that hangs at the Countway Library at Harvard Medical School.

這是一幅

And it shows the first time an organ was ever transplanted.

掛在哈佛醫學院 Countway 圖書館的畫。

In the front, you see, actually, Joe Murray

它描繪著史上第一次的器官移植。

getting the patient ready for the transplant,

在前排，你可以看到 Joe Murray

while in the back room you see Hartwell Harrison,

正在調整病人狀況，使其適合器官移植。

the Chief of Urology at Harvard,

在房間的後面，你可以看到 Hartwell Harrison，

actually harvesting the kidney.

哈佛泌尿科主任，

The kidney was indeed the first organ

正在採集腎臟。

ever to be transplanted to the human.

腎臟是第一個

That was back in 1954,

成功移植到人類身上的器官。

55 years ago.

那發生在 1954 年，

Yet we're still dealing with a lot of the same challenges

55 年前，

as many decades ago.

他們仍然面對著許多跟數十年前

Certainly many advances, many lives saved.

相同的挑戰。

But we have a major shortage of organs.

當然進步了許多，救了很多生命。

In the last decade the number of patients

但是可供移植的器官數量極為短缺。

waiting for a transplant has doubled.

過去十年間

While, at the same time, the actual number of transplants

等待器官移植的病人數量倍增。

has remained almost entirely flat.

在此同時，器官移植的術例

That really has to do with our aging population.

幾乎完全沒有增加。

We're just getting older.

這是因為我們的平均壽命延長了，

Medicine is doing a better job

我們變老了。

of keeping us alive.

醫學使我們的壽命

But as we age, our organs tend to fail more.

延長了。

So, that's a challenge,

但是在我們變老的同時，器官也更容易衰竭。

not just for organs but also for tissues.

因此，這是一個挑戰，

Trying to replace pancreas,

不只是器官，人體組織也一樣。

trying to replace nerves that can help us with Parkinson's.

嘗試移植胰臟，

These are major issues.

嘗試移植可以幫助帕金森氏症病人的神經組織。

This is actually a very stunning statistic.

這些是重大的問題。

Every 30 seconds

這邊有個非常令人震驚的統計數據，

a patient dies from diseases

每卅秒，

that could be treated with tissue regeneration or replacement.

就有一個病人因為疾病死亡，

So, what can we do about it?

但其實這個疾並可以藉由組織再生或更換來醫治。

We've talked about stem cells tonight.

那麼，我們又能夠做些什麼？

That's a way to do it.

我們今晚已經聽過了關於幹細胞的演講，

But still ways to go to get stem cells into patients,

那是方法之一。

in terms of actual therapies for organs.

但是從將幹細胞注入病人體內，

Wouldn't it be great if our bodies could regenerate?

直到真的對器官層次發生療效，這路途還很遙遠。

Wouldn't it be great if we could actually harness the power

如果我們的身體能夠自行再生，那該多好？

of our bodies, to actually heal ourselves?

如果我們能夠掌握身體自我治癒的能力，

It's not really that foreign of a concept, actually;

那該多好？

it happens on the Earth every day.

這其實不是個什麼新奇的概念，事實上，

This is actually a picture of a salamander.

在地球上，這類的事的每天都在發生著。

Salamanders have this amazing capacity to regenerate.

這是一張蠑螈的照片，

You see here a little video.

蠑螈擁有不可思議的再生能力。

This is actually a limb injury in this salamander.

這邊有一小段影片，

And this is actually real photography,

這是那蠑螈的腳受傷

timed photography, showing how that limb regenerates

的真實照片，

in a period of days.

定時攝像，顯示那隻腳如何在

You see the scar form.

數天內再生回來。

And that scar actually grows out

你看到痂的產生，

a new limb.

然而這個痂事實上向外

So, salamanders can do it.

長成了一隻新的腳。

Why can't we? Why can't humans regenerate?

因此，蠑螈能夠做到，

Actually, we can regenerate.

我們為什麼不能？人類為什麼無法自行再生？

Your body has many organs

事實上，我們可以的。

and every single organ in your body

你的身體擁有許多器官，

has a cell population

而你體內的每一個器官

that's ready to take over at the time of injury. It happens every day.

都有一個細胞的群體，

As you age, as you get older.

準備好當受傷時能夠立即反應，這樣的戲碼每天都在上演。

Your bones regenerate every 10 years.

當你變老，

Your skin regenerates every two weeks.

