Alan Russell 人体的再生

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http://dotsub.com/view/c9325bd6-95a2-4a48-a76c-c1079408df1a
Alan Russell 人体的再生
我今天将要跟大家讲的 但愿能化恐惧为希望 现今，当我们去看医生的时候 当我们走进诊疗室 有些名词是我们所不愿意听到的 有些词我们是打心底害怕的 糖尿病，癌症，帕金森症，阿兹海默（老年痴呆） 心衰，肺衰 这些疾病我们已经知道是能压垮一个人 但我们对它们却基本束手无策。
我今天将描述的是 一种新的对待这类疾病的思维方式。 这为什么很重要？ 为什么如果没有它，也许我们的医疗保障系统就会瓦解？ 如果你不认为它已经走到了这一步的话。 我们目前临床上能做到什么，以及我们未来可能做到什么， 还有路途上需要克服的一些障碍都在哪里。 我保证，在18分钟内，我一定讲完这些。
我想从这张图片开始 因为这张图能告诉大家“科学”杂志是怎么看待这个问题的 这是2002年的一期 上面刊登了很多不同的关于仿生人的文章。 这期杂志从根本上讲的是关于再生医学的。 再生医生其实是个异常简单的概念 谁都可以理解。 它简单的说就是加快了身体自我修复的速度 加快到有临床意义的范围内。 图上我们可以看到我们已经在很多方面知道怎么做到这点。 我们知道如果髋关节受伤了，我们可以手术安装一个人工髋关节进去。 这就是这期“科学”杂志封面上所表达出来的理念。
这完全和再生医学是相反的。 这不是再生医学。 再生医学是"商业周刊“封面上所讨论的， 当他们在不久之前写了一篇关于再生医学的报导的时候。 我们的想法是，不要去想办法改善症状 用医疗器械或者药物之类的 -- 我还会再多次重复讨论这个主题的 -- 我们不要那么做，我们换一种方式，来重建身体失去的功能， 通过受伤器官和组织的再生。 如此一来，在治疗结束之后， 你的身体状态和你生病之前是一模一样的。
很少有好的主意 - 如果你同意这是一个好主意的话 - 好的主意很少是完全新颖的。 我们所讨论的这个主意也一样。 如果你回顾历史的话， 查尔斯·林白 -- 他在飞机驾驶方面（飞跃大西洋）更为著名 -- 其实是第一个想到这个主意的人之一。 他与Rockefeller来的诺贝尔奖获得者卡莱耳一起 开始考虑这个问题：我们能不能培养器官？ 然后他们在1937年出版了一本书， 书里他们竟然已经开始想了， 我们如何从生物反应器中培养出完整的器官来？ 与当年相比，我们现在已经是有了长足的进步了。 我马上要和大家分享一些正在进行中的，令人兴奋的研究工作。
但在做这个之前，我想要先做的是 跟你们分享一下我对于医疗保障系统的忧虑， 以及我们为什么有必要忧虑。 昨天很多的演讲都讨论到了 关于提高生活质量和减少贫困。 并从实质上增加全球人类的预期生命长度。 其中的一个挑战是，我们越富有就会活得越久。 我们活得越久，开销就会越大， 需要费更多的钱来处理我们老了之后会得的各种疾病。
这个问题很简单，就是一个国家的财富 与它超过65岁的人口的相关性。 然后你基本上就会看到，一个国家越富有 它国民的人口平均年龄就会越高。 为什么这个很重要？ 为什么这在今天是一个尤其严峻的考验？ 如果人口的平均年龄是30岁的话， 那么需要治疗的一般疾病 可能只是偶尔的崴脚 也许加上点哮喘。 如果国家的人口平均年龄是45到55岁的话， 那么一个普通的公民就可能面对糖尿病， 早发型糖尿病，心脏衰竭，冠心病。 这些病从根本上是更难治疗的， 治疗起来也贵得多。
光看看这里美国的人口统计资料。 这是从美利坚合众国来的。 在1930年，每个退休人员由41个劳动人口养。 41个没有什么严重疾病的人， 来为一个因病丧失劳动力的退休人员的医疗护理买单。 在2010年，每个退休人员只对2个劳动人口。 世界上每个工业化的富有的国家的情况都如此。 我们怎么可能有足够的钱来为病人提供所需的医疗服务， 当人口老龄化的现实是这个样子的？
