驚人的特性。
03:13
But that belies two remarkable attributes.
62
181941
2513
03:16
The first is they can divide like crazy.
63
184922
2315
第一，它們能瘋狂地分裂。
03:19
So I can take a single cell,
and in a month's time,
and in a month's time,
64
187261
2834
我可以用僅僅一個細胞，
在一個月之内，
在一個月之内，
培養出高達十億個細胞。
03:22
I can grow this up to billions of cells.
65
190119
1968
03:24
The second is they can differentiate
or become more specialized,
or become more specialized,
66
192550
4801
第二，它們可以分化或特化，
03:29
so these simple little round cells
can turn into skin, can turn into brain,
can turn into skin, can turn into brain,
67
197375
4145
所以，這些簡單的小圓細胞
可以轉變成皮膚、轉變成大腦、
可以轉變成皮膚、轉變成大腦、
03:33
can turn into kidney and so forth.
68
201544
2175
轉變成腎臟等等。
03:36
Now, some tissues in our bodies
are chock-full of stem cells.
are chock-full of stem cells.
69
204377
3086
我們體內的一些組織裡
充滿了幹細胞。
充滿了幹細胞。
03:39
Our bone marrow, for example, cranks out
billions of blood cells every day.
billions of blood cells every day.
70
207487
3897
比如，我們的骨髓每天都會
產生出數十億個血細胞。
產生出數十億個血細胞。
03:43
Other tissues like the heart
are quite stable,
are quite stable,
71
211808
2434
其他組織，如心臟，就十分穩定，
03:46
and as far as we can tell,
the heart lacks stem cells entirely.
the heart lacks stem cells entirely.
72
214266
4160
就我們所知，
心臟完全沒有幹細胞。
心臟完全沒有幹細胞。
03:50
So for the heart, we're going to have
to bring stem cells in from the outside,
to bring stem cells in from the outside,
73
218450
3961
所以，我們必須從外界
把幹細胞帶入心臟。
把幹細胞帶入心臟。
03:54
and for this, we turn to
the most potent stem cell type,
the most potent stem cell type,
74
222435
2880
為此，我們將目光轉向了
最強大的一種幹細胞，
最強大的一種幹細胞，
03:57
the pluripotent stem cell.
75
225339
2003
多功能性幹細胞。
03:59
Pluripotent stem cells are so named
76
227366
1716
這種幹細胞被稱為多功能性幹細胞，
04:01
because they can turn into
any of the 240-some cell types
any of the 240-some cell types
77
229106
3069
是因為它們能轉變為組成人體的
04:04
that make up the human body.
78
232199
1854
約 240 種細胞當中的任何一種。
04:06
So this is my big idea:
79
234684
1983
所以，我的想法是：
04:08
I want to take human
pluripotent stem cells,
pluripotent stem cells,
80
236691
2754
我想要取得人類的多功能性幹細胞，
04:11
grow them up in large numbers,
81
239469
2127
大量繁殖它們，
04:13
differentiate them
into cardiac muscle cells
into cardiac muscle cells
82
241620
2800
將它們特化轉成心肌細胞，
04:16
and then take them out of the dish
83
244444
1741
接著把它們從培養皿中取出，
04:18
and transplant them into the hearts
of patients who have had heart attacks.
of patients who have had heart attacks.
84
246209
3904
移植到心臟病病人的心臟裡。
04:22
I think this is going to reseed the wall
with new muscle tissue,
with new muscle tissue,
85
250137
3519
我認為這樣就能夠在心室壁中
重新種下新的肌肉組織，
重新種下新的肌肉組織，
04:25
and this will restore
contractile function to the heart.
contractile function to the heart.
86
253680
3592
這樣就能恢復心臟的收縮功能。
04:29
(Applause)
87
257296
5655
（掌聲）
04:36
Now, before you applaud too much,
this was my idea 20 years ago.
this was my idea 20 years ago.