每十年，你的骨骼就會全部再生一次。

So, your body is constantly regenerating.

你的皮膚每兩星期再生一次。

The challenge occurs when there is an injury.

因此，你的身體其實是不斷地在更新的。

At the time of injury or disease,

困難之處在於，當受傷時，

the body's first reaction

在受傷或生病的時候，

is to seal itself off from the rest of the body.

你身體的第一個反應

It basically wants to fight off infection,

是將它與身體其他部份隔絕。

and seal itself, whether it's organs inside your body,

基本上，它想與感染作戰，

or your skin, the first reaction

並將戰場侷限住，不管那是在你身體的器官裡面，

is for scar tissue to move in,

或是你的皮膚，第一個反應都是

to seal itself off from the outside.

讓結痂組織移入，

So, how can we harness that power?

將之與外界隔離。

One of the ways that we do that

那麼，我們要怎樣才能重拾那樣的能力呢？

is actually by using smart biomaterials.

其中一個辦法是，

How does this work? Well, on the left side here

使用智慧型生物材料。

you see a urethra which was injured.

這其中原理是什麼呢？在畫面左邊

This is the channel that connects the bladder to the outside of the body.

你可以看到一個損傷的尿道。

And you see that it is injured.

這是將膀胱的尿液排出體外的渠道，

We basically found out that you can use these smart biomaterials

你可以看到它受傷了。

that you can actually use as a bridge.

我們基本上發現使用這些智慧型生物材料，

If you build that bridge, and you close off

你可以使用其作為橋樑跨接，

from the outside environment,

如果你建造那座橋，然後你將其與

then you can create that bridge, and cells

外在環境隔絕，

that regenerate in your body,

那麼，你建造的這座橋，可以讓

can then cross that bridge, and take that path.

那些能夠另你身體再生的細胞

That's exactly what you see here.

通過，並使用這座橋來聯絡。

It's actually a smart biomaterial

這就是你在這邊看到的。

that we used, to actually treat this patient.

這就是我們使用的

This was an injured urethra on the left side.

智慧型生物材料，醫治這個病人的情形。

We used that biomaterial in the middle.

左邊是受損的尿道，

And then, six months later on the right-hand side

我們在中間使用了生物材料，

you see this reengineered urethra.

然後，右邊是六個月後的復原情形，

Turns out your body can regenerate,

你看到尿道被重建了。

but only for small distances.

這證實了你的身體可以再生，

The maximum efficient distance for regeneration

但是僅限於非常短的距離，

is only about one centimeter.

能夠再生的最大範圍

So, we can use these smart biomaterials

只有大約一公分。

but only for about one centimeter

所以就算我們使用這些智慧型生物材料，

to bridge those gaps.

也只能跨接並治癒

So, we do regenerate, but for limited distances.

大約一公分的距離。

What do we do now,

因此，我們再生，但是距離有限。

if you have injury for larger organs?

接下來該怎麼做？

What do we do when we have injuries

如果你體內的大型器官受損了？

for structures which are much larger

如果我們體內比一公分大得多

than one centimeter?

的構造受到了損傷，

Then we can start to use cells.

我們該怎麼辦？

The strategy here, is if a patient comes in to us

這時候，我們可以開始使用細胞。

with a diseased or injured organ,

這裡的策略是，如果病人來向我們求助，

you can take a very small piece of tissue from that organ,

而他們的器官受到了感染或是損傷，

less than half the size of a postage stamp,

你可以從那器官上取下一塊非常小的組織，

you can then tease that tissue apart,

只要大約一半郵票的大小，

and look at its basic components,

現在你可以將這組織分離，

the patient's own cells,

分析其基本組成，

you take those cells out,

這是病人自身的細胞，

grow and expand those cells outside the body in large quantities,

你可以將這些細胞取出，

and then we then use scaffold materials.

在體外大量培養並增殖這些細胞，

To the naked eye they look like a piece of your blouse,

然後我們使用支持材料，

or your shirt, but actually

肉眼看起來這材料像是你罩衫

these materials are fairly complex

或襯衫的布料，但事實上

and they are designed to degrade once inside the body.

這些材料非常地複雜，

It disintegrates a few months later.

而且它們被設計成可在體內被分解。

It's acting only as a cell delivery vehicle.

它會於數個月之後被分解。

It's bringing the cells into the body. It's allowing

它只是一個運送細胞的載體。

the cells to regenerate new tissue,

它把細胞帶入體內，

and once the tissue is regenerated the scaffold goes away.