这是年龄与医疗护理的费用之间的关系图。 你可以看到，就在大约45岁的时候，40到45岁之间， 医疗费用会突然激增。 这其实挺有意思的 - 如果你做了适当的统计研究， 你可以看你个人在你的医疗方面花费的多少，把它画在平面坐标图的 Y轴上， 然后X轴标出你的生命时间。 然后在你死亡之前大概7年的时候，就会看到一个高峰。 然后你事实上就可以。。。
（笑声） -- 我们就不详细说这个问题了。 （笑声）
有一些事情，很少量的一些事情，是我们真的可以做的 这些事情会改变对这类疾病的治疗方式， 并让我们体验所谓的“健康的老去”。 我想提议的有4样东西， 而且这4样东西与保险系统和法律系统无关。 这些系统所作的只是改变谁来买单。 但他们不能从根本上改变医疗成本的高低。
其中一个就是不去治疗。你可以定量配给“医疗”资源。 我们就不多讨论这个了。这个太令人抑郁了。 你可以预防。 显然很多经费应该被投入到预防之中。
但也许更能引起人兴趣的是，至少对我来说，也更重要的是 能够在疾病恶化之前对它进行诊断， 并且根治疾病， 而不只是治疗它的症状。 比如，以糖尿病为例。 在今天，当一个人有糖尿病的时候，我们能做什么？ 我们最终是会确诊这个病的，但只是在它的症状明显的表现出来的时候。 在接下来的10，20，30，40年里，我们治疗就是减轻它的症状。 效果还行。胰岛素替代是一个不错的疗法。 但最终它还是会失去治疗效果的。 糖尿病将会引起并发症所导致的疾病是可以预见得到的。
我们为什么不能简单地给胰腺里面注射一点儿什么 在糖尿病的早期就促使胰腺再生 或许甚至在症状显现之前？ 也许这一针在注射的时候会很昂贵 但如果它有效，我们就真的可以以一种新的方式来解决问题了。
这个视频，我想，能够很好的让大家理解我所说的概念。 这是一只水螈，在进行肢体的再生。 如果水螈能办到这样的事情，为什么我们不行呢？ 过一会儿我会给你们看一些更重要的特征 关于肢体再生的。 但我们在再生医学中所讲的 是让身体的每一个器官系统都能做到这种再生 为自己的组织和自己的器官。 今天的现实是，如果我们生病了， 我们得到的讯息是，我们可以治疗你的症状， 但你需要适应一种新的生活方式
我要提议的是，明天 - 我们可以辩论这个“明天”具体是什么时候， 但在可以预见的将来 - 我们会实现再生康复。 这是一个假肢 事实上很类似于士兵们 从伊拉克战场回来之后装上的… 从伊拉克回来的士兵里面，有370人都失去了肢体 试想一下，如果他们不需要去面对那个（假肢）， 而是面对肢体的再生。 这是一个很大胆的想法。 过一会儿我会向你们展示我们为实现这个想法已做的工作。
但，再强调一遍， 这对于每个器官系统都是可以实现的。 我们怎么能做到？ 我们做到的方法就是展开和身体的对话。 我们需要讲我们身体所讲的语言， 并重新发掘当我们曾经是胎儿的时候所拥有的再生能力。 一个哺乳类动物的胎儿，如果在孕期的头三个月失去了一个肢体， 他就会重新长出来它来。 所以，我们的DNA有这种自愈的机制。 这是一个自然的行为。 但当随着我们的年龄增长就遗失了。 一个小孩，在大概6个月大之前， 如果他们在某次意外中失去了自己的手指尖， 他们就可以重新长出那个手指尖。 当他们长到5岁大的时候，他们就失去了那样的能力了。
所以，如果要跟身体对话的话， 我们必须要会讲我们身体的语言。 一下是目前正在使用的一些技术 我要介绍其中的3种技术 通过这些技术我们可以与身体进行对话
第一个是细胞疗法。 显然，在我们自然的伤口愈合过程中， 细胞进行了大部分的修复工作。 因此，只要找到合适的细胞， 然后把它们植入人体，他们也许就会开始修复工作。 第二，我们可以使用外来材料。 昨天的讲话告诉了我们新材料的重要性。 如果我们能发明合成材料，设计材料， 或着从自然界中提炼出新的材料。 或许就可以利用这些材料诱发发身体的修复功能。 最后，我们也许可以利用一些精巧的装置 分担身体的负担，并给他机会他自行愈合。
我将会针对每种技术出示一个例子， 先从材料开始。 匹兹堡大学的学者Steve Badylak 大约在10年前有过一个卓越的点子。 这个点子就是，猪的小肠， 如果你能剥除所有的细胞， 如果你能在保持其生物活性的前提下做到这个， 这里面就可能包括所有必需的因子和信号 来启动身体自我修复的功能。 他同时提出一个很重要的问题。 他问了一个问题， 如果我能拿这个材料，这是一种天然的材料 放在小肠里通常可以诱发小肠的愈合， 如果我把它放在人体的其他地方， 是否在每种组织里面都可以诱发正确的修复反应， 还是我尝试长出一个新耳朵，但它还是会长出小肠来？
