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骨骼如何造血 – 译学馆
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骨骼如何造血

How bones make blood - Melody Smith

“我们仅拥有那些所付出的东西” ——Isabel Allende
At any given moment,
每时每刻
trillions of cells are traveling through your blood vessels,
你的血管中运送着数万亿个细胞
sometimes circling the body in just one minute.
有时 仅需1分钟它们就能流遍全身
Each of these cells has its origins deep in your bones.
其中的每一个都来源于你的骨骼深处
Bones might seem rock-solid,
骨头看似坚如磐石
but they’re actually quite porous inside.
但其内部实际上是多孔结构
Large and small blood vessels enter through these holes.
大大小小的血管由这些孔洞进入骨头
And inside most of the large bones of your skeleton is a hollow core
人体骨骼中多数大骨头的内部是空心的
filled with soft bone marrow.
其中充满柔软的骨髓
Marrow contains fat and other supportive tissue,
骨髓含有脂肪和其它支持组织
but its most essential elements are blood stem cells.
但它最重要的成分是造血干细胞
These stem cells are constantly dividing.
这些干细胞不断分裂
They can differentiate into red blood cells,
它们可以分化为红细胞
white blood cells, and platelets,
白细胞和血小板
and send about hundreds of billions of new blood cells
并且每日输送数千亿新的血细胞
into circulation every day.
参与血液循环
These new cells enter the bloodstream
这些新的细胞通过骨髓中的
through holes in small capillaries in the marrow.
毛细血管上的孔洞进入血流
Through the capillaries, they reach larger blood vessels
经由毛细血管进入更大的血管
and exit the bone.
并离开骨骼
If there’s a problem with your blood,
如果你的血液有问题
there’s a good chance it can be traced back to the bone marrow.
其源头很有可能追溯到骨髓
Blood cancers often begin with genetic mutations in the stem cells.
血癌通常始于干细胞的基因突变
The stem cells themselves are not cancerous,
干细胞本身不会癌变
but these mutations can interfere with the process of differentiation
但这些突变会干扰干细胞的分化过程
and result in malignant blood cells.
从而产生恶性血细胞
So for patients with advanced blood cancers
因此对于白血病 淋巴瘤等
like leukemia and lymphoma,
晚期血癌患者
the best chance for a cure is often an allogeneic bone marrow transplant,
最有可能的治愈手段通常是异体骨髓移植
which replaces the patient’s bone marrow with a donor’s.
用捐献者的骨髓替换患者的骨髓
Here’s how it works.
操作流程如下
First, blood stem cells are extracted from the donor.
首先 从供体中提取造血干细胞
Most commonly, blood stem cells are filtered out of the donor’s bloodstream
最常见的是通过一台血液成分分离机
by circulating the blood through a machine
循环供体的血液
that separates it into different components.
从血流中过滤出造血干细胞
In other cases,
其他案例中
the marrow is extracted directly from a bone in the hip, the iliac crest,
会用针头从髋部骨骼(髂嵴)
with a needle.
直接提取骨髓
Meanwhile, the recipient prepares for the transplant.
也此同时 受体也在为移植做准备
High doses of chemotherapy or radiation kill the patient’s existing marrow,
用高剂量的化疗或放射线杀死患者现存的骨髓
destroying both malignant cells and blood stem cells.
将恶性细胞和造血干细胞同时摧毁
This also weakens the immune system,
这样做也会削弱免疫系统
making it less likely to attack the transplanted cells.
降低其排斥移植细胞的可能性
Then the donor cells are infused into the patient’s body through a central line.
而后将供体细胞通过中心静脉导管注入患者体内
They initially circulate in the recipient’s peripheral bloodstream,
起初 供体细胞在受体的外周血流中循环
but molecules on the stem cells, called chemokines,
不过 干细胞上被称为趋化因子的分子
act as homing devices and quickly traffic them back to the marrow.
使细胞归巢 迅速将供体细胞运回骨髓
Over the course of a few weeks,
短短几周时间
they begin to multiply and start producing new, healthy blood cells.
它们开始增殖并产生新的健康的血细胞
Just a small population of blood stem cells
仅需少量的造血干细胞
can regenerate a whole body’s worth of healthy marrow.
就可再生出整个身体所需的健康骨髓
A bone marrow transplant can also lead to
骨髓移植还会导致
something called graft-versus-tumor activity,
“移植物抗肿瘤效应”
when new immune cells generated by the donated marrow
即受赠骨髓所产生的新的免疫细胞
can wipe out cancer cells the recipient’s original immune system couldn’t.
能清除受体原始的免疫系统所无法消灭的癌细胞
This phenomenon can help eradicate stubborn blood cancers.
这种现象可帮助患者根除顽固的血癌
But bone marrow transplants also come with risks,
但骨髓移植也伴有风险
including graft-versus-host disease.
包括移植物抗宿主病
It happens when the immune system generated by the donor cells
该病发生于供体细胞所产生的免疫系统
attacks the patient’s organs.
攻击患者器官之时
This life-threatening condition occurs in about 30–50% of patients
在供体细胞来自非同卵双胞胎的患者中
who receive donor cells from anyone other than an identical twin,
这种危及生命情况的发生率约为30—50%
particularly when the stem cells are collected from the blood
特别是当干细胞采集自血液
as opposed to the bone marrow.
而非骨髓之时
Patients may take immunosuppressant medications
通过让患者服用免疫抑制药物
or certain immune cells may be removed from the donated sample
或者将特定的免疫细胞从捐献样本中移除
in order to reduce the risk of graft-versus-host disease.
可以降低移植物抗宿主病的风险
But even if a patient avoids graft-versus-host disease,
但即使患者躲过了移植物抗宿主病
their immune system may reject the donor cells.
其免疫系统也可能排斥供体细胞
So it’s crucial to find the best match possible in the first place.
因此第一步先找到最匹配的捐献者至关重要
Key regions of the genetic code determine
遗传密码的关键区域决定了
how the immune system identifies foreign cells.
免疫系统识别外来细胞的方式
If these regions are similar in the donor and the recipient,
如果受体和供体在该区域相似
the recipient’s immune system is more likely to accept the donor cells.
受体的免疫系统就更有可能接受供体细胞
Because these genes are inherited,
由于这些基因可遗传
the best matches are often siblings.
最佳配型往往是兄弟姐妹
But many patients who need a bone marrow transplant
但很多需要接受骨髓移植的患者
don’t have a matched family member.
没有匹配的家庭成员
Those patients turn to donor registries of volunteers
这些患者转而向愿意提供骨髓的
willing to offer their bone marrow.
志愿者捐献库求助
All it takes to be on the registry is a cheek swab
只需做个口腔拭子测试基因配型
to test for a genetic match.
就能完成捐献登记
And in many cases,
在多数情况下
the donation itself isn’t much more complicated than giving blood.
捐献骨髓并不比献血复杂得多
It’s a way to save someone’s life
这是用一种完全可再生的资源
with a resource that’s completely renewable.
救人一命的方法
If you’d like to join a bone marrow registry,
如果你想加入骨髓捐献库
you can visist bethematch.org to get started,
可以登录bethematch.org进行申请
or to find a list of affiliated registeries around the world.
或者找份全球分库登记处的名单 联系看看

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视频概述

详细介绍了骨骼造血的原理,普及了骨髓移植的医学知识。

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视频来源

https://www.youtube.com/watch?v=1Qfmkd6C8u8

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