Syndrome

by Thomas Hoover

  But competition was fierce, and the bigger players like Merck and J amp;J had limitless research capital. They could write off dead ends a lot easier. Thus it was that five years ago, when his pipeline was drying up, Winston Bartlett took the biggest gamble of his life. He acquired a cash-strapped new start-up called the Gerex Corporation, whose head scientist was at the cutting edge of stem cell research. Karl Van de Vliet, M.D., Ph.D., had just had his funding terminated and his laboratory at Stanford University closed after a political flap by right-wingers.

  Bartlett had moved Van de Vliet here to New Jersey and poured millions into his stem cell efforts, bleeding BMD's working capital white and racking up 85 million in short-term debt just to keep the rest of the company afloat. Now, though, the gamble was paying off. This month Gerex was winding up stage-three clinical trials for the National Institutes of Health. These trials validated a revolutionary procedure that changed the rules of everything known about healing the human body. Already his CFO, Grant Hampton, was heading a negotiating team hammering out a deal with the British biotech conglomerate Cambridge Pharmaceuticals to sell them a 49 percent stake in Gerex. Over 650 million in cash and stock were on the table, and there were escalators, depending on the results of the trials now under way.

  The problem was, Cambridge had only seen the financial and summaries of data from Gerex's successful clinical trials. They knew nothing about the fiasco of the Beta procedure.

  "Karl called just before we left and said she's worse this morning," Bartlett remarked to Noda. He was removing his aviator shades and there was deep frustration in his eyes. "God I feel so damned responsible. She was-"

  "Having the Beta was Kristen's idea," Noda reminded him. "Shewantedto do it."

  What he didn't say was on both their minds: what about Bartlett himself? After Kristen Starr had had the Beta, and it had seemed successful, Bartlett decided to have it too. Now his daily blood tests here at the institute were showing that the telomerase enzyme was starting to metastasize and replicate in his bloodstream, just as it had in hers.

  "Well," Bartlett went on, "Karl thinks he's got a new idea that might save us. Hampton is supposed to be on the case this very morning." He stared out the chopper's window, down at the rooftops of his empire. At the north end of the industrial park was the main laboratory, where stents and titanium joint replacements were tested on animals-mostly sterile pigs, though some primate testing also was under way. The central area had two large manufacturing facilities where the more complex devices were made.

  The buildings were all white cinder block, except for the one they were hovering above now. It was at the far south end, a massive three-story mansion nestled among ancient pines and reached by a long cobblestone driveway. Though it was actually the oldest building of the group by a hundred years, it was the latest acquisition for the complex. It fronted a beautiful ten-acre lake, and had been a summerpalacioof a nineteenth-century railroad baron. Around mid-century it was turned into a luxury retirement home, complete with nursing services. Its ornate appointments reminded patients of the Frick Gallery, if one could imagine those marble halls teeming with wheelchairs and nurses.

  Bartlett had bought the defunct manufacturing complex next to it eighteen years earlier for the BMD industrial park, but it was only six years ago that the owners of the mansion, a group of squabbling heirs, finally relented and agreed to part with the property. It was now a flagship holding of BMD.

  He had an eye for design and he had loved remodeling the old mansion and making it into a modern clinic and research facility. He had renamed it the Dorian Institute and moved in Karl Van de Vliet and the research staff of the Gerex Corporation. He also had put a landing pad on the expansive roof, along with a stair leading down to an elevator that could take him directly to the laboratory in the basement.

  Kenji Noda settled the McDonnell Douglas onto the pad and cut the engines. Bartlett never let himself worry about the noise. The patients in the clinical trials were here at no charge, so they really couldn't complain, particularly since they were now part of what was possibly turning out to be the greatest advance in the history of medicine. If your Alzheimer's had just been reversed at no charge, you weren't going to complain about a little hubbub on the roof.

  "I'll wait here," Noda said opening the side door. His bald pate, reminiscent of an eighteenth-century samurai, glistened in the early spring sun.

