[SHAPE YOUR FUTURE]
[塑造你的未來]
(Slam) Ow!
(撞擊聲) 噢!
As anyone who’s stubbed a toe in the dark or spent an hour searching for their keys knows we're often limited by what we can or cannot see. In fact, even our own bodies can be black boxes.
任何曾在黑暗中撞到腳趾 或是花一個小時找鑰匙的人都知道, 我們常常被那些 看得到或看不到的東西限制住。 事實上,我們自己的身體像是黑盒子。
Today, I want to take you through a vision of health care that scientists and engineers, myself included, are building. We are creating a diagnostic lab inside your body that can provide a continuous analysis of your health so that we can better see what's happening in patients.
今天,我想帶你了解 包括我自己在內的一些科學家和工程師 所一起建設的醫療保健願景。 我們要在你體內建造一座診斷實驗室, 它可以持續分析您的健康狀況, 這樣我們就可以更清楚地觀察 患者的身體狀況。
Currently, if someone is sick, we may diagnose them by using a biopsy to bring disease tissue outside the body where we can see it. We do this if we suspect, for instance, that a growth might be cancerous. Unfortunately, this approach can't work all the time because of two major problems. First, some tissues, like brains or spinal cords, can't be routinely biopsied. And second, doctors often don't know which tissue is causing the problem, so they don't know what to biopsy. So far, we've dealt with these issues using external medical tests, like MRIs or blood tests. These provide a broad overview of the health of a patient, but they can't see the molecular and cellular changes that occur within tissues, and they certainly can't provide enough information to proactively treat patients before symptoms develop. This is unfortunate because it's these invisible changes that ultimately cause disease. Our inability to measure these changes results in a disparity between what we can see on a test and what we know is happening in patients.
現在,如果有人生病了, 我們可能會透過組織切片去診斷他們, 這是方法是將病變組織帶出體外, 讓我們可以看到它。 例如,我們懷疑腫瘤 可能會癌變時就會這樣做。 不幸的是,這個方法 有兩個很大的問題, 所以在有些狀況下無法使用。 首先,有些組織,像是大腦或脊隨, 不能做一般的切片檢查。 其次,醫生通常不知道 是哪些組織出了問題, 所以也不知道該採檢什麼組織。 迄今,我們處理這些問題時, 運用的是核磁共振 和抽血檢查體等體外的醫學測試。 這些方法為患者的健康 提供了一個廣泛的概括了解, 但無法看到組織裡分子和細胞的變化, 當然也無法提供足夠的資訊 為患者在症狀出現之前積極治療。 這很不幸, 因為最終就是這些 看不見的身體變化導致疾病。 我們無法衡量這些變化, 使得我們在檢驗結果看到的狀況 和患者體內實際發生的事 有很大的差異。
Let's take multiple sclerosis as an example. In MS, which is an autoimmune disease, the immune system attacks two specific tissues: the brain and the spinal cord, resulting in damage and in some cases, paralysis. Now, we obviously can't catch MS by routinely biopsying people's brains, where there would be abundant and active disease-inducing cells. And we can't catch it using a blood test because the MS-inducing cells are so rare and inactive in the blood that we simply can't see them. Even brain imaging technologies like MRI can't provide the information we need to be proactive about MS.
以 MS,也就是多發性硬化症為例。 這是一種自身免疫性疾病, 免疫系統攻擊兩種特定組織 : 大腦和脊隨; 造成腦和脊隨的損害, 有時候甚至導致癱瘓。 我們顯然不能定期做腦組織切片 來診斷病人是否患有 MS, 但患有 MS 的腦部必然有 大量活耀的疾病誘導細胞。 驗血也無法發現 MS, 因為 MS 誘導細胞在血液中 很罕見也沒有活性, 以至於我們根本無法看到它們。 即便是腦成像技術,像是核磁共振, 也無法提供我們所需要的資訊 去積極應對 MS。
So we need to rethink how we see. My coworkers at the University of Michigan and I decided to do just that. Instead of taking an outside-in approach to diagnostics, we're taking an inside-out approach. We are creating implantable sites that have similarities to other sites in the body, and will improve our vision by giving us real-time access to molecular and cellular information about diseased tissues. These insights will enable us to predict the onset of disease and even identify therapies likely to work in an individual patient.
