- hace 7 meses
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Narrador: José Manuel Vieira
Hace unas décadas, habría sido difícil encontrar muchos sobrevivientes de cirugía de trasplante. Hoy en día, hemos llegado a esperar que dicha cirugía funcione.
El cirujano Roy Calne es uno de los pioneros que hizo de la cirugía de trasplante una herramienta médica práctica. También es un pintor cuyas obras capturan temas tan diversos como un tigre en la selva y la historia de estos sorprendentes avances médicos.
Cuando comenzó como cirujano, casi todos estos procedimientos fracasaban debido a la negativa del cuerpo a aceptar el nuevo órgano.
Presentado por el genetista y ambientalista de renombre mundial, David Suzuki, cada semana presenta historias que son impulsadas por una comprensión científica del mundo.
Titulo original:
The Nature of Things - Up Close and Toxic
Sigue mi pagina de Face: https://www.facebook.com/VicsionSpear/
#documentales
#españollatino
#historia
#relatos
Hace unas décadas, habría sido difícil encontrar muchos sobrevivientes de cirugía de trasplante. Hoy en día, hemos llegado a esperar que dicha cirugía funcione.
El cirujano Roy Calne es uno de los pioneros que hizo de la cirugía de trasplante una herramienta médica práctica. También es un pintor cuyas obras capturan temas tan diversos como un tigre en la selva y la historia de estos sorprendentes avances médicos.
Cuando comenzó como cirujano, casi todos estos procedimientos fracasaban debido a la negativa del cuerpo a aceptar el nuevo órgano.
Presentado por el genetista y ambientalista de renombre mundial, David Suzuki, cada semana presenta historias que son impulsadas por una comprensión científica del mundo.
Titulo original:
The Nature of Things - Up Close and Toxic
Sigue mi pagina de Face: https://www.facebook.com/VicsionSpear/
#documentales
#españollatino
#historia
#relatos
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TecnologíaTranscripción
00:00La Mujer Llena de Vida
00:30La Mujer Llena de Vida
01:00La Mujer Llena de Vida
01:29La Mujer Llena de Vida
01:59La Mujer Llena de Vida
02:29La increíble tenacidad de Mary Beth
02:34La ha ayudado a soportar cinco años de intensa terapia
02:37Pero con el tiempo llegó al límite
02:40Su habilidad para hablar y moverse no iba a mejorar más
02:44Luego escuchó un rumor sobre una nueva y tal vez peligrosa terapia experimental
02:51Mary Beth se sometería a un trasplante entre especies distintas
02:58El llamado senotrasplante
03:00Las células cerebrales de un feto de cerdo serían inyectadas en el área dañada de su cerebro
03:05The cells come from an embryonic pig
03:10And the cells are from a part of the brain called the putamen or the striatum
03:14So we were looking for a patient who had an area of damage in the striatum in that area
03:19So the cells would be the same type of cells who didn't have too much damage elsewhere
03:24They shave the little patch on my head and they drill a hole the size of a nickel in my skull
03:31They put a needle in that hole and then they eject 30 million cells
03:37Se espera que estas células fetales de cerdo se adapten a su nuevo entorno
03:43Y regeneren las conexiones que fueron dañadas por la apoplejía
03:47El senotrasplante de Mary Beth es un procedimiento experimental
04:14Sus resultados aún son muy preliminares
04:17Nuestro modesto amigo del establo parece ser un héroe improbable
04:25Tal vez hasta renuente
04:27Pero puede que le haya devuelto la vida a Mary Beth
04:30¿Podrá hacer lo mismo por otros pacientes que esperan por un trasplante?
04:36¿Pueden los órganos completos de otras especies y no solo sus células
04:40Ser tomadas de una especie y utilizadas en otra como la nuestra?
04:44Incluso el trasplante entre individuos de una misma especie
04:49De humano a humano
04:50Es una posibilidad relativamente nueva
04:53Hace solo algunas décadas
04:55Era un experimento sumamente controvertido
04:57Los pioneros en este campo
04:59No podían más que soñar con que algún día
05:01Se convirtiera en un tratamiento médico de rutina
05:04Creo que puedo hablar para todos los médicos
05:06Y para todas las personas como yo
05:08Que trabajan en laboratorios
05:08Cuando digo que nuestra última visión
05:11Es que los métodos de transplante
05:14Deberían ser recibidos
05:15En el repertorio perfecto de la práctica de la práctica de cirugía
05:18Después de solo unas décadas
05:30El sueño de Medawar se ha hecho realidad
05:33Hoy en día
05:36Para cirujanos como el Dr. Wall
05:38En London, Ontario
05:39El trasplante entre humanos
05:40Es un procedimiento médico rutinario
05:42Thousands upon thousands of lives
05:46Have been saved as a result of organ transplantation
05:50And we know now that 80% to 90% of recipients
05:55Who receive kidney grafts, liver, heart grafts
05:59Survive, and not only survive
06:00But they're restored to full and active
06:02And productive lives in the community
06:04I was waiting on a double lung transplant
06:07And I got it on November 16th
06:09November 16th, that's only a few weeks ago
06:11Yep
06:13How are you feeling?
