There's a medical revolution happening all around us,

有項醫學上的變革正在我們身邊發生

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

這將幫助我們克服

some of society's most dreaded conditions,

社會最憂慮的部份狀況

including cancer.

包括癌症

The revolution is called angiogenesis,

這項變革被稱做血管新生

and it's based on the process

也就是在我們體內

that our bodies use to grow blood vessels.

血管生長的過程

So why should we care about blood vessels?

為什麼我們得在乎血管呢？

Well, the human body is literally packed with them:

因為，我們的身上到處都是血管

60,000 miles worth in a typical adult.

將一位標準體型的成人體內所有的血管

End to end, that would form a line

頭尾相連，能連成一條長度約十萬公里

that would circle the earth twice.

可繞地球整整兩圈的直線

The smallest blood vessels are called capillaries;

最小的血管被稱做微血管

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

我們體內約有190億條微血管

And these are the vessels of life, and,

微血管是生之徑

as I'll show you,

同時，如我將展示給各位看的

they can also be the vessels of death.

它們也可以是死之徑

Now the remarkable thing about blood vessels

微血管有個驚人之處：

is that they have this ability

它們能因應不同的生長環境

to adapt to whatever environment they're growing in.

出現不同的形式

For example, in the liver they form channels

比如說：在肝臟裡

to detoxify the blood;

微血管是讓血液解毒的管道

in the lung they line air sacs for gas exchange;

在肺臟裡則形成氣囊幫助氣體交換

in muscle they corkscrew so that muscles can contract

在肌肉中以如軟木塞開瓶器的形狀排列

without cutting off circulation;

這樣在肌肉收縮時，血液循環也不會中斷

and in nerves they course along like power lines,

在神經中，微血管蜿蜒如電線

keeping those nerves alive.

維持神經細胞的活力

We get most of these blood vessels

我們身上大部分的血管

when we're actually still in the womb,

是在胎兒時期就長出來的

And what that means is that as adults,

也就是說，在正常情況下

blood vessels don't normally grow.

成人身上的血管不會自發地生長

Except in a few special circumstances:

某些特別的情況則是例外

In women, blood vessels grow every month

每個月，女人的子宮裡

to build the lining of the uterus;

血管會增生形成內膜

during pregnancy, they form the placenta,

懷孕時，子宮內膜將演變成胎盤

which connects mom and baby.

也就是母親和寶寶間的連結

And after injury, blood vessels

我們受傷時，在傷疤下

actually have to grow under the scab

血管會不斷生長

in order to heal a wound.

來幫助傷口癒合

And this is actually what it looks like,

這是血管的真實樣貌

hundreds of blood vessels

數以百計的微血管

all growing toward the center of the wound.

全都長在傷口的中間

So the body has the ability to regulate

可見，我們的身體在任何時候

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

都有調節全身血管數量的能力

It does this through an elaborate

身體藉著計畫完善精良的調控系統

and elegant system of checks and balances,

來維持那些控制血管新生的

stimulators and inhibitors of angiogenesis,

刺激物或是抑制物間的平衡

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

也就是說，若是在短時間內需要大量血管

the body can do this by releasing stimulators,

體內會釋放血管新生的刺激物

proteins called angiogenic factors

這是一種被稱為血管新生因子的蛋白質

that act as natural fertilizer

就像我們體內的天然肥料一般

and stimulate new blood vessels to sprout.

能刺激新血管的萌發

And when those excess vessels are no longer needed,

若是體內不再需要這樣過量的血管

the body prunes them back to baseline

身體就會藉著自然釋放的血管新生抑制因子

using naturally occurring inhibitors of angiogenesis.

讓血管新生速度降到基準值

Now there are other situations where we start beneath the baseline

而在其他需要比基準速度更低的血管新生

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

的情況，這時我們就得讓血管生長回到正常值

for example, after an injury --

像是受傷後

and a body can do that too,

我們體內的血管先大量增生

but only to that normal level,

再降到健康時的正常數量

that set point.