88
264490
3315
在各位給太多掌聲之前，我得
先說明，這是我二十年前的想法。
先說明，這是我二十年前的想法。
04:39
(Laughter)
89
267829
2039
（笑聲）
04:41
And I was young,
I was full of it, and I thought,
I was full of it, and I thought,
90
269892
3900
我當時很年輕，很自滿，我心想，
04:45
five years in the lab,
and we'll crank this out,
and we'll crank this out,
91
273816
2325
在實驗室中研究五年，
我就能完成它，
我就能完成它，
04:48
and we'll have this into the clinic.
92
276165
2574
我們就能在臨床上使用了。
04:50
Let me tell you what really happened.
93
278763
2030
讓我告訴各位真正發生的實情。
04:52
(Laughter)
94
280817
1119
（笑聲）
04:53
We began with the quest to turn these
pluripotent stem cells into heart muscle.
pluripotent stem cells into heart muscle.
95
281960
4705
我們開始努力嘗試
將多功能性幹細胞轉成心肌。
將多功能性幹細胞轉成心肌。
04:58
And our first experiments worked, sort of.
96
286689
2516
我們的第一次實驗成功了，算是吧。
05:01
We got these little clumps of beating
human heart muscle in the dish,
human heart muscle in the dish,
97
289229
3766
我們在培養皿中得到了這些
小塊狀物，會跳動的人類心肌。
小塊狀物，會跳動的人類心肌。
05:05
and that was cool,
because it said, in principle,
because it said, in principle,
98
293019
2424
這很不錯，因為原則上，這就意味著
05:07
this should be able to be done.
99
295467
2262
（這件事）是有可能辦到的。
05:09
But when we got around
to doing the cell counts,
to doing the cell counts,
100
297753
2275
但，當我們去計算細胞數量時，
05:12
we found that only one
out of 1,000 of our stem cells
out of 1,000 of our stem cells
101
300052
3031
我們發現，我們的幹細胞中
只有千分之一
只有千分之一
05:15
were actually turning into heart muscle.
102
303107
2418
實際轉變為了心肌。
05:17
The rest was just a gemisch
of brain and skin and cartilage
of brain and skin and cartilage
103
305937
5520
其他的都成了大腦、
皮膚、軟骨、腸子的混合物。
05:23
and intestine.
104
311481
1785
05:25
So how do you coax a cell
that can become anything
that can become anything
105
313824
3329
所以，你要如何誘使
能變成任何東西的細胞
能變成任何東西的細胞
05:29
into becoming just a heart muscle cell?
106
317177
2279
只轉變成心肌細胞？
05:32
Well, for this we turned
to the world of embryology.
to the world of embryology.
107
320243
2595
為此，我們轉向胚胎學的世界。
05:34
For over a century, the embryologists
had been pondering
had been pondering
108
322862
2698
一個多世紀以來，
胚胎學者一直在探索
胚胎學者一直在探索
05:37
the mysteries of heart development.
109
325584
1682
心臟發展的謎團。
05:39
And they had given us
what was essentially a Google Map
what was essentially a Google Map
110
327290
3357
他們給了我們像
Google 地圖一樣的資訊，
Google 地圖一樣的資訊，
05:42
for how to go from a single fertilized egg
111
330671
2480
讓我們知道如何從單一受精卵
05:45
all the way over to a human
cardiovascular system.
cardiovascular system.
112
333175
3101
一路走到人類心血管系統。
05:48
So we shamelessly absconded
all of this information
all of this information
113
336656
3731
所以我們很不要臉地
帶走了這些訊息，
帶走了這些訊息，
05:52
and tried to make human cardiovascular
development happen in a dish.
development happen in a dish.
114
340411
4148
嘗試把人類心血管發展的過程
在培養皿中重現。
在培養皿中重現。
05:57
It took us about five years, but nowadays,
115
345105
2466
我們花了大約五年，而如今，
05:59
we can get 90 percent of our stem cells
to turn into cardiac muscle --
to turn into cardiac muscle --
116
347595
3591
我們可以讓九成幹細胞
轉變成心肌——
轉變成心肌——
06:03
a 900-fold improvement.
117
351210
2073
這是九百倍的改善。
06:05
So this was quite exciting.
118
353671
1500
所以，這很讓人興奮。
06:08
This slide shows you
our current cellular product.
our current cellular product.
