2010年度十大医学突破——《时代》周刊：iPS榜上有名 - 新闻区干细胞之家

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发表于 2010-12-11 23:16 |只看该作者 |倒序浏览 |打印

本帖最后由 sunsong7 于 2010-12-11 23:39 编辑

美国《时代》周刊在其网站上公布了2010年十大医学突破名单，其中“可降低HIV感染风险的抗艾滋病药”、“人工合成细胞”、“老年性痴呆症的血液检测”及“更快更安全培育iPS细胞”等成果入选。生物谷编辑根据网友编译和原文整理如下：
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1.可降低HIV感染风险的抗艾药
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1. AIDS Drugs Lower the Risk of HIV Infection

研究者在对来自6个国家的2500名HIV阳性同性恋男性进行的一项高风险试验期间，研究人员发现与安慰剂相比，一种被称作Truvada的抗逆转录病毒药物能降低44%的HIV感染风险。科学家对那些每天服用这种药物最积极的试验参与者进行更进一步研究，发现他们感染HIV的风险甚至更低，比服用安慰剂的参与者低近73%。
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目前还需要进行更多研究才能确定抗逆转录病毒药物对预防HIV的好处，公共卫生专家发出警告说，即使最终结果证实这种方法确实有效，它也不能取代最好的预防方法：安全性生活和使用避孕套。这是因为所谓的暴露前预防方法的工作原理，是让高风险人群在接触这种病毒前服用抑制HIV抗逆转录病毒药物，这样做能促使该药尽快对抗HIV。但是抗逆转录病毒药物不会像疫苗一样，激活免疫系统预防感染。
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Antiretroviral drugs have turned the AIDS epidemic around, by thwarting the virus in HIV-positive patients. But new research suggests that this powerful treatment may have another benefit — as a weapon against infection in healthy individuals.
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In a trial involving nearly 2,500 HIV-negative, but high risk, gay men in six countries, researchers found that a combination antiretroviral pill called Truvada reduced the risk of HIV infection by 44%, compared with placebo. When scientists looked more carefully at the study volunteers who took the medication most faithfully, on a daily basis, they found that the risk of contracting HIV was even lower — 73% lower than the placebo group.  X% A4 M: }) Y/ p# v

More studies will need to confirm the benefit of antiretrovirals in the prevention of HIV, and public health experts warn that even if the results hold up, it would not replace the best method of prophylaxis: safe sex and consistent use of condoms. That's because the way so-called pre-exposure prophylaxis, or PrEP, works is to load up high-risk people with HIV-disabling antiretroviral drugs before exposure to the virus, which allows the medication to hit HIV as early as possible. But the drugs do not work as a vaccine would, by priming the immune system to actually prevent infection.4 P3 |9 Y6 N3 o* k' b2 p5 ~

2.人工合成细胞
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2. Synthetic Cell5 [% n2 f3 _  R+ `3 Z% V$ v! r0 T
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形象地说，人类基因图谱的联合绘制者克雷格.文特尔就是21世纪版的弗兰肯斯泰因(玛丽.雪莱小说中的科学怪人，他创造的怪物最终毁灭了他本人)。2010年，文特尔又朝着在实验室创造生命的道路上向前迈出一步。通过将人工合成的DNA的化学物质“拼接”在一起，文特尔合成了一种细菌的完整基因组，基因组随后被注入一个细胞进行自我复制。克雷格.文特尔的“人造细胞”显然不具备雪莱笔下的怪物那样可怕的性格，但不管怎样，它终究是一个人造生命。& `0 M  Q6 q3 I# H* Q3 U

