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SiddharthaMukherjee_2015-_忘记药丸吧，细胞疗法即将到来_
I want to talk to you about the future of medicine. 我想跟各位聊聊未来的药物。
But before I do that, I want to talk a little bit about the past. 在聊未来之前,我想稍稍回顾一下过去。
Now, throughout much of the recent history of medicine, we've thought about illness and treatment in terms of a profoundly simple model. 纵观医疗药物的历史, 我们对于疾病和药物治疗的观念 还停留在一个非常简单的模型上。
throughout:adv.自始至终,到处;全部;prep.贯穿,遍及; treatment:n.治疗;疗法;对待;处理;讨论; profoundly:adv.深刻地;深深地;极度地;
In fact, the model is so simple that you could summarize it in six words: have disease , take pill , kill something. 事实上这个模型简单到 可以用六个英语单词概括: 生病,吃药,杀死一些东西。
summarize:v.总结;概述;概括;归纳; disease:n.病,[医]疾病;弊病;vt.传染;使…有病; pill:n.[医]药丸;药品;
Now, the reason for the dominance of this model is of course the antibiotic revolution . 这个简单的模型占据主导地位 原因显然是由于抗生素革命带来的。
dominance:n.优势;统治;支配; antibiotic:adj.抗生的;抗菌的;n.抗生素,抗菌素; revolution:n.革命;旋转;运行;循环;
Many of you might not know this, but we happen to be celebrating the hundredth year of the introduction of antibiotics into the United States. 可能很少有人知道,我们前不久 刚刚庆祝了抗生素进入美国一百周年。
antibiotics:n.抗菌素;抗生素(如青霉素);(antibiotic的复数) United:adj.联合的; v.联合,团结; (unite的过去分词和过去式)
But what you do know is that that introduction was nothing short of transformative . 但你们一定知道, 抗生素的引入简直是个重大变革。
transformative:adj.变化的,变形的;有改革能力的;
Here you had a chemical , either from the natural world or artificially synthesized in the laboratory , and it would course through your body, it would find its target, lock into its target -- a microbe or some part of a microbe -- and then turn off a lock and a key with exquisite deftness , exquisite specificity . 你拿到的化学制剂,不管是从自然提取的 还是从实验室人工合成的, 服用之后它会遍布至你的全身 找到它的目标 然后锁定目标—— 一种微生物或者它的一部分—— 通过非常精巧和特别的手段 关闭目标的某一个功能。
chemical:n.化学制品,化学药品;adj.化学的; artificially:adv.人工地;人为地;不自然地; synthesized:adj.合成的;综合的;v.合成(synthesize的过去分词);综合; laboratory:n.实验室,研究室; microbe:n.细菌,微生物; exquisite:adj.精致的;细腻的;优美的,高雅的;异常的;剧烈的;n.服饰过于讲究的男子; deftness:n.熟练;灵巧;敏捷; specificity:n.[免疫]特异性;特征;专一性;
And you would end up taking a previously fatal , lethal disease -- a pneumonia , syphilis , tuberculosis -- and transforming that into a curable , or treatable illness. 结果就是当你感染了过去的不治之症—— 例如肺炎,梅毒,肺结核—— 变成可以治愈的疾病。
previously:adv.先前;以前; fatal:adj.致命的;灾难性的;毁灭性的;导致失败的; lethal:adj.致命的,致死的;n.致死因子; pneumonia:n.肺炎; syphilis:n.[性病]梅毒; tuberculosis:n.肺结核;结核病; transforming:v.使改变形态;使改变外观(或性质);使改观;(transform的现在分词) curable:adj.可治愈的;可医治的;可矫正的; treatable:adj.能治疗的;好对付的;能处理的;
You have a pneumonia, you take penicillin , you kill the microbe and you cure the disease. 这个巨大网络的一个小小边角。 你可以服用盘尼西林, 你杀死了微生物, 你治好了疾病。
penicillin:n.盘尼西林(青霉素);
So seductive was this idea, so potent the metaphor of lock and key and killing something, that it really swept through biology . 多么美妙的想法, 钥匙、锁的比喻多么贴切 还有杀死一些东西的归纳, 横扫了生物医学。
seductive:adj.有魅力的;性感的;引人注意的; potent:adj.有效的;强有力的,有权势的;有说服力的; metaphor:n.暗喻,隐喻;比喻说法; swept:v.扫除(sweep的过去式和过去分词);adj.扫频的; biology:n.(一个地区全部的)生物;生物学;
It was a transformation like no other. 这种转变是史无前例的。
transformation:n.转变;(用于南非)民主改革;
And we've really spent the last 100 years trying to replicate that model over and over again in noninfectious diseases , in chronic diseases like diabetes and hyperte nsion and heart disease. 而过去100年间 我们一直不停的尝试复制这个模型 想要用到非感染导致的疾病上, 像是糖尿病、高血压、心脏病之类的慢性病。
replicate:vt.复制; vi.重复; adj.复制的; n.复制品; over and over again:adv.一再地;反复不断地; noninfectious:adj.非传染性的; diseases:n.[医]病(disease的复数);[医]疾病;[植保]病害;疾病种类; chronic:adj.慢性的;长期的;习惯性的;
And it's worked, but it's only worked partly. 有些管用,有些不行。
Let me show you. 让我来详细说明。
You know, if you take the entire universe of all chemical reactions in the human body, every chemical reaction that your body is capable of, most people think that that number is on the order of a million. 现在如果把你体内 所有可能的化学反应 都列举出来组成一个大集合 大部分人都会觉得至少得上百万种反应。
reactions:n.反应;回应;抗拒;生理反应;副作用(reaction的复数) capable:adj.能干的,能胜任的;有才华的;
Let's call it a million. 我们假设是100万种。
And now you ask the question, what number or fraction of reactions can actually be targeted by the entire pharmacopoeia, all of medicinal chemistry? 现在你会问, 在所有药物的医学化学反应中 有多少部分是真正能够有效锁定的?
