ABOUT THE SPEAKER
Jocelyne Bloch - Functional neurosurgeon
Jocelyne Bloch is helping to unlock potential self-healing capacities of the human brain.

Why you should listen

Swiss neurosurgeon Jocelyne Bloch is an expert in deep brain stimulation and neuromodulation for movement disorders. Her recent work focuses on cortical cells, called doublecortin, related to neurogenesis and brain repair. In collaboration with Jean François Brunet and others, she is pioneering the development of adult brain cell transplantation for patients with stroke, using their own stem cells. She aims at gathering all these novel therapeutic strategies under a common umbrella that will optimize treatment options for patients suffering from neurological impairments. She is in charge of the functional neurosurgery unit at the Lausanne University Hospital (CHUV).

More profile about the speaker
Jocelyne Bloch | Speaker | TED.com
TEDGlobal>Geneva

Jocelyne Bloch: The brain may be able to repair itself -- with help

Jocelyne Bloch: 大脑也许可以在辅助下进行自我修复

Filmed:
3,127,181 views

通过对中风和在车祸中大脑受到损伤的患者进行细致的治疗,神经外科医生 Jocelyne Bloch了解到大脑并不能彻底实现自我修复。但是现在,她提出,她和同事们可能已经找到了神经修复的关键所在:DCX阳性细胞。与干细胞类似,它们的可塑性很强,而且从大脑中被提取出之后,经过培养,再重新植入同一大脑的受损区域,它们就能够帮助大脑进行修复和重构。“只需要一点点的辅助,”Bloch说,“大脑也许就能自我复原。”
- Functional neurosurgeon
Jocelyne Bloch is helping to unlock potential self-healing capacities of the human brain. Full bio

Double-click the English transcript below to play the video.

