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