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  • Translator: Morton Bast Reviewer: Thu-Huong Ha

    譯者: Alex M. Chang 審譯者: Yuguo Zhang

  • I'm going to start with a little story.

    我要用一個小故事做開場。

  • So, I grew up in this neighborhood. When I was 15 years old,

    我在這附近長大。15歲時,

  • I went from being what I think was a strapping young athlete,

    我從一個自信身材魁梧的年輕運動員,

  • over four months, slowly wasting away until

    四個多月,逐漸消瘦,

  • I was basically a famine victim

    瘦到像是個饑荒的災民,

  • with an unquenchable thirst.

    無時無刻覺得口渴

  • I had basically digested away my body.

    我的身體基本上被消化掉了。

  • And this all came to a head when I was on a backpacking trip,

    狀況嚴重到,當我自助旅行到西維吉尼亞州,

  • my first one ever actually, on Old Rag Mountain

    到 Old Rag Mountain, 那是我頭一回自助旅行

  • in West Virginia, and was putting my face into puddles

    我渴到像狗一樣趴到地上

  • of water and drinking like a dog.

    從地上的水坑喝水

  • That night, I was taken into the emergency room

    那天晚上,我被送進急診室,

  • and diagnosed as a type 1 diabetic in full-blown ketoacidosis.

    確診為第一型糖尿病、導致酮酸中毒。

  • And I recovered, thanks to the miracles of modern medicine,

    感謝現代醫學的奇蹟,胰島素和其他的東西,

  • insulin and other things, and gained all my weight back and more.

    我恢復健康,體重也回復,而且又胖了一些。

  • And something festered inside me after this happened.

    在那之後,一些念頭開始醞釀。

  • What I thought about was, what caused the diabetes?

    我開始想,到底是什麼造成糖尿病?

  • You see, diabetes is an autoimmune disease

    你們知道的,糖尿病是一種自體免疫疾病,

  • where your body fights itself, and at the time people thought

    你的身體攻擊自身正常的細胞,當時的認知是,

  • that somehow maybe exposure to a pathogen

    人體在某些狀況下接觸到的病原體

  • had triggered my immune system to fight the pathogen

    引發了免疫系統來對抗病原體

  • and then kill the cells that make insulin.

    結果殺死了製造胰島素的細胞。

  • And this is what I thought for a long period of time,

    關於這個理論,我思考了很長一段時間,

  • and that's in fact what medicine and people have focused on quite a bit,

    而醫界和大眾也大多專注在這個觀念上

  • the microbes that do bad things.

    那就是: 微生物是有害的。

  • And that's where I need my assistant here now.

    現在,我需要我的助理幫忙。

  • You may recognize her.

    你們可能認得她。

  • So, I went yesterday, I apologize, I skipped a few of the talks,

    其實,昨天,很抱歉的,我跳過了一些會談,

  • and I went over to the National Academy of Sciences building,

    去了國家科學院的大樓一趟,

  • and they sell toys, giant microbes.

    那邊有賣玩具,巨型微生物。

  • And here we go!

    所以...接住!

  • So you have caught flesh-eating disease if you caught that one.

    如果你接住那一個,你已經得到噬肉菌了

  • I gotta get back out my baseball ability here.

    很明顯的我已經很久沒玩棒球了

  • (Laughter)

    (笑聲)

  • So, unfortunately or not surprisingly, most of the microbes

    因此,不幸的,但不意外的是,國家科學院大樓賣的微生物娃娃,

  • they sell at the National Academy building are pathogens.

    大多數都是病菌,

  • Everybody focuses on the things that kill us,

    大家都只看到有害致死的東西,

  • and that's what I was focusing on.

    那也是我當時研究的重點。

  • And it turns out that we are covered in a cloud of microbes,

    事實上,我們被厚厚一層微生物雲覆蓋,

  • and those microbes actually do us good much of the time,

    而這些微生物大多時對我們有益,

  • rather than killing us.

    並不會致我們於死地。

  • And so, we've known about this for some period of time.

