Detlev Ganten   德国海德堡大学

    <International Circulation>:  First I wanted to say that I really liked your talk on evolutionary medicine.  Could you briefly describe for us what evolutionary medicine is and indicate its basic precepts?

  《国际循环》：Ganten教授您好！首先我要说的是我非常希望您能谈一谈进化医学。您能简短的向大家介绍一下什么是进化医学吗？进化医学有什么基本规则呢？
 
Prof. Ganten:  The basis is that now that we understand the basics of evolution than we did five years ago.  This has been made possible by the development of high frequency sequencing technology so we have the ability to virtually sequence every organism’s genetic code.  We know all organisms from the beginning of life until today.  We are able to understand more clearly why we are as we are.  For instance， why do we have a spine?  Why do cells divide the way they do?  Why do we get the whole structure that we have?  The whole basis of evolution can be understood on the basis of mutation and changes in the genome.  It is an evolution of understanding.  The important thing in evolutionary medicine is that once nature has developed a mechanism that works， nature will tend to stick to that mechanism.  For example， the spine was developed in lancet fish under a condition that swimming in the water， where gravity doesn’t play an important role.  Later when amphibia and reptilia went ashore and colonized land， they were stuck with a spine.  This creates a vulnerability.  We know why we have a spine now based on the genomic setup that could not be discontinued.  Once you are stuck with a pattern of development for instance， you are stuck with it unless all creatures with a spine die.  If they continue to reproduce and propagate then we are stuck with it.  As humans， we are stuck with all those old patterns found in amphibia， reptilia， fish that were advantageous with respect to their survival and reproduction.  Evolution is about surviving and reproducing under certain living conditions.  Various traits came into existence under different living conditions and now we have urbanized， man-made living conditions that， in effect， creates a gap between biology and civilization， which we understand better and better.  This then creates a totally different， new way to look at medicine.  The approach of medicine is no longer asking questions like how does the sympathetic system or rennin-angiotensin system function from a mechanistic point of view， which still prevails in medicine today.  Pharmacology is all about understanding the mechanism well enough to be able to interfere.  If， on the other hand， we ask the question why do we have the system?   What is it good for?  If it is not good for our living conditions now when was it good and for whom?  If we understand these questions and their answers we can， in a rational way， devise prevention， living conditions， therapies， etc， which go back to the origin of the mechanism or disease we are interested in.  Evolution is about the struggle of the biology of the body with the environment， and viruses are the winners.  We are no longer the winners.  We win sometimes because we spend a lot of money developing medical technologies and treatments to use for our survival.  Evolutionary medicine is not antagonistic to modern day science-based medicine， it is a completely new approach and way of thinking about biology and medicine.  Eventually we may not need drugs to cure disease.  This is already the case for many ailments affecting the cardiovascular system.  For the immune system， of course， we still need and in many cases only have the option to treat with drugs.  We have a very complex immune system， which develops immediately after birth.  First a baby is born sterile in the womb of the mother with no functioning immune system.  The first germs the baby comes into contact with are the germs of the mother.  When the mother breastfeeds she passes along antibodies against her own germs so they do not harm the newborn.  This is a wonderful evolutionary phenomenon， that the baby can passively acquire immunity from the mother in this way.  Slowly the baby becomes exposed to other germs and the immune system develops.  In urban living we are being brought up in a more or less sterile environment.  We live in an apartment， sanitized for your convenience.  Children don’t have things like worms anymore and the usual infections people normally would have， we do not have anymore.  This creates an underdeveloped immune system that is postulated to be linked to the potential to develop things like cancer and a lot of different diseases that depend on a functional， sophisticated immune system.  Allergies are a great example.  Suddenly one is exposed to chemical agents that you are not used to and for which the immune system is ilprepared.  The immune system is not able to cope with these types of antigens.  Allergies are one of the biggest burdens on health these days.  Myself for example， was brought up in the dirty environment of the countryside in post-WWII Germany with all sorts of infections and I have no allergies.  My children were brought up in Berlin， an urban society， and they have allergies.  

