WEBVTT 00:00:00.740 --> 00:00:04.426 In the space that used to house one transistor, 00:00:04.426 --> 00:00:07.265 we can now fit one billion. 00:00:07.819 --> 00:00:11.661 That made it so that a computer the size of an entire room 00:00:11.661 --> 00:00:14.036 now fits in your pocket. 00:00:14.273 --> 00:00:17.292 You might say the future is small. NOTE Paragraph 00:00:17.731 --> 00:00:18.961 As an engineer, 00:00:18.961 --> 00:00:22.815 I'm inspired by this miniaturization revolution in computers. 00:00:23.034 --> 00:00:24.358 As a physician, 00:00:24.358 --> 00:00:30.104 I wonder whether we could use it to reduce the number of lives lost 00:00:30.104 --> 00:00:34.173 due to one of the fastest-growing diseases on Earth: 00:00:34.173 --> 00:00:35.249 cancer. NOTE Paragraph 00:00:35.646 --> 00:00:36.924 Now when I say that, 00:00:36.924 --> 00:00:40.337 what most people hear me say is that we're working on curing cancer. 00:00:40.682 --> 00:00:42.028 And we are, 00:00:42.028 --> 00:00:44.724 but it turns out that there's an incredible opportunity 00:00:44.724 --> 00:00:49.508 to save lives through the early detection and prevention of cancer. NOTE Paragraph 00:00:49.833 --> 00:00:55.343 Worldwide, over two-thirds of deaths due to cancer are fully preventable 00:00:55.343 --> 00:00:58.479 using methods that we already have in hand today. 00:00:58.479 --> 00:01:03.611 Things like vaccination, timely screening and of course, stopping smoking. 00:01:04.419 --> 00:01:08.035 But even with the best tools and technologies that we have today, 00:01:08.035 --> 00:01:10.121 some tumors can't be detected 00:01:10.121 --> 00:01:13.814 until 10 years after they've started growing, 00:01:13.814 --> 00:01:17.577 when they are 50 million cancer cells strong. 00:01:18.178 --> 00:01:19.964 What if we had better technologies 00:01:19.964 --> 00:01:23.093 to detect some of these more deadly cancers sooner? 00:01:23.093 --> 00:01:24.616 When they could be removed, 00:01:24.616 --> 00:01:26.427 when they were just getting started. NOTE Paragraph 00:01:26.673 --> 00:01:29.924 Let me tell you about how miniaturization might get us there. 00:01:31.204 --> 00:01:33.735 This is a microscope in a typical lab 00:01:33.735 --> 00:01:37.159 that a pathologist would use for looking at a tissue specimen, 00:01:37.159 --> 00:01:39.597 like a biopsy or a pap smear. 00:01:40.054 --> 00:01:42.253 This $7,000 microscope 00:01:42.253 --> 00:01:45.532 would be used by somebody with years of specialized training 00:01:45.532 --> 00:01:47.321 to spot cancer cells. 00:01:48.277 --> 00:01:51.346 This is an image from a colleague of mine at Rice University, 00:01:51.346 --> 00:01:52.949 Rebecca Richards-Kortum. 00:01:52.949 --> 00:01:54.434 What she and her team have done 00:01:54.434 --> 00:01:58.783 is miniaturize that whole microscope into this $10 part 00:01:58.783 --> 00:02:01.802 and it fits on the end of an optical fiber. 00:02:02.122 --> 00:02:05.779 Now what that means is instead of taking a sample from a patient 00:02:05.779 --> 00:02:07.451 and sending it to the microscope, 00:02:07.451 --> 00:02:10.066 you can bring the microscope to the patient. 00:02:10.324 --> 00:02:14.802 And then instead of requiring a specialist to look at the images, 00:02:14.802 --> 00:02:19.864 you can train the computer to score normal versus cancerous cells. NOTE Paragraph 00:02:20.212 --> 00:02:21.560 Now this is important 00:02:21.560 --> 00:02:24.620 because what they found working in rural communities, 00:02:24.620 --> 00:02:27.746 is that even when they have a mobile screening van 00:02:27.746 --> 00:02:30.685 that can go out into the community and perform exams 00:02:30.685 --> 00:02:32.085 and collect samples, 00:02:32.085 --> 00:02:35.263 and send them to the central hospital for analysis, 00:02:35.263 --> 00:02:36.630 that days later, 00:02:36.630 --> 00:02:39.320 women get a call with an abnormal test result 00:02:39.320 --> 00:02:41.033 and they're asked to come in. 00:02:41.033 --> 00:02:45.190 Fully half of them don't turn up because they can't afford the trip. NOTE Paragraph 00:02:45.857 --> 00:02:49.304 Now with the integrated microscope and computer analysis, 00:02:49.304 --> 00:02:52.155 Rebecca and her colleagues have been able to create a van 00:02:52.155 --> 00:02:55.615 that has both a diagnostic setup and a treatment setup. 