fraction:n.分数;小部分;小数;少量; medicinal:adj.药的;药用的;治疗的(等于medicinable);有益的;
That number is 250. 答案是250个。
The rest is chemical darkness. 其他是未知的化学领域。
In other words, 0.025 percent of all chemical reactions in your body are actually targetable by this lock and key mechanism . 换句话说你体内只有 0.025% 的化学反应 适用于现在的钥匙和锁的机制。
targetable:可命中目标的; mechanism:n.机制;原理,途径;进程;机械装置;技巧;
You know, if you think about human physiology as a vast global telephone network with interacting nodes and interacting pieces, then all of our medicinal chemistry is operating on one tiny corner at the edge, the outer edge, of that network. 如果你将人体生理学 看成是一个巨大的全球的电话网络, 有着相互作用的节点和部分, 那么我们所有的化学药物加起来 也只是占据了 这个巨大网络的一个小小边角。
physiology:n.生理学;生理机能; global:adj.全球的;总体的;球形的; interacting:v.交流;沟通;合作;相互影响;(interact的现在分词) nodes:n.茎节;(根或枝上的)瘤,节,结;节点;(node的复数) outer:adj.外面的,外部的;远离中心的;n.环外命中;
It's like all of our pharmaceutical chemistry is a pole operator in Wichita , Kansas who is tinkering with about 10 or 15 telephone lines. 我们现有的药物加起来就像是 堪萨斯州州威奇托市的一个小小接线员 在笨拙地处理10条或15条电话线。
pharmaceutical:adj.制药(学)的;n.药物; pole:n.磁极;电极;柱子;杆子;v.用篙撑船;摆船; operator:n.算子;接线员;操作人员;骗子; Wichita:n.威奇托(美国堪萨斯州城市); Kansas:n.堪萨斯州(美国州名); tinkering:v.(尤指不起作用地)小修补,小修理;(tinker的现在分词)
So what do we do about this idea? 所以现在我们应该怎么办？
What if we reorganized this approach ? 我们是否能够重新组织现有的方式？
What if:如果…怎么办? reorganized:v.重组(reorganize的过去分词);整顿;重新制定;adj.重组的;重新制定的; approach:n.方法;路径;v.接近;建议;着手处理;
In fact, it turns out that the natural world gives us a sense of how one might think about illness in a radically different way, rather than disease, medicine, target. 事实上,我们发现自然界 为我们提供了一个完全不一样的视角 去看待疾病。 跟“疾病,药物,目标”模式不同。
radically:adv.根本上;彻底地;以激进的方式;
In fact, the natural world is organized hierarchically upwards , not downwards , but upwards , and we begin with a self-regulating , semi-autonomous unit called a cell. 自然界是自下向上的一层一层发展起来的, 不是自上向下,而是自下而上。 我们首先有了一些能够自我控制、半自主的单位,称为细胞。
hierarchically:adv.分层次,分等级地; upwards:adv.向上;在上部;向上游; downwards:adv.向下,往下; self-regulating:adj.自制的;自动调节的; semi-autonomous:半自治的;
These self-regulating, semi-autonomous units give rise to self-regulating, semi-autonomous units called organs , and these organs coalesce to form things called humans, 这些基本的单元 结合在一起组成了器官, 这些器官有机地组合在一起,构成了人
give rise to:使发生,引起; organs:n.[生物]器官;机构;风琴(organ的复数); coalesce:vi.合并;结合;联合;vt.使…联合;使…合并;
and these organisms ultimately live in environments, which are partly self-regulating and partly semi-autonomous. 这最终构造了这个丰富的生态系统。 这个系统也是能够自我约束,是半自主的。
organisms:n.[生物]生物体(organism的复数);[生物]有机体; ultimately:adv.最终;最后;归根结底;终究;
What's nice about this scheme , this hierarchical scheme building upwards rather than downwards, is that it allows us to think about illness as well in a somewhat different way. 这种层次化的模式的好处在于, 相对于自上向下的模式而言, 它带给了我们一个完全不同的视角 去看待疾病。
scheme:n.计划;方案;体系;体制;阴谋;v.密谋;图谋;想;认为; somewhat:n.几分;某物;adv.有点;多少;几分;稍微;
Take a disease like cancer . 拿癌症作为例子。
cancer:n.癌症;恶性肿瘤;
Since the 1950s, we've tried rather desperately to apply this lock and key model to cancer. 自从1950年代以来, 我们竭尽全力用锁和钥匙的模型去攻克癌症。
desperately:adv.拼命地;绝望地;不顾一切地;极度地; apply:v.申请;涂,敷;应用;适用;请求;
We've tried to kill cells using a variety of chemotherapies or targeted therapies, and as most of us know, that's worked. 我们用了大量的靶向疗法 和放化疗手段去杀死细胞, 我们都知道这取得了一些效果。
variety:n.多样;种类;杂耍;变化,多样化; chemotherapies:n.[医]化学疗法;(chemotherapies是chemotherapy的复数);
It's worked for diseases like leukemia . 对于白血病这样的疾病有效。
leukemia:n.[内科][肿瘤]白血病;
It's worked for some forms of breast cancer, but eventually you run to the ceiling of that approach. 对于某些类型的乳腺癌有效, 但是最终你走到了这条路的尽头。