    而且我們了解這點已經有一段時間了。

  • People have used microscopes to look at the microbes that cover us,

    人們用顯微鏡觀察研究覆蓋人體的微生物,

  • I know you're not paying attention to me, but ...

    我知道你沒有在聽我講話,但...

  • (Laughter)

    (笑聲)

  • The microbes that cover us.

    這些覆蓋人體的微生物。

  • And if you look at them in the microscope,

    如果你用顯微鏡觀察它們,

  • you can see that we actually have 10 times as many cells

    你會發現,在人身上,

  • of microbes on us as we have human cells.

    微生物細胞數量其實會有人體細胞的10倍。

  • There's more mass in the microbes than the mass of our brain.

    而這些微生物的總重量比我們的大腦還重。

  • We are literally a teeming ecosystem of microorganisms.

    我們的身體是其實的微生物豐富的生態系統。

  • And unfortunately, if you want to learn about the microorganisms,

    可惜的是,如果你想了解這些微生物,

  • just looking at them in a microscope is not sufficient.

    只是用顯微鏡觀察是不夠的

  • And so we just heard about the DNA sequencing.

    我們剛才聽到的DNA定序,

  • It turns out that one of the best ways to look at microbes

    後來發現是研究微生物的最佳方法之一,

  • and to understand them is to look at their DNA.

    藉由研究它們的DNA,我們得到更多資訊。

  • And that's what I've been doing for 20 years,

    而這是我這20年來的一直在做的,

  • using DNA sequencing, collecting samples from various places,

    我用DNA定序分析不同來源收集的樣本,

  • including the human body, reading the DNA sequence

    包括人體樣本。藉由DNA定序技術,

  • and then using that DNA sequencing to tell us about

    我們可以從收集到DNA序列來了解

  • the microbes that are in a particular place.

    特定地方的微生物。

  • And what's amazing, when you use this technology,

    神奇的是,當你使用這個技術

  • for example, looking at humans, we're not just covered

    研究,例如,人體,覆蓋我們的微生物

  • in a sea of microbes.

    不只是數量眾多,

  • There are thousands upon thousands of different kinds of microbes on us.

    這些微生物有數千種不同的種類。

  • We have millions of genes of microbes in our human

    我們身上的「人體微生物群系」包含了

  • microbiome covering us.

    數百萬的基因,

  • And so this microbial diversity differs between people,

    而且每個人身上的微生物體系的組成都不相同,

  • and what people have been thinking about in the last 10,

    在過去10或15年,人們一直在思考,

  • maybe 15 years is, maybe these microbes,

    也許是人體裡外的微生物,

  • this microbial cloud in and on us,

    每個人身上的微生物雲

  • and the variation between us, may be responsible

    組成的差異,可能決定了

  • for some of the health and illness differences between us.

    一些的健康和疾病上的個體差異。

  • And that comes back to the diabetes story I was telling you.

    而這回到剛剛的我的糖尿病故事,

  • It turns out that people now think that one of the triggers

    現在人們認為,引發一型糖尿病的原因

  • for type 1 diabetes is not fighting a pathogen,

    不是因為人體不去對抗病原體,

  • but is in fact trying to -- miscommunicating with the microbes

    而是人體跟居住於其內外的微生物群

  • that live in and on you.

    溝通不良。

  • And somehow maybe the microbial community that's

    而也許是在我身上的微生物群突然不知怎的

  • in and on me got off, and then this triggered some sort

    消失了,然後引發某種免疫反應,

  • of immune response and led to me killing the cells

    導致我體內製造胰島素的細胞

  • that make insulin in my body.

    被攻擊破壞。

  • And so what I want to tell you about for a few minutes is,

    所以,接下來這幾分鐘,我想分享的是,

  • what people have learned using DNA sequencing techniques

    經由DNA定序技術,我們學到了些什麼,

  • in particular, to study the microbial cloud

    尤其是在研究人體內外的

  • that lives in and on us.

    存在的微生物雲。

  • And I want to tell you a story about a personal project.

