So I tore my knee joint meniscus cartilage

那麼，讓我直接開始講我的故事。

playing soccer in college.

我大學時代踢足球的時候，

Then I went on to tear my ACL, the ligament in my knee,

撕傷了我膝關節的半月軟骨。

and then developed an arthritic knee.

然後我又撕傷了我膝關節上的前交叉韌帶，

And I'm sure that many of you in this audience have that same story,

因此病情惡化成為膝關節炎。

and, by the way, I married a woman

而且我確定在座的各位當中，有許多人跟我有著同樣的故事。

who has exactly the same story.

順帶一提，我娶到了一個

So this motivated me to become an orthopedic surgeon

跟我有著完全一樣經歷的妻子。

and to see if I couldn't focus on solutions for those problems

因此這激勵了我成為一名骨外科醫生，

that would keep me playing sports and not limit me.

看看我是否能夠專注於找出讓這些使我不能運動的毛病

So with that, let me just show you a quick video

不再限制我的解決方法。

to get you in the mood of what we're trying to explain.

以此為楔子，讓我很快地放一段影片給大家看，

Narrator: We are all aware of the risk of cancer,

讓你們對於我將要解釋的東西，有個大概的了解。

but there's another disease

旁白：我們都清楚地明白癌症的風險，

that's destined to affect even more of us: arthritis.

但是另外有一種疾病，

Cancer may kill you, but when you look at the numbers,

其影響的人甚至比癌症還要多，那就是關節炎。

arthritis ruins more lives.

癌症也許是致命的，但是如果你看看統計數字，

Assuming you live a long life, there's a 50 percent chance

更多的性命毀在關節炎手上。

you'll develop arthritis.

假設你能活到高齡，你患有關節炎的機率

And it's not just aging that causes arthritis.

高達百分之五十。

Common injuries can lead to decades of pain,

導致關節炎的原因並不是因為老化。

until our joints quite literally grind to a halt.

常見的運動傷害能導致數十年的疼痛，

Desperate for a solution, we've turned to engineering

直到我們的關節磨損到不能再使用為止。

to design artificial components

亟需解決方案，我們已朝向設計製造

to replace our worn-out body parts,

人工關節組件

but in the midst of the modern buzz

來替換我們耗盡的身體部件。

around the promises of a bionic body,

但是在圍繞著仿生機械身體美好前景

shouldn't we stop and ask if there's a better, more natural way?

的摩登炒作中，

Let's consider an alternative path.

我們是否該停下來問問，有沒有其他更好、更自然的方法？

What if all the replacements our bodies need

讓我們考慮另一個替代方案。

already exist in nature,

如果我們身體所需求的所有替代品

or within our own stem cells?

都已經存在於自然界，

This is the field of biologic replacements,

或者存在於我們自身的幹細胞中，那將如何？

where we replace worn-out parts with new, natural ones.

這就是生物性替換的領域，

Kevin Stone: And so, the mission is:

以自然的、新的部件來替換我們耗盡的部件。

how do I treat these things biologically?

Kevin Stone: 所以任務是：

And let's talk about both what I did for my wife,

我要如何利用生物性的方法來治療這些疾病？

and what I've done for hundreds of other patients.

讓我們來談談，我為我妻子所做的事，

First thing for my wife,

和我已經為其他數百名病患所做的事。

and the most common thing I hear from my patients,

首先是為我妻子所做的，

particularly in the 40- to 80-year-old age group, 70-year-old age group,

也是我從病人那最常聽到的事，

is they come in and say,

特別是介於 40~80 歲的族群、70 歲的族群，

"Hey, Doc, isn't there just a shock absorber you can put in my knee?

他們通常進來後會說，

I'm not ready for joint replacement."

「醫生，難道沒有可以吸震的東西放到我的膝蓋裡嗎？

And so for her, I put in a human meniscus allograft donor

我還沒有準備好做關節置換手術。」

right into that [knee] joint space.

因此，在我妻子身上，我將人類半月板移植供應體

And [the allograft] replaces [the missing meniscus].

