I'm going to talk to you today about my work on suspended animation. Now, usually when I mention suspended animation, people will flash me the Vulcan sign and laugh. But now, I'm not talking about gorking people out to fly to Mars or even Pandora, as much fun as that may be. I'm talking about the concept of using suspended animation to help people out in trauma.
今天我想跟大家談談我在"暫停生命"的研究 通常, 當我提到"暫停生命"時 人們多是像我比出向外星人致敬的手勢並大笑 我並不是要將人類瞬間 傳輸到火星或其他地方 即使那會是多麼有趣 而我在說的概念 是利用暫停生命 幫助人們能脫離傷害
So what do I mean when I say "suspended animation"? It is the process by which animals de-animate, appear dead and then can wake up again without being harmed. OK, so here is the sort of big idea: If you look out at nature, you find that as you tend to see suspended animation, you tend to see immortality. And so, what I'm going to tell you about is a way to tell a person who's in trauma -- find a way to de-animate them a bit so they're a little more immortal when they have that heart attack.
所以到底什麼是我的本意 當我說"暫停生命"呢? 那是一種程序能使 動物暫時不動 就像死亡 但又能無害地被救醒 好吧!這就是大致上的概念 在自然界中 能找到的 關於暫停生命 就似乎是"不死" 所以 我打的比方就是 在極度創傷中的人們 能暫停一下他們的生命 例如 心臟病發時 他們可以稍稍的"不死"
An example of an organism or two that happens to be quite immortal would be plant seeds or bacterial spores. These creatures are some of the most immortal life forms on our planet, and they tend to spend most of their time in suspended animation. Bacterial spores are thought now by scientists to exist as individual cells that are alive, but in suspended animation for as long as 250 million years. To suggest that this all, sort of, about little, tiny creatures, I want to bring it close to home. In the immortal germ line of human beings -- that is, the eggs that sit in the ovaries -- they actually sit there in a state of suspended animation for up to 50 years in the life of each woman.
一兩個關於有機生命體 能有著不死的能力 就是植物種子 或是細菌孢子 它們都是些 地球上能"不死"的代表 他們絕大部分時間是處於 暫停生命的狀態 細菌孢子已被科學家認為 能以個別細胞單獨存在 它們以假死的狀態活著 長達2億5千萬年之久 若質疑這些例子多是小細胞 我也能帶些更貼近的例子 在人類身體"不死" 的例子中 就是 卵子於卵巢中 會處於一不死的狀態 長達50年之久
So then there's also my favorite example of suspended animation. This is Sea-Monkeys. Those of you with children, you know about them. You go to the pet store or the toy store, and you can buy these things. You just open the bag, and you just dump them into the plastic aquarium, and in about a week or so, you'll have little shrimps swimming around. Well, I wasn't so interested in the swimming. I was interested in what was going on in the bag, the bag on the toy store shelf where those shrimp sat in suspended animation indefinitely. So these ideas of suspended animation are not just about cells and weird, little organisms.
也有我最喜歡 關於"暫停生命"的例子 就是豐年蝦 有小孩的 你們一定知道這東西 到寵物或是玩具痁 可以買到這些 打開包裝帶 將它們倒入 壓克力水族缸 大約一週後 就會看到小蝦子四處游動 我對游泳並不關心 我只對袋子的狀態有興趣 一直待在販售架上的包裝袋 卻是讓蝦子 處於無限期的暫停生命狀態 所以 有關"暫停生命" 並不只僅限於細胞 或是小型有機生命體
Occasionally, human beings are briefly de-animated, and the stories of people who are briefly de-animated that interest me the most are those having to do with the cold. Ten years ago, there was a skier in Norway that was trapped in an icy waterfall, and she was there for two hours before they extracted her. She was extremely cold, and she had no heartbeat -- for all intents and purposes she was dead, frozen. Seven hours later, still without a heartbeat, they brought her back to life, and she went on to be the head radiologist in the hospital that treated her.