    我現在要告訴你們另一個故事,是關於我的個人計畫。

  • My first personal experience with studying the microbes

    我第一次開始研究人體微生物的個人經驗,

  • on the human body actually came from a talk that I gave,

    其實是緣起一個我發表的講座。

  • right around the corner from here at Georgetown.

    那講座是在喬治城,就在附近而已。

  • I gave a talk, and a family friend who happened to be

    我是主講人,喬治城醫學院院長

  • the Dean of Georgetown Medical School was at the talk,

    也是我們家族的朋友,出席了那個講座。

  • and came up to me afterwards saying, they were doing

    講座結束後,院長上前來告訴我

  • a study of ileal transplants in people.

    他們正在做人體迴腸移植的研究。

  • And they wanted to look at the microbes after the transplants.

    他們想研究移植後的微生物分布情況。

  • And so I started a collaboration with this person,

    所以我開始跟 Michael Zasloff 及 Thomas Fishbein合作,

  • Michael Zasloff and Thomas Fishbein, to look at the microbes

    我們觀察迴腸移植後,

  • that colonized these ilea after they were transplanted into a recipient.

    微生物在迴腸內繁殖的情形。

  • And I can tell you all the details about the microbial study

    我可以告訴你這個微生物研究的所有細節

  • that we did there, but the reason I want to tell you this story

    還有我們做了什麼。但我想告訴你這個故事的原因

  • is something really striking that they did at the beginning

    是因為在研究計畫的初期階段,他們做了一個

  • of this project.

    很特別的嘗試。

  • They take the donor ileum, which is filled with microbes from a donor

    他們取得捐贈者的迴腸,充滿捐贈者身上的微生物,

  • and they have a recipient who might have a problem

    同時,受贈的病人體內微生物群也許已經失常了,

  • with their microbial community, say Crohn's disease,

    舉例來說,克隆氏症的患者,

  • and they sterilized the donor ileum.

    然後他們消毒捐贈者的迴腸,

  • Cleaned out all the microbes, and then put it in the recipient.

    清除所有的微生物,然後移植到受贈患者的體內。

  • They did this because this was common practice

    他們這樣做,是因為醫學上這是通常的手續,

  • in medicine, even though it was obvious

    即使很明顯的,

  • that this was not a good idea.

    並不是個好主意。

  • And fortunately, in the course of this project,

    還好,在這個研究的過程中

  • the transplant surgeons and the other people

    移植外科醫生和所有其他成員,

  • decided, forget common practice. We have to switch.

    決定:「別用慣用的手續了,我們必須更新做法。」

  • So they actually switched to leaving some of the microbial

    因此,他們留下部分原有的微生物群

  • community in the ileum. They leave the microbes with the donor,

    在迴腸裡。這些從捐贈者來源留下來

  • and theoretically that might help the people who are

    的微生物,理論上,可能會

  • receiving this ileal transplant.

    對接受移植的人有幫助。

  • And so, people -- this is a study that I did now.

    所以了,大家,這就是我過去幾年中所做的研究。

  • In the last few years there's been a great expansion

    用DNA技術來檢視人體微生物的研究

  • in using DNA technology to study the microbes in and on people.

    在過去幾年來有很大的擴展。

  • There's something called the Human Microbiome Project

    人類微生物群系研究計畫

  • that's going on in the United States,

    正在美國進行中,

  • and MetaHIT going on in Europe, and a lot of other projects.

    而在歐洲,人類腸道菌叢誌基因辨異研究計畫(MetaHIT),和很多其他的研究也在進行。

  • And when people have done a variety of studies,

    當人們做了各種研究,

  • they have learned things such as, when a baby is

    他們發現,如,當一個嬰兒

  • born, during vaginal delivery you get colonized by the

    經由產道出生時,會得到

  • microbes from your mother.

