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Subtitles and Transcript 0:13 Good afternoon. There's a medical revolution happening all around us, and it's one that's going to help us conquer some of society's most dreaded conditions, including cancer. The revolution is called angiogenesis, and it's based on the process that our bodies use to grow blood vessels. 0:32 So why should we care about blood vessels? Well, the human body is literally packed with them -- 60,000 miles worth in a typical adult. End to end, that would form a line that would circle the earth twice. The smallest blood vessels are called capillaries. We've got 19 billion of them in our bodies. And these are the vessels of life, and as I'll show you, they can also be the vessels of death. Now, the remarkable thing about blood vessels is that they have this ability to adapt to whatever environment they're growing in. For example, in the liver, they form channels to detoxify the blood; in the lungs, they line air sacs for gas exchange. In muscle, they corkscrew, so that muscles can contract without cutting off circulation. And in nerves, they course along like power lines, keeping those nerves alive. We get most of these blood vessels when we're actually still in the womb. And what that means is that as adults, blood vessels don't normally grow. Except in a few special circumstances. In women, blood vessels grow every month, to build the lining of the uterus. During pregnancy, they form the placenta, which connects mom and baby. And after injury, blood vessels actually have to grow under the scab in order to heal a wound. And this is actually what it looks like, hundreds of blood vessels, all growing toward the center of the wound. 1:55 So the body has the ability to regulate the amount of blood vessels that are present at any given time. It does this through an elaborate and elegant system of checks and balances, stimulators and inhibitors of angiogenesis, such that, when we need a brief burst of blood vessels, the body can do this by releasing stimulators, proteins called angiogenic factors, that act as natural fertilizer, and stimulate new blood vessels to sprout. When those excess vessels are no longer needed, the body prunes them back to baseline, using naturally-occurring inhibitors of angiogenesis. There are other situations where we start beneath the baseline, and we need to grow more blood vessels, just to get back to normal levels -- for example, after an injury -- and the body can do that too, but only to that normal level, that set point. 2:42 But what we now know, is that for a number of diseases, there are defects in the system, where the body can't prune back extra blood vessels, or can't grow enough new ones in the right place at the right time. And in these situations, angiogenesis is out of balance. And when angiogenesis is out of balance, a myriad of diseases result. For example, insufficient angiogenesis -- not enough blood vessels -- leads to wounds that don't heal, heart attacks, legs without circulation, death from stroke, nerve damage. And on the other end, excessive angiogenesis -- too many blood vessels -- drives disease, and we see this in cancer, blindness, arthritis, obesity, Alzheimer's disease. In total, there are more than 70 major diseases affecting more than a billion people worldwide, that all look on the surface to be different from one another, but all actually share abnormal angiogenesis as their common denominator. And this realization is allowing us to re-conceptualize the way that we actually approach these diseases, by controlling angiogenesis. 3:46 Now, I'm going to focus on cancer, because angiogenesis is a hallmark of cancer -- every type of cancer. So here we go. This is a tumor: dark, gray, ominous mass growing inside a brain. And under the microscope, you can see hundreds of these brown-stained blood vessels, capillaries that are feeding cancer cells, bringing oxygen and nutrients. But cancers don't start out like this, and in fact, cancers don't start out with a blood supply. They start out as small, microscopic nests of cells, that can only grow to one half a cubic millimeter in size. That's the tip of a ballpoint pen. Then they can't get any larger because they don't have a blood supply, so they don't have enough oxygen or nutrients. 