in terms of the shortage of organs.

那就是可供移植人體器官的短缺。

The fact is that we're living longer.

事實上，我們活得更長久了；

Medicine has done a much better job

現代醫學對於讓我們活得更長久

of making us live longer,

居功厥偉。

and the problem is, as we age,

問題是：當我們老化，

our organs tend to fail more,

我們器官衰竭的機率也增加。

and so currently

因此現今，

there are not enough organs to go around.

可供使用的器官並不足夠。

In fact, in the last 10 years,

事實上，過去十年間，

the number of patients requiring an organ has doubled,

需要接受器官移植的病人數量倍增，

while in the same time,

但同時，

the actual number of transplants has barely gone up.

真正的器官移植術例卻幾乎沒有增加。

So this is now a public health crisis.

因此，這已經是公眾醫療健康的危機了，

So that's where this field comes in

也因此，這也是我們為什麼需要進行這個領域研究的原因，

that we call the field of regenerative medicine.

我們稱這個研究領域為 — 再生醫學。

It really involves many different areas.

它其實牽涉了許多不同的區域，

You can use, actually, scaffolds,

你可以使用，例如說：支架、

biomaterials --

生物材料 --

they're like the piece of your blouse or your shirt --

它們就好像男裝或女裝襯衫上面的一塊布料 --

but specific materials you can actually implant in patients

但是這些是由可以真正植入病人體內的專門材料所製成，

and they will do well and help you regenerate.

它們無害地在你體內，協助你再生與癒合。

Or we can use cells alone,

或是我們可以單獨使用細胞，

either your very own cells

不管是你自體本身的細胞，

or different stem cell populations.

或是不同的幹細胞群。

Or we can use both.

或者我們兩者兼用；

We can use, actually, biomaterials

事實上，我們可以將生物材料

and the cells together.

與細胞一起使用。

And that's where the field is today.

這就是今日這個領域的現況。

But it's actually not a new field.

但事實上，這並不是一個新興的領域。

Interestingly, this is a book

非常有趣地，

that was published back in 1938.

這裡有一本早在 1938 年出版的書。

It's titled "The Culture of Organs."

書名叫做《器官培養》

The first author, Alexis Carrel, a Nobel Prize winner.

第一作者是 Alexis Carrel ，一名諾貝爾獎得主。

He actually devised some of the same technologies

他實際上發明了一些

used today for suturing blood vessels,

今日縫合血管仍在使用的技術。

and some of the blood vessel grafts we use today

我們今日所使用的某些血管嫁接法

were actually designed by Alexis.

就是 Alexis 設計的。

But I want you to note his co-author:

但是我想要你們注意一下他的共同作者：

Charles Lindbergh.

查爾斯•林白

That's the same Charles Lindbergh

是的，就是那個飛越大西洋的林白，

who actually spent the rest of his life

他的後半輩子

working with Alexis

都跟著 Alexis 一起

at the Rockefeller Institute in New York

在紐約的洛克斐勒醫學研究機構（現為洛克斐勒大學）

in the area of the culture of organs.

進行器官培養的研究。

So if the field's been around for so long,

那麼，如果這個領域已經存在了這麼多年，

why so few clinical advances?

為什麼臨床的突破這麼的少？

And that really has to do to many different challenges.

這其實跟許多不同的難題有關。

But if I were to point to three challenges,

但如果讓我來列出三大心目中的難題，

the first one is actually the design of materials

第一個將會是材料的設計，

that could go in your body

一個能夠進入你的身體

and do well over time.

並且長時間穩定無害的材料。

And many advances now,

這方面現今已經有了很多的進展，

we can do that fairly readily.

我們可以相當迅速的做到這點。

The second challenge was cells.

第二個難題是細胞，

We could not get enough of your cells to grow outside of your body.

我們無法獲得足量的病人細胞，並在病人體外進行培養。

Over the last 20 years, we've basically tackled that.

在過去的廿年間，基本上我們克服了這個難題。

Many scientists can now grow many different types of cells.

許多科學家現在可以培養許多不同種類的細胞 --

Plus we have stem cells.

更何況我們還有幹細胞。

But even now, 2011,

但是就算現在，2011 年，

there's still certain cells that we just can't grow from the patient.

