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  • I'm going to talk to you today about

    翻訳: Takako Sato 校正: Yasushi Aoki

  • hopefully converting fear into hope.

    今日 お話しするのは

  • When we go to the physician today --

    願わくは恐怖を希望に変えることです

  • when we go to the doctor's office and we walk in,

    私達は病院に行くと

  • there are words that we just don't want to hear.

    診察室の中で

  • There are words that we're truly afraid of.

    耳にしたくない言葉があります

  • Diabetes, cancer, Parkinson's, Alzheimer's,

    私達が本当に恐れている言葉です

  • heart failure, lung failure --

    糖尿病 癌 パーキンソン病 アルツハイマー

  • things that we know are debilitating diseases,

    心不全 肺不全

  • for which there's relatively little that can be done.

    私達の認識は 身体をむしばむ

  • And what I want to lay out for you today is

    対処法がほとんどない病気ということです

  • a different way of thinking about how to treat debilitating disease,

    今日お話したいのは

  • why it's important,

    不治の病への従来とは違ったアプローチと

  • why without it perhaps our health care system will melt down

    その重要性です

  • if you think it already hasn't,

    それがなければ 医療制度は崩壊するでしょう

  • and where we are clinically today, and where we might go tomorrow,

    まだ していなければの話ですが…

  • and what some of the hurdles are.

    臨床の現在と 明日の方向性

  • And we're going to do all of that in 18 minutes, I promise.

    問題点を取り上げ

  • I want to start with this slide,

    以上の点を18分で紹介します

  • because this slide sort of tells the story the way Science Magazine thinks of it.

    こちらを見てください

  • This was an issue from 2002

    サイエンスマガジン誌の見方が表れています

  • that they published with a lot of different articles on the bionic human.

    バイオニックヒューマンに関する

  • It was basically a regenerative medicine issue.

    様々な記事を集めた2002年の特集号です

  • Regenerative medicine is an extraordinarily simple concept

    要は 再生医療特集ということです

  • that everybody can understand.

    再生医療とは非常に簡単な概念で

  • It's simply accelerating the pace at which the body heals itself

    誰でも理解できます

  • to a clinically relevant timescale.

    自然治癒のスピードを医療処置のように

  • So we know how to do this in many of the ways that are up there.

    加速するのです

  • We know that if we have a damaged hip, you can put an artificial hip in.

    ここに挙げられている様々な方法を我々は知っています

  • And this is the idea that Science Magazine used on their front cover.

    股関節疾患には人工関節で治します

  • This is the complete antithesis of regenerative medicine.

    サイエンスマガジン誌の表紙で紹介された考え方です

  • This is not regenerative medicine.

    実はこれは再生医療とは正反対で

  • Regenerative medicine is what Business Week put up

    再生医療とは呼びません

  • when they did a story about regenerative medicine not too long ago.

    ビジネスウィーク誌が少し前に

  • The idea is that instead of figuring out how to ameliorate symptoms

    特集したのが本当の再生医療です

  • with devices and drugs and the like --

    その概念とは 器具や薬で症状を

  • and I'll come back to that theme a few times --

    改善させようとする代わりに

  • instead of doing that, we will regenerate lost function of the body

    これは後から触れますが

  • by regenerating the function of organs and damaged tissue.

    臓器や傷ついた組織の機能を再生することで

  • So that at the end of the treatment,

    失われた体の機能を再生するのです

  • you are the same as you were at the beginning of the treatment.

    治療が終了すると

  • Very few good ideas -- if you agree that this is a good idea --

    健康時の体が取り戻せます

  • very few good ideas are truly novel.

    これは良いアイディアだと思いますが

  • And this is just the same.

    良いアイディアは新しくないことが多いものです

  • If you look back in history,

    この案も同じです

  • Charles Lindbergh, who was better known for flying airplanes,

    歴史を振り返れば

  • was actually one of the first people

    有名な飛行家のチャールズ リンドバーグは

  • along with Alexis Carrel, one of the Nobel Laureates from Rockefeller,

    ノーベル賞を受賞した―

  • to begin to think about, could you culture organs?