00:12
So I'm a neurosurgeon神经外科医生.
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我是一名神经外科医生。
00:15
And like most of my colleagues同事,
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跟我的大多数同事一样,
我每天都要面对各种人世间的悲剧。
00:17
I have to deal合同, every一切 day,
with human人的 tragedies悲剧.
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00:22
I realize实现 how your life can change更改
from one second第二 to the other
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我认识到一次严重的中风
或者一次车祸,
就足以在下一秒改变一个人的命运。
00:27
after a major重大的 stroke行程
or after a car汽车 accident事故.
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00:32
And what is very frustrating泄气
for us neurosurgeons神经外科医生
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对我们这些神经外科医生来说,
最难过的事情就是意识到
与其他身体器官不同,
00:35
is to realize实现 that unlike不像
other organs器官 of the body身体,
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大脑几乎不能进行自我修复。
00:40
the brain has very little
ability能力 for self-repair自我修复.
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00:45
And after a major重大的 injury
of your central中央 nervous紧张 system系统,
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在中枢神经系统受到一次严重损伤后,
00:50
the patients耐心 often经常 remain
with a severe严重 handicap阻碍.
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患者将会终身面对严重的残疾。
00:55
And that's probably大概
the reason原因 why I've chosen选择
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这可能也是我想要成为一名
功能性神经外科医生的原因。
00:57
to be a functional实用 neurosurgeon神经外科医生.
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01:01
What is a functional实用 neurosurgeon神经外科医生?
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功能性神经外科医生是做什么的?
01:03
It's a doctor医生 who is trying to improve提高
a neurological神经 function功能
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他们主要通过各种不同的手术方法
来改善神经功能。
01:08
through通过 different不同 surgical外科 strategies策略.
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01:12
You've certainly当然 heard听说 of
one of the famous著名 ones那些
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你们一定听说过
很多主流方法中的一个,
叫做深度脑电刺激,
01:14
called deep brain stimulation促进,
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01:17
where you implant注入 an electrode电极
in the depths深处 of the brain
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通常是把一个电极植入大脑深处,
通过调控神经元电流
01:21
in order订购 to modulate调制 a circuit电路 of neurons神经元
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来改善神经功能。
01:24
to improve提高 a neurological神经 function功能.
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01:27
It's really an amazing惊人 technology技术
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这项技术不可思议地
扭转了患有帕金森,
01:29
in that it has improved改善
the destiny命运 of patients耐心
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和被颤抖及疼痛困扰的
01:32
with Parkinson's帕金森氏 disease疾病,
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患者的命运。
01:34
with severe严重 tremor, with severe严重 pain疼痛.
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01:38
However然而, neuromodulation神经调节
does not mean neuro-repair神经修复.
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但是,神经调控并不意味着
神经元的修复。
01:45
And the dream梦想 of functional实用 neurosurgeons神经外科医生
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而功能性神经外科医生希望有朝一日
能够修复受损的大脑。
01:47
is to repair修理 the brain.
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01:51
I think
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我认为
我们正在一步步接近这个目标。
01:52
that we are approaching接近 this dream梦想.
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我想让大家看看
01:54
And I would like to show显示 you
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01:57
that we are very close to this.
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我们离成功已经近在咫尺了。
02:00
And that with a little bit of help,
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只需要一点点的人工辅助,
大脑就可以进行自我修复。
02:03
the brain is able能够 to help itself本身.
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02:08
So the story故事 started开始 15 years年份 ago.
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事情还要从15年前说起。
02:11
At that time, I was a chief首席 resident居民
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那时候我还是一名住院总医师,
夜以继日地在急诊室忙碌。
02:13
working加工 days and nights
in the emergency room房间.
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02:16
I often经常 had to take care关心
of patients耐心 with head trauma外伤.
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我经常要护理有大脑损伤的病患。
02:21
You have to imagine想像 that when a patient患者
comes in with a severe严重 head trauma外伤,
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你们可以想象一下,
带有严重脑外伤的患者被推进来,
他的大脑不断肿胀,
02:25
his brain is swelling肿胀
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颅内压越来越高。
02:28
and he's increasing增加
his intracranial颅内 pressure压力.
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02:31
And in order订购 to save保存 his life,
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要挽救他的生命,
就必须要降低颅内压。
02:33
you have to decrease减少
this intracranial颅内 pressure压力.
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要做到这一点,
02:36
And to do that,
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有时候就需要移除一部分肿胀的脑组织。
02:37
you sometimes有时 have to remove去掉
a piece of swollen brain.
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02:42
So instead代替 of throwing投掷 away