4:30 In fact, we're probably forming these microscopic cancers all the time in our body. Autopsy studies from people who died in car accidents have shown that about 40 percent of women between the ages of 40 and 50 actually have microscopic cancers in their breasts. About 50 percent of men in their 50s and 60s have microscopic prostate cancers, and virtually 100 percent of us, by the time we reach our 70s, will have microscopic cancers growing in our thyroid. Yet, without a blood supply, most of these cancers will never become dangerous. Dr. Judah Folkman, who was my mentor and who was the pioneer of the angiogenesis field, once called this "cancer without disease." 5:15 So the body's ability to balance angiogenesis, when it's working properly, prevents blood vessels from feeding cancers. And this turns out to be one of our most important defense mechanisms against cancer. In fact, if you actually block angiogenesis and prevent blood vessels from ever reaching cancer cells, tumors simply can't grow up. But once angiogenesis occurs, cancers can grow exponentially. And this is actually how a cancer goes from being harmless, to being deadly. Cancer cells mutate, and they gain the ability to release lots of those angiogenic factors, natural fertilizer, that tip the balance in favor of blood vessels invading the cancer. And once those vessels invade the cancer, it can expand, it can invade local tissues, and the same vessels that are feeding tumors allow cancer cells to exit into the circulation as metastases. And unfortunately, this late stage of cancer is the one at which it's most likely to be diagnosed, when angiogenesis is already turned on, and cancer cells are growing like wild. 6:20 So, if angiogenesis is a tipping point between a harmless cancer and a harmful one, then one major part of the angiogenesis revolution is a new approach to treating cancer by cutting off the blood supply. We call this antiangiogenic therapy, and it's completely different from chemotherapy, because it selectively aims at the blood vessels that are feeding the cancers. We can do this because tumor blood vessels are unlike normal, healthy vessels we see in other places of the body -- they're abnormal, they're very poorly constructed, and because of that, they're highly vulnerable to treatments that target them. In effect, when we give cancer patients antiangiogenic therapy -- here, an experimental drug for a glioma, which is a type of brain tumor -- you can see that there are dramatic changes that occur when the tumor is being starved. Here's a woman with a breast cancer, being treated with the antiangiogenic drug called Avastin, which is FDA approved. And you can see that the halo of blood flow disappears after treatment. 7:28 Well, I've just shown you two very different types of cancer that both responded to antiangiogenic therapy. So a few years ago, I asked myself, "Can we take this one step further and treat other cancers, even in other species?" So here is a nine year-old boxer named Milo, who had a very aggressive tumor called a malignant neurofibroma growing on his shoulder. It invaded into his lungs. His veterinarian only gave him three months to live. So we created a cocktail of antiangiogenic drugs that could be mixed into his dog food, as well as an antiangiogenic cream, that could be applied on the surface of the tumor. And within a few weeks of treatment, we were able to slow down that cancer's growth, such that we were ultimately able to extend Milo’s survival to six times what the veterinarian had initially predicted, all with a very good quality of life. 8:20 And we've subsequently treated more than 600 dogs. We have about a 60 percent response rate, and improved survival for these pets that were about to be euthanized. So let me show you a couple of even more interesting examples. This is 20-year-old dolphin living in Florida, and she had these lesions in her mouth that, over the course of three years, developed into invasive squamous cell cancers. So we created an antiangiogenic paste. We had it painted on top of the cancer three times a week. And over the course of seven months, the cancers completely disappeared, and the biopsies came back as normal. 8:58 Here's a cancer growing on the lip of a Quarter Horse named Guinness. It's a very, very deadly type of cancer called an angiosarcoma. It had already spread to his lymph nodes, so we used an antiangiogenic skin cream for the lip, and the oral cocktail, so we could treat from the inside as well as the outside. And over the course of six months, he experienced a complete remission. And here he is six years later, Guinness, with his very happy owner. 