Return of Alpha Gal

Introduction

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Summer and Ticks

0:51Hello, it's Lulu. It's summer here in the Northern Hemisphere, which means the ticks. The ticks are out. And also the barbecues are out. You know, hot dogs, hamburgers, ticks, and burning meat, which made me think of today's episode, which combines the two into a wildly eerie, scary, but perhaps hopeful, ethically complex tale. It's one of my all-time favorite Radiolabs, and we're going to play it for you today.

1:22It is 10 years old, but lucky for you, it has a pretty thrilling scientific update at the end. So here we go. Wait, you're listening. Okay. All right. Okay.

Radiolab Introduction

1:34All right.

Radiolab Introduction

1:35You're listening to Radiolab. Radiolab. From WNYC. See? See? Yeah.

1:44Rewind.

1:50Good.

1:54Okay. Is your mic on? Yeah. I'm getting, it's making me nervous. Maybe I should get my EpiPen. Are you allergic to radio greatness? Not that I know of. I haven't been really exposed to it yet. Anyway, let's go. Are we rolling? We're good? We're going? We are rolling. Okay.

2:15I'm Robert Krolwich.

Amy's Story

2:16This is Radiolab. And today we're going to begin with a conversation between Dan Pashman. Okay. Host of a podcast here at WNYC called The Sporkful. It's about food. And Amy Pearl. Amy. Yes. A digital producer here at the station who likes food. And the conversation they had was about something that happened to Amy, which she never expected, certainly didn't want, and yet it could happen to any of us at any time. So, years ago before any of this happened to you, just tell me, what was your relationship

2:46with meat? My relationship with meat? Yeah. Well, you know how when you're little and your mom is like, you can have any special dinner for your birthday? My dinner was meatballs. And she was like, except meatballs, they're so hard to make. So, it was pot roast.

3:05And then Peter Luger, you know what Peter Luger is? Famous steakhouse in Brooklyn. Yeah. I used to go there quite often and I live there and I have a Peter Luger credit card. Are those hard to get? You know, I don't know how they give them out, but nobody seems to have one. I don't think they give them out anymore. But I mean, I was very into Peter Luger. I was living in Williamsburg and it just, it opened at like one o'clock every day and you could just walk in at one. They had an amazing bar. There was no tablecloths on the table.

3:35These old German waiters, they bring out your porterhouse for three. They put a little plate upside down and then put the big platter on top of it so it's tilted and all the juice runs to the end. And then they like have this special double spoon thing that they somehow like scoop juice onto your steak and oh, so good. And also like the smell of burning fat from a hamburger. What about hot dogs? Oh my God, I love hot dogs so much. When you bite into them and they're like clack and have like a snap and like having a weenie

4:10roast out in the open air is just, it's like the, oh God, it's so good. Anyway, I, I was always very into meat. What changed? Oh my God, it was terrible.

Terrible Experience

4:23It was, what happened was I was having this beautiful, it was springtime. I was having a beautiful leg of lamb with some neighbors and we like put it on the grill and it was just a delicious, beautiful dinner. And I had served with it some ramps that I foraged in my mom's yard. A ramp, by the way, is just a wild onion. And so, so we had this delicious meal and then, you know, I went home and I was going to sleep at like midnight, like a few hours later and I just felt weird.

4:55I was like, God, something's wrong. I feel like really anxious, like something's wrong with me. And I went in the bathroom and I like look in the mirror and my face was like all weird looking. And I was like, I kept laying down and be like, I'll just sleep it off, whatever it is. But every time I lay down, I felt like I was going to faint. So I was like, prop myself up and I was like, oh God, I'm having terrible like stomach cramps and just like a weird feeling of impending doom, you know, but just like anybody, I'm just like, just get a good night's sleep. This will pass. I like splash a little water on my face.

5:26I mean, I don't know what made me think this, but I thought like maybe a snail, a tiny snail was on one of the ramps that I ate and it was like poisoning me somehow. You know, snails, I mean, they probably poison us.

5:42So I called my friends in the morning. I was like, hey, how you guys doing? How was dinner? And they were like, oh, so great. And I was like, really? So great? Nothing weird? No horrific panic attacks? They were like, oh, that was so lovely. Thank you so much. Let's do it again. And I was like, wow, I really had a rough night. But I didn't think anything of it and I went on with my life, you know, just like whatever. And then about a week or two later, I made some cheeseburgers and I ate a cheeseburger and

6:14I was watching Goodbye, Mr. Chips, really tear jerking movie and a good book too. And about a couple of hours after I ate, I was like started to feel really weird. Again, I was like feeling like I was like had to stand up. I was like, I think I'm going to faint. I feel really lightheaded. I can't catch my breath. I feel like really woozy. But if any time I lay down, I really felt like I was going to faint. So I was like trying to stay sitting upright. And I was like, oh, my God, this is very similar. I ran into the bathroom and I was like looking in the mirror.

