There's a medical revolution happening all around us,

こんにちは

and it's one that's going to help us conquer

我々の周りでは医学革命が起きています

some of society's most dreaded conditions,

社会が最も恐れる

including cancer.

ガンを含む様々な状況を

The revolution is called angiogenesis,

克服するのに役立つものです

and it's based on the process

その革命は血管新生と呼ばれ

that our bodies use to grow blood vessels.

体内で血管が増える―

So why should we care about blood vessels?

プロセスが基盤となっています

Well, the human body is literally packed with them:

血管に重点を置くのは

60,000 miles worth in a typical adult.

人間の体は血管だらけだからです

End to end, that would form a line

その長さは平均的な成人で約10万km

that would circle the earth twice.

一直線につなげると

The smallest blood vessels are called capillaries;

地球を２周する長さです

we've got 19 billion of them in our bodies.

一番細い血管は毛細血管で

And these are the vessels of life, and,

体内には190億もの毛細血管があります

as I'll show you,

毛細血管は生きる上で欠かせないもので

they can also be the vessels of death.

これからご覧いただきますが

Now the remarkable thing about blood vessels

死の脈管にもなります

is that they have this ability

血管の驚くべき点は

to adapt to whatever environment they're growing in.

血管が生成されるいかなる環境にも

For example, in the liver they form channels

順応することです

to detoxify the blood;

肝臓では血液を

in the lung they line air sacs for gas exchange;

解毒するための管を作りだし

in muscle they corkscrew so that muscles can contract

肺では肺胞を張りめぐらし ガス交換をします

without cutting off circulation;

筋肉では 血液の循環を妨げずに

and in nerves they course along like power lines,

筋肉が収縮できるように らせん状になっています

keeping those nerves alive.

神経内は電線のように

We get most of these blood vessels

巡っています

when we're actually still in the womb,

血管のほとんどは

And what that means is that as adults,

胎児の時につくられます

blood vessels don't normally grow.

と言うのも 大人になると

Except in a few special circumstances:

稀なケースを除いて

In women, blood vessels grow every month

血管は通常つくられることはありません

to build the lining of the uterus;

女性の子宮では 毎月

during pregnancy, they form the placenta,

血管が子宮内膜をつくります

which connects mom and baby.

妊娠すると それが胎盤となり

And after injury, blood vessels

母親と胎児をつなぎます

actually have to grow under the scab

怪我をすると 血管は

in order to heal a wound.

傷を治すために

And this is actually what it looks like,

かさぶたの下でつくられています

hundreds of blood vessels

こんな感じです

all growing toward the center of the wound.

何百もの血管が

So the body has the ability to regulate

傷の中心のほうに生成されています

the amount of blood vessels that are present at any given time.

どんな時でも体は

It does this through an elaborate

存在する血管の数を制限することができます

and elegant system of checks and balances,

血管新生の刺激物質や

stimulators and inhibitors of angiogenesis,

阻害物質を分泌して

such that, when we need a brief burst of blood vessels,

均衡と抑制を行います

the body can do this by releasing stimulators,

体が血管の増加を必要とするとき

proteins called angiogenic factors

刺激物質を放ち 血管を増やします

that act as natural fertilizer

血管新生因子という たんぱく質が

and stimulate new blood vessels to sprout.

天然肥料のような役割を果たし

And when those excess vessels are no longer needed,

新しい血管が形成されるように促進します

the body prunes them back to baseline

余分な血管が必要ではなくなると

using naturally occurring inhibitors of angiogenesis.

体は自然に血管新生の阻害物質を出して

Now there are other situations where we start beneath the baseline

基準線まで切り戻します

and we need to grow more blood vessels just to get back to normal levels --

基準線以下から標準値に戻すため

for example, after an injury --

血管を増やす必要がある場合もあります

and a body can do that too,

例えば怪我をした後です

but only to that normal level,

体は血管を自己調整できますが

that set point.

標準値である―

But what we now know is that for a number of diseases,

設定点までです

there are defects in the system

しかし現在わかっているのは 数々の病気には

where the body can't prune back extra blood vessels

このシステムに不具合があり

or can't grow enough new ones

体は余分な血管を戻したり

in the right place at the right time.