9:26 (Applause) 9:29 Now obviously, antiangiogenic therapy could be used for a wide range of cancers. And in fact, the first pioneering treatments for people as well as dogs, are already becoming available. There are 12 different drugs, 11 different cancer types. But the real question is: How well do these work in practice? So here's actually the patient survival data from eight different types of cancer. The bars represent survival time taken from the era in which there was only chemotherapy, or surgery, or radiation available. But starting in 2004, when antiangiogenic therapies first became available, you can see that there has been a 70 to 100 percent improvement in survival for people with kidney cancer, multiple myeloma, colorectal cancer, and gastrointestinal stromal tumors. That's impressive. But for other tumors and cancer types, the improvements have only been modest. 10:26 So I started asking myself, "Why haven't we been able to do better?" And the answer, to me, is obvious: we're treating cancer too late in the game, when it's already established, and oftentimes, it's already spread or metastasized. And as a doctor, I know that once a disease progresses to an advanced stage, achieving a cure can be difficult, if not impossible. So I went back to the biology of angiogenesis, and started thinking: Could the answer to cancer be preventing angiogenesis, beating cancer at its own game, so the cancers could never become dangerous? This could help healthy people, as well as people who've already beaten cancer once or twice, and want to find a way to keep it from coming back. So to look for a way to prevent angiogenesis in cancer, I went back to look at cancer's causes. And what really intrigued me, was when I saw that diet accounts for 30 to 35 percent of environmentally-caused cancers. 11:30 Now the obvious thing is to think about what we could remove from our diet, what to strip out, take away. But I actually took a completely opposite approach, and began asking: What could we be adding to our diet that's naturally antiangiogenic, and that could boost the body's defense system, and beat back those blood vessels that are feeding cancers? In other words, can we eat to starve cancer? (Laughter) Well, the answer is yes, and I'm going to show you how. And our search for this has taken us to the market, the farm and to the spice cabinet, because what we've discovered is that Mother Nature has laced a large number of foods and beverages and herbs with naturally-occurring inhibitors of angiogenesis. 12:13 Here's a test system we developed. At the center is a ring from which hundreds of blood vessels are growing out in a starburst fashion. And we can use this system to test dietary factors at concentrations that are obtainable by eating. Let me show you what happens when we put in an extract from red grapes. The active ingredient is resveratrol, it's also found in red wine. This inhibits abnormal angiogenesis, by 60 percent. Here's what happens when we added an extract from strawberries. It potently inhibits angiogenesis. And extract from soybeans. And here is a growing list of antiangiogenic foods and beverages that we're interested in studying. For each food type, we believe that there are different potencies within different strains and varietals. And we want to measure this because, well, while you're eating a strawberry or drinking tea, why not select the one that's most potent for preventing cancer? 13:13 So here are four different teas that we've tested. They're all common ones: Chinese jasmine, Japanese sencha, Earl Grey and a special blend that we prepared, and you can see clearly that the teas vary in their potency, from less potent to more potent. But what's very cool is when we combine the two less potent teas together, the combination, the blend, is more potent than either one alone. This means there's food synergy. 13:45 Here's some more data from our testing. Now in the lab, we can simulate tumor angiogenesis, represented here in a black bar. And using this system, we can test the potency of cancer drugs. So the shorter the bar, the less angiogenesis -- that's good. And here are some common drugs that have been associated with reducing the risk of cancer in people. Statins, nonsteroidal anti-inflammatory drugs, and a few others -- they inhibit angiogenesis, too. And here are the dietary factors going head-to-head against these drugs. You can see they clearly hold their own, and in some cases, they're more potent than the actual drugs. Soy, parsley, garlic, grapes, berries. I could go home and cook a tasty meal using these ingredients. Imagine if we could create the world's first rating system, in which we could score foods according to their antiangiogenic, cancer-preventative properties. And that's what we're doing right now. 14:45 Now, I've shown you a bunch of lab data, and so the real question is: What is the evidence in people that eating certain foods can reduce angiogenesis in