And like most of my colleagues,

我是一位神經㚈科醫生。

I have to deal, every day, with human tragedies.

就像我的大部分同事一樣，

I realize how your life can change from one second to the other

我每天要面對很多人間悲剧。

after a major stroke or after a car accident.

使我明白到人可能因為一次 嚴重中風或車禍，

And what is very frustrating for us neurosurgeons

而瞬間改變一生的命運。

is to realize that unlike other organs of the body,

最令我們這些神經學家苦惱的，

the brain has very little ability for self-repair.

就是知道腦部不似其他器官，

And after a major injury of your central nervous system,

很難自我修復。

the patients often remain with a severe handicap.

病人的中央神經系統 受到嚴重受創後，

And that's probably the reason why I've chosen

最後常常變成嚴重殘障。

to be a functional neurosurgeon.

可能因為這樣，

What is a functional neurosurgeon?

我決定成為功能性神經㚈科醫生。

It's a doctor who is trying to improve a neurological function

功能性神經㚈科醫生 做什麼工作呢？

through different surgical strategies.

這些醫生採用不同的㚈科方法，

You've certainly heard of one of the famous ones

致力改善神經功能。

called deep brain stimulation,

各位一定聽過其中一個著名的方法

where you implant an electrode in the depths of the brain

叫做腦部深層刺激手術。

in order to modulate a circuit of neurons

就是植入一種電極在腦部深層，

to improve a neurological function.

改變神經元的迴路，

It's really an amazing technology

繼而改善神經系統的功能。

in that it has improved the destiny of patients

這種科技實在神奇，

with Parkinson's disease,

因為它已經改變一些病人的命運，

with severe tremor, with severe pain.

例如柏金遜症、

However, neuromodulation does not mean neuro-repair.

嚴重腦震盪和痛症。

And the dream of functional neurosurgeons

但是神經調節並不是修復神經。

is to repair the brain.

功能性㚈科醫生的夢想

I think

就是修復腦部。

that we are approaching this dream.

我想

And I would like to show you

我們正朝著這個夢想前進。

that we are very close to this.

而且我想告訴大家

And that with a little bit of help,

我們很快實現夢想。

the brain is able to help itself.

只需要一點的幫忙，

So the story started 15 years ago.

腦部就能自我修復。

At that time, I was a chief resident

這件事源自15年前，

working days and nights in the emergency room.

那時我是駐院總醫師，

I often had to take care of patients with head trauma.

在急診室日夜不停工作。

You have to imagine that when a patient comes in with a severe head trauma,

常常要照顧腦創傷病人。

his brain is swelling

可以想像當一個病人頭部 受到重創入院，

and he's increasing his intracranial pressure.

他的腦部不斷腫脹，

And in order to save his life,

顱內壓增加，

you have to decrease this intracranial pressure.

為了拯救他的生命，

And to do that,

一定要降低顱內壓。

you sometimes have to remove a piece of swollen brain.

因此

So instead of throwing away these pieces of swollen brain,

有時需要替病人移除一塊 腫脹的腦組織。

we decided with Jean-François Brunet,

我們沒有把那塊腦組織丟棄，

who is a colleague of mine, a biologist,

反而決定跟我的一位同事，

to study them.

那是生物學家Jean-Francois Brunet

What do I mean by that?

一同硏究。

We wanted to grow cells from these pieces of tissue.

我那樣說是什麼意思呢？

It's not an easy task.

那時我們想從這些腦組織 培育細胞。

Growing cells from a piece of tissue

但這是並非容易的事。

is a bit the same as growing very small children

從一塊腦組織培育細胞

out from their family.

就像把一個幼童跟家人分開，

So you need to find the right nutrients,

由我們養育一樣。

the warmth, the humidity

所以一定要找到適合的營養食物、

and all the nice environments to make them thrive.

溫暖和濕度的環境，

So that's exactly what we had to do with these cells.

和所有良好的外圍 使他們茁壯成長。

And after many attempts,

這正是我們培養 這些細胞的想法。

Jean-François did it.

經過多次嘗試，

And that's what he saw under his microscope.

Jean-Francois 終於成功。

And that was, for us, a major surprise.

這是他在顯微鏡下看到的東西。

Why?

我們知道結果後，感到很驚訝。

Because this looks exactly the same as a stem cell culture,

為什麼？

with large green cells surrounding small, immature cells.

因為這個情況就跟培養 幹細胞一樣，

And you may remember from biology class

有大的綠色細胞包圍著 未長成的小細胞。

that stem cells are immature cells,

或許你會記得上生物課，

able to turn into any type of cell of the body.

學過幹細胞是未成熟的細胞，

The adult brain has stem cells, but they're very rare

可以變成身體任何一種細胞。

and they're located in deep and small niches

成人的腦部也有幹細胞， 但十分稀少。

in the depths of the brain.

這些細胞存在於腦部低層

So it was surprising to get this kind of stem cell culture

深處小小的位置。

from the superficial part of swollen brain we had

所以能夠從手術室病人 腫脹的腦部表面，

in the operating theater.

