In the space that used to house one transistor, we can now fit one billion. That made it so that a computer the size of an entire room now fits in your pocket. You might say the future is small.
U prostor koji je nekad bio potreban da se smesti jedan tranzistor, sad možemo smestiti jednu milijardu. Tako kompjuter veličine čitave jedne sobe sad stane u vaš džep. Može se reći da je budućnost mala.
As an engineer, I'm inspired by this miniaturization revolution in computers. As a physician, I wonder whether we could use it to reduce the number of lives lost due to one of the fastest-growing diseases on Earth: cancer. Now when I say that, what most people hear me say is that we're working on curing cancer. And we are. But it turns out that there's an incredible opportunity to save lives through the early detection and prevention of cancer.
Kao inženjer, nadahnuta sam ovom revolucijom minijaturizacije kompjutera. Kao lekar, pitam se da li je možemo upotrebiti da smanjimo broj izgubljenih života zbog jedne od najraširenijih bolesti na svetu: raka. Kad to kažem, ono što mnogi pomisle jeste da radimo na izlečenju raka. I radimo. Međutim, ispostavlja se da postoji neverovatna mogućnost da se spasu životi ranim otkrivanjem i prevencijom raka.
Worldwide, over two-thirds of deaths due to cancer are fully preventable using methods that we already have in hand today. Things like vaccination, timely screening and of course, stopping smoking. But even with the best tools and technologies that we have today, some tumors can't be detected until 10 years after they've started growing, when they are 50 million cancer cells strong. What if we had better technologies to detect some of these more deadly cancers sooner, when they could be removed, when they were just getting started?
Širom sveta, preko dve trećine smrti od raka su potpuno preventabilne uz pomoć metoda koje već danas imamo na raspolaganju. To su stvari poput vakcinacije, pravovremenih pregleda i, naravno, prestanka pušenja. Ipak, čak i uz pomoć najboljih alata i tehnologija koje danas imamo, neke tumore je nemoguće otkriti sve do 10 godina nakon što su počeli da rastu, kada su jačine 50 miliona kancerogenih ćelija. Šta ako bismo imali bolja sredstva za ranije otkrivanje nekih od ovih smrtonosnih kancera, dok ih je moguće ukloniti, kad tek počnu da rastu?
Let me tell you about how miniaturization might get us there. This is a microscope in a typical lab that a pathologist would use for looking at a tissue specimen, like a biopsy or a pap smear. This $7,000 microscope would be used by somebody with years of specialized training to spot cancer cells. This is an image from a colleague of mine at Rice University, Rebecca Richards-Kortum. What she and her team have done is miniaturize that whole microscope into this $10 part, and it fits on the end of an optical fiber. Now what that means is instead of taking a sample from a patient and sending it to the microscope, you can bring the microscope to the patient. And then, instead of requiring a specialist to look at the images, you can train the computer to score normal versus cancerous cells.
Reći ću vam kako nas minijaturizacija može dovesti do toga. Ovo je mikroskop u tipičnoj laboratoriji koji bi patolog koristio za posmatranje uzorka nekog tkiva kao što su biopsija ili papa test. Ovaj mikroskop vredan 7 000 dolara koristio bi neko s dugogodišnjom specijalističkom obukom da opaža ćelije raka. Ovo je slika od jedne moje koleginice sa Univerziteta Rajs, Rebeke Ričards Kortum. Ona i njen tim su smanjili čitav taj mikroskop na ovaj deo vredan deset dolara, koji staje na kraj jednog optičkog vlakna. To znači da umesto uzimanja uzorka od pacijenta i njegovog slanja pod mikroskop, moguće je doneti mikroskop do pacijenta. A onda, umesto zahteva da specijalista pogleda slike, moguće je obučiti kompjuter da obeleži normalne ćelije naspram kancerogenih.
Now this is important, because what they found working in rural communities, is that even when they have a mobile screening van that can go out into the community and perform exams and collect samples and send them to the central hospital for analysis, that days later, women get a call with an abnormal test result and they're asked to come in. Fully half of them don't turn up because they can't afford the trip. With the integrated microscope and computer analysis, Rebecca and her colleagues have been able to create a van that has both a diagnostic setup and a treatment setup. And what that means is that they can do a diagnosis and perform therapy on the spot, so no one is lost to follow up.