6:47And lo and behold, I had hives all over my stomach. And then they started coming out of my hands. And I was like, oh, my God, something's happening. And at one point I did get up and unlock my door because I did feel like I'm going to pass out, call an ambulance, and then they're not going to be able to get in. So, I mean, I was in a little bit afraid of what was happening.

Researching Allergy

7:06And when I woke up in the morning, the first thing I did was Google sudden meat allergy because I was like, this seems like an allergy. And the only thing that was the same was meat. And I'm going through and like the second thing that came up was this article that was like Florida man has sudden meat allergy. I was like, oh, my God, I think is it possible I could have this? And so I made an appointment with my doctor. I brought in the article. I'm like, I'm going to be this person, but I can do it. I had the article in my pocket. What person? You know, the person who goes to their doctor was something I found on the Internet.

7:39So I brought the article. It was in my pocket. And, like, I got through the whole, like, checkup, and I was too chicken. I went, when I was paying the receptionist, I pulled it out and gave it to the receptionist. And I was like, could you give this to the doctor? So that was, like, the best I could do. And then I did call my doctor and had a conversation with him on the phone asking him if I could get tested. And he was like, no, there's no such thing as a meat allergy, blah, blah, blah. So some people think allergies are just, like, in your head.

Science Writer Peter Smith

8:13This is science writer Peter Smith. We got in touch with him after we heard Amy's story because Peter is an investigator of many things, including strange allergies. And people are like, mushrooms hurt them, or they think... Wi-Fi hurts them. Yeah, Wi-Fi hurts them. And when our producer, Latif Nasser, and I got into the studio and we told him about Amy's story, he said... Yeah, all right. I know exactly who you need to talk to. Hello. Yeah, hi. Thomas Platts Mills. This is Thomas Platts Mills. That's right. How are you?

8:44I'm very well. Dr. Platts Mills is down at the University of Virginia in Charlottesville. He's a professor and he works at an allergy clinic. In an allergy clinic, we are constantly sifting through stories which not only you don't believe, but are actually nonsense.

Dr. Platts Mills

8:59And he told us in the last 10 years or so, he started hearing lots of stories just like Amy's. Right. Somebody shows up at the office convinced that they're allergic all of a sudden, for no apparent reason, to red meat. The first time I heard it was probably as early as 2004. And every single time he heard the story, he would tell the patient exactly what Amy's doctor told her. No. No way. No, no, no. It's not possible. Right. So, what was wrong with these complaints, you know, in an orthodox medical way?

9:30Oh, everything. Everything. Adults don't become allergic to something they've eaten for 40 years out of the blue and certainly not red meat. So, you're basically saying to these patients, I think you must be making this up because I can't explain it. Well, I don't use language like that. I say they're there. I was trying to give you your inner voice. Oh, you don't want to know what doctors are thinking in their inner voices. You know, you often think in the middle of an interview, is it possible that he's got, you know, some ghastly disease?

10:04Mad cow. Yeah, you know. The point is that when he'd hear a story like Amy's, he just didn't believe it. But then everything changed. Thanks, oddly enough, to a cancer drug. This new cancer drug called cetuximab. In New York today, Martha Stewart was indicted on criminal charges relating to... This is the very drug that got Martha Stewart in all that trouble for insider trading. Remember that? I went to jail for six months? Yeah. Anyway, very promising, exciting new drug.

10:34But then...

10:37Doctors were giving people this injection and they would just like end up on the floor of the doctor's office. In shock? Yeah, they would be in anaphylactic shock. Their hearts would start beating faster, they'd get short of breath, they'd get stomach cramps. Their immune system would start to overreact to something new, an alien that came in with the drug. Basically a classic allergic reaction. So the mystery lands on Thomas Platts Mills' desk.

Investigating Alpha-Gal

11:03Yes.

Investigating Alpha-Gal

11:04So we were asked to look at cetuximab to see if they could figure out what was causing the reaction. And he tests two groups of blood, a control sample and then people that have this allergy. And he quickly zeroed in on a particular molecule, a sugar, that was part of the drug. This sugar, galactose alpha-1-3-galactose, or alpha-gal. Alpha-gal? Yeah. As in a particularly great lady? Yeah. Better than the beta or gamma-gal? It's like alpha male, but alpha female didn't quite have a ring to it.

11:35It's the alpha-gal. Anyway, it seemed like alpha-gal was the culprit. Yeah, and if you told me four years earlier that there's a whole lot of people out there who are allergic to this sugar, I'd have thought you were smoking, you know, vaping again. Because not only does this sugar alpha-gal show up in the cancer drug, and this is where we get back to Amy, it also shows up in the blood of mammals. All non-primate mammals.

