WEBVTT 1 00:00:00.920 --> 00:00:03.879 Welcome. This is Marsha for Radio I, and today I 2 00:00:03.919 --> 00:00:08.240 would be reading National Geographic Magazine dated June twenty twenty five, 3 00:00:08.800 --> 00:00:12.119 which is donated by the publisher as a reminder. RADIOI 4 00:00:12.279 --> 00:00:15.320 is a reading service intended for people who are blind 5 00:00:15.800 --> 00:00:18.359 or have other disabilities that make it difficult to read 6 00:00:18.399 --> 00:00:22.320 printed material. Please join me now for the continuation of 7 00:00:22.359 --> 00:00:26.120 the article I began last time, entitled this Pig Could 8 00:00:26.199 --> 00:00:32.320 Save Your Life by Matthew Cher. The idea was not unprecedented. 9 00:00:32.399 --> 00:00:36.960 For decades, scientists had been transfusing animal blood into or 10 00:00:37.000 --> 00:00:41.399 grafting animal skin onto human patients. The kidney and the 11 00:00:41.520 --> 00:00:46.320 use of immunosuppressants in the human recipients would merely represent 12 00:00:46.439 --> 00:00:50.399 a step up in scale and complexity. A few years later, 13 00:00:51.039 --> 00:00:55.880 Remsma was vindicated when one of his patients survived approximately 14 00:00:55.960 --> 00:00:59.719 nine months with the chimpanzee kidney, a promising feat in 15 00:00:59.759 --> 00:01:02.759 an era when the stakes for patients with failing kidneys 16 00:01:03.159 --> 00:01:05.920 were even higher than they are today. There was no 17 00:01:05.959 --> 00:01:10.120 widespread access to dialysis treatment, and there was no national 18 00:01:10.120 --> 00:01:14.719 donor database for kidney transplants. Euphoria was short lived. In 19 00:01:14.760 --> 00:01:18.680 the nineteen sixties, kidney disease had already reached crisis scale 20 00:01:18.680 --> 00:01:22.760 in the United States, and even if zeno transplantation could 21 00:01:22.799 --> 00:01:28.799 be perfected a big if. Considering twelve of reama's thirteen 22 00:01:28.879 --> 00:01:33.519 patients lasted no more than eight weeks on the chimpanzee organs, 23 00:01:33.799 --> 00:01:37.840 how could scientists possibly secure enough primates A hard to 24 00:01:37.879 --> 00:01:41.719 come by solution simply didn't make sense, says Robert Montgomery, 25 00:01:41.760 --> 00:01:46.719 a transplant specialist at New York University Langone Health and 26 00:01:46.920 --> 00:01:50.760 himself the recipient of a donor heart, he already had 27 00:01:50.799 --> 00:01:54.519 the animal welfare angle. People like Jane Goodall have added 28 00:01:54.560 --> 00:01:57.439 so much to our understanding of how similar we are 29 00:01:57.439 --> 00:02:01.079 to primates, he said. Finally, Montgomery added, there was the 30 00:02:01.200 --> 00:02:04.640 arrival of AIDS, which is believed to have originated in apes. 31 00:02:05.079 --> 00:02:07.879 Having a donor species that is closer to humans on 32 00:02:07.920 --> 00:02:10.960 an evolutionary scale is going to make it easier to 33 00:02:10.960 --> 00:02:13.759 get a good result, Montgomery told me. But by the 34 00:02:13.759 --> 00:02:17.280 same token, it's also easier to pass a pathogen from 35 00:02:17.319 --> 00:02:19.800 a primate to a human than it would be with 36 00:02:19.919 --> 00:02:27.199 another animal, like a pig, say, Despite being notably intelligent creatures, 37 00:02:27.240 --> 00:02:30.080 pigs tend not to be viewed with any particular reverence 38 00:02:30.120 --> 00:02:34.439 by most people eb white, notwithstanding, by one estimate, more 39 00:02:34.479 --> 00:02:37.080 than a billion of the creatures are slaughtered and eaten 40 00:02:37.120 --> 00:02:41.360 by humans every year, and pigs breed with alacrity, typically 41 00:02:41.439 --> 00:02:44.639 twice a year and sometimes three, with litterous averaging eight 42 00:02:44.680 --> 00:02:47.439 to twelve piglets. This is one of the reasons that, 43 00:02:47.520 --> 00:02:51.039 beginning in the nineteen nineties, many researchers in the zeno 44 00:02:51.159 --> 00:02:55.240 field began to gravitate away from primates. But the shift 45 00:02:55.319 --> 00:02:58.919 presented its own unique obstacles, the most vexing of which 46 00:02:59.039 --> 00:03:05.199 was represented by a porcine antigen known as galactose oligos 47 00:03:05.199 --> 00:03:10.400 saccharide or alphagal for short. This antigen, found in pigs, 48 00:03:10.439 --> 00:03:13.280 is not present in the human body, which will attempt 49 00:03:13.319 --> 00:03:16.840 to rid it from the bloodstream by producing antibodies that 50 00:03:16.919 --> 00:03:20.840 bind to the antigen. When this occurs after an organ transplant, 51 00:03:21.159 --> 00:03:24.240 it usually prompts the acute rejection of the donor organ. 