cancer? Well, the best example I know is a study of 79,000 men followed over 20 years, in which it was found that men who consumed cooked tomatoes two to three times a week, had up to a 50 percent reduction in their risk of developing prostate cancer. Now, we know that tomatoes are a good source of lycopene, and lycopene is antiangiogenic. But what's even more interesting from this study, is that in those men who did develop prostate cancer, those who ate more servings of tomato sauce, actually had fewer blood vessels feeding their cancer. So this human study is a prime example of how antiangiogenic substances present in food and consumed at practical levels, can have an impact on cancer. And we're now studying the role of a healthy diet -- with Dean Ornish at UCSF and Tufts University -- the role of this healthy diet on markers of angiogenesis that we can find in the bloodstream. 15:51 Obviously, what I've shared with you has some far-ranging implications, even beyond cancer research. Because if we're right, it could impact consumer education, food services, public health and even the insurance industry. And in fact, some insurance companies are already beginning to think along these lines. Check out this ad from BlueCross BlueShield of Minnesota. For many people around the world, dietary cancer prevention may be the only practical solution, because not everybody can afford expensive end-stage cancer treatments, but everybody could benefit from a healthy diet based on local, sustainable, antiangiogenic crops. 16:29 Now, finally, I've talked to you about food, and I've talked to you about cancer, so there's just one more disease that I have to tell you about, and that's obesity. Because it turns out that adipose tissue -- fat -- is highly angiogenesis-dependent. And like a tumor, fat grows when blood vessels grow. So the question is: Can we shrink fat by cutting off its blood supply? The top curve shows the body weight of a genetically obese mouse that eats nonstop until it turns fat, like this furry tennis ball. (Laughter) And the bottom curve is the weight of a normal mouse. 17:08 If you take the obese mouse 17:09 and give it an angiogenesis inhibitor, it loses weight. Stop the treatment, gains the weight back. Restart the treatment, loses the weight. Stop the treatment, it gains the weight back. And, in fact, you can cycle the weight up and down simply by inhibiting angiogenesis. So this approach that we're taking for cancer prevention may also have an application for obesity. The truly interesting thing about this is that we can't take these obese mice and make them lose more weight than what the normal mouse's weight is supposed to be. In other words, we can't create supermodel mice. (Laughter) And this speaks to the role of angiogenesis in regulating healthy set points. 17:47 Albert Szent-Györgi once said, "Discovery consists of seeing what everyone has seen, and thinking what no one has thought." I hope I've convinced you that for diseases like cancer, obesity and other conditions, there may be a great power in attacking their common denominator: angiogenesis. And that's what I think the world needs now. Thank you. 18:07 (Applause) 18:17 June Cohen: I have a quick question for you. 18:19 JC: So these drugs aren't exactly in mainstream cancer treatments right now. For anyone out here who has cancer, what would you recommend? Do you recommend pursuing these treatments now, for most cancer patients? 18:31 William Li: There are antiangiogenic treatments that are FDA approved, and if you're a cancer patient, or working for one or advocating for one, you should ask about them. And there are many clinical trials. The Angiogenesis Foundation is following almost 300 companies, and there are about 100 more drugs in that pipeline. So, consider the approved ones, look for clinical trials, but then between what the doctor can do for you, we need to start asking what can we do for ourselves. This is one of the themes I'm talking about: We can empower ourselves to do the things that doctors can't do for us, which is to use knowledge and take action. And if Mother Nature has given us some clues, we think there might be a new future in the value of how we eat, and what we eat is really our chemotherapy three times a day. 19:17 JC: Right. And along those lines, for people who might have risk factors for cancer, would you recommend pursuing any treatments prophylactically, or simply pursuing the right diet, with lots of tomato sauce? 19:29 WL: Well, you know, there's abundant epidemiological evidence, and I think in the information age, it doesn't take long to go to a credible source like PubMed, the National Library of Medicine, to look for epidemiological studies for cancer risk reduction based on diet and based on common medications. And that's certainly something that anybody can look into. Well, thank you so much. 19:49 (Applause)