eventually:adv.最后,终于;
And it's only in the last 10 years or so that we've begun to think about using the immune system , remembering that in fact the cancer cell doesn't grow in a vacuum . 直到近10年前左右 我们开始考虑利用自身的免疫系统, 毕竟癌细胞并不是长在真空里的。
immune system:n.免疫系统; vacuum:n.真空; adj.真空的; v.用真空吸尘器清扫;
It actually grows in a human organism. 癌细胞确实是长在人体器官里的。
And could you use the organismal capacity , the fact that human beings have an immune system, to attack cancer? 你可以用器官自身的机制来防御。 所以能够借用人类自身的免疫系统去攻击癌细胞？
capacity:n.能力;容量;资格,地位;生产力;
In fact, it's led to the some of the most spectacular new medicines in cancer. 事实上这个思维转变诞生了一些非常令人瞩目的新药物。
spectacular:adj.壮观的;壮丽的;令人惊叹的;n.壮观的场面;精彩的表演;
And finally there's the level of the environment, isn't there? 最后还有环境级别的问题,不是么？
finally:adv.终于;最终;(用于列举)最后;彻底地;
You know, we don't think of cancer as altering the environment. 当我们改变环境的时候,没想过癌症的问题
altering:n.变更;v.变更(alter的现在分词);
But let me give you an example of a profoundly carcinogenic environment. 但是让我来给你展示一个高度致癌物环境。
carcinogenic:adj.致癌的;致癌物的;
It's called a prison. 称之为「囚禁」。
You take loneliness, you take depression , you take confinement , and you add to that, rolled up in a little white sheet of paper, one of the most potent neurostimulants that we know, called nicotine , 你拿来孤独,你加上沮丧,再加上约束, 都加上, 放在一张白纸上卷起来, 加上一种最为有效的神经刺激物,尼古丁,
depression:n.沮丧;洼地;不景气;忧愁; confinement:n.限制;监禁;分娩; sheet:n.薄板;床单;纸张;报纸;v.覆盖;展开;给…铺床单;铺开;adj.片状的; nicotine:n.[有化]尼古丁;[有化]烟碱;
and you add to that one of the most potent addictive substances that you know, and you have a pro-carcinogenic environment. 你把这种最容易成瘾的致癌成分放进来, 你就有了一个容易引发癌症的环境。
addictive:adj.使人上瘾的;使人入迷的; substances:n.[物]物质;基本内容;物品药物(substance的复数);
But you can have anti-carcinogenic environments too. 但是你也可以拥有抗癌症环境。
There are attempts to create milieus, change the hormonal milieu for breast cancer, for instance . 可以尝试自己创造一个小环境, 例如为了预防乳腺癌而改变荷尔蒙环境。
attempts:n.企图,试图;尝试(attempt的复数);v.试图;努力去做(attempt的三单形式); hormonal:adj.荷尔蒙的,激素的; milieu:n.环境;周围;出身背景; instance:n.实例;情况;建议;v.举...为例;
We're trying to change the metabolic milieu for other forms of cancer. 我们正在尝试为其它癌症而改变新陈代谢环境。
metabolic:adj.变化的;新陈代谢的;
Or take another disease, like depression. 或者像是抑郁这样的疾病。
Again, working upwards, since the 1960s and 1970s, we've tried, again, desperately to turn off molecules that operate between nerve cells -- serotonin , dopamine -- and tried to cure depression that way, and that's worked, but then that reached the limit. 再次重申,自下向上地, 从1960和1970年代开始,我们当时还是竭力地 尝试去关闭神经细胞之间运行的分子 如血清素、多巴胺 尝试从这个角度治疗抑郁。 一开始有一些进展,但是很快就走到了尽头。
molecules:n.[化学]分子,微粒;[化学]摩尔(molecule的复数); nerve:n.神经;勇气;神经质;神经紧张;v.鼓足勇气;振作精神; serotonin:n.[生化]血清素;5-羟色胺(血管收缩素); dopamine:n.[生化]多巴胺(一种治脑神经病的药物);
And we now know that what you really probably need to do is to change the physiology of the organ, the brain, rewire it, remodel it, and that, of course, we know study upon study has shown that talk therapy does exactly that, and study upon study has shown that talk therapy combined with medicines, pills , really is much more effective than either one alone. 现在我们知道,更好的方式 或许是改变组织的生理状况,也就是大脑的结构 改变大脑的结构和连接, 而且,理所当然的,我们注意到 谈话疗法能够有效的做到这一点, 并且后续的研究也表明 谈话疗法和药物质量的结合 要比单独使用任何一种方法都要更加有效。
rewire:vt.给…再打电报;给…换新电线;vi.再发电报;重装电线; remodel:vt.改造;改变;改型; therapy:n.治疗,疗法; pills:n.药丸; v.起球; (pill的第三人称单数和复数) effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象;
Can we imagine a more immersive environment that will change depression? 我们能否构想出一种能够改变抑郁的浸入式的环境？
immersive:n.沉浸式;沉浸感;增加沉浸感;