52 00:03:24.960 --> 00:03:29.560 Antibiotics and immunosuppressants can help, but not in the long term. 53 00:03:29.800 --> 00:03:34.280 As waves of researchers reluctantly concluded, they realized the need 54 00:03:34.360 --> 00:03:37.919 to remove the alphagal antigen from the pig kidney. A 55 00:03:38.039 --> 00:03:42.120 time consuming process. An efficient solution to this issue was 56 00:03:42.199 --> 00:03:47.280 pioneered in twenty twelve when scientists Emmanuel Charpentier and Jennifer A. 57 00:03:47.560 --> 00:03:52.919 Dudna patented a technology known as Crisper cast nine and 58 00:03:53.080 --> 00:03:56.879 oft used simile likens it to a pair of molecular scissors. 59 00:03:57.639 --> 00:04:01.680 With Crisper, scientists made cuts in humans in human and 60 00:04:01.840 --> 00:04:06.919 animal genetic code, thus replacing disease causing mutations and fundamentally 61 00:04:07.000 --> 00:04:10.479 changing the way genes were expressed in the US and Europe. 62 00:04:10.560 --> 00:04:14.840 Any experimental intervention must pass through two stages before it 63 00:04:14.919 --> 00:04:18.759 is made publicly available. In the preclinical stage, a drug 64 00:04:18.879 --> 00:04:21.720 or surgery is tested in the lab. In the second, 65 00:04:21.839 --> 00:04:26.959 providing the results are acceptable to regulators, research researchers can 66 00:04:27.120 --> 00:04:30.160 move on to humans. In twenty seventeen, a year before 67 00:04:30.240 --> 00:04:34.639 Rick Slayman received a human donor kidney, scientists affiliated with 68 00:04:34.720 --> 00:04:38.720 e Genesis opened a pre clinical trial on several long 69 00:04:38.759 --> 00:04:42.959 tailed macoques that were outfitted with lab modified pig kidneys 70 00:04:43.319 --> 00:04:48.279 informally dubbed knockouts, a nod to the antigens removed via 71 00:04:48.360 --> 00:04:52.399 the gene editing process. One monkey lived nearly three hundred days. 72 00:04:53.000 --> 00:04:55.560 We had a meeting with the FDA, and we basically asked, 73 00:04:55.800 --> 00:04:57.519 what would you need to see in order for us 74 00:04:57.560 --> 00:05:00.839 to move to the next stage? Recalled e e Genesis 75 00:05:00.839 --> 00:05:04.279 CEO Curtis, They gave us a figure of twelve months 76 00:05:04.279 --> 00:05:07.279 survival in a monkey. I was like, well, look, we're 77 00:05:07.319 --> 00:05:10.680 clearly moving in the right direction. But Egenesis was not 78 00:05:10.759 --> 00:05:15.920 alone in its pursuit of FDA approval. Revivicore, a subsidiary 79 00:05:15.959 --> 00:05:20.720 of the biotech firm United Therapeutics, had simultaneously been working 80 00:05:20.759 --> 00:05:24.959 on its own modified porcine kidneys. At a high level, 81 00:05:25.040 --> 00:05:29.199 the engineering methods employed by e Genesis and United Therapeutics, 82 00:05:29.199 --> 00:05:33.600 which is publicly traded and designated as a public benefit corporation, 83 00:05:35.120 --> 00:05:39.600 appear remarkably similar. Scientists at each company start by editing 84 00:05:39.680 --> 00:05:44.759 porcine fetal cells to remove the expression of dangerous antigens, 85 00:05:44.800 --> 00:05:48.360 before cloning the cells via nuclear transfer, a technique that 86 00:05:48.439 --> 00:05:52.879 yields embryos of matching genetic composition. Healthy embryos are then 87 00:05:52.959 --> 00:05:56.879 implanted into female pigs, which give birth to litters of 88 00:05:56.879 --> 00:06:01.720 piglets with identically edited cells. But there the resemblance and 89 00:06:01.759 --> 00:06:06.319 approach end United Therapeutics, for its part, knocks out just 90 00:06:06.399 --> 00:06:09.839 four poresene genes, preferring to utilize a breed of pig 91 00:06:10.199 --> 00:06:14.480 the land race for its fertility and litter size. Conversely, 92 00:06:14.519 --> 00:06:18.639 Egenesis makes sixty different edits to its cells, sixty two 93 00:06:18.759 --> 00:06:23.560 of which are knockouts and even of which and seven 94 00:06:23.600 --> 00:06:26.800 of which are additions from the human genome, and those 95 00:06:26.839 --> 00:06:30.839 cells are different in origin. Egenesis favors relying on the 96 00:06:30.879 --> 00:06:35.160 smaller Eucatan pig breed, whose organs more closely match a 97 00:06:35.240 --> 00:06:38.920 human's in size. In September twenty twenty one, n y 98 00:06:39.079 --> 00:06:44.160 U Langon was granted permission by regulators to transplant a 99 00:06:44.279 --> 00:06:48.879 United Therapeutics edited pig KINDI kidney into a brain dead 100 00:06:49.040 --> 00:06:52.879 human patient. As a brain dead patient is considered legally dead, 101 00:06:53.199 --> 00:06:56.199 the body would be supported by a ventilator during the procedure. 