06:15Really good
06:15I don't have to wear oxygen anymore
06:18Or take medicine
06:19I just, the only thing I gotta take now is pills
06:21Which doesn't really bother me
06:24Matty had a hole in his bowel
06:27And he was having severe liver failure
06:29And they didn't think that he would make it actually
06:33Through a, through a, he would
06:34The only hope for him would be a transplant
06:36And it was determined that my liver was exactly the
06:40The shape required to take one lobe of it
06:43And implant it into Matty
06:45Which is what happened
06:46I had a heart transplant on November the 3rd
06:50And if I keep listening to what I'm being told
06:53And keep doing what I'm told to do
06:55You know, I'm gonna have a long life ahead of me
06:57And I have, I have two children at home
07:00And a eight year old and a nine year old
07:01Son and daughter
07:02And I have everything to live for
07:05No hace mucho tiempo
07:11Los sobrevivientes de trasplantes eran criaturas extrañas
07:14En la actualidad es normal que dicha cirugía funcione
07:18El cirujano Roy Kelm
07:29Es uno de los pioneros que hizo de la cirugía de trasplante
07:32Una herramienta médica práctica
07:34Es además un pintor cuyo trabajo abarca temas tan diversos
07:40Como un tigre en la selva
07:41Y la historia de estos sobrecogedores avances médicos
07:44El cirujano Kelm se convirtió en ciruroy
07:52En reconocimiento a una vida de contribuciones a la medicina
07:55En sus comienzos como cirujano
07:58La mayoría de estos procedimientos fallaba
08:01Porque el cuerpo se rehusaba a aceptar el nuevo órgano
08:03Sir Roy ayudó a convertir la cirugía de trasplante en algo práctico
08:26Al demostrar el hecho improbable de que el hongo del suelo
08:29Podía ser la clave para superar el problema del rechazo
08:32La tendencia del cuerpo a tratar al órgano nuevo como el objeto foráneo que es
08:37It was the discovery of the cyclosporine molecule in 1976
08:45By Jean Burrell and Sir Roy Kahn's triumphant demonstration
08:49Of the effectiveness of that drug in controlling rejection
08:51That really changed the face of organ transplantation worldwide
08:54And there was an enormous impact
08:57And good results obtained as a result of that
09:01And what was previously not possible
09:03Not only became possible
09:05But in transplantation it became routine
09:08She had an emergency liver transplant about a month ago
09:18But she developed acute rejection of the liver
09:22Which we could not control with our current immunosuppressive drugs
09:26That's very rare today
09:28The drugs are so good to manage rejection
09:31That we rarely see an irreversible rejection of the liver
09:35But occasionally it does occur
09:37Long, heavy scissors
09:39You see on the tracing up there
09:45Her blood pressure is still well maintained
09:48So that liver is about two times normal size
09:57It's all blunted
09:58You see how rounded it is
10:00That's typical of a swollen rejected liver
10:03Okay
10:04You see how much smaller this liver was than the other one
10:09And how beautiful color it is
10:11Nice walnut and brown color
10:12Looks absolutely perfect
10:14So we've got about 30 minutes to sew this thing in
10:18And restore its blood supply
10:20Before it gets to be about 10 degrees sonograde
10:23And when it's above 10 degrees sonograde
10:27It starts to want oxygen
10:28I have a dilated cardiomyopathy
10:38Which is a heart enlargement
10:39And it got to the point where it could not be treated with medication anymore
10:43So my only option was to come here for a heart assessment
10:46And ultimately a heart transplant
10:47And I haven't been able to do a lot of things
10:51Since I was diagnosed with the problem
10:53And over time it's gotten worse
10:56And it's been difficult
10:59But I sure look forward to the day
11:00Where I can go out and enjoy myself again
11:02Para pacientes como Liam
11:06Que de otro modo sería un individuo sano
11:08Un corazón nuevo significaría una nueva vida
11:11La escasez de órganos los ubica a todos
11:14Bajo las reglas de la rigurosa ley de selección
11:16El difícil proceso de decidir
11:19Quién recibe el órgano
11:20Y quién morirá
11:21Patients on the waiting list
11:25See other people on the waiting list dying
11:28Waiting for an organ
11:29And there is enormous pressure and interest
11:34And a wish that we could transplant organs from animals to man
11:38Ultimately we must work towards the use of grafts
11:42Transplanted from one species to another
11:45From chimpanzee to man
11:47Conceivably from sheep to man
11:49So were on the threshold of a very important new discovery
11:53Anticipándose a esta escasez
11:58Los pioneros de la cirugía de trasplante
12:00Intentaron realizar cenotrasplantes
12:03Utilizando otras especies de animales como donantes de órganos
12:06Pero el problema del rechazo se magnificó enormemente
12:11En estos experimentos entre especies diferentes
12:13Capturado por cámaras de televisión
12:40Y transmitido a todo el mundo
12:41Fue uno de esos momentos que definen una generación
12:45Los cenotrasplantes atraparon la imaginación del público en 1984
12:50Cuando un caso particular hizo historia
12:53La pequeña Faye
12:58Nacida con un corazón defectuoso
13:00Recibió un trasplante de un mandril
13:02Fue un procedimiento altamente controvertido
13:08Que pronto terminó en tragedia
13:10La pequeña Faye murió
13:17No por el corazón de mandril que latía en su pecho
13:20Sino por las grandes dosis de ciclosporina