Can you lock out the signals that elicit depression? 你能够完全隔绝抑郁发出的刺激信号吗？
elicit:v.抽出,引出;引起;
Again, moving upwards along this hierarchical chain of organization . 再次重申,需要顺着组织构成的层次自下向上地考虑。
organization:n.组织;机构;体制;团体;
What's really at stake perhaps here is not the medicine itself but a metaphor. 在这里最重要的事情, 可能不是有药物本身,而是比喻的说法
stake:n.桩,棍子;赌注;火刑;奖金;v.资助,支持;系…于桩上;把…押下打赌;
Rather than killing something, in the case of the great chronic degenerative diseases -- kidney failure, diabetes, hypertension, osteoarthritis -- maybe what we really need to do is change the metaphor to growing something. 相比于现在的“杀死某些东西”, 对于大量的慢性退行性疾病—— 肾衰竭、糖尿病、高血压、关节炎 或许我们要做的反而应该是“培养一些东西”。
degenerative:adj.退化的;变质的;退步的; kidney:n.[解剖]肾脏;腰子;个性; osteoarthritis:n.[外科]骨关节炎;
And that's the key, perhaps, to reframing our thinking about medicine. 而这之中的关键, 可能就是重塑我们的药物观。
reframing:n.重新构造;v.再构造;给…装上新框架(reframe的ing形式);
Now, this idea of changing, of creating a perceptual shift , as it were , came home to me to roost in a very personal manner about 10 years ago. 这个想法, 即感知认识上的转变, 来自我10年前一次个人经历。
perceptual:adj.知觉的;感知的;有知觉的; shift:n.移动;变化;手段;轮班;v.移动;转变;转换; as it were:可以说是,似乎就是;好像; roost:n.栖木;鸟窝;群栖的禽鸟;vi.栖息;安歇;vt.使…栖息;为…提供歇息处; personal:adj.个人的;身体的;亲自的;n.人事消息栏;人称代名词;
About 10 years ago -- I've been a runner most of my life -- 大概10年前——我常年跑步——
I went for a run, a Saturday morning run, 我在周六早上照常跑了一会儿,
I came back and woke up and I basically couldn't move. 回来后从床上醒来时发现腿动不了了。
basically:adv.主要地,基本上;
My right knee was swollen up, and you could hear that ominous crunch of bone against bone. 我的右膝盖肿得厉害 而且能够听见骨头跟骨头摩擦的声音。
swollen:adj.肿胀的,浮肿的;浮夸的;激动兴奋的; ominous:adj.预兆的;不吉利的; crunch:n.咬碎,咬碎声; vt.压碎; vi.嘎吱作响地咀嚼;
And one of the perks of being a physician is that you get to order your own MRIs. 做医生有一样好处,便是可以自己预约MRI扫描。
perks:n.特权; v.打扮; physician:n.[医]医师;内科医师;
And I had an MRI the next week, and it looked like that. 第二周我做了MRI扫描,结果就像展示的那样
Essentially , the meniscus of cartilage that is between bone had been completely torn and the bone itself had been shattered . 简单的说,骨头之间的半月型软骨层 已经被彻底的磨掉了,骨头也受损了。
Essentially:adv.本质上;本来; meniscus:n.[解剖]半月板;弯月面;新月形物; cartilage:n.软骨; shattered:adj.受到严重打击的; v.(使)破碎,碎裂; (shatter的过去式和过去分词)
Now, if you're looking at me and feeling sorry, let me tell you a few facts. 现在,如果你为我感到难过, 那么让我来告诉你一些信息。
If I was to take an MRI of every person in this audience, 60 percent of you would show signs of bone degeneration and cartilage degeneration like this. 如果给在做的所有人都做一次MRI, 在座各位中60%以上的人 会看到跟我一样的骨头和软骨退化的迹象。
degeneration:n.退化;[医]变性;堕落;恶化;
85 percent of all women by the age of 70 would show moderate to severe cartilage degeneration. 70岁以上女性中有85%的人 会出现中度或重度的软骨退化。
moderate:v.缓和; adj.适度的; n.持温和观点者(尤指政见); severe:adj.极为恶劣的;十分严重的;严厉的;苛刻的;
50 to 60 percent of the men in this audience would also have such signs. 在座的男性中有50%到60% 已经出现了这种症状。
So this is a very common disease. 所以这是非常常见的疾病。
Well, the second perk of being a physician is that you can get to experiment on your own ailments . 作为医生的第二个好处 是你可以自己给自己治病。
ailments:n.疾病,小病(ailment复数形式);
So about 10 years ago we began, we brought this process into the laboratory, and we began to do simple experiments, mechanically trying to fix this degeneration. 所以大约10年前,我们开始着手, 把这些方法带到实验室。 并且开始做一些简单的实验, 呆板地想解决退化的问题。
process:v.处理;加工;列队行进;n.过程,进行;方法,adj.经过特殊加工(或处理)的; mechanically:adv.机械地;呆板地;物理上地;
We tried to inject chemicals into the knee spaces of animals to try to reverse cartilage degeneration, and to put a short summary on a very long and painful process, essentially it came to naught . 我们尝试了将一些化学成分注入动物的关节囊 尝试反转退化现象, 经过了痛苦而漫长的尝试,结果简单概括就是, 基本上没有任何效果。