102 00:06:56.759 --> 00:07:00.160 My Gretgomery of n y U Langon was tasked with 103 00:07:00.199 --> 00:07:02.879 carrying out the surgery. I have spent most of my 104 00:07:02.959 --> 00:07:05.759 career trying to increase the number of living organ donors, 105 00:07:06.040 --> 00:07:09.600 Montgomery told me, noting that the annual number of living 106 00:07:09.720 --> 00:07:13.639 human kidney donors has been a flat line for fifteen years, 107 00:07:13.920 --> 00:07:16.879 hovering at six thousand. It was hard not to see 108 00:07:16.920 --> 00:07:20.360 the transplant as a breakthrough. You could sense the enthusiasm. 109 00:07:20.519 --> 00:07:23.879 I felt it too. In October of twenty twenty one, 110 00:07:24.120 --> 00:07:27.720 n Yu Langong went public with the news the Zeno 111 00:07:27.839 --> 00:07:31.319 transplanted kidney had been attached by a network of blood 112 00:07:31.399 --> 00:07:34.639 vessels to the patient's upper leg, where it started to 113 00:07:34.680 --> 00:07:39.040 function immediately creating urine for nearly three days. Just one 114 00:07:39.079 --> 00:07:43.399 major step remained a test on a living patient. Within 115 00:07:43.439 --> 00:07:48.759 hours of Slayman's final informed consent meeting at Winfried William's office, 116 00:07:49.120 --> 00:07:53.360 ears began turning at the Genesis Farming facility. As Bjorn 117 00:07:53.439 --> 00:07:56.600 Petersen watched. The small pig was loaded into the van, 118 00:07:57.040 --> 00:08:00.319 which raced down the road and onto the freeway, douing 119 00:08:00.319 --> 00:08:04.000 cross country journey was a whole logistical dance, Mike Curtiz 120 00:08:04.040 --> 00:08:07.040 told me. Traveling east through the night, the pig reached 121 00:08:07.040 --> 00:08:11.439 a veterinary center in western Massachusetts. There, both its kidneys 122 00:08:11.439 --> 00:08:16.639 were removed by Slayman's surgical team, with euthanasia administered post 123 00:08:16.959 --> 00:08:21.639 pre procedurement. By noon, the organs were packed into a 124 00:08:21.879 --> 00:08:24.800 refrigerated box and placed in the back of a different truck, 125 00:08:25.120 --> 00:08:29.519 who did this time toward Boston. At mass General. Slayman, 126 00:08:29.600 --> 00:08:33.600 who had already been prescribed a strong course of immunosuppressants, 127 00:08:33.960 --> 00:08:36.799 was put under and prepped for surgery while his family 128 00:08:36.840 --> 00:08:39.639 waited anxiously in the waiting area. At one p m. 129 00:08:39.720 --> 00:08:44.960 On March sixteenth, the procedure commenced. From his position in 130 00:08:44.960 --> 00:08:49.360 the operating theater, Williams watched his colleague's Leonardo Riella, Mass 131 00:08:49.360 --> 00:08:54.279 General's medical director of kidney transplantation, Tatsuo Kowai, who had 132 00:08:54.279 --> 00:08:58.840 performed Slayman's original kidney transplant years earlier, had and had 133 00:08:58.879 --> 00:09:04.120 worked with Riella to coordinate the FDA approvals, and Nahel Elias, 134 00:09:04.320 --> 00:09:08.679 surgical director of kidney Transplantation, carried out the procedure. They 135 00:09:08.679 --> 00:09:11.679 all knew the difficulties that Slayman's long struggle with kidney 136 00:09:11.720 --> 00:09:16.519 disease and hypertension would present. His whole vascular anatomy had changed. 137 00:09:16.639 --> 00:09:21.480 Williams said, he had very calcified, very hardened vessels, and 138 00:09:21.559 --> 00:09:24.720 you can't just crack open calcified vessels and make them work. 139 00:09:25.200 --> 00:09:29.320 You've got to find the right anatomic distribution. Plus you 140 00:09:29.399 --> 00:09:31.799 need to remember that mister Slayman was a big guy, 141 00:09:32.200 --> 00:09:34.600 and the vessels that were available for attachment to the 142 00:09:34.639 --> 00:09:38.519 donor kidney were sort of deep within his abdominal cavity. 