119
356112
2910
這張投影片上的是
我們目前的細胞產品。
我們目前的細胞產品。
06:11
We grow our heart muscle cells
in little three-dimensional clumps
in little three-dimensional clumps
120
359466
3289
我們在小小的 3D 團塊中
培養我們的心肌細胞，
培養我們的心肌細胞，
這一團塊叫做「類心臟器官」。
06:14
called cardiac organoids.
121
362779
1510
06:16
Each of them has 500 to 1,000
heart muscle cells in it.
heart muscle cells in it.
122
364313
3143
每一塊當中都有五百
到一千個心肌細胞。
到一千個心肌細胞。
06:20
If you look closely, you can see these
little organoids are actually twitching;
little organoids are actually twitching;
123
368003
3807
如果再靠近看，可以看到這些
小小的類器官其實正在抽動；
小小的類器官其實正在抽動；
06:23
each one is beating independently.
124
371834
1807
每一個都獨自在跳動。
06:26
But they've got another trick
up their sleeve.
up their sleeve.
125
374094
2143
但，它們還有另一項技能。
06:28
We took a gene from jellyfish
that live in the Pacific Northwest,
that live in the Pacific Northwest,
126
376793
3171
我們從美國西北部太平洋岸
附近的水母身上取得基因，
附近的水母身上取得基因，
06:31
and we used a technique
called genome editing
called genome editing
127
379988
2400
我們採用了一種叫做
基因組編輯的技術，
基因組編輯的技術，
06:34
to splice this gene into the stem cells.
128
382412
3014
把這個水母基因結合到幹細胞中。
06:37
And this makes our heart muscle cells
flash green every time they beat.
flash green every time they beat.
129
385450
4425
這麼做就能讓我們的心肌細胞
每跳動一次就閃爍一次綠光。
每跳動一次就閃爍一次綠光。
06:41
OK, so now we were finally ready
to begin animal experiments.
to begin animal experiments.
130
389899
3689
這樣，我們終於準備好
要做動物實驗了。
要做動物實驗了。
06:45
We took our cardiac muscle cells
131
393612
2361
我們把我們的心肌細胞
06:47
and we transplanted them
into the hearts of rats
into the hearts of rats
132
395997
2274
移植到老鼠的心臟中，
06:50
that had been given
experimental heart attacks.
experimental heart attacks.
133
398295
2222
牠們先前已發作過實驗性心臟病。
06:52
A month later, I peered anxiously
down through my microscope
down through my microscope
134
400541
3552
一個月後，我很急切地
透過我的顯微鏡，
透過我的顯微鏡，
06:56
to see what we had grown,
135
404117
1891
想仔細看看我們培養出了什麼，
06:58
and I saw ...
136
406032
1305
而我看到……
06:59
nothing.
137
407807
1165
什麼都沒有。
07:01
Everything had died.
138
409616
1767
一切都死了。
07:03
But we persevered on this,
and we came up with a biochemical cocktail
and we came up with a biochemical cocktail
139
411407
3948
但我們堅持不懈，又做出了
一種生物化學雞尾酒，
一種生物化學雞尾酒，
07:07
that we called
our "pro-survival cocktail,"
our "pro-survival cocktail,"
140
415379
2304
我們稱它是我們的「助生雞尾酒」，
07:09
and this was enough to allow
our cells to survive
our cells to survive
141
417707
2623
這足以讓我們的細胞
在很有壓力的移植過程中存活下來。
07:12
through the stressful process
of transplantation.
of transplantation.
142
420354
3078
07:15
And now when I looked
through the microscope,
through the microscope,
143
423456
2150
現在，當我透過顯微鏡觀察時，
07:17
I could see this fresh, young,
human heart muscle
human heart muscle
144
425630
2515
我能看到這些新鮮、年輕的人類心肌，
07:20
growing back in the injured wall
of this rat's heart.
of this rat's heart.
145
428169
3049
在這隻老鼠受傷的心室壁中長回來。
07:23
So this was getting quite exciting.
146
431750
1793
這十分讓人興奮。
07:25
The next question was:
147
433567
1539
下一個問題是：
07:27
Will this new muscle beat in synchrony
with the rest of the heart?
with the rest of the heart?