these pieces of swollen brain,
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不过我们并没有把这一部分
肿胀的大脑直接丢弃,
而是在与生物学家 ,
也是我的一位同事
02:46
we decided决定 with Jean-Fran让 - 弗朗索瓦çoisOIS Brunet布吕内,
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Jean-François Brunet商量之后,
02:49
who is a colleague同事 of mine, a biologist生物学家,
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决定对这部分组织进行进一步研究。
02:51
to study研究 them.
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02:53
What do I mean by that?
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具体要怎么研究呢?
我们想让这一部分组织长出细胞来。
02:55
We wanted to grow增长 cells细胞
from these pieces of tissue组织.
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03:00
It's not an easy简单 task任务.
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这可不是件容易的事儿。
03:02
Growing生长 cells细胞 from a piece of tissue组织
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让组织生长出细胞,
就好比一个家庭开始
03:04
is a bit the same相同 as growing生长
very small children孩子
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养育一个小宝宝。
03:08
out from their family家庭.
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03:11
So you need to find the right nutrients营养成分,
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需要找到合适的营养成分,
合适的温度和湿度,
03:14
the warmth热情, the humidity湿度
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保证它们能够在适宜的环境下存活。
03:15
and all the nice不错 environments环境
to make them thrive兴旺.
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我们就是要在这样的条件下
培养这些细胞。
03:19
So that's exactly究竟 what we had
to do with these cells细胞.
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03:22
And after many许多 attempts尝试,
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尝试过很多次之后,
03:24
Jean-Fran让 - 弗朗索瓦çoisOIS did it.
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Jean-François成功了。
03:27
And that's what he saw
under his microscope显微镜.
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这就是他在显微镜下看到的一幕。
03:31
And that was, for us, a major重大的 surprise.
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对我们来说,这是个天大的惊喜。
03:34
Why?
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为什么呢?
因为这看起来跟干细胞群落
几乎一模一样,
03:35
Because this looks容貌 exactly究竟 the same相同
as a stem cell细胞 culture文化,
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小的,尚未成熟的细胞被一大群
绿色,较大的细胞包围着。
03:40
with large green绿色 cells细胞
surrounding周围 small, immature未成熟的 cells细胞.
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03:47
And you may可能 remember记得 from biology生物学 class
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你们可能还记得生物课上讲过,
干细胞是未发育成熟的细胞,
03:50
that stem cells细胞 are immature未成熟的 cells细胞,
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可以演变成人体的任何一种细胞。
03:53
able能够 to turn into any type类型
of cell细胞 of the body身体.
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03:59
The adult成人 brain has stem cells细胞,
but they're very rare罕见
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成人的大脑也有干细胞,
但是数量很少,
而且分布于大脑深处
04:04
and they're located位于
in deep and small niches壁龛
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隐蔽的角落里。
04:08
in the depths深处 of the brain.
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所以能够在操作室里从肿胀的
04:10
So it was surprising奇怪 to get
this kind of stem cell细胞 culture文化
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大脑表面获得这种干细胞群落,
04:14
from the superficial part部分
of swollen brain we had
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真是太让人意外了。
04:16
in the operating操作 theater剧院.
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而我们还观察到了
另外一个有趣的现象:
04:18
And there was another另一个
intriguing奇妙 observation意见:
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04:21
Regular定期 stem cells细胞
are very active活性 cells细胞 --
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正常的干细胞非常活跃——
它们可以不断地进行快速分裂。
04:26
cells细胞 that divide划分, divide划分,
divide划分 very quickly很快.
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04:30
And they never die,
they're immortal不朽 cells细胞.
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它们也不会凋亡,能够一直存活。
04:33
But these cells细胞 behave表现 differently不同.
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但是这些细胞却有着不同的行为。
04:36
They divide划分 slowly慢慢地,
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它们分裂得很慢,
而且仅仅过了几个星期,
04:38
and after a few少数 weeks of culture文化,
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就会慢慢死掉。
04:40
they even died死亡.
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04:43
So we were in front面前 of a strange奇怪
new cell细胞 population人口
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于是我们面前就出现了
一个奇怪的新的细胞群落,
看起来像干细胞,
但其行为却又跟干细胞有着天壤之别。
04:46
that looked看着 like stem cells细胞
but behaved differently不同.
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04:51
And it took us a long time
to understand理解 where they came来了 from.
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我们花了好长时间
才搞清楚它们是从哪儿来的。
它们来自于这些细胞。
04:55
They come from these cells细胞.
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04:58
These blue蓝色 and red cells细胞 are called
doublecortin-positivedoublecortin阳性 cells细胞.
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这些蓝色和红色的细胞称为
DCX(doublecortin-positive)阳性细胞。
05:04
All of you have them in your brain.
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它们存在于我们每个人的大脑中,
05:07
They represent代表 four percent百分