如果这个故事不让人信服的话我就不会讲它了。 接下来我要展示的图片 - （笑声） 是很有说服力的图片。 不过，对于那些比较敏感的人们 - 即使你们可能不想在朋友面前承认 - 灯光很暗。这是一个很好的机会来低头看你的脚， 查查手机，做什么都好，就是不要看荧幕。 （笑声）
我将要给你展示的是一个糖尿病引起的溃疡。 虽然 - 最好在看这个之前大笑一下。 这是糖尿病的现实。 我觉得，很多时候，当我们听到糖尿病，糖尿病溃疡， 我们就是无法把溃疡跟最终的治疗方法联系起来， 这个治疗方法就是截肢，如果你不能让它愈合的话。 我现在要展示这张图片了。不会很久。 这就是一个糖尿病溃疡。这是一个悲剧。 唯一的治疗方法就是截肢。 这是一位老年女士。她在患有糖尿病的同时还有肝癌， 并且她决定了要在死的时候保持她身体的完整性。
所以这位女士在尝试治疗那个溃疡一年之后决定 想尝试Steve发明的这个新治疗方法。 这是这个伤口在11周的治疗之后的样子。 这个材料只包含天然的信号因子。 并且这个材料引导着身体重新启动了它的修复程序。 这个修复反应在之前是没有发生的。
我接下来还要给你看几张可怕的图片 - 对于那些敏感的人，我会告诉你们什么时候可以再抬头看屏幕的。 这是一匹马。这匹马并没有感到痛苦。 如果这匹马痛苦的话，我就不会给你们看这张图片了。 这匹马只是长出了一个多余的鼻孔。 这是因为一次骑马的意外事故。 仅仅在几周的治疗之后 - 这次是把这个材料制成了凝胶， 包住整个创面，并重复这样的治疗几次 - 这匹马的伤口愈合了。 如果你看这个创口的B超检查图的话，它的愈合情况看起来会是很好的。
这是一只海豚，它的鳍被重新接上了。 现在全球已有40万病人 都使用了这个新材料来愈合他们的伤口。 我们能不能重新长出一个肢体？ DARPA（美国国防部研究计划署）刚拨出了1千5百万的经费给了Steve，让他领导一个将由8个研究单位合作完成的项目 来开始探索才的那个问题。
我会给你们看这个价值1千5百万美元的图片。 这是一个78岁的老年男子。他失去了他的指尖。 记得我之前说过幼儿失去指尖之后可以重新长出但大人就不行的事情吧。 在接受治疗之后，它看起来就是这个样子的。 这样的事情现在已经可以实现。 这在现在是有临床意义的。 现在已经存在能做到这个的材料。有种心脏修复的贴片。
但我们是否能有更进一步的发展？ 我们能否，比如，不要用材料， 而是在使用这个材料的同时更够取出一些细胞， 并清除一块受伤的组织， 然后放一个人体可以自行降解的材料上去？ 这里你可以看到一小块心脏肌肉正在一个培养皿里面跳动。 这个是东京女子医院的Teruo Okano的研究成果。 他可以在培养皿里面培养出会跳动的组织。 然后让培养皿冷却，来改变它的特性， 之后他就可以把组织直接从培养皿中剥离下来。 这真的是很酷。
我现在要展示给你们的是基于细胞的再生疗法。 我现在要给你们看的 是从一个病人的髋部采集干细胞。 与以前一样，如果你比较敏感的话，就不要看了。 不过这个还是挺酷的。 这是一个心脏搭桥手术，跟Al Gore做过的那个一样， 但还是有区别的。 不同的是，在这里，在心脏搭桥做完之后， 我们将会看到病人的干细胞， 在手术开始的时候采集的干细胞， 将被直接注射进病人的心脏。 我现在站在这里，是因为过一会儿， 我要给大家指出这个技术现在还在很初级阶段。 现在干细胞进去了，直接被注入病人还在跳动的心脏。 如果大家很仔细得看， 大概就在这个时候， 就会看到反向逆流。 你会看到干细胞被冲出来。 我们需要各种新的技术和装置， 设法让细胞在正确的时间到达正确的部位。
这里有一点实验数据，只是一点点数据。 这是一个随机的试验。 当时的样本数目只有20个，现在已经累积到近100个了。 简单的说，如果一个重病患者 接受了搭桥手术，他的症状会稍微好转。 如果他们在搭桥的同时接受了干细胞治疗， 那么这些病人的症状就会完全消失。 这些数据已经是两年前的了。 最酷的是如果你能在疾病的早期就确诊， 并防止疾病恶化的可能性。