148
435130
3617
新的肌肉會和心臟的
其他部分同步跳動嗎？
其他部分同步跳動嗎？
為了找出答案，
07:31
So to answer that,
149
439453
1161
07:32
we returned to the cells that had
that jellyfish gene in them.
that jellyfish gene in them.
150
440638
4026
我們返回有水母基因的那些細胞。
07:37
We used these cells essentially
like a space probe
like a space probe
151
445330
3127
基本上，我們是把這些細胞
當作「太空探測器」來用，
當作「太空探測器」來用，
07:40
that we could launch
into a foreign environment
into a foreign environment
152
448481
2240
我們可以把它們
發射到陌生的環境中，
發射到陌生的環境中，
07:42
and then have that flashing
report back to us
report back to us
153
450745
2320
接著，透過閃光得到反饋，
07:45
about their biological activity.
154
453089
2058
來了解它們的生理活動。
07:47
What you're seeing here
is a zoomed-in view,
is a zoomed-in view,
155
455171
2081
各位現在看到的是放大的影像，
07:49
a black-and-white image
of a guinea pig's heart
of a guinea pig's heart
156
457276
2222
這張黑白影像上的是白鼠的心臟，
07:51
that was injured and then received
three grafts of our human cardiac muscle.
three grafts of our human cardiac muscle.
157
459522
3601
這顆心臟受過傷，接著接受了
三塊嫁接的人類心肌。
三塊嫁接的人類心肌。
你們可以看到有一些
白色的對角線。
白色的對角線。
07:55
So you see those sort of diagonally
running white lines.
running white lines.
158
463147
2642
每一條極細的軌道
07:57
Each of those is a needle track
159
465813
1486
都含有數百萬個人類心肌細胞。
07:59
that contains a couple of million
human cardiac muscle cells in it.
human cardiac muscle cells in it.
160
467323
3696
08:03
And when I start the video,
you can see what we saw
you can see what we saw
161
471713
2754
我開始播放影片時，各位就能看到
我們當時透過顯微鏡所看到的。
08:06
when we looked through the microscope.
162
474491
2020
08:09
Our cells are flashing,
163
477011
1563
我們的細胞在閃爍，
08:10
and they're flashing in synchrony,
164
478598
2025
且它們是同步在閃爍，
08:12
back through the walls
of the injured heart.
of the injured heart.
165
480647
2089
透過受傷的心室壁將閃光傳回來。
08:15
What does this mean?
166
483117
1151
這意味著什麼？
08:16
It means the cells are alive,
167
484292
1484
意味著這些細胞是活的，
08:17
they're well, they're beating,
168
485800
2148
它們很健康，它們在跳動，
08:19
and they've managed
to connect with one another
to connect with one another
169
487972
2229
而且它們找到方式和彼此連結，
08:22
so that they're beating in synchrony.
170
490225
2072
因此它們能夠同步跳動。
08:24
But it gets even more
interesting than this.
interesting than this.
171
492321
2115
但這還不是最有趣的。
08:26
If you look at that tracing
that's along the bottom,
that's along the bottom,
172
494460
2443
請看看最底部的描繪線，
08:28
that's the electrocardiogram
from the guinea pig's own heart.
from the guinea pig's own heart.
173
496927
3345
那是白老鼠自己心臟的心電圖。
08:32
And if you line up the flashing
with the heartbeat
with the heartbeat
174
500296
3153
如果和呈現在底部的閃爍心跳
互相對照著看，
08:35
that's shown on the bottom,
175
503473
1300
08:36
what you can see is there's a perfect
one-to-one correspondence.
one-to-one correspondence.
176
504797
3187
你會發現它們完美地一對一呼應。
08:40
In other words, the guinea pig's
natural pacemaker is calling the shots,
natural pacemaker is calling the shots,
177
508008
4466
換言之，白老鼠的
天然心臟節律器在主導，
天然心臟節律器在主導，
08:44
and the human heart muscle cells
are following in lockstep
are following in lockstep
178
512498
2984
而人類心肌細胞則是
亦步亦趨跟隨著，
亦步亦趨跟隨著，
08:47
like good soldiers.