    Ganten教授：进化医学的这个基础就是现在我们比5年前要更能理解进化的基本原则。这可能是因为高频测序技术引的快速发展引起的，因此实际上现在我们能对每一种生物的基因编码进行测序。我们也了解了从生命起源到今天的所有生物。我们能够更清楚的知道为什么我们是现在这个样子。例如，我们为什么会有脊椎？为什么细胞会按照他们的方式进行分裂？我们身体的整个结构是怎么形成的？。在基因组突变和改变的基础上我们就能理解进化的整个原则。这是一种认知的发展。在进化医学中需要明白的重要的一点是一旦自然进化出了它工作的机制，它也就会继续坚持这一机制。比如，脊椎是帆蜥鱼在水中生活的情况中进化出来的，在那种情况下地球引力并没有起到很大的作用。后来当两栖类和爬行类动物开始上岸并在陆地上繁衍，他们就必须依靠脊椎来活动。这就出现了弱点。我们现在根据不能被中断的基因组执行程序知道了为什么我们会有脊椎。一旦你发展出一种进化的模式，你就会一直遵循这种模式，例如你无法摆脱脊椎除非所有的有脊椎动物都死亡。如果这些已经进化出的物种持续繁衍，那时我们就会遵循这一已进化出的法则。对于人类来说，我们依然遵循着那些在两栖类动物、爬虫类动物以及鱼类中发现的所有利于它们幸存和生殖方面的古老法则。进化就是在一定生活条件下的生存和生殖原理。在不同生活环境下就会出现各种不同的特点，并且我们现在的城市化、人造的生活环境实质上造成了生物学和文明之间的鸿沟，现在我们已经能越来越好的理解这一点了。对这些情况的理解产生了完全不同的结果，也因此使我们发现了研究医学的新途径。这种医学研究方法已经不是像以前那样探索一些问题，比如询问从机械学的角度看交感神经系统或肾素-血管紧张素系统是如何产生作用的，但是这种单纯从机械学角度研究问题的方法在今日的医学研究中依然很盛行。药理学是关于如何更好的发现药物的作用机制以便于对疾病进行干预。从另一个角度来说，假如我们对为什么我们存在这种系统进行提问呢？存在这种又有什么好处呢？如果这种系统对我们现在的生活没有益处，那它在什么时候又对什么样的物种有益呢？假如我们能理解这些问题并用合理的方法找到它们的答案，设计出预防的方法、生活环境以及治疗方法等，就能找到这些机制和我们感兴趣的疾病的原因。进化就是机体的生物学在和环境及病毒的斗争中决定出谁胜谁负。我们已经不再是胜者了。我们在一些时候取得胜利因为我们花费了大量的金钱来发明医疗技术和治疗方法来使我们继续存活下去。进化医学并不是和基于科学的现代医学相敌对的医学，它是一种对生物学和医学进行思考的完全新的方法和途径。最终我们可能不需要药物来治愈疾病。已经有这样的案例比如现在发现很多小的病变会影响心血管系统。当然对于免疫系统来说，我们仍然需要药物治疗并且在很多情况下只能做出用药物治疗的选择。我们人类的免疫系统非常复杂，它在出生后就迅速发展起来。首先婴儿出生前是生活在母亲子宫内的无菌环境中，此时他的免疫系统还没有功能。婴儿首次接触到的病菌是母亲体内的病菌。当母亲给婴儿母乳喂养时对抗她体内的病菌所产生的抗体就通过母乳传递给了婴儿，因此这些病菌就不能侵害婴儿。这是一种非常奇妙的进化现象，婴儿能通过这种方式从母亲那里被动获得免疫。后来婴儿逐渐暴露于其他病菌下，这时它自己的免疫系统就发展起来。在城市生活中我们或多或少是在无菌环境下成长起来的。我们住在公寓里，能很便利的进行消毒。孩子们不再有蠕虫类的寄生虫感染，并且我们不再有那些人们常常会得的感染性疾病。这使我们的免疫系统发育并不完善，因此假设这和发生一些潜在的疾病比如肿瘤和很多不同的疾病相关，因为对抗这些疾病需要功能完善的免疫系统。过敏症就是一个很非常好的例子。一个人突然暴露于那些他没有适应的化学物质下并且免疫系统还没有对抗这种物质的能力时就会发生过敏。在这种情况下免疫系统不能处理这些抗原。最近敏症成了最大的健康负担。比如说我自己是在第二次世界大战后德国卫生状况很差的乡村环境下长大的。我的孩子们在柏林长大，柏林是个都市，他们就都有过敏症。