这手术跟刚刚看到的类似，但采用了低侵入手术方法， 只要在心脏周围的身体打3个孔 然后利用内窥镜手术注入干细胞。 现在干细胞进去了。 我没有时间来讲它的详细过程， 但基本上这个方法是可行的。 我们可以让症状比较轻的病人 回复到几乎无症状的状态， 只要使用了这种治疗方法。
这是另一个尚未进入临床试验阶段的干细胞疗法的例子， 但我想不久以后会进入临床了。 这是匹兹堡大学的Kacey Marra的研究成果， 她与世界各地的很多科学家合作。 他们认为抽脂手术时取出的脂肪液体， 在美国，我们可是有很多的抽脂手术抽出的脂肪液体。 （笑声） 这其实是很好的干细胞来源。 脂肪液中慢慢的塞着很多干细胞。 所以你可以去诊所，抽个脂来获得你想要的扁平的小腹。 然后就能抽出脂肪液。 在这个病例中，被分离出来的干细胞被转成神经元。 这全部都是在实验室里完成的。 我想在不久的将来，我们就能看到患者接受这中治疗 使用他们自己的脂肪或者脂肪细胞里分离出来的干细胞。
我前面也提到过用一些精巧的装置 去颠覆治疗疾病的方式。 我在结束前再提最后一个例子。 这也是件悲惨的事情。 我们与ISR （美国陆军外科研究所）的科学家们有着很长但也令人心碎的 的合作关系。 他们需要治疗1万1千名从伊拉克回来的年轻人。 其中很多都有严重烧伤。
但如果说我们对烧伤有什么了解的话， 我们对它的了解就是烧伤目前还无法治愈。 目前治疗烧伤的所有方法 - 基本上就是皮肤移植。 我们从某个部位取下一块皮肤， 再把它移植到被烧伤的地方， 然后试着让他们长到一起。 这个病例中，我们设计出了一种新的可以贴在人体上的生物反应器 - 年底ISR（美国陆军外科研究所）应该就会让它进入临床试验 - 这个反应器是由匹兹堡大学的Joerg Gerlach设计的。 这种生物反应器可以铺在创面上。 大家看到的那个喷枪则会喷上细胞。 将细胞均匀的喷洒到伤口上。 这个反应器将会营养周围的环境， 同时也运输一些其他的物质， 所以我们就跟播撒草种子让它来长出草坪一样， 而不是把草皮从一个地方揭下来再铺到另一个地方。 这是个全然不同的治疗方法。
嗯，我的18分钟快要结束了。 让我以一些好的消息来结束这次演讲吧， 也许也有一小部分是坏消息。 好消息是，这些研究现在都在进行着。 这是很伟大的工作。 很显然，那些图片会让你体会到这点。 这不是一般的困难，因为他需要很多不同领域学科的高度合作。 几乎每个科学工程领域和临床医学都涉及到了， 都在努力让人体的再生成为现实。
许多政府，以及很多地区， 都已经清楚的认识到这是一种新的治疗疾病的方式。 日本政府可能是第一个， 当他们决定先在这个领域投资30亿， 然后又加投了20亿的时候。 这绝非巧合。 从人口的平均年龄上讲，日本是世界上最“老”的国家。 因此他们需要让这项研究成功，不然他们的医疗系统就要垮掉。 所以在瞄准领域他们做了很多策略性的投资。 欧盟做了同样的事情。 中国，也是同样的事情。 中国的国家组织工程研究中心才刚刚落成。 第一年的研究经费预算就有2亿5千万美元。
在美国，我们倒是采取了一种不同的做法。我们 - （笑声） - 哦，如果能让戈尔来当现实世界的总统。 我们的做法是不同的。 这个做法基本上就是有项目报上来就顺水推舟给点儿资助， 但没有任何战略性的投资 来把保证必需的资源和条件搜集到一起并且很好地集中使用它们。
我将引用一段话来结束我的讲话，可能有点儿不上台面， 是关于NIH （美国国家卫生研究院）的负责人，很有魅力的一个人。 我与哈佛大学的Jay Vacanti 拜访了他跟其他几位卫生研究院的院长 大概就是在几个月前， 我们试着说服到时候该分给我们一点儿东西了， 他可以从明年的275亿预算中拨出一小部分来资助我们 并有策略地集中使用它，来保证我们可以加快研究的步伐， 让患者早日受益。 在这个火药味很浓的会谈的最后， NIH （美国国家卫生研究院）的负责人是这么跟我说的： “我们的胃口太小了，装不下你那么大的理想。” 作为结束语，我想说，没有人能改变我们的理想， 但如果我们齐心协力的话，就可以改变他的胃口。
谢谢。