inject:v.注入;注射; chemicals:n.化学制品;化学品;(chemical的复数) reverse:n.反面; v.颠倒; adj.相反的; summary:adj.简易的;扼要的;n.概要,摘要,总结; painful:adj.痛苦的;疼痛的;令人不快的; naught:n.[数]零;无价值;adj.无价值的;无用的;
Nothing happened. 一点用都没有,什么都没发生。
And then about seven years ago, we had a research student from Australia. 直到大概7年前,我们来了个澳大利亚研究生。
The nice thing about Australians is that they're habitually used to looking at the world upside down . 澳洲人的优点 就是他们习惯把世界倒转来看。
habitually:adv.习惯地;日常地; upside down:adj.颠倒的;乱七八糟的;
(Laughter) （笑声）
And so Dan suggested to me, "You know, maybe it isn't a mechanical problem. 这个名叫丹的学生跟我说,“或许这不是机能问题,”
Maybe it isn't a chemical problem. Maybe it's a stem cell problem." “或许也不是化学问题,或许是干细胞问题。”
stem cell:干细胞;
In other words, he had two hypotheses . 换句话说,他有两个假想:
hypotheses:n.假定;臆测(hypothesis的复数);
Number one, there is such a thing as a skeletal stem cell -- a skeletal stem cell that builds up the entire vertebrate skeleton , bone, cartilage and the fibrous elements of skeleton , just like there's a stem cell in blood, just like there's a stem cell in the nervous system . 第一,假设真有这样的骨干细胞-- 构造了整个脊椎骨架, 骨头、软骨组织、以及骨架周边的支持物, 就像是血液中的造血干细胞, 就像是神进系统中的神经干细胞。
skeletal:adj.骨骼的,像骨骼的;骸骨的;骨瘦如柴的; vertebrate:adj.脊椎动物的;有脊椎的;n.脊椎动物; skeleton:n.骨架,骨骼;纲要;骨瘦如柴的人;adj.骨骼的;骨瘦如柴的;概略的; fibrous:adj.纤维的,纤维性的;纤维状的; elements:n.要素;基本部分;少量;一群;(element的复数) nervous system:n.神经系统;
And two, that maybe that, the degeneration or dysfunction of this stem cell is what's causing osteochondral arthritis, a very common ailment. 假设二,可能是因为骨干细胞的退化或失能, 导致了关节炎这种常见的疾病。
dysfunction:n.功能紊乱;机能障碍;官能不良;vi.功能失调;出现机能障碍;垮掉; osteochondral:骨软骨的;
So really the question was, were we looking for a pill when we should have really been looking for a cell. 所以问题根源可能在于我们一直在找治疗药物 但是实际上我们应该寻找的是这种细胞。
So we switched our models, and now we began to look for skeletal stem cells. 于是我们换用了新模型, 开始寻找这种骨干细胞。
And to cut again a long story short, about five years ago, we found these cells. 长话短说, 大概五年前我们终于找到了。
They live inside the skeleton. 它们存在于骨架内部。
Here's a schematic and then a real photograph of one of them. 图上是原理图和真实的骨头
schematic:adj.图解的;概要的;n.原理图;图解视图;
The white stuff is bone, and these red columns that you see and the yellow cells are cells that have arisen from one single skeletal stem cell -- columns of cartilage, columns of bone coming out of a single cell. 白色的是骨头, 你看到的红色管状的,黄色的细胞 都是由一个单独的干细胞生长而来的—— 软骨、骨组织都来自同一个干细胞,
stuff:n.东西:物品:基本特征:v.填满:装满:标本: columns:n.柱:(通常为)圆形石柱:(书,报纸印刷页上的)栏(column的复数) arisen:v.出现;发生;兴起;(人早上)起来;(arisen是arise的过去分词)
These cells are fascinating . They have four properties. 这些细胞太神奇了,它们有四个特点。
fascinating:adj.极有吸引力的;迷人的;v.深深吸引;迷住;(fascinate的现在分词)
Number one is that they live where they're expected to live. 第一,它们就存在于我们预期的位置。
They live just underneath the surface of the bone, underneath cartilage. 它们就存在于骨头表面之下, 存在于软骨组织下面。
underneath:prep.在…的下面;在…的支配下;n.下面;底部;adj.下面的;底层的;
You know, in biology, it's location , location , location. 你或许知道在生物学上,位置是很重要的,
location:n.地方;地点;位置;定位
And they move into the appropriate areas and form bone and cartilage. 所以这些干细胞移动到了合适的位置方便生成骨和软骨。
appropriate:adj.适当的;恰当的;v.占用,拨出;
That's one. 这是第一个特点。
Here's an interesting property. 还有一个有意思的特点。
You can take them out of the vertebrate skeleton, you can culture them in petri dishes in the laboratory, and they are dying to form cartilage. 你可以将这些细胞从脊椎动物骨架中分离出来 放在实验室的培养皿中, 它们会拼命的构造软骨组织。
Remember how we couldn't form cartilage for love or money ? 要知道我们无论用多少钱和爱都没办法生成软骨。
