So I was privileged to train in transplantation under two great surgical pioneers: Thomas Starzl, who performed the world's first successful liver transplant in 1967, and Sir Roy Calne, who performed the first liver transplant in the U.K. in the following year. I returned to Singapore and, in 1990, performed Asia's first successful cadaveric liver transplant procedure, but against all odds. Now when I look back, the transplant was actually the easiest part. Next, raising the money to fund the procedure. But perhaps the most challenging part was to convince the regulators -- a matter which was debated in the parliament -- that a young female surgeon be allowed the opportunity to pioneer for her country. But 20 years on, my patient, Surinder, is Asia's longest surviving cadaveric liver transplant to date. (Applause) And perhaps more important, I am the proud godmother to her 14 year-old son.
能在两位伟大的外科先驱者 手下学习移植手术,是我的荣幸。 一位是托马斯·斯达泽, 世界上第一个成功完成肝脏移植手术的人 在1967年, 另一位是罗伊·卡恩爵士, 在英国第一个完成肝脏移植手术的人 在世界首例肝脏手术完成之后的一年(1978)。 我回到新加坡 然后,在1990年 完成了亚洲首例 尸肝移植手术, 尽管手术困难重重。 现在,当我回过头来看的时候, 手术部分其实是最简单的。 其次是,凑钱来准备手术的费用。 但最有难度的是 是让那些立法者明白一件事实-- 这件事曾在议会辩论过-- 就是一个年轻女外科医生 有没有资格 获得国家外科先驱的称号。 20年过去了, 我的病人,萨伦德, 是到目前为止的亚洲尸肝移植的 最长存活者。 (掌声) 但更重要的是, 我有幸成为她 14岁儿子的教母。
(Applause)
(掌声)
But not all patients on the transplant wait list are so fortunate. The truth is, there are just simply not enough donor organs to go around. As the demand for donor organs continues to rise, in large part due to the aging population, the supply has remained relatively constant. In the United States alone, 100,000 men, women and children are on the waiting list for donor organs, and more than a dozen die each day because of a lack of donor organs. The transplant community has actively campaigned in organ donation. And the gift of life has been extended from brain-dead donors to living, related donors -- relatives who might donate an organ or a part of an organ, like a split liver graft, to a relative or loved one.
但并不是所有在移植手术表单上排队等侯的病人 都是那么幸运。 现实是, 捐献的器官根本不够 用。 对捐献器官需求 持续的增加, 很大程度上是因为人口的老龄化, 然而器官的供应还是相对的保持不变。 仅美国而言, 就有10万人,有男人,女人还有小孩 都在等待捐助的器官的名单之中, 而且每天有十几人死亡 就因为缺少捐献的器官。 移植团体 活跃于器官捐献的活动中。 而且器官(捐赠范围) 已经被扩大化 从脑死亡的捐献者 到还在世的有血缘关系的亲属捐献者 这样的亲属捐献者可能会捐献整个器官 或者部分器官, 例如将肝脏部分移植 给亲属或者是所爱的人。
But as there was still a dire shortage of donor organs, the gift of life was then extended from living, related donors to now living, unrelated donors. And this then has given rise to unprecedented and unexpected moral controversy. How can one distinguish a donation that is voluntary and altruistic from one that is forced or coerced from, for example, a submissive spouse, an in-law, a servant, a slave, an employee? Where and how can we draw the line? In my part of the world, too many people live below the poverty line. And in some areas, the commercial gifting of an organ in exchange for monetary reward has led to a flourishing trade in living, unrelated donors.
