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.
過去可容納一個電晶體的空間, 我們現在可以放進 10 億個。 這使得過去一個房間大小的電腦 現在可以放進你的口袋裡了。 你可能會說,未來的東西會是小的。
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.
身為一位工程師, 我被這個電腦的 微型化革命所啟發。 而身為一位醫師, 我在想,我們是否可以利用它來降低 癌症 ─ 地球上成長最快速的疾病之一 的死亡人數。 現在,當我這樣說時, 大部份聽到的人會說, 我們是研究癌症治療的。 的確是! 但事實上, 有一個不可思議的機會 可以拯救生命, 就是藉由癌症的早期發現與預防。
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?
全球因癌症死亡的病例 超過 2/3 是可預防的 , 經由使用我們現今已有的方法, 像是接種疫苗、定期篩檢, 當然,戒菸也是。 但即使現在我們已經有 最好的工具與科技, 某些腫瘤要開始成長十年後 才能被偵測出來, 那時的癌細胞已多達 5 千萬個了。 要是我們有更好的科技, 可以更早偵測到更多這些致命的癌症, 也就是在它們可以被移除 或剛長出時,那該有多好?
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.
讓我向各位說明 微型化科技將如何讓我們做到。 這是一般實驗室裡的一台顯微鏡, 病理學家用它來觀察組織的樣本, 例如活體切片或子宮頸抹片檢查。 這台 $7000 美金的顯微鏡 , 會被某些受多年專業訓練的人 用來找出癌細胞。 這一張圖是來自我的 一位萊斯大學的同事 麗貝卡·理查茲卡頓, 她和她的團隊所做的 就是把顯微鏡縮小成為一個 價值十元的零件, 並且可以裝在光纖的末端上。 意思是,不需要從病人身上取出檢體, 送到顯微鏡下觀察, 而是你可以把顯微鏡放到病人體內。 並且,不需要專家來檢視影像, 你可以訓練電腦區分 正常細胞與癌症細胞。
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.
這很重要, 因為他們發現在郊區工作, 即使有一台行動篩檢箱型車, 可以開到社區裡進行檢查, 及收集檢體 並把它們送回醫院做分析, 過幾天後, 受測女士們接到 檢查結果不正常的電話, 並被要求到醫院來, 但她們至少有一半不會來, 因為付不起旅費。 藉由整合顯微鏡與電腦分析, 麗貝卡和她的同事 已經可以做出一台 同時具有診斷與治療設施的廂型車。 意思就是,他們可以直接在現場 做診斷與治療, 這樣就沒人會錯過追蹤了。
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.
這僅是一個微型化科技 如何拯救人命的案例之一。 身為工程師, 我們認為這就是微型化, 你把一個大的東西變小了。 但我稍早跟各位提到 有關於電腦 改變了我們的生活, 當它們變得 小到可以讓我們帶到任何地方時。 在醫學上, 有什麼東西是相對等的改變呢? 如果你有一個偵測器, 它小到可以在你的體內循環, 並靠它自己找到腫瘤, 而且還能把訊號傳到體外呢? 這聽起來有點像科幻小說, 但實際上,奈米科技 已經可以讓我們做到了。 奈米科技已經讓我們能夠 把製造偵測器的零件 從原本是頭髮寬度即100微米 縮更小到其 1/1000, 也就是100奈米。 這樣就有很大的影響了,
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.
也就是說,材質實際上 以奈米規格改變其特性。 就拿黃金這個普遍的材質來說, 當你把黃金磨到奈米粒子的大小, 它會從金色變成紅色。 如果你再拿一個更奇特的材質, 像是硒化鎘 ── 一個大而黑的晶體, 若把它製成奈米大小, 然後放進一種液體裡, 並以光線照射它 它們會發光。 它們會發出藍色、綠色、 黃色、橘色、紅色的光, 僅依據它們的大小不同。 這太神奇了!你可想像 這樣一個在宏觀世界裡的物體嗎? 就好比你衣櫃裡那些 全都是棉製的牛仔褲, 會依它們的尺寸大小 而有不同的顏色。
(Laughter)
(笑聲)
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.
所以,身為一位醫師, 讓我感興趣的 不只是材質 會依奈米規格的大小而改變顏色; 它們在你身體裡面的 運行方式也會改變。 而我們將運用這種觀察方式 來製作更好的癌症偵測器。
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.