12:08So every time you eat lamb or beef goat, camel, even tripe or pig's kidneys, you're also eating alpha-gal. So I'm reading this article and it says, like, it's this thing called alpha-galactase or alpha-gal or whatever. So it made no sense that someone like Amy, who'd been eating meat all her life, would suddenly somehow be allergic to alpha-gal. I just was like, this was so stupid. So, one day. It's getting to be barbecue season.

12:39I usually have, like, a couple of barbecues where I just do a whole pork butt and a brisket and, like, hang out all day doing it. And I was, like, very wanted to do that. And I was like, I'm just going to not eat meat and not even know. So I was like, forget it. My doctor won't test me. I'm going to test myself. So I was, like, going to be very careful. I got a thing of Benadryl. And I was like, I'm not going to do it alone. I'll do it with my mom, my poor mom. And so I went up to my mom's and she's, like, really into food, too.

13:12So she was like, oh, this is so exciting. I got two porterhouse steaks and salad stews. Did you explain to her what you were testing? Yeah, I did because I had talked a little bit about it with her. So, like, fire up the grill, do the porterhouse. I even think I, like, Instagrammed it as a joke. Like, ha, ha, ha, this might be the last time you hear from me. But so, you know, we're having a nice summer day, just me and my mom having our steak. I only ate, like, a couple bites because I was slightly nervous.

13:43And I was, like, sitting in the grass with my dog and reading a book and trying to think, like, do I feel normal? Which, try it, folks. Because it's hard to figure out when you start asking yourself, do I feel normal? Does this, am I breathing? Is my stomach hurt? Is something wrong? And I was, like, after a while, I was, like, oh, I feel pretty good. And the neighbor came over and was, like, chatting with us. And it was in the middle of that conversation where I was, like, I kind of feel like I have to go to the bathroom.

14:17But maybe I just have to go to the bathroom. So I went to the bathroom and I was sitting there and I was, like, oh, God, something feels bad. And then I was, like, oh, God, I definitely, this is not right. Something's wrong. And I went in to get the Benadryl and I took the Benadryl and I went on my bed and in the guest room at my mom's. And I was, like, sitting on there and I was, like, I just don't feel right.

14:43Maybe I just take a deep breath. I'll just stand up. Maybe I'll just put my hands over my head like this. Oh, that does feel slightly better, I think. And then I was finally, like, I think we should go to the hospital. And I went outside. I was, like, Mom, I think you have to drive me to the hospital. She was, like, talking to her neighbor, like, what? Oh, my God, honey, what? Oh, let me go change my clothes.

15:05Change my clothes. Like, Mom, you know, she's not wearing the hospital level clothes. So I'm, like, okay, hurry up, Mom. Mom, are you ready, Mom? And then I was, like, while she was changing her clothes, I suddenly was, like, oh, my God. Got my wallet out and my cell phone and I, like, threw it towards my mom's bedroom door. And I was, like, here's my insurance card. Call an ambulance. And I just, like, hit the floor. So eventually the ambulance arrives and I got stabilized. I was strapped to the thing. I was in the emergency room.

15:36Like, they were shooting me full of, I don't know what, epinephrine and adrenaline. And the little, like, 12-year-old emergency room doctor runs in and he was, like, I looked it up on the Internet. Alpha gal. Fascinating. What? That's terrible. I've never heard of that. Could it be true? Yes, it's true. Like, they're all having this discussion there. Then when I went back to my doctor after that and I was, like, hey, just get out of the emergency room because they tested me for alpha gal and I'm allergic to meat. But it's still like a mystery.

16:28Right. There are. Thomas Platts Mills couldn't figure out why people like Amy, who had lived for 40 years eating porterhouse steaks at Peter Luger's with a credit card, why would she suddenly develop an allergy now? There would got to be some kind of trigger. Yes. So we were looking for anything that could explain it. It could be a mold, it could be a nematode. A worm or a fungus. But then he looked again and noticed that all the people who had had bad reactions to the cancer drug. They were in a particular area of the country.

17:01It was Virginia, North Carolina, Southern Missouri, Tennessee, Arkansas. No cases in Salt Lake City, no cases in Denver, just smatterings down the west. So he turned to his technician, Jake, and he said. I said, you've got to Google every map you can find and say what matches that area. Creatures or diseases that appear wherever the allergy appears. So Jake starts Googling. Googling and Googling and Googling and. And eventually he comes across a map that. Matches where the cases are very beautifully.

17:34The maximum area for Rocky Mountain spotted fever. So he made this little map and it's like the shaded dark areas of the country are places with Rocky Mountain spotted fever. And then there's like some stars where, you know, this allergy had appeared. Yeah. And they overlap. Ah, very interesting. And then all of a sudden it clicks. Rocky Mountain spotted fever is a tick-borne disease. This is the distribution of the Lone Star tick. And actually just a little before this, it turns out an allergist down in Australia, Cheryl Van Noonan.

