| 1 | TED | Alan Russell: The potential of regenerative medicine | 80675 | 502 | 53 | 38.2 | positive | 21:23 | I'm going to talk to you today about hopefully converting fear into hope. When we go to the physician today, when we go to the doctor's office and we walk in, there are words that we just don't want to hear. There are words that we're truly afraid of. Diabetes, cancer, Parkinson's, Alzheimer's, heart failure, lung failure, things that we know are debilitating diseases for which there's relatively little that can be done. What I want to lay up for you today is a different way of thinking about how to treat debilitating disease, why it's important, why without it perhaps our healthcare system will melt down if you think it already hasn't. Where we are clinically today and where we might go tomorrow and what some of the hurdles are. We're going to do all of that in 18 minutes, I promise. I want to start with this slide because this slide sort of tells the story the way science magazine thinks of it. This was an issue from 2002 that they published with a lot of different articles on the bionic human. It was basically a regenerative medicine issue. Regerative medicine is an extraordinary simple concept that everybody can understand. It's simply accelerating the pace at which the body heals itself to a clinically relevant timescale. So we know how to do this in many other ways that are up there. We know that if we have a damaged tip you can put an artificial hip in and this is the idea that science magazine used on their front cover. This is the complete antithesis of regenerative medicine. This is not regenerative medicine. Regerative medicine is what business week put up when they did a story about regenerative medicine not too long ago. The idea is that instead of figuring out how to ameliorate symptoms with devices and drugs and the like and I'll come back to that theme a few times. Instead of doing that we will regenerate lost function of the body by regenerating the function of organs and damaged tissues. So that at the end of the treatment you were the same as you were at the beginning of the treatment. Very few good ideas if you agree that this is a good idea very few good ideas are truly novel and this is just the same. If you look back in history Charles Lindbergh who was better known for flying airplanes was actually one of the first people along with Alexis Correll one of the Nobel laureates from Rockefeller to begin to think about could you culture organs and they published this book in 1937 where they actually began to think about what could you do in buyer reactors to grow whole organs. We've come a long way since then I'm going to share with you some of the exciting work that's going on but before doing that what I'd like to do is share my depression about the health care system and the need for this with you. Many of the talks yesterday talked about improving the quality of life and reducing poverty and essentially increasing life expectancy all around the globe. One of the challenges is is that the richer we are the longer we live and the longer we live the more expensive it is to take care of our diseases as we get older. This is simply the wealth of a country versus the percent of population over the age of 65 and you can basically see that the richer a country is the older the people are within it. Why is this important and why is this a particularly dramatic challenge right now? If the average age of your population is 30 then the average kind of disease that you have to treat is maybe a broken ankle every now and again maybe a little bit of asthma. If the average age in your country is 45 to 55 now the average person is looking at diabetes early onset diabetes heart failure coronary artery disease things that are inherently more difficult to treat and much more expensive to treat. Just have a look at the demographics in the US here this is from the untied states of America. In 1930 there were 41 workers per retiree 41 people who were basically outside of being really sick paying for the one retiree who was experiencing debilitating disease. In 2010 two workers per retiree in the US and this is matched in every industrialized wealthy country in the world. How can you actually afford to treat patients when the reality of getting old looks like this this is age versus cost of health care and you can see that right around age 45 40 to 45 there's a sudden spike in the in the cost of health care. It's actually quite interesting if you do the right studies you can look at how much you as an individual spend on your own health care plotted over your lifetime and about seven years before you're about to die there's a spike and you can actually we won't get into that. There are very few things very few things that you can really do that will change the way that you can treat these kinds of diseases and and experience what I would call healthy aging. I'd suggest there are four things and none of these things include an insurance system or a legal system all those things do is change who pays they don't actually change what the actual cost of the treatment is. One thing you can do is not treat you can ration health care we won't talk about that anymore it's too depressing you can prevent obviously a lot of money should be put into prevention but perhaps most interesting to me anyway most important is the idea of diagnosing a disease much earlier on in the progression and then treating the disease to cure the disease instead of treating a symptom think of in terms of diabetes for instance today with diabetes what do we do we diagnose the disease eventually once it becomes symptomatic and then we treat the symptom for 10 20 30 40 years and we do okay in Cielins a pretty good therapy but eventually it stops working and diabetes leads to a predictable onset of debilitating disease why couldn't we just inject the pancreas with something to regenerate the pancreas early on in the disease perhaps even before it