也就是身體設定好的正常值

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

但現在我們知道，就有些疾病而言

there are defects in the system

這個控制血管生長的系統有缺陷

where the body can't prune back extra blood vessels

身體沒辦法減低過量的血管

or can't grow enough new ones

或是沒辦法讓新生血管

in the right place at the right time.

出現在正確的時間或是位置

And in these situations, angiogenesis

這樣的情況就是

is out of balance.

血管新生失去平衡

And when angiogenesis is out of balance,

而血管新生失去平衡

a myriad of diseases result.

是非常嚴重的疾病

For example, insufficient angiogenesis --

比方說，血管新生不夠

not enough blood vessels --

體內就不會有足夠的血管

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

這樣傷口不會癒合、心肌梗塞

legs without circulation, death from stroke,

足部血液循環不良、因為中風死亡

nerve damage.

或是傷害神經

And on the other end, excessive angiogenesis --

相反的，過多的血管新生

too many blood vessels -- drives disease,

會讓體內有過多的血管，也會造成疾病

and we see this in cancer, blindness,

如癌症、失明

arthritis, obesity,

關節炎、肥胖

Alzheimer's disease.

阿茲海默症

In total, there are more than 70 major diseases

總的來說，有70多種疾病

affecting more than a billion people worldwide,

正影響著世界上十億人口

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

它們表面上看起來毫無關係

but all actually share

但事實上，這些疾病

abnormal angiogenesis

都以異常血管新生

as their common denominator.

為共同特徵

And this realization is allowing us

明白這一點

to reconceptualize

能讓我們重新思考

the way that we actually approach these diseases

如何藉著控制血管新生

by controlling angiogenesis.

來治療這些疾病的確切方法

Now I'm going to focus on cancer

現在，我將重點放在癌症

because angiogenesis is a hallmark of cancer,

因為無論是哪一種癌症

every type of cancer.

都以血管新生為重要特徵

So here we go.

好，我們來談談癌症

This is a tumor: dark, gray, ominous mass

這是一個腫瘤。一團深灰色、

growing inside a brain.

看來不妙的細胞團在腦中生長

And under the microscope, you can see

在顯微鏡下，你可以看見

hundreds of these brown staining blood vessels,

數以百計如這樣被染成褐色的血管

capillaries that are feeding cancer cells,

或是正在餵養癌細胞的微血管

bringing oxygen and nutrients.

將氧氣或是養份帶給它們

But cancers don't start out like this.

然而，腫瘤一開始不是這樣

And, in fact, cancers don't start out

事實上，腫瘤一開始

with a blood supply.

沒有血液供給

They start out as small, microscopic nests of cells

原初的腫瘤是顯微鏡下的小細胞群

that can only grow to

它們頂多長成

one half a cubic millimeter in size;

半立方毫米大小

that's the tip of a ballpoint pen.

大概是是筆尖大小

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

這些腫瘤長不大就是因為它們沒有血液供給

so they don't have enough oxygen or nutrients.

也就沒有足夠的氧氣和養分

In fact, we're probably forming these

事實上，我們的體內可能

microscopic cancers all the time in our body.

隨時都在形成這些微腫瘤

Autopsy studies from people who died in car accidents

對因癌症而死的病人進行的病理解剖顯示

have shown that about 40 percent of women

在40到50歲的女性裡

between the ages of 40 and 50

有百分之40的人

actually have microscopic

的確有這樣的微腫瘤

cancers in their breasts,

存在於乳房內

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

年約50到60歲的男性

have microscopic prostate cancers,

其中50%於攝護腺裡有微腫瘤

and virtually 100 percent of us,

我們到了70歲以後

by the time we reach our 70s,

百分之百的人

will have microscopic cancers growing in our thyroid.

甲狀腺裡有生長中的微腫瘤

Yet, without a blood supply,

然而，在沒有血液供給的情況下

most of these cancers

大部分這樣的微腫瘤

will never become dangerous.

是不會變得有害的

Dr. Judah Folkman, who was my mentor

我的導師，佛克曼醫師

and who was the pioneer of the angiogenesis field,

同時也是血管新生研究的先驅者

once called this "cancer without disease."