  Bartlett nodded, knowing that his pilot did not trust physicians and hospitals. Taking care of your body was your responsibility, Kenji Noda frequently declared and he trained his own daily. He ate no meat and drank gallons of green tea. When he practicedkendoswordplay, he had the reflexes of a man half his age. He never discussed why he had left Japan, but Bartlett assumed it was for reasons best left in the dark.

  Bartlett headed down the metal stairs leading to the self-service elevator. This daily ordeal of flying out to give a blood sample and to see Kristen was increasingly unsettling. As he inserted his magnetic card into the elevator security box, he felt his hand shaking slightly.

  So close to the eternal dream of humankind. So close. How was it going to end?

  Sunday, April 5

  8:38a.m.

  "Dr. Vee, I'm feeling so much better, I can't tell you." Emma Rosen reached out and caught her physician by the collar of his lab coat, pulling him down and brazenly bussing his cheek. She'd been longing to do this for three weeks but hadn't mustered the nerve until now. "This morning I climbed the stairs to the third floor, twice, up and back without any chest pain. Oy, can you believe? It's a miracle."

  Karl Van de Vliet was a couple of inches over six feet, with a trim face and sandy hair that some older patients judged too long for a physician. His English normally was perfect, though sometimes he made a mistake when trying to sound too colloquial. But everyone, young and old adored his retiring Dutch manner and those deep blue eyes that carried some monumental sadness from the past. They also were sure he would soon be recognized worldwide as the miracle worker he was. The prospect of a Nobel didn't actually seem that far-fetched.

  "Emma, please, I begged you to rest." He sighed and checked the dancing electronic pens of her EKG. They were in the basement of the Dorian Institute. Upstairs, the "suites"-nobody called them rooms-were intended to invoke a spa more than a clinic, so most of the heavy-duty diagnostic equipment was kept in a row of examining rooms down near the subterranean lab. "For another week at least. Why won't you listen? You've been a very naughty girl. I may have to tell your daughter."

  He glanced at the seventy-three-year-old woman's readout one last time, made a quick note on his handheld computer, and then laid a thin hand across her brow for a fleeting, subjective temperature check.

  She's all but fully recovered, he told himself. It's truly astonishing.

  Five weeks earlier, she had come through the front door of the Dorian Institute in a wheelchair pushed by her youngest, a bottle blonde named Shelly. He took one look and scuttled the normal security precautions, the frisk for cameras and recording devices. Emma's low cardiac output had deteriorated to the point that her left leg below the knee was swollen to almost twice its normal size, owing to renal retention of fluid, and she was so short of breath she required oxygen. He hadn't wanted to complicate the clinical trials by taking on another patient at that late date, but she had been referred by a physician friend in the city, begging. How could he turn her away?

  He had removed a microscopic amount of bone marrow from her right ankle, extracted the stem cells, applied the hormonal signal that told them to develop into heart muscle, and then injected a thriving cell factory into her heart. Since stem cells could be made to ignore the body's rules to stop replicating after a certain number, they were able to reproduce forever, constantly renewing themselves. The only other cells with that immortal characteristic were cancer cells. In fact, it was as though he had given Emma a new kind of cancer-one that produced cells as healthy as those in a newborn. Today she probably could have run
up those stairs.

  Although his stem cell technology was going to create a new era in regenerative medicine, he had experienced his share of bumps in the road. Five years earlier, Stanford University had canceled his research project there since the work he had been doing involved the special stem cells in unused fertility-clinic embryos. The university claimed there had been death threats to its president. The Board of Regents had finally decided with a sham show of remorse, to revoke his funding. They called him in one sunny afternoon in May and pulled the plug. He thanked them and tore up his contract. By that time he had already demonstrated that, using the right chemical signals, stem cells could be coaxed into becoming almost any organ. Inserted into the heart, they became new heart muscle, replacing scars; inserted into the brain, they became neural tissue. No way was he going to be stopped now. They didn't know what they were losing.