所以我們必須要重新思考 我們「看」的方式。 這正是我跟密西根大學的 同事決定的做法, 我們用由內而顯於外的診斷方法 去取代由外推測體內狀況的診斷方法。 我們在體表尋找可植入的部位, 這些部位必須與體內 特定部位有相似之處, 如此我們就能夠取得 即時的分子、細胞資訊 來改善我們可看到的範圍。 這些觀察結果讓我們 能夠預測疾病的發生, 甚至找出對個別患者 可能會起作用的療法。
So what does this inside-out approach look like? Step one is to engineer new tissues just under the skin. These tissues have similarities to other inaccessible sites in the body, like the brain or the lungs. By implanting a porous plastic disk made of FDA-approved biomaterials, I can harness the body's natural responses to allow cells to migrate into the disk, survive at the site and form a tissue. Eventually, we're left with an engineered tissue with integrated immune cells, just the cells we need for diagnosis. Although these tissues are complex and chronically inflamed, they're also innocuous and after a few weeks, nearly imperceptible. Our engineered tissues contain information not present in the blood, and they can help bridge the gap between what we can see on a traditional test and cellular changes we know occur in disease.
那這個由內而顯於外的方法 是什麼樣子呢? 第一步是在皮下製造新組織, 這些組織與身體其他難以觀察的部位, 比如說大腦或肺, 有著相似之處, 接著植入FDA 認可的生物材料 所做成的多孔塑膠盤, 我可以利用身體的自然反應, 讓細胞遷移到塑膠盤裡, 在那兒存活下來並生成組織。 最終,我們得到的 是具有整合免疫細胞的人造組織, 正是我們診斷所需要的細胞。 即使這些組織很複雜 以及會長期發炎, 他們依舊是無害的。 幾週後就感覺不到它的存在。 我們製造的組織 含有在血液中找不到的訊息, 而且能幫助補足 在傳統測試中無法取得的資訊, 也就是患部細胞實際發生的變化。
Step two is to read this signal. Currently, I could take a biopsy of my engineered site and analyze it because I made them accessible just under the skin. But it would certainly be better if we could incorporate and read a sensor noninvasively. Within the next decade, rapidly converging technologies could enable diagnosis at such an implant by harnessing simple detectors, like a blood pressure cuff or smartwatch does now. The mechanisms for diagnosing and monitoring disease could be as simple as opening an app, like Candy Crush on your phone.
第二步就是讀取這些訊號。 現在,我可以在人造的部位 做切片並加以分析, 因為位在皮下,易於採檢。 但如果我們也能以非侵入性的方式 使用和讀取感應器 就更好了。 在未來十年內, 技術的快速融合可能讓我們 透過操控簡單的探測器, 類似腕式血壓計或智能手錶, 在這種植入物上進行診斷。 這個診斷以及監測疾病的機制, 可以如同在手機上打開一個 像 Candy Crush 的 APP 一樣簡單。
Step three is to harness the huge array of knowledge in fields like engineering and material science to improve these implants and our ability to read their data. Eventually, tens, if not hundreds of individual engineered tissues with integrated sensors may be implantable with a single application.
第三步是運用工程 和材料科學等領域的大量知識, 去改善那些植入物 以及我們讀取那些數據的能力。 最後,數十種甚或數百種 帶有整合感應器的人造組織 可以一次植入。
Now, this approach to diagnosis is unconventional, to be sure, but it is robust. So far, my colleagues and I have used it to diagnose models of metastatic cancer, type 1 diabetes, multiple sclerosis and organ transplant rejection. But this is just the beginning of what we can see. With continuous improvements, we will be able to truly create a diagnostic lab inside your body that provides a continuous analysis of your health. By changing how we see what's going wrong in patients, we will be able to diagnose and treat diseases better and faster than ever before. If you're willing to rethink how you see, you may be surprised what comes into view.
這種診斷方法是非傳統的, 但很牢靠。 迄今,我和同事們曾運用它 來做轉移性癌症、 第 1 型糖尿病、多發性硬化症 以及移植器官排斥的診斷實驗。 但這只是冰山的一角。 經過持續的改善, 我們將能夠真正地創造 一個可以持續分析您健康狀況的 體內診斷實驗室。 藉由改變我們「看見」疾病的方法, 我們能比以前更好、更快地 診斷和治療疾病。 如果你願意重新思考「看」的方式, 你或許會對你所看到的感到驚訝。
Thank you.
謝謝。