    母體的微生物群。

  • There are risk factors associated with cesarean sections,

    剖腹產是帶有風險的,

  • some of those risk factors may be due to mis-colonization

    部分的風險因素可能起因為,

  • when you carve a baby out of its mother

    嬰兒直接經由剖腹被取出母體時

  • rather than being delivered through the birth canal.

    無法經由產道取得母體的菌群。

  • And a variety of other studies have shown that the

    許多不同的研究已經發現,

  • microbial community that lives in and on us

    在於我們體內及表面的微生物群落,

  • helps in development of the immune system,

    有益於我們免疫系統的發展,

  • helps in fighting off pathogens, helps in our metabolism,

    幫助我們擊退病原體,促進新陳代謝,

  • and determining our metabolic rate, probably

    並調節我們的代謝速度,可能

  • determines our odor, and may even shape our behavior

    還形成了我們的體味,甚至在很多的方面都,

  • in a variety of ways.

    影響我們的行為.

  • And so, these studies have documented or suggested

    而且這些研究已經證明或是推斷

  • out of a variety of important functions for the microbial community,

    各種重要機能經由這些微生物群、

  • this cloud, the non-pathogens that live in and on us.

    這層雲、非-病原體,在我們體內及體表的運作。

  • And one area that I think is very interesting,

    有個領域我覺得相當有意思的是,

  • which many of you may have now that we've thrown

    剛剛既然我們丟了一堆菌給你們,你們之中有許多人也許有這個

  • microbes into the crowd, is something that I would call "germophobia."

    我會稱之為「 恐菌症」。

  • So people are really into cleanliness, right?

    人們真的很重視清潔,你說是嗎?

  • We have antibiotics in our kitchen counters,

    我們廚房流理台上有抗菌產品,

  • people are washing every part of them all of the time,

    人們無時無刻在清洗身上的每個部分,

  • we pump antibiotics into our food, into our communities,

    抗生素被注入我們的食物、我們的居住環境,

  • we take antibiotics excessively.

    我們無結制地濫用抗生素。

  • And killing pathogens is a good thing if you're sick,

    如果你生病,殺光病原體是好事,

  • but we should understand that when we pump chemicals

    但是我們必須了解,當我們使用化學製品

  • and antibiotics into our world, that we're also killing

    跟抗生素在我們的環境裡,我們同時也在抹滅

  • the cloud of microbes that live in and on us.

    跟我們共生的微生物雲。

  • And excessive use of antibiotics, in particular in children,

    抗生素的過度使用,尤其是在兒童身上,

  • has been shown to be associated with, again, risk factors

    研究發現,跟造成肥胖、自體免疫疾病

  • for obesity, for autoimmune diseases, for a variety

    還有其他各種健康問題的風險因素息息相關,

  • of problems that are probably due to disruption

    因為人體的微生物群落,

  • of the microbial community.

    被抗生素干擾破壞。

  • So the microbial community can go wrong

    所以微生物群落可能會失常,

  • whether we want it to or not,

    不管我們喜不喜歡,

  • or we can kill it with antibiotics,

    或者可以用抗生素殺光這些微生物,

  • but what can we do to restore it?

    但我們怎樣可以重建微生物群落?

  • I'm sure many people here have heard about probiotics.

    我相信這裡有很多人聽說過關於益生菌。

  • Probiotics are one thing that you can try and do to restore

    益生菌可以用來嘗試

  • the microbial community that is in and on you.

    重建體內及體表的微生物群落,

  • And they definitely have been shown to be effective in some cases.

    而且已經有些成功的案例。

  • There's a project going on at UC Davis where people are using

    在加州大學戴維斯分校正在進行一個計畫,

  • probiotics to try and treat, prevent,

    他們嘗試用益生菌來治療和預防

  • necrotizing enterocolitis in premature infants.

    早產兒的壞死性腸炎。

  • Premature infants have real problems with their microbial community.

    早產兒的身上的微生物群落問題多多,

  • And it may be that probiotics can help prevent

    而也許益生菌可以幫助預防

  • the development of this horrible necrotizing enterocolitis

    早產兒罹患

  • in these premature infants.