143 00:09:39.039 --> 00:09:41.279 In the days leading up to the operation, p. S. 144 00:09:41.279 --> 00:09:44.879 Slayman reminded to Haarrish herself how confident her father had 145 00:09:44.919 --> 00:09:47.879 been that the surgery would be a success. When she 146 00:09:48.000 --> 00:09:50.759 entered the recovery sweep that evening, she took her father 147 00:09:50.840 --> 00:09:54.120 by the hand and wept with relief. Although he grasped 148 00:09:54.120 --> 00:09:57.200 the history making meaning of the procedure and the interest 149 00:09:57.240 --> 00:10:00.919 it would inspire in reporters, Slayman told her hospital staff 150 00:10:01.120 --> 00:10:04.279 he'd prefer to stay out at the limelight. Gamely, he 151 00:10:04.320 --> 00:10:06.759 agreed to pose for a few photos with his family 152 00:10:07.080 --> 00:10:09.840 before returning to the house that he shared with his fiancee, 153 00:10:10.360 --> 00:10:14.360 Farren Woolery. Following week was hard. Within a few days 154 00:10:14.360 --> 00:10:17.519 of the surgery, Slayman was diagnosed with symptoms of acute 155 00:10:17.600 --> 00:10:21.480 rejection and treated with what Williams described as the same 156 00:10:21.559 --> 00:10:25.159 anti rejection medication we would use in a garden variety 157 00:10:25.240 --> 00:10:29.679 human transplant. The treatment was effective, but fifty one days 158 00:10:29.720 --> 00:10:33.480 post transplant, Slayman returned once more for an appointment with 159 00:10:33.600 --> 00:10:37.519 Kawai and Riella. The doctors noticed signs of volume depletion. 160 00:10:38.000 --> 00:10:40.919 He was losing more nutrients and fluids than he was 161 00:10:40.960 --> 00:10:43.639 taking in. Sleiman was hooked up to an ivy to 162 00:10:43.720 --> 00:10:47.039 boost fluid volume. Williams told me, and he had a 163 00:10:47.080 --> 00:10:51.159 magnesium infusion to address some low levels. That same day, 164 00:10:51.240 --> 00:10:55.639 Slayman and Woolery left mass Gen General and picked up 165 00:10:55.639 --> 00:10:58.639 groceries near their home in the Massachusetts town of Weymouth. 166 00:10:59.159 --> 00:11:02.879 They made stops two stores. Slayman accompanied his fiancee into 167 00:11:02.879 --> 00:11:05.240 the first one, but begged off when it came to 168 00:11:05.320 --> 00:11:07.879 the second. He didn't feel up to it, he told Woolery. 169 00:11:08.480 --> 00:11:11.559 That night, after eating dinner and watching television together, the 170 00:11:11.600 --> 00:11:14.720 couple went to lie down in the bedroom. Woolery noticed 171 00:11:14.759 --> 00:11:18.639 Slayman's breathing had grown labored and shallow around eleven thirty 172 00:11:18.639 --> 00:11:22.919 p m. Around midnight, Slaman went into cardiac arrest. Woolery 173 00:11:22.960 --> 00:11:25.879 called nine one one, then dialed Williams, who told the 174 00:11:25.919 --> 00:11:28.919 empty crew by phone to take Slayman to the nearest 175 00:11:28.919 --> 00:11:32.600 a muge emergency room. Williams rushed to meet them at 176 00:11:32.639 --> 00:11:36.159 South Shore Hospital in Weymouth, but their combined efforts as 177 00:11:36.320 --> 00:11:39.679 at resuscitation came up short. Slaman passed away in the 178 00:11:39.720 --> 00:11:43.000 early morning of May eleventh, at the age of sixty two. 179 00:11:43.120 --> 00:11:45.720 In the hours after Slamon's death, his family huddled with 180 00:11:45.799 --> 00:11:49.759 Williams at South Shore for a debriefing. Sliman's brother and 181 00:11:49.799 --> 00:11:53.200 fiancee were on hand. Williams explained that it was critical 182 00:11:53.240 --> 00:11:56.639 to understand what had happened to Slayman, giving his relatively 183 00:11:56.720 --> 00:12:00.240 healthy status earlier in the day. After making a call 184 00:12:00.320 --> 00:12:03.399 to Slayman's mother, the family granted permission for an autopsy. 185 00:12:04.120 --> 00:12:07.320 The results, which were published earlier this year, revealed that 186 00:12:07.360 --> 00:12:10.600 the issue had been Slayman's heart, not the kidney. What 187 00:12:10.679 --> 00:12:13.080 we think happened, william said, is that because of his 188 00:12:13.200 --> 00:12:18.080 severe cardiac disease, he had a rhythmia, and he suffered 189 00:12:18.159 --> 00:12:21.440 an a rhythmic event that led to his death. The 190 00:12:21.480 --> 00:12:23.960 tissue of the kidney was healthy, and although there was 191 00:12:24.080 --> 00:12:28.320 residual evidence of the initial rejection symptoms, there was no 192 00:12:28.440 --> 00:12:31.159 acute kidney failure that would have been caused for mister 193 00:12:31.200 --> 00:12:36.080 Slayman's demise. Williams said, bottom line is that the xenograph 194 00:12:36.600 --> 00:12:40.200 was functioning reasonably well. It could be difficult to see 195 00:12:40.200 --> 00:12:42.720 it that way, of course, given that recipients of a 196 00:12:42.799 --> 00:12:46.120 kidney from a diseased human donor can live twelve years, 197 00:12:46.440 --> 00:12:49.039 and recipients of an organ from a living donor up 198 00:12:49.039 --> 00:12:52.679 to two decades. Slayman managed less than two months with 199 00:12:52.759 --> 00:12:56.600 a handful of medical interventions in between, and Lisa Paisano, 200 00:12:56.720 --> 00:13:00.080 who in April twenty twenty four became the second living 201 00:13:00.159 --> 00:13:04.559 patient to receive a modified pig kidney hers from United Therapeutics, 202 00:13:04.879 --> 00:13:08.679 passed away three months after her transplant due to heart issues. 