甚至 包含人類自己 都有可能短暫的暫停生命 在那些許多有關人類能短暫停止生命的故事中 我最感興趣的是那些 與低環境溫度有關的 例如 10年前 挪威的滑雪者 被困在結冰的瀑布中 她待在其中兩個小時 才被救出 她是完全的冰封 沒有心跳脈搏 就當時情況而言 她確實死了,被冰凍著 七個小時後 仍然 沒有心跳 最後他們還是將她救回 而且她後來成為 輻射治療之專家 就服務於那所救她的醫院
A couple of years later -- so I get really excited about these things -- about a couple of years later, there was a 13-month-old, she was from Canada. Her father had gone out in the wintertime; he was working night shift, and she followed him outside in nothing but a diaper. And they found her hours later, frozen, lifeless, and they brought her back to life.
就在意外發生的幾年後 -- 我一直對這些事感到興奮 隔了幾年 一個13個月大的加拿大女嬰 她的父親需要於冬季值夜班出門 她卻跟著他 只穿了尿片 數小時後 他們找到她 結凍的無生命跡象 她最後被救回
There was a 65-year-old woman in Duluth, Minnesota last year that was found frozen and without a pulse in her front yard one morning in the winter, and they brought her back to life. The next day, she was doing so well, they wanted to run tests on her. She got cranky and just went home. (Laughter)
另外 一個65歲的老婦人 去年於明尼蘇達州 冬季的一個早晨在她的院子 被發現受凍且無心跳 醫院也把她救活回來 第二天 她的狀況出奇的好 醫院想多做些測試 她十分不耐煩 就直接回家去了 (觀眾笑)
So, these are miracles, right? These are truly miraculous things that happen. Doctors have a saying that, in fact, "You're not dead until you're warm and dead." And it's true. It's true. In the New England Journal of Medicine, there was a study published that showed that with appropriate rewarming, people who had suffered without a heartbeat for three hours could be brought back to life without any neurologic problems. That's over 50 percent. So what I was trying to do is think of a way that we could study suspended animation to think about a way to reproduce, maybe, what happened to the skier.
所以是有奇蹟的 對吧! 這些都是無法置信的奇蹟發生 醫生有這樣的說法 唯有當你是死時有體溫, 才是確實死去 這真的是這樣 真的 在新英格蘭醫學期刊上 有研究顯示 經過適當的回溫 即使經過三小時的無心跳 是可能被救復活 也無神經功能上的損傷 有超過50%的成功率 所以 我想做的事 是能研究 暫時停止生命 設計一套程序 或是重新呈現 在那位滑雪者身上發生的事
Well, I have to tell you something very odd, and that is that being exposed to low oxygen does not always kill. So, in this room, there's 20 percent oxygen or so, and if we reduce the oxygen concentration, we will all be dead. And, in fact, the animals we were working with in the lab -- these little garden worms, nematodes -- they were also dead when we exposed them to low oxygen. And here's the thing that should freak you out. And that is that, when we lower the oxygen concentration further by 100 times, to 10 parts per million, they were not dead, they were in suspended animation, and we could bring them back to life without any harm. And this precise oxygen concentration, 10 parts per million, that caused suspended animation, is conserved. We can see it in a variety of different organisms. One of the creatures we see it in is a fish. And we can turn its heartbeat on and off by going in and out of suspended animation like you would a light switch.
恩,我得告訴你們一些奇怪的事情 就是 處於缺氧環境下 也不一定致命死亡 在這個屋內 氧氣含量約為20% 如果我們降低氧氣含量 我們會缺氧而死 事實上 實驗室中的動物實驗 如這些庭園中的蚯蚓 線蟲 當我們將它放在低氧狀態,它們一樣死亡 然後接下來是會嚇到你的事 就是,當我們再繼續降低氧氣比例 100倍以下 也就是 10ppm時 它們不會死 反而是處於一暫時停止生命的狀態 我們能回復它們的生命 而無任何傷害 而這奇特地含氧濃度 10ppm 能促使它們暫停生命 是 屢試不爽的 我們也見到多種生物有如此特性 其中一種就是 魚類 我們能啟動或停止它的心跳 就像是利用電源開關式地進進出出"暫停生命"的狀態
So this was pretty shocking to me, that we could do this. And so I was wondering, when we were trying to reproduce the work with the skier, that we noticed that, of course, she had no oxygen consumption, and so maybe she was in a similar state of suspended animation. But, of course, she was also extremely cold. So we wondered what would happen if we took our suspended animals and exposed them to the cold. And so, what we found out was that, if you take animals that are animated like you and I, and you make them cold -- that is, these were the garden worms -- now they're dead. But if you have them in suspended animation, and move them into the cold, they're all alive. And there's the very important thing there: If you want to survive the cold, you ought to be suspended. Right? It's a really good thing.