13:23Que evitaban que su cuerpo rechazara dicho corazón
13:26La mayoría de los primeros intentos de cenotrasplantes
13:33Utilizaron órganos de nuestros parientes más cercanos en la cadena evolutiva
13:38Esto presentaba una serie de problemas tanto médicos como éticos
13:43El doctor Christian Barnard
13:47Realizó el primer trasplante exitoso de un corazón humano
13:50También fue el pionero en el uso de seno injertos
13:53If we can control rejection adequately
13:56There is no reason that the hearts of animals cannot use for transplantation
14:00I want to qualify that statement by pointing out to you
14:03That I don't mean the use of the hearts of animals such as the chimpanzee
14:09I mean we should advance the stage where we can animals like
14:12The animals that are being slaughtered every day
14:14Goats and pigs and calves
14:16Because you yourself tried to transplant a chimpanzee heart in 1977
14:20I tried it and that's why I know how emotionally traumatic this can be
14:24I would never use the heart of a chimpanzee again
14:26Por razones médicas, éticas y de relaciones públicas
14:37La idea de utilizar primates como fuentes de órganos para humanos
14:40Adquirió mala fama con rapidez
14:43Esto podría significar que sentimos menos escrúpulos al sacrificar estas criaturas
15:12Pero también existen otras ventajas
15:15Sabemos mucho acerca de la cría de cerdos
15:18Y estos paren en grandes cantidades
15:21Esto significaría una constante y mucho más económica fuente de órganos
15:25Que podrían hacerse crecer hasta el tamaño adecuado
15:28También existe el beneficio adicional de que la distancia evolutiva entre ellos y nosotros
15:37Implica que hay menos riesgos de infecciones entre las especies
15:41Mientras que el uso de cerdos podría resolver el problema de la disponibilidad
15:45No resolverá el problema del rechazo
15:48Haría falta otro tipo de avance científico para hacer de los senotrasplantes algo factible
15:56It wasn't really until the last half of the 1980s that laboratories such as my own said
16:05There's a good reason to again go back to xenotransplantation
16:09Because the pioneers in the 60s and 70s did not have the modern tools of what we call genetic engineering
16:17Of understanding the genes in our cells
16:20Of understanding the function
16:22And above all else of being able to take a gene
16:25A gene that's responsible for a given trait
16:27And move it from one animal to another
16:30In our case we thought maybe we needed to put some human genes into the pigs
16:36Where those human genes would act to prevent things that would lead to rejection of the pig organ
16:42Were we ever to transplant it to a human
16:44Nuestras nuevas tecnologías nos permiten criar cerdos cuyos órganos tienen ADN humano
16:53Es una solución audaz que simplificaría el problema del rechazo
16:57Al engañar al cuerpo haciéndolo creer que las células de cerdo son células humanas
17:02Of course you can't just engineer the pig and go straight and transplant a heart into a patient
17:10You have obviously got to test whether your hypothesis works
17:14And we have been doing this by transplanting hearts and kidneys
17:19From our transgenic, our molecularly changed pigs
17:23Into monkeys
17:25And we've demonstrated that this hyperacute rejection reaction
17:31Can be overcome by our little genetic trick
17:35And we're currently developing the immunosuppressive protocols
17:39That will be safe for man
17:42And give long-term survival of these organs
17:46The fact that she's rejected one liver transplant
17:49Doesn't mean she's any more likely to reject the second one
17:52Than anyone would the first time around
17:54I shouldn't jinx ourselves
17:57When these clamps come off a lot of things can go wrong
18:00Even under control
18:02Agregar genes humanos a los órganos de cerdo
18:08Es una prometedora posibilidad para la evasión del rechazo hiperagudo
18:12Otra posibilidad sería alterar al paciente y no al cerdo
18:17Ever since anybody was interested in organ transplantation
18:25There's been a holy grail that we've sought
18:28Which is called tolerance
18:29And it was, the idea was first put about by Medowa
18:34Peter Medowa, who got the Nobel Prize for the work he did in it
18:38In which an animal is made to, or is persuaded
18:44That a foreign tissue from another animal of the same species
18:47Is its own
18:49It's even true, you know
18:50That you can't remove a scale from one goldfish
18:54And transplant it to another goldfish
18:57And expect it to survive
18:58In other words, there is this kind of inbuilt diversity
19:01Even among goldfish
19:03And the same would be true
19:03Lizards, birds, mice, so forth
19:05The same kind of inbuilt incompatibility
19:08As there is between human beings
19:09So it isn't a distinction of our own
19:13This very fine grain diversity between individuals
19:18Of which one symptom is the fact that one can't transplant organs freely between different individuals
19:23Medowa tomó células de un ratón blanco
19:27Y las inyectó en un ratón café recién nacido
19:30Una vez que el ratón café había madurado
19:37Medowa le injertó un pedazo de piel
19:39Del ratón blanco
19:40En lugar de rechazar el pedazo de piel
19:44Por ser algo foráneo
19:45El ratón café lo aceptó
19:46Como si fuese propio
19:48Sin ningún problema
19:49Medowa fue más allá
19:51Y con el tiempo tuvo éxito
19:53Al producir tolerancia
19:54Hasta tal punto
19:55Que logró que un ratón
