人类首次成功接受猪心脏移植，患者术后状况良好_OK阅读网
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人类首次成功接受猪心脏移植，患者术后状况良好
In a First, Man Receives a Heart From a Genetically Altered Pig

来源：纽约时报    2022-01-11 03:04



        A 57-year-old man with life-threatening heart disease has received a heart from a genetically modified pig, a groundbreaking procedure that offers hope to hundreds of thousands of patients with failing organs.
        一名因患心脏病有生命危险的57岁男子移植了来自一只经过基因改造的猪的心脏，这项开创性的手术为数十万器官衰竭的患者带来了希望。
        It is the first successful transplant of a pig’s heart into a human being. The eight-hour operation took place in Baltimore on Friday, and the patient, David Bennett Sr. of Maryland, was doing well on Monday, according to surgeons at the University of Maryland Medical Center.
        这是第一次成功地将猪的心脏移植到人体内。据马里兰大学医学中心的外科医生称，这项耗时8小时的手术于周五在巴尔的摩进行，来自马里兰州的患者老戴维·贝内特周一状况良好。
        “It creates the pulse, it creates the pressure, it is his heart,” said Dr. Bartley Griffith, the director of the cardiac transplant program at the medical center, who performed the operation.
        “它能产生脉搏，产生血压，成为了他的心脏，”执行手术的医疗中心心脏移植项目主任巴特利·格里菲斯博士说。
        “It’s working and it looks normal. We are thrilled, but we don’t know what tomorrow will bring us. This has never been done before.”
        “它正在跳动，看起来很正常。我们都很兴奋，但我们不知道接下来会怎样。这是前所未有的。”
        Last year, some 41,354 Americans received a transplanted organ, more than half of them receiving kidneys, according to the United Network for Organ Sharing, a nonprofit that coordinates the nation’s organ procurement efforts.
        根据协调美国器官采购工作的非营利组织器官共享联合网络(United Network for Organ Sharing)的数据，去年约有41354名美国人接受了移植器官，其中一半以上是肾脏。
        But there is an acute shortage of organs, and about a dozen people on the lists die each day. Some 3,817 Americans received human donor hearts last year as replacements, more than ever before, but the potential demand is still higher.
        但器官严重短缺，名单上平均每天约有十多人死亡。去年有3817名美国人接受了捐赠心脏移植，该数字高过以往任何时候，但潜在需求仍然更高。
        Scientists have worked feverishly to develop pigs whose organs would not be rejected by the human body, research accelerated in the past decade by new gene editing and cloning technologies. The heart transplant comes just months after surgeons in New York successfully attached the kidney of a genetically engineered pig to a brain-dead person.
        科学家们一直在努力培育器官不会在人体内产生排斥反应的猪，过去10年中，新的基因编辑和克隆技术加速了研究。在这次心脏移植手术的几个月前，纽约的外科医生成功地将一头基因改造猪的肾脏移植到一个脑死亡的人体内。
        Researchers hope procedures like this will usher in a new era in medicine in the future when replacement organs are no longer in short supply for the more than half a million Americans who are waiting for kidneys and other organs.
        研究人员希望这样的手术将在未来开启医学的一个新时代，届时超过50万正在等待肾脏和其他器官的美国人所需的替代器官将不再短缺。
        “This is a watershed event,” said Dr. David Klassen, the chief medical officer of the United Network for Organ Sharing and a transplant physician. “Doors are starting to open that will lead, I believe, to major changes in how we treat organ failure.”
        “这是一个分水岭事件，”器官共享联合网络的首席医疗官兼器官移植医师大卫·克拉森博士说。“我相信，机会的大门正在打开，这将使我们治疗器官衰竭的方式发生重大变化。”
        But he added that there were many hurdles to overcome before such a procedure could be broadly applied, noting that rejection of organs occurs even when a well-matched human donor kidney is transplanted.
        但他还说，在这种手术可以广泛应用之前，还有许多障碍需要克服，并指出器官排斥反应即使在移植了匹配良好的人类供体肾脏后也会发生。
        “Events like these can be dramatized in the press, and it’s important to maintain perspective,” Dr. Klassen said. “It takes a long time to mature a therapy like this.”
        “像这样的事件在媒体上可能被夸大，保持客观很重要，”克拉森博士说。“这样的治疗需要很长时间才能成熟。”
        Mr. Bennett decided to gamble on the experimental treatment because he would have died without a new heart, had exhausted other treatments and was too sick to qualify for a human donor heart, family members and doctors said.