這就是非常令我感到震驚的 我們居然能夠做到如此程度 因此我在想,我們何時可以 複製那滑雪者的情況 我們留意到 她確實是處於缺氧狀態 所以她也就暫時 處於一類似暫停生命的狀態 同時 她也處於極低溫狀態 也就聯想到 將我們的實驗動物 也置於低溫 所以 我們發現 若我們將動物 或就是你我一般的動物 直接處於低溫狀態 就像 庭園蚯蚓 它們會死去 但程序若是 將他們先處於 暫停生命狀態 再移動到低溫狀態 它們全都能活下來 這是重要的一點: 若想要存活於低溫狀態 一定要先處於暫停生命狀態 這是非常好的一點
And so, we were thinking about that, about this relationship between these things, and thinking about whether or not that's what happened to the skier. And so we wondered: Might there be some agent that is in us, something that we make ourselves, that we might be able to regulate our own metabolic flexibility in such a way as to be able to survive when we got extremely cold, and might otherwise pass away? I thought it might be interesting to sort of hunt for such things. You know?
所以 我們就想像 連結所有可能因素 猜想 那滑雪者所有與眾不同的情境 所以我們猜測 可能有一機制 能夠自然地讓我們 有改變生命狀態的彈性 讓我們能遇到低溫狀態還能存活下來的方式 不然只有死亡一途 我對搜尋如此的機制感到興趣 你知道嗎?
I should mention briefly here that physiology textbooks that you can read about will tell you that this is a kind of heretical thing to suggest. We have, from the time we are slapped on the butt until we take our last dying breath -- that's when we're newborn to when we're dead -- we cannot reduce our metabolic rate below what's called a standard, or basal metabolic rate. But I knew that there were examples of creatures, also mammals, that do reduce their metabolic rate such as ground squirrels and bears, they reduce their metabolic rate in the wintertime when they hibernate. So I wondered: Might we be able to find some agent or trigger that might induce such a state in us?
我該在此簡短聲明 生理學教科書 只會稱這樣的企圖是邪教 我們從出生被打屁股時 直到死前的最後一口呼吸 那就是 從生到死 我們都不能改變我們的代謝速率 低於所謂的標準值 或稱為基本的代謝速率 但我同時知道一些 生物實例 也是哺乳動物 能降低代謝速率 如松鼠 熊 他們能降低代謝速率 於冬天休眠狀態 所以 我希望能找到一些機制或觸發 能引起我們自然地進入此狀態
And so, we went looking for such things. And this was a period of time when we failed tremendously. Ken Robinson is here. He talked about the glories of failure. Well, we had a lot of them. We tried many different chemicals and agents, and we failed over and over again. So, one time, I was at home watching television on the couch while my wife was putting our child to bed, and I was watching a television show. It was a television show -- it was a NOVA show on PBS -- about caves in New Mexico. And this particular cave was Lechuguilla, and this cave is incredibly toxic to humans. The researchers had to suit up just to enter it. It's filled with this toxic gas, hydrogen sulfide. Now, hydrogen sulfide is curiously present in us. We make it ourselves. The highest concentration is in our brains. Yet, it was used as a chemical warfare agent in World War I. It's an extraordinarily toxic thing. In fact, in chemical accidents, hydrogen sulfide is known to -- if you breathe too much of it, you collapse to the ground, you appear dead, but if you were brought out into room air, you can be reanimated without harm, if they do that quickly.