    這可怕的壞死性腸炎。

  • But probiotics are sort of a very, very simple solution.

    但是,益生菌是一個非常,非常簡易的解決方式。

  • Most of the pills that you can take or the yogurts that you can eat

    大多數的益生菌錠或是優酪乳

  • have one or two species in them, maybe five species in them,

    含有一或兩種菌種,或是五種菌種,

  • and the human community is thousands upon thousands of species.

    而人體的微生物群系有數千種的菌種。

  • So what can we do to restore our microbial community

    所以,什麼方法可以重建我們的微生物群系

  • when we have thousands and thousands of species on us?

    當我們的微生物群系是由數千種菌種組成的?

  • Well, one thing that animals seem to do is,

    嗯,動物所做的一件事是,

  • they eat poo -- coprophagia.

    他們吃便便 - 所謂的嗜糞癖。

  • And it turns out that many veterinarians,

    原來,許多獸醫,

  • old school veterinarians in particular,

    尤其是老經驗的獸醫,

  • have been doing something called "poo tea,"

    一直在用一種叫「便便茶」,

  • not booty, but poo tea, to treat colic and other

    不是屁屁,而是便便茶,來治療馬和牛

  • ailments in horses and cows and things like that,

    腹絞痛及其他之類的毛病。

  • where you make tea from the poo from a healthy

    作法是用健康的動物的糞便做成茶,

  • individual animal and you feed it to a sick animal.

    然後餵食給生病的動物。

  • Although, unless you have a fistulated cow with a big hole in its side,

    但是,除非你有隻牛,肚子一側開了一個大洞,

  • and you can put your hand into its rumen,

    你可以把你的手,伸入牠的瘤胃之外,

  • it's hard to imagine that the delivery of microbes

    很難想像,從嘴巴經過整個上消化道

  • directly into the mouth and through the entire

    將微生物送入

  • top of the digestive tract is the best delivery system,

    會是最好的運輸方式。

  • so you may have heard in people they are now doing

    所以,你可能已經聽說有人在做

  • fecal transplants, where rather than delivering

    糞便移植,與其將少數益生菌種

  • a couple of probiotic microbes through the mouth,

    經由口部送入,

  • they are delivering a community of probiotics,

    他們是將整個益生菌的群系,

  • a community of microbes from a healthy donor,

    從健康的捐贈者取得的群系,

  • through the other end.

    從消化道的另一端送入。

  • And this has turned out to be very effective in fighting

    結果發現這樣做對於

  • certain intransigent infectious diseases

    對抗某些頑固的傳染病非常有效。

  • like Clostridium difficile infections that can stay

    例如可以存留人體多年的

  • with people for years and years and years.

    困難腸梭菌。

  • Transplants of the feces, of the microbes from the feces,

    經由糞便移植,

  • from a healthy donor has actually been shown to cure

    取得健康捐贈者的糞便中的微生物,

  • systemic C. dif infections in some people.

    事實上已經有成功治癒困難腸梭菌感染的案例。

  • Now what these transplants, these fecal transplants, or

    因為這些新的移植手術手法、糞便移植

  • the poo tea suggest to me, and many other people

    或是便便茶的應用,讓我還有許多人

  • have come up with this same idea, is that

    有了同一個想法,就是

  • the microbial community in and on us, it's an organ.

    這存在於我們體內及表面的微生物群系,其實是個器官。

  • We should view it as a functioning organ, part of ourselves.

    我們應該把這當做是一個正常運作的器官,自己的一部分看待。

  • We should treat it carefully and with respect,

    我們應該認真對待和尊重,

  • and we do not want to mess with it, say by C-sections

    不應該擾亂其平衡,像是沒有必要的狀況下,

  • or by antibiotics or excessive cleanliness,

    進行剖腹產、使用抗生素、

  • without some real good justification.

    或是過度清潔。

  • And what the DNA sequencing technologies are allowing people to do now

    而因為DNA定序技術,今天人們可以

  • is do detailed studies of, say, 100 patients who have Crohn's disease

    做詳細的研究,比方說,比較100個克隆氏症患者

  • and 100 people who don't have Crohn's disease.