置入她膝關節的空間內。

And then for that unstable ligament,

這個 [移植] 取代了 [缺失的半月板] 。

we put in a human donor ligament

而對於那個不穩定的韌帶，

to stabilize the knee.

我們也放入了一個人類捐贈的韌帶

And then for the damaged arthritis on the surface,

來穩定住膝蓋。

we did a stem cell paste graft,

而那些因為關節炎而受損的表面，

which we designed in 1991,

我們使用了幹細胞黏貼移植法，

to regrow that articular cartilage surface

這方法是我們於 1991 年設計出來的，

and give it back a smooth surface there.

能夠重新長出關節軟骨表面，

So here's my wife's bad knee on the left,

因此重回原本滑順的表面。

and her just hiking now

在這邊，左邊是我妻子的爛膝蓋，

four months later in Aspen, and doing well.

而如今她剛剛能夠登山健行，

And it works, not just for my wife, but certainly for other patients.

手術完成的四個月後，她去阿斯彭參加健行，反應良好。

The girl on the video, Jen Hudak,

手術很成功，不僅對我妻子是這樣，對其他病人一定也是一樣。

just won the Superpipe in Aspen

影片中的女孩，Jen Hudak，

just nine months after having destroyed her knee,

剛在阿斯彭贏得 Superpipe 極限滑雪大賽，

as you see in the other image --

僅僅在毀了她膝蓋的九個月後，

and having a paste graft to that knee.

如同你在其他照片所看到的一般 —

And so we can regrow these surfaces biologically.

她的膝蓋進行了黏貼移植。

So with all this success,

因此我們可以生物性的重新長出這些表面。

why isn't that good enough, you might ask.

即使有了這些成功，

Well the reason is because there's not enough donor cycles.

你可能會問，這樣還不夠好嗎？

There's not enough young, healthy people

因為沒有足夠的捐贈者，

falling off their motorcycle

沒有足夠的年輕、健康的人們

and donating that tissue to us.

從摩托車上摔下來，

And the tissue's very expensive.

然後捐贈那些組織給我們。

And so that's not going to be a solution

也因此，這些組織非常的昂貴。

that's going to get us global with biologic tissue.

因此，這不會是個能夠

But the solution is animal tissue

提供我們全球性生物組織來源的解決方案。

because it's plentiful, it's cheap,

但是，解決方案就是動物組織，

you can get it from young, healthy tissues,

因為它們不虞匱乏，並且便宜。

but the barrier is immunology.

你可以很容易取得年輕、健康的組織，

And the specific barrier

但是障礙就是免疫反應。

is a specific epitope

這個專一性的障礙是

called the galactosyl, or gal epitope.

有一種特別的蛋白免疫表位

So if we're going to transplant animal tissues to people,

稱作半乳糖基或是 gal 表位。

we have to figure out a way to get rid of that epitope.

因此，如果我們要移植動物性組織到人類身上，

So my story in working with animal tissues

我們就必須找出一種方法，移除這個免疫表位。

starts in 1984.

因此，我與動物組織一起工作的故事

And I started first

始於 1984。

with cow Achilles tendon,

我首先從

where we would take the cow Achilles tendon,

牛的跟（阿基里斯）腱開始，

which is type-I collagen,

我們使用牛的跟腱，

strip it of its antigens

它是甲型膠原蛋白，

by degrading it with an acid and detergent wash

以酸性溶劑與清潔劑清洗

and forming it into a regeneration template.

來移除它的抗原，

We would then take that regeneration template

再將它塑型成可供再生的模板。

and insert it into the missing meniscus cartilage

然後我們利用這個再生模板，

to regrow that in a patient's knee.

將之置入缺失的半月軟骨處，

We've now done that procedure,

在病人的膝蓋內重新生長出來。

and it's been done worldwide in over 4,000 cases,

這樣我們就完成了這項手術，

so it's an FDA-approved and worldwide-accepted way

這手術在全球已經有超過四千起成功的術例，

to regrow the meniscus.

因此它已經是 FDA 核准並被世界所接受

And that's great when I can degrade the tissue.

重新生長半月軟骨的方法。

But what happens for your ligament when I need an intact ligament?

這方法在我能夠降解組織的時候，一切都很好。

I can't grind it up in a blender.