讓細胞再生成新組織，

And that's what we did for this piece of muscle.

一但組織再生完成，那些支架也就不見了。

This is actually showing a piece of muscle and how we go through

這就是我們在這塊肌肉上所做的事。

the structures to actually engineer the muscle.

這裡顯示了一塊肌肉以及我們從

We take the cells, we expand them,

如何建立結構到真正的能夠做出這些肌肉。

we place the cells on the scaffold,

我們取出細胞，將細胞增殖，

and we then place the scaffold back into the patient.

並把細胞放到支架上，

But actually, before placing the scaffold into the patient,

然後我們把支架放回病人體內。

we actually exercise it.

但事實上，在我們將支架放回病人體內之前，

We want to make sure that we condition

我們必須讓它運動。

this muscle, so that it knows what to do

我們希望確定我們給這些肌肉

once we put it into the patient.

足夠的訓練，因此等到我們將之放回病人體內後，

That's what you're seeing here. You're seeing

它將知道該怎麼做。

this muscle bio-reactor

這就是你在這裡看到的。你正在觀看一個

actually exercising the muscle back and forth.

肌肉生物反應槽，

Okay. These are flat structures that we see here,

在這反應槽內，我們不停的往復運動肌肉。

the muscle.

直到現在，我們看到的都還只是平面的構造，

What about other structures?

例如肌肉。

This is actually an engineered blood vessel.

那麼其他的構造呢？

Very similar to what we just did, but a little bit more complex.

這是一條人造血管，

Here we take a scaffold,

製作過程跟我們剛剛所提及的非常相似，但是更複雜。

and we basically -- scaffold can be like a piece of paper here.

在這邊我們用一個支架，

And we can then tubularize this scaffold.

這支架可以是這邊所顯示的一張紙。

And what we do is we, to make a blood vessel, same strategy.

然後我們將這個支架捲曲成管狀。

A blood vessel is made up of two different cell types.

然後我們就能以同樣的策略做出血管了。

We take muscle cells, we paste,

血管是由兩種不同種類的細胞所組成。

or coat the outside with these muscle cells,

我們拿取肌肉細胞，

very much like baking a layer cake, if you will.

將之貼在管壁的外緣，

You place the muscle cells on the outside.

就好像烘培千層糕一般，如果你這樣比喻。

You place the vascular blood vessel lining cells on the inside.

將肌肉細胞貼在管壁外緣，

You now have your fully seeded scaffold.

將血管相關條狀細胞貼在管壁內側。

You're going to place this in an oven-like device.

現在你的支架就已經植入好細胞了。

It has the same conditions as a human body,

然後我們將這個東西放入一個類似烤箱的裝置，

37 degrees centigrade,

這裝置的內部狀態調整到與人體相同，

95 percent oxygen.

攝氏 37 度，

You then exercise it, as what you saw on that tape.

95% 的含氧量。

And on the right you actually see a carotid artery that was engineered.

然後我們給它運動，就像這影片中顯示的一樣。

This is actually the artery that goes from your neck to your brain.

在畫面右側，你看到的是人造的頸動脈，

And this is an X-ray showing you

就是從你的頸部通往腦部的動脈。

the patent, functional blood vessel.

這 X 光影像可以讓你看到

More complex structures

明顯的，功能正常的血管。

such as blood vessels, urethras, which I showed you,

更多複雜的構造，

they're definitely more complex

像是血管、尿道，這些我已經讓你們看過的例子，

because you're introducing two different cell types.

它們很複雜，

But they are really acting mostly as conduits.

因為你必須引入兩種不同種類的細胞。

You're allowing fluid or air to go through

但是它們最主要的功能只是個渠道。

at steady states.

只要能夠讓液體或是空氣

They are not nearly as complex as hollow organs.

以穩定的狀態通過。

Hollow organs have a much higher degree of complexity,

它們的複雜度跟空腔臟器比起來是小巫見大巫。

because you're asking these organs to act on demand.

空腔臟器的複雜度要大得多，

So, the bladder is one such organ.

因為你需要這些器官對於人體需求能正確的反應。

Same strategy, we take a very small piece of the bladder,

例如，膀胱就是一個這樣的例子。

less than half the size of a postage stamp.

同樣的策略，我們取下一塊非常小的膀胱，

We then tease the tissue apart

比郵票的一半還小。

into its two individual cell components,

我們將這個組織拆解開來，

muscle, and these bladder specialized cells.