曾經說這些微腫瘤是「非病腫瘤」

So the body's ability to balance angiogenesis,

因此，我們的身體有平衡血管新生的能力

when it's working properly,

當這樣的能力運作良好

prevents blood vessels from feeding cancers.

就能避免血管餵養癌症生長

And this turns out to be

這樣的機制也就變成

one of our most important defense mechanisms

我們體內最重要抵抗癌症的

against cancer.

防禦機轉之一

In fact, if you actually block angiogenesis

事實上，當你能確實阻斷血管新生

and prevent blood vessels from ever reaching cancer cells,

讓血管永遠無法和癌細胞接觸

tumors simply can't grow up.

腫瘤就不會生長

But once angiogenesis occurs,

然而，一旦腫瘤周圍出現血管新生

cancers can grow exponentially.

它們就能以倍數成長

And this is actually how

這就是腫瘤

a cancer goes from being

如何從無害變得

harmless to deadly.

有害的實情

Cancer cells mutate

癌細胞突變

and they gain the ability to release

並且釋放許多

lots of those angiogenic factors, natural fertilizer,

跟血管新生有關的物質

that tip the balance in favor of blood vessels

這些天然肥料會刺激血管生長

invading the cancer.

進入腫瘤組織

And once those vessels invade the cancer,

一旦血管進入腫瘤

it can expand, it can invade local tissues.

腫瘤就能擴張，侵犯周邊的組織

And the same vessels that are feeding tumors

在血管餵養腫瘤的同時

allow cancer cells to exit into the circulation

腫瘤也得以進入循環系統

as metastases.

這就是所謂的轉移

And, unfortunately, this late stage of cancer

當血管已經開始生長

is the one at which it's most likely

腫瘤就會瘋狂地增生

to be diagnosed,

而不幸的，在這個癌症發展的

when angiogenesis is already turned on

最後階段，轉移癌是

and cancer cells are growing like wild.

幾乎不可能被診斷的

So, if angiogenesis

所以，如果血管新生

is a tipping point

是從無害的微腫瘤轉變成

between a harmless cancer and a harmful one,

有害的癌症的關鍵點

then one major part of the angiogenesis revolution

那麼，這個血管新生革命的主要部份

is a new approach to treating cancer

就是藉著切斷血液供給

by cutting off the blood supply.

來治療癌症的新方法

We call this antiangiogenic therapy,

我們稱之為抗血管新生治療

and it's completely different from chemotherapy

這跟化療完全不同

because it selectively aims

因為這個療法選擇性地瞄準

at the blood vessels that are feeding the cancers.

供應腫瘤養份的血管

And we can do this because

之所以能這麼做，是因為

tumor blood vessels are unlike normal, healthy vessels

腫瘤的血管跟一般健康的

we see in other places of the body:

在身體其他部分的血管不同

They're abnormal;

腫瘤的血管異常之處

they're very poorly constructed;

在於它們的結構脆弱

and, because of that, they're highly vulnerable

因此，這類血管對專門來

to treatments that target them.

對付它們的藥物很敏感

In effect, when we give cancer patients

臨床上，當我們在癌症病人身上

antiangiogenic therapy --

施以對抗血管新生的藥物

here, an experimental drug for a glioma,

像是這個治療神經膠細胞瘤的實驗性藥物

which is a type of brain tumor --

神經膠細胞瘤是一種腦瘤

you can see that there are dramatic changes that occur

我們可以在病人身上看到

when the tumor is being starved.

當腫瘤不再有養分時產生的顯著變化

Here's a woman with a breast cancer

這是一位有乳癌的女士

being treated with the antiangiogenic drug called Avastin,

她接受美國食品藥物管理局核准的

which is FDA approved.

血管新生藥物Avastin的治療

And you can see that the halo of blood flow

如你所見，這區血流在治療後

disappears after treatment.

即消失不見

Well, I've just shown you

我剛剛已經告訴妳們

two very different types of cancer

抗血管新生藥物對

that both responded to antiangiogenic therapy.

兩種癌症有效

So, a few years ago, I asked myself,

所以，幾年前，我自問

"Can we take this one step further

我們能夠更進一步

and treat other cancers,

用這種藥來治療其他癌症嗎

even in other species?"