18:10First name Cheryl, S-H-E-R-Y-L, Van Noonan, V-A-N, and then N-U-N-E-N. And I'm from the Tick-Induced Allergies Research and Awareness Centre in Sydney, Australia. She says she was now being visited by all kinds of people who claimed suddenly to be allergic to meat. And whenever I take a history, so for example, I'd ask them was there a family history of rhinitis, eczema, asthma, stinging insect allergy, and they say they've all been bitten by ticks. When we started asking patients, we suddenly heard the stories just out the kazoo.

18:43But at this point, Dr. Platt's mills, all he has is a map, some stories, and a hunch. Right. So what does he do?

Testing the Theory

18:53He decides, well, maybe I'll just do this to myself. He does what? He decides to test it on himself. Oh my God. He sort of like denies that he did it intentionally. I know I had no intention. I mean, I think he also likes to walk and amble and think about things. Right. So he goes for a long walk along the Blue Ridge Mountains. And I knew I wanted to be off trail because I'm actually rather allergic to humans. So he's walking and walking and walking. And along the way, he bumps into a whole bunch of ticks.

19:26And if you walk into a nest of those things... Oh my God, this sounds like a nightmare. Yeah, absolutely. I got 200 seed ticks. Oh boy. And then in November of that year, I was taken out to dinner and the lamb chops were particularly delicious and the French wine was delicious. And six hours later, I woke up covered in hives. He's got an allergy to red meat. All just because of a... Tick bite. Tick bite. That's right. He'll bite you right back after this.

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22:39This is Radiolab. Now we go back to Amy just when she's discovered that the allergy to meat that she's developed comes from a tick bite. A tick bite? Hang on a second. Because, like, a few weeks before all this started happening, as I said, I was foraging for ramps in my mom's backyard, and I had a tick on my arm. Now it turns out that not only was that tick bite a terrible thing for Amy, it was a kind

23:09of double tragedy. Hidden from view amongst the trees and in the undergrowth. And I think it's only right at this point to back up. Is a fascinating world of wonders. And consider the story from a tick's point of view.

23:28Okay, so I'm Graham Hickling. I'm a wildlife disease ecologist at the University of Tennessee. So I was wondering if you could help us tell the story of, in this case, the lone star tick that bit Amy. Oh yeah, sure. So they start off in this little pile of eggs, perhaps a mass of 2,000 eggs, under the leaves. The proud mom who just gave birth. At that point, she's just a kind of a withered husk. Meaning dead.

23:58But anyway. A few weeks later, those eggs will hatch, and this mass of 2,000 baby ticks emerge from under the leaves. And could I see them with my naked eye? If you ran into a mass of them all up together, you would feel like you've got a little smudge of dirt, and then the dirt starts walking. And so they'll just climb up, and they'll, you know, potentially all be on the same leaf or the same twig, looking for something to feed on. Now one teeny little tiny problem for these teeny little tiny ticks is that they dry out.

24:29So when they come up from under the leaves, they come up briefly, and then they go back down. Get a little water, come back up, get thirsty, go back down. And rehydrate. So they, like, commute. Exactly. And we refer to the behavior as questing. Oh, questing. So if you were one of these little baby ticks up questing for food. While you're up there, you are essentially Velcro. Because on each one of your little legs. You have little kind of hook-like structures. And so you're flat against the leaf. Sort of sniffing in the air with your two little front legs.

25:00That can detect CO2 heat movement. So let's say one day you're sitting there on your leaf, and you pick up the scent of a nearby mouse. Mice are the potato chips of the ecosystem. Everything eats them. Which means you might be about to have your very first meal. So you basically stand up. Stretch out all your little legs. And do a tick dance. And so it's kind of interpretive dance-like movements. While you're waiting for that mouse to come just close enough that you can grab onto it. So you're dancing, and you're waiting, and you're dancing, and you're waiting, and you're

25:32dancing, and you're waiting, and you're dancing, and you're waiting. To be honest, you are probably going to wait your entire life and die unfulfilled. Because there are 2,000 of you starting off, and a stable tick population, there's only going to be 2 of you that survive. Oh my gosh. So, 1,998 little baby ticks are born. And then that's it for them.

26:03But, let's say that you're one of the lucky ones. And one sunny day, there you are hanging out on your little leaf, when you detect two incoming mammals. One is a 40-year-old hominid, the other is her dog. So, you perk up, you thrust your legs out. Wave, do the tick dance. And say that you're waving, and you're dancing, and you're hoping, and you're waving, and you're dancing, and you're hoping, and you're waving, and you're dancing, and you're hoping, and slowly the dog's getting closer, and closer, and closer, and you reach out with one of your tiny little lips, and you'll get, grab on, and eat, and survive.