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Subtitles and Transcript Translated by Senzos Osijek Reviewed by Jelena Horvat 00:13 Dobar dan. Upravo se događa medicinska revolucija oko nas i ona će nam pomoći da pobijedimo neke od najstrašnijih bolesti današnjeg društva, uključujući rak. Revolucija se zove angiogeneza, a temelji se na procesu kojim naš organizam stvara krvne žile. 00:32 Dakle, zašto bismo brinuli oko krvnih žila? Ta ljudsko tijelo obiluje njima: 96 500 kilometara u prosječnog odraslog čovjeka. To bi skupno činilo nit kojom bismo mogli opasati Zemlju dva puta. Najmanje krvne žile u tijelu jesu kapilare; ima ih 19 milijardi u našem organizmu. I to su žile života, a kao što ću vam pokazati, mogu biti i žile smrti. Osobitost krvnih žila jest njihova sposobnost prilagodbe bilo kojem okruženju u kojemu rastu. Primjerice u jetri formiraju kanale za detoksikaciju krvi, u plućima oplakuju alveole u svrhu izmjene plinova, u mišiću one tvore krivulje koje omogućuju kontrakciju mišića bez prekida cirkulacije. U živcima se pružaju uzdužno poput dalekovoda i održavaju te živce živima. Organizam stvara većinu tih krvnih žila tijekom prenatalnog razvoja. To sugerira da u odraslih krvne žile u normalnom organizmu ne rastu. Izuzev nekoliko osobitih situacija: U žena krvne žile rastu svakoga mjeseca stvarajući oblogu maternice. Tijekom trudnoće one formiraju posteljicu koja povezuje majku i dijete. A nakon ozljede krvne žile moraju rasti ispod kraste kako bi ozljeda zacijelila. I ovako to zapravo izgleda, tisuće krvnih žila rastu prema centru ozljede. 01:55 Dakle organizam ima sposobnost regulacije količine prisutnih krvnih žila u određenom vremenu. Organizam to obavlja kroz usavršen i fini sustav kontrola i ravnoteža, stimulatora i inhibitora angiogeneze, primjerice kada je potrebna brza i značajna količina krvnih žila, organizam to ostvaruje otpuštanjem stimulatora, proteina koji se zovu faktori angiogeneze koji djeluju kao prirodno „gnojivo“ i stimuliraju razvitak novih krvnih žila. A kada te krvne žile postanu suvišne, organizam ih reducira do normalne vrijednosti koristeći prirodne inhibitore angiogeneze. No postoje i druge situacije kada je količina krvnih žila u organizmu ispod potrebne vrijednosti te organizam mora izgraditi nove krvne žile kako bi postigao normalnu vrijednost, na primjer, nakon ozljede, tijelo to može učiniti, ali samo do normalne vrijednosti, do normalnog stanja. 02:42 No ono što danas znamo, a tiče se većeg broja bolesti, jest da u organizmu postoje defekti kada organizam ne može reducirati suvišne krvne žile ili ne može formirati nove na odgovarajućim mjestima u odgovarajuće vrijeme. U tim situacijama, angiogeneza je neuravnotežena. A kada je angiogeneza neuravnotežena, kao rezultat pojavljuje se značajan broj bolesti. Na primjer, nedostatna angiogeneza, nedovoljno krvnih žila, dovodi do ozljeda koje ne zacjeljuju, srčane kapi, loše cirkulacije u nogama, smrti uslijed kapi, živčanih oštećenja. S druge strane, intenzivna angiogeneza, previše krvnih žila potiče bolesti, a to uočavamo kod tumora, sljepoće, artritisa, pretilosti, Alzheimerove bolesti. U konačnici, postoji više od 70 značajnih bolesti koje pogađaju više od milijardu ljudi diljem svijeta, a koje se prividno međusobno razlikuju dok ih zapravo povezuje nenormalna angiogeneza kao zajednička komponenta. Ovo shvaćanje nam dopušta da promijenimo način pristupa ovim bolestima kontroliranjem angiogeneze. 03:47 Sada ću se usredotočiti na rak s obzirom da je angiogeneza obilježje raka, svakog tipa raka. Dakle, krenimo. Ovo je tumor: tamna, siva, zloćudna masa koja raste u mozgu. I pod mikroskopom, možete vidjeti tisuće ovih smeđih krvnih žila, kapilara koje prehranjuju stanice raka, donoseći kisik i hranjive tvari. No tumori ne nastaju na ovaj način. I, zapravo, tumori u početku nisu prožeti krvnim žilama. Tumori nastaju iz malog, mikroskopskog gnijezda stanica koje može narasti do najviše pola kubičnog milimetra. To je veličina vrška kemijske olovke. Oni više od toga ne mogu narasti jer im nedostaje opskrba krvlju, stoga ne primaju dovoljno kisika i hranjivih tvari. 