新しい血管を増やす事を

And in these situations, angiogenesis

必要な場所と時間に行えません

is out of balance.

このような状況下では 血管新生は

And when angiogenesis is out of balance,

不安定な状態です

a myriad of diseases result.

血管新生が不安定だと

For example, insufficient angiogenesis --

数々の病気が現れます

not enough blood vessels --

血管新生が不十分なとき

leads to wounds that don't heal, heart attacks,

つまり血管が足りないと

legs without circulation, death from stroke,

慢性創傷や心臓発作

nerve damage.

脚の血行不良や脳卒中

And on the other end, excessive angiogenesis --

神経損傷に陥ります

too many blood vessels -- drives disease,

反対に血管新生が過剰な場合

and we see this in cancer, blindness,

要は血管が多すぎても 病気になります

arthritis, obesity,

例えば ガンや失明

Alzheimer's disease.

関節炎　肥満

In total, there are more than 70 major diseases

アルツハイマー病が挙げられます

affecting more than a billion people worldwide,

全て合わせると 70以上の主要な病気で

that all look on the surface to be different from one another,

世界中で10億人以上の人たちを苦しめています

but all actually share

外見だと別の病気に見えますが

abnormal angiogenesis

全ての病気に

as their common denominator.

共通して見られるのは

And this realization is allowing us

血管新生の異常です

to reconceptualize

この認識は

the way that we actually approach these diseases

血管新生を調整することで

by controlling angiogenesis.

このような病気を

Now I'm going to focus on cancer

治療できることを示唆しています

because angiogenesis is a hallmark of cancer,

ここで ガンに焦点を置きます

every type of cancer.

どんなガンでも 血管新生の特徴が

So here we go.

見られるからです

This is a tumor: dark, gray, ominous mass

では始めましょう

growing inside a brain.

濃いグレーの不気味な固まりは

And under the microscope, you can see

脳腫瘍です

hundreds of these brown staining blood vessels,

顕微鏡で見ると

capillaries that are feeding cancer cells,

何百もの毛細血管が

bringing oxygen and nutrients.

酸素と栄養分を

But cancers don't start out like this.

ガン細胞に運んでいるのがわかります

And, in fact, cancers don't start out

しかし ガンはこのように発生しません

with a blood supply.

ガンは血液の供給によって

They start out as small, microscopic nests of cells

発生するのではありません

that can only grow to

非常に小さな細胞巣から発生し

one half a cubic millimeter in size;

大きさにして

that's the tip of a ballpoint pen.

0.5立方ミリメートルにしかなりません

Then they can't get any larger because they don't have a blood supply,

ボールペンのペン先ほどです

so they don't have enough oxygen or nutrients.

血液の供給がなければ

In fact, we're probably forming these

酸素や栄養分が届かないため 大きくなりません

microscopic cancers all the time in our body.

実のところ 我々の体内では

Autopsy studies from people who died in car accidents

このようなガンが常に作られています

have shown that about 40 percent of women

解剖研究では 車の事故で亡くなった―

between the ages of 40 and 50

40～50歳の女性の約４割に

actually have microscopic

微小の乳ガンが

cancers in their breasts,

あったことが

about 50 percent of men in their 50s and 60s

示されています

have microscopic prostate cancers,

50～60代の男性の約半数には

and virtually 100 percent of us,

微小の前立腺ガンがあり

by the time we reach our 70s,

事実上 我々誰もが

will have microscopic cancers growing in our thyroid.

70代になるまでには

Yet, without a blood supply,

甲状腺に微小のガンができるのです

most of these cancers

しかし 血液の供給がなければ

will never become dangerous.

このようなガンの大半が

Dr. Judah Folkman, who was my mentor

悪性になることはありません

and who was the pioneer of the angiogenesis field,

血管新生の権威である―

once called this "cancer without disease."