仍然有部分特定的細胞，我們就是無法從病人身上培養。

Liver cells, nerve cells, pancreatic cells --

肝臟細胞，神經細胞，胰臟細胞 --

we still can't grow them even today.

就算是今天，我們仍然無法培養這些細胞。

And the third challenge is vascularity,

第三個難題就是血管結構，

the actual supply of blood

能夠真正的供給血液

to allow those organs or tissues to survive

給這些器官或組織

once we regenerate them.

讓它們在人工再生後得以存活。

So we can actually use biomaterials now.

現在我們已經可以使用生物材料了。

This is actually a biomaterial.

這就是生物材料。

We can weave them, knit them, or we can make them like you see here.

我們可以對它們進行編織、接合，或是我們可以將它們做成你看到的這樣。

This is actually like a cotton candy machine.

這其實像台棉花糖機，

You saw the spray going in.

你們看到水花噴進去，

That was like the fibers of the cotton candy

這就像是棉花糖的細絲ㄧ般，

creating this structure, this tubularized structure,

組成了這個結構，這個管狀的結構，

which is a biomaterial

這就是接下來

that we can then use

我們可以用來

to help your body regenerate

幫助你身體再生的生物材料，

using your very own cells to do so.

而我們所使用的原料，是你自身的細胞。

And that's exactly what we did here.

這就是我們在這邊所做的。

This is actually a patient

這是一位病人，

who [was] presented with a deceased organ,

他的某個器官病變壞死了，

and we then created one of these smart biomaterials,

我們製造出這些智慧型生物材料，

and then we then used that smart biomaterial

並使用這些智慧型材料

to replace and repair

來取代並修復

that patient's structure.

病人自身的結構。

What we did was we actually

我們事實上

used the biomaterial as a bridge

使用生物材料來當做橋樑，

so that the cells in the organ

因此器官內的細胞

could walk on that bridge, if you will,

可以在橋樑上走動，好比說，

and help to bridge the gap

然後幫忙跨越缺口

to regenerate that tissue.

使組織再生。

And you see that patient now six months after

然後在這邊你們看到了同一位病患治療後六個月

with an X-ray showing you the regenerated tissue,

的 X 光片，你們可以看到再生的組織，

which is fully regenerated

當你在顯微鏡下仔細觀察後，

when you analyze it under the microscope.

你可以發現它已經完全癒合了。

We can also use cells alone.

我們也可以只利用細胞。

These are actually cells that we obtained.

這些是我們所獲得的細胞。

These are stem cells that we create from specific sources,

這些是我們從特定來源所製造出來的幹細胞，

and we can drive them to become heart cells,

我們可以使它們變為心藏細胞，

and they start beating in culture.

接著它們在培養基中開始跳動。

So they know what to do.

因此它們知道該做什麼，

The cells genetically know what to do,

細胞們經由遺傳而知道它們該做什麼，

and they start beating together.

然後它們開始一起跳動。

Now today, many clinical trials

今日，許多臨床試驗

are using different kinds of stem cells

使用了不同種類的幹細胞

for heart disease.

來治療心臟疾病。

So that's actually now in patients.

因此這個成果事實上已經在病人身上使用了，

Or if we're going to use larger structures

又或者，如果我們將使用更大型的結構

to replace larger structures,

來替換更大的器官，

we can then use the patient's own cells,

我們可以使用病人自身的細胞，

or some cell population,

或是一部分細胞群、

and the biomaterials,

生物材料和

the scaffolds, together.

支架構造等等一起使用。

So the concept here:

所以這裡的概念是：

so if you do have a deceased or injured organ,

如果你有一個生病或是破損的器官，

we take a very small piece of that tissue,

我們從這器官上取下一個非常小片的組織，

less than half the size of a postage stamp.

比一張郵票的一半還小。

We then tease the cells apart,

然後我們使這些細胞分離，

we grow the cells outside the body.

我們在體外培養這些細胞。

We then take a scaffold, a biomaterial --

然後我們拿取一個支架，是生物材料製成的，

again, looks very much like a piece of your blouse or your shirt --

一樣，看起來就跟你們男裝或女裝襯衫的一小片一樣。

we then shape that material,

然後我們使用這個材質來塑型，

and we then use those cells to coat that material

然後使用這些細胞包覆這個物質，

one layer at a time --

一次一層 --

very much like baking a layer cake, if you will.