00:02:56.034 --> 00:02:58.771 And what that means is that they can do a diagnosis 00:02:58.771 --> 00:03:01.375 and perform therapy on the spot, 00:03:01.375 --> 00:03:03.513 so no one is lost to follow up. NOTE Paragraph 00:03:03.950 --> 00:03:07.898 That's just one example of how miniaturization can save lives. 00:03:08.236 --> 00:03:09.427 Now as engineers, 00:03:09.427 --> 00:03:11.819 we think of this as straight-up miniaturization. 00:03:12.213 --> 00:03:14.396 You took a big thing and you made it little. 00:03:14.644 --> 00:03:16.957 But what I told you before about computers 00:03:16.957 --> 00:03:19.290 was that they transformed our lives 00:03:19.290 --> 00:03:23.516 when they became small enough for us to take them everywhere. 00:03:23.873 --> 00:03:28.169 So what is the transformational equivalent like that in medicine? NOTE Paragraph 00:03:28.683 --> 00:03:31.811 Well, what if you had a detector 00:03:31.811 --> 00:03:36.096 that was so small that it could circulate in your body, 00:03:36.096 --> 00:03:38.383 find the tumor all by itself 00:03:38.383 --> 00:03:40.752 and send a signal to the outside world? 00:03:41.185 --> 00:03:43.239 It sounds a little bit like science fiction, 00:03:43.239 --> 00:03:47.060 but actually, nanotechnology allows us to do just that. 00:03:47.487 --> 00:03:52.391 Nanotechnology allows us to shrink the parts that make up the detector 00:03:52.391 --> 00:03:54.475 from the width of a human hair, 00:03:54.475 --> 00:03:55.976 which is 100 microns, 00:03:55.976 --> 00:03:58.602 to a thousand times smaller, 00:03:58.602 --> 00:04:00.297 which is 100 nanometers. NOTE Paragraph 00:04:00.527 --> 00:04:03.337 And that has profound implications. 00:04:03.762 --> 00:04:04.757 It turns out 00:04:04.757 --> 00:04:09.021 that materials actually change their properties at the nanoscale. 00:04:09.446 --> 00:04:11.967 You take a common material like gold, 00:04:11.967 --> 00:04:13.676 and you grind it into dust, 00:04:13.676 --> 00:04:15.266 into gold nanoparticles, 00:04:15.266 --> 00:04:18.578 and it changes from looking gold to looking red. 00:04:19.297 --> 00:04:23.133 If you take a more exotic material like cadmium selenide -- 00:04:23.133 --> 00:04:25.284 forms a big, black crystal -- 00:04:25.284 --> 00:04:27.998 if you make nanocrystals out of this material 00:04:27.998 --> 00:04:29.594 and you put it in a liquid, 00:04:29.594 --> 00:04:31.307 and you shine light on it, 00:04:31.307 --> 00:04:32.638 they glow. 00:04:32.638 --> 00:04:38.292 And they glow blue, green, yellow, orange, red, 00:04:38.292 --> 00:04:40.567 depending only on their size. 00:04:40.991 --> 00:04:41.991 It's wild. 00:04:41.991 --> 00:04:45.097 Can you imagine an object like that in the macro world? 00:04:45.097 --> 00:04:51.691 It would be like all the denim jeans in your closet are all made of cotton, 00:04:51.691 --> 00:04:56.002 but they are different colors depending only on their size. NOTE Paragraph 00:04:56.538 --> 00:04:57.908 (Laughter) NOTE Paragraph 00:04:59.070 --> 00:05:00.686 So as a physician, 00:05:00.686 --> 00:05:02.933 what's just as interesting to me, 00:05:02.933 --> 00:05:05.305 is that it's not just the color of materials 00:05:05.305 --> 00:05:07.145 that changes at the nanoscale; 00:05:07.145 --> 00:05:10.860 the way they travel in your body also changes. 