    跟100個沒有克隆氏症的人。

  • Or 100 people who took antibiotics when they were little,

    或是比較100個小時候服用過生素的人,

  • and 100 people who did not take antibiotics.

    跟100個沒有服用抗生素的人。

  • And we can now start to compare the community of microbes

    我們現在可以開始比較群系裡的微生物,

  • and their genes and see if there are differences.

    和他們的基因,看看是否有差異。

  • And eventually we may be able to understand if they're not

    最終我們可能能夠明白,是否他們不

  • just correlative differences, but causative.

    只是有相關的差異,還有因果上的差異性。

  • Studies in model systems like mouse and other animals

    使用老鼠或是其他動物的實驗模型系統所做的研究,

  • are also helping do this, but people are now using

    也同時幫助我們了解更多,但人們使用DNA

  • these technologies because they've gotten very cheap,

    技術是因為其成本已經變得非常低廉,

  • to study the microbes in and on a variety of people.

    可研究不同人身上的微生物。

  • So, in wrapping up, what I want to tell you about is,

    作為總結,我現在想告訴你們的是,

  • I didn't tell you a part of the story of coming down with diabetes.

    我剛剛沒告訴你們我得到糖尿病的過程。

  • It turns out that my father was an M.D.,

    其實,我父親是醫生,

  • actually studied hormones. I told him many times

    而且他的專科是研究內分泌激素。 很多次我告訴他,

  • that I was tired, thirsty, not feeling very good.

    我很累,很渴,人很不舒服。

  • And he shrugged it off, I think he either thought

    他聳聳肩,我認為,他要麼想,

  • I was just complaining a lot, or it was the typical

    我只是愛抱怨,或是

  • M.D. "nothing can be wrong with my children."

    醫生常有的「我的小孩怎麼可能會有毛病」心態

  • We even went to the International Society of Endocrinology

    甚至 我們全家一起去魁北克

  • meeting as family in Quebec.

    參加國際內分泌學會會議時,

  • And I was getting up every five minutes to pee,

    我每五分鐘就要起床尿尿,

  • and drinking everybody's water at the table,

    吃飯時我渴到得喝光每個人的水

  • and I think they all thought I was a druggie.

    我想,他們大概都認為我嗑藥了。

  • (Laughter)

    (笑聲)

  • But the reason I'm telling you this is that

    但我告訴你這個的原因是,

  • the medical community, my father as an example,

    醫學界,以我父親作為一個例子,

  • sometimes doesn't see what's right in front of their eyes.

    有時反而看不見眼前發生的事。

  • The microbial cloud, it is right in front of us.

    這層微生物雲,就在我們眼前,

  • We can't see it most of the time. It's invisible.

    即使大部分時間我們看不見它,它是隱形的。

  • They're microbes. They're tiny.

    微生物是極渺小的,

  • But we can see them through their DNA,

    但是我們可以看見他們,經由他們的DNA。

  • we can see them through the effects that they have on people.

    但是我們可以看見他們,經由他們對人們的影響。

  • And what we need now

    而我們現在需要的是,

  • is to start thinking about this microbial community in the context

    開始思考微生物群落

  • of everything in human medicine.

    在人類醫學的每一個層面。

  • It doesn't mean that it affects every part of us,

    這不表示微生物影響我們的每一部分,

  • but it might.

    但不排除這樣的可能性。

  • What we need is a full field guide to the microbes

    我們需要的是對人體的微生物

  • that live in and on people, so that we can understand

    有一個整體的了解,才能了解

  • what they're doing to our lives.

    他們對我們生活的影響。

  • We are them. They are us.

    微生物跟人類,共生共存。

  • Thank you.

    謝謝

  • (Applause)

    (掌聲)

Translator: Morton Bast Reviewer: Thu-Huong Ha

譯者: Alex M. Chang 審譯者: Yuguo Zhang

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