19:56Aceptara un pedazo de piel humana
19:58Como propio
20:09El trasplante es tolerante
20:10Y eso ha sido demostrado muy gráficamente en tres casos al menos
20:15En la actualidad
20:24David Sachs trabaja en ampliar el trabajo de Medowa
20:28Sobre tolerancia
20:29No se trata de cerdos ordinarios
20:46Estos puercos miniatura
20:48Han sido criados para ser idénticos entre sí
20:50Y su tamaño hace que sus órganos sean adecuados para ser utilizados por pacientes humanos
20:56La esperanza del Dr. Sachs
21:11Es que al ser inyectado con material genético de cerdo
21:14El sistema inmunológico del paciente humano
21:17Se ha instado a aceptar los órganos de cerdo como propios
21:20Fritz Bach dirige un laboratorio que lleva años desarrollando técnicas
21:48Para superar los problemas relacionados con el rechazo de senotejidos
21:52Se apresura a aclarar que
21:54Aunque estamos adquiriendo conocimientos
21:56Estamos muy lejos de tener todas las respuestas que necesitamos
22:00We have probably overcome hyperacute rejection
22:03There's more we can do
22:04But we have overcome that
22:06But we now have another problem
22:08Again a problem we don't ordinarily see
22:11In transplanting a human organ to another human
22:14And that new problem
22:18That new kind of rejection
22:19We refer to as delayed xenograft rejection
22:22It occurs on day three or four
22:24Others refer to as acute vascular rejection
22:27But it's one of the same phenomena
22:30And again I think we're gaining the kind of insights
22:33The kind of knowledge
22:35And have the ideas
22:36And when I say we
22:37I certainly mean people in my laboratory
22:39We're working ardently on this
22:41Trying to develop the knowledge that we can move forward
22:44In xenotransplantation
22:46But we are developing not only the knowledge
22:49But also the therapeutic approaches
22:51That many of us think might help us overcome
22:53This second phase of rejection
22:56We're going to put a little cannula
22:58In this vein
22:59In a moment
23:00And
23:00El problema del rechazo
23:02Podría ser superado
23:03Por una mezcla de drogas
23:04Ingeniería genética del donante
23:06Y la inducción de tolerancia
23:08En el paciente
23:09Pero eso aún nos dejaría
23:12Con muchos problemas por superar
23:14Y muchas preguntas por responder
23:16Nada ilustra los límites de nuestra sabiduría
23:31O la audacia de esta aventura
23:33Como el hecho de que aún no sabemos
23:35Si un órgano de animal
23:36Podrá hacer el trabajo
23:38We know many examples
23:42Where the human molecule does not work in the pig
23:46Or the pig molecule does not work in the human
23:48So even if we can get over the barrier of rejection
23:51We have this additional physiological barrier
23:55There are people who think that for many reasons
23:59The organ just won't function
24:00In addition to the molecular incompatibilities
24:03We're not going to know an answer to that
24:05Until we have reached that point
24:07And can really try it
24:09Hey Mr. Costa, how are you feeling today?
24:13I'm pretty good
24:14I saw you up and walking in the hallway
24:17How is that going?
24:18Good, good
24:19Yeah?
24:19I feel good when I'm up right
24:20Yeah
24:20Yeah
24:21El corazón del señor Costa está enfermo
24:25Mientras espera por un trasplante
24:27Se encuentra conectado a una máquina
24:29Que hace el trabajo que en condiciones normales
24:32Haría el lado izquierdo de su corazón
24:34And so we're waiting for a call
24:36The call
24:37The call
24:38The call
24:38And as soon as we know
24:41You'll know
24:41And hopefully it won't be too much longer
24:43Okay, thanks for stopping by
24:44Yeah
24:45Mr. Costa, as you can see, is a young man
24:52And he's on this machine
24:54Until a heart becomes available for transplantation
24:59And if we had endless supply of hearts
25:03He wouldn't have no need for the machine
25:05And he'd have a heart transplant right now
25:07What we're trying to do is to address the shortage of human hearts
25:12By bringing into the mix the potential for pig hearts
25:15El doctor Madsen es un cirujano
25:22Y a la vez un investigador
25:23Que explora los posibles beneficios de los senotrasplantes
25:26Es una combinación que lo hace muy sensible
25:30A lo que estos avances tecnológicos significan para sus pacientes
25:33When I'm operating on animals in the experimental laboratory situation
25:40There is a feeling of impatience and frustration
25:44Due to the fact that I think we're so close
25:46To bringing what we know works in the lab to the bedside
25:51And I feel that every day
25:53We're on the cusp of really doing some major good for patients
25:59No todos creen en los beneficios de los senotrasplantes
26:09Algunos se oponen porque les parece que no tenemos derecho
26:21A utilizar otras especies de esta manera
26:23Already xenotransplantation research has consumed the lives of thousands of animals
26:29And not just the ordinary laboratory species that people think of
26:33The rats, the mice, the hamsters
26:35But also dogs, monkeys, chimpanzees, tigers, wolves, dingoes, goats, sheep, cows
26:41All those animals have been used to understand the immune system
26:45To develop the techniques of transplanting organs from one species to another species
26:49The level of suffering of those many thousands of animals over many years
26:54Is almost indescribable
26:56In a previous attack a bomb caused extensive damage at Bristol University
27:00And the police say anyone