但是捐献器官还是非常紧缺, 接着器官(捐赠范围)再一次扩大 从活着的有血缘关系的亲属捐献者 到现在活着的没有血缘关系的非亲属捐献者。 这样就引发了 前所未有的 一场道德纷争。 怎么才能辨别出 捐献者是出于自愿和无私 而不是被迫或强制捐献器官 举个例子,在 顺从的伴侣,媳婿, 仆人,奴隶, 雇员这样的身份下我们如何分辨捐赠的自愿性? 这条界限我们如何以及怎样加以区分? 在我生活周围, 很多人都生活在贫困线之下。 在有些地方, 用活体器官 来换取金钱上的回报 已经是非常盛行的 的一种商业交易。
Shortly after I performed the first liver transplant, I received my next assignment, and that was to go to the prisons to harvest organs from executed prisoners. I was also pregnant at the time. Pregnancies are meant to be happy and fulfilling moments in any woman's life. But my joyful period was marred by solemn and morbid thoughts -- thoughts of walking through the prison's high-security death row, as this was the only route to take me to the makeshift operating room. And at each time, I would feel the chilling stares of condemned prisoners' eyes follow me. And for two years, I struggled with the dilemma of waking up at 4:30 am on a Friday morning, driving to the prison, getting down, gloved and scrubbed, ready to receive the body of an executed prisoner, remove the organs and then transport these organs to the recipient hospital and then graft the gift of life to a recipient the same afternoon. No doubt, I was informed, the consent had been obtained.
在完成首例肝移植后不久, 我接到的下一个任务 就是去监狱里 从执行死刑的犯人身上 获取器官。 在那时我已经怀孕了。 孕期 是个让人高兴和充满喜悦的时期 对每个女人来说都是这样。 但是本该属于我的这段喜悦的时期 却被一种幽暗的病态的境况所损坏。 这种境况就是步行穿过 监狱的最高安保的死囚区, 因为这是到临时的手术室(从死刑犯身上移取器官) 的唯一的一条路。 每当这时, 我就能感到那 跟随我的死刑犯人眼中的令人毛骨悚然的目光。 之后的2年, 我都挣扎在这样的困境中 每周五早上 凌晨四点半醒来, 开车去到监狱, 着手准备,戴上手套,消毒, 准备从 死刑犯人的尸体中 移出器官 然后将这些器官带回 到接受者的医院 之后当天下午 给接受者移植这些器官。 毫无疑问,手术是 是获得了准许(捐赠器官)。
But, in my life, the one fulfilling skill that I had was now invoking feelings of conflict -- conflict ranging from extreme sorrow and doubt at dawn to celebratory joy at engrafting the gift of life at dusk. In my team, the lives of one or two of my colleagues were tainted by this experience. Some of us may have been sublimated, but really none of us remained the same. I was troubled that the retrieval of organs from executed prisoners was at least as morally controversial as the harvesting of stem cells from human embryos. And in my mind, I realized as a surgical pioneer that the purpose of my position of influence was surely to speak up for those who have no influence. It made me wonder if there could be a better way -- a way to circumvent death and yet deliver the gift of life that might exponentially impact millions of patients worldwide.
但是我一生, 我拥有的唯一在行的技术 使我产生了情感上的冲突 这种感情上的冲突 从清晨时的极度悲伤和疑虑一直延续 到黄昏时 庆祝移植器官成功的喜悦。 在我的团队中, 有一两个同事的生活 也被这样的经历所困扰。 我们中的一些人已经可以接受这样的状况, 但是实际上没有人还是原来的自己。 我很担忧 这种从死刑囚犯上得来器官的做法。 这种做法起码在道德上看来是有争议的 就像从人类胚胎中 获取干细胞一样有争议。 而且我认为, 作为一名外科先锋人物 我拥有影响力的地位的目的 就是为了 替那些没有影响力的人说话。 这让我思考 是否有更好的方法-- 即能绕过死亡 而又同时获得器官的方法。 这样可能会以指数级的影响力影响到 全世界成千上万的病人。
Now just about that time, the practice of surgery evolved from big to small, from wide open incisions to keyhole procedures, tiny incisions. And in transplantation, concepts shifted from whole organs to cells. In 1988, at the University of Minnesota, I participated in a small series of whole organ pancreas transplants. I witnessed the technical difficulty. And this inspired in my mind a shift from transplanting whole organs to perhaps transplanting cells. I thought to myself, why not take the individual cells out of the pancreas -- the cells that secrete insulin to cure diabetes -- and transplant these cells? -- technically a much simpler procedure than having to grapple with the complexities of transplanting a whole organ.