04:30 Zapravo, u našem organizmu vjerojatno neprestano nastaju ovakvi mikroskopski tumori. Nalazi obdukcija žrtava prometnih nezgoda pokazali su da 40% žena između četrdesete i pedesete godine zapravo imaju mikroskopske tumore u dojkama, oko 50% muškaraca u pedesetim i šezdesetima godinama imaju mikroskopske tumore prostate, a gotovo 100% nas do sedamdesetih godina života imat će mikroskopske tumore u štitnoj žlijezdi. Ipak, bez opskrbe krvlju, većina ovih tumora nikada neće postati opasna. Judah Folkman, koji je bio moj mentor i pionir u polju angiogeneze, nazvao je ovaj fenomen "tumor koji ne uzrokuje bolesti". 05:15 Dakle, sposobnost tijela da održava ravnotežu angiogeneze, kada normalno funkcionira, sprječava krvne žile da prehranjuju tumor. Ispada da je to jedan od naših najvažnijih obrambenih mehanizama protiv tumora. U stvari, ako blokiramo angiogenezu i spriječimo razvoj krvnih žila u tumoru, tumori tada jednostavno ne mogu rasti. No kada se angiogeneza ostvari, tumori mogu rasti eksponencijalno. I to je zapravo način kojim bezopasan tumor postaje smrtonosan. Tumorske stanice mutiraju i pridobe sposobnost otpuštanja angiogenetskih faktora, umjetnih gnojiva, koji pomiču ravnotežu u smjeru invazije krvnih žila u tumoru. I jednom kada krvne žile urastu u tumor, on se može širiti, zauzeti lokalna tkiva. I iste krvne žile koje prehranjuju tumor omogućuju tumorskim stanicama ulazak u cirkulaciju kao metastaze. I, nažalost, u toj kasnoj fazi tumora, tumor će najvjerojatnije biti dijagnosticiran, kada je angiogeneza uznapredovala i kada tumorske stanice nekontrolirano rastu. 06:21 Stoga, ako je angiogeneza ključna točka pretvorbe tumora iz bezopasnog u opasni, tada najveći dio angiogenetske revolucije čini novi pristup liječenju tumora prekidom krvne opskrbe tumora. Zovemo to antiangiogenetska terapija, i ona je potpuno drugačija od kemoterapije jer je usmjerena selektivno na krvne žile koje prehranjuju tumor. To možemo učiniti zato što se tumorske krvne žile razlikuju od normalnih, zdravih krvnih žila koje susrećemo u ostalim dijelovima tijela: one su abnormalne, loše građene i zahvaljujući tome, iznimno ranjive na terapiju usmjerenu protiv njih. U stvari, kada pacijenta tretiramo antiangiogenetskom terapijom ovdje, eksperimentalni lijek protiv glioma, jedan tip tumora mozga, možete vidjeti da se odvijaju dramatične promjene tijekom gladovanja tumora. Ovo je žena oboljela od tumora dojke i bila je tretirana antiangiogenetskim lijekom koji se zove Avastin i kojeg je odobrila Američka agencija za hranu i lijekove. I možete vidjeti da je polovina krvnog toka nestala nakon terapije. 07:28 Dakle, upravo sam vam pokazao dva izrazito različita tipa raka koja reagiraju na antiangiogenetsku terapiju. I unatrag nekoliko godina, zapitao sam se: „Možemo li učiniti korak više i liječiti ostale tipove raka, čak i u drugih vrsta?“ Ovo je devetogodišnji bokser Milo koji je patio od agresivnog tumora koji se naziva maligni neurofibrom a koji je rastao na njegovu ramenu. Metastazirao je u njegova pluća. Veterinar je prognozirao još tri mjeseca života. No mi smo pripremili koktel antiangiogenetskih lijekova koje je moguće pomiješati sa psećom hranom te antiangiogenetsku kremu koja se može nanijeti na površinu tumora. I tijekom nekoliko tjedana terapije, uspjeli smo usporiti tumorski rast tako da smo uspjeli produžiti Milov životni vijek šest puta više negoli je to veterinar u početku predvidio, a sve uz vrlo dobru kvalitetu života. 08:20 Naknadno smo tretirali više od 600 pasa. Ostvarili smo stopu reakcije od oko 60% i unaprijedili preživljavanje ovih kućnih ljubimaca za koje je bila planirana eutanazija. Dopustite mi da vam pokažem nekoliko još zanimljivijih primjera. Ovo je dvadesetogodišnji delfin koji živi na Floridi, i ona je imala lezije u ustima koje su se razdoblju od tri godine razvile u zloćudne, skvamozne tumorske stanice. Mi smo pripremili antiangiogenetsku pastu. Nanosili smo je na vrh tumora tri puta tjedno. I u roku od 7 mjeseci, tumor je u potpunosti nestao, a nalaz biopsije dao je normalne rezultate. 08:58 Ovo je tumor koji raste na usni jahaćeg konja Guinnessa. To je jako, jako smrtonosan tip tumora koje se zove angiosarkom. Već je metastazirao u limfne čvorove. Stoga smo koristili antiangiogenetsku kremu za usne te oralni koktel, te smo tumor mogli tretirati kako izvana tako i iznutra. I tijekom sljedećih 6 mjeseci, Guinness je doživio potpunu remisiju. I evo ga nakon šest godina, Guinness i njegov zadovoljni vlasnik. 09:29 Dakle, očito je da je antiangiogenetsku terapiju moguće koristiti u borbi protiv širokog spektra karcinoma. Zapravo su prve terapije za ljude kao i za pse već dostupne. Dostupno je 12 lijekova za 11 različitih tipova raka. No pravo je pitanje: koliko su učinkoviti ti lijekovi u praksi? Ovo je dijagram preživljavanja pacijenata oboljelih od osam različitih tipova raka. Stupci predstavljaju preostali životni vijek u vremenu kada se primjenjivala isključivo kemoterapija, operacija ili terapija zračenjem. Počevši s 2004. kada je započela primjena antioangiogenetske terapije, možete vidjeti od 70 do 100 posto poboljšanja u vidu preživljavanja pacijenata oboljelih od karcinoma bubrega, multiplog mijeloma, kolorektalnog karcinoma i gastrointestinalnog stromalnog tumora. To je impresivno. No za ostale tipove karcinoma poboljšanje je bilo skromno. 