of your cortical皮质 brain cells细胞.
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组成了我们4%的大脑皮层细胞。
05:11
They have a very important重要 role角色
during the development发展 stage阶段.
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在大脑发育过程中,
这些细胞起着至关重要的作用。
在婴儿时期,
05:15
When you were fetuses胎儿,
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05:18
they helped帮助 your brain to fold itself本身.
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它们能帮助大脑产生褶皱。
05:22
But why do they stay in your head?
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但它们为什么会一直留在大脑中呢?
05:25
This, we don't know.
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这一点我们还不清楚。
05:27
We think that they may可能
participate参加 in brain repair修理
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我们认为它们可能参与了大脑修复,
是因为我们发现在大脑损伤的部位
05:30
because we find them
in higher更高 concentration浓度
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它们的浓度比较高。
05:34
close to brain lesions病变.
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但我们还不是非常确定。
05:35
But it's not so sure.
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05:37
But there is one clear明确 thing --
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但有一点已经很清楚了——
也就是从这些细胞中,
05:40
that from these cells细胞,
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我们得到了干细胞群落。
05:41
we got our stem cell细胞 culture文化.
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05:45
And we were in front面前
of a potential潜在 new source资源 of cells细胞
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我们面前正是一群有可能修复大脑的
细胞的新来源。
05:48
to repair修理 the brain.
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05:50
And we had to prove证明 this.
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我们需要证明这一点。
那么想要证明,
05:51
So to prove证明 it,
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我们决定设计一组对照试实验。
05:52
we decided决定 to design设计
an experimental试验 paradigm范例.
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基本概念就是在大脑中一块
05:56
The idea理念 was to biopsy活检 a piece of brain
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功能尚不明确的区域进行活组织提取,
05:59
in a non-eloquent非佞 area of the brain,
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然后用Jean-François在实验室
06:02
and then to culture文化 the cells细胞
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尝试过的同样的方法培养细胞。
06:04
exactly究竟 the way Jean-Fran让 - 弗朗索瓦çoisOIS
did it in his lab实验室.
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然后给它们做标记,染色,
06:07
And then label标签 them, to put color颜色 in them
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这样就可以在大脑中追踪它们的活动。
06:10
in order订购 to be able能够
to track跟踪 them in the brain.
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06:13
And the last step was to re-implant重新植入 them
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最后一步就是把它们重新移植入
相同的个体中。
06:15
in the same相同 individual个人.
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我们把这叫做
06:17
We call these
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自体同源嫁接——自嫁接。
06:18
autologous自体 grafts移植物 -- autografts自体移植.
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06:21
So the first question we had,
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我们的第一个问题就是,
“如果我们把这些细胞
重新植入一个正常的大脑,
06:24
"What will happen发生 if we re-implant重新植入
these cells细胞 in a normal正常 brain,
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或者一个受过损伤的大脑,
06:29
and what will happen发生
if we re-implant重新植入 the same相同 cells细胞
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会有什么区别呢?”
06:32
in a lesioned毁损 brain?"
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很幸运,在Eric Rouiller教授的帮助下,
06:33
Thanks谢谢 to the help
of professor教授 Eric埃里克 RouillerRouiller,
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我们得以在猴子身上进行试验。
06:36
we worked工作 with monkeys猴子.
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06:39
So in the first-case第一例 scenario脚本,
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在第一种情况中,
我们把这些细胞移植入了正常大脑中,
06:41
we re-implanted再注入的 the cells细胞
in the normal正常 brain
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发现它们在
仅仅几周后就完全消失了,
06:45
and what we saw is that they completely全然
disappeared消失 after a few少数 weeks,
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就好像被从大脑中清除了一样,
06:50
as if they were taken采取 from the brain,
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它们被驱赶出了这一区域,
06:53
they go back home,
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这里没有多余的空间了,
06:54
the space空间 is already已经 busy,
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它们发挥不了任何作用,于是就消失了。
06:56
they are not needed需要 there,
so they disappear消失.
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06:59
In the second-case第二壳体 scenario脚本,
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在第二种情况中,
我们用了受损的大脑,
07:01
we performed执行 the lesion病变,
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把一模一样的细胞移植了进去,
07:03
we re-implanted再注入的 exactly究竟 the same相同 cells细胞,
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而这一次,细胞存活了下来——
07:06
and in this case案件, the cells细胞 remained保持 --
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它们发育成了成熟的神经细胞。
07:10
and they became成为 mature成熟 neurons神经元.
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07:13
And that's the image图片 of what
we could observe under the microscope显微镜.