也就是在那个时候, 外科手术 逐渐从宏观到微观 从大的开放性的切口 到孔洞式的 微创技术。 而且移植手术的概念已经转变成了 从完整的器官移植到细胞移植。 1988年,在明尼苏达大学, 我参与了一个小规模的 完整胰脏移植手术。 我亲眼目睹了此项技术的难度。 同时这激发了我 关于从移植整个器官 到移植细胞的思考。 我在想, 为什么不能把那些能分泌出胰岛素治愈糖尿病的个体细胞 移出 胰腺 然后移植这些细胞呢? 从技术的角度讲这更为简单 相比起进行整个器官移植 手术的复杂性。
And at that time, stem cell research had gained momentum, following the isolation of the world's first human embryonic stem cells in the 1990s. The observation that stem cells, as master cells, could give rise to a whole variety of different cell types -- heart cells, liver cells, pancreatic islet cells -- captured the attention of the media and the imagination of the public. I too was fascinated by this new and disruptive cell technology, and this inspired a shift in my mindset, from transplanting whole organs to transplanting cells. And I focused my research on stem cells as a possible source for cell transplants.
当时, 干细胞研究 已经有了一定的进展, 世界上首次分离出 人类胚胎干细胞 是在90年代。 干细胞,也叫主细胞, 能发育成 完整的不同种类的细胞- 像心肌细胞,肝细胞, 胰岛细胞-- 这项发现引起了媒体的广泛关注 也激发了公众的想象力。 我也被这种全新的 分离细胞的技术所吸引, 同时这激发了我思维上的转变, 从移植整个器官 到移植细胞。 我把研究集中放在 可能会成为 细胞移植来源的干细胞中。
Today we realize that there are many different types of stem cells. Embryonic stem cells have occupied center stage, chiefly because of their pluripotency -- that is their ease in differentiating into a variety of different cell types. But the moral controversy surrounding embryonic stem cells -- the fact that these cells are derived from five-day old human embryos -- has encouraged research into other types of stem cells.
今天我们认识到 有很多种不同种类的干细胞。 其中,胚胎干细胞 占据了中心地位, 主要是因为它的多能性-- 就是胚胎干细胞能轻松的分化成 不同种类的细胞。 但是之所以胚胎干细胞 在道德上备受非议是 因为这些细胞来源于 5天大的人类胚胎-- 正是因为这种争议才激励人们研究 其他类型的干细胞。
Now to the ridicule of my colleagues, I inspired my lab to focus on what I thought was the most non-controversial source of stem cells, adipose tissue, or fat, yes fat -- nowadays available in abundant supply -- you and I, I think, would be very happy to get rid of anyway. Fat-derived stem cells are adult stem cells. And adult stem cells are found in you and me -- in our blood, in our bone marrow, in our fat, our skin and other organs. And as it turns out, fat is one of the best sources of adult stem cells. But adult stem cells are not embryonic stem cells. And here is the limitation: adult stem cells are mature cells, and, like mature human beings, these cells are more restricted in their thought and more restricted in their behavior and are unable to give rise to the wide variety of specialized cell types, as embryonic stem cells [can].
