Kate set him on his stomach, pulled the covers up, and went out to talk to Julie for a while before each woman went back to her own computer terminal and her own studies.
On Wednesday the three RS-Project teams came together in the windowless meeting room near the imaging lab. In addition to the team leaders and their top assistants, Director Mauberly and two other top CDC administrators were there.
Bob Underhill and Alan Stevens opened with their presentation on the absorption organ. When they were finished, the room was filled with a shocked silence.
Ken Mauberly broke the silence. “What you’re saying is that this child… Joshua…has a specially mutated adaptation of the stomach lining which can absorb blood for nutritional purposes.”
Underhill nodded. “But that purpose is secondary, we think. The primary reason for this mutation’s existence is to break down the blood into its constituent parts so that the retrovirus—what Chandra and Neuman are calling the J-virus—can most efficiently begin the distribution of the borrowed RNA for immunoreconstruction purposes.”
Mauberly chewed on his expensive fountain pen. “But for this to work, the child would have to ingest blood.”
Alan Stevens shook his head. “No. Blood is directed through the capillaries of the absorption organ no matter how it enters the body. We estimate that it actually would take several hours longer for it to begin working there via ingestion rather than transfusion, but of course we haven’t experimented with this…” He paused, looked at Kate, and then looked down at his notes. Stevens cleared his throat. “No one wishes to give the patient blood to ingest, although if we are to continue the analysis of the absorption organ, this would be necessary.”
Mauberly was frowning. “I don’t… I can’t see the survival value in drinking blood. I mean, it makes one think of…well…”
Kate stood up. “Vampires?” she said. “Bela Lugosi?”
There was a ripple of nervous laughter.
“We’ve all made or heard those jokes since the project began,” said Kate, smiling, defusing the tension, “and it’s obvious given the fact of where Joshua was born. Transylvania. Vampire country. And there may be a reason for that.” She nodded to Chandra.
The virologist stood up and used a remote control to turn out the lights and advance a slide on the projector. “These charts show a projected family or clan over twenty generations, since approximately fifteen hundred A.D. to the present, illustrating the spread of the J-virus mutation within that family. Given the trait’s recessive-recessive nature plus the high mortality rate one would assume with the immunodeficiency disorder which goes with the trait, you see that even if we might consider it a relatively benign mutation, its spread would not be too considerable…”
Everyone worked at decoding the long strands of hypothetical family growth, the J-virus mutation strands helpfully drawn in red. After thirty seconds it was Bob Underhill who whistled. “I thought that the mutation must be new or we would have seen it before, but this shows that it could be around for centuries without spreading too widely.”
Chandra nodded and advanced the slide. “Assuming for the spread of the mutation through marriage and genetic dispersion, we would still be talking about a relatively small set of survivors from the initial breeding couple—three hundred to two thousand people, worldwide.” Chandra looked at Kate. “And these people would need a relatively constant supply of whole blood for transfusions to survive into adulthood, assuming the disease continues beyond infancy, and we have no reason to believe otherwise.”
It was one of the CDC bigwigs, a doctor/administrator named Deborah Rawlings, who said. “But there were no transfusions in the fifteenth century…or anywhere until the last century…” She paused.
Kate stood in the light from the projector. “Precisely. For this trait to be passed down at all, the survivors would have had to have actually ingested blood. Literally fed blood to their children, if the children possessed the J-virus recessive-recessive. Only in the last century would transfusions have saved the J-virus mutation individuals.” She waited a minute for the full impact to settle on the specialists and administrators.
“Vampires,” said Ken Mauberly. “The myth has its origins in reality.”
Kate nodded. “Not fanged creatures of the night,” she said, “but members of a family who did have to ingest human blood in order to survive their own faulty immune systems. The tendency would be for secrecy, solidarity, inbreeding…the recessive-recessive traits would have been more frequent as a result, much as with the hemophilia which plagued the royal houses of Europe.”
An assistant virology researcher named Charlie Tate hesitantly raised his hand as if he were a high school student.