26:40But the reason that tick ended up on me was I slept in bed with my dog naked. I mean, she's always naked, but I was also naked. I mean, that's not gross. I don't, I mean, does that sound weird? No. But how do you know that's when it happened? Because I know that, like, I did a good tick check on myself, and I took a shower and everything, and then in the middle of the night, I woke up with an itching sensation, and I went to the bathroom, and I couldn't really see what was on, like, something was on the back of

27:12my arm, and it was a tick. So, as the tick is biting into Amy, what is it giving Amy that's going to make her allergic to meat? Well, actually, I need to stop you there, Robert. Hmm. Difficult one, Robert. I don't know the answer to that. Um, that's Peter Smith, and rejoining us is Cheryl Van Noon, the scientist. It's all up for speculation. We don't really know, but here's the theory. Normally, when you eat a piece of meat, you put alpha-gal in your stomach, and your stomach digests it, and it's in your body, and it's no big deal.

27:42But the tick cunningly will drill into you, poke into you, and injects its saliva. We'll call that tick spit. Tick spit into its victims. Straight into its victim's largest organ. The skin. And tick spit has an anti-clotting factor, an anesthetic, anti-inflammatory compounds, and we think the alpha-gal. Now, Peter says the thing about the skin is the skin is like this enormous, like, surveillance system. It's always on the lookout for invaders. So, when the alpha-gal comes through your skin, covered by all that bad, bad tick spit

28:17stuff. That's going to really, like, set off your immune system. The immune system freaks out. Like, oh. Uh-uh. And the alpha-gal, covered now in bad spit, almost sort of by mistake, gets labeled bad. And now it's on the bad guy watch list. So, therefore, the next time you eat meat, the meat comes in. And then, the body unleashes wave upon wave upon wave of chemical attacks. To do battle against this alpha-gal. And this reaction gets way out of hand. You've got so many antibodies multiplying, multiplying, multiplying, multiplying, making

28:50you, rather in this case, Amy, feel just horrible. Right. I mean, it's very weird. It sounds like a science fiction movie. It sounds like the beginning of a science fiction, at least kids book. Let's not go to movie. But, like, it's just strange. Which all goes to say that this really is a kind of double tragedy for Amy and her tick. Yeah. Because ticks didn't evolve to bite humans. Right. We're a mistake.

29:20Like, we have opposable thumbs. We're either going to pull them off. I actually woke my mom up and she helped get it off. Or if they drop off, they're going to drop off in an airport terminal or a Walmart car park or somewhere like that. Or a shag carpet. Or a shag carpet indoors and they're doomed. And for us, well, we lose something that, historically, anyway, is a big part of who we are. Yeah. Because we adapted in the grand evolutionary scheme of things to, like, eat flesh, to eat meat.

29:53Yeah. Yeah. I mean, I'm actually sitting here picturing a steak. But actually the thing, I mean, hot dogs, like, wrap ramps around a weenie and roast. Yum, that sounds so good. My mouth's watering. Weenies and ramps. But I am going to my allergist tomorrow because I did, you know, I was reading about this allergy a lot when I first got it. And I read that for some people, the allergy can fade away. So I'm going to get a blood test to see what my blood level of alpha-gal is.

30:28So I'm a little. So what are you hoping for tomorrow? I want to be normal. Again. That was the end of the Dan and Amy conversation. She was going to go to the doctor, get herself tested, find out whatever. So we asked her back in. Okay. To find out what happened. So I actually did get an appointment with my allergist, Dr. Korn. Her name is Dr. Korn.

31:00She's really nice. Um, so I got the appointment, I got the blood draw, whatever. And a few days later, my doctor called me and she said that my numbers were still really high. And I was like, well, how high are they? And she was like, three. And I was like, three, that's not high. And she's like, they're supposed to be like one or something. So they had gone down, but they were still, you know, many times more than they should be. So when you left and you were waiting for the call, were you waiting with the hope that

31:32what, that you would soon be eating a bit of hot dog? I mean, honestly, I was hoping no, no, no, I don't. Wait a second. You are, you are the big, the great, you, you. No, but I was afraid that she would be like, oh my God, your numbers are so low. I think you could probably eat meat. Let's do a food challenge. I would be like, ah, cause like, that's such a scary memory. Yeah, I don't, you know, actually just the other night I was eating at an Indian place and I was eating vegetarian, but like, I felt something and I pulled it out.

32:04And in the dim light of an Indian restaurant, like, why are they all lit like that? I was like, was this bacon? And I suddenly, you know, like you just get this drop in your stomach and I'm like, what time is it? Four hours from now, if I, you know, cause it's, there's something about it being delayed that makes it so difficult. It just is like. Like a suspense movie with you and a victim. It's like, it could happen in the next three hours or maybe not. I don't know. I mean, honestly, the only thing that, the real reason I want to be able to eat meat is

32:36so that I will be prepared to eat it in case of emergency. I mean, I went on a canoe trip in the Adirondacks and I was like, well, what happens if I get stranded out here? And like, what if I have to hunt? But I can't even eat meat. I would have to hunt fish. But then when the lake freezes over, what would I eat? I can't survive. Something's wrong with me. I feel evolutionarily challenged. This is what I think about before I go to bed every night. Would I be able to survive if I had just what's on me right now? A pen, underwear, my dog.