在同事的嘲讽声中, 我将实验放在 集中研究 最没有争议的干细胞源 那就是脂肪组织,或叫脂肪,对是肥肉 现如今随处可以找到脂肪 我想你和我一样肯定很乐意摆脱它。 脂肪源干细胞 是一种成体干细胞。 成体干细胞在 你和我身上都能找到-- 它存在于血液,骨髓, 脂肪,皮肤和其他器官中。 同时这也证明, 脂肪是成体干细胞的 最优来源之一。 但是成体干细胞 并不是胚胎干细胞。 它有其自身的局限性: 成体干细胞是成熟的细胞, 就像成年人一样, 较难改变它们的思维定势 较难改变它们的行为方式 同时它们也不能像胚胎干细胞一样 分化成很多种 特定的功能细胞。
But in 2007, two remarkable individuals, Shinya Yamanaka of Japan and Jamie Thomson of the United States, made an astounding discovery. They discovered that adult cells, taken from you and me, could be reprogrammed back into embryonic-like cells, which they termed IPS cells, or induced pluripotent stem cells. And so guess what, scientists around the world and in the labs are racing to convert aging adult cells -- aging adult cells from you and me -- they are racing to reprogram these cells back into more useful IPS cells. And in our lab, we are focused on taking fat and reprogramming mounds of fat into fountains of youthful cells -- cells that we may use to then form other, more specialized, cells, which one day may be used as cell transplants. If this research is successful, it may then reduce the need to research and sacrifice human embryos.
但是在2007年, 两位杰出人士, 日本京都大学教授山中伸弥教授 和美国的杰米·汤普逊, 有了一项令人震惊的发现。 他们发现 那些从你我身上获取的成体细胞 可以重组 变回到类似胚胎的干细胞, 他们将这些细胞命名为IPS细胞, 或称为诱导性多潜能干细胞。 你猜怎么着, 全世界科学家在实验室中 争先恐后的 转变 从你我身上的得来的成体细胞, 他们竞相重组这些细胞 使之成为更有用的IPS细胞。 在实验室, 我们专注于提取脂肪 并重新编辑, 将成堆的脂肪 变成幼年细胞 我们可以将这些幼年的细胞 转化为其他细胞, 更为特定的细胞, 而转化后的这些细胞或许也可以用作细胞移植。 如果这项实验成功的话, 它就能减少用于 研究和 牺牲人类胚胎的需求数量。
Indeed, there is a lot of hype, but also hope that the promise of stem cells will one day provide cures for a whole range of conditions. Heart disease, stroke, diabetes, spinal cord injury, muscular dystrophy, retinal eye diseases -- are any of these conditions relevant, personally, to you?
真的,这样说也许有些夸张,但是我们也希望 干细胞 能够在将来治愈 下列一系列的病症, 心脏病,中风,糖尿病, 脊髓损伤,肌肉萎缩, 视网膜病症-- 在以上病症中有与你 有关的吗?
In May 2006, something horrible happened to me. I was about to start a robotic operation, but stepping out of the elevator into the bright and glaring lights of the operating room, I realized that my left visual field was fast collapsing into darkness. Earlier that week, I had taken a rather hard knock during late spring skiing -- yes, I fell. And I started to see floaters and stars, which I casually dismissed as too much high-altitude sun exposure. What happened to me might have been catastrophic, if not for the fact that I was in reach of good surgical access. And I had my vision restored, but not before a prolonged period of convalescence -- three months -- in a head down position. This experience taught me to empathize more with my patients, and especially those with retinal diseases.
2006年5月, 有件恐怖的事情发生在我身上。 我在进行常规手术的准备, 但是当我走出电梯 来到手术室的明亮炫目的手术灯下的时候, 我感觉到 左眼 很快就看不到任何东西了。 那一周的早些时候, 我在春末滑雪时 跌了蛮重的一跤--是的,我摔倒了。 紧接着眼冒金星, 当时我并没有重视这个现象 只认为那是高海拔阳光照射过多的缘故。 这件事 发生以后, 如果我没有 接受良好的手术治疗的话,我想现在对我来说,肯定是场大灾难。 经过了三个月(并不算长的时间) 一直保持头向下的状态的康复期 之后 我的视力恢复了。 这次的经历 让我更加能体谅患者 特别是有视觉疾病的患者。
37 million people worldwide are blind, and 127 million more suffer from impaired vision. Stem cell-derived retinal transplants, now in a research phase, may one day restore vision, or part vision, to millions of patients with retinal diseases worldwide. Indeed, we live in both challenging as well as exciting times. As the world population ages, scientists are racing to discover new ways to enhance the power of the body to heal itself through stem cells.
