Chapter 33: Probiotics (3)
The pancreas secreted a substance called insulin when the sugar level in someone’s blood increased after eating. It circulated the body through the blood vessels and ordered cells to digest the sugar. Then, the cells would absorb the sugar in the blood and blood sugar levels would go down as a result.
In diabetes mellitus, a state of high blood sugar continued because this system was broken. The term diabetes mellitus was derived from Latin, diabetes meaning discharge and mellitus meaning honey sweet, describing the sweet urine produced when the excess sugar in the body is excreted through urine.[1]
Type 1 diabetes was when insulin wasn’t secreted even when blood sugar levels were high, and type 2 diabetes was when insulin was secreted, but certain cells around the body did not listen. It was called insulin resistance. The molecular biology of the cause of insulin resistance was yet to be discovered... Until now.
‘Now I know the reason.’
Rosaline showed Young-Joon. This was related to an immune response.
The immune system was usually soldiers of the body that existed to destroy invading enemies like viruses or bacteria. But they malfunctioned in some people’s bodies. Some of these immune cells had gone crazy and invaded allies like fat tissue, muscles, liver, and even the bone to cut off the insulin signal by holding a knife to the throats of cells in those tissues. This was the cause of type 2 diabetes.
Then how did intestinal microorganisms like Clorotonis or Akkermansia suppress diabetes? It was because they were not human cells, but bacteria; they were the ones that immune cells actually paid attention to. Even if the immune cells were powerful soldiers who created a coup d'etat and forcibly occupied the government, they still had to defend the country if North Korea invaded, right?
Amuc, a biomaterial that Clorotonis released, was an attractant that immune cells went crazy for.[2] Amuc stuck onto immune cells and controlled their activity, ultimately resulting in them no longer attacking random places to stop the insulin signal. Clorotonis could get the immune cells to wake up just by hiding in the mucus layer in the intestines and releasing vesicles containing Amuc. As a result, insulin resistance was cured, and therefore type 2 diabetes as well.
“Frick, is this real...”
Young-Joon had discovered the mechanism of type 2 diabetes, one of the biggest problems in medicine in the twentieth century that no one knew the cause of. He felt like someone had hit him in the head as he had absorbed such a huge amount of shocking knowledge. Now, this wasn’t just a supplement.
It wasn’t that the healthcare industry wasn’t important since it was clear that maintaining the health of a healthy person and preventing diseases was the best plan, but the probiotics that Young-Joon was going to develop could also cure patients on top of that.
Then was this a drug? Not necessarily, since almost all drugs had toxic side effects when taken for a long period of time. As such, it was the rule that the patient took it on a scheduled regimen. However, this probiotic would have no side effects even if a healthy person took it every day; it was like vitamin C.
It was normal for strains of bacteria such as Akkermansia or Clorotonis to exist in a healthy person’s body; the problem was that they disappeared in type 2 diabetes patients. As such, if this was given to a normal person, it would just be excreted since there would be no free space in the intestines for the microorganisms to establish themselves, thus keeping the characteristic of healthcare.
Now, this wasn’t a drug nor was it healthcare. It had an overwhelming level of efficiency that could make all the type 2 diabetes treatments in the market retire, but it was also a natural health booster that would have no side effects whether a patient or a healthy person took it every day.
‘How could something like this be made?’
This was like an invasive species like the Northern snakehead or bass that would destroy the ecosystem of the type 2 diabetes drug market.
Young-Joon called Choi Myung-Joon.
—Yes, Mr. Director!
Choi Myung-Joon answered brightly.
“... I don’t know where you heard it from, but I am not a director yet.
—Hahaha, you will become one soon. I knew long before this that you would succeed, Doctor Ryu. Congratulations, sir!
‘... I can see through this guy so clearly.’
It wasn’t disgusting or anything, but it was funny to see that he changed completely when he was nothing but condescending before Young-Joon created iPSCs.
“Alright. Manager Choi, when do you think we will be able to get the Clorotonis limuvitus that we requested from the University of Madras in India?”
—It will arrive in five days!
Choi Myung-Joon’s voice was filled with energy.
‘Five days?’
Young-Joon was surprised.
The process of importing microorganisms was actually very complicated. They could not just ship it over and receive it. First of all, they had to freeze-dry it or spread it on a solid medium so that the microorganisms did not die during long-term transportation. Then, they had to submit a bunch of documents about what the microorganism was, whether it had gene variations, if it was safe or not, and a lot more to the Korea Research Institute of Bioscience & Biotechnology. They had to submit the certificate of importation, import contract, a transportation plan, a safety plan, a summary of the experiment, its use, invoices, and more.