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Alan Russell on regenerating our bodies
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.

And what I want to lay out for you today is a different way of thinking about how to treat debilitating disease, why it's important. Why without it, perhaps, our health care system will melt down, if you think it already hasn't. And where we are clinically today, and where we might go tomorrow, and what some of the hurdles are. And 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. Regenerative medicine is an extraordinarily 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 of the ways that are up there. We know that if we have a damaged hip, 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. Regenerative 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 tissue. So that at the end of the treatment, you are 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 Carrel, 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 bio-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 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 U.S. 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 U.S. 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 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 -- (Laughter) -- we won't get into that. (Laughter)

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 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 monies should be put into prevention.

But perhaps most interesting, to me anyway, and 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 it 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 OK. Insulin's 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, re-growing 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's reality is that if we get sick, the message is we will treat your symptoms, and you need to adjust to a new way of life.

I would pose to 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 370 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 re-grow that limb. So our 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 re-grow their fingertip. By the time they're 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, and I'm going to start with materials. Steve Badylak -- who's at 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 this story if it wasn't compelling. The picture I'm about to show you -- (Laughter) -- 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 Blackberry, do anything other than look at the screen. (Laughter)

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 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 going to put the slide up now. It won't be up for long. This is a diabetic ulcer. It's tragic. The treatment for this is amputation. This is an 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 new therapy that Steve invented. That's what the wound looked 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 going to be a couple more distressing slides for those of you -- 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 this slide. The horse just has another nostril that'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 fin's been re-attached. 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 dollars to lead an eight-institution project to begin the process of asking that question.

And I'll show you the 15 million dollar picture. This is a 78 year-old man who's lost the end of his fingertip. Remember that I mentioned before 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. There are the heart patches.

But 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 damaged piece of tissue, put a bio-degradable material on there? You can see here a little bit of heart muscle beating in a dish. This was done by Teruo Okano 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 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. And 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 all sorts of 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 N of 20. Now there's an N of about 100. Basically, if you take an extremely sick patient and 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. There 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 Kacey Marra 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. (Laughter) 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 bio-reactor has been designed -- it should be tested clinically later this year at ISR -- by Joerg Gerlach in Pittsburgh. And that bio-reactor 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 reactor will 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 inter-disciplinary. 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 3 billion, later another 2 billion in this field. It's no coincidence. Japan is the oldest country on earth in 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 -- (Laughter) -- 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 fund 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 Jay Vacanti from Harvard went to visit with him and a number of his directors of his institute 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 testy 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.