00:05:11.304 --> 00:05:14.113 And this is the kind of observation that we're going to use 00:05:14.113 --> 00:05:16.253 to make a better cancer detector. NOTE Paragraph 00:05:16.253 --> 00:05:18.211 So let me show you what I mean. 00:05:18.902 --> 00:05:21.201 This is a blood vessel in the body. 00:05:21.201 --> 00:05:23.590 Surrounding the blood vessel is a tumor. 00:05:23.838 --> 00:05:26.953 We're going to inject nanoparticles into the blood vessel 00:05:26.953 --> 00:05:31.133 and watch how they travel from the bloodstream into the tumor. 00:05:31.559 --> 00:05:35.934 Now it turns out that the blood vessels of many tumors are leaky, 00:05:35.934 --> 00:05:40.300 and so nanoparticles can leak out from the bloodstream into the tumor. 00:05:40.732 --> 00:05:43.866 Whether they leak out depends on their size. NOTE Paragraph 00:05:44.188 --> 00:05:45.303 So in this image, 00:05:45.303 --> 00:05:49.870 the smaller, hundred-nanometer, blue nanoparticles are leaking out, 00:05:49.870 --> 00:05:53.289 and the larger, 500-nanometer, red nanoparticles 00:05:53.289 --> 00:05:54.794 are stuck in the bloodstream. 00:05:55.134 --> 00:05:57.245 So that means as an engineer, 00:05:57.245 --> 00:06:01.260 depending on how big or small I make a material, 00:06:01.260 --> 00:06:04.301 I can change where it goes in your body. NOTE Paragraph 00:06:05.448 --> 00:06:10.142 In my lab, we recently made a cancer nanodetector 00:06:10.142 --> 00:06:15.390 that is so small that it could travel into the body and look for tumors. 00:06:15.691 --> 00:06:19.737 We designed it to listen for tumor invasion: 00:06:19.737 --> 00:06:24.386 the orchestra of chemical signals that tumors need to make to spread. 00:06:25.012 --> 00:06:28.015 For a tumor to break out of the tissue that it's born in, 00:06:28.015 --> 00:06:30.694 it has to make chemicals called enzymes 00:06:30.694 --> 00:06:33.804 to chew through the scaffolding of tissues. 00:06:34.001 --> 00:06:38.575 We designed these nanoparticles to be activated by these enzymes. 00:06:39.233 --> 00:06:45.582 One enzyme can activate a thousand of these chemical reactions in an hour. NOTE Paragraph 00:06:45.582 --> 00:06:46.683 Now in engineering, 00:06:46.683 --> 00:06:50.727 we call that one-to-one thousand ratio a form of amplification, 00:06:50.727 --> 00:06:53.096 and it makes something ultrasensitive. 00:06:53.096 --> 00:06:57.131 So we've made an ultrasensitive cancer detector. NOTE Paragraph 00:06:57.395 --> 00:07:02.318 OK, but how do I get this activated signal to the outside world 00:07:02.318 --> 00:07:04.079 where I can act on it? 00:07:04.079 --> 00:07:07.654 For this we're going to use one more piece of nanoscale biology 00:07:07.654 --> 00:07:09.504 and that has to do with the kidney. 00:07:09.818 --> 00:07:11.931 So the kidney is a filter. 00:07:12.209 --> 00:07:16.783 It's job is to filter out the blood and put waste into the urine. 00:07:17.324 --> 00:07:22.548 It turns out that what the kidney filters is also dependent on size. 00:07:22.943 --> 00:07:24.075 So in this image, 00:07:24.075 --> 00:07:25.253 what you can see 00:07:25.253 --> 00:07:29.843 is that everything smaller than five nanometers is going from the blood, 00:07:29.843 --> 00:07:32.107 through the kidney into the urine, 00:07:32.107 --> 00:07:34.777 and everything else that's bigger is retained. 00:07:35.406 --> 00:07:40.376 OK, so if I make a 100-nanometer cancer detector, 00:07:40.376 --> 00:07:42.871 I inject it in the bloodstream, 00:07:42.871 --> 00:07:45.180 it can leak into the tumor, 00:07:45.180 --> 00:07:50.653 where it's activated by tumor enzymes to release a small signal 00:07:50.653 --> 00:07:54.027 that is small enough to be filtered out of the kidney 00:07:54.027 --> 00:07:56.124 and put into the urine, 00:07:56.124 --> 00:08:00.165 I have a signal in the outside world that I can detect. NOTE Paragraph 00:08:00.723 --> 00:08:02.464 OK, but there's one more problem. 