於是我們四處找這樣的東西 那時就是我們遭遇極度失敗的階段 Ken Robinson 在這裡談到輝煌的失敗 我們也有過好多的輝煌失敗 我們試過很多的化學元素與機制 而一直是失敗接著失敗 直到有一天 我在家 看電視 而我太太正哄著孩子入睡 我看著一個電視節目 是個電視節目 NOVA製作的PBS節目 有關於新墨西哥州的洞穴 那次特別介紹 Lechuguilla 洞穴 這個洞穴對人類而言是有致命毒性 研究人員需要穿著特殊裝備才能進入 它充滿著致命毒氣 硫化氫 但是 硫化氫又能奇妙的存於我們的體內 我們會自然而然地製造硫化氫 最濃的地方是在我們的腦部 硫化氫被用來做 第一次世界大戰的化學武器 是個對人類毒性極高的氣體 在化學意外事故中 硫化氫被用來做一直被認為 若吸入過多 會倒地不起 呈現死亡狀態 但實際上若能再帶回正常空氣 是能夠復活而無任何傷害 一切都要快速進行
So, I thought, "Wow, I have to get some of this." (Laughter) Now, it's post-9/11 America, and when you go into the research institute, and you say, "Hi. I'd like to buy some concentrated, compressed gas cylinders of a lethal gas because I have these ideas, see, about wanting to suspend people. It's really going to be OK." So that's kind of a tough day, but I said, "There really is some basis for thinking why you might want to do this." As I said, this agent is in us, and, in fact, here's a curious thing, it binds to the very place inside of your cells where oxygen binds, and where you burn it, and that you do this burning to live. And so we thought, like in a game of musical chairs, might we be able to give a person some hydrogen sulfide, and might it be able to occupy that place like in a game of musical chairs where oxygen might bind? And because you can't bind the oxygen, maybe you wouldn't consume it, and then maybe it would reduce your demand for oxygen. I mean, who knows?
所以 哇! 我想弄些那氣體 (觀眾笑) 那時是 911恐怖攻擊之後的美國 所以 當你走進一研究單位 說: "嗨! 我想買些高濃度的 壓縮氣體鋼瓶 而且是致命氣體 就只因為我有這些想法 想要暫停人們的生命 而且 一定會成功的" 可想而知 那時是相當難進行的 但我強調 有著強烈 的基本動機促使我們要做這樣研究 因為 那樣的機制(毒物)是存在體內的 更奇怪的是 硫化氫被用來做 在我們的細胞內 與氧氣 是同樣的鍵結方式 這樣的鍵結氧化燃燒 使細胞存活 所以 我們聯想到 "搶椅子遊戲" 我們是否可以給人 一些 硫化氫 它 能取代 鍵結 就像搶椅子遊戲般 取代氧氣鍵結 因為細胞 不能連結氧氣 所以 不用氧化燃燒 也就降同時降低對氧氣的需求 我猜想的
So -- (Laughter) So, there's the bit about the dopamine and being a little bit, what do you call it, delusional, and you might suggest that was it. And so, we wanted to find out might we be able to use hydrogen sulfide in the presence of cold, and we wanted to see whether we could reproduce this skier in a mammal. Now, mammals are warm-blooded creatures, and when we get cold, we shake and we shiver, right? We try to keep our core temperature at 37 degrees by actually burning more oxygen. So, it was interesting for us when we applied hydrogen sulfide to a mouse when it was also cold because what happened is the core temperature of the mouse got cold. It stopped moving. It appeared dead. Its oxygen consumption rate fell by tenfold. And here's the really important point. I told you hydrogen sulfide is in us. It's rapidly metabolized, and all you have to do after six hours of being in this state of de-animation is simply put the thing out in room air, and it warms up, and it's none the worse for wear.
所以 (笑) 有些像多巴胺 或有些像是妄想 都是可被質疑的 所以,我們要證實 或許利用 硫化氫再加上低溫環境 是不是能夠 於哺乳動物身上 再複製那滑雪者的情況 哺乳動物是溫血動物 遇到低溫 我們會發抖打顫 會儘量保持體內溫度於37度C 卻是藉由燃燒更多的 氧氣 對我們有趣的是 當我們使用硫化氫 在一低溫的老鼠身上 老鼠體溫下降 如環境溫度 它不再活動 呈現死亡 而氧氣的消耗量 也降低十倍 重要的事是這個 剛剛提到硫化氫是存在人體內 快速的代謝 而處於暫停生命狀態六小時後 所要做的 僅只是恢復到正常室內空氣 它會恢復體內溫度
Now, this was cosmic. Really. Because we had found a way to de-animate a mammal, and it didn't hurt it. Now, we'd found a way to reduce its oxygen consumption to rock-bottom levels, and it was fine. Now, in this state of de-animation, it could not go out dancing, but it was not dead, and it was not harmed. So we started to think: Is this the agent that might have been present in the skier, and might have she had more of it than someone else, and might that have been able to reduce her demand for oxygen before she got so cold that she otherwise would have died, as we found out with our worm experiments?