我が師 フォークマン博士は この状態を

So the body's ability to balance angiogenesis,

“病気ではないガン” と呼んでいました

when it's working properly,

血管新生の釣り合いを保つ―

prevents blood vessels from feeding cancers.

体の力は 正常であれば

And this turns out to be

ガンを成長させる血管を防ぐのです

one of our most important defense mechanisms

これはガンに対する

against cancer.

一番重要な

In fact, if you actually block angiogenesis

防衛機制です

and prevent blood vessels from ever reaching cancer cells,

血管新生を遮断して

tumors simply can't grow up.

ガン細胞に血管が届かないようにすれば

But once angiogenesis occurs,

腫瘍は大きくなれません

cancers can grow exponentially.

しかし 血管新生が始まってしまうと

And this is actually how

ガン細胞は急激に大きくなります

a cancer goes from being

このようにガン細胞は

harmless to deadly.

無害の状態から

Cancer cells mutate

致命的になっていきます

and they gain the ability to release

ガン細胞は突然変異を起こし

lots of those angiogenic factors, natural fertilizer,

天然肥料である―

that tip the balance in favor of blood vessels

血管新生因子をたくさん放出し

invading the cancer.

栄養補給のための

And once those vessels invade the cancer,

血管をつくろうとします

it can expand, it can invade local tissues.

この血管が形成してしまうと

And the same vessels that are feeding tumors

ガン細胞は大きくなり 周囲の細胞もやられてしまいます

allow cancer cells to exit into the circulation

腫瘍を大きくさせる同じ血管が

as metastases.

ガン細胞を血液循環に取り込み

And, unfortunately, this late stage of cancer

転移させます

is the one at which it's most likely

残念ながら ガン患者が

to be diagnosed,

ガンと診断されるのは

when angiogenesis is already turned on

このステージに来たときが ほとんどで

and cancer cells are growing like wild.

血管新生は既に活発化して

So, if angiogenesis

ガン細胞は歯止めがかかりません

is a tipping point

ですから血管新生が

between a harmless cancer and a harmful one,

良性腫瘍と悪性腫瘍を

then one major part of the angiogenesis revolution

分け隔てる境目となるならば

is a new approach to treating cancer

血管新生革命を推し進めるのに鍵をにぎる要素の一つは

by cutting off the blood supply.

血管供給を遮ることで

We call this antiangiogenic therapy,

ガン治療を行う新しい方法です

and it's completely different from chemotherapy

これは血管新生抑制療法と呼ばれる治療法で

because it selectively aims

化学療法とはまったく異なります

at the blood vessels that are feeding the cancers.

ガンを大きくする―

And we can do this because

血管のみを狙った治療なのです

tumor blood vessels are unlike normal, healthy vessels

それが可能なのも

we see in other places of the body:

腫瘍を大きくする血管は

They're abnormal;

健康な血管とは違うからです

they're very poorly constructed;

腫瘍の血管は異常で

and, because of that, they're highly vulnerable

つくりが脆いため

to treatments that target them.

狙いを定めて治療をすると

In effect, when we give cancer patients

効果があります

antiangiogenic therapy --

実際のガン患者に

here, an experimental drug for a glioma,

血管新生抑制治療を行い

which is a type of brain tumor --

グリオーマという脳腫瘍の試験薬を

you can see that there are dramatic changes that occur

投与しました

when the tumor is being starved.

血管が遮られると劇的な変化が

Here's a woman with a breast cancer

起きる事がわかります

being treated with the antiangiogenic drug called Avastin,

この女性は乳ガンで

which is FDA approved.

血管新生抑制剤であるアバスチンで治療中です

And you can see that the halo of blood flow

FDAで認可されている薬です

disappears after treatment.

ガンを進行させていた血流の輪が

Well, I've just shown you

治療後になくなっているのがわかります

two very different types of cancer

血管新生抑制治療は

that both responded to antiangiogenic therapy.

この２種類のガンに

So, a few years ago, I asked myself,

効果を発揮しました

"Can we take this one step further

数年前 私が自問したのは

and treat other cancers,

これを一歩進めて

even in other species?"