27:02El debate sobre la investigación de senotrasplantes
27:04Promete ser cada vez más intenso
27:06Los sentimientos sobre los derechos de los animales son muy profundos
27:10En varias ocasiones
27:12Esos sentimientos se han traducido en amenazas y acciones violentas
27:16Contra laboratorios, investigadores e incluso inocentes
27:20Que esta bomba fue pensada de matar
27:22Y este pequeño niño muy cerca murió
27:25Tenemos una verdadera miedo
27:27Que si nos acercamos a los bombas
27:30Alguien va a morir con bombas en el futuro
27:34Everyone is entitled to their view about animal rights and so forth
27:41But I think the majority of people who understand that animals are sacrificed by the tens of thousands in North America every week
27:51So that we can have bacon at breakfast
27:53Are not going to raise a strong objection to raising some animals to save human lives
27:59El Dr. Wall podría tener razón en que una sociedad que se alimenta de tocino y huevos
28:07No se preocupará demasiado por el uso médico de cerdos
28:11Pero muchos se preocuparán por el uso que le estamos dando a los pocos dólares destinados a la salud
28:18We're heading for a procedure that's a high-tech procedure
28:23Transplantation in general is very costly
28:25And we're adding to that
28:28Because hopefully we'll be able to transplant many more people
28:30I don't think anybody has come out with a careful analysis
28:34This is an ethical issue
28:35Do you spend money on operations that may cost a quarter of a million dollars per patient
28:40When there are kids starving because there's not enough food or dirty water supplies
28:47These are issues that should be addressed
28:49Existen otros aspectos de este debate que son más urgentes y más aterradores
29:01We're talking about taking the organ from a pig
29:05And plunging that organ right into the center of the human body
29:09Plumbing it into the blood supply
29:11This is a perfect situation for an animal virus which may have been silent
29:17To reactivate or to recombine with genes in the human body to form a new virus
29:22La idea de que los cerdos transmitan enfermedades a la gente no es de ningún modo descabellada
29:31Estudios muestran que los cerdos son una pieza clave en la incubación de nuevas epidemias de influenza
29:37También son transmisores de otros virus menos conocidos
29:41Como uno mortal que apareció repentinamente en Malasia en 1999
29:46Comenzó con algunas muertes inexplicables y luego se propagó
29:51Poniendo en peligro todas las granjas porcinas de Malasia
29:55De pronto el virus pasó de los cerdos a las personas
30:03Y a los pocos días cientos murieron
30:06El ejército fue convocado
30:08Y piaras enteras fueron destruidas en un intento por detener esta nueva plaga
30:13El virus NEPA
30:15Se presentan algunas preguntas aterradoras
30:18¿Qué tan serios son estos riesgos?
30:20¿Qué significan para nosotros?
30:23¿Tenemos la capacidad para lidiar con infecciones masivas de virus como esta?
30:30Al virólogo Robin Wise le preocupan menos los virus que conocemos
30:34Que aquellos que apenas sospechamos que existen
30:38El virus parece que está creciendo bien
30:41Estas son células humanas, ¿no?
30:45Wise ya ha descubierto algunos datos inquietantes
30:48Si vamos a usar pobres para transmitir hearts o vidrios
30:55No vamos a ir a Malasia y tomar pobres
30:57Pesos infectados con el nuevo NEPA virus
31:00Que sabemos que transmite a humanos y killslos
31:03No vamos a ir a la pregunta
31:05Any pigs that are used for transplantation
31:08Are going to be kept in high containment
31:10And specially bred
31:12And one will try and eliminate
31:14As many viruses as possible
31:16Now there's two problems with that
31:19The viruses that haven't yet been discovered
31:22But might nonetheless be lurking in those pigs
31:25Because you can't screen for something you don't know about
31:28And the viruses that you cannot eliminate
31:32These porcine endogenous retroviruses
31:36Or PURPS for short
31:38Because they're embedded in the chromosomes
31:41Can't be eliminated by clean animal husbandry
31:45Pig organs, pig cells, pig genetic material
31:49Carries viral sequences
31:51Carries the genes for viruses
31:53Some of them known as retroviruses
31:55We don't know what other infectious particles
31:57There's the possibility
31:59Which everybody agrees to
32:01That if you were to transplant a pig organ into a human
32:04Eventually one of these pig viruses
32:08Might get into the human cells
32:10Might mutate
32:11Might change genetically
32:12And behave like other viruses
32:15That it could be passaged from that human patient
32:18The pig virus now
32:19But changed in some way
32:20To other humans
32:22Raising the possibility
32:23That the virus could spread to the general population
32:26Wines estremeció al mundo de la senoinvestigación
32:31Cuando demostró que el riesgo era una realidad
32:34Estos virus pueden activarse en sus huéspedes humanos
32:37We found indeed that there were three strains
32:41And two of those three strains would grow in human cells
32:46And that's what set the alarm bells ringing
32:49Pero tenemos una larga y enmarañada historia con los cerdos
32:58Durante miles de años los hemos criado, matado, procesado y comido
33:03Hasta su piel ha sido utilizada para cubrir tejido humano seriamente quemado
33:09Con la esperanza de que lo proteja y sane
33:11Si existiera algún virus por contraer
33:17¿Acaso ya no lo sabríamos?
