Brain | Tumor | Research | Michael Berens | TEDxArrowheadRanch

mic if it was your seven-year-old with a brain tumor what would you do again someone that was reaching out for help calls in this case it was my wife's cell phone ringing and I knew she was with a patient at Phoenix Children's Hospital a dear family friend and the cry from the mom was if it was your child what would you do a malignant brain tumor in a little one what would I do what would I do what do I do I'm a brain cancer scientist and now there's been an invasion into a family well what I do is encourage people that they're not alone we are in this together which is really good news often in pain and distress and fear we run away and we try to hide and we try to regain composure it's a very difficult place it's also a place of loneliness whereas among friends and those that care we can derive strength the other benefit of not being alone is that we get counsel and encouragement and guidance and at the end of the day we need to make decisions how will we know what to do every one is different and every family is different I want to take a bit of a walk through the brain through tumors and they don't want to talk about research which I believe is an idea worth sharing well let's talk about how we move forward in this business of a brain where does it come from let's take a bit of a journey we think about the development of the human system where I come from and those types of things so recall that I am me because once upon a time a man and a woman fall in love my mom and my dad and that conception my dad contributes DNA and my mom contributes DNA and that fertilized egg now is a combination of genetic material that's never existed on the planet before I'm a spectacularly unique fertilized egg I'm one cell before you know it in nine months by the time you reach an adult we have 37 trillion cells that make up our body that fertilized egg we call pluripotent it could become all kinds of things it can become a liver and muscle cells bone some cells are transparent the cornea of my eye is made up of living cells that let light pass through them they look to us to be clear or invisible it's an amazing thing other cells are pigmented and dark and they protect us from ultraviolet radiation in our skin produce melanin all from the same fertilized egg with the same identical genetic material in all 37 trillion cells that make up my body what an amazing thing and I'm different than my four siblings remarkable the combination of events that happens it makes each of us unique so we wander through life and we grow up and we pursue things and then disease hits a family hits an individual and we're trying to make sense of this how do we go forward with decision making and what's the right thing to do it's important that we understand the ownership of our health and the ownership of the health of our families the family structure is designed to protect preserve nurture grow and that's where the decision-making gets made and then we seek for wisdom and guidance for those that are in our community that can help us understand what are the options and what can we do in the instance of malignant brain tumors our options are frustrate frustratingly marginally effective although last night I was talking to an individual who is twenty five year survival from a brain tumor it was not a malignant it was a benign tumor and he probably will have a totally normal lifespan but for the aggressive brain tumors that afflict us these are very challenging problems and the brain is an amazing organ with a hundred billion cells that have differentiated and become this functioning organ that allows us to think to feel emotion to sense changes in our environment so where do these tumors come from and how do they create a problem the brain basically has two different kinds of cells in it it has neurons and not neurons I like it when it can sort of divide it into two simple groups but the neurons as we understand it are the thinking parts of the brain that is where signals are processed neurotransmitters are sent and received and it activates how we behave it establishes reflexes it allows us to choose to move our muscles through neural circuitry almost never do the neurons become tumors a curious thing they can in children these very immature neurone pre neuronal cells can become tumors but in adults the neurons don't become tumors it's the not neurons the support cells that become tumors in the brain those cells make up the insulation around neurons that allow them to fire faithfully as electrical circuits those cells produce the cerebral spinal fluid and those cells are these metabolically supportive cells that nurture and strengthen the neurons the glial cells it's those glial cells those support cells that become really bad actors in the brains of individuals when they become tumors well how are we going to move forward let's let's dive a little bit into tumor biology shift into what we understand about tumors what we know and that can help guide us in making decisions as we pursue things when we think about the growth from one cell to trillions of cells there's a lot of turnover that happens and in fact cell growth is a normal of life one of the fastest-growing entities on the planet is a fertilized egg it goes from one cell to millions and billions and trillions so that a viable baby can be born in a few months it's an extremely rapidly growing system but with fantastic control mechanisms during fetal development this there is skin between my fingers I literally have webbed webbing on my hands and those cells all died they disappeared that gives me far more fluidity and control because normal process of cell death has happened and allows me to develop this dexterity in this control cell death and cell birth cell growth and cell dying those are trade-offs on keeping the body normal now some cells in my body are replaced almost every day the whole GI tract from the mouth all the way through is constantly being replaced the lifespan of the cells that line the gastrointestinal tract is very short and cells are slough off and new cells behind it that were born realign this system in that environment other cells are far more long-lived we believe neurons basically live your whole life interestingly the internal machinery in the neuron is replaced about every 30 days so while the packaging of a neuron may look like it doesn't ever turn over because the cell doesn't divide the biochemical machinery inside the cell in fact is renewed and refreshed quite frequently the biomolecules turn over this business of balance between birth and death and replenishing and recycling is a part of life and it helps us control and stay healthy and fit as we move forward all happens without us having to worry about it it's an amazing process that just operates because I have a Y chromosome I'm a male part way in my fetal development there happened to have been a flood of testosterone because I have a Y chromosome on and that part of development the consequence of that flooded testosterone from my brain development was catastrophic I lost millions of neurons most women know that men are brain damaged I'm here to tell you it's true what's also true is that I carry more than twice the mutational load in my genome than my wife does having a Y chromosome is a very dangerous thing and it's an it's an interesting thing to find out that there are these profound differences in how the brain architecture is set up because I'm a male and my mutational burden in my genome I