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文特尔希望他的发现将是合成生物学领域第一个实验室制造的生物。通过混合和匹配遗传物质并与适当的化合物结合，文特尔正制造出可能充当新型生物燃料的生物体，通过允许研究人员将现成不同流感病毒株摆在实验室的架子上，他制造的生物体甚至可以加速流感疫苗生产。
Move over, Dr. Frankenstein, and make room for your 21st-century counterpart, Dr. Venter. That's J. Craig Venter, co-mapper of the human genome, who this year took another step toward creating life in the lab. Generated from a painstaking process of stitching together the chemicals that compose DNA, Venter synthesized the entire genome of a bacterium, which was inserted into a cell and was able to replicate. Granted, Venter's "synthetic cell" had hardly the personality of Mary Shelley's angst-fueled monster, but it's man-made life nonetheless. Venter hopes his findings will be the first of a long line of lab-made creatures in synthetic biology. By mixing and matching genetic material into viable combinations, Venter is already generating organisms that may serve as new types of biofuel, or even speed up flu vaccine production by allowing researchers to keep ready-made versions of different viral strains of influenza on lab shelves.! T( m4 S7 O' N' K/ @* L
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3.老年性痴呆症的血液检测
3. Blood Test for Alzheimer's
虽然临床医生用以诊断疾病的方法越来越先进，但即便运用最尖端的成像与分子探针手段，老年性痴呆症(亦称阿尔茨海默病)仍然难以确诊。只有在尸检时才能确定一个人是否患有这种退化性疾病，因为到那时，病理学家可以证实大脑中是否存在病斑等老年性痴呆症的标志性特征。但是，一种颇具前景的新型血液检测手段或能在疾病发展过程中提前做出确诊，从而给预防痴呆和智力衰退提供了可能性，甚至在最早的症状出现以前。2 |/ }0 Y! E; K

新的检测手段通过分析血液中二十多种蛋白，诊断老年性痴呆症的准确率高达80%。这只是旨在提前发现和确定老年性痴呆症的一系列最新手段之一，这些手段还包括测试脊髓液。提前确诊可以帮助患者充分利用行为干预手段，如保持社会接触和学习新事物以保持大脑活跃，从而减缓老年性痴呆症造成的智力衰退。
Despite the increasingly sophisticated methods clinicians have for diagnosing disease, Alzheimer's remains out of reach for even the most advanced imaging and molecular probes. The degenerative illness can be definitively diagnosed only at autopsy, when pathologists can confirm the presence of hallmark plaques and tangles in the brain. But a promising new blood test may help confirm a diagnosis early in the disease's progression, which opens the possibility for prevention of dementia and mental decline even before the earliest onset of symptoms. The new test analyzes more than two dozen proteins in the blood, and is 80% accurate in identifying patients with the disease. It is only the latest in a series of new methods, including tests of spinal fluid, aimed at detecting and confirming Alzheimer's earlier in patients' lives. Quicker diagnoses could help patients take advantage of behavioral interventions — such as keeping the mind active by maintaining social contacts and learning new things — that may slow the mental deterioration of Alzheimer's.

4. FDA Approves Botox for Migraines
4.FDA批准使用肉毒杆菌治疗偏头痛5 p0 m! F8 s, {! K/ c
在前额处接受肉毒杆菌注射以防止皱纹产生之后，一些患者报告称他们的偏头疼症状似乎也有所缓解。获知此事之后，科学家，尤其是肉毒杆菌生产商Allergan的科学家，决定对此进行研究。依靠1000多名患者参与的两项大型测试获得的数据，Allergan成功让美国食品与药物管理局(FDA)相信，面部注射肉毒杆菌的患者每月出现偏头疼的次数低于那些并未接受这种肌肉麻痹注射的患者。

食品与药物管理局批准使用肉毒杆菌治疗偏头痛意味着，保险公司可能要支付患者使用肉毒杆菌的治疗费用。几个月注射肉毒杆菌的费用达到数千美元。专家们表示，现在仍很难预测哪种类型的头疼患者能够成为最大受益者，但至少偏头疼患者不必偷偷摸摸地找到整形外科医生，缓解他们的痛苦，他们也不必为这种治疗自掏腰包。
Who knew that vanity could yield a new treatment for pain? After some patients who received Botox injections to prevent wrinkles in their forehead reported that their migraines also seemed to diminish, scientists — especially those at Allergan, the manufacturer of Botox — decided to investigate. Based on data from two large trials involving more than 1,000 patients, the company successfully convinced the Food and Drug Administration (FDA) that patients receiving Botox in the facial area experienced fewer days of migraine pain each month than those who did not get the muscle paralyzing injections. The FDA approval means that insurers may start covering the cost of Botox, which can cost thousands of dollars over several months, to treat migraines. It's still difficult to predict which headache patients will benefit the most, say experts, but at least migraine sufferers won't have to visit the plastic surgeon on the sly to relieve pain — or pay for treatments out of pocket.( `5 r$ t# }& X* S: b9 ]8 i' o( ~
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5.修订心肺复苏术急救指南
5. Taking the Resuscitation Out of CPR
自1960年心肺复苏术问世以来，急救人员在过去50年以相同方式挽救了无数生命：口对口人工呼吸结合胸部按压，令失去知觉的人苏醒过来。然而，最新数据表明，在抢救心搏停止患者时，仅靠胸部按压就与传统心肺复苏术一样有效，于是，美国心脏学会(AHA)决定对这种具有数十年历史的急救手段进行更新。) t- a" B4 R* y" I# Q P0 w/ E