33:06And so, yeah, I mean, that's a real issue is like, it's not a real issue. Obviously, it's never going to happen. I live in Brooklyn. But I do, for some reason, I always think like I want to be prepared in case. But yeah, you know, I don't think I would go back to eating meat necessarily. Like you are still more, more frightened than game, so to speak. Well, also like I wish I could be a vegetarian for ethical reasons because it's not so much

33:40just the eating meat, but just like, you know, the factory farming and that kind of stuff. So I feel like morally superior now. I can be like, well, I don't eat red meat. Of course, I'm forced to not eat it. But at the same time, I would if I had the willpower. I'd probably go that way anyway. And then also, I think it's great. It's like we're all evolving to be on this planet, which is getting harder to be on. And we know that meat takes a lot of resources. And like now I don't, now I'm not doing that.

34:11So like the tick is helping me evolve into a better human being. Like, so one could, instead of thinking of the tick as your teeny weeny irritating enemy, you could think of it as a guiding light, making the world safer to share with your fellow earthlings. Yeah.

34:34So you may have lost your relationship with meat, but at least you have your moral superiority. Yeah. I mean, I am superior.

34:54So huge thanks to Amy Pearl for telling a story which never stopped, never stopped being scary and wonderful. And to the fellow who brought her into the room, Dan Pashman, whose podcast, The Sporkful, is, it's all about food in every conceivable way. He talks about eating it, preparing it, worrying about it, as you've heard, getting sick from it, getting fat from it, whatever. And you can find his show on iTunes or Stitcher or on the internet at sporkful.com.

35:24And this story was produced by Annie McKeown and Matt Kilty with reporting help from Latif Nassar. See you next time. All right. So that was the original piece.

Update on Alpha-Gal

35:35We're going to take a quick break now. But when we come back, Zahra and Soren are going to follow the thread from Amy's allergy to this brand new genetically modified pig that can help a human who needs a kidney and also maybe solve Amy's problem. Or maybe make it worse. Stick with us. Radio Lab is supported by Capital One. With no fees or minimums on checking accounts, it's no wonder that Capital One Bank Guy is so passionate about banking with Capital One. If he were here, he wouldn't just tell you about no fees or minimums. He'd also talk about how Capital One Cafés are open seven days a week to assist with your banking needs, even on weekends.

36:10It's pretty much all he talks about in a good way. What's in your wallet? Terms apply. See CapitalOne.com slash Bank Guy. Capital One N.A. Member FDIC. This episode is supported by BetterHelp. Hey there, Lulu here. So apparently every year, BetterHelp does a survey called the State of the Stigma Report, where they survey over 2,000 Americans trying to figure out how people feel about seeking mental health support. Good news first, 85% of the people surveyed said that seeking mental health support is a good thing, which is significantly up from last year's result.

36:43Which, okay, small study, but still fabulous, refreshing, take that stigma, boom. The only bummer is that 74% of those same people said society discourages people from seeking the mental health support that they need. Why is that, society? I say, let's all do what we can to de-stigmatize seeking professional help for mental health. I mean, I seek professional help for my teeth, for my hair. Why not get professional help for what's going on on the inside of the head, you know? I don't have some worries. Get a little support.

37:14But seriously, if a friend or loved one comes to you seeming a little more overwhelmed or blue or scared than usual, why not encourage them to seek help, praise them for doing it, and if they don't know where to begin, one thing you could do is suggest better help. A short questionnaire gets them matched with one of over 30,000 fully licensed therapists available at any time of day at the push of a button. And if they don't like the first one they try, remind them that they can switch therapists at any time, as many times as it takes to find the right fit, because mental health is important and none of us can do it on our own. So for any of you listening to this who are curious about therapy but worried about judgment, I say don't let stigma stand in the way of support.

37:51Start therapy with BetterHelp. Sign up and get 10% off at BetterHelp.com slash Radiolab. That's BetterHelp.com slash Radiolab.

38:01Radiolab is supported by Bombas. Summer's here and it is time for all things outdoors, from hikes to runs in the park to just kicking up those feet on the grass. You can make the most out of your summer plans with Bombas supporting the base of your plans, of you, of your feet. Get it? I don't know. Anyway, they've got a whole line of pro-level, sports-specific socks for golf, yoga, the gym, and socks for every kind of runner. These socks are soft and cushioned right where you want it, plus they're airy, sweat-wicking, so your feet will feel as good at the end of your workout as they did at the start.

38:32Head on over to Bombas.com slash Radiolab and use code Radiolab for 20% off your first purchase. That's B-O-M-B-A-S dot com slash Radiolab, code Radiolab at checkout.