work at a genomics Research Institute where we study the 3 billion letters of the genetic code in the human genome 3 billion base pairs our technology is exquisitely sensitive but we want to make our analysis assured that when we look at a genome that we don't pick up spelling errors because of miss reading part of the genome so we don't read the genome once we usually read it 30 to 200 to 300 times when we're doing a genetic analysis on an individual on a patient 3 billion base pairs times 300 times we read it to make sure we get it right is whopping big data just to give some perspective we like downloading videos and things on the internet we think that's exciting we can't move the human genome data fast enough over the Internet to the supercomputers to do our analysis we take the hard drive out of the DNA sequencers put it in a car and drive it to the supercomputer it's faster to move the data by FedEx or in a car than it is to try to ship it over the Internet its whopping big data for us to do this analytics you also can't ask a human being to read that much information and to proof check it so we have algorithms and computer codes that read this speed is vitally important when we're looking to support the medical community in making treatment planning decisions based on the genome of a tumor so let's transition now into the cancer space cancer is mostly normal this is probably important to know it's mostly normal so when we think about the power of how the body is put together and when there is a mistake and a cell starts to grow too much it's because most of the biochemistry in a tumour cell is actually normal and there are mistakes that happen where loss of control has occurred now that loss of control shows up in a variety of ways one of the interesting things we talked about cell birth and cell death one of the things that tumor loses is the ability to die so whereas normal cells would reproduce and cells get old and die tumor cells adopt what we refer to as an immortal behavior and in mortal phenotype they lose control of those genes that tell the cell it's time to check out and those cells instead of degenerating and decomposing themselves they stay around and they continue to grow an amazing thing tumor cells also have the ability to wander we refer to this tragically because we see it as metastasis cells start forming a tumor it might be in the lung it could be in the pancreas it could be in the prostate gland could be in the breast tissue and those cells will adopt an invasive malignant behavior normal cells don't do that so the tumor cells pick up new functions like moving around when they shouldn't they lose their orientation to the normal architecture and they've moved in other places and they lose the ability to die which is a real problem because that tumor mass starts to expand depending on where the tumor starts if it's in a place like the lung there's lots of excess capacity of the lung and a tumor can get very large before a patient will become symptomatic in an enclosed space like in the cranium in the brain expansion of a tumor creates high intracranial pressure and that pressure will cause damage to the tissue to the normal brain and the patient will start to experience symptoms and these are neurological symptoms there's something curious about the brain the brain tissue itself feels no pain the brain processes all the signals from the nerves and alerts the body if there's damage to tissue but the brain organ itself does not have pain receptors it's a very curious thing and so the physical symptoms the clinical symptoms of a person with a brain tumor are going to be neurological and basis a visual problem balance problems pressure that's like a headache that becomes severe and unrelenting the tumor is affecting the speech center of the brain the patient will experience problem forming words or vocalizing the thoughts that they're having so these problems will bring a patient to an emergency room or to their doctor and they'll get worked up and by imaging will find tragically there's a brain tumor now what do we do what would we do as we look to find ways to help these patients so we understand the genetic basis of the tumor there's too much growth there's not enough cell death and we're looking for ways to try to control a process where most of the biochemical machinery is totally normal so he can't go after those mechanisms because it'll have side effects on the patient's normal cells in sequencing the human genome and sequencing the genomes of a patient's tumor we do find remarkable clear signals of genetic drivers of tumor events and this is the hope of precision medicine where classically and effectively medicine grew up figuring out that patients with these symptoms and these problems that we could put them into clinical trials with the new medication and put a hundred patients in a control group and a hundred patients in a experimental group and see if we can't do better over time the heroes of this story are the patients and their families that recognize we need to trying to do something different if we want a better outcome than standard of care the patients and their families are the heroes that say we will work with you to help to understand better ways to care for this one of the themes that I like to carry and when I think about dealing in answering this question what would I do is understanding that part of the problem of cancer is that it's a rogue cell it's a renegade it wanders away it does its own thing and these cells lose their orientation and just like pain makes us want to withdraw the reality is when we gather around those that care for us and who can bring counsel and wisdom is where things get more correct and we get to analyze that and make weighted decisions so this dynamic process of balancing between how do we treat the tumor and protect the normal cells becomes a challenge and so we look at the genome of the tumor and we can match drugs to genes and sort out how the process may indicate unique ways that we can intervene this precision medicine holds tremendous promise and it points to ways we might be able to guide for immune based therapeutics targeted therapeutics that address a mutated form of a driver event in the tumor and maybe even those that are most likely to benefit greatly from standard therapy like radiation or chemotherapy I want to go back to this question that was raised so pointedly on the telephone mic what would you do what would you do on this research side we don't know what to do and so that makes it difficult to come up with direct counsel and solving that issue but what would I do I would try to address that question among a family how do we go forward in this situation and because they're all unique here's an idea we're sharing when you have a friend ask you what should I do I'm not a medical doctor my family's dealing with the disease there's a powerful comforting phrase for you to come alongside that I found is a great one to share with people that you care for that is you love this one continue to do that love them by making decisions for the most best days and talk about what's best you as a family what's best for you as a patient what are the most best days that would allow you to go forward thank you

Channel: TEDx Talks

Views: 29,592

Keywords: TEDxTalks, English, United States, Science (hard), Biology, Brain, Cancer, Children, Compassion, Drugs, Genetics, Health, Medicine, Neuroscience, Research, Science

Id: UitX_kUS0Ik

Length: 18min 15sec (1095 seconds)

Published: Tue May 31 2016