就跟烘培千層糕一般，好比說。

We then place it in an oven-like device,

然後我們將它放入一個類似烘箱的裝置中，

and we're able to create that structure

然後我們就能創造出這結構

and bring it out.

並且取出它。

This is actually a heart valve

這是一個我們所製造的

that we've engineered,

心臟辦膜。

and you can see here, we have the structure of the heart valve

你可以在這邊看到，我們有心臟辦膜的結構，

and we've seeded that with cells,

然後我們在其上種滿了細胞，

and then we exercise it.

然後我們讓它做運動。

So you see the leaflets opening and closing --

所以你可以看到這些葉瓣不斷的開合 --

of this heart valve

那是這個心臟辦膜的葉瓣，

that's currently being used experimentally

這個心臟瓣膜還在實驗性試用階段，

to try to get it to further studies.

嘗試著用它來做更進一步的研究。

Another technology

另一個我們已經

that we have used in patients

在病人身上實際使用的科技

actually involves bladders.

事實上與膀胱有關。

We actually take a very small piece of the bladder from the patient --

我們從病人身上取下一片非常小的膀胱組織 --

less than half the size of a postage stamp.

比一張郵票的一半還小。

We then grow the cells outside the body,

然後我們在體外培養這些細胞，

take the scaffold, coat the scaffold with the cells --

拿取支架，以細胞包覆支架 --

the patient's own cells, two different cell types.

這些細胞來自病人自身，屬於兩種不同的細胞類型。

We then put it in this oven-like device.

然後我們將之放入這個類似烘箱的裝置，

It has the same conditions as the human body --

這裝置內的環境條件，與人體內部一樣 --

37 degrees centigrade, 95 percent oxygen.

攝氏 35 度，含氧量 95%。

A few weeks later, you have your engineered organ

數周後，你就得到了一個我們可以用來移植回病人身上

that we're able to implant back into the patient.

屬於病人的人工器官。

For these specific patients, we actually just suture these materials.

對這些特定的病人來說，我們事實上只是將這些材料給接合起來。

We use three-dimensional imagining analysis,

雖然我們使用了 3D 立體影像分析技術，

but we actually created these biomaterials by hand.

但事實上我們是手工製作這些生物材料。

But we now have better ways

但是我們現在有了更好的方法

to create these structures with the cells.

來利用細胞製造這些結構。

We use now some type of technologies,

我們現在使用某種科技，

where for solid organs, for example,

對於實心臟器，舉例來說，

like the liver,

像是肝臟，

what we do is we take discard livers.

我們拿取被丟棄不要的肝臟。

As you know, a lot of organs are actually discarded, not used.

如你所知，很多器關事實上是被丟棄的，沒有使用的。

So we can take these liver structures,

所以我們能夠使用這些肝臟的結構，

which are not going to be used,

反正也沒有人要用這些肝臟，

and we then put them in a washing machine-like structure

然後我們將其放入類似洗衣機的裝置，

that will allow the cells to be washed away.

在那，肝臟細胞將會被洗去。

Two weeks later,

兩週後，

you have something that looks like a liver.

你就得到了一個看起來像是肝臟的東西，

You can hold it like a liver,

你將它捧在手心，感覺就是個肝臟，

but it has no cells; it's just a skeleton of the liver.

但是它不含任何細胞，它只是肝臟的骨架。

And we then can re-perfuse the liver with cells,

然後我們現在可以重新將細胞散佈在肝臟上，

preserving the blood vessel tree.

保存血管的樹狀結構。

So we actually perfuse first the blood vessel tree

因此事實上我們先將血管的樹狀結構

with the patient's own blood vessel cells,

浸置在病人自己的血管細胞中，

and we then infiltrate the parenchyma with the liver cells.

然後我們再將肝臟細胞滲透到薄壁組織中。

And we now have been able just to show

現在我們能夠展示

the creation of human liver tissue

就這過去一個月

just this past month

使用這種科技

using this technology.

創造人類肝臟組織的成果。

Another technology that we've used

我們所使用的另一項科技是 —

is actually that of printing.

事實上是列印器官。

This is actually a desktop inkjet printer,

這就是一個桌上型噴墨印表機，

but instead of using ink,

但是不同於使用墨水匣，

we're using cells.