世界上3700万人 是盲人, 同时1亿2700万的人 饱受视觉受损的困扰。 视网膜干细胞移植, 目前正处于研究的阶段, 也许将来的某天它就能帮世界上成千上万 视觉障碍患者 重现光明,或者恢复部分视力。 确实,我们生活在 一个即富有挑战 又令人刺激的年代。 当全球人口出现老龄化, 科学家们竞相 去寻找新的方法: 通过干细胞治愈自身 来达到提高人体机能的目的。
It is a fact that when our organs or tissues are injured, our bone marrow releases stem cells into our circulation. And these stem cells then float in the bloodstream and hone in to damaged organs to release growth factors to repair the damaged tissue. Stem cells may be used as building blocks to repair damaged scaffolds within our body, or to provide new liver cells to repair damaged liver. As we speak, there are 117 or so clinical trials researching the use of stem cells for liver diseases.
事实上, 当器官或者组织受损时, 我们的骨髓 会通过血液循环向血液中 释放干细胞。 这些干细胞 漂浮在血液中 找到受损的器官然后 释放出生长因子 来修复受损组织。 干细胞就好比是砌墙用的砖块 修复身体中受损的支架, 或是变成新的肝细胞 来修复受损的肝脏。 在我们说话的时候,大约有117例用 干细胞来治疗肝脏疾病 的临床实验在进行。
What lies ahead? Heart disease is the leading cause of death worldwide. 1.1 million Americans suffer heart attacks yearly. 4.8 million suffer cardiac failure. Stem cells may be used to deliver growth factors to repair damaged heart muscle or be differentiated into heart muscle cells to restore heart function. There are 170 clinical trials investigating the role of stem cells in heart disease. While still in a research phase, stem cells may one day herald a quantum leap in the field of cardiology.
那种病症是世界上的头号杀手? 心脏病 是世界上首要死亡原因。 每年有110万美国人 心脏病发作。 480万人 患有心力衰竭。 干细胞可以通过 传递生长因子 来修复受损的心肌 也可以分化成 不同的心肌细胞 来恢复心脏机能。 有170例临床实验 正在研究干细胞在心脏疾病中所起的作用。 这虽然尚在研发阶段, 但是干细胞就给我们预示了 以后会在心脏学领域会有巨大的突破。
Stem cells provide hope for new beginnings -- small, incremental steps, cells rather than organs, repair rather than replacement. Stem cell therapies may one day reduce the need for donor organs. Powerful new technologies always present enigmas. As we speak, the world's first human embryonic stem cell trial for spinal cord injury is currently underway following the USFDA approval. And in the U.K., neural stem cells to treat stroke are being investigated in a phase one trial.
干细胞为新的起点带来了希望, 这个希望是循序渐进的, 是用细胞移植来代替是器官移植, 是用修复器官来代替是取代器官。 干细胞疗法 将来会减少对于捐献器官的需求。 强有力的新科技 总是向人们展现它的神秘。 就在我们说话的时候, 世界上首例用人类胚胎干细胞治疗脊髓受损的实验 在美国食品药物管理局批准下 正在进行当中。 同时在英国, 用神经干细胞来治疗中风 也正处于临床阶段。
The research success that we celebrate today has been made possible by the curiosity and contribution and commitment of individual scientists and medical pioneers. Each one has his story. My story has been about my journey from organs to cells -- a journey through controversy, inspired by hope -- hope that, as we age, you and I may one day celebrate longevity with an improved quality of life.
我们今天所称赞的这些研究成果 之所以成为现实 是要归功于那些具有探索和献身精神的 科学家 和医学界先锋们。 每个人都有属于自己的故事。 而我的故事是我从器官移植 走到细胞移植的一段旅程, 这其中即充满了争议, 同时又有希望的鼓舞。 这个希望就是当我们老去的时候 你和我有一天能在良好的生活水平下 来庆祝人类的长寿。
Thank you.
谢谢。