33:25La escasez de drogas en Rusia
33:27Implicó que en ocasiones
33:29Órganos de cerdo fueran conectados a las personas
33:32Para filtrar los fluidos corporales del paciente
33:35Rara vez utilizada en el occidente
33:38Es una práctica que aquí se ha hecho relativamente común
33:41Si queremos saber cuáles son las posibilidades
33:47De que estos virus nos infecten
33:48Podríamos encontrar alguna evidencia
33:51En la sangre de los pacientes
33:52Que han sido sometidos a estos procedimientos
33:54Y otros similares
33:56En su esfuerzo por lograr que el gobierno aprobara pruebas clínicas
34:06Imutran, compañía propiedad del gigante farmacéutico Novartis
34:11Recopiló exactamente ese tipo de información en todo el mundo
34:14Casparody lideró los esfuerzos de Imutran
34:22No problem, we'll get that done
34:24Okay, thanks
34:25In the 160 patients that we tested
34:28We didn't find any of these to be positive
34:31What we did find, though, is that there were some patients
34:36And they were all the Russian patients
34:38That had pig cells that were still circulating in their body
34:41And they were circulating for up to eight and a half years
34:44After they'd had their procedure
34:45And even though they had pig cells for such a long time
34:49And each pig cell contains the DNA
34:54Which is potentially a virus
34:56None of these patients showed any clinical symptoms
34:59Or any sign of infection
35:01Robin Weiss está entre quienes piensan que el estudio
35:05Aunque importante, está incompleto
35:08The limitations of the survey of people already exposed to pig tissues
35:13Is that most of them were not immunosuppressed
35:16And, of course, xenotransplant recipients will be heavily immunosuppressed
35:21Now, we do know that all sorts of latent infections
35:25Come up and cause disease in immunosuppressed individuals
35:30Whether it's people who've had, say, human mismatched
35:35Unmatched kidney transplants
35:37Or whether it's people with HIV infection
35:40Where the HIV is causing the immunological damage
35:45And then they become open to other infections
35:47And this includes animal infections
35:49We know that HIV-1
35:54The virus that's causing the main pandemic in the world
35:56Probably came from chimpanzees
36:00Who naturally harbour a similar virus
36:03So here we have an animal-to-human infectious event
36:07Or zoonosis, as we call it in technical terms
36:11But one that then spread from human-to-human
36:13And has now infected over 50 million people
36:17And caused more than 14 million deaths
36:20That's the scenario we wish to avoid
36:24In xenotransplantation
36:26The risk is vanishingly small
36:29But we can't say that it's zero
36:31Nuestros mitos y leyendas
36:40Nos dicen que es peligroso si se cruzan las fronteras
36:43Que separan al ser humano de otras criaturas
36:45Es aquí, en esta zona prohibida
36:49Donde nacen los dioses y los monstruos
36:52Aquí se nublan las definiciones y se pierden las identidades
36:56La atracción y la repulsión
37:02Las fuertes emociones que rodean a estos míticos apareamientos
37:06Se reflejan en este debate moderno
37:09People who've had organs from animals put inside them
37:13Have been shown to have cells from those animals
37:16In every tissue that's been looked at
37:18And this is called chimerism
37:20And it means that the patient is effectively a chimera
37:24A human pig chimera
37:26And I think that that would have profound psychological implications for people
37:29There may be some difficulties with identity
37:32In fact, we have been through this
37:36With human-to-human transplantation
37:39Take heart transplants
37:41As a biologist, I may think of the heart as a pumping station
37:46But we know that throughout human history
37:50We've thought of the heart as more
37:53The heart as a seat of emotions
37:55And all the metaphors of the heart are there
38:00So I think if we are concerned about this loss of human identity
38:06We could look first at the many hundreds of people
38:11Who've had heart transplants from other humans
38:14Do they feel a loss of their individual identity?
38:20How do they feel about having someone else's heart?
38:23The heart from a dead person inside them?
38:27By and large, it's been acceptable
38:29But if we inquired a bit more about their feelings
38:34It might give us some inkling
38:35Of how it would feel to have pig tissues inside you
38:39They do foresee me getting out of this brace
38:45At some point in my life
38:47And that's all I need to hear to keep trying
38:49Mary Beth tomó la opción que para ella tuvo sentido
38:55Cualquiera de nosotros habría tomado la misma decisión
38:58Por las mismas razones
38:59Solo pregúntele a alguien que haya estado allí
39:03I'd be willing to try it, yeah
39:07Provided that, you know, they could guarantee me
39:13Or, you know, almost assure me
39:14That I was going to have, like I said, the normal life again
39:17The quality of life that I want to have
39:20Yeah, I'd go for it
39:22I would have tried anything
39:23I would have tried anything
39:25To stay alive
39:26Like I said, I have two kids at home
39:27A girl and a boy
39:29And that's my world
39:30You know, I just feel that, you know
39:32While there's life, there's hope
39:33And, you know, if that helps save our children
39:36And our people, then terrific
39:39I would have done it, no doubt, yeah
39:42If I needed a heart transplant
39:47And a pig transplant was good at work
39:49And there was no human heart available
39:51I'd personally take the pig heart
39:53But suppose I did become infected
39:58Suppose I passed the infection on to my wife
40:01Or the person sitting next to me on the metro
40:04What then?