Kate paused. “Charlie?”
The young man adjusted his round glasses. “How in the hell… I mean, how did that first J-virus sufferer find out that blood would save him…or her… I mean, how did someone start drinking blood?”
“In the Middle Ages,” said Kate, “there are records of noblewomen who bathed in blood because legend had it this would make their skin more beautiful. The Masai still drink lion’s blood to absorb the animal’s courage. Blood has—until recent decades—been the source of superstition and awe.” She paused a second, looking at Chandra. “Now, with AIDS, it’s regaining that terror and mystery.” Kate sighed and rubbed her cheek. “We don’t know how it began, Charlie,” she said softly. “But once it worked, the J-virus sufferers had no choice…find human blood or perish.”
The silence stretched on for another thirty seconds before Kate went on. “Part of my work has been to end that cycle,” she said. “And it looks as if I have a solution.” She advanced the slide, and an image of a pig’s face filled the screen.
The doctors in the room giggled despite themselves.
Kate smiled. “Most of you know about the DNX breakthrough on human blood substitute this past June—”
Ken Mauberly held up his fountain pen. “Refresh our overworked administrative memories, please, Kate.”
“DNX is a small biotech lab in Princeton, New Jersey,” said Kate. “In June of this year they announced that they had perfected a way of producing human hemoglobin in pigs via genetic engineering. They’ve given the research to the FDA and are applying for human trials even as we speak.”
Mauberly tapped his pen against his lower lip. “How does this artificial hemoglobin help in the J-virus research?”
“It’s not really artificial hemoglobin,” answered Kate, “merely not created in the human body.” She advanced the slide carousel again. “Here you see a simplified schematic of the process. By the way, I’ve been working with an old friend, Doctor Leonard Sutterman, who is chief hematology consultant for DNX, as well as with Doctor Robert Winslow, chief of the Army’s blood research division at the Letterman Institute of Research in San Francisco, so we’re duplicating research with permission here and being careful not to tread on DNX’s pending patents.
“Anyway, here is the schematic. First, the researchers extract the two human genes we know are responsible for producing hemoglobin in the human body.” Kate glanced at the administrators. “Hemoglobin, of course, is the oxygen-carrying component in the blood.
“All right—having extracted the genetic information, these genes are then copied and injected into day-old pig embryos taken from a donor pig. These embryos are then inserted into the womb of a second pig, where they grow to term and are born as normal, healthy piglets. The only difference is that these pigs have human DNA in them, directing them to produce human hemoglobin along with their own pig-variety blood.”
“Excuse me, Kate,” interrupted Bob Underhill. “What’s the percentage on that?”
Kate started to answer and then paused. “On which, Bob? The number of successful transgenic pigs or on the amount of human hemoglobin the successful ones produce?”
Underhill spread his hands. “Either. Both.”
“About five pigs in a thousand successfully carry the
transfers,” said Kate. “Of those, each averages about fifteen percent of their blood cells carrying human-type hemoglobin. But DNX is working on getting the ratio up closer to fifty percent of the cells.”
She waited a second, but there were no more immediate questions. Kate advanced the slide again. “You see here that DNX’s real breakthrough is not in the genetic engineering…that was straightforward enough…but in patenting a process to purify the swine blood so that useful human hemoglobin can be recovered. This is what so excites my friends Doctor Leonard Sutterman and Doctor Gerry Sandler with the blood division of the Red Cross.”
Kate advanced the slide to an empty frame and stood a minute in the brilliant light. “Think of it, substitute human blood…only much more useful than whole blood or plasma.”
“How so?” asked Deborah Rawlings.
“Whole red blood cells are made of perishable membranes,” said Kate. “Outside the body they have to be refrigerated, and even then spoil after a month or so. Also, each cell carries the body’s immune codes, so blood has to be matched by type if it’s not to be rejected. Pure hemoglobin avoids both these problems. As a chemical, it can be stored for months…recent experiments show that it can even be freeze-dried and stored indefinitely. The Army’s Doctor Winslow estimates that about ten thousand of Vietnam’s fifty thousand battlefield fatalities could have been saved if this oxygenated blood substitute had been available.”
