So let me just start with my story. So I tore my knee joint meniscus cartilage playing soccer in college. Then I went on to tear my ACL, the ligament in my knee, and then developed an arthritic knee. And I'm sure that many of you in this audience have that same story, and, by the way, I married a woman who has exactly the same story. So this motivated me to become an orthopedic surgeon and to see if I couldn't focus on solutions for those problems that would keep me playing sports and not limit me. So with that, let me just show you a quick video to get you in the mood of what we're trying to explain.
现在开始讲述我的故事 在大学踢足球时 我将我的半月板软骨撕裂 随后,我的前十字韧带也被撕裂了 但不久之后,人工膝盖出现了 我确信在座的很多听众都经历过此类的事情 顺便说一句,我结婚了 我的妻子也经历过同样的事情 这些事情促使我成为一名整形外科医生 我希望能够解决如何让我们 如何可以无拘束的运动问题 带着这个问题,我先让我们看一个简短的视频 让它带着你们了解我们所希望解决的问题
Narrator: We are all aware of the risk of cancer, but there's another disease that's destined to affect even more of us: arthritis. Cancer may kill you, but when you look at the numbers, arthritis ruins more lives. Assuming you live a long life, there's a 50 percent chance you'll develop arthritis. And it's not just aging that causes arthritis. Common injuries can lead to decades of pain, until our joints quite literally grind to a halt. Desperate for a solution, we've turned to engineering to design artificial components to replace our worn-out body parts, but in the midst of the modern buzz around the promises of a bionic body, shouldn't we stop and ask if there's a better, more natural way? Let's consider an alternative path. What if all the replacements our bodies need already exist in nature, or within our own stem cells? This is the field of biologic replacements, where we replace worn-out parts with new, natural ones.
视频旁白:我们都很关注癌症的风险 但是还有另一种疾病 能够比癌症还要影响更多的人—关节炎 癌症也许会让你死亡,但关节炎 会毁掉更多人的生活 假设你可活得很长命,你将有50%的概率 患上关节炎 这并不是因为年老而引起的疾病 常见的损伤可以导致数十年的伤痛 直到关节经过长时间磨损而停止工作 我们迫切地想得到解决的方法,随之我们转向工程学 以来设计人造关节 来替代我们早已磨损且不堪重负的身体器官 但在研究新方法时 都是围绕着仿生学这一前提 我们是否应该暂时停下脚步看看有没有更好、更自然的方法 让我们一起考虑一个替代方法 如果我们将我们身体某一部分的需要替换为 已经存在的生物器官 又或者用我们自己的干细胞培养会怎么样 这就是生物置换领域 它将我们已磨损的器官替换为新的、自然的器官
Kevin Stone: And so, the mission is: how do I treat these things biologically? And let's talk about both what I did for my wife, and what I've done for hundreds of other patients. First thing for my wife, and the most common thing I hear from my patients, particularly in the 40- to 80-year-old age group, 70-year-old age group, is they come in and say, "Hey, Doc, isn't there just a shock absorber you can put in my knee? I'm not ready for joint replacement." And so for her, I put in a human meniscus allograft donor right into that [knee] joint space. And [the allograft] replaces [the missing meniscus]. And then for that unstable ligament, we put in a human donor ligament to stabilize the knee. And then for the damaged arthritis on the surface, we did a stem cell paste graft, which we designed in 1991, to regrow that articular cartilage surface and give it back a smooth surface there. So here's my wife's bad knee on the left, and her just hiking now four months later in Aspen, and doing well. And it works, not just for my wife, but certainly for other patients. The girl on the video, Jen Hudak, just won the Superpipe in Aspen just nine months after having destroyed her knee, as you see in the other image -- and having a paste graft to that knee. And so we can regrow these surfaces biologically.
Kevin Stone:任务就是 我们如何用生物学知识处理这类事情 下面然我们谈谈,我对我的妻子 以及数以百计的病人的治疗方法 这是从我的妻子那里最先听到的 以及从我的患者口中 尤其是那些40-80岁年龄组中的70岁年龄组 最常听到的是 嘿,医生,我的膝盖中的放得只是一个减震器对吗 我并没有做好换关节的准备 对我的妻子来说我对她进了半月板手术 在膝盖连接处行了同种异体的植入 这种异基因移植物替换了缺失的半月板 随后对原来的韧带进行替换 我们放入了其他人捐赠的韧带 以使她的膝盖得到稳定的支撑 第三,则是对关节表面的损坏 我们进行了干细胞黏贴移植 这个则是我们在1991年设计出来的 可以使得关节软骨组织再生 使他们还原为光滑的表面 左边这个是我爱人原已损坏的膝盖 但是看右边,她在四个月后的Aspen 已经可以徒步旅行了,并且一切都很好 手术成功了,但并这个成功并不仅仅局限于我的爱人,其他患者也同样受益 视频中的女孩,Jen Hudak 刚刚在Aspen赢得了雪道滑雪 而这发生在她膝盖损坏后的九个月 正如你们看到视频 她有着经过干细胞修复过的膝盖 所以我们从生物学的角度将是可以修复关节表面的
So with all this success, why isn't that good enough, you might ask. Well the reason is because there's not enough donor cycles. There's not enough young, healthy people falling off their motorcycle and donating that tissue to us. And the tissue's very expensive. And so that's not going to be a solution that's going to get us global with biologic tissue. But the solution is animal tissue because it's plentiful, it's cheap, you can get it from young, healthy tissues, but the barrier is immunology. And the specific barrier is a specific epitope called the galactosyl, or gal epitope. So if we're going to transplant animal tissues to people, we have to figure out a way to get rid of that epitope.