    アレクシス カレルと共に 臓器の培養を

  • And they published this book in 1937,

    最初に考えた1人です

  • where they actually began to think about,

    彼らは1937年に本を出版し

  • what could you do in bio-reactors to grow whole organs?

    バイオリアクターで

  • We've come a long way since then.

    いかに臓器を生成できるのか考え始め それ以降

  • I'm going to share with you some of the exciting work that's going on.

    躍進を遂げました

  • But before doing that, what I'd like to do

    進行中の素晴らしい事例を幾つか紹介します

  • is share my depression about the health care system

    でも その前に 医療制度に対する

  • and the need for this with you.

    私の不満と 再生医療の必要性を

  • Many of the talks yesterday talked about

    話したいと思います

  • improving the quality of life, and reducing poverty,

    昨日は生活の質の向上や

  • and essentially increasing life expectancy all around the globe.

    貧困を減らすという話をたくさん聞きました

  • One of the challenges is that the richer we are, the longer we live.

    実質的に平均寿命を延ばすということです

  • And the longer we live, the more expensive it is

    でも より裕福になれば 寿命も延びるわけで

  • to take care of our diseases as we get older.

    寿命が延びれば 加齢と共に

  • This is simply the wealth of a country

    病気の治療費も増加するということです

  • versus the percent of population over the age of 65.

    これは65歳以上の人口の割合と

  • And you can basically see that the richer a country is,

    国の豊かさの関係を示した図です

  • the older the people are within it.

    国が より裕福であればあるほど

  • Why is this important?

    高齢者は多くなります

  • And why is this a particularly dramatic challenge right now?

    なぜ これが重要なのか?

  • If the average age of your population is 30,

    なぜ これが危急の難題なのか?

  • then the average kind of disease that you have to treat

    平均年齢が30歳だと

  • is maybe a broken ankle every now and again,

    処置が必要な平均的な病気は

  • maybe a little bit of asthma.

    時折見られる足首の骨折や

  • If the average age in your country is 45 to 55,

    喘息などでしょう

  • now the average person is looking at diabetes,

    平均年齢が45歳から55歳になると

  • early-onset diabetes, heart failure, coronary artery disease --

    平均的なのは 早期の糖尿病

  • things that are inherently more difficult to treat,

    心不全 冠動脈疾患などです

  • and much more expensive to treat.

    治療がより難しく 医療費がより高い―

  • Just have a look at the demographics in the U.S. here.

    病気が出てきます

  • This is from "The Untied States of America."

    これは米国の人口統計データです

  • In 1930, there were 41 workers per retiree.

    ある本から借用した資料です

  • 41 people who were basically outside of being really sick,

    1930年 年金生活者1人に対し労働者は41人

  • paying for the one retiree who was experiencing debilitating disease.

    基本的に健康には さほど問題のない41人が

  • In 2010, two workers per retiree in the U.S.

    医療費のかさむ年金生活者1人を養っています

  • And this is matched in every industrialized, wealthy country in the world.

    2010年の米国は 年金生活者1人に対し労働者2人

  • How can you actually afford to treat patients

    これは世界中の裕福な産業国すべてに当てはまります

  • when the reality of getting old looks like this?

    高齢化の現実がこのような状態で

  • This is age versus cost of health care.

    いかに患者を治療すればいいか?

  • And you can see that right around age 45, 40 to 45,

    これは年齢と医療費のグラフです

  • there's a sudden spike in the cost of health care.

    ちょうど40~45歳のあたりで

  • It's actually quite interesting. If you do the right studies,

    医療費の急激な増加が見られます

  • you can look at how much you as an individual spend on your own health care,

    興味深いのは 研究をすれば

  • plotted over your lifetime.

    個人の医療費が生涯に渡ってどれだけかかるか

  • And about seven years before you're about to die, there's a spike.

    わかるということです

  • And you can actually --

    死の約7年前に費用が急激に上昇します

  • (Laughter)

    ここから分かるのは…

  • -- we won't get into that.