The time the government took to process these was absolutely disgusting. The microorganisms were not able to come into the country and were stuck in airport storage units until they were approved. And although it was hard to believe, the microorganisms that were locked up for long-term storage sometimes died because they had surpassed their lifespan. That was how long the importing of microorganisms took, but what did Choi Myung-Joon say right now?
“It’s reaching in five days?” Young-Joon asked again.
“What did you do to get it done in five days? You have to report it to the government, right?”
—Yes, that’s right. But we are one of the departments that specializes in microorganisms at A-Gen. We have reported the import of microorganisms to the government departments thousands of times. And nothing was wrong with all of them. I’m saying that we have extraordinary credibility. On top of this, since we conduct our own safety screening, our materials are processed quite quickly. Also, I asked them to prioritize this case in particular.
Choi Myung-Joon went on about the strengths of him and his department. It was like Young-Joon was interviewing him.
“Thank you. Then the processing will be quicker,” Young-Joon said.
—Of course. And since we spent the night writing the documents to report the import and submitted it already, we should be approved around the day after tomorrow. The University of Madras also said that they were going to send it on the earliest flight tomorrow. I will go and get it right away when it arrives at the airport.
“Thank you. Please contact me when it arrives.”
—Of course! I look forward to that!
Choi Myung-Joon shouted. Young-Joon hung up the phone.
Choi Myung-Joon clenched his fists in delight.
“Yes!”
It was quite funny how he was sucking up to when Young-Joon was twenty years his junior in the field, but Young-Joon was one of the few geniuses that existed in human history. It was like he was Bob Ross; Young-Joon did a couple of strokes and created induced pluripotent stem cells. That easy! Young-Joon also created optic nerves with a couple of strokes. That easy![3]
Choi Myung-Joon wondered what Young-Joon would do from now on. He knew that he had to align himself well, so he was determined to show that he was extremely useful. He felt like the first assignment Young-Joon gave to him regarding Clorotonis limuvitus was a success.
Ring!
Choi Myung-Joon’s phone rang again.
“Yes, Mr. Director!” Choi Myung-Joon answered again with an energetic voice.
—There was something that I forgot to mention before. We have to alter the genes of limuvitus when they arrive.
“Alter the genes?”
—Yes. We have to increase the expression of seven genes. Could you take care of that part for me? I will give you detailed instructions for the experiment.
“Oh, of course. I will spend the night perfecting it to your liking if needed!” Choi Myung-Joon replied.
He had gotten his second mission.
* * *
The seeds that Young-Joon planted were ripening and bearing fruit. The very first one he harvested was the new flu drug, which was the first one he commissioned. The cell experiment had been completed a while ago, and now he had the data for the animal experimentation. Cell Bio had sent all their data to Young-Joon, and he had sent all of it to Patent Attorney Lee Hae-Won.
Patent Attorney Lee Hae-Won, who had just finished filing the claim for the patent evaluation, received Young-Joon’s email as she was taking a break and scrolling through Instagram in her office.
[Subject: Regarding the patent application of 122 new animal drugs for pets and livestock]
Lee Hae-Won had received animal experiment data from thirty-one drugs that had been tested first out of the one hundred twenty-two drugs for thirty-four different kinds of diseases.
“No...”
Lee Hae-Won wanted to cry.
‘Doctor, I am too busy... Please...’
Lee Hae-Won was debating whether to close her office because she didn’t have enough work, but now she had too much work. She could hire someone just for the amount of work Young-Joon brought her.
“Phew. I should still do it. Where am I going to get another business partner like this?”
Young-Joon wasn’t rude, the speed at which he produced results was unmatched, and the request documents he filled out were done well as well.
Lee Hae-Won began to write the patent application for the new animal drug.
At the same time, Young-Joon was reading a report on using stem cells in clinical trials.
‘Clinical trials are coming up soon.’
After Young-Joon secured the technology to make iPSCs into optic nerves, the work to start the clinical trials was transferred to the Stem Cells Department. He collaborated with them to obtain tissues from patients and developed them into iPSCs, then optic nerve cells.
The next step was for the hospital. They had sent him a progress report of the clinical trial. Although this project was still a “joint-department project” for the Life Creation Department, the recipient of the Exceptional Performance Award, it was nothing but a formality; the actual director of this project was Young-Joon.