179
515506
1488
就像優秀的士兵。
08:49
(Applause)
180
517922
4616
（掌聲）
08:56
Our current studies have moved into
what I think is going to be
what I think is going to be
181
524017
3000
我們目前的研究已即將開始
用在我個人認為
用在我個人認為
08:59
the best possible predictor
of a human patient,
of a human patient,
182
527041
2661
最能模擬人類病人的動物身上，
09:01
and that's into macaque monkeys.
183
529726
2117
也就是獼猴。
09:05
This next slide shows you
a microscopic image
a microscopic image
184
533350
3096
下一張投影片是顯微鏡的影像，
09:08
from the heart of a macaque that was given
an experimental heart attack
an experimental heart attack
185
536470
4442
影像中的是獼猴的心臟，
我們讓牠發生過實驗性心臟病，
我們讓牠發生過實驗性心臟病，
09:12
and then treated with a saline injection.
186
540936
2079
接著用沙林注射液來治療牠。
09:15
This is essentially like
a placebo treatment
a placebo treatment
187
543039
2233
基本上，這就像是安慰劑治療，
09:17
to show the natural history
of the disease.
of the disease.
188
545296
2165
用來呈現疾病的自然歷史。
09:19
The macaque heart muscle is shown in red,
189
547485
2268
紅色部分是彌猴的心肌，
09:21
and in blue, you see the scar tissue
that results from the heart attack.
that results from the heart attack.
190
549777
3504
藍色部分是心臟病
所造成的疤痕組織。
所造成的疤痕組織。
09:25
So as you look as this, you can see how
there's a big deficiency in the muscle
there's a big deficiency in the muscle
191
553305
3882
所以，各位可以從這張圖看到，
有一部分的心室壁非常缺乏肌肉。
09:29
in part of the wall of the heart.
192
557211
1918
09:31
And it's not hard to imagine
how this heart would have a tough time
how this heart would have a tough time
193
559153
3243
不難想像，這顆心臟實在是
09:34
generating much force.
194
562420
1468
使不上力。
09:37
Now in contrast, this is one
of the stem-cell-treated hearts.
of the stem-cell-treated hearts.
195
565105
3376
相對的，這是用幹細胞治療的心臟。
09:41
Again, you can see
the monkey's heart muscle in red,
the monkey's heart muscle in red,
196
569290
3935
同樣，紅色部分是猴子的心肌，
09:45
but it's very hard to even see
the blue scar tissue,
the blue scar tissue,
197
573249
2707
但幾乎看不見多少藍色的疤痕組織，
09:47
and that's because we've
been able to repopulate it
been able to repopulate it
198
575980
3120
那是因為我們讓人類心肌
重新入住到這顆心臟裡，
09:51
with the human heart muscle,
199
579124
1864
09:53
and so we've got this nice, plump wall.
200
581012
2182
才會有這種撲通跳的優良心室壁。
09:55
OK, let's just take a second and recap.
201
583218
2118
好，咱們花點時間來做重點回顧。
09:57
I've showed you
that we can take our stem cells
that we can take our stem cells
202
585678
2534
我已經讓各位看到，
我們能取用人類幹細胞
我們能取用人類幹細胞
10:00
and differentiate them
into cardiac muscle.
into cardiac muscle.
203
588236
2512
將它們特化，轉變成心肌。
10:02
We've learned how to keep them alive
after transplantation,
after transplantation,
204
590772
3200
我們也學會了如何
在移植時不讓它們死亡，
在移植時不讓它們死亡，
10:05
we've showed that they beat
in synchrony with the rest of the heart,
in synchrony with the rest of the heart,
205
593996
3255
各位也看到，它們能
和心臟的其他部分同步跳動。
和心臟的其他部分同步跳動。
10:09
and we've shown that we can scale them up
206
597275
1995
我們還能更進一步，
10:11
into an animal that is the best possible
predictor of a human's response.
predictor of a human's response.
207
599294
4350
把它們放到最能預測
人類反應的動物體內。
人類反應的動物體內。
10:16
You'd think that we hit all the roadblocks
that lay in our path, right?
that lay in our path, right?
208
604592
5763
你們可能會認為，我們該碰到的
障礙都碰過了，是吧？
障礙都碰過了，是吧？
10:23
Turns out, not.