“But plasma already has the shelf-life attributes you’re talking about,” said Rawlings, “and it doesn’t require expensive genetic engineering.”
“Right,” said Kate, “but it does require human donors. Plasma availability is restricted by the same factors that mean that whole blood is sometimes unavailable. The human hemoglobin acquired via the DNX process only requires pigs.”
“A lot of pigs,” said Alan Stevens.
“DNX figures that four million donor pigs could provide risk-free blood for the entire U.S. population,” Kate said softly. “And it would only take about two years to grow those donor pigs.”
Bob Underhill whistled again.
Mauberly raised his fountain pen like a baton. “Kate, I see where you’re going with this for the RS-Project. Someone with the J-virus immunodeficiency disease could theoretically be injected with this genetically altered swine blood, but it seems to me that this wouldn’t help at all.”
Kate nodded. “Right, Ken. The only genes cloned in the DNX process are those which govern the production of hemoglobin. This is my suggestion.” She clicked her last slide on and gave everyone a minute to study it.
“You see,” she said at last, aware that her voice was thickening with emotion for some reason, “what I’ve done is piggyback on Richard Mulligan, Tom Maniatis, and Frank Grosveld’s work on transplanting human beta-globin genes via retrovirus for immunoreconstruction. Mulligan and the others have been concentrating on curing beta-thalassemics and adenosine deaminase deficiency, although they’ve also done some startling work with boosting tumor-infiltrating lymphocytes, TIL cells, with interleukin-2 hormone, putting the cells back in cancer patients, and watching the gene-boosted cells attack tumors.”
“But you’re not after tumors,” said Charlie Tate. The young man sounded like he was talking to himself.
“No,” agreed Kate. “But I’ve used the same cloning and retrovirus injection technique to isolate the regulatory genes which code for antigen-specific cellular and humoral responses.”
“SCID,” Ken Mauberly said very softly. “The whole range of congenital immunodeficiency diseases.”
“Yes,” said Kate, irritated that her voice threatened to betray her by showing emotion. She cleared her throat. “Using the DNX-style genetically engineered human hemoglobin as a carrier template…taken from pigs, remember, not human beings… I have been successful in cloning and attaching normal ADA genes to deal with the adenosine deaminase deficiency, as well as the necessary human DNA to deal with the other three types of Severe Combined Deficiency. The DNX blood substitute is an excellent carrier. As well as providing clean, well-oxygenated blood which does not have to be matched for the subject, the virally introduced DNA should cure all SCID symptoms.”
There was a long moment of almost absolute silence.
Finally, Bob Underhill said, “Kate, that would allow the J-virus to continue rebuilding the child’s immune system…without ever needing actual human blood again. Question…where did you get the DNA to clone for the ADA, B-lymphocyte, and other immunoreconstructive genes?”
She blinked. “My own blood,” she said, her throat closing on her. She doused the projector lamp and took a minute to recover her composure before turning the lights back on. Some people in the room were rubbing their eyes as if the light hurt.
“Ken,” Kate said, her voice steady again, “when can we begin human trials on Joshua?”
Mauberly tapped his pen. “We can begin applying to the FDA for permission almost immediately, Kate. But because of the DNX patent and the complicated nature of the process, my guess would be at least a year…perhaps longer.”
Kate nodded and sat down. She would not tell them that the evening before, in the most flagrant violation of professional ethics she had ever imagined, she had injected her adopted son with the modified DNX hemoglobin. Joshua had slept well and been healthy and happy in the morning.
Mauberly took the floor. “We’re all excited by these developments,” he said. “I’ll notify CDC Atlanta immediately, and well begin to discuss possible involvement by the World Health Organization and other agencies.”