Ovo je važno, jer ono što su otkrili radeći u ruralnim zajednicama, jeste da, čak i kad postoji pokretni kombi za preglede kojim se može otići na teren i izvršiti pregled i sakupiti uzorci koji se šalju na analizu u centralnu bolnicu, nekoliko dana kasnije, žene dobiju poziv zbog abnormalnih rezultata testa i zamole ih da dođu. Polovina njih se ne pojavi jer ne mogu da priušte put. Uz pomoć integrisanog mikroskopa i kompjuterske analize, Rebeka i njene kolege su uspeli da naprave kombi koji ima opremu i za dijagnostiku i za lečenje. To znači da mogu da postave dijagnozu i daju terapiju na licu mesta, tako da nikog ne izgube u pratećem postupku.
That's just one example of how miniaturization can save lives. Now as engineers, we think of this as straight-up miniaturization. You took a big thing and you made it little. But what I told you before about computers was that they transformed our lives when they became small enough for us to take them everywhere. So what is the transformational equivalent like that in medicine? Well, what if you had a detector that was so small that it could circulate in your body, find the tumor all by itself and send a signal to the outside world? It sounds a little bit like science fiction. But actually, nanotechnology allows us to do just that. Nanotechnology allows us to shrink the parts that make up the detector from the width of a human hair, which is 100 microns, to a thousand times smaller, which is 100 nanometers. And that has profound implications.
To je samo jedan primer kako minijaturizacija može spasiti živote. Kao inženjeri, o ovom razmišljamo kao o direktnoj minijaturizaciji. Uzmemo jednu veliku stvar i načinimo je malom. Ono što sam vam ranije rekla za kompjutere jeste da su nam oni transformisali živote onda kad su postali dovoljno mali da bismo ih mogli svuda poneti. Koji je transformacioni ekvivalent tome u medicini? Šta ako bismo imali detektor koji bi bio toliko mali da može da kruži u našem telu, sam pronađe tumor i pošalje signal u spoljašnji svet? Pomalo zvuči kao naučna fantastika, ali u stvari, nanotehnologija nam upravo to omogućava. Nanotehnologija nam dopušta da smanjimo delove koji sačinjavaju detektor sa širine ljudske dlake, što iznosi sto mikrona, na hiljadu puta manju veličinu, što iznosi sto nanometara, a to ima dalekosežne implikacije.
It turns out that materials actually change their properties at the nanoscale. You take a common material like gold, and you grind it into dust, into gold nanoparticles, and it changes from looking gold to looking red. If you take a more exotic material like cadmium selenide -- forms a big, black crystal -- if you make nanocrystals out of this material and you put it in a liquid, and you shine light on it, they glow. And they glow blue, green, yellow, orange, red, depending only on their size. It's wild! Can you imagine an object like that in the macro world? It would be like all the denim jeans in your closet are all made of cotton, but they are different colors depending only on their size.
Ispostavlja se da materijali zapravo menjaju svoja svojstva na nanoskali. Ako uzmemo običan materijal poput zlata i sameljemo ga u prah, u zlatne nanočestice, promeniće izgled od zlatnog u crveni. Ako uzmemo egzotičniji materijal poput kadmijum selenida u formi velikog crnog kristala, ako napravimo nanokristale od ovog materijala, stavimo to u tečnost i osvetlimo, on sija. Sija plavo, zeleno, žuto, narandžasto, crveno, isključivo u zavisnosti od veličine. Potpuno ludo! Možete li zamisliti takav predmet u makro svetu? Kao kad bi sve farmerice u vašem ormanu bile napravljene od pamuka ali bi bile različite boje, isključivo u zavisnosti od njihove veličine.
(Laughter)
(Smeh)
So as a physician, what's just as interesting to me is that it's not just the color of materials that changes at the nanoscale; the way they travel in your body also changes. And this is the kind of observation that we're going to use to make a better cancer detector.