209
611141
1190
然而，並不是這樣。
10:24
These macaque studies also taught us
210
612982
2395
這些彌猴研究讓我們認識到，
10:27
that our human heart muscle cells created
a period of electrical instability.
a period of electrical instability.
211
615401
4703
人類心肌細胞會造成
一段時間内的電流不穩定。
一段時間内的電流不穩定。
10:32
They caused ventricular arrhythmias,
or irregular heartbeats,
or irregular heartbeats,
212
620128
3581
這些細胞會造成心室心律不整，
或心臟節律不整，
或心臟節律不整，
10:35
for several weeks after
we transplanted them.
we transplanted them.
213
623733
2264
在移植後數週都會有這種現象。
10:39
This was quite unexpected, because
we hadn't seen this in smaller animals.
we hadn't seen this in smaller animals.
214
627038
3577
這是我們沒有預料到的，
因為在小動物身上並沒有發生。
因為在小動物身上並沒有發生。
10:43
We've studied it extensively,
215
631266
1787
我們對這個狀況進行了廣泛研究，
10:45
and it turns out that it results
from the fact that our cellular graphs
from the fact that our cellular graphs
216
633077
3988
結果發現，發生的原因
是因為我們的細胞圖
是因為我們的細胞圖
10:49
are quite immature,
217
637089
1538
還不太成熟，
10:50
and immature heart muscle cells
all act like pacemakers.
all act like pacemakers.
218
638651
3582
而不成熟的心肌細胞
都像是有自己的心臟節律器一般。
都像是有自己的心臟節律器一般。
10:54
So what happens is,
we put them into the heart,
we put them into the heart,
219
642257
2395
情況是，我們一旦把
這些細胞放進心臟，
這些細胞放進心臟，
10:56
and there starts to be a competition
with the heart's natural pacemaker
with the heart's natural pacemaker
220
644676
3445
它們就開始和心臟的
天然節律器競爭，
天然節律器競爭，
11:00
over who gets to call the shots.
221
648145
1619
搶著要主導權。
這就有點像是
11:02
It would be sort of like
222
650502
1163
11:03
if you brought a whole gaggle of teenagers
into your orderly household all at once,
into your orderly household all at once,
223
651689
4617
你把一群吵鬧的青少年
通通放到很有秩序的家庭裡，
通通放到很有秩序的家庭裡，
11:08
and they don't want to follow the rules
and the rhythms of the way you run things,
and the rhythms of the way you run things,
224
656330
4137
而他們不想遵守規則
和你做事的節奏。
和你做事的節奏。
11:12
and it takes a while to rein everybody in
225
660491
1972
要花一點時間才能控制住每個人，
11:14
and get people working
in a coordinated fashion.
in a coordinated fashion.
226
662487
2477
讓大家用很和諧的方式合作。
11:17
So our plans at the moment
227
665471
1249
所以，我們此時的計畫
11:18
are to make the cells go through
this troubled adolescence period
this troubled adolescence period
228
666744
3143
是要讓細胞還在培養皿中的時候，
就先度過這段麻煩的青春期，
11:21
while they're still in the dish,
229
669911
1982
11:23
and then we'll transplant them in
in the post-adolescent phase,
in the post-adolescent phase,
230
671917
4421
接著，我們再把青春期後的
細胞拿來做移植。
細胞拿來做移植。
11:28
where they should be much more orderly
231
676362
1970
這時候的細胞便會更有秩序，
11:30
and be ready to listen
to their marching orders.
to their marching orders.
232
678356
2730
且準備好聽命令來行軍了。
11:33
In the meantime, it turns out
we can actually do quite well
we can actually do quite well
233
681110
2804
同時，我們也發現
使用抗心律不整的藥物
使用抗心律不整的藥物
11:35
by treating with
anti-arrhythmia drugs as well.
anti-arrhythmia drugs as well.
234
683938
2404
進行治療的效果也相當好。
11:39
So one big question still remains,
235
687064
2590
但是，有個大問題仍然沒解決，
11:41
and that is, of course, the whole purpose
that we set out to do this:
that we set out to do this:
236
689678
3289
當然，那個問題也就是
我們動手做這一切的目的：
我們動手做這一切的目的：
11:44
Can we actually restore function
to the injured heart?
to the injured heart?