Flap. Flap.
Young-Joon read each page of the report carefully.
In the meantime, A-Gen wrote a clinical trial plan and submitted it for approval to the Ministry of Food and Drug Safety and the Institutional Review Board.
This project was also closely observing this project as well. Since it was the first step of the driver of future medicine, its success would be a great symbol and be rewarded accordingly. The support of the government could increase, which would affect next year’s election. Conversely, the losses would be great if it failed. As such, the Ministry of Food and Drug Safety and the Institutional Review Board examined EyeStem, a stem cell therapy that recovered a patient’s optic nerves, very carefully and approved the trial at last.
Now, this project was handed over to Sunyoo University, the clinical trial investigation institution. This was who A-Gen was working with on this project.
* * *
“Soo-Young, we’re going to be entering the trial now. We asked you this when we harvested your somatic cells, but we’re going to ask one more time,” The employee from the Ministry of Food and Drug Safety said.
“Has the trial investigator explained everything about this clinical trial?”
“Yes.”
The woman who replied was in her thirties and sitting on the hospital bed. Her husband was holding her hand tightly.
“This clinical trial injects optic nerves created from induced pluripotent stem cells into your retina. Do you understand?”
“Your optic nerves may not be repaired, and considering it is stem cell therapy, there is a possibility of getting a tumor. Have you had this part explained to you?”
“Yes.”
“Thank you. So, when you undergo this treatment...”
“Doctor,” Son Soo-Young said. “I could sell my soul if I could see my baby’s face just once.”
She had already lost vision in her left eye due to macular degeneration a long time ago, and now it was time for the right eye. She had problems with this eye ever since she was in high school, and the timing of it was terrible since she was pregnant. Eye pressure usually went down with pregnancy, but it was the opposite for her. The acute glaucoma that happened with the sudden increase in eye pressure was difficult for the doctor to treat as well.
A large amount of glaucoma treatments were harmful to the fetus, and carbonic anhydrase inhibitors could cause deformities in the fetus. None of the drugs proved to be safe in clinical trials, and toxicity was reported in most of the drugs during animal experiments. Son Soo-Young had tried a laser treatment called selective laser trabeculoplasty according to the doctor’s recommendation, but it was not successful. So, the doctor recommended brimonidine; its effects on the fetus hadn’t been confirmed, but it was the safest option.
Son Soo-Young thought about it for a long time: her remaining vision and the baby in her stomach. When she realized she was weighing the two against each other, she refused the doctor’s suggestion after a sense of shame. She was determined that she would not send anything to her fetus that could cause even the littlest bit of harm. Afterward, she fought her disease alone and gave birth to her daughter, but she still hadn’t seen her face; her eyes had lost the light forever.
But the tragedy did not end there. Sometimes, someone’s life could be more tragic than the main character of a soap opera.
This time, it was the baby. She had a condition called persistent pulmonary hypertension of the newborn. The hospital put her in intensive care and treated her by administering one hundred percent oxygen or injecting her with alkaline solutions to correct acidemia in the incubator. Still, she was in a dangerous situation. The doctor told her that the baby would not be able to live long with a dejected voice.
When she heard this news from the postpartum care room, Son Soo-Young cried more than she had in her entire life. Now, her eyes had not only lost light, but she had shed all her tears.
‘It’s because of me. It’s because I thought about it. It’s because I contemplated whether to put in the medicine or not.’
It was a false sense of guilt, but she had to turn the blame onto herself because otherwise, if no one did anything wrong and her daughter left without anyone responsible, the despair would have been too great for her to bear.
Son Soo-Young was broken, her body and mind. She had given up on everything and prepared herself. She was also ready to let her daughter go, but she had one last wish.
She pleaded to the employee, “Please, I just want to be able to see my daughter just once. Doctor, I beg you.”
1. 糖尿 is Dang-Nyo, which is Hanja for diabetes. Dang is Hanja for sweet, and Nyo is Hanja for urine, directly translating to sweet urine, which refers to the excess sugar in the urine of diabetes patients. ?
2. In real life, Amuc is released by Akkermansia muciniphila. ?
3. This is a Korean meme that came from the time Bob Ross went on Korean TV and taught painting. The program was dubbed, and the channel translated “That easy!”, which Ross used as words of encouragement, into “So easy, right?”, making it seem like Ross was painting with a difficult technique and calling it easy. It became a meme that pros use to newbies when showing them something insanely difficult and making it look easy. ?
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