“But I've spent a lot of my time and the Center's resources in trying to cure my son,” Kate said softly.
The administrator rubbed his fingers together. “That's totally understandable, Kate. What I'd hoped to do with you is discuss some alternatives. A friend of mine, Dick Clempton, is at Children's Hospital in Denver, and he's one of the best ADA men in“
Kate unsnapped her briefcase, removed a thick file, and shoved it across the desk to her boss. Mauberly blinked.
“Read it, Ken,” she said.
Without another word he pulled his glasses out of his shirt pocket and began reading. After the third page, he took his glasses off and stared at her. “This is hard fact?”
Kate nodded. “You see who signed the imaging and lab reports. Donna McPherson has repeated the tests twice. There's no doubt that the patient's body . . . Joshua's body . . . is somehow cannibalizing the necessary genetic components to reinvigorate its own immune system.”
Mauberly glanced through the rest of the papers, skimming the more technical pages to read the conclusions. “My God,” he said at last. “Have you conferred with anyone outside the Center?”
“I've gotten some ideas without revealing all of what you're looking at,” said Kate. “Yamasta at the Georgetown University International Center for Interdisciplinary Studies of Immunology, Bennet at SUNY Buffalo, Paul Sampson at Trudeau . . . all good people.”
“And?”
“And none of them have even a hypothesis how a SLID child can effect a spontaneous remission of such marked hypogammaglobulinemia with just blood transfusions as a catalyst. “
Mauberly rubbed his lower lip with the earpiece of his glasses. “And do you? Have a hypothesis, I mean.”
Kate took a deep breath. She had not suggested such a thing to anyone yet. But now everything depended on sharing her thoughts with her boss: not just the incredible breakthroughs she thought might be possible, not just her job, but Joshua's life.
“Yes,” she said, “I have a theory.” Unable to stay seated, Kate stood and leaned on the back of her chair. “Ken, imagine a group of peoplean extended family, sayliving in a remote region of an isolated Eastern European country. Say that family has suffered from a severe but classic case of SCID . . . a form of the disease that exhibited all four strains: reticular dysgenesis, Swisstype, ADA deficiency, and SCID with B lymphocytes.”
Mauberly nodded. “I'd say that family would die out in a generation. “
“Yes,” said Kate and leaned farther forward, “unless there were a cellular or physiological mutation in that familypassed on only through recessive geneswhich allowed it to cannibalize genetic material from donor blood so that their own immunodeficiency was overcome. Such a group could survive for centuries without being noticed by medical authorities. And given the rarity of the double recessive appearing, few offspring would be born with either SCID or the mutational compensation.”
“All right,” said Mauberly, “assuming there are a few peoplea very few peoplein the world with this accelerated immune response. And the child you adopted is one of them. How does it work?”
Kate went over the broad outlines of the data, never talking down to Mauberly as laymanhe was too brilliant and too conversant in medical realities for thatbut also never getting bogged down in either overly technical details or idle speculation.
“All right,” she summarized, “this indicates thatone, Joshua's body has a way of adapting human blood as a repair mechanism for his own immunodeficiency; two, there is someplacepossibly that bloodrich shadow organ Alan isolatedwhere the blood is broken down; three, the constituent genetic material is disseminated throughout his body to catalyze the immune system.”
“How?” said Mauberly. The administrator's eyes were very bright.
Kate spread her hands in front of her the way she did when guestlecturing at a medical school. “Best guess is that the transmitter component of Joshua's disease is a retrovirus . . . something as persistent as HIV, only with lifegiving rather than fatal consequences. From the data, we know the dissemination is very rapid, much more aggressive than HIV even in its most virulent stages.”
“It would have to be,” interrupted Mauberly, “if it were to have any survival value for the SCIDsymptomized family or families in which the mutation appeared. A slow immunological reconstruction would be useless when the slightest head cold in the interim would be fatal.”
“Exactly,” said Kate, unable to hide her own excitement. “But if the mutated retrovirus can be isolated . . . cloned . . . then“She was unable to go on, despite the importance of doing so.
Mauberly's gaze was elsewhere. His voice was shaky. “It's premature, Kate. You know what we're thinking is premature.”
“Yes, but“
He held up one hand. “But the payoff would be so dramatic . . . so miraculous. “ He closed Joshua's file and slid it back across the desk to her. “What do you need?”
Kate almost collapsed into her chair. “I need time to work on this project. We'll codename it . . . oh, RS91 or R3.”
Mauberly raised an eyebrow.
“RS for retrovirus search and for Romanian Solution,” she said with the slightest smile. “R3 for Romanian Recessive Retrovirus.”
“You'll get the time,” promised Mauberly. “And the budget. If I have to sell one of the Crays. What else?”
Kate had thought it all out. “Continued use of the imaging facilities, Pathology, and at least one ClassVI lab,” she said. “And the best people to go with them.”
“Why the ClassVI biolab?” asked Mauberly. The expensive and supersecure facilities were used only with the most dangerous and experimental toxins, viruses, and recombinant DNA experiments. “Oh,” he said, seeing the answer almost immediately, “you'll be trying to isolate and clone the retrovirus.” The thought sobered him. “All right,” he said at last. “You can have Chandra.”
Kate nodded in surprise and appreciation. Susan McKay Chandra was CDC's superstar, one of the two or three top vital and retroviral experts in the world. She normally worked out of Atlanta but had been a temporary researcher at Boulder CDC before. Well, thought Kate, I did ask for the best.
“We'll have to submit this to the Human BioEthics Review Board,” began Mauberly.
Kate stood up. “No! Please . . . I mean . . . “ She calmed herself. “Ken, think . . . we're not experimenting on a human being.”
Mauberly frowned. “But your son . . .”
“Has undergone a few advanced but very basic medical tests,” said Kate. “And he will have to submit to a few more. Blood and urine tests. Another CT scan, more ultrasound, perhaps MR, and maybe isotopic scintigraphy if we find his bone marrow involved in this . . . although I'd rather avoid that because bone imaging can be uncomfortable . . . but we are not experimenting! Just carrying out standard diagnostic techniques for isolating the kind and severity of immunodeficiency that this patient has. The Review Board will tie us up for months . . . perhaps years.”
“Yes, but“said Mauberly.
“If we isolate the R3 retrovirus and if we can clone it to adapt it to HIV or oncological research, “ pleaded Kate, “then we can approach the Board. We would have to. But then there would be no doubt as to the need for human experimentation. “
Ken Mauberly nodded, rose, and came around the desk to her. Kate rose to meet him.
Amazingly, he kissed her on the cheek. “Go,” he said. “As of ten A.M. today, you are officially detached for the RSProject. Bertha will take care of the paperwork. And, Kate . . . if we can help you or the family with the aftereffects of Saturday's problem, well, just ask . . . we'll do it.”
He walked her to the office door. Outside, Kate shook her headnot only at the magnitude of what had just happened, but at her realization that for a few minutes she had forgotten all about “Saturday's problem.”