Kao lekaru, ono što mi je jednako zanimljivo jeste to da nije samo boja materijala koja se menja na nanoskali, već se menja i način na koji putuju po telu. Ovu vrstu opažanja ćemo upotrebiti da napravimo bolji detektor za rak.
So let me show you what I mean. This is a blood vessel in the body. Surrounding the blood vessel is a tumor. We're going to inject nanoparticles into the blood vessel and watch how they travel from the bloodstream into the tumor. Now it turns out that the blood vessels of many tumors are leaky, and so nanoparticles can leak out from the bloodstream into the tumor. Whether they leak out depends on their size. So in this image, the smaller, hundred-nanometer, blue nanoparticles are leaking out, and the larger, 500-nanometer, red nanoparticles are stuck in the bloodstream. So that means as an engineer, depending on how big or small I make a material, I can change where it goes in your body.
Pokazaću vam šta hoću da kažem. Ovo je krvni sud u telu. Tumor okružuje krvni sud. Ubrizgaćemo nanočestice u taj krvni sud i posmatrati kako putuju iz krvotoka u tumor. Ispostavlja se da su krvni sudovi mnogih tumora propustljivi i tako nanočestice mogu iscuriti iz krvotoka u tumor. Da li će iscuriti zavisi od njihove veličine. Na ovoj slici, manje, plave čestice od sto nanometara cure, dok veće, crvene nanočestice od 500 nanometara ostaju zaglavljene u krvotoku. To znači da kao inženjer, u zavisnosti od toga koliko velikim ili malim napravim materijal, mogu da odredim kuda će on otići u vašem telu.
In my lab, we recently made a cancer nanodetector that is so small that it could travel into the body and look for tumors. We designed it to listen for tumor invasion: the orchestra of chemical signals that tumors need to make to spread. For a tumor to break out of the tissue that it's born in, it has to make chemicals called enzymes to chew through the scaffolding of tissues. We designed these nanoparticles to be activated by these enzymes. One enzyme can activate a thousand of these chemical reactions in an hour. Now in engineering, we call that one-to-a-thousand ratio a form of amplification, and it makes something ultrasensitive. So we've made an ultrasensitive cancer detector.
U mojoj laboratoriji, nedavno smo napravili nanodetektor raka koji je toliko mali da može da putuje po telu i traži tumore. Koncipirali smo ga tako da traži invaziju tumora: skup hemijskih signala koje tumori moraju da odaju da bi se širili. Da bi se tumor proširio van tkiva na kom je rođen, mora da proizvede hemikalije po imenu enzimi da bi progrizao svoj put kroz tkiva. Napravili smo ove nanočestice tako da ih ovi enzimi aktiviraju. Jedan enzim može aktivirati hiljadu ovakvih hemijskih reakcija na sat. U inženjeringu, to nazivamo odnosom jedan prema hiljadu, to je vrsta uvećanja koja čini nešto izuzetno osetljivim. Tako smo napravili izuzetno osetljivi detektor raka.
OK, but how do I get this activated signal to the outside world, where I can act on it? For this, we're going to use one more piece of nanoscale biology, and that has to do with the kidney. The kidney is a filter. Its job is to filter out the blood and put waste into the urine. It turns out that what the kidney filters is also dependent on size. So in this image, what you can see is that everything smaller than five nanometers is going from the blood, through the kidney, into the urine, and everything else that's bigger is retained. OK, so if I make a 100-nanometer cancer detector, I inject it in the bloodstream, it can leak into the tumor where it's activated by tumor enzymes to release a small signal that is small enough to be filtered out of the kidney and put into the urine, I have a signal in the outside world that I can detect.
U redu, ali kako ovaj aktivirani signal dovodimo do spoljašnjeg sveta gde možemo preduzeti nešto? Za ovo, upotrebićemo još jedan deo biologije na nanoskali koji ima veze s bubrezima. Bubreg je filter. Posao mu je da filtrira krv i otpatke pošalje u urin. Ispostavlja se da ono što bubrezi isfiltriraju takođe zavisi od veličine. Na ovoj slici, možete videti da sve ono što je manje od pet nanometara ide iz krvi, kroz bubreg, u urin, a sve drugo što je veće, ostaje. Dakle, ako napravim detektor za rak od sto nanometara i ubrizgam ga u krvotok, on može da prodre u tumor gde ga aktiviraju enzimi tumora da bi otpustio mali signal koji je dovoljno mali da bi ga bubreg isfiltrirao i poslao u urin. Imam signal u spoljnom svetu koji mogu detektovati.
