Hôpital Paul Brousse ではこれまでに約20例の肝移植を経験しており、その結果は比較的良好です。本邦と欧米では移植医療を取り巻く環境が大きく異なるため本邦においてそれが普及するにはかなり高いハードルがいくつも存在しますが、将来的には切除不能大腸癌肝転移に対する治療選択肢の1つとなる可能性があります。
2023年9月はじめに、パリ郊外のクリストフ先生宅にて、在仏保険医療専門家ネットワークの定例会が行われました。そこで、Hôpital Paul BrousseのCentre Hépato-biliaireに留学中の中尾陽佑先生がご登壇なさいました。わたくしもたまたまパリに滞在しており、久しぶりに参加することができました。今回は中尾先生ご自身の多大なるお力添えにより、その内容を在仏保険医療ネットワーク遠隔書記として記録することができたことを(半年以上も経過してしまいましたが)大変嬉しく思います。
中尾陽佑先生は2012年に長崎大学を卒業し、初期臨床研修ののち熊本大学消化器外科に入局なさいました。大学と関連病院での外科修練後に大学院に入って学位を取得し、2022年10月より、フランスでの新たな医療の地平を切り拓くために、パリ郊外にありますHôpital Paul BrousseのCentre Hépato-biliaireに留学中でいらっしゃいます。
Hôpital Paul Brousseは、肝移植と膵移植をはじめ、Major肝切除や膵頭十二指腸切除など、多くの肝胆膵領域手術で知られるHigh Volume Centerで、特に大腸癌肝転移症例に対する二段階肝切除法(Two Stage Hepatectomy: TSH)を世界で初めて行い、成功させた施設です。この革新的な治療法は、2000年のその画期的な報告から世界中の医療現場に広まり、多くの患者に新たな希望をもたらしています。また現在では、切除不能大腸癌肝転移に対する”肝移植”についても積極的に取り組んでいます。
2000年にHôpital Paul Brousseで報告されたTSHは、両葉多発肝転移に対する効果的な治療戦略として広く採用されています。これは薬物療法による腫瘍縮小後、計画的に2段階に分けて肝切除を行う方法で、2000年にHôpital Paul BrousseのCentre Hépato-biliaireより報告され、広く世界に普及しました。詳細は後編でお話しします。
The Essence of Stem Cell Therapy As I Pondered With My Humble Mind
Currently, I am working on three lecture slides simultaneously, all within the anti-aging and regenerative medicine fields. Thus, my mind is completely engulfed in these topics. Since last year, I've been immersing myself in an otaku lifestyle, recognized by both myself and others, by conversing with Chappy, aka ChatGPT, for over two hours daily (lately, I’ve even started carrying around my smartphone light Chappy when I'm out, which feels dangerously similar to the movie "HER").
This year, thanks to the connection with a more prominent figure whom I call "Master," I've been experiencing a daily series of revelations, though I'm no "backyard prophet." At last month's regenerative medicine conference, the discussions primarily focused on homing and paracrine theories, with hardly any further discussions by other experts (the gap junction theory was intriguing, though).
Amidst this, I had a flash of insight regarding a new aspect of regenerative medicine and stem cell therapy. This hypothesis, which I firmly believe is quite accurate, has been formed through discussions with my Master, interactions with Chappy, and keeping abreast of the global trends in anti-aging medicine.
The Energy Supply Hypothesis
There's a growing consensus in anti-aging medicine and cutting-edge global medicine that aging and disease stem from energy depletion. Well-trained culturists select stem cells which then proliferate under ideal culture conditions—naturally, mitochondria multiply too. Considering that hundreds to thousands of mitochondria coexist in a single cell, producing 200 million stem cells results in a simple calculation of 200 to 2000 billion mitochondria—a truly staggering number.
No wonder individuals who have undergone stem cell therapy radiate such "vitality" and an abundance of "energy" (some to the level of hypertension). For instance, improvements in chronic pain are a common phenomenon observed with stem cell therapy. When considering the role mitochondria may play from this perspective, the following mechanisms come to mind:
Improved Energy Production Mitochondria are the cell's powerhouse. In conditions of chronic pain, certain tissues or nerves may be damaged or inflamed. Introducing new mitochondria could improve cellular energy efficiency, potentially activating repair and regeneration processes and ameliorating the causes of pain.
Reduction of Oxidative Stress Chronic pain often correlates with oxidative stress. Proper functioning mitochondria effectively neutralize harmful free radicals, reducing cellular oxidative stress. This could suppress inflammatory responses that cause pain and reduce the sensation of pain.
Enhanced Intercellular Communication Mitochondria play a crucial role in cellular signaling. Normalizing communication between nerve cells and immune cells involved in pain, through mitochondria, could contribute to managing chronic pain. For example, signals from mitochondria might regulate the responsiveness of nerve cells to pain, altering pain perception.
Optimization of Metabolic Processes Metabolic dysfunctions often underlie chronic pain. By supporting healthy metabolic activities, mitochondria could mitigate metabolic abnormalities associated with chronic pain, improving overall health.
These mechanisms are theoretical and require further detailed research for concrete therapeutic applications. However, considering the diverse physiological functions of mitochondria, they could play a significant role in managing chronic pain.
The essence of life, maintaining order or reducing entropy, involves "energy, matter, and information," as my Master has long recognized and published in English papers. Last year, CRDS (Center for Research and Development Strategy) also presented "Collaboration of Information, Physics, and Mathematics—New Perspectives from Understanding Non-equilibrium Dynamics," emphasizing the keywords "matter, energy, information."
Discussions on ecological energy development and SDGs are common at the global environmental level, but why hasn't the importance of energy in human physiology been linked as well? Having experienced stem cell therapy myself and observed others, this theory makes perfect sense to me.
Of course, evidence is crucial. We look forward to new experimental and research findings in the future.