甚至是其他物種的癌症

So here is a nine year-old boxer named Milo

這是一隻九歲大的鬥牛犬，Milo

who had a very aggressive tumor

牠的肩膀有個惡性神經纖維瘤

called a malignant neurofibroma growing on his shoulder.

這是一種極具侵入性的腫瘤

It invaded into his lungs.

已經進入牠的肺臟

His veterinarian only gave him three months to live.

獸醫認為牠只有三個月可活

So we created a cocktail of antiangiogenic drugs

因此，我們做了可以混在牠食物中的

that could be mixed into his dog food

抗血管新生藥物的雞尾酒配方

as well as an antiangiogenic cream

跟可以塗抹在腫瘤表面的

that could be applied on the surface of the tumor.

抗血管新生藥物乳霜

And within a few weeks of treatment,

在數個星期的治療後

we were able to slow down that cancer's growth

我們得以減緩腫瘤的生長

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

最終得以延長Milo的壽命

to six times what the veterinarian had initially predicted,

達獸醫預測的時間六倍長之久

all with a very good quality of life.

生活品質也很好

And we subsequently treated more than 600 dogs.

接著我們治療了其他600多隻狗

We have about a 60 percent response rate

其中大概有60%的治療率

and improved survival for these pets

也能增加那些將被安樂死的

that were about to be euthanized.

寵物的壽命

So let me show you a couple of

接著，讓我向你們報告

even more interesting examples.

幾個更有趣的病例

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

這是一隻20歲，生活在佛州的海豚

and she had these lesions in her mouth

牠的口裡有些

that, over the course of three years,

出現大概3年多的病灶

developed into invasive squamous cell cancers.

漸漸形成侵入性的鱗狀上皮癌

So we created an antiangiogenic paste.

為此，我們做了抗血管生成的藥糊

We had it painted on top of the cancer

塗抹在病灶上

three times a week.

每個星期三次

And over the course of seven months,

經過七個月的療程後

the cancers completely disappeared,

上皮癌完全消失了

and the biopsies came back as normal.

切片的結果也正常

Here's a cancer growing on the lip

這是一隻名叫Guiness的奎特馬

of a Wuarter horse named Guinness.

牠嘴唇上的腫瘤

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

是一種非常非常致命的腫瘤，血管肉瘤

It had already spread to his lymph nodes,

已經侵犯到牠的淋巴結

so we used an antiangiogenic skin cream for the lip

我們用了能抹在嘴唇上的抗血管新生的藥膏

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

跟口服的雞尾酒藥物

as well as the outside.

讓治療得以內用跟外服雙管齊下

And over the course of six months,

經過6個月的療程

he experienced a complete remission.

腫瘤完全消失了

And here he is six years later,

這是Guiness接受治療後6年

Guinness, with his very happy owner.

跟飼主快樂的合照

(Applause)

（掌聲）

Now, obviously, antiangiogenic therapy

現在，顯然的，抗血管新生藥物

could be used for a wide range of cancers.

能被廣泛的運用在各種癌症的治療上

And, in fact, the first pioneering treatments

事實上，第一個於人類

for people, as well as dogs,

跟於狗身上的前驅治療

are already becoming available.

已經可以取得

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

總共有12種藥物，用來治療11種癌症

But the real question is:

但真正的問題是

How well do these work in practice?

這些藥物的實際成效如何？

So here's actually the patient survival data

數據為8種不同癌症

from eight different types of cancer.

患者的存活時間

The bars represent survival time

柱狀圖為

taken from the era

僅有化療

in which there was only chemotherapy,

手術或是放射線治療時的

or surgery, or radiation available.

患者存活時間

But starting in 2004,

從2004年

when antiangiogenic therapies first became available,

抗血管新生藥物出現在市面上

well you can see that there has been

你可以注意到

a 70 to 100 percent

腎臟癌、多發性硬化症

improvement in survival

大腸癌和胃腸道基質腫瘤等

for people with kidney cancer, multiple myeloma,

癌症患者的存活時間

colorectal cancer, and gastrointestinal stromal tumors.

增加了70-100%

That's impressive.

非常令人印象深刻