這是件大事 因為我們已找到 如何暫停哺乳動物的生命 也不至於 傷害它 我們已經找到降低 氧化消耗的速率 到其最低限度 也OK 在這 暫停生命狀態 雖不能再活動 但它並未死去 一點都無其他傷害 所以我們開始思考:是不是這樣的機制 也就是使滑雪者存活的原因 還是她有著較常人還多的濃度 也就使她能降低 對氧的需求量 一切都得在她失溫之前達成 不然必死無疑 是根據我們的蟲蟲實驗?
So, we wondered: Can we do anything useful with this capacity to control metabolic flexibility? And one of the things we wondered -- I'm sure some of you out there are economists, and you know all about supply and demand. And when supply is equal to demand, everything's fine, but when supply falls, in this case of oxygen, and demand stays high, you're dead. So, what I just told you is we can now reduce demand. We ought to be able to lower supply to unprecedented low levels without killing the animal. And with money we got from DARPA, we could show just that. If you give mice hydrogen sulfide, you can lower their demand for oxygen, and you can put them into oxygen concentrations that are as low as 5,000 feet above the top of Mt. Everest, and they can sit there for hours, and there's no problem. Well this was really cool. We also found out that we could subject animals to otherwise lethal blood loss, and we could save them if we gave them hydrogen sulfide.
我們在想: 我們是否能 利用這些已知 來控制代謝的彈性呢? 其中一件我們想解決的事 --- 我相信 你們當中一定有些是經濟學家 都明瞭 供給與需求 當供給等於需求時 皆大歡喜 但當供給短缺 --- 在這裡就是 缺氧 --- 而需求依舊 那就死定了 剛剛在說明的重點 就是我們能降低對氧氣的需求 我們必須降低供給 達到前所未有的程度 又不致死 利用從DARPA所支持的研究經費 我們已能驗證這些 如果我們給老鼠硫化氫 就能降低牠們對氧的需求 放置在氧氣濃度低於 5000英呎以上的Everest高山 牠們能停留數小時 沒有任何問題 這真的是非常棒 我們也發現對於 嚴重失血的動物 我們也能救回它們 還是利用硫化氫
So these proof of concept experiments led me to say "I should found a company, and we should take this out to a wider playing field." I founded a company called Ikaria with others' help. And this company, the first thing it did was make a liquid formulation of hydrogen sulfide an injectable form that we could put in and send it out to physician scientists all over the world who work on models of critical care medicine, and the results are incredibly positive.
所以這些槪念式的實驗證明 讓我決定集資成立公司 我們應該將此推廣到更大的場域 我成立了一家公司叫 Ikaria 得到其他人的相助 這家公司第一件事就是 製成了液態狀的硫化氫 能由注射方式地注入體內 能安全地送到世界各處 需要急救醫療用藥的醫生手中 結果是非常的正面
In one model of heart attack, animals given hydrogen sulfide showed a 70 percent reduction in heart damage compared to those who got the standard of care that you and I would receive if we were to have a heart attack here today. Same is true for organ failure, when you have loss of function owing to poor perfusion of kidney, of liver, acute respiratory distress syndrome and damage suffered in cardiac-bypass surgery. So, these are the thought leaders in trauma medicine all over the world saying this is true, so it seems that exposure to hydrogen sulfide decreases damage that you receive from being exposed to otherwise lethal-low oxygen.