  What he needed was a "white knight." He did some poking around and came up with Winston Bartlett, then floated feelers to Bartlett's people. What if, he proposed, Bartlett acquired the Gerex Corporation for BMD and made it a for-profit business? No more public funding (and maddening administrative meddling). The research already completed was so close to a payoff, after years and years of grinding lab work and thousands of white mice, that the deal could be considered an investment where 95 percent of the seed money had already been supplied by taxpayers.

  Winston Bartlett had liked the sound of that, and Karl Van de Vliet had his white knight.

  Once his financing was secure, he decided to begin by solving the problem that had dogged him at Stanford. Since there would always be a distracting public-relations problem hounding any researcher in the United States who made use of aborted embryos, even if it was to save lives, he was determined to find a less controversial way to trick Mother Nature and garner "pluripotent" stem cells, the name given those that could give rise to virtually any tissue type.

  He had. After he moved his research team into the Dorian Institute just over 4 1/2 years ago, he had perfected a way to use a human protein, an enzyme called telomerase, to make adult stem cells do most of the miracles once only thought possible with embryonic cells.

  The phase-three clinical trials over the past seven months had proved conclusively that the technique worked. Adult stem cells, when treated with the telomerase enzyme to arrest the process of cell senescence, could indeed regenerate everything from the human brain to the human heart, from Parkinson's to acute myocardial infarction.

  Twenty-three days from now, when the phase-three clinical trials were formally scheduled to be completed, Karl Van de Vliet would have enough data for the National Institutes of Health to confirm one of the most important breakthroughs in the history of medicine.

  Unfortunately, however, there was that other bit of data that he would not be sharing with the NIH. The Beta.

  Thinking about that, his heart heavy, he turned back to the situation at hand.

  "Emma, you're making wonderful progress," he continued on with the banter, "but don't push yourself too hard just yet."

  She laughed, sending lines across her forehead. Her voice was deep and rich, sultry in its own way. "When you get as old as I am, honey, you do anything you can get away with. What am I saving it for? I just might go to Atlantic City next week and pick up a sailor."

  "Well, then, I may have to have Shelly go along and keep an eye on you," he said with one last programmed smile. Then he checked his watch. Bartlett should be arriving any minute now. Time to get Emma Rosen the hell out of here and back upstairs.

  He turned and signaled for Ellen O'Hara, the head nurse, to start removing the suction-cup electrodes that had been stuck on Emma for her EKG. Ellen had been with him when he was at Stanford and her loyalty was unquestioned. She had made sure that the Beta disaster with Kristen hadn't become the gossip of the institute. Still, how much longer could it be kept quiet?

  Then Sandra Hanes, the lively, dark-haired woman in charge of the second floor for this shift, walked into the examination room. She knew nothing about Kristen.

  "Perfect timing," he said. Then he drew her aside. "Keep an eye on Emma, will you? Try and keep her in her room and quiet as much as you can. The last blood work showed her white-cell count over twelve K/CMM. It could mean there's some minimal rejection rearing its head. Probably nothing to worry about, but can you just keep her away from the stairs for godsake? I don't want her tiring herself out."

  "I'll tie her to the bed if I have to," Sandra answered. The clinical trials had required a mountain of paperwork, and her face was strained from working long shifts, including a lot of weekends, like this one. But he suspected she actually appreciated the overtime. She was forty-five, divorced and putting a straight-A daughter through Rutgers.

  She also was a first-rate nurse, like all the others at the institute, and her loyalty couldn't be more secure. Still, he knew that she and all the other staffers were bursting to tell the world about the miracles they'd witnessed. That was why Bartlett had insisted on an ironclad nondisclosure agreement in the contract of every employee to be strictly enforced. (And to put teeth into the security, all employees were body-searched for documents or cameras or tapes on the way in and out.) To violate it would be to open yourself to a life-altering lawsuit. During World War II the claim had been that "loose lips sink ships." Here they would render you a pauper for life. Nobody dared even whisper about the spectacular success of the clinical trials.