was symptomatic and it might be a little bit expensive at the time that we did it but if it worked we would truly be able to do something different this video I think gets across the concept that I'm talking about quite dramatically this is a newt regrowing its limb if a newt can do this kind of thing why can't we I'll actually show you some more important features about limb regeneration in a moment but what we're talking about in regenerative medicine is doing this in every organ system of the body for tissues and for organs themselves so today today's reality is that if we get sick the messages we will treat your symptoms and you need to adjust to a new way of life I would post you that tomorrow and when tomorrow is we could debate but it's within the foreseeable future we will talk about regenerative rehabilitation there's a limb prosthetic up here similar actually to the one that the soldier that's come back from Iraq there are three hundred and seventy soldiers that have come back from Iraq that have lost limbs imagine if instead of facing that they could actually face the regeneration of that limb it's a wild concept I'll show you where we are at the moment in working towards that concept but it's applicable again to every organ system how can we do that the way to do that is to develop a conversation with the body we need to learn to speak the body's language and to switch on processes that we knew how to do when we were a fetus a mammalian fetus if it loses a limb during the first trimester of pregnancy will regrow that limb so a DNA has the capacity to do these kinds of wound healing mechanisms it's a natural process but it is lost as we age in a child before the age of about six months if they lose their fingertip in an accident they'll regrow their fingertip by the time that five they won't be able to do that anymore so to engage in that conversation with the body we need to speak the body's language and there are certain tools in our toolbox that allow us to do this today I'm going to give you an example of three of these tools through which to converse with the body the first is cellular therapies clearly we heal ourselves in a natural process using cells to do most of the work therefore if we can find the right cells and implant them in the body they may do the healing secondly we can use materials we heard yesterday about the importance of new materials if we can invent materials design materials or extract materials from a natural environment then we might be able to have those materials induce the body to heal itself and finally we may be able to use smart devices that will offload the work of the body and allow it to heal I'm going to show you an example of each of these I'm going to start with materials Steve Badlack is the University of Pittsburgh about a decade ago had a remarkable idea and that idea was that the small intestine of a pig if you threw away all the cells and if you did that in a way that allowed it to remain biologically active may contain all of the necessary factors and signals that would signal the body to heal itself and he asked a very important question he asked the question if I take that material which is a natural material that usually induces healing in the small intestine and I place it somewhere else on a person's body would it give a tissue specific response or would it make small intestine if I tried to make a new ear I wouldn't be telling you the story if it if it wasn't compelling the picture I'm about to show you is a compelling picture however for those of you that are even the slightest bit squeamish even though you may not like to admit it in front of your friends the lights are down this is a good time to look at your feet check your black berry do anything other than look at the screen what I'm about to show you what I'm about to show you is a diabetic ulcer and although it's good to laugh before we look at this this is the reality of diabetes I think a lot of times we'll hear about diabetics diabetic ulcers we just don't connect the ulcer with the eventual treatment which is amputation if you can't heal it so I'm gonna put the slide up now it won't be up for long this is a diabetic ulcer it's it's tragic the treatment for this is amputation this is a older lady she has cancer of the liver as well as diabetes and has decided to die with what's left of her body intact and this lady decided after a year of attempted treatment of that ulcer that she would try this this new therapy that Steve invented that's what her wound look like 11 weeks later that material contained only natural signals and that material induced the body to switch back on a healing response that it didn't have before there's gonna be a couple more distressing slides for those out I'll let you know when you can look again this is a horse the horse is not in pain if the horse was in pain I wouldn't show you the slide the horse just has another nostril it's developed because of a riding accident just a few weeks after treatment in this case taking that material turning it into a gel and packing that area and then repeating the treatment a few times and the horse heals up and if you took an ultrasound of that area it would look great here's a dolphin where the fins being reattached there are now 400,000 patients around the world who have used that material to heal their wounds could you regenerate a limb DARPA just gave Steve $15 million to lead a eight institution project to begin the process of asking that question and I'll show you the $15 million picture this is a 78 year old man who's lost the end of his fingertip remember that I mentioned before the the children who lose their fingertips after treatment that's what it looks like this is happening today this is clinically relevant today there are materials which do this here are hot patches could you go a little further could you say instead of using material can I take some cells along with the material and remove a damage piece of tissue put put