for love or money:无论如何;
These cells are dying to form cartilage. 它们会拼命的构造软骨组织。
They form their own furls of cartilage around themselves. 它们通过构造软骨组织把自己卷起来。
They're also, number three, the most efficient repairers of fractures that we've ever encountered . 第三点, 它们是我们见过的最神速的修补匠。
efficient:adj.有效率的;有能力的;生效的; repairers:n.修理者;修补者; fractures:v.(使)断裂,折断,破裂;(使)分裂;(fracture的第三人称单数) encountered:v.遭遇,遇到;偶然碰到;意外地遇见;(encounter的过去分词和过去式)
This is a little bone, a mouse bone that we fractured and then let it heal by itself. 这是一个老鼠的骨头被我们掰断了 然后任由其自然恢复。
fractured:v.(使)断裂,折断,破裂;(使)分裂;(fracture的过去式和过去分词) heal:v.复原;治疗(病人);使又愉快起来;(使)结束
These stem cells have come in and repaired, in yellow, the bone, in white, the cartilage, almost completely. 骨干细胞出现修复了骨头（黄色部分） 修复了软骨（白色部分）基本上完好如初。
So much so that if you label them with a fluorescent dye you can see them like some kind of peculiar cellular glue coming into the area of a fracture, fixing it locally and then stopping their work. 所以基本上如果你给这些细胞染上颜色 你就能够看到它们就像是某种细胞胶水 填充到骨折的地方, 修复好,然后收工。
label:n.标签;标记;谓;唱片公司;v.贴标签于;用标签标明; fluorescent:adj.荧光的;萤光的;发亮的;n.荧光;日光灯; dye:n.染料;染液;v.染;给…染色; peculiar:adj.特殊的;独特的;奇怪的;罕见的;n.特权;特有财产; cellular:adj.细胞的;多孔的;由细胞组成的;n.移动电话;单元; glue:n.胶;胶水;v.粘贴; locally:adv.在本地;局部地;在地方上;
Now, the fourth one is the most ominous, and that is that their numbers decline precipitously , precipitously , tenfold , fiftyfold , as you age. 现在,第四点也是最不好的, 这些细胞的数量下降地出乎意料的快, 随着你的年龄十倍或者十五倍的减少。
decline:v.下降;衰退;减少;谢绝;n.下降; precipitously:adv.陡峭地;出乎意料地;陡然地; tenfold:adj.十倍的;十重的;adv.十倍地;成十倍;n.十倍; fiftyfold:adj.五十倍的;adv.五十倍地;
And so what had happened, really, is that we found ourselves in a perceptual shift. 这里最重要的, 是我们发现自己的观念转变了。
We had gone hunting for pills but we ended up finding theories. 我们一开始是为了寻找药物而努力 最后却发现了新的理论。
And in some ways we had hooked ourselves back onto this idea: cells, organisms, environments, because we were now thinking about bone stem cells, we were thinking about arthritis in terms of a cellular disease. 从某个角度看, 我们回到了一开始的想法上: 细胞,组织,环境, 现在我们从骨干细胞的角度出发 我们开始将关节炎当作是细胞疾病来看待。
hooked:adj.弯曲的; v.(使)钩住,挂住; (hook的过去分词和过去式)
And then the next question was, are there organs? 接下来的问题就是那么器官级别的呢？
Can you build this as an organ outside the body? 我们能在体外培育这样的器官么？
Can you implant cartilage into areas of trauma ? 我们能够在磨损的位置直接植入软骨么？
implant:vt.种植;灌输;嵌入;n.[医]植入物;植入管;vi.被移植; trauma:n.[外科]创伤(由心理创伤造成精神上的异常);外伤;
And perhaps most interestingly , can you ascend right up and create environments? 还有更加有趣的, 我们能否继续向上创造出适宜的环境？
interestingly:adv.有趣地; ascend:vi.上升;登高;追溯;vt.攀登,上升;
You know, we know that exercise remodels bone, but come on, none of us is going to exercise. 当然,我们都知道运动可以重塑骨骼, 但是得了吧,没人愿意运动。
So could you imagine ways of passively loading and unloading bone so that you can recreate or regenerate degenerating cartilage? 所以你想过有一天你能把骨头拆下来再装回去 这样你就可以重塑已经退化的软骨组织了？
passively:adv.被动地;顺从地; unloading:v.(从车、船上)卸,取下; (unload的现在分词) recreate:vt.再现;再创造 regenerate:vt.使再生;革新;vi.再生;革新;adj.再生的;革新的; degenerating:vt.使退化;恶化;vi.退化;堕落;adj.退化的;堕落的;n.堕落的人;
And perhaps more interesting, and more importantly, the question is, can you apply this model more globally outside medicine? 最有意思、也是最重要的, 这个模型能否更加广泛的在医疗界推广？
What's at stake, as I said before, is not killing something, but growing something. 重要的是,如我之前所言,不是杀死什么 而是培育什么
as I said:正如我所说的
And it raises a series of, I think, some of the most interesting questions about how we think about medicine in the future. 这进一步的引发了一系列有趣的问题, 影响到我们未来对于药物观念。
series:n.系列,连续;[电]串联;级数;丛书;