237
692991
3322
我們真的能夠幫
受傷的心臟恢復功能嗎？
受傷的心臟恢復功能嗎？
11:49
To answer this question,
238
697218
1260
為了找到答案，
11:50
we went to something that's called
"left ventricular ejection fraction."
"left ventricular ejection fraction."
239
698502
3766
我們轉向所謂的
「左心室射出分率」，
「左心室射出分率」，
11:54
Ejection fraction is simply
the amount of blood
the amount of blood
240
702292
2330
射出分率就是每一次心跳時，
11:56
that is squeezed
out of the chamber of the heart
out of the chamber of the heart
241
704646
2366
從心室擠出的血液量。
11:59
with each beat.
242
707036
1172
12:00
Now, in healthy macaques,
like in healthy people,
like in healthy people,
243
708232
2459
健康的彌猴就跟健康的人一樣，
12:02
ejection fractions are about 65 percent.
244
710715
2470
射出分率大約是 65%。
12:05
After a heart attack, ejection fraction
drops down to about 40 percent,
drops down to about 40 percent,
245
713748
4120
在心臟病發之後，
射出分率會下降到約 40%，
射出分率會下降到約 40%，
12:09
so these animals are
well on their way to heart failure.
well on their way to heart failure.
246
717892
2834
所以這些動物正在走向心臟衰竭。
12:12
In the animals that receive
a placebo injection,
a placebo injection,
247
720750
2275
針對接受安慰劑注射的動物，
12:15
when we scan them a month later,
248
723049
1575
我們在一個月後掃瞄牠們時，
12:16
we see that ejection
fraction is unchanged,
fraction is unchanged,
249
724648
2289
發現射出分率並沒有改變，
12:18
because the heart, of course,
doesn't spontaneously recover.
doesn't spontaneously recover.
250
726961
2861
因為，當然啦，
心臟並不會自己復原。
心臟並不會自己復原。
12:22
But in every one of the animals
that received a graft
that received a graft
251
730489
2783
但，在所有接受
人類心肌細胞嫁接的動物身上，
12:25
of human cardiac muscle cells,
252
733296
1711
12:27
we see a substantial improvement
in cardiac function.
in cardiac function.
253
735031
2998
我們都發現心臟功能
有了大幅的改善，
有了大幅的改善，
12:30
This averaged eight points,
so from 40 to 48 percent.
so from 40 to 48 percent.
254
738053
3934
從 40% 增加到 48%，
平均有 8% 的提升。
平均有 8% 的提升。
12:34
What I can tell you
is that eight points is better
is that eight points is better
255
742011
3056
我能告訴各位的是，
8% 的成果已經勝過
8% 的成果已經勝過
12:37
than anything that's
on the market right now
on the market right now
256
745091
2328
目前市面上用來治療
心臟病病人的任何東西。
12:39
for treating patients with heart attacks.
257
747443
2011
12:41
It's better than everything
we have put together.
we have put together.
258
749478
2729
比我們所有的療法加起來都還要好。
12:44
So if we could do
eight points in the clinic,
eight points in the clinic,
259
752231
2153
所以，若我們
在臨床上能達成 8%，
在臨床上能達成 8%，
12:46
I think this would be a big deal
that would make a large impact
that would make a large impact
260
754408
3011
我認為，這會是件大事，
對於人類健康會有巨大的影響。
12:49
on human health.
261
757443
1186
12:51
But it gets more exciting.
262
759137
3581
但，更讓人興奮的還在後頭。
12:54
That was just four weeks
after transplantation.
after transplantation.
263
762742
2679
剛才談的只是移植後四週的狀況。
12:57
If we extend these studies
out to three months,
out to three months,
264
765445
2900
如果我們把這些研究
延伸到三個月，
延伸到三個月，
13:00
we get a full 22-point gain
in ejection fraction.
in ejection fraction.