我們使用細胞。

And you can actually see here the printhead

在這邊，你可以看到其噴頭

going through and printing this structure,

正在運作並列印出這構造。

and it takes about 40 minutes to print this structure.

印出這整個構造大約需耗時四十分鐘，

And there's a 3D elevator

這邊有一個立體升降台，

that then actually goes down one layer at a time

當每次噴頭經過的時候，

each time the printhead goes through.

會一層一層的往下降。

And then finally you're able to get that structure out.

最終，你將可以得到這整個結構。

You can pop that structure out of the printer and implant it.

你可以簡單的將這構造從印表機上取下並移植它。

And this is actually a piece of bone

這是一小塊骨頭，

that I'm going to show you in this slide

在這張投影片中，我會展示給你們看，

that was actually created with this desktop printer

這就是使用桌上型印表機所製造，

and implanted as you see here.

然後如你們在這邊所看到的一般，移植到這邊。

That was all new bone that was implanted

所有這些移植的新骨頭，

using these techniques.

都是使用這些科技。

Another more advanced technology we're looking at right now,

另一個我們現在正在評估地更先進的技術，

our next generation of technologies,

我們的新一代科技，

are more sophisticated printers.

是更繁複的印表機。

This particular printer we're designing now

這個我們目前正在設計的特別印表機，

is actually one where we print right on the patient.

將會直接在病人身體上列印。

So what you see here --

因此你在這邊看到的 --

I know it sounds funny,

我知道聽起來很可笑，

but that's the way it works.

但這就是它運作的方式。

Because in reality, what you want to do

因為在現實生活中，你會希望的是 --

is you actually want to have the patient on the bed with the wound,

你希望病人躺在床上，帶著病灶，

and you have a scanner,

而你拿著掃描器，

basically like a flatbed scanner.

基本上就像個平板掃描器。

That's what you see here on the right side.

就是你在這裡右手邊所看到的，

You see a scanner technology

你看到了掃描器技術，

that first scans the wound on the patient

首先掃描病人的傷口，

and then it comes back with the printheads

然後變成噴頭回來，

actually printing the layers that you require

直接就在病人身上

on the patients themselves.

列印出你所需要的組織層。

This is how it actually works.

這就是它運作的方式。

Here's the scanner going through,

這是掃描器

scanning the wound.

掃描傷口的過程。

Once it's scanned,

一旦掃描完成，

it sends information in the correct layers of cells

它就將訊息轉換成正確的細胞層，

where they need to be.

並將它們列印在應該在的地方。

And now you're going to see here

在這邊你將會看到

a demo of this actually being done

一小段在一個代表性傷口上的

in a representative wound.

真實的操作示範。

And we actually do this with a gel so that you can lift the gel material.

我們實際上是使用凝膠來做這個示範，因此你可以將膠狀材質剝下。

So once those cells are on the patient

因此一旦這些細胞被列印在病人身上

they will stick where they need to be.

它們將會待在它們應該在的位置。

And this is actually new technology

而且事實上這是一項

still under development.

仍在發展的新科技。

We're also working on more sophisticated printers.

我們也正在研發更繁複的印表機。

Because in reality, our biggest challenge

因為在現實世界中，我們最大的難題是

are the solid organs.

實心器官。

I don't know if you realize this,

我不知道你們是否了解這點，

but 90 percent of the patients on the transplant list

但是在器官移植等待者名單上約 90% 的病人

are actually waiting for a kidney.

事實上是在等待腎臟。

Patients are dying every day

每天都有病患撐不下去而過世，

because we don't have enough of those organs to go around.

因為我們沒有足夠的這些器官流通。

So this is more challenging --

因此這是一個比

large organ, vascular,

大型器官，血管更大的難題。

a lot of blood vessel supply,

血管的供給充足，

a lot of cells present.

有很多的血管細胞能夠被取得。

So the strategy here is --

因此我們的策略是 --

this is actually a CT scan, an X-ray --

這是一個電腦斷層掃描，一個 X 光照片 --

and we go layer by layer,

然後一層層堆疊起來，

using computerized morphometric imaging analysis

使用電腦化形態影像分析

and 3D reconstruction

來重建 3D 立體影像，

to get right down to those patient's own kidneys.

來獲得病人自身腎臟的資訊。

We then are able to actually image those,

我們便能夠真正地看到它們，

do 360 degree rotation

360 度旋轉

to analyze the kidney