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  • Good afternoon.

    午安

  • 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,

    經過七個禮拜的療程後

  • 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