203 00:13:09.039 --> 00:13:13.440 But Montgomery, who led Pizzano's surgery team, offered a useful 204 00:13:13.480 --> 00:13:17.000 reminder patients on the edge of dying already. Patients were 205 00:13:17.039 --> 00:13:20.639 trying to rescue with a brand new technology we're still refining. 206 00:13:21.080 --> 00:13:23.519 Are just not good indicators of how the science will 207 00:13:23.559 --> 00:13:26.840 faire in the long term, Montgomery said, we kind of 208 00:13:26.879 --> 00:13:30.480 set ourselves up with the most difficult scenario. Several days 209 00:13:30.519 --> 00:13:34.240 after Slayman's passing, William's recalt he received an invitation to 210 00:13:34.279 --> 00:13:38.679 speak at his funeral, held at a Baptist church in Milton, Massachusetts. 211 00:13:39.120 --> 00:13:41.679 He wasn't sure how he would be greeted. His mind 212 00:13:41.759 --> 00:13:45.279 traced back to the lingering legacy of the Tuskegee experiments. 213 00:13:45.679 --> 00:13:48.360 When you walk into this kind of congregation, you never 214 00:13:48.440 --> 00:13:50.360 know how you're going to be received, he told me, 215 00:13:50.919 --> 00:13:54.279 because there may be this suspicion, even if it's unspoken, 216 00:13:54.639 --> 00:13:57.720 that they experimented on this individual, like this is what 217 00:13:57.799 --> 00:14:01.399 they do to black people. The church, Williams was joined 218 00:14:01.399 --> 00:14:04.840 by Slayman's entire medical team, and he began his remarks 219 00:14:04.879 --> 00:14:09.960 by introducing Kowai. Immediately, William's fears about his reception vanished. 220 00:14:10.240 --> 00:14:13.639 Before I finished speaking his full name. The entire congregation 221 00:14:13.759 --> 00:14:16.399 gets up and gives us a standing ovation. It was 222 00:14:16.480 --> 00:14:19.840 just unbelievable, the energy. Recounting to me what he told 223 00:14:19.840 --> 00:14:23.159 the pack church, Williams held back his tears. I said, 224 00:14:23.200 --> 00:14:25.600 he'll go down in the pantheon of medical history, he 225 00:14:25.679 --> 00:14:28.080 told me. I wanted them to understand that he had 226 00:14:28.080 --> 00:14:31.679 provided new hope for patients everywhere. In the wake of 227 00:14:31.720 --> 00:14:36.440 Slayman and Pizzano's operations, e Genesis and United Therapeutics, along 228 00:14:36.440 --> 00:14:40.720 with hospitals around the country, fielded a torrent of inquiries 229 00:14:40.759 --> 00:14:42.879 from patients who had spent years on a list for 230 00:14:42.919 --> 00:14:46.519 a human donor kidney. It didn't matter that FDA regulators 231 00:14:46.519 --> 00:14:51.159 were still only authorizing expanded access trials. News of the 232 00:14:51.200 --> 00:14:54.919 transplants had opened the floodgates. People were asking why not me? 233 00:14:55.120 --> 00:14:58.679 Curtis recalled, my health is already declining, why should I 234 00:14:58.720 --> 00:15:01.799 have to wait? Notice, for his part, could only respond 235 00:15:01.840 --> 00:15:04.960 with the truth, Egenesis was working as hard as possible 236 00:15:05.240 --> 00:15:08.200 to get the technology to more patience. I'd say, we 237 00:15:08.279 --> 00:15:10.399 want the same thing, but we want to do this right, 238 00:15:10.519 --> 00:15:13.639 he told me, and doing it right would require approval 239 00:15:13.720 --> 00:15:17.039 for trials on healthier patients. He went on, patients like 240 00:15:17.080 --> 00:15:21.440 Tim Andrews, a former supermarket manager from Concord, New Hampshire. 241 00:15:21.759 --> 00:15:26.039 Andrew Drew's sixty seven, had for two years undergone thrice 242 00:15:26.200 --> 00:15:30.080 weekly dialysis, a process that often took six hours, including 243 00:15:30.120 --> 00:15:33.039 travel in prep time, and left him exhausted and weak. 244 00:15:33.360 --> 00:15:36.120 When I spoke with him about the difficulty of dialysis, 245 00:15:36.200 --> 00:15:39.080 he recalled his appetite disappearing as he dealt with near 246 00:15:39.120 --> 00:15:42.600 constant nausea. He began to stare at the likely reality 247 00:15:42.639 --> 00:15:45.639 of never receiving a human organ and of repeating this 248 00:15:45.720 --> 00:15:49.200 emotionally draining routine for the rest of his life, as 249 00:15:49.240 --> 00:15:51.480 had been the case for Slayman. It was a daunting 250 00:15:51.559 --> 00:15:55.200 thing to try to accept. But last August Andrews was 251 00:15:55.240 --> 00:16:01.159 offered the opportunity to undergo Xeno transplantsy at Mass General 252 00:16:01.480 --> 00:16:04.799 as part of a new three patient FDA approved trial 253 00:16:05.200 --> 00:16:08.600 launched by Egenesis. If he agreed, he'd have the chance 254 00:16:08.679 --> 00:16:11.039 to start over, to have, as he put it, a 255 00:16:11.080 --> 00:16:14.360 second chance. His family was leary. His sister and nurse 256 00:16:14.399 --> 00:16:17.879 warned him about the risks, but he was adamant. This 257 00:16:18.039 --> 00:16:19.759 is not how I want to go out. I want 258 00:16:19.759 --> 00:16:23.200 to do something, Andrews recalls saying, and I knew that 259 00:16:23.279 --> 00:16:25.320 I might die right off, and I said to my 260 00:16:25.360 --> 00:16:28.000 wife and to the Mass General team. If I die 261 00:16:28.000 --> 00:16:30.559 and you learn something, so be it. And if I don't, 262 00:16:30.600 --> 00:16:32.840 then I get to give people hope. That's what I 263 00:16:32.919 --> 00:16:37.960 really wanted. In January, Andrews underwent his transplant, with Kawai 264 00:16:38.159 --> 00:16:41.279 leading the surgery team. Once more, Andrews walked out of 265 00:16:41.279 --> 00:16:45.200 the hospital, beaming, wife Karen at his side. Nothing was certain, 266 00:16:45.240 --> 00:16:47.919 he knew still he had what he'd hoped, a new 267 00:16:48.000 --> 00:16:50.879 lease on life. Every day, he said, is a new day. 268 00:16:51.799 --> 00:16:55.039 When we spoke in March, Andrew's recovery was progressing as planned. 269 00:16:55.399 --> 00:16:58.360 He goes to Planet Fitness twice a week regularly takes 270 00:16:58.399 --> 00:17:01.279 his nine year old German short hair pointer on walks 271 00:17:01.639 --> 00:17:04.839 and helps his wife around the house by vacuuming. If 272 00:17:04.880 --> 00:17:07.200 all continues to go well, he said, next year the 273 00:17:07.240 --> 00:17:10.240 couple will board a plane and visit her relatives in 274 00:17:10.359 --> 00:17:14.920 northern Italy. With his energy returning, Andrews is also trying 275 00:17:14.920 --> 00:17:17.319 to serve as inspiration for the tens of thousands of 276 00:17:17.359 --> 00:17:22.359 people affected by the organ donation crisis. Every Wednesday night, 277 00:17:22.440 --> 00:17:25.480 he meets online with a support group for transplant patients. 278 00:17:25.960 --> 00:17:28.400 They encourage one another on their journeys, and of course 279 00:17:28.720 --> 00:17:31.640 they ask about his poor seeing kidney. I want to 280 00:17:31.680 --> 00:17:34.920 give that hope to everybody else that's on dialysis or 281 00:17:35.119 --> 00:17:38.759 is struggling with kidney disease, he said. This an escape 282 00:17:38.759 --> 00:17:44.079 from dialysis. A whole body reinvigoration is the future for Andrews, 283 00:17:44.119 --> 00:17:47.519 but potentially for dozens of people in the coming years, 284 00:17:47.920 --> 00:17:50.720 should the clinical trials expand to a field of fifty 285 00:17:50.759 --> 00:17:54.559 patients as planned, and both Andrews and Curtis recognize none 286 00:17:54.599 --> 00:17:58.240 of it would be possible without Sleiman and Pizzano, who 287 00:17:58.279 --> 00:18:01.960 proved that the potential of genetic modified kidneys was more 288 00:18:02.000 --> 00:18:05.960 than hypothetical in a real solution worth pursuing to get here. 289 00:18:06.000 --> 00:18:08.519 We owe so much to brave people like mister Slayman, 290 00:18:08.920 --> 00:18:12.240 and to all scientists on whose shoulders we stand. Kurtis 291 00:18:12.319 --> 00:18:14.839 told me, we have been fortunate to enter the field 292 00:18:14.920 --> 00:18:18.200 when we have because we're able to leverage decades of 293 00:18:18.240 --> 00:18:21.880 progress and research and integrate it all into making this 294 00:18:21.920 --> 00:18:24.680 thing a reality. You have to kind of pinch yourself, 295 00:18:24.839 --> 00:18:28.799 but here we are proud to design a life saving kidney. 