a biodegradable material on there you can see here a little bit of hot muscle beating in a dish this was done by Taru Akano at Tokyo Women's Hospital he can actually grow beating tissue in a dish he chills the dish it changes its properties and he peels it right out of the dish it's the coolest stuff now I'm going to show you cell-based regeneration and what I'm going to show you here is stem cells being removed from the hip of a patient again if you're squeamish you don't want to watch but this one's kind of cool so this is a this is a bypass operation just like what Al Gore had with a difference in this case at the end of the bypass operation you're going to see the stem cells from the patient that were removed at the beginning of the procedure being injected directly into the heart of the patient and I'm standing up here because at one point I'm going to show you just how early this technology is here go the stem cells right into the beating heart of the patient if you look really carefully it's going to be right around this point you'll actually see a back flush you see the cells coming back out we need also to new technology new devices to get the cells to the right place at the right time just a little bit of data a tiny bit of data this was a randomized trial at this time this was an end of 20 now there's an end of about a hundred basically if you take an extremely sick patient you give them a bypass they get a little bit better if you give them stem cells as well as their bypass for these particular patients they became asymptomatic these are now two years out the coolest thing would be is if you could diagnose the disease early and prevent the onset of the disease to a bad state this is the same procedure but now done minimally invasively with only three holes in the body where they're taking the heart and simply injecting stem cells through a laparoscopic procedure they go the cells we don't have time to go into all of those details but basically that works too you can take patients who are less sick and bring them back to an almost asymptomatic state through that kind of therapy here's another example of stem cell therapy that isn't quite clinical yet but I think very soon will be this is the work of Casey Mara from Pittsburgh along with a number of colleagues around the world they've decided that liposuction fluid which in the United States we have a lot of liposuction fluid it's a great source of stem cells stem cells are packed in that liposuction fluid so you could go in you could get your tummy tuck out comes the liposuction fluid and in this case the stem cells are isolated and turned into neurons all done in the lab and I think fairly soon you will see patients being treated with their own fat derived or adipose derived stem cells I talked before about the use of devices to dramatically change the way we treat disease here's just one example before I close up this is equally tragic we have a very abiding and heartbreaking partnership with our colleagues at the Institute for Surgical Research in the US Army who have to treat the now 11,000 kids that have come back from Iraq many of those patients are very severely burned and if there's anything that's been learned about burn it's that we don't know how to treat it everything that is done to treat burn basically we do a sodding approach we make something over here and then we transplant it onto the site of the wound and we try and get the two to take in this case here a new wearable bioreactor has been designed it should be tested clinically later this year at ISR by your girl Akim Pittsburgh and that bioreactor will lay down in the wound bed the gun that you see there sprays cells that's going to spray cells over that area the reactual serve to fertilize the environment deliver other things as well at the same time and therefore we will seed that lawn as opposed to try the sodding approach it's a completely different way of doing it so my 18 minutes is up so let me finish up with some good news and maybe a little bit of bad news the good news is that this is happening today it's very powerful work clearly the images kind of get that across it's incredibly difficult because it's highly interdisciplinary almost every field of science engineering and clinical practice is involved in trying to get this to happen a number of governments and a number of regions have recognized that this is a new way to treat disease the Japanese government were perhaps the first when they decided to invest first three billion later another two billion in this field it's no coincidence Japan is the oldest country on earth terms of its average age they need this to work or their health system dies so they're putting a lot of strategic investment focused in this area the European Union same thing China the same thing China just launched a national tissue engineering center the first year budget was 250 million US dollars in the United States we've had a somewhat different approach we oh for Al Gore to come and be in the real world as president we've had a different approach and the approach has basically been to just sort of fun things as they come along but there's been no strategic investment to bring all of the necessary things to bear and focus them in a careful way and I'm going to finish up with a quote maybe a little cheap shot at the director of the NIH who's a very charming man myself and Javakanti from Harvard went to visit with him and a number of his directors of his institutes just a few months ago to try and convince him that it was time to take just a little piece of that 27.5 billion dollars that he's going to get next year and focus it in a strategic way to make sure we can accelerate the pace at which these things get to patients and at the end of a very testing meeting what the NIH director said is your vision is larger than our appetite I'd like to close by saying that no one's going to change our vision but together we can change his appetite thank you | ↗ |