  As the examining room emptied out, he checked his watch one more time. Winston Bartlett was due any minute now and he had nothing but bad news for the man.

  Trying to control his distress, he walked to the end of the hallway and prepared to enter the lab. Whereas the ground floor and the two above were for reception, common dining, and individual rooms, the basement contained the laboratory, his private office, the examination rooms, and an OR (never yet used, thankfully). There also was a sub-basement, accessible only through an elevator in the lab or an alarmed set of fire stairs. It was an intensive-care area, and it was where Kristen, the Beta casualty, was being kept.

  He zipped a magnetic card through the reader on the door and entered the air lock. The lab was maintained under positive pressure to keep out the slightest hint of any kind of contaminant. It was as sterile as a silicon chip factory.

  The room was dominated by a string of black slate workbenches, then rows and rows of metal shelves with tissue- containing vials of a highly volatile solvent cocktail he had engineered especially for this project, along with a computer network and a huge autoclave and several electron microscopes.

  He walked in and greeted his research team. He'd managed to keep the core group that had been closest to him at Stanford, four people who, he believed, were among the finest medical minds in the country. They were the renowned molecular biologist David Hopkins, Ph.D., the strikingly beautiful and widely published endocrinologist Debra Connolly, M.D., and two younger staffers, a couple who'd met and married at his Stanford lab, Ed and Beth Sparks, both Ph.D.'s who'd done their post-doc under him. They all were here now in the wilds of northern New Jersey because they knew they were making medical history.

  David was waiting, his long shaggy forelock down over his brow as always. But his eyes told it all.

  "Karl, Bartlett's blood work from yesterday just got faxed up from the lab at Princeton. His enzyme level has increased another three point seven percent."

  "Damn." It was happening for sure. "Did you run-"

  "The computer simulation? A one-standard-deviation estimate is that he's going to go critical sometime between seventeen and nineteen days."

  "The Syndrome." Van de Vliet sighed.

  "Just like Kristen."

  "She faked us out. There were no side effects for weeks." Van de Vliet shook his head sadly as he set his handheld Palm computer onto a side table. Later he would transfer all the day’s patient data into the laboratory's server, the Hewlett- Packard they all affectionately called the Mothership. Then he began taking o
ff his white coat.

  "Bartlett looks to be inevitable now." David exhaled in impotent despair. The frustration and the tension were getting to everybody. They all knew what was at stake. "It's in two and a half weeks, give or take."

  What had supposedly been a cosmetic procedure had gone horribly awry. Van de Vliet wondered if it wasn't the ultimate vengeance of the quest for something you shouldn't have.

  "His AB blood type is so rare. If we'd just kept a sample before the procedure, we'd have something to work with now," Van de Vliet said sadly. "We still might be able to culture some antibodies."

  He hadn't told his research team yet about the other possible option-using somebody else as an AB blood-type incubator.

  His last-ditch idea was to find a patient with a blood type of AB positive and introduce a small quantity of the special Beta telomerase enzyme into them. The theory was that this might induce their body to produce compatible antibodies, which could then be extracted and cultured in the laboratory. If a sufficient quantity could be produced they could be injected into Bartlett and hopefully arrest the enzyme's pattern of entering the host's bloodstream and metastasizing into the more complex form that brought on the Syndrome. And if it did work, then there might even be some way to adapt the procedure to Kristen.

  "Karl, if Cambridge Pharmaceuticals finds out about the Beta fiasco, how's it going to affect-"

  "How do youthinkit's going to affect the sale? If this gets out, there'll be no sale. To anybody. Bartlett will be ruined, and Gerex along with him. That's everybody here, in case you're counting." He turned and exited the lab, pushing pensively through the air lock, and then he walked slowly toward his office, collecting his thoughts. He was just passing the elevator when it opened.