Could your medicine be a cell and not a pill? （未来）你的药物有没有可能不是药片而是细胞？
How would we grow these cells? 我们如何培育这些细胞？
What we would we do to stop the malignant growth of these cells? 我们如何阻止这些细胞的恶性增殖？
malignant:adj.[医]恶性的;有害的;有恶意的;n.保王党员;怀恶意的人;
We heard about the problems of unleashing growth. 我们已经听说了不受控的细胞增殖。
unleashing:v.发泄;突然释放;使爆发(unleash的现在分词)
Could we implant suicide genes into these cells to stop them from growing? 我们能否在细胞中植入一些自杀基因 来阻止它们的增长？
suicide:n.自杀;自杀行为;自杀者;adj.自杀的;v.自杀;vi.自杀; genes:n.基因;(gene的复数)
Could your medicine be an organ that's created outside the body and then implanted into the body? 未来你的药物有没有可能就是一个身体器官 在体外培育然后植入体内？
implanted:植入的;
Could that stop some of the degeneration? 这样能否阻止器官的老化？
What if the organ needed to have memory? 如果这些器官需要记忆呢？
In cases of diseases of the nervous system some of those organs had memory. 例如神经系统中的一些器官保存了记忆。
How could we implant those memories back in? 我们怎么把这些记忆移植回来？
Could we store these organs? 我们能保存这些器官么？
Would each organ have to be developed for an individual human being and put back? 这些器官能否根据患者的不同而分别培育 然后再移植回去？
individual:n.个人;有个性的人;adj.单独的;个别的;
And perhaps most puzzlingly, could your medicine be an environment? 最后可能是最令人困惑的, 你的药物可以是环境么？
Could you patent an environment? 治疗的环境能否（像药物一样）申请专利？
patent:vt.授予专利; adj.专利的; n.专利权;
You know, in every culture, shamans have been using environments as medicines. 每个人类文化里 都有巫师这样的角色,将环境视为治疗的药物。
shamans:n.萨满教巫医(Shaman的复数);
Could we imagine that for our future? 你能想象我们未来是那样的么？
I've talked a lot about models. I began this talk with models. 我们聊了很多模型,也是从模型开始说起的。
So let me end with some thoughts about model building. 让我在结束的时候再聊一聊如何构造模型。
That's what we do as scientists. 我们科学家就是做这个的。
You know, when an architect builds a model, he or she is trying to show you a world in miniature . 你知道,当建筑师建造一个模型, 他（她）会尝试用微型图向你展示想象的世界
architect:n.建筑师;设计师;创造者; miniature:adj.微型的,小规模的;n.缩图;微型画;微型图画绘画术;vt.是…的缩影;
But when a scientist is building a model, he or she is trying to show you the world in metaphor. 但是当一个科学家构造模型的时候, 他（她）给你展示的是世界的隐喻。
He or she is trying to create a new way of seeing. 他（她）尝试从新的角度看这个世界。
The former is a scale shift. The latter is a perceptual shift. 前者是比例的变化,后者是观念的变化。
scale:n.规模;比例;鳞;刻度;天平;数值范围;v.衡量;攀登;剥落;生水垢; latter:adj.后者的;近来的;后面的;较后的;
Now, antibiotics created such a perceptual shift in our way of thinking about medicine that it really colored, distorted , very successfully, the way we've thought about medicine for the last hundred years. 现在,抗生素创造了观念的变化 非常成功地改变了过去百年来我们对药物的看法 以前的看法是过度夸张和歪曲事实。
distorted:adj.歪曲的;受到曲解的;v.扭曲(distort的过去式和过去分词);
But we need new models to think about medicine in the future. 但是未来我们需要新的模型。
That's what's at stake. 这是最重要的。
You know, there's a popular trope out there that the reason we haven't had the transformative impact on the treatment of illness is because we don't have powerful-enough drugs, and that's partly true. 你知道的,现在有种论调很流行 说我们之所以在疾病的治疗上 没有改革性的影响 是因为我们还没有找到足够强大的药物, 这倒说对了一半。
trope:n.比喻;修辞;转义; impact:n.影响;效果;碰撞;冲击力;v.挤入,压紧;撞击;对…产生影响;
But perhaps the real reason is that we don't have powerful-enough ways of thinking about medicines. 但是可能真正的原因是 我们对药物没有足够强大的思维模式。
It's certainly true that it would be lovely to have new medicines. 有一点是肯定的 有新的药物自然是令人喜悦的。
But perhaps what's really at stake are three more intangible M's: mechanisms , models, metaphors . 但是可能当前最紧要的还是这三个难以理解的 Ｍ 机制、模型、隐喻。
intangible:adj.无形的,触摸不到的;难以理解的; mechanisms:n.机制;[机]机构(mechanism的复数);机械;[机]机构学; metaphors:n.隐喻(metaphor的复数形式);
Thank you. 感谢大家。
(Applause) （掌声）
Chris Anderson: I really like this metaphor.