讓我向各位解釋一下, 這是身體裡面的一條血管, 圍繞著血管的是一個腫瘤。 我們把奈米粒子注射到血管裡面, 然後觀察它們如何從 血流中進到腫瘤裡面。 結果我們看到 許多腫瘤的血管有漏洞, 所以奈米粒子會從血流漏向腫瘤, 它們是否會漏出去 取決於它們的大小。 在這影像 較小、100奈米的 藍色奈米粒子正在漏出去, 較大、500奈米的紅色奈米粒子 則留在血流當中。 所以身為一位工程師, 依據我所製作的物質大小, 可改變它在你身體裡的去處。
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.
在我的實驗室,我們最近 作出一種癌症奈米偵測器, 它小到可以進入身體並找尋腫瘤, 我們設計它用來監聽腫瘤的侵犯: 腫瘤需要製造這些 化學訊號的樂音來擴散。 腫瘤為了要從它長出來的 組織突破出去, 它必須製造一種 稱為「酵素」的化學物質, 來穿破組織架構而出。 我們設計這些奈米粒子 可被腫瘤酵素活化, 一個酵素一小時內 可活化一千個這種化學反應。 用工程術語來說,我們稱這種 1:1000 比率為一種放大率, 它會變得超靈敏。 所以我們製造出一種 超靈敏的癌症偵測器,
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.
但我要如何把這個活化訊號傳到體外, 我要從那裡著手呢? 為此,我們要再利用另一個 奈米規格生物學, 而這與腎臟有關。 腎臟是一種過濾器, 它的功能就是將廢物 從血液濾出並排入尿液, 其實腎臟所過濾的物質 也是根據大小而定。 所以在這影片,各位可以看到 任何小於 5 奈米的物質, 會從血液通過腎臟而排入尿液, 其他比較大的物質會被留下來。 好,如果我做了一個 100 奈米的癌症偵測器, 然後把它注射到血流裡面, 它會漏入腫瘤裡面, 被腫瘤酵素活化, 並釋放一種微小訊號, 小到可以被腎臟過濾出來, 然後排到尿液裡面, 這樣在體外 就有我可以偵測到的訊號了。
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.
好,但還有一個問題。 這是一個很微小的訊號, 我要如何偵測呢? 訊號其實只是一種分子, 是我們工程師設計出來的分子。 它們完全是合成的, 我們可以設計它們, 讓它與我們選擇的工具完全相容。 如果我們要用一種 相當靈敏的昂貴設備 ── 叫做質譜儀, 那麼我們會製造 一種特定質量的分子。 或許我們想讓它 不那麼昂貴且方便攜帶, 那麼我們會製造 能被試紙抓住的分子, 就像驗孕一樣。 事實上,現在有很多的試紙測試方法, 已廣泛應用在「試紙診斷」領域了。
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.
好的,我們做這個有什麼用處呢? 接下來我要告訴各位的是 身為一位終身研究員, 我想對各位訴說我的夢想。 我不能說這是個承諾; 但它至少是個夢想。 我認為我們都必須有夢想 來讓我們向前邁進, 甚至,特別是癌症研究人員。
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.
我要告訴各位我期望 我的技術將來會有何進展, 我的團隊和我都會盡心盡力地 讓這期望成真。 好的,我要開始了。 我夢想有一天, 大家不用再使用昂貴的篩檢設備 來做大腸鏡檢查 或乳房攝影檢查 或子宮頸抹片檢查, 而是你可能扎一針, 等一個小時, 然後在試紙上做尿液檢測即可。 我想像這甚至 不需要穩定的電流 或專業醫療人士在檢驗室裡就可能做到。 或許他們可以遠隔千里 僅用智能手機連結影像即可。
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.
我知道這聽起來像是個夢想, 但在實驗室, 我們已經用在老鼠身上了, 對於偵測肺癌、大腸癌及卵巢癌, 這比現行方法更有用。 而這也意味著我期望 有一天,在病人腫瘤開始成長的10年內, 我們就可以偵測到。 在各行各業、世界各地的人都能受惠, 這會促成早期治療, 藉由早期發現, 我們能比今日拯救更多人的性命。
Thank you.
謝謝!
(Applause)
(掌聲)