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这就是我们在显微镜下看到的图像。
这些是重新移植过的细胞。
07:17
Those are the cells细胞
that were re-implanted再注入的.
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07:20
And the proof证明 they carry携带,
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证据表明,
这些小点就是我们在体外标记过的
07:22
these little spots斑点, those
are the cells细胞 that we've我们已经 labeled标记
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还处在群落状态下的细胞。
07:26
in vitro体外, when they were in culture文化.
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07:29
But we could not stop here, of course课程.
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但这肯定还远远不够。
07:32
Do these cells细胞 also help a monkey
to recover恢复 after a lesion病变?
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那么这些细胞到底会不会
修复猴子的脑损伤呢?
为了证明这一点,我们训练猴子
完成一些有关肢体敏捷性的任务。
07:37
So for that, we trained熟练 monkeys猴子
to perform演出 a manual手册 dexterity灵巧 task任务.
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它们需要从盘子里取出食物。
07:42
They had to retrieve取回
food餐饮 pellets小球 from a tray托盘.
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它们一向很擅长这种事儿。
07:45
They were very good at it.
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07:47
And when they had reached到达
a plateau高原 of performance性能,
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当它们的表现稳定后,
我们在大脑的运动皮层管理手部动作的
区域人为制造了一些损伤。
07:51
we did a lesion病变 in the motor发动机 cortex皮质
corresponding相应 to the hand motion运动.
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07:57
So the monkeys猴子 were plegicplegic,
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于是猴子们失去了手部行动能力,
手再也不停使唤了。
07:59
they could not move移动 their hand anymore.
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08:02
And exactly究竟 the same相同 as humans人类 would do,
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跟人类一样,
它们自动恢复到了某种水平,
08:05
they spontaneously自发 recovered恢复
to a certain某些 extent程度,
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跟中风后的情形相同。
08:08
exactly究竟 the same相同 as after a stroke行程.
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中风患者完全不具备行动能力,
08:10
Patients耐心 are completely全然 plegicplegic,
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他们会试图利用大脑的弹性机制,
08:12
and then they try to recover恢复
due应有 to a brain plasticity可塑性 mechanism机制,
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恢复到某种程度,
08:17
they recover恢复 to a certain某些 extent程度,
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猴子也是一样。
08:19
exactly究竟 the same相同 for the monkey.
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于是当我们很确定猴子的自我恢复能力
08:21
So when we were sure that the monkey
had reached到达 his plateau高原
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已经到达极限时,
08:24
of spontaneous自发 recovery复苏,
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我们移植了它自身的细胞。
08:27
we implanted植入 his own拥有 cells细胞.
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08:30
So on the left side, you see the monkey
that has spontaneously自发 recovered恢复.
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在左边,你们可以看到
猴子自行恢复的状况。
08:37
He's at about 40 to 50 percent百分
of his previous以前 performance性能
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与大脑受到损伤之前的状况相比,
它大概恢复了
40-50%的行动能力。
08:42
before the lesion病变.
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08:44
He's not so accurate准确, not so quick.
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它的动作不是很精准,也比较慢。
08:47
And look now, when we re-impant再impant the cells细胞:
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再看看现在,我们重新移植了细胞之后:
同样的个体,移植两个月后的状况。
08:50
Two months个月 after re-implantation再注入,
the same相同 individual个人.
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08:57
(Applause掌声)
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(掌声)
09:04
It was also very exciting扣人心弦 results结果
for us, I tell you.
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说实话,这样的结果
就连我们也感到很意外。
09:09
Since以来 that time, we've我们已经 understood了解
much more about these cells细胞.
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从那时起,
我们对这些细胞就更加了解了。
09:13
We know that we can cryopreserve冷冻保存 them,
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我们知道我们能对
它们进行加密保存,
以后也能用得到。
09:15
we can use them later后来 on.
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09:18
We know that we can apply应用 them
in other neuropathological神经病理学 models楷模,
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我们也知道我们可以把它们应用到
其他神经病理学模型中,
比如帕金森。
09:22
like Parkinson's帕金森氏 disease疾病, for example.
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但我们始终梦想有一天
能把它们移植入人体中。
09:24
But our dream梦想 is still
to implant注入 them in humans人类.
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09:28
And I really hope希望 that I'll be able能够
to show显示 you soon不久
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我真的希望很快就能让你们看到
09:33
that the human人的 brain is giving us
the tools工具 to repair修理 itself本身.
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人类大脑为我们提供了
让它进行自我修复的工具。
谢谢大家。
09:38
Thank you.
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(掌声)
09:39
(Applause掌声)
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Bruno Giussaini(BG):
Jocelyne,这太精彩了,
09:45
Bruno布鲁诺 Giussani吉萨尼: Jocelyne主任Jocelyne, this is amazing惊人,
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现在我很确定,在座的很多人,
09:49