分成兩種不同的細胞組成，

We grow the cells outside the body in large quantities.

那就是肌肉和這些膀胱特化細胞。

It takes about four weeks to grow these cells from the organ.

我們在體外大量的培養這些細胞。

We then take a scaffold that we shape like a bladder.

從器官取出這些細胞後，大約需要四星期的培養時間。

We coat the inside with these bladder lining cells.

然後我們拿一個我們做成膀胱造型的支架。

We coat the outside with these muscle cells.

我們將這些膀胱特化細胞放置在內部，

We place it back into this oven-like device.

外部則披上肌肉細胞。

From the time you take that piece of tissue, six to eight weeks later

然後我們將其放回這個像烤箱的裝置。

you can put the organ right back into the patient.

從你取出那塊組織的時候算起，六到八星期後，

This actually shows the scaffold.

你就可以將這個器官放回病人體內。

The material is actually being coated with the cells.

這是那支架的樣子。

When we did the first clinical trial for these patients

這材料上面其實覆滿了細胞。

we actually created the scaffold specifically for each patient.

當我們首次對這些病人做臨床試驗的時候，

We brought patients in,

事實上我們針對每個病人量身訂做了這些支架。

six to eight weeks prior to their scheduled surgery, did X-rays,

這些病患於

and we then composed a scaffold specifically for that patient's size

他們手術預定時間的六到八星期前來照 X 光，

pelvic cavity.

然後我們就做了一個跟那個病人骨盆腔

For the second phase of the trials

一樣大小的支架。

we just had different sizes, small, medium, large and extra-large.

臨床試驗的第二期，

(Laughter)

我們就只分成幾種尺寸，小、中、大和特大。

It's true.

（笑聲）

And I'm sure everyone here wanted an extra-large. Right?

這是真的。

(Laughter)

而且我相信這裡的每個人都想要特大號，對吧？

So, bladders are definitely a little bit more complex

（笑聲）

than the other structures.

因為這樣，膀胱比起其他的構造

But there are other hollow organs that have added complexity to it.

又更複雜。

This is actually a heart valve, which we engineered.

但是還有其他的空腔臟器比膀胱更複雜。

And the way you engineer this heart valve is the same strategy.

這是一個我們做出來的心臟辦膜。

We take the scaffold, we seed it with cells,

一樣的製作策略，

and you can now see here, the valve leaflets opening and closing.

用支架，種細胞，

We exercise these prior to implantation.

在這邊你們可以看到，辦膜的葉片不斷的開合著。

Same strategy.

在植入人體前，我們給它運動。

And then the most complex are the solid organs.

一樣的策略。

For solid organs, they're more complex

然而，最複雜的是實心器官。

because you're using a lot more cells per centimeter.

對於實心器官，他們的複雜度在於

This is actually a simple solid organ like the ear.

每一公分你需要使用的細胞量大大的增加。

It's now being seeded with cartilage.

這是一個簡單的實心器官，耳朵。

That's the oven-like device;

它現在被植上軟骨。

once it's coated it gets placed there.

這是像烤箱的裝置，

And then a few weeks later we can take out the cartilage scaffold.

一旦它被覆上細胞，我們就把它放置在這邊。

This is actually digits that we're engineering.

然後數星期後，我們就可以把軟骨支架取出。

These are being layered, one layer at a time,

這是我們做的指頭。

first the bone, we fill in the gaps with cartilage.

它們是一層層製作出來的，每次一層，

We then start adding the muscle on top.

先是骨頭，然後用軟骨填充空隙。

And you start layering these solid structures.

最後再加上肌肉。

Again, fairly more complex organs,

就這樣，你開始將實心器官分成一層層的看待。

but by far, the most complex solid organs

的確，相對來說非常複雜的器官。

are actually the vascularized, highly vascularized,

但是到目前為止，最複雜的實心器官

a lot of blood vessel supply,

是那些高度血管化，

organs such as the heart,

需要很多血管供給的器官，

the liver, the kidneys.

像是心臟、

This is actually an example -- several strategies

肝臟和腎臟。

to engineer solid organs.

這邊有一個實例，製作實心臟器

This is actually one of the strategies. We use a printer.

的數個策略。

And instead of using ink, we use -- you just saw an inkjet cartridge --

這是數個策略之一，我們使用印表機。

we just use cells.

但是我們不使用墨水，我們使用，這是墨水夾，

This is actually your typical desktop printer.

我們使用細胞來列印。