265
768369
4062
射出分率能增加足足 22%。
13:04
(Applause)
266
772455
3998
（掌聲）
13:11
Function in these
treated hearts is so good
treated hearts is so good
267
779874
2450
這些接受治療的心臟，
功能變得非常好，
功能變得非常好，
13:14
that if we didn't know up front
that these animals had had a heart attack,
that these animals had had a heart attack,
268
782348
3830
好到如果我們沒有事先知道
這些動物曾經心臟病發過，
這些動物曾經心臟病發過，
13:18
we would never be able to tell
from their functional studies.
from their functional studies.
269
786202
5476
光從它們心臟的功能上來看，
我們甚至不會知道它們有心臟病。
我們甚至不會知道它們有心臟病。
13:24
Going forward, our plan
is to start phase one,
is to start phase one,
270
792757
3654
至於未來，我們的計畫
是要展開第一階段，
是要展開第一階段，
13:28
first in human trials here at
the University of Washington in 2020 --
the University of Washington in 2020 --
271
796435
3645
2020 年先在華盛頓大學
這裡做人體實驗——
這裡做人體實驗——
13:32
two short years from now.
272
800104
1992
也就是短短的兩年後。
13:34
Presuming these studies
are safe and effective,
are safe and effective,
273
802834
3068
假設這些研究是安全且有效的，
13:37
which I think they're going to be,
274
805926
1946
我認為應該會是如此，
13:39
our plan is to scale this up
and ship these cells all around the world
and ship these cells all around the world
275
807896
4141
那麼我們的計畫就是把規模擴大，
把這些細胞運往全世界，
把這些細胞運往全世界，
13:44
for the treatment of patients
with heart disease.
with heart disease.
276
812061
2300
去治療心臟病病人。
13:46
Given the global burden of this illness,
277
814996
1962
這種疾病在全球都是很大的負擔，
13:48
I could easily imagine this treating
a million or more patients a year.
a million or more patients a year.
278
816982
3548
我很容易就能想像，這個方法
每年可以治療至少一百萬名病人。
每年可以治療至少一百萬名病人。
13:52
So I envision a time,
maybe a decade from now,
maybe a decade from now,
279
820916
2656
我的遠景是，將來，
也許十年之後，
也許十年之後，
13:55
where a patient like my mother
will have actual treatments
will have actual treatments
280
823596
3209
像我母親這樣的病人
能接受可以根治的治療，
能接受可以根治的治療，
13:58
that can address the root cause
and not just manage her symptoms.
and not just manage her symptoms.
281
826829
4114
而不只是在處理她的症狀。
14:02
This all comes from the fact
that stem cells give us the ability
that stem cells give us the ability
282
830967
3072
所有這些，都是因為
幹細胞讓我們有能力
幹細胞讓我們有能力
14:06
to repair the human body
283
834063
1699
可以從人類身體的
各組成部分來修復人類身體。
各組成部分來修復人類身體。
14:07
from its component parts.
284
835786
2210
14:10
In the not-too-distant future,
285
838774
2091
在不久的將來，
14:12
repairing humans is going to go
286
840889
3087
修復人類將不再是
14:16
from something that is
far-fetched science fiction
far-fetched science fiction
287
844000
3220
牽強附會的科幻小說，
14:19
into common medical practice.
288
847244
2267
而會變成是常見的醫療做法。
14:22
And when this happens,
289
850043
1329
當這一天到來時，
14:23
it's going to have
a transformational effect
a transformational effect
290
851396
2078
將會帶來轉化性的效應，
14:25
that rivals the development
of vaccinations and antibiotics.
of vaccinations and antibiotics.
291
853498
3769
不輸給疫苗和抗生素
被開發出來的壯舉。
被開發出來的壯舉。
非常謝謝各位聆聽。
14:30
Thank you for your attention.
292
858148
1447
14:31
(Applause)
293
859619
2613
（掌聲）
ABOUT THE SPEAKER
Chuck Murry - Physician, scientistChuck Murry founded and currently directs the Institute for Stem Cell and Regenerative Medicine at the University of Washington.
Why you should listen
Heart failure -- now the number one cause of death worldwide -- is the motivation behind Dr. Chuck Murry's specialized research into innovative treatments. Murry believes that it's not enough simply to help patients who are plagued with chronic disease survive. Instead, his pioneering work seeks to harness the potential of human stem cells to eliminate the disease from the body.
Chuck Murry | Speaker | TED.com