10:26 Stoga sam se zapitao: „Zašto nismo mogli polučiti bolje rezultate?" Odgovor je očit; počinjemo prekasno tretirati karcinom, kada se već razvio i često kada se već proširio i metastazirao. A kao liječnik znam da kada bolest uđe u uznapredovalu fazu, izlječenje je teško postići, ako ne i nemoguće. Stoga sam se usmjerio na biologiju angiogeneze i promišljao: "Može li odgovor na problem liječenja karcinoma biti prevencija angiogeneze, pobjeda karcinoma u njegovoj vlastitoj igri tako da ni ne postane opasan?" To bi moglo pomoći zdravim ljudima, ali i ljudima koji su već jedanput ili dvaput pobijedili karcinom i žele pronaći način sprječavanja njegova povratka. Kako bih pronašao način prevencije angiogeneze u tumoru, vratio sam se proučavanju uzroka tumora. I ono što je zaista pobudilo moje zanimanje, bilo je to kad sam vidio da ishrana čini 30 do 35 posto vanjskih uzročnika karcinoma. 11:30 Očito je da trebamo razmišljati o tome što možemo ukloniti iz naše prehrane, što trebamo izbaciti. No ja sam zapravo zauzeo u potpunosti oprečno stajalište i zapitao se: što možemo uvesti u našu prehranu, a da se ponaša kao prirodni antiangiogenetski faktor koji može ojačati obrambeni mehanizam i pobijediti krvne žile koje prehranjuju karcinom? Drugim riječima, možemo li prehranom izgladnjivati tumor? (smijeh) Odgovor je da i pokazat ću vam kako. Naše istraživanje odvelo nas je na tržnicu, farmu i među začine jer smo otkrili da nam je majka priroda darovala veliki broj namirnica, pića i biljaka koji sadrže prirodne inhibitore angiogeneze. 12:13 Ovo je sustav koji smo razvili. U centru je smješten prsten od kojega rastu tisuće krvnih žila tvoreći zvjezdastu formu. I mi možemo iskoristiti ovaj sistem radi testiranja prehrambenih faktora u koncentracijama koje dobivamo tijekom jela. Dopustite mi da vam pokažem što se događa kada dodamo ekstrakt crnog grožđa Aktivni sastojak jest resveratrol, koji se može naći i u crnom vinu. On inhibira abnormalnu angiogenezu za 60%. Ovo se događa kada dodamo ekstrakt jagode; on je snažan inhibitor angiogeneze. I ekstrakt soje. Ovo je lista koja još uvijek raste, antiangiogenetskih namirnica i pića koje želimo proučiti. Vjerujemo da za svaki tip hrane postoje različiti potencijali unutar različitih vrsta i sojeva. I mi to želimo izmjeriti jer, pa, kada već jedete jagode ili pijete čaj, zašto ne biste izabrali onaj koji je najsnažniji u prevenciji raka. 13:13 Ovo su četiri različite vrste čaja koje smo testirali. Svi su uobičajeni: kineski jasmin, japanski sencha zeleni čaj, Earl Grey te posebna mješavina koju smo pripremili. I možete jasno vidjeti da čajevi variraju u svojoj potenciji inhibicije angiogeneze od slabih do snažnih inhibitora. No ono što je super je kada smo kombinirali dva slabija čaja, kombinacija, mješavina, snažnija je od svakog čaja zasebno. To sugerira da postoji sinergija hrane. 13:45 Evo nekih podataka iz naših testiranja. Sada, u laboratoriju, možemo simulirati angiogenezu tumora, što prikazuje crni stupac. Koristeći ovaj sustav, možemo testirati snagu antikancerogenih lijekova. Dakle kraći stupac znači slabiju angiogenezu, to je dobro. I evo nekih uobičajenih lijekova koji se povezuju sa smanjenjem rizika oboljenja od raka. Statini, nesteroidni protuupalni lijekovi i još neki, koji također inhibiraju angiogenezu. A evo i hranidbenih faktora koji idu rame uz rame sa spomenutim lijekovima. Možete vidjeti, oni očito imaju vlastitu snagu, u nekim slučajevima, čak su i snažniji od spomenutih lijekova. Soja, peršin, češnjak, grožđe, bobičasto voće, mogao bih otići kući i skuhati ukusan obrok koristeći ove sastojke. Zamislite da možemo napraviti prvi vrijednosni sustav u kojemu bismo mogli vrednovati hranu ovisno o njenim antiangiogenetskim svojstvima, svojstvima koja preveniraju rak. I to je ono što upravo sada radimo. 