296 00:18:29.200 --> 00:18:31.799 Placing a pig's kidney inside a human patient is more 297 00:18:31.799 --> 00:18:35.160 complicated than merely swapping one organ for another. For the 298 00:18:35.160 --> 00:18:40.559 biotechnology company, e genesis process begins by genetically modifying the 299 00:18:40.599 --> 00:18:44.039 embryo of a Yucatan pig so or grow kidneys that 300 00:18:44.200 --> 00:18:47.480 will be accepted by the human body. Here's how it's done. 301 00:18:48.000 --> 00:18:51.440 One evaluate a tissue sample. A specimen from the ear 302 00:18:51.519 --> 00:18:55.119 of a Yucatan pig is carefully reviewed or sequenced to 303 00:18:55.279 --> 00:18:57.920 ensure there are no issues that will interfere with the 304 00:18:58.000 --> 00:19:03.400 gene editing process. Two delete problematic pig genes using the 305 00:19:03.480 --> 00:19:08.200 gene editing technology Crisper. E Genesis scientists must alter the 306 00:19:08.400 --> 00:19:11.519 tissue sample to prevent the spread of viral disease. And 307 00:19:11.559 --> 00:19:16.599 potential organ rejection. This means removing four pig specific genes 308 00:19:17.319 --> 00:19:21.519 three make it more human. Scientists then insert seven human 309 00:19:21.559 --> 00:19:24.759 genes into the sample's DNA that will protect the future 310 00:19:24.839 --> 00:19:29.359 kidney from inflammation, cell damage, and coagulation, and also trick 311 00:19:29.440 --> 00:19:35.680 the human immune system into accepting the foreign organ. Four 312 00:19:35.960 --> 00:19:39.799 insert the modified DNA. The edited DNA is then fused 313 00:19:40.119 --> 00:19:43.839 with a nuclei of fetal pig cells. Scientists implant these 314 00:19:43.920 --> 00:19:47.160 developing embryos into a sow that will give birth to 315 00:19:47.200 --> 00:19:52.759 piglets capable of growing human ready kidneys. Five, harvest the 316 00:19:52.880 --> 00:19:56.680 organ and transplant into patient. Whence the piglets reach maturity, 317 00:19:57.079 --> 00:20:01.119 their kidneys can be harvested and prepared for transplant. After surgery, 318 00:20:01.160 --> 00:20:07.079 patients must still take immunosuppressive drugs to prevent human organ rejection. 319 00:20:08.200 --> 00:20:12.680 Beyond kidneys, pigs are ideal candidates for xeno transplantation because 320 00:20:12.720 --> 00:20:15.279 their organs are similar in size to ours and have 321 00:20:15.359 --> 00:20:18.680 a similar anatomy and function. Research is under way to 322 00:20:18.759 --> 00:20:22.160 determine which body parts from pigs could be most useful 323 00:20:22.279 --> 00:20:26.359 to humans a kidney crisis. More people than ever need 324 00:20:26.400 --> 00:20:29.480 a kidney transplant, but in twenty twenty four is thirty 325 00:20:29.480 --> 00:20:32.720 percent of patients on the waiting list received one. Doctors 326 00:20:32.759 --> 00:20:37.000 hope Zeno transplantation could soon address that unmet need for 327 00:20:37.119 --> 00:20:40.880 more kidneys and endless weight. Patients who are able to 328 00:20:40.920 --> 00:20:44.039 immediately receive a kidney from a human donor are often 329 00:20:44.079 --> 00:20:47.960 required to go through painful and tiring dialysis treatments to 330 00:20:48.000 --> 00:20:53.640 stay alive. Next article Oases on the Brink by Tristan 331 00:20:53.720 --> 00:20:57.079 mc connell. Across the world, hundreds of millions of people 332 00:20:57.079 --> 00:21:00.839 have relied for centuries on desert wetlands that are now vanishing. 333 00:21:01.240 --> 00:21:04.839 In southern Morocca, one community is blending ancient knowledge with 334 00:21:05.000 --> 00:21:09.480 modern innovation to protect the oasis. Driving south out of 335 00:21:09.480 --> 00:21:13.680 the Atlas Mountains into Morocco's Draw Valley, travelers find that 336 00:21:13.720 --> 00:21:17.680 the landscape becomes increasingly stark until the paved National Highway 337 00:21:17.759 --> 00:21:21.759 vanishes into the desert. At the oasis town of Mohammed 338 00:21:22.079 --> 00:21:26.480 el Ghislane, the sometimes known as the gateway to the Sahara, 339 00:21:26.759 --> 00:21:30.240 Ahmed and its surrounding villages are home to about sixty 340 00:21:30.279 --> 00:21:34.640 one hundred people for generations. The settlement has straddled the 341 00:21:34.759 --> 00:21:38.559 Dara River, with wispy tamarisk trees lining the road on 342 00:21:38.640 --> 00:21:41.960 the north bank of the river and palm plantations spreading 343 00:21:41.960 --> 00:21:45.240 out to the south. But today the concrete bridge built 344 00:21:45.279 --> 00:21:47.720 to span the water rises over a dry riverbed of 345 00:21:47.759 --> 00:21:52.079 sand and gravel. Tourists still come to Mohamed, drawn to 346 00:21:52.200 --> 00:21:55.440 camel tracks, camping and sand boarding. They arrive by the 347 00:21:55.480 --> 00:21:57.519 bus load and make their way to hotels that offer 348 00:21:57.559 --> 00:22:02.319 swimming pools and massages. A leam spy, fifty five tall 349 00:22:02.359 --> 00:22:05.519 and bespectacled with dark gray flecked hair, was borne in 350 00:22:05.559 --> 00:22:08.119 the town like a lot of residence. He remembers a 351 00:22:08.119 --> 00:22:11.720 different Mohmet, greener