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心肺复苏术的新规定更加注重胸部按压，有时可以辅以口对口人工呼吸。近年来，一系列研究发现，未经专业培训的人更适合实施胸部按压——即便是在经过专业培训的急救人员的帮助下，那些仅接受胸部按压的患者的存活几率同接受心肺复苏术的存活几率一样大。再加上需要心肺复苏术急救的患者当中只有30%接受了这种手段的处理——部分原因是未经专业培训的人不愿实施这种他们认为相当复杂的处理，美国心脏学会被迫对心肺复苏术的急救指南做出修订。

新的急救指南建议，包括经过专业培训的医疗急救人员在内的所有救助者，将心肺复苏术的当前顺序颠倒过来，先进行30分钟的有力胸部按压，接着再实施口对口人工呼吸。美国心脏学会专家称，针对那些心脏可能处于危险的人，首先要考虑的是使心脏再次跳动起来，而以胸部按压开始急救，则可能将心脏停止跳动带来的损害降至最低程度。
For 50 years, ever since cardiopulmonary resuscitation (CPR) was first described in 1960, rescuers have been saving lives the same way, by combining mouth-to-mouth resuscitation with chest compressions to revive unresponsive victims. But after new data showed that chest compressions alone were just as effective as traditional CPR in rescuing victims of cardiac arrest, the American Heart Association (AHA) decided to update the decades-old process. The new rules for CPR put more emphasis on the chest compressions, and in some cases do away with resuscitating breaths altogether.( e: N, b. B. m( Z! G3 [+ M$ O, _

In recent years, several studies have found that untrained bystanders are more comfortable performing chest compressions, without mouth-to-mouth — even with the help of a trained 911 operator — and that victims who receive only compressions are as likely to survive as those who receive full CPR. These results, coupled with the fact that only 30% of those in need of CPR actually get it — in large part because of untrained bystanders' reluctance to perform what they view as a complex procedure — forced the AHA to revise its CPR guidelines.

The new recommendations advise all rescuers, including trained emergency medical personnel, to reverse the current protocol for CPR and begin with 30 firm chest compressions, then turn to resuscitating breaths. The priority for those whose hearts may be in distress, say AHA experts, is to get the heart pumping again, and starting off with chest compressions may keep damage from a stopped heart to a minimum.
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6.美国食品及药品管理局限制使用文迪雅(Avandia): S& b6 b8 C6 b
6. The FDA Restricts Avandia
治疗糖尿病的药物文迪雅打入市场11年，成为一颗全球性重磅炸弹后，现在它受到美国食品及药品管理局有史以来最严厉的药品限制的沉重打击。现在只有那些经过登记，保证知道服用这种药物可增加心脏病发作风险的医生，才有权给患者开这种用来控制二型糖尿病患者的血糖的药物。而且只有在患者尝试了所有其他治疗方法都不见效后，这些医生才能给他们开梵帝雅，患者也必须签字，表明自己清楚相关风险。

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据一些专家说，人们早就期待美国食品及药品管理局做出这样的决定， 2007年研究人员首次发现这种药物可增加服用者的心脏病发作风险。当时该局在文迪雅的标签上第一次提出警告。对该药的安全性进行的一项政府评估显示，世界领先的制药业巨擘葛兰素史克公司在1999年文迪雅打入市场后不久，就知道它可增加心脏病风险。最新研究显示，名叫Actos的类似药物似乎不会给心脏带来相同风险，对那些感觉文迪雅效果不错，但是在最新限令的影响下，很难买到该药的患者来说，这是个天大的好消息。6 g2 c# u3 B/ R
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Eleven years after it hit the market and became a worldwide blockbuster, the diabetes medication Avandia (rosiglitazone) was slapped with the FDA's most stringent drug restrictions yet. Now, the medication that helps control blood sugar in patients with Type II diabetes can be prescribed only by physicians who are part of a registry certifying that they are aware of the increased risk of heart attack associated with the drug. These doctors may dispense Avandia only if their patients have exhausted all other treatment options, and patients must sign off on these risks as well.7 j9 F! f: J& F7 \
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The FDA's decision, according to some experts, was long overdue, considering that researchers first reported increased heart risks among Avandia users in 2007. At that time, the FDA instituted its first warning on the drug's label. And yet a government review of the drug's safety revealed that its manufacturer, GlaxoSmithKline, was aware of the heightened risks associated with its product not long after it hit the market in 1999.