得到這些幹細胞培養組織，

And there was another intriguing observation:

實在令人感到意外。

Regular stem cells are very active cells --

還有另一個有趣的觀測結果：

cells that divide, divide, divide very quickly.

正常的幹細胞非常活躍－

And they never die, they're immortal cells.

它們不停分裂，非常迅速。

But these cells behave differently.

永遠不會死亡，是一種不死細胞。

They divide slowly,

但是這些細胞行為不一樣。

and after a few weeks of culture,

它們緩慢地分裂，

they even died.

經過數星期的培養，

So we were in front of a strange new cell population

它們甚至死亡。

that looked like stem cells but behaved differently.

所以我們面對了一群 奇怪的新細胞，

And it took us a long time to understand where they came from.

它們貌似幹細胞，但行為有分別。

They come from these cells.

我們花了很長時間， 才知道它們從那

These blue and red cells are called doublecortin-positive cells.

就是來自這些細胞，

All of you have them in your brain.

這些藍色、紅色細胞叫做 微管相關蛋白正向細胞。

They represent four percent of your cortical brain cells.

在座各位的腦部都有這些細胞。

They have a very important role during the development stage.

它們佔了腦部皮質細胞的4％。

When you were fetuses,

對人類的成長期很重要。

they helped your brain to fold itself.

在胚胎期，

But why do they stay in your head?

它們幫助腦部摺疊起來。

This, we don't know.

但為什麼它們仍然留在 大家的腦部呢？

We think that they may participate in brain repair

這個我們不知道。

because we find them in higher concentration

或許它們要參與腦部的修復，

close to brain lesions.

因為我們發現它們 在腦損傷的附近

But it's not so sure.

比較高度聚集。

But there is one clear thing --

但我們仍然不能確定。

that from these cells,

但是有一件事實很清楚-

we got our stem cell culture.

我們從這些細胞，

And we were in front of a potential new source of cells

可以培養幹細胞。

to repair the brain.

這些具有潛力的新細胞 就在我們面前，

And we had to prove this.

它們能夠修復腦部。

So to prove it,

我們一定要證實這個論點。

we decided to design an experimental paradigm.

為了證實它，

The idea was to biopsy a piece of brain

我們決定設計一個實驗範例。

in a non-eloquent area of the brain,

方法是在腦部不重要的區域

and then to culture the cells

做活體組織切片，

exactly the way Jean-François did it in his lab.

然後培殖這些細胞，

And then label them, to put color in them

就跟Jean-Francois在實驗室 試驗的方法一樣。

in order to be able to track them in the brain.

然後把它標籤再染上顏色，

And the last step was to re-implant them

方便追踨它在腦部的位置。

in the same individual.

最後把它再次植入在

We call these

同一個病人。

autologous grafts -- autografts.

我們稱這些是

So the first question we had,

自體移植物。

"What will happen if we re-implant these cells in a normal brain,

我們首先有一個疑問，

and what will happen if we re-implant the same cells

「如果我們再次植入這些細胞 在正常腦部，會有什麼事；

in a lesioned brain?"

又或者再次植入有創傷的腦部，

Thanks to the help of professor Eric Rouiller,

又會發生什麼事情呢？

we worked with monkeys.

很多謝Eric Rouiller 教授的幫忙，

So in the first-case scenario,

我們一同利用猴子做研究，

we re-implanted the cells in the normal brain

第一個的方案，

and what we saw is that they completely disappeared after a few weeks,

我們再次植入細胞 在正常的腦部，

as if they were taken from the brain,

數星期後，我們發現 這些細胞完全消失，

they go back home,

就如它們從腦部帶走，

the space is already busy,

後來回到從前腦部的家，

they are not needed there, so they disappear.

由於地方實在太擠擁，

In the second-case scenario,

所以沒需要再逗留， 唯有自行消失。

we performed the lesion,

第二個方案，

we re-implanted exactly the same cells,

我們替

and in this case, the cells remained --

跟著再次植入完全一樣的細胞，

and they became mature neurons.

這一次細胞繼續留下來-

And that's the image of what we could observe under the microscope.

而且變成成熟的神經元。

Those are the cells that were re-implanted.

這是我們在顯微鏡下 觀察到的影像。

And the proof they carry,

這是再次植入的細胞。

these little spots, those are the cells that we've labeled

它們帶了實證，

in vitro, when they were in culture.

這些小點就是我們培養細胞時，

But we could not stop here, of course.

在試管

Do these cells also help a monkey to recover after a lesion?

當然我們不會就此停下來。

So for that, we trained monkeys to perform a manual dexterity task.

這些細胞是否可以幫助 有腦創傷的猴子恢復呢？

They had to retrieve food pellets from a tray.

因此我們訓練猴子做一些 手指靈巧的動作。

They were very good at it.

牠們要從托盤拿起食物粒。

And when they had reached a plateau of performance,

猴子做得勝任有餘。

we did a lesion in the motor cortex corresponding to the hand motion.