14:45 Sada, pokazao sam vam mnoštvo laboratorijskih podataka, i pravo pitanje jest: kakvi su dokazi na ljudima da konzumiranje određene hrane može reducirati tumorsku angiogenezu? Pa, najbolji primjer koji poznajem jest istraživanje provedeno na 79 000 muškaraca u proteklih 20 godina, koje pokazuje da muškarci koji su konzumirali kuhane rajčice dva do tri puta tjedno imaju 50% manji rizik od razvijanja raka prostate. Sada, znamo da su rajčice dobar izvor likopena, a likopen djeluje antiangiogenetski. No što je još zanimljivije u ovom istraživanju jest da oni muškarci koji su ipak oboljeli od raka prostate, oni koji su jeli više umaka od rajčica, zapravo su imali manje krvnih žila koje su prehranjivale njihov tumor. Dakle ovo istraživanje na ljudima glavni je odgovor na pitanje kakav utjecaj antiangiogenetske tvari, prisutne u hrani i konzumirane u praktičnim količinama, imaju na tumor. I sada proučavamo ulogu zdrave prehrane u suradnji s Deanom Ornishem, Kalifornijskim univerzitetom i Univerzitetom Tufts ulogu zdrave ishrane na markere angiogeneze koje možemo pronaći u krvotoku. 15:52 Sada, očigledno, podijelio sam s vama neke šire implikacije, čak izvan okvira istraživanja raka. Jer ako smo u pravu, to bi moglo utjecati na obrazovanje potrošača, restorane, javno zdravstvo i čak na osiguravajuće kuće. I, zapravo, neke osiguravajuće kuće već počinju razmišljati sukladno ovim spoznajama. Pogledajte ovaj oglas iz Blue Cross Blue Shield iz Minnesote. I za mnogo ljudi diljem svijeta, prevencija raka prehranom možda je jedino praktično rješenje jer ne mogu si svi priuštiti skupe terapije liječenja raka, ali svatko može imati koristi od zdrave prehrane temeljene na lokalnim, održivim, antiangiogenetskim usjevima. 16:29 Sada, konačno, govorio sam vam o hrani, i govorio sam vam o raku, preostala je još samo jedna bolest o kojoj vam nisam govorio, a to je pretilost. Ispostavlja se da je masno tkivo, salo, ovisno o angiogenezi. Kao i tumor, salo se razvija kada se razvijaju i krvne žile. Stoga je pitanje: možemo li smanjiti salo prekidom krvne opskrbe istog? Gornja krivulja prikazuje tjelesnu masu genetički pretilog miša koji neprestano jede dok ne postane pretio, poput ove krznene teniske loptice. Donja krivulja prikazuje tjelesnu masu normalnog miša. 17:08 Ukoliko pretilog miša tretirate angiogenetskim inhibitorom, on izgubi na tjelesnoj masi. Ukoliko prekinete tretman, opet postane pretio. Opet započnete tretman, miš opet izgubi na tjelesnoj masi. Obustavite tretman, miš opet postaje pretio. I zapravo možete mijenjati težinu miša inhibiranjem angiogeneze. Dakle ovaj pristup koji koristimo u prevenciji raka također se može primijeniti i na pretilost. Doista zanimljiva stvar u tome jest da tretiranjem pretiloga miša ne možemo smanjiti njegovu težinu na vrijednost manju od težine normalnog miša. Drugim riječima, ne možemo dobiti miševe supermodele. (smijeh) To govori o ulozi angiogeneze u regulaciji zdravstvenih vrijednosti. 17:47 Albert Szent-Gyorgi jednom je rekao: „Otkriće je u tome da vidimo ono što su svi već vidjeli a razmišljamo o čemu još nitko nije razmišljao.“ Nadam se da sam vas uvjerio da kod bolesti poput raka, pretilosti i ostalih stanja, možda postoji velika snaga u napadanju njihove zajedničke značajke: angiogeneze. I mislim da je to ono što je svijetu trenutačno potrebno. Hvala. 18:18 June Cohen: Imam kratko pitanje za vas. Dakle ovi lijekovi zapravo nisu, zapravo nisu uključeni u normalnu terapiju raka trenutačno. Za bilo koga ovdje oboljelog od raka, što biste preporučili? Preporučujete li provođenje ovih tretmana sada za većinu oboljelih od raka? 18:31 William Li: Dakle, postoje antiangiogenetski tretmani koje je odobrila Američka agencija za hranu i lijekove, i ako ste oboljeli od raka ili radite za, odnosno zastupate nekog oboljelog od raka, trebate se raspitati za njih. I postoje mnoga klinička ispitivanja. Angiogenetska zaklada obuhvaća gotovo 300 tvrtki i postoji još oko 100 potencijalnih lijekova. Stoga uzmite u obzir odobrene lijekove, potražite klinička istraživanja, no osim onoga što liječnik može učiniti za vas, moramo se upitati što možemo učiniti sami za sebe. I to je jedna od tema o kojoj govorim; mi možemo osnažiti sebe tako da činimo stvari koje liječnici ne mogu činiti za nas, tj. sami iskoristiti znanje i biti poduzetni. I ako nam je majka priroda dala neke tragove, mi smatramo da nas čeka nova budućnost u vidu vrijednosti onoga što jedemo. I ono što jedemo zapravo je naša kemoterapija tri puta dnevno. 19:17 JC: Točno. I zajedno s ovim preporukama, za ljude koji možda imaju rizične faktore za razvoj raka, biste li im preporučili da slijede bilo koji preventivni tretman, ili da se jednostavno pridržavaju odgovarajuće dijete s mnogo umaka od rajčica? 19:29 WL: Pa, znate, postoje bogati epidemiološki dokazi. I mislim da u današnje vrijeme nije potrebno mnogo vremena da bi se našao vjerodostojni izvor kao što je Nacionalna medicinska knjižnica Pubmed, i pogledalo epidemiološko istraživanje o smanjenu faktora rizika raka, baziranih na prehrani ili uobičajenim lijekovima. To svakako bilo tko može pogledati. Mnogo hvala.