The good news for patients who respond well to Avandia but are finding it difficult to keep their prescription filled under the new restrictions is that a similar drug, Actos (pioglitazone), does not seem to pose the same risks to the heart.

7.验血可诊断心脏病发作
7. Blood Test for Heart Attack, H* |' m6 R. J, U
心脏病发作始于血管阻塞，因此，血液检测可以成为预测心脏问题的一种更理想方式。目前，检查心血管状况的最可靠方式就是血管造影。这是一种侵入式方式，需要将一根细细的管子伸入大腿动脉血管。现在，研究人员已经确定了23个为血白质合成指定遗传密码的基因，利用这种方式检查与心脏病有关的血管阻塞情况的准确率高达83%。6 V/ |! e: B* P$ {3 L, x

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如果医生将这种血液检测与现有的心脏病发作风险诊断手段--包括胸疼症状和家族疾病史--结合在一起，确定患者属于高风险还是低风险人群的准确率将比单纯使用传统手段提高16%。期待血检本身能够预测心脏病发作还不切实际，至少目前如此，但对于那些高危患者来说，它可以充当一个早期预警信号。也许通过改变饮食结构和生活习惯，这些患者便可以预防心脏病发作。* V0 t) U7 t" Q4 w* n
A heart attack starts with blockages in the blood vessels, so where better to look for predictors of heart trouble than in the blood? At the moment, the most reliable way to check the status of the heart's vessels is by angiogram, an invasive procedure that involves snaking a thin tube into the vessels from an artery in the leg. But researchers have now identified a preliminary panel of 23 genes that code for blood proteins, which was 83% accurate in detecting blood-vessel obstructions typical of heart disease. When doctors added this blood test to existing measures of heart attack risk — including symptoms of chest pain and family history of health problems — it improved by 16% their ability to classify patients as being at high or low risk, compared with traditional methods alone. It's too much to expect that the blood test by itself can predict heart attack, at least for now, but it could serve as an early warning call for patients who register as high risk. Perhaps by prompting changes in diet and lifestyle habits in these patients, it can help prevent them from ever having a heart attack at all.

8.试管受精新突破可精确测定胚胎健康状况
8. Predicting IVF Success
http://www.bioon.com/biology/Upl ... 010121113064485.jpg
对选择通过试管受精要小宝宝的夫妇来说，这种方法的成功概率并不那么尽如人意。即使在最佳环境下，通过这一程序安全降生小宝宝的概率也仅为30%。不过斯坦福大学的研究人员最近传出喜讯，他们找到一种方法可以挑选出最强壮的晶胚，最大限度地增加受孕和成功产下小宝宝的概率。/ v9 W" z5 j: T) c5 T* n& C, @% F b3 ^

科学家通过拍摄受精后前几个小时的晶胚活动情况，可以确定一个晶胚是否能继续发育下去和存活好几天，而不是死掉。确保得出正确结论的其他标准包括：晶胚由一个细胞分裂成两个细胞所用的时间，以及它需要多长时间才能进行这种分裂。下一步是对这种以视频录像为基础的评估进行试管受精临床试验，确定这一分析结果是否能提高成功受孕和安全生下小宝宝的概率。
For couples choosing to start a family with in vitro fertilization (IVF), the odds are not always in their favor. The procedure, even under the best circumstances, has a 30% chance of resulting in a live birth on average. So it was welcome news indeed when Stanford University researchers reported on a new method for selecting the strongest embryos, which would most likely result in a pregnancy and live birth.

By filming the first few hours of an embryo's activity after fertilization, the scientists were able to come up with a profile of characteristics of embryos that were most likely to continue developing and survive for several days, instead of dying off. Among other things, the criteria included the time that the embryos took to make their first division from one cell into two, as well as the time that this division itself took to unfold. The next step will be to put this video-based assessment to the test in an IVF clinic, and determine whether the analysis can actually improve pregnancy and live birth rates.