38:47I'm Amy Scott, host of How We Survive, a podcast about the messy business of climate solutions. To a lot of people, geoengineering might seem like a dangerous, outlandish way to play God. But some are embracing this sci-fi-inspired approach as a solution to the climate crisis. Listen to How We Survive on your favorite podcast app.

39:17Good morning. Walking into M.I.U. This building is huge. Hello. Hello. All right. How are you? I'm doing well. I don't know. Do we shake hands? I don't know. I haven't done this in a really long time. Okay. I'm listening. You ready for the Radiolab? Yeah, sure. Yep. Everybody, come on in. Awesome.

Genetically Modified Pig

39:41So our update today comes to us from producer Sarakari, who you just heard wandering the halls of NYU's Lingone Health Hospital back in 2021. That is when we made this update. Hello. Hi, guys. Hello. Hello. Oh, this is really exciting. As well as our executive editor, Soren. Willie, Willie. Wheeler. I can give us a start if you want me to. All right. Yeah, actually, yeah. You should tell us how you even had the idea. Yeah. I mean, I had the idea by someone else having had an idea that I saw their idea in a newspaper.

40:15It's called reading. But like, I don't know, what, a month ago, maybe? I was reading the news. The news I was reading was the New York Times. Heard of it. Heard of it. It was like a science section news thing. And the article is basically announcing this big breakthrough. News this evening about a major medical breakthrough. It's been called an astonishing step in medicine. Basically, a group of surgeons had managed to put a pig kidney into a human being. To a human patient. And it worked. Successfully transferring a pig kidney to a human patient.

40:50For the first time ever, the person's body didn't reject the kidney. Which, when you think about all the people waiting on kidneys, you know. Game changer. Yeah, totally. So I'm just, I'm reading through this article. But then in the middle of it, there's just a couple lines about a particular pig that they used for this kidney. That drew this very weird line back to a story we had told here on Radiolab. That's when I, so I brought in Sarah to like report this whole thing out. So I actually went to talk to the doctor who, who did this transplant. Hi, how's it going?

41:20Nice to meet you. How do you do? Good. How are you? His name is Robert Montgomery. He's at NYU Langone Health and he's the head of transplant surgery there. So when did it first occur to you that transplanting a pig kidney into a human would even be... I just started with like the most basic question, which is like, why would you do this? Because we don't have an adequate supply of organs for the people who need them when they need them. And so a lot of people die waiting. And so the idea of xenotransplant...

41:50And he just made the argument that using animal kidneys was the best way that he could think of to... Make a dent into that waiting list of 90,000 people. And do you know, is this person still walking around and is the pig still walking around? Good question. So, so no. We did this transplant and someone who had been declared brain dead, who had wanted to donate their organs, but were unable to donate their organs. And so their family essentially donated their whole body so that we could test a xenotransplant.

42:24Like, we're going to try this crazy thing that's never been done and see how it goes. And determine whether this was going to be safe to move into living humans. I guess a proof of concept type thing. They didn't want to... Yeah. So the family agreed and the doctors did the transplant and they could see, you know, like that it worked and the body wasn't rejecting the kidney. The kidney was doing its kidney stuff. But the sort of amazing thing is...

42:54Actually, as we sit here today, the same thing happened yesterday. While we were sitting there talking, he told me... You know, we... At two in the morning, we did our second xenotransplant. We actually just did the second one. You want to see? What? That's like happening right now. That's happening right now. And if you want to, you know, come down with me, I'll show you what we're doing. So... And I was like, um, yes. Um, and he took me downstairs to this big room.

43:26It's like a conference room. Okay. It was totally silent. There was like a window looking into this operating room. Okay. Can we walk up to the glass? And you could see just like the jumble of machines and like medical equipment. What are we looking at? All right. So there's a ventilator over here. And in the middle of the room, you could see this person. That's the recipient. Lying there on the table covered by this blue surgical shroud. You can see the patient's body kind of like rising and falling as they breathe.

43:57Yeah, that's the ventilator, you know. And they actually attach the kidney at the person's thigh because they sort of want to be able to watch it. And they're not worried about the person getting up and walking around. So there's this incision at the thigh. And in that oval incision, you could see the pig kidney kind of like poking out. It was like covered by plastic. And Dr. Montgomery told me that, you know, when a body rejects a kidney... The kidney will literally turn black moments after the blood goes into it.

44:27But you could see like with this one, it was bright pink. And kind of amazingly, just like the first one... Within moments, it started to make urine, believe it or not. And so we knew right away that it was working. Wow. See right where it's dripping in? See how fast it's dripping? All that urine is coming out from that kidney. So, you know, this is just the second one that worked. But eventually, Dr. Montgomery and his team want to get to the point where they can do clinical trials on people who are walking around and doing things and living their lives.