    (笑)

  • (Laughter)

    …よしておきます

  • There are very few things, very few things that you can really do

    (笑)

  • that will change the way that you can treat these kinds of diseases

    このような病気の治療法を変え

  • and experience what I would call healthy aging.

    私が健康的な加齢と呼ぶものを

  • I'd suggest there are four things,

    実現できる方法は あまりありません

  • and none of these things include an insurance system or a legal system.

    提案する方法は4つ

  • All those things do is change who pays.

    保険や法律に関連したことではありません

  • They don't actually change what the actual cost of the treatment is.

    それらは負担者を変えるだけで

  • One thing you can do is not treat. You can ration health care.

    治療費に変化は出せません

  • We won't talk about that anymore. It's too depressing.

    1つの方法は 医療を制限し 治療をやめることです

  • You can prevent.

    こんな暗い話題はやめましょう

  • Obviously a lot of monies should be put into prevention.

    もう1つは予防です

  • But perhaps most interesting, to me anyway, and most important,

    予防に多くの費用をかけるべきなのは明白です

  • is the idea of diagnosing a disease much earlier on in the progression,

    興味深く 最も重要なのは

  • and then treating the disease to cure the disease

    病気の早期発見をして

  • instead of treating a symptom.

    対症療法ではなく

  • Think of it in terms of diabetes, for instance.

    完治するように治療すること

  • Today, with diabetes, what do we do?

    糖尿病を例に考えてみましょう

  • We diagnose the disease eventually, once it becomes symptomatic,

    現在の糖尿病への対応とは?

  • and then we treat the symptom for 10, 20, 30, 40 years.

    症状が現れてから診断がなされ

  • And we do OK. Insulin's a pretty good therapy.

    そして何十年と長期に渡る治療をし

  • But eventually it stops working,

    インスリンが効くので健康を保てますが

  • and diabetes leads to a predictable onset of debilitating disease.

    結局は効かなくなり

  • Why couldn't we just inject the pancreas with something

    糖尿病がどんどん身体を弱らせる素因になります

  • to regenerate the pancreas early on in the disease,

    症状が現れる前の初期の段階で

  • perhaps even before it was symptomatic?

    すい臓を再生させる注射をすることは

  • And it might be a little bit expensive at the time that we did it,

    できないでしょうか?

  • but if it worked, we would truly be able to do something different.

    その時は多少費用が必要ですが

  • This video, I think, gets across the concept that I'm talking about quite dramatically.

    効果が出れば 違いは著しいでしょう

  • This is a newt re-growing its limb.

    私が話している概念は このビデオで劇的に伝えられると思います

  • If a newt can do this kind of thing, why can't we?

    これは再生中のイモリの手です

  • I'll actually show you some more important features

    イモリに可能ならば 我々にも可能なのでは?

  • about limb regeneration in a moment.

    もう少し後で 手足再生に関する―

  • But what we're talking about in regenerative medicine

    もっと重要な事を紹介します

  • is doing this in every organ system of the body,

    再生医療とは

  • for tissues and for organs themselves.

    体中すべての組織や

  • So today's reality is that if we get sick,

    器官全体に適用できます

  • the message is we will treat your symptoms,

    今日の実情では 病気になった場合

  • and you need to adjust to a new way of life.

    治療されるのは症状であり 患者には

  • I would pose to you that tomorrow --

    新しいあり方への適応が求められます

  • and when tomorrow is we could debate,

    いつ起きるのかは

  • but it's within the foreseeable future --

    議論の余地がありますが

  • we will talk about regenerative rehabilitation.

    近い将来に

  • There's a limb prosthetic up here,

    再生医療を伴うリハビリが行われるようになるでしょう

  • similar actually one on the soldier

    この義足は

  • that's come back from Iraq.

    イラク帰還兵が使用しているものに

  • There are 370 soldiers that have come back from Iraq that have lost limbs.

    よく似ています

  • Imagine if instead of facing that, they could actually

    手足を失ったイラク帰還兵が370名もいます

  • face the regeneration of that limb.