所以经过了这些的成功 你们也许会问为什么还不够好呢 这是因为还没有足够的数据来支撑这个实践 没有足够健康的年轻人 从他们的模特车上摔倒 并且将他们的器官捐赠给我们 并且这个手术十分昂贵 这就是这个办法没有得到普及的原因 也使得我们将事业放眼于全球去寻找合适的生物组织 随后我们用动物组织进行替代 因为生物组织可以随处找到,并且价格也不高 并且可以得到年轻、健康的生物组织 但是,该种方法的障碍就是免疫问题 这种特别的障碍是由 特殊的抗原决定基所导致 这种抗原决定基就是”半乳糖基“ 所以,如果我们想将动物组织移植到人类的身体上 则必须找到一种方法去除掉半乳糖基
So my story in working with animal tissues starts in 1984. And I started first with cow Achilles tendon, where we would take the cow Achilles tendon, which is type-I collagen, strip it of its antigens by degrading it with an acid and detergent wash and forming it into a regeneration template. We would then take that regeneration template and insert it into the missing meniscus cartilage to regrow that in a patient's knee. We've now done that procedure, and it's been done worldwide in over 4,000 cases, so it's an FDA-approved and worldwide-accepted way to regrow the meniscus. And that's great when I can degrade the tissue. But what happens for your ligament when I need an intact ligament? I can't grind it up in a blender. So in that case, I have to design -- and we designed with Uri Galili and Tom Turek -- an enzyme wash to wash away, or strip, those galactosyl epitopes with a specific enzyme. And we call that a "gal stripping" technique. What we do is humanize the tissue. It's by gal stripping that tissue we humanize it (Laughter), and then we can put it back into a patient's knee. And we've done that. Now we've taken pig ligament -- young, healthy, big tissue, put it into 10 patients in an FDA-approved trial -- and then one of our patients went on to have three Canadian Masters Downhill championships -- on his "pig-lig," as he calls it. So we know it can work. And there's a wide clinical trial of this tissue now pending.
所以我的工作 从1984年开始研究动物组织 我首先从 牛的跟腱开始 我们可以将牛的跟腱中的 一种胶原质 从其抗原中分离 进过一种酸和清洁剂的冲洗降解 使其成为一种再生模板 我们随后可以将这个再生模板 插入半月板软骨撕裂处 让其在患者的膝盖再生 直到现在,通过使用这种方法 我们已经在全球范围内治愈了逾4000位患者 所以这是一个可以被美国食品及药物管理局以及全世界所接受的 膝盖半月板再生法 而且当我们能够降解生物组织时将会更好 但是,当你需要一个完整的韧带时 我不能将其在搅拌机里将其磨碎 所以,这种情况下 我必须进行研究设计,与我一起设计的还有Uri Galili和Tom Turek 我们一起设计一种酶洗之法 用一种特殊的酶 以洗掉或脱离掉 那些半乳糖抗原决定基 这种酶素洗法我们称之为“半乳糖脱离”技术 我们所做的就是将组织做的更加人性化 用半乳糖脱离法 我们可以将其处理的更加接近人的组织 然后我们就可以 将这个组织放回患者的膝盖处 我们已经做过这个实验,现在我们采用猪的韧带 年轻的、健康的、大的组织 将其放入是为患者的体内,当然这个实验是经过美国食品药品监督管理局的批准 不久,其中一位患者就继续参加了 三个加拿大斜坡大师冠军赛 当然,这都是经过他自己称之为“猪膝盖”的做功。这让我们了解到这种方法管用 而且,一个更大规模的临床试验将要进行
So what about the next step? What about getting to a total biologic knee replacement, not just the parts? How are we going to revolutionize artificial joint replacement? Well here's how we're going to do it. So what we're going to do is take an articular cartilage from a young, healthy pig, strip it of its antigens, load it with your stem cells, then put it back on to that arthritic surface in your knee, tack it on there, have you heal that surface and then create a new biologic surface for your knee. So that's our biologic approach right now. We're going to rebuild your knee with the parts. We're going to resurface it with a completely new surface.
那么我们的下一步将会做什么 做一个整体生物膝盖置换怎么样 不再局限于一个部分 我们如何对人在关节置换进行革命性改变 这就是我们如何做这件事情 我们将会用一个 来自年轻、健康的猪的 关节软骨 剥离掉它的抗原 载上你自己的干细胞 然后将其放回 你自己膝盖处的关节 将其固定,让你自己治愈破损的表面 并让其自己为你的膝盖生长一个新的生物表面 这就是我们现在的生物方法 我们可以用部分组织让你的膝盖得以重生 我们将原组织表面生成一个全新的表面
But we have other advantages from the animal kingdom. There's a benefit of 400 million years of ambulation. We can harness those benefits. We can use thicker, younger, better tissues than you might have injured in your knee, or that you might have when you're 40, 50 or 60. We can do it as an outpatient procedure. We can strip that tissue very economically, and so this is how we can get biologic knee replacement to go global.
但是,我们可以从动物王国哪里得到其他的利益 这个利益是他们有四亿年的 移动历史 我们可以利用那些有事 我们可以利用那些更加厚实、年轻 比你自身更好的组织 或比你40、50、60岁时更好的组织 我们可以将其发展为门诊式的程序 我们还可以将脱离技术发展为更为经济的方法 这就是我们如何在全球范围内 获得生物膝盖置换的方法
And so welcome to super biologics. It's not hardware. It's not software. It's bioware. It's version 2.0 of you. And so with that, coming to a -- (Laughter) coming to an operating theater near you soon, I believe.
欢迎进入生物学的世界 他不是硬件 也不是软件 是生物部件 是你身体部件的第二代 我深信不久人们将会在 (笑声) 各个医院中见到它的使用
Thank you very much.
谢谢
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