9.成功培育人造卵巢
9. Artificial Ovary( o9 U" b' i0 N! E
科学家今年报告称，他们成功培育出人造卵巢，将来有一天可让人类卵子在体外发育成熟，这对于那些不孕不育的人来说无疑是个好消息。美国布朗大学科研人员领导的一个研究小组成功将患者捐赠的三个初生卵细胞培育成与卵巢相似的三维组织结构。在实验室中，培育出来的这几种细胞可以像正常卵巢一样相互作用，用于各种用途和目的，研究人员甚至成功将人类卵子从最初阶段培育成发育完全的形式。! Y1 R/ h* Y n: k( I6 K5 z) w

人造卵巢培育成功带来的最为直接的影响是，可以帮助人工受精(IVF)领域的技术人员提高成功率。目前，当女性为某个人工受精治疗周期捐赠卵子时，她们提供了各种成熟和不成熟的卵子；发育越不成熟的卵子受精变成胚胎的可能性越小。
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如果技术人员可以在实验室中使不成熟的卵子发育完全，那么这就能帮助每个人工受精治疗周期在令患者怀孕并最终产子的过程上更加有效。此外，人造卵巢或许还能帮助患有卵巢疾病的女性(这样的患者不能产生成熟的卵子)，让她们利用人工受精技术拥有自己的宝宝。
In more good news for those struggling with infertility, scientists reported success in creating an artificial ovary that could one day nurture immature human eggs outside the body. Researchers led by a team at Brown University managed to coax three primary ovary cells donated by patients into a 3-D structure resembling an ovary. In the lab, the cell types interacted with one another and functioned for all intents and purposes like a real ovary, even successfully maturing a human egg from its earliest stages in the follicle to a fully developed form.. V7 D5 K' \2 |) j! k

Most immediately, the structure could help IVF technicians improve success rates. Currently when women donate eggs for a cycle of IVF, they provide a range of both mature and immature eggs; the less developed ones are less likely to be fertilized to become embryos. But by allowing technicians to mature these eggs in the lab, researchers might be able to help each IVF cycle become more efficient in leading to a pregnancy and eventual life birth. In addition, the artificial ovary could help women with ovarian disease, who are unable to produce mature eggs, take advantage of IVF to have children of their own.' W! |" ]& G& a! R/ `- H- F2 y
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10.更快更安全培育iPS细胞6 O* @/ j& \* c1 _- ]
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10. Creating iPS Cells Safer and Faster" [) k: D4 F) B. Q# L+ S( K8 F) D. X; D
借助干细胞疗法治疗疾病仍是未来才可能实现的事情，但在将实验室研究成果应用于临床的道路上，科学家正不断取得重大进步。在培育诱导多功能干细胞(iPS)--可以使用皮肤细胞培育，完全无需使用胚胎--过程中，波士顿儿童医院的研究人员克服了一个重要障碍，能够将这种技术安全地应用于人类患者。

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直到现在，在使用皮肤细胞培育iPS细胞时，研究人员仍需将皮肤细胞暴露在两种病毒以及致癌基因环境下，而后通过“编程”使其进入类似胚胎的状态。现在，波士顿的科学家已成功利用另一种被称之为“RNA”的基因，消除因注射病毒和致癌基因造成的风险。在培育iPS细胞方面，这项技术的效率大约是其他传统方式的100倍。科学家的目标是能够在未来使用干细胞充当新健康细胞的来源以取代被疾病破坏的细胞。在朝着这一目标前进过程中，上演这一新发现的波士顿科学家无疑向前迈进了一大步。
While the promise of a stem-cell treatment to treat disease remains far off, scientists continue to take giant steps toward bringing that potential from the lab to the clinic. Working with the groundbreaking type of stem cell known as induced pluripotent stem (iPS) cells — which can be generated from a skin cell, completely bypassing the need for embryos — researchers at Children's Hospital Boston have overcome a critical hurdle in making the technology safe for human patients. Until now, to create iPS cells from skin cells, researchers needed to expose the skin cells to both viruses and cancer-causing genes to reprogram them to an embryo-like state. Now the Boston scientists report success in using another form of the added genes, known as RNA, that eliminates the danger posed by the insertion of the viruses and cancer-promoting genes. And as an unexpected bonus, the technique is about 100 times more efficient in making iPS cells than the older method. The new findings mark a significant advance toward someday using stem cells as a source of new and healthy cells to replace those that have been destroyed by disease.' p- G( C. d W- g' y
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