        家人和医生说，由于贝内特已经用尽了其他治疗方法，如果没有新的心脏，他就会死亡，而且他病得太重，不符合获得人类捐赠的心脏的资格，于是决定赌一把，进行实验性治疗。
        His prognosis is uncertain. Mr. Bennett is still connected to a heart-lung bypass machine, which was keeping him alive before the operation, but that is not unusual for a new heart transplant recipient, experts said.
        他的预后尚不确定。专家说，贝内特仍然连接着一台心肺搭桥机，这台机器在手术前维持他的生命，但这对于心脏移植接受者来说并不罕见。
        The new heart is functioning and already doing most of the work, and his doctors said he could be taken off the machine on Tuesday. Mr. Bennett is being closely monitored for signs that his body is rejecting the new organ, but the first 48 hours, which are critical, passed without incident.
        新的心脏正在运作并且已经自主完成了大部分工作，他的医生说他有可能在周二离开机器。贝内特正在密切监测他的身体是否有排斥新器官的迹象，但至关重要的前48小时没有发生任何事故。
        He is also being monitored for infections, including porcine retrovirus, a pig virus that may be transmitted to humans, although the risk is considered low.
        他还接受了感染监测，包括猪逆转录病毒，一种可能传播给人类的猪病毒，尽管风险很低。
        “It was either die or do this transplant,” Mr. Bennett said before the surgery, according to officials at the University of Maryland Medical Center. “I want to live. I know it’s a shot in the dark, but it’s my last choice.”
        据马里兰大学医学中心的官员称，贝内特在手术前说：“要么死，要么做移植手术。我想活。我知道这是闭眼一博，但这是我最后的选择。”
        Dr. Griffith said he first broached the experimental treatment in mid-December, a “memorable” and “pretty strange” conversation.
        格里菲斯说，他在12月中旬首次提出了实验性治疗，这是一次“令人难忘”且“非常奇怪”的对话。
        “I said, ‘We can’t give you a human heart; you don’t qualify. But maybe we can use one from an animal, a pig,” Dr. Griffith recalled. “It’s never been done before, but we think we can do it.’”
        “我说，‘我们不能给你一颗人类心脏；你不符合资格。但也许我们可以使用一颗来自动物的心脏，一颗猪的心脏，”格里菲斯回忆道。“以前从未做过这样的治疗，但我们认为我们可以做到。”
        “I wasn’t sure he was understanding me,” Dr. Griffith added. “Then he said, ‘Well, will I oink?’”
        “我不确定他是否明白我说的，”格里菲斯接着说。“然后他说，‘好吧，我会发出猪叫吗？’”
        Xenotransplantation, the process of grafting or transplanting organs or tissues from animals to humans, has a long history. Efforts to use the blood and skin of animals go back hundreds of years.
        异种移植——从动物身上移植或移植器官或组织给人类的过程——由来已久。使用动物血液和皮肤的尝试可以追溯到数百年前。
        In the 1960s, chimpanzee kidneys were transplanted into some human patients, but the longest a recipient lived was nine months. In 1983, a baboon heart was transplanted into an infant known as Baby Fae, but she died 20 days later.
        在1960年代，黑猩猩的肾脏被移植到一些人类患者体内，但接受者最长存活了9个月。1983年，一颗狒狒的心脏被移植到一个名为菲宝宝的婴儿体内，但她在20天后死亡。
        Pigs offer advantages over primates for organ procurements, because they are easier to raise and achieve adult human size in six months. Pig heart valves are routinely transplanted into humans, and some patients with diabetes have received porcine pancreas cells. Pig skin has also been used as a temporary graft for burn patients.
        相较于灵长类动物，猪在器官供源上有优势，因为猪更易于培育，可以在六个月内达到成年人类器官的大小。人类移植猪心瓣膜已经很常见，一些糖尿病患者接受了猪胰腺细胞移植。猪的皮肤会用于烧伤患者的暂时性植皮。
        Two newer technologies — gene editing and cloning — have yielded genetically altered pig organs less likely to be rejected by humans. Pig hearts have been transplanted successfully into baboons by Dr. Muhammad Mohiuddin, a professor of surgery at University of Maryland School of Medicine who established the cardiac xenotransplantation program with Dr. Griffith and is its scientific director. But safety concerns and fear of setting off a dangerous immune response that can be life-threatening precluded their use in humans until recently.