Kate could imagine the scramble of researchers through Romania and Eastern Europe, hunting for other J-virus individuals.
“Doctor Chandra,” said Mauberly, “would you like to brief us at this time on the results of the J-virus research on our hunt for an HIV cure?”
“No,” said Chandra.
Mauberly nodded and cleared his throat. “All right,” he said, “but soon, perhaps?”
“Soon,” agreed Chandra.
Ken Mauberly tucked his pen back in his shirt pocket and clapped his hands together. “Well, all right then. I imagine everyone wants to get back to work. I only want to say—”
The room emptied of researchers before he could finish.
Tom came into her office at about six P.M. For a second Kate could not believe it was Tom—he never had come up to her CDC office—and then her heart began to pound wildly. “Joshua?” she said. “What’s wrong?”
Her ex-husband raised an eyebrow. “Nothing’s wrong. Relax. I just came from there… Josh and Julie are playing in the mud near the patio. They’re both fine.”
Kate exited the program she had been working on. “Then what?”
“I thought it was a good night to take you out to dinner,” he said.
Kate took her reading glasses off and rubbed her eyes. “Thanks, Tom. I really appreciate the offer. But I’ve got another couple of hours of work to do before—”
“I have reservations at Sebanton’s,” he said softly, still holding the door open.
Kate turned the computer off, hung her white coat on the rack near the door, and pulled on the blazer she had worn for the presentation that morning. “I’ll have to go home,” she said. “Wash up. Feed Joshua.”
“Joshua’s been fed. Julie loves the idea of putting the kiddo to bed tonight. Leave your Cherokee in the parking lot, I’ll give you a ride to work in the morning. Now, use your executive lav,” he said. “Reservations are for six-thirty.”
Boulder, Colorado, was a town with too many restaurants, most of them indifferent, a few very good, and one or two excellent. Sebanton’s was none of the above because it was not in Boulder. The French restaurant was on the main street of Longmont, an unassuming cow town twelve miles down the Diagonal Highway. Even finding the little restaurant was a chore since it was tucked away between ugly storefronts that had once been a small town’s drugstore or department store or hardware store, and were now flea markets and taxidermy s
hops. But Sebanton’s, while hard to find and not aesthetically pleasing from the outside, was simply the finest French restaurant in Colorado…possibly in the Rocky Mountain region. Kate did not consider herself a gourmet, but she had never turned down an invitation to Sebanton’s.
Two hours later the view out the restaurant window was softened by darkness, and the small interior was illuminated only by candlelight. Kate returned to the table and smiled at the coffee and cheesecake that had materialized while she was on the phone.
“Julie and Josh OK?” asked Tom.
“Both fine,” said Kate. “She put Josh down about eight. She says he had a great day creeping around the patio and that he seems to feel fine.” She leaned forward and said, “All right, Tommy. What’s the occasion?”
He sat back and lifted his coffee cup with both hands. “Does there have to be an occasion?”
“No,” said Kate, “but I can tell that there is. Your face always gets a little extra red when you’re building up to something. Tonight you could guide Santa’s sleigh.”
Tom set his coffee down, coughed, folded his hands, unfolded them, and leaned back to cross his arms. “Well, there is something. I mean… I’ve been thinking about you up there on the hill by yourself…nobody but Julie around, and she’ll be leaving in December.”
Kate softly bit her lip. “It’s all right, Tom. I’ll find someone. Besides, things are going to slow down in the lab so I’ll have more time to spend with—”
Tom shook his head and leaned closer. “No, I don’t mean that, Kat. Bad start. What I mean is…how would you feel about me moving back in for a while? Not permanently, but just for a few weeks or months. Just to see if it feels right—” He stopped. His face was redder than the Victorian wallpaper in the restaurant.
Kate took a deep breath. She knew that she and Tom were not destined for a new beginning. She loved him…she had always loved him in one way or another…but she was also certain that their marriage had been wrong, out of synch, a union that had done little except mess up a wonderful friendship. She was certain of that.