How does it link in? 它们怎么联系起来的？
There's a lot of talk in technologyland about the personalization of medicine, that we have all this data and that medical treatments of the future will be for you specifically , your genome , your current context . 科技领域有很多的讨论 都提到了个体化医疗, 说我们汇集所有的数据,然后 未来的药物会基于你的基因组和所处环境量身定做
personalization:n.个性化; treatments:n.治疗;疗法;对待;处理;讨论;(treatment的复数) specifically:adv.特别地;明确地; genome:n.基因组;染色体组; context:n.环境;上下文;来龙去脉;
Does that apply to this model you've got here? 这种说法跟你提到的模型是契合的吗？
Siddhartha Mukherjee: It's a very interesting question. SM:这个问题很有意思。
We've thought about personalization of medicine very much in terms of genomics . 我们已经从基因角度考虑个体化医疗 有一段时间了。
genomics:n.基因组学;基因体学;
That's because the gene is such a dominant metaphor, again, to use that same word, in medicine today, that we think the genome will drive the personalization of medicine. 那是因为基因本身就是主流的隐喻, 同样也是这个词,在今天的医疗界 我们认为基因组会主导个体化医疗的进展。
dominant:adj.显性的;占优势的;支配的,统治的;n.显性;
But of course the genome is just the bottom of a long chain of being, as it were. 但是显然的,基因组这个概念 只是这个链条最基础的部分。
That chain of being, really the first organized unit of that, is the cell. 这个链条最开始真正有组织的单元是“细胞”。
So, if we are really going to deliver in medicine in this way, we have to think of personalizing cellular therapies, and then personalizing organ or organismal therapies, and ultimately personalizing immersion therapies for the environment. 所以如果我们真的要开始个体化医疗了, 我们需要考虑的是个性化的 细胞疗法 , 然后是个性化的组织和器官疗法, 最后的最后是个性化的浸入式的环境疗法。
personalizing:v.个体化(personalize的ing形式); immersion:n.沉浸;陷入;专心;
So I think at every stage, you know -- there's that metaphor, there's turtles all the way. 我觉得现在每个阶段...你知道 用一个比喻可以形容 -“龟速”。
turtles:n.海龟;龟;陆龟;水龟;鳖;(turtle的复数)
Well, in this, there's personalization all the way. 也因如此,才可以做到医疗个性化。
CA: So when you say medicine could be a cell and not a pill, you're talking about potentially your own cells. CA:所以当你说未来的药物是细胞 而不是药物的时候 你说的是有可能是自己的细胞？
potentially:adv.可能地,潜在地;
SM: Absolutely . CA: So converted to stem cells, perhaps tested against all kinds of drugs or something, and prepared. SM:绝对地。CA:转换成干细胞, 可能还会跟各种药物或者别的东西做测试,然后准备好。
Absolutely:adv.绝对地;完全地; converted:adj.修改的;改变信仰的;v.转变;改变信仰(convert的过去式和过去分词形式);
SM: And there's no perhaps. This is what we're doing. SM:这不是可能。我们现在就在做。
This is what's happening, and in fact, we're slowly moving, not away from genomics, but incorporating genomics into what we call multi-order, semi-autonomous, self-regulating systems, like cells, like organs, like environments. 这是正在发生的事情,实际上,我们正在慢慢取得进展。 并没有脱离基因组,而是跟基因组结合 我们称之为多层级、半自动、自制系统, 像是细胞、器官、环境。
incorporating:v.将…包括在内;包含;吸收;使并入;注册成立;(incorporate的现在分词)
CA: Thank you so much. CA:非常感谢。
SM: Pleasure. Thanks. SM:很荣幸。谢谢。