40:05Suppose they passed it on again
40:07Now, that possibility is even more remote
40:12Than me as an individual becoming infected
40:16But it's not entirely impossible
40:20And the consequences of an epidemic arising in that way
40:25Are, of course, more devastating
40:27So what does this mean?
40:30It means that we're putting people in the general population
40:33Your kids, my kids, at risk
40:36We don't know the size of that risk
40:38But we know the risk is there
40:40And it comes down to the question
40:42Who gets to decide whether it's proper to put them at risk
40:45And if we put them at risk
40:47Under which conditions
40:48Are we going to put them at risk?
40:50Las plagas se propagan con rapidez
40:55En un mundo cada vez más pequeño
40:57Ya algunos gobiernos han manifestado
41:00Que los beneficiarios de cenotrasplantes
41:02Deberán aceptar restricciones al viajar
41:05Entre otras intrusiones
41:06En diversos aspectos de sus vidas privadas
41:09They'll watch me for the rest of my life
41:14Because of it
41:15You have to have this blood work
41:17Every month for the first six months
41:20We have to go to Boston for checkups
41:24And they take blood
41:25And also
41:27We signed papers
41:30Where Mirabeth
41:31Is not to have children
41:33And she carries a donor card
41:36In case something ever happened to her
41:37That they could perform
41:39Autopsy
41:40To see how
41:41The procedure has worked
41:43So that they could do an autopsy
41:45What else?
41:48I can't ever donate my organs
41:50Or my blood anymore
41:51Because of a pig cell being injected
41:55Ante la ausencia de suficientes donantes humanos
42:01Estas restricciones pudieran parecer inconvenientes menores
42:05Para alguien cuya vida está en juego
42:07Y puede que no tengamos que esperar mucho tiempo
42:10Antes de que alguien tenga la oportunidad
42:12De tomar esa opción
42:13Estamos en medio de un verdadero esfuerzo
42:16Por parte de varias compañías
42:18Para pasar del laboratorio a la clínica
42:20Y al parecer sucederá pronto
42:22The type of clinical trials
42:24That we would be considering
42:26Are either transplanting hearts or kidneys
42:28We would consider doing this
42:31In a well regulated environment
42:34We wouldn't try to do it in a place
42:36Where xenotransplantation would be allowed
42:38Because there are no laws
42:39I think it's best to do it
42:41Where it's well controlled and regulated
42:43And so that's the next step
42:45How long will it take?
42:48Certainly more than a year
42:50Probably more than two years
42:52More than that
42:54Perhaps not
42:55We don't know if a pig kidney
42:57Will be able to control
43:00Body fluid levels
43:01And blood pressure
43:03In the way that a human kidney does
43:04We don't know if a pig heart
43:07Will maintain the level of blood pressure
43:10That the human being requires
43:11The pig is a horizontal animal
43:13The human being is a vertical animal
43:15With the brain right at the top
43:17The most important organ
43:18Nobody knows if a pig heart
43:21Is going to be able to sustain
43:22A blood pressure that will support the brain
43:24So this work is rushing ahead
43:27The scientists are focusing on the rejection problem
43:30Without doing the basic science
43:32To find out if those organs
43:34Will actually support human life
43:35Pero el empuje por el traslado del laboratorio a la clínica
43:43No es solo motivado por preocupaciones humanitarias
43:47These commercial companies doing this work
43:51Are forcing the pace
43:52They're forcing the development of this work
43:55They are putting pressure on governments
43:57To license the developmental work
43:59They're putting pressure on governments
44:00To allow for the first clinical trials
44:03The whole thing is being commercially driven
44:06So that companies that are already making big profits
44:10Are going to make even bigger profits
44:12Asustados quizás por la reacción del público
44:17A los alimentos modificados genéticamente
44:20Y a la enfermedad de las vacas locas
44:22Tiene sentido que estas compañías
44:24Hagan todo lo posible para controlar las imágenes
44:27Que informan al debate público sobre los senotrasplantes
44:30Los críticos de compañías como Immutran
44:34Piensan que los intereses comerciales
44:36Se han vuelto más importantes
44:38Que la preocupación por la seguridad pública
44:40Immutran has never published full statistics
44:44Of the number of genetically engineered pigs
44:47It's produced
44:48How many of them survived
44:49How many of them were sick
44:51The availability of information
44:54To the public
44:55And to the scientific community
44:57Is tightly controlled
44:58Los senotrasplantes prometen ser un gran negocio
45:05Pero los inversionistas se atemorizan al menor indicio
45:08De que algo pueda entorpecer su desarrollo
45:11No existe duda de que declaraciones como esa
45:37Pueden afectar al mercado
45:39Pero una industria joven y controvertida
45:42Puede ser algo serio