lusher. When he was a kid, he 352 00:22:11.759 --> 00:22:14.720 herd a live stock beneath the dense shade of thick 353 00:22:14.799 --> 00:22:18.759 groves of palm trees and fished in the draw, Morocco's 354 00:22:18.759 --> 00:22:22.039 longest river as it wound lazily through town. In the 355 00:22:22.079 --> 00:22:24.799 decades since, he has watched the oasis shrivel as the 356 00:22:24.920 --> 00:22:27.720 rain has all but stopped and the river has dried up. 357 00:22:28.119 --> 00:22:30.759 The thick forests of dap palms have withered and thinned, 358 00:22:31.039 --> 00:22:33.519 and the fields of fruit and olive trees have produced 359 00:22:33.599 --> 00:22:36.640 less and less each year. Most young people have escaped 360 00:22:36.680 --> 00:22:39.920 for a better life elsewhere, leaving houses in entire neighborhoods 361 00:22:39.960 --> 00:22:44.519 to be swallowed by the encrossed croaching dunes. When there 362 00:22:44.559 --> 00:22:47.400 is no water, nothing green, the sand becomes very strong, 363 00:22:47.680 --> 00:22:50.799 a very fast enemy, says Spy. It takes a lot 364 00:22:50.799 --> 00:22:53.400 of land. The desert is pressing in from every direction. 365 00:22:53.920 --> 00:22:58.039 According to Spy, the outer edge of the oasis moves 366 00:22:58.119 --> 00:23:00.400 inward by more than three hundred feet eet each year. 367 00:23:00.839 --> 00:23:04.160 Sometimes Sabai worries that he might be witnessing the end 368 00:23:04.240 --> 00:23:07.799 of the oasis altogether, and with it an ancient ecosystem 369 00:23:08.160 --> 00:23:11.559 and the nomadic culture and traditions it enables that he 370 00:23:11.680 --> 00:23:14.759 holds deer. For thousands of years, people have lived and 371 00:23:14.839 --> 00:23:20.000 thried in oayses, developing a complex agricultural system finely calibrated 372 00:23:20.039 --> 00:23:23.279 to the harsh desert environment with its water scarcity and 373 00:23:23.359 --> 00:23:29.119 ecological fragility. By some measurements, owases occupied seven hundred forty 374 00:23:29.160 --> 00:23:32.599 thousand square miles worldwide, roughly three times the area of 375 00:23:32.640 --> 00:23:37.799 Texas and in North Africa, and Asians sustain an estimated 376 00:23:37.799 --> 00:23:42.440 one hundred fifty million pupil. In Morocco, oases are home 377 00:23:42.519 --> 00:23:46.160 to one million pupil. The stresses of contemporary climate change 378 00:23:46.359 --> 00:23:52.160 are accelerating with increasing aridity, temperatures, and the desertification, as 379 00:23:52.200 --> 00:23:56.240 well as destructive floods and wildfires. Yet, Sabai is an 380 00:23:56.240 --> 00:23:59.920 optimist steeped in nomadic culture, and he believes that owaysies 381 00:24:00.119 --> 00:24:04.119 contain the seeds of their own salvation. What is an 382 00:24:04.119 --> 00:24:08.799 oasis an imagined place, a mythical one, an isolated palm 383 00:24:08.920 --> 00:24:12.680 fringed pool in the desert, a place of safety, somewhere 384 00:24:13.000 --> 00:24:16.400 desperate travelers might find relief or dismay if the oasis 385 00:24:16.440 --> 00:24:19.519 turns out to be a mirage. Ecologically, it is simply 386 00:24:19.599 --> 00:24:22.359 an area made fertile by a water source in an 387 00:24:22.359 --> 00:24:26.720 otherwise harsh and arid environment. But human ingenuity has transformed 388 00:24:26.720 --> 00:24:32.039 oases into complex civilizations. Ten thousand years ago, northern Africa 389 00:24:32.160 --> 00:24:36.200 was hammered by strong monsoon rains and the Sahara was burdened. 390 00:24:36.599 --> 00:24:39.400 With the climate gradually shifted and the grasslands and rivers 391 00:24:39.480 --> 00:24:43.640 dried up. In the newly unforgiving desert landscape. Water was scarce. 392 00:24:44.160 --> 00:24:47.119 Where people found it, they exploited it and created pockets 393 00:24:47.160 --> 00:24:50.319 of habitable land that made life not just possible, with 394 00:24:50.440 --> 00:24:56.359 prosterus providing homes and livelihoods to many thousands. Radiocarbon dated 395 00:24:56.440 --> 00:24:59.720 barley and wheat grains, as well as millstones used to 396 00:24:59.720 --> 00:25:03.319 grind flower show that oases were already developing in the 397 00:25:03.400 --> 00:25:08.039 Draw Valley during the fifth century. As oasis grew, so 398 00:25:08.200 --> 00:25:12.160 too did Saharan trade. Date palms. The hallmark species of 399 00:25:12.200 --> 00:25:15.720 the oasis are drought and heat resistant and grow steadily 400 00:25:15.720 --> 00:25:18.759 in the desert wherever there's water close to the surface, 401 00:25:19.119 --> 00:25:22.279