    彼らが直面するのが 手足の喪失ではなく

  • It's a wild concept.

    手足の再生であるところを想像してみてください

  • I'll show you where we are at the moment in working towards that concept.

    興味深いですね

  • But it's applicable, again, to every organ system.

    その発想に向けた進行中の事例を紹介します

  • How can we do that?

    どの器官にも有効な方法です

  • The way to do that is to develop a conversation with the body.

    その方法とは

  • We need to learn to speak the body's language.

    肉体と会話をすること

  • And to switch on processes that we knew how to do when we were a fetus.

    肉体の言語を話し

  • A mammalian fetus, if it loses a limb during the first trimester of pregnancy,

    胎児だった時に使っていたプロセスを起動するのです

  • will re-grow that limb.

    哺乳類の胎児は妊娠3ヶ月までに手足を失っても

  • So our DNA has the capacity to do these kinds of wound-healing mechanisms.

    再び形成されます

  • It's a natural process,

    私たちのDNAはそのような怪我を治癒する機能を備えているのです

  • but it is lost as we age.

    これは自然な能力ですが

  • In a child, before the age of about six months,

    成長と共に失われます

  • if they lose their fingertip in an accident,

    生後6ヶ月以内の乳児であれば

  • they'll re-grow their fingertip.

    指先を事故で失っても

  • By the time they're five, they won't be able to do that anymore.

    元通りになりますが

  • So to engage in that conversation with the body,

    5歳児だと 元通りにはなりません

  • we need to speak the body's language.

    そこで 肉体と対話する為には

  • And there are certain tools in our toolbox that allow us to do this today.

    肉体の言葉を話す必要があります

  • I'm going to give you an example of three of these tools

    現在 そのための道具立てを我々は持っています

  • through which to converse with the body.

    肉体と対話する能力3つの例を

  • The first is cellular therapies.

    お見せします

  • Clearly, we heal ourselves in a natural process,

    1つめは細胞セラピー

  • using cells to do most of the work.

    私たちは主に細胞の働きによって

  • Therefore, if we can find the right cells

    自然なプロセスとして自ら治癒します

  • and implant them in the body, they may do the healing.

    適切な細胞を見つけ

  • Secondly, we can use materials.

    体に移植すれば 細胞が治してくれるかもしれません

  • We heard yesterday about the importance of new materials.

    2つめは物質を使うこと

  • If we can invent materials, design materials,

    昨日 新物質の重要性について聞きました

  • or extract materials from a natural environment,

    もし物質を発明したり 設計したり

  • then we might be able to have those materials induce the body to heal itself.

    自然界から抽出することが出来れば

  • And finally, we may be able to use smart devices

    その物質で体自身が治癒するように誘導できるかもしれません

  • that will offload the work of the body and allow it to heal.

    最後に 体の機能を肩代わりして

  • I'm going to show you an example of each of these,

    体が治癒できるようにする知的な装置を作れるかもしれません

  • and I'm going to start with materials.

    それぞれの例を紹介します

  • Steve Badylak -- who's at the University of Pittsburgh --

    物質から始めます

  • about a decade ago had a remarkable idea.

    ピッツバーグ大学のバディラック氏は

  • And that idea was that the small intestine of a pig,

    10年程前に素晴らしい事を思いつきました

  • if you threw away all the cells,

    生物学的に活性な状態のまま 豚の小腸からすべての細胞を

  • and if you did that in a way that allowed it to remain biologically active,

    取り除いたなら

  • may contain all of the necessary factors and signals

    体に治癒を促すのに必要なすべての要素と信号が

  • that would signal the body to heal itself.

    そこには含まれているかもしれない―

  • And he asked a very important question.

    というアイディアです

  • He asked the question,

    彼はとても重要な

  • if I take that material, which is a natural material

    質問をしました

  • that usually induces healing in the small intestine,

    通常は小腸で治癒を誘発する―

  • and I place it somewhere else on a person's body,

    天然の物質を取り 人の耳の部分に

  • would it give a tissue-specific response,

    移植したら 組織固有の反応を見せて

  • or would it make small intestine if I tried to make a new ear?