但是當我需要一個完整的韌帶組織時，你的韌帶又將會如何？

So in that case,

我不能再用攪拌器將組織打碎。

I have to design -- and we designed with Uri Galili and Tom Turek --

因此，

an enzyme wash

我們與 Uri Galili 和 Tom Turek 一同設計了 —

to wash away, or strip,

一種酵素洗劑

those galactosyl epitopes

來洗掉，或脫除

with a specific enzyme.

這些半乳糖基免疫表位，

And we call that a "gal stripping" technique.

藉由一種特殊的酵素。

What we do is humanize the tissue.

我們稱之為「gal 脫除法」。

It's by gal stripping that tissue

我們所做的是將這組織「人類」化。

we humanize it (Laughter),

藉由脫除組織上的 gal 基

and then we can put it back

我們就使其「人類」化了，

into a patient's knee.

然後我們將之放回

And we've done that. Now we've taken pig ligament --

到病人的膝蓋內。

young, healthy, big tissue,

因為手術的成功，現在我們能用豬的韌帶 —

put it into 10 patients in an FDA-approved trial --

年輕、健康、大組織，

and then one of our patients went on to have

在一個 FDA 核准的實驗性療法中，將之置入十個病人身上 —

three Canadian Masters Downhill championships --

然後我們其中一位病人獲得了

on his "pig-lig," as he calls it. So we know it can work.

三項加拿大大師級下坡滑雪競賽大獎 —

And there's a wide clinical trial of this tissue now pending.

用他的「豬腳」，他自己取的。所以我們知道這方法可行。

So what about the next step?

關於這組織療法的擴大臨床試驗計畫正在審查階段。

What about getting to a total biologic knee replacement,

那麼，下一步是什麼？

not just the parts?

一個完全生物性的膝關節置換聽起來如何？

How are we going to revolutionize artificial joint replacement?

不只是零部件而已。

Well here's how we're going to do it.

我們要如何推動人工關節置換革命？

So what we're going to do is take

那麼，我就告訴你我們準備如何下手。

an articular cartilage

我們所將要做的是，使用

from a young, healthy pig,

從年輕、健康的豬隻身上

strip it of its antigens,

所取得的關節軟骨，

load it with your stem cells,

脫去它的抗原，

then put it back on to that

裝載上你的幹細胞，

arthritic surface in your knee,

然後把它放回

tack it on there, have you heal that surface

你膝蓋的軟骨表面上，

and then create a new biologic surface for your knee.

釘在那邊，直到你那邊的軟骨表面癒合為止，

So that's our biologic approach right now.

然後也就產生了你膝蓋新的生物性表面。

We're going to rebuild your knee with the parts.

這就是現在我們的生物性策略。

We're going to resurface it with a completely new surface.

我們將要用零部件來重新建造你的膝蓋。

But we have other advantages from the animal kingdom.

我們將重鋪全新的軟骨關節表面。

There's a benefit of 400 million years

但是，動物界提供了我們其他的優勢。

of ambulation.

行走 40 億年

We can harness those benefits.

所提供的利基。

We can use thicker, younger, better tissues

我們可以利用這些優惠。

than you might have injured in your knee,

我們可以使用比你膝蓋受傷前，

or that you might have when you're 40, 50 or 60.

更厚，更年輕，更好的組織，

We can do it as an outpatient procedure.

或者比起你 40, 50 或 60 歲時好的組織。

We can strip that tissue very economically,

我們可以以門診手術來進行。

and so this is how we can get biologic knee replacement

我們可以非常經濟地脫去組織上的抗原。

to go global.

這就是我們如何可以讓生物性膝關節置換

And so welcome to super biologics.

拓展到全球的方法。

It's not hardware.

歡迎來到超級生物工程學。

It's not software.

不是硬體。

It's bioware.

不是軟體。

It's version 2.0 of you.

是生物體。

And so with that, coming to a --

是第二代的你。

(Laughter)

最後～

coming to an operating theater near you soon, I believe.

（笑聲）

Thank you very much.

我相信，很快地就會在你們附近的戲院上映。

(Applause)

非常謝謝你們。