OK, but there's one more problem. This is a tiny little signal, so how do I detect it? Well, the signal is just a molecule. They're molecules that we designed as engineers. They're completely synthetic, and we can design them so they are compatible with our tool of choice. If we want to use a really sensitive, fancy instrument called a mass spectrometer, then we make a molecule with a unique mass. Or maybe we want make something that's more inexpensive and portable. Then we make molecules that we can trap on paper, like a pregnancy test. In fact, there's a whole world of paper tests that are becoming available in a field called paper diagnostics.
U redu, ali postoji još jedan problem. Ovo je maleni signal, pa kako ću ga onda otkriti? Signal je samo jedan molekul. To su molekuli koje smo napravili kao inženjeri. Oni su u potpunosti sintetički i možemo ih koncipirati tako da budu kompatibilni sa alatom po našem izboru. Ako želimo da koristimo stvarno osetljiv, luksuzni instrument koji se zove maseni spektometar, onda ćemo napraviti molekul jedinstvene mase. Ili želimo da napravimo nešto manje skupo, a prenosivo. Onda ćemo napraviti molekule koje možemo zadržati na papiru, poput testa za trudnoću. U stvari, postoji čitav svet papirnih testova koji postaju dostupni u oblasti koja se zove papirna dijagnostika.
Alright, where are we going with this? What I'm going to tell you next, as a lifelong researcher, represents a dream of mine. I can't say that's it's a promise; it's a dream. But I think we all have to have dreams to keep us pushing forward, even -- and maybe especially -- cancer researchers.
U redu, kud nas ovo vodi? Ono što ću vam sledeće reći, kao dugogodišnji istraživač, predstavlja moj san. Ne mogu reći da je to obećanje; to je san. No, mislim da svi moramo imati snove koji će nas terati napred, čak i - ili možda, naročito - istraživači raka.
I'm going to tell you what I hope will happen with my technology, that my team and I will put our hearts and souls into making a reality. OK, here goes. I dream that one day, instead of going into an expensive screening facility to get a colonoscopy, or a mammogram, or a pap smear, that you could get a shot, wait an hour, and do a urine test on a paper strip. I imagine that this could even happen without the need for steady electricity, or a medical professional in the room. Maybe they could be far away and connected only by the image on a smartphone.
Reći ću vam šta se nadam da će se desiti s mojom tehnologijom čemu ćemo se moj tim i ja i srcem i dušom posvetiti da bi postalo stvarnost. Dakle, evo ga. Sanjam da će jednog dana, umesto odlaska u skupu ustanovu za skrining da bi se uradila kolonoskopija, mamogram ili papa test, da ćemo moći dobiti injekciju, sačekati sat vremena i uraditi test urina pomoću papirne trake. Mislim da se ovo može uraditi čak i bez potrebe za stabilnom strujom ili medicinskim osobljem u prostoriji. Možda bi oni mogli biti daleko i povezani samo slikom na pametnom telefonu.
Now I know this sounds like a dream, but in the lab we already have this working in mice, where it works better than existing methods for the detection of lung, colon and ovarian cancer. And I hope that what this means is that one day we can detect tumors in patients sooner than 10 years after they've started growing, in all walks of life, all around the globe, and that this would lead to earlier treatments, and that we could save more lives than we can today, with early detection.
Znam da ovo zvuči kao san, ali u laboratoriji ovo već funkcioniše na miševima, funkcioniše bolje od postojećih metoda za otkrivanje raka pluća, debelog creva i jajnika. Nadam se da ovo znači da ćemo jednog dana moći otkrivati tumore kod pacijenata pre nego što prođe deset godina od početka njihovog rasta, u svim slojevima društva, širom sveta, a da će ovo dovesti do ranijeg lečenja, i da ćemo moći spasiti više života nego što možemo danas, ranim otkrivanjem.
Thank you.
Hvala vam.
(Applause)
(Aplauz)