    耳を作り出すのか それとも小腸を

  • I wouldn't be telling you this story if it weren't compelling.

    作り出すのか という質問です

  • The picture I'm about to show you

    興味深い話でなければ この話はしていません

  • is a compelling picture.

    これからお見せする写真は…

  • (Laughter)

    (スライド: 目をそらすなら今のうち) (笑)

  • However, for those of you that are even the slightest bit squeamish --

    注目に値する写真です

  • even though you may not like to admit it in front of your friends --

    でも 友人には認めたくなくても

  • the lights are down. This is a good time to look at your feet,

    怖ければ 明かりを落とすので

  • check your Blackberry, do anything other than look at the screen.

    足下を気にしたり 携帯を確認したり

  • (Laughter)

    スクリーンを見る以外のことをして下さい

  • What I'm about to show you is a diabetic ulcer.

    (笑)

  • And although -- it's good to laugh before we look at this.

    お見せするのは糖尿病性潰瘍です

  • This is the reality of diabetes.

    笑うのは今のうちです

  • I think a lot of times we hear about diabetics, diabetic ulcers,

    これが糖尿病の現実です

  • we just don't connect the ulcer with the eventual treatment,

    糖尿病や糖尿病性潰瘍はよく耳にしますが

  • which is amputation, if you can't heal it.

    治癒しなければ切断 という最終段階と

  • So I'm going to put the slide up now. It won't be up for long.

    潰瘍をあまり関連づけすることはありません

  • This is a diabetic ulcer. It's tragic.

    では始めます 長くはありません

  • The treatment for this is amputation.

    これが糖尿病性潰瘍 悲惨なものです

  • This is an older lady. She has cancer of the liver as well as diabetes,

    治療法は切断です

  • and has decided to die with what' s left of her body intact.

    この66歳の女性は糖尿病の他に肝臓ガンも患っており

  • And this lady decided, after a year of attempted treatment of that ulcer,

    死ぬのであれば 体は傷つけずにいようと決めたのですが

  • that she would try this new therapy that Steve invented.

    1年間の潰瘍治療の末 バディラック氏の

  • That's what the wound looked like 11 weeks later.

    新しい治療法を試すことにしました

  • That material contained only natural signals.

    11週後の傷口の様子です

  • And that material induced the body to switch back on a healing response

    その物質には自然の信号だけが含まれていました

  • that it didn't have before.

    この物質が以前には無かった治癒反応を

  • There's going to be a couple more distressing slides for those of you --

    引き起こしました

  • I'll let you know when you can look again.

    ショッキングな写真があと数枚出てきます

  • This is a horse. The horse is not in pain.

    終わったら 言いますね

  • If the horse was in pain, I wouldn't show you this slide.

    これは馬です 痛みは感じていません

  • The horse just has another nostril that's developed

    そうでなければ お見せしません

  • because of a riding accident.

    乗馬事故に巻き込まれて

  • Just a few weeks after treatment --

    このようになってしまいました

  • in this case, taking that material, turning it into a gel,

    治療数週間後です

  • and packing that area, and then repeating the treatment a few times --

    このケースでは 物質をジェル状にして

  • and the horse heals up.

    傷口を覆い それを何度か繰り返して

  • And if you took an ultrasound of that area, it would look great.

    完治しました

  • Here's a dolphin where the fin's been re-attached.

    超音波でもはっきりわかります

  • There are now 400,000 patients around the world

    これは新しい背びれを得たイルカです

  • who have used that material to heal their wounds.

    世界中には現在40万人もの患者が

  • Could you regenerate a limb?

    この物質を用いた怪我の治療を受けています

  • DARPA just gave Steve 15 million dollars to lead an eight-institution project

    手足は再生できるのでしょうか?

  • to begin the process of asking that question.

    この疑問の解明のため 8組織に渡るプロジェクトの資金として

  • And I'll show you the 15 million dollar picture.

    国防省の研究機関が1500万ドルを提供しました

  • This is a 78 year-old man who's lost