他の動物の

So here is a nine year-old boxer named Milo

ガン治療にも使えるかどうか でした

who had a very aggressive tumor

９歳のボクサー犬 マイロです

called a malignant neurofibroma growing on his shoulder.

肩に悪性の

It invaded into his lungs.

神経線維腫ができています

His veterinarian only gave him three months to live.

肺に転移して

So we created a cocktail of antiangiogenic drugs

獣医の診断は余命３か月でした

that could be mixed into his dog food

我々は血管新生抑制薬の混ぜ物を

as well as an antiangiogenic cream

ドッグフードに入れて食べさせ

that could be applied on the surface of the tumor.

腫瘍に塗るための

And within a few weeks of treatment,

血管新生抑制クリームもつくりました

we were able to slow down that cancer's growth

数週間もしないうちに

such that we were ultimately able to extend milo's survival

ガンの進行が弱まったことが確認され

to six times what the veterinarian had initially predicted,

獣医が予想していた余命を

all with a very good quality of life.

６倍に延ばすことができました

And we subsequently treated more than 600 dogs.

充実した生活をおくりながらです

We have about a 60 percent response rate

その後 治療した犬は600頭以上

and improved survival for these pets

奏効率は約60％で

that were about to be euthanized.

安楽死になるところだった―

So let me show you a couple of

ペットの寿命を延ばしました

even more interesting examples.

もっと興味深い例を

This is 20-year-old dolphin living in Florida,

二つお見せします

and she had these lesions in her mouth

フロリダにいる20歳のイルカです

that, over the course of three years,

口の中にできた傷が

developed into invasive squamous cell cancers.

３年の間に

So we created an antiangiogenic paste.

浸潤性扁平上皮ガンになりました

We had it painted on top of the cancer

そこで我々は血管新生抑制ペーストをつくり

three times a week.

週に３回

And over the course of seven months,

ガンに塗りました

the cancers completely disappeared,

７か月の間に

and the biopsies came back as normal.

ガンは完全に消え

Here's a cancer growing on the lip

生命組織検査は正常値に戻りました

of a Wuarter horse named Guinness.

これは唇にガンができた―

It's a very, very deadly type of cancer called an angiosarcoma.

ギネスという名の馬です

It had already spread to his lymph nodes,

血管肉腫という致命的なガンです

so we used an antiangiogenic skin cream for the lip

リンパ節に転移していたため

and an oral cocktail, so we could treat from the inside

血管新生抑制剤のスキンクリームを唇に塗り

as well as the outside.

内服薬も使用して 内と外から

And over the course of six months,

治療しました

he experienced a complete remission.

６か月の治療の末

And here he is six years later,

ガンは完治しました

Guinness, with his very happy owner.

これはその６年後

(Applause)

ギネスと飼い主の幸せな姿です

Now, obviously, antiangiogenic therapy

（拍手）

could be used for a wide range of cancers.

明らかに 血管新生抑制療法は

And, in fact, the first pioneering treatments

様々なガンに効きます

for people, as well as dogs,

人間や犬用の

are already becoming available.

先駆的治療は

There's 12 different drugs, 11 different cancer types.

既に利用できるようになっています

But the real question is:

11種類のガンに12種類の薬があります

How well do these work in practice?

しかし実際問題として

So here's actually the patient survival data

効果が気になります

from eight different types of cancer.

これはガン患者の生存データで

The bars represent survival time

８種類のガンが対象になっています

taken from the era

この棒線が示す生存時間は

in which there was only chemotherapy,

化学療法や手術―

or surgery, or radiation available.

放射線治療しか

But starting in 2004,

治療法がなかった頃のものです

when antiangiogenic therapies first became available,

しかし2004年に

well you can see that there has been

血管新生抑制治療が

a 70 to 100 percent

初めて登場して以来

improvement in survival

生存期間は

for people with kidney cancer, multiple myeloma,

70～100％も向上しました

colorectal cancer, and gastrointestinal stromal tumors.

腎臓ガンや多発性骨髄腫や大腸ガン

That's impressive.

消化管間質腫瘍の患者から得られた数値です