當訓練牠們到了穩定期時，

So the monkeys were plegic,

我們替牠們手部動作相應的腦部 皮質做了一個傷口。

they could not move their hand anymore.

於是猴子癱瘓了，

And exactly the same as humans would do,

雙手不能移動，

they spontaneously recovered to a certain extent,

就跟人類的情況一樣，

exactly the same as after a stroke.

猴子中風後，

Patients are completely plegic,

身體自行恢復到某個程度。

and then they try to recover due to a brain plasticity mechanism,

病人完全癱瘓，

they recover to a certain extent,

病人希望康復，由於腦部的 可塑性機制，

exactly the same for the monkey.

病人能夠恢復到某一程度，

So when we were sure that the monkey had reached his plateau

就跟猴子的情況完全一樣。

of spontaneous recovery,

當我們確定猴子已經完成

we implanted his own cells.

身體自行恢復的階段，

So on the left side, you see the monkey that has spontaneously recovered.

我們便植入牠自己的細胞。

He's at about 40 to 50 percent of his previous performance

在左方，你可以見到猴子 已經自行恢復。

before the lesion.

牠跟未有腦損傷時的表現，

He's not so accurate, not so quick.

大概做到4至5成。

And look now when we re-implant the cells:

牠的動作並不那麼準確和敏捷。

Two months after re-implantation, the same individual.

再看看，我們再次植入這些細胞：

(Applause)

兩個月後，同一隻猴子。

It was also very exciting results for us, I tell you.

（鼓掌聲）

Since that time, we've understood much more about these cells.

那是令人非常興奮的結果。

We know that we can cryopreserve them,

從此我們更加了解這些細胞。

we can use them later on.

也知道可以把細胞超低溫冷凍，

We know that we can apply them in other neuropathological models,

留待日後再用。

like Parkinson's disease, for example.

我們可以應用在其他 神經病理模式。

But our dream is still to implant them in humans.

例如柏金遜症。

And I really hope that I'll be able to show you soon

但是我們的夢想仍是 把細胞植入人腦。

that the human brain is giving us the tools to repair itself.

我真的希望很快顯示各位面前，

Thank you.

我們可以利用人腦成為 人體自我修復的功具。

(Applause)

謝謝。

Bruno Giussani: Jocelyne, this is amazing,

（鼓掌聲）

and I'm sure that right now, there are several dozen people in the audience,

Bruno Glussani： Jocelyne， 真是令人驚嘆呢，

possibly even a majority,

我肯定在座有很多觀眾，

who are thinking, "I know somebody who can use this."

甚至可能大部分人

I do, in any case.

都在想：「我知道某人可以 接受這個治療。」

And of course the question is,

無論如何我也認同。

what are the biggest obstacles

但問題是

before you can go into human clinical trials?

什麼是你進行人體臨床試驗時，

Jocelyne Bloch: The biggest obstacles are regulations. (Laughs)

最大的阻力呢？

So, from these exciting results, you need to fill out

Jocelyne Bloch: 最大的阻力 就是規條。（笑聲）

about two kilograms of papers and forms

雖然有這些令人興奮的結果，

to be able to go through these kind of trials.

但要填寫大約2公斤的表格，

BG: Which is understandable, the brain is delicate, etc.

才能獲准去做這些試驗。

JB: Yes, it is, but it takes a long time

BG：這是可以理解，因為腦部是那麼纖細脆弱等等。

and a lot of patience and almost a professional team to do it, you know?

JB: 對的，但是需要很長的時間，

BG: If you project yourself --

需要耐力和一个專業的團隊。

having done the research

BG: 如果你自己預測

and having tried to get permission to start the trials,

完成研究

if you project yourself out in time,

和獲准開始試驗後，

how many years before somebody gets into a hospital

假如妳可以預計需要多少時間，

and this therapy is available?

病人要入院接受這種治療，

JB: So, it's very difficult to say.

需要等多少年呢？

It depends, first, on the approval of the trial.

JB : 這樣很難說。

Will the regulation allow us to do it soon?

首先要看做實驗可否獲批。

And then, you have to perform this kind of study

那些規條會否讓我們 盡快做試驗呢？

in a small group of patients.

然後要替一小撮病人

So it takes, already, a long time to select the patients,

進行硏究。

do the treatment

那又要花長時間挑選病人

and evaluate if it's useful to do this kind of treatment.

接受治療，

And then you have to deploy this to a multicentric trial.

然後評估這類治療是否有效。

You have to really prove first that it's useful

繼而要展開多核心試驗。

before offering this treatment up for everybody.

一定先要證實那是對病人有作用，

BG: And safe, of course. JB: Of course.

才能給大眾接受治療。

BG: Jocelyne, thank you for coming to TED and sharing this.

BG：當然要安全可靠。 JB：一定。

BG: Thank you.

BG：Jocelyne，謝謝妳來到Ted 跟我們分享這些見解。

(Applause)

BG：謝謝。