        利用两项较新的技术——基因编辑和克隆——可以获得经过基因改造的猪器官，降低被人体排斥的几率。马里兰大学医学院外科教授穆罕默德·莫修丁博士曾成功将猪心脏移植到狒狒体内，莫修丁与格里菲斯共同创办了异种心脏移植项目，并任科学总监。由于安全方面的担忧，加之害怕导致可能危及生命的危险免疫反应，这些技术直到最近才开始应用到人体上。
        Dr. Jay Fishman, the associate director of the transplantation center at Massachusetts General Hospital, said that using pig organs provides the ability to perform genetic manipulations, the time to carry out better screening for infectious diseases, and the possibility of a new organ at the time that the patient needs it.
        麻省总医院移植中心助理主任杰·费希曼博士说，使用猪器官意味着可以进行基因控制，可以有更多的时间进行传染病筛查，还可以根据病人的需要决定进行移植的时间。
        “There are challenges for sure, but also opportunities,” he said.
        “这些当然都是挑战，但也是机会，”他说。
        The heart transplanted into Mr. Bennett came from a genetically altered pig provided by Revivicor, a regenerative medicine company based in Blacksburg, Va.
        贝内特的移植所用到的基因改造猪由弗吉尼亚州布莱克斯堡再生医学公司Revivicor提供。
        The pig had 10 genetic modifications. Four genes were knocked out, or inactivated, including one that encodes a molecule that causes an aggressive human rejection response.
        这只猪进行了10处基因修改。四个基因被剔除或失活，其中一个携带了一种可导致剧烈人体排斥反应的分子的编码。
        A growth gene was also inactivated to prevent the pig’s heart from continuing to grow after it was implanted, said Dr. Mohiuddin,who, with Dr. Griffith, did much of the research leading up to the transplant.
        莫修丁说，一个生长基因也被失活，以防止猪心脏在移植后继续生长，此次移植的相当一部分研究工作是由他和格里菲斯进行的。
        In addition, six human genes were inserted into the genome of the donor pig — modifications designed to make the porcine organs more tolerable to the human immune system.
        此外在供体猪的基因组内还插入了四个人类基因——这一修改的目的是让猪器官更能适应人类免疫系统。
        The team used a new experimental drug developed in part by Dr. Mohiuddin and made by Kiniksa Pharmaceuticals to suppress the immune system and prevent rejection. It also used a new machine perfusion device to keep the pig’s heart preserved until surgery.
        团队使用了由莫修丁参与开发、Kiniksa制药公司生产的一种实验性新药，用于抑制免疫系统，防止排异反应。此外还用到一种新型灌注设备，用于手术前的猪心脏保存。
        The Food and Drug Administration worked intensely toward the end of the year, finally giving the transplant surgeons an emergency authorization for the operation on New Year’s Eve.
        食品药品监督管理局在去年底加紧工作，终于在新年夜向移植医生提供了紧急批准。
        The surgeons encountered a number of unexpected turns.
        手术师们遇到了一些意想不到的转折。
        “The anatomy was a little squirrelly, and we had a few moments of ‘uh-oh’ and had to do some clever plastic surgery to make everything fit,” Dr. Griffith said. As the team removed the clamp restricting blood supply to the organ, “the heart fired right up” and “the animal heart began to squeeze.”
        “解剖构造上有点怪，我们几次遇到让我们‘哎呀’一下的瞬间，不得不做了些灵巧的整形手术，这样才能匹配，”格里菲斯说。随着团队去掉限制向器官供血的夹钳，“心脏当即启动工作”而且“动物心脏开始收缩”。
        When Mr. Bennett first told his son, David Bennett Jr., about the upcoming transplant, he was flummoxed.
        当贝内特第一次跟儿子小戴维·贝内特提起即将进行的移植时，他很困惑。
        “At first I didn’t believe him,” the younger Mr. Bennett, who lives in Raleigh, N.C., said. “He’d been in the hospital a month or more, and I knew delirium could set in. I thought, no way, shape or form is that happening.”
        “一开始我是不信，”住在北卡罗来纳州罗利的小贝内特说。“他已经住院一个多月了，我知道会有出现精神错乱的可能。我心想，这怎么可能是真的呢。”
        He said his father had had a pig’s valve inserted about a decade ago, and he thought his father might be confused. But after a while, Mr. Bennett said, “I realized, ‘Man, he is telling the truth and not going crazy. And he could be the first ever.’”
        他说父亲在大约十年前植入了猪心脏瓣膜，所以还以为他是搞混了。但是贝内特说，过了一会，“我意识到，‘哇，他说的是真事，不是脑子坏掉了。他会是第一个这样做的人。’”
        
        
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