45:43Como en muchos aspectos de la vida moderna
45:47El resultado es, con frecuencia
45:49Una maraña de intereses públicos y privados
45:52Immutran trasladó parte de sus investigaciones
46:04A la Universidad Canadiense de Wealth
46:06Sin duda era un local atractivo
46:09Dadas las décadas de investigaciones especializadas
46:12Que aquí se han llevado a cabo
46:14Las primeras investigaciones
46:19Fueron mostradas en estas tomas
46:21De un episodio de 1978
46:23Del programa de la CBS
46:25Science Magazine
46:27Por razones de agricultura
46:37Que nada tienen que ver con senotrasplantes
46:39Estos científicos habían estado trabajando
46:42En la cría de cerdos libres de patógenos
46:44Esta investigación sobre el alumbramiento y cría
47:08De cerdos en condiciones estériles
47:10Fue pagado con dinero de los impuestos canadienses
47:13Mientras que la Universidad de Wealth
47:26Brindó una calurosa bienvenida a nuestro equipo
47:29Incluso después de casi dos años de negociaciones
47:32Immutran decidió que no nos permitirían
47:34Utilizar imágenes de sus cerdos genéticamente alterados
47:38Los cuales, nacidos aquí por cesárea
47:40Eran criados en aislamiento
47:42Parece irónico, para decir lo menos
47:56Que Immutran declarara que la versión actual
47:59De este programa en una universidad canadiense
48:02Mantenida con fondos públicos
48:04No debía ser transmitida por la televisora pública
48:07En 1978
48:10Nadie trató de censurar estas imágenes
48:13Porque pudieran ser perturbadoras
48:15No hay duda de que las sensibilidades cambian con el tiempo
48:19Algo que no ha cambiado
48:21Es que aquel que le paga al flautista
48:23Escoge la canción
48:24Y la realidad de quien controla la investigación
48:28Y el acceso a ella
48:29Está cambiando radicalmente en este nuevo mundo
48:32Donde las finanzas corporativas
48:35Pagan por las instituciones públicas
48:37¿Quién responderá a la difícil interrogante
48:42De si los senotrasplantes son una manera ética
48:44De lidiar con la escasez de órganos?
48:47¿Podrán llegar a ser suficientemente seguros?
48:50¿Es hora de pasar del laboratorio a las pruebas clínicas?
48:54¿Por qué?
48:55¿Por qué?
48:55¿Por qué?
48:56¿Por qué?
48:57I was previously rather opposed
49:01to moving from the laboratory to the clinic
49:05unless there were long-term survivors of pig to monkey
49:09but I now feel that so much work has been done carefully and conscientiously
49:15and we know what's possible with monkeys
49:18and it seems to me unlikely we're going to get much better with monkeys
49:21I feel equivocal about it
49:24but I come down on the side of saying
49:28that I don't think the dangers are so great
49:30that we shouldn't proceed
49:31with limited trials
49:34and I think the knowledge will gain
49:38about human health
49:40about health dangers
49:42about whether it works at all
49:44will take us to the next stage
49:47so I myself would be in favor of going forward cautiously
49:53Otros investigadores como Fritz Bach
49:58piensan que las pruebas clínicas son prematuras
50:01There are two sides to it
50:03One of the little girls, little boys
50:06who need a heart transplant
50:07need a kidney transplant
50:08have no other way of living potentially even
50:11which is a very commanding immediate need
50:14The other side
50:16and all kinds of things in between
50:18is the fact
50:19that we're going to add yet one more incremental risk
50:22to the public
50:23namely the possibility of this kind of infection in the public
50:26The people who decide this
50:28one, have to represent the public
50:31that is to be their only interest
50:33both the patients and the public in general
50:35to balance altruism
50:37against this added risk to our lives
50:40At the same time
50:42those people should have no conflicts of interest
50:45I think that the public debate is all right for information
50:49but as far as
50:51the transplants from animals to man is concerned
50:54if it's a pig, it's the donor
50:56if it works, it'll be great and hailed as a wonderful
50:59new advance
51:01and if it doesn't work
51:02the people who do it will be castigated as experimental cowboys
51:06so I don't think
51:07I don't think it matters
51:08what the public debate says
51:10Resulta fácil imaginar que la visión de Sir Roy
51:17está informada por memorias de vaqueros y héroes
51:20de un tiempo no muy lejano
51:21cuando los trasplantes de humano a humano
51:24eran considerados imposibles
51:26in morales
51:27o andos
51:28Entonces, como ahora
51:31la gloria fue del primero en cruzar la línea de meta
51:35Si no continuamos con los senotrasplantes
52:04¿Cómo podremos suplir la creciente demanda de órganos?
52:11Las opciones son difíciles
52:14cargadas de peligros y esperanzas
52:16con temas que retan nuestro sentido de la ética
52:19y nuestro sentido de quién y qué somos
52:23¡Ayías!
52:24¡Ayías!
52:27¡Ayías!
52:28¡Ayías!
52:28¡Gracias!
52:58¡Gracias!
53:28¡Gracias!
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