and I'm sure that right now, there are
several一些 dozen people in the audience听众,
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甚至可能是大部分人,
09:53
possibly或者 even a majority多数,
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都在想,“我知道什么人会需要这项技术。”
09:54
who are thinking思维, "I know
somebody who can use this."
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总之我很确信。
09:57
I do, in any case案件.
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当然我还有个问题,
09:59
And of course课程 the question is,
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在你们能够进行人体临床试验之前,
10:01
what are the biggest最大 obstacles障碍
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你们面临的最大障碍都有哪些呢?
10:03
before you can go
into human人的 clinical临床 trials试验?
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10:07
Jocelyne主任Jocelyne Bloch布洛赫: The biggest最大
obstacles障碍 are regulations法规. (Laughs)
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Jocelyne Bloch (JB):
最大的障碍就是监管制度。(笑声)
就是说,有了这些不可思议的结果,
你就得开始处理
10:13
So, from these exciting扣人心弦 results结果,
you need to fill out
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10:15
about two kilograms公斤 of papers文件 and forms形式
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大约两公斤的各种文件和表格,
然后才能开始临床试验。
10:19
to be able能够 to go through通过 these
kind of trials试验.
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BG:这还算合理吧,毕竟大脑太复杂了,
还有其他种种需要考虑的问题。
10:22
BGBG: Which哪一个 is understandable可理解,
the brain is delicate精巧, etc等等.
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JB:的确,但是这个过程太漫长了,
10:24
JBJB: Yes, it is, but it takes a long time
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需要极度的耐心,还有一个专业团队
来做这个事儿,对吧?
10:27
and a lot of patience忍耐 and almost几乎
a professional专业的 team球队 to do it, you know?
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BG:如果你们自己立项——
10:31
BGBG: If you project项目 yourself你自己 --
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自己做研究,
10:33
having doneDONE the research研究
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然后试着拿到临床试验的许可,
10:34
and having tried试着 to get
permission允许 to start开始 the trials试验,
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如果能够按时完成这一系列过程,
10:38
if you project项目 yourself你自己 out in time,
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10:42
how many许多 years年份 before
somebody gets得到 into a hospital醫院
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一个普通人要去医院做这种治疗
还要等上几年呢?
10:46
and this therapy治疗 is available可得到?
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10:49
JBJB: So, it's very difficult to say.
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JB:这很难说。
首先取决于临床试验的批准日期。
10:51
It depends依靠, first,
on the approval赞同 of the trial审讯.
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监管机构会让我们尽快开始吗?
10:55
Will the regulation allow允许 us
to do it soon不久?
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其次我们还得先在一小部分患者中间
10:58
And then, you have to perform演出
this kind of study研究
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进行预试验。
11:01
in a small group of patients耐心.
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光是挑选合适的患者就要花上一阵子,
11:04
So it takes, already已经, a long time
to select选择 the patients耐心,
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还得进行治疗,
11:07
do the treatment治疗
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再评估这种治疗是否有效。
11:09
and evaluate评估 if it's useful有用
to do this kind of treatment治疗.
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之后还要进行多中心治疗。
11:13
And then you have to deploy部署
this to a multicentric多中心 trial审讯.
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我们必须在把这种治疗推广到
11:17
You have to really prove证明
first that it's useful有用
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普通大众身上之前确认它是有效的。
11:21
before offering this treatment治疗
up for everybody每个人.
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BG:当然还要安全。
JB:肯定的。
11:24
BGBG: And safe安全, of course课程. JBJB: Of course课程.
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BG:Jocelyne,
感谢你来TED分享这项研究。
11:26
BGBG: Jocelyne主任Jocelyne, thank you for coming未来
to TEDTED and sharing分享 this.
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BG:谢谢。
(掌声)
11:29
BGBG: Thank you.
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11:30
(Applause掌声)
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Reviewed by Yinchun Rui

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ABOUT THE SPEAKER
Jocelyne Bloch - Functional neurosurgeon
Jocelyne Bloch is helping to unlock potential self-healing capacities of the human brain.

Why you should listen

Swiss neurosurgeon Jocelyne Bloch is an expert in deep brain stimulation and neuromodulation for movement disorders. Her recent work focuses on cortical cells, called doublecortin, related to neurogenesis and brain repair. In collaboration with Jean François Brunet and others, she is pioneering the development of adult brain cell transplantation for patients with stroke, using their own stem cells. She aims at gathering all these novel therapeutic strategies under a common umbrella that will optimize treatment options for patients suffering from neurological impairments. She is in charge of the functional neurosurgery unit at the Lausanne University Hospital (CHUV).

More profile about the speaker
Jocelyne Bloch | Speaker | TED.com