在一心臟病發的研究 實驗動物被注射了硫化氫 顯現降低了70%機率的心臟損害 這是與按照一般救護的控制組比較 這種心臟病發就是我們身邊所見到的那種 同樣說明也可延伸至其他器官衰竭 例如腎衰竭, 肝功能衰竭 急性呼吸功能衰竭 以及由心導管手術造成的損傷 我們的療法也經由世界各地之頂尖創傷醫學專家 驗證真實性 所以 各個研究顯示硫化氫 能降低因氧氣不足 所導致的致命性傷害
And I should say that the concentrations of hydrogen sulfide required to get this benefit are low, incredibly low. In fact, so low that physicians will not have to lower or dim the metabolism of people much at all to see the benefit I just mentioned, which is a wonderful thing, if you're thinking about adopting this. You don't want to be gorking people out just to save them, it's really confusing. (Laughter)
我也必須強調 要達到此種急救效益 硫化氫的濃度是 非常非常低的 事實上, 醫生根本不至於 降低傷患之代謝速率太多 就能達到前述的急救效益 這是件好事, 能更加快大家採用這樣的技術 你不必要完全暫停生命 就只為了一般性急救醫療,那會是非常惱人的 (笑)
So, I want to say that we're in human trials. Now, and so -- (Applause) Thank you. The Phase 1 safety studies are over, and we're doing fine, we're now moved on. We have to get to Phase 2 and Phase 3. It's going to take us a few years. This has all moved very quickly, and the mouse experiments of hibernating mice happened in 2005; the first human studies were done in 2008, and we should know in a couple of years whether it works or not. And this all happened really quickly because of a lot of help from a lot of people.
所以 我要結論的是 我們已進入人體臨床試驗了 現在 ... (掌聲) 謝謝大家。安全性驗證已完成 一切順利,進入下一階段 我們要陸續進到第二階與第三階 那會需要幾年的時間 一切都是加速進行 老鼠實驗中的冬眠試驗 是在2005年執行 第一個人體試驗是在2008年進行 我們應該在一兩年 便知道可行與否 一切進展都是非常快 因為有著來自各方的相助
I want to mention that, first of all, my wife, without whom this talk and my work would not be possible, so thank you very much. Also, the brilliant scientists who work at my lab and also others on staff, the Fred Hutchinson Cancer Research Center in Seattle, Washington -- wonderful place to work. And also the wonderful scientists and businesspeople at Ikaria. One thing those people did out there was take this technology of hydrogen sulfide, which is this start-up company that's burning venture capital very quickly, and they fused it with another company that sells another toxic gas that's more toxic than hydrogen sulfide, and they give it to newborn babies who would otherwise die from a failure to be able to oxygenate their tissues properly. And this gas that is delivered in over a thousand critical care hospitals worldwide, now is approved, on label, and saves thousands of babies a year from certain death. (Applause)
最重要的我想感謝 我的太太, 沒有她這一切都不會實現的 所以非常謝謝大家 以及曾在我實驗室努力的聰明科學家 與其他同事 在華盛頓州西雅圖市的Fred Hutchinson 癌症研究中心 那是個非常棒的工作環境 以及目前在 Ikaria 公司的科學家 與商業經營團隊 他們不同的經營手法 讓這耗費巨資新創公司的 硫化氫技術 能與另一公司技術結合 那家公司供應另一毒性氣體 那是比硫化氫還毒的氣體 提供給面臨難產或猝死的新生兒 以補救無法吸收氧氣的緊急情況 這種氣體已經提供給 超過1000所緊急救護醫院 合格驗證地 每年救回數以千計的嬰兒 免於某些猝死症狀 (掌聲)
So it's really incredible for me to be a part of this. And I want to say that I think we're on the path of understanding metabolic flexibility in a fundamental way, and that in the not too distant future, an EMT might give an injection of hydrogen sulfide, or some related compound, to a person suffering severe injuries, and that person might de-animate a bit, they might become a little more immortal. Their metabolism will fall as though you were dimming a switch on a lamp at home. And then, they will have the time, that will buy them the time, to be transported to the hospital to get the care they need. And then, after they get that care -- like the mouse, like the skier, like the 65-year-old woman -- they'll wake up. A miracle? We hope not, or maybe we just hope to make miracles a little more common.
這真的是太棒了 讓我與有榮焉 而我要強調的是 我們正在一個過程 是為了明瞭代謝彈性的 最基本機制 且就在不遠的將來 想像一個急救小組注入硫化氫 或其他化合物 到一嚴重創傷的病患 使他輕微地暫停生命 他反而是不會死 他的代謝會降低 就像我們在家控制燈光明暗似的 能為他爭取到些時間 能轉往醫院 得到較完善的急救 當完成施救後 就像是那實驗老鼠,或是那滑雪者 或是那 65歲的老婦人 都會再度醒來 只是奇蹟? 希望不是,我們只希望 把奇蹟能控制得更頻繁些
Thank you very much. (Applause)
謝謝大家 (掌聲)