00:08:02.783 --> 00:08:04.592 This is a tiny, little signal, 00:08:04.592 --> 00:08:06.564 so how do I detect it? 00:08:06.897 --> 00:08:09.077 Well, the signal is just a molecule. 00:08:09.077 --> 00:08:11.905 There are molecules that we designed as engineers -- 00:08:11.905 --> 00:08:13.764 they're completely synthetic -- 00:08:13.764 --> 00:08:18.319 and we can design them so that they are compatible with our tool of choice. 00:08:18.319 --> 00:08:21.855 If we want to use a really sensitive, fancy instrument 00:08:21.855 --> 00:08:23.790 called a mass spectrometer, 00:08:23.790 --> 00:08:26.182 then we make a molecule with a unique mass. 00:08:26.806 --> 00:08:30.173 Or maybe we want make something that's more inexpensive and portable. 00:08:30.657 --> 00:08:34.369 Then we make molecules that we can trap on paper, 00:08:34.369 --> 00:08:36.161 like a pregnancy test. 00:08:36.161 --> 00:08:38.810 In fact there's a whole world of paper tests 00:08:38.810 --> 00:08:43.322 that are becoming available in a field called Paper Diagnostics. NOTE Paragraph 00:08:43.910 --> 00:08:46.236 All right, where are we going with this? NOTE Paragraph 00:08:46.812 --> 00:08:48.554 What I'm going to tell you next, 00:08:48.554 --> 00:08:50.247 as a life-long researcher, 00:08:50.247 --> 00:08:52.126 represents a dream of mine. 00:08:52.571 --> 00:08:54.665 I can't say that's it's a promise; 00:08:54.665 --> 00:08:55.942 it's a dream. 00:08:56.180 --> 00:08:59.850 But I think we all have to have dreams to keep us pushing forward, 00:08:59.850 --> 00:09:00.850 even -- 00:09:00.850 --> 00:09:03.626 and maybe especially, cancer researchers. NOTE Paragraph 00:09:03.816 --> 00:09:07.220 I'm going to tell you what I hope will happen with my technology, 00:09:07.220 --> 00:09:10.013 that my team and I will try -- 00:09:10.013 --> 00:09:13.417 we'll put our heart and souls into making a reality. NOTE Paragraph 00:09:13.417 --> 00:09:15.182 OK, here goes ... 00:09:15.194 --> 00:09:18.572 I dream that one day, 00:09:18.572 --> 00:09:23.379 instead of going into an expensive screening facility to get a colonoscopy, 00:09:23.379 --> 00:09:24.725 or a mammogram, 00:09:24.725 --> 00:09:26.935 or a pap smear, 00:09:26.935 --> 00:09:28.536 that you could get a shot, 00:09:28.536 --> 00:09:30.219 wait an hour, 00:09:30.219 --> 00:09:33.377 and do a urine test on a paper strip. 00:09:33.876 --> 00:09:39.486 I imagine that this could even happen without the need for steady electricity, 00:09:39.486 --> 00:09:42.067 or a medical professional in the room. 00:09:42.067 --> 00:09:43.550 Maybe they could be far away 00:09:43.550 --> 00:09:46.360 and connected only by the image on a smartphone. NOTE Paragraph 00:09:46.955 --> 00:09:48.671 Now I know this sounds like a dream, 00:09:48.671 --> 00:09:51.897 but in the lab we already have this working in mice, 00:09:51.897 --> 00:09:54.137 where it works better than existing methods 00:09:54.137 --> 00:09:58.108 for the detection of lung, colon and ovarian cancer. 00:09:58.834 --> 00:10:01.028 And I hope that what this means 00:10:01.028 --> 00:10:06.186 is that one day we can detect tumors in patients 00:10:06.186 --> 00:10:09.590 sooner than 10 years after they've started growing, 00:10:09.590 --> 00:10:11.598 in all walks of life, 00:10:11.598 --> 00:10:13.470 all around the globe, 00:10:13.470 --> 00:10:16.228 and that this would lead to earlier treatments, 00:10:16.228 --> 00:10:21.058 and that we could save more lives than we can today with early detection. NOTE Paragraph 00:10:21.686 --> 00:10:22.801 Thank you. NOTE Paragraph 00:10:23.242 --> 00:10:24.728 (Applause)