45:01And who would hold on to this kidney? Wow. Allow me to presume that you have two questions, which I think you do, even if you haven't said them yet. Which is like, one, why did this never work before? And then two, why are we even telling you this? It's not our usual stick to just pick up a New York Times Science News article and relay that to you. Fair. Which brings me back to that little part of the article that piqued my interest in the beginning. Because the pig that they got the kidney from to do this was a very special pig.

45:32Normally, pigs and other mammals that aren't primates have a sugar in their body that our bodies don't have. And so we don't like it or see it as foreign. And that's why usually an organ from another animal would get rejected. But this pig had been genetically modified. It had had the gene that makes that sugar removed. So it didn't have that sugar, which is part of the reason this worked. And that sugar just so happens to be called alpha-gal.

46:02Alpha-gal.

46:05Hey, our old friend. There it is. There's the Radiolab connection. Our old friend to me. It's really only the food that was kind of eluding us. Because we've known and have been also pursuing various medical device applications of the gal-safe pig. You know, we've had conversations with... So I actually called up the company that makes this pig. They call it the gal-safe pig. The company itself is called Revivicor. Started out as the U.S. division of the Scottish company that cloned Dolly the sheep.

46:39The U.K. company that did Dolly the sheep, this is like their sort of like American offshoot. Got it. Okay. And from there, we actually cloned the world's first pigs. So anyway, I talked to David Ayers. He's the company's chief scientific officer and also John Bianchi. Lead product development enterprises at Revivicor. And I also am in charge of regulatory affairs. So at what point, and either of you can take this, at what point did you guys realize, okay...

47:12And I just wanted to ask them, like, okay, you made this pig for all of these medical transplant reasons. But did you know about the whole food side of things? I'll take this one, Dave, unless... Sure. I'm the poor sap that had to work with the FDA. I shouldn't say that. It was a very collaborative effort with the FDA. And they told me that while they were in the middle of getting FDA approval for this pig to be used for medical reasons, they heard a certain radio show.

47:45After listening to the Radiolab episode, the original episode, and listening to Amy Pearl, we thought, hmm, why not just expand the application to include food? We realized that the pigs that we had developed so that their organs wouldn't be rejected would also be a food source for these patients that have the afligal allergy or the red meat allergy. Okay, wait. So hearing Amy Pearl on our show had something to do with thinking that, oh, we should make this a food product? It was absolutely a motivation of mine after listening to Amy.

48:19What? Yeah, totally. Yes. So, yeah, now because of Amy Pearl and her story, this pig is now FDA approved for medical devices and things like that and transplants, but also for food to use the meat of those pigs to make pork products that like people with alpha-gal syndrome can eat. Wow. So, of course, we immediately like called up Amy Pearl and we're like, Amy Pearl, Amy Pearl, Amy Pearl, Pearl, Pearl. Hi. Hello. We got something to tell you.

48:49Look at this. Oh, no. Oh, my God. You always have like tiny little bundles of cuteness in your life. When we talked to her, she had a couple of really small foster kittens like scrambling up and down her shoulders and mewing in the background. So, we explained to her, you know, the whole deal. There's this pig that doesn't have alpha-gal that's being used for transplants from which you could make meat that would be safe to eat for people like you, Amy Pearl.

49:20Oh, it's kind of, I mean, I just, I feel kind of disgusted because it's been a long time, long time since I've had pork or beef. I've found plenty of delicious things to eat that aren't bacon. And she said that, you know, even if there is now some pork that's totally safe, she still feels sort of the same way she did at the end of the original show, which is that she's kind of just over red meat. I've kind of moved on from it, honestly.

49:52And happily, it sounds. Yeah. I feel like it's better for my peace of mind. It's better for my health. It's better for the planet's health. And I feel lucky and happy. It's kind of like. But then, of course, you know, we had to tell her that, you know, we talked to the guys at Revivacore and that she and her story were sort of an inspiration for this meat becoming available to people. I'll just play you a clip of something they said to me.

50:23It was absolutely a motivation of mine after listening to Amy. When I heard the Radiolab podcast, I'm thinking, well, we hold the hammer.

50:34Oh, God.

50:37Great. I mean, it's so funny. Oh, well. But it's fine. I mean, I guess he sounds like such a nice guy.

50:52Say more. Say more on what you feel. What were you thinking as you heard it? You sort of like hung your head. I mean, I was thinking that. Never should have gone on Radiolab. I don't know, I'm just like always thinking misanthropic things. But I was thinking like, here's a person who's like, here's me just like talking about how delicious meat is and like juices. And they're like, yeah, I love meat too. And they're like, she seems sad.

51:24I'm going to make meat for her. And then it's like, but I actually don't really, I actually, anyway, I can make it for you. I figured it out. I have the hammer. But I actually don't want, it's okay, I'm making it. Here it is. I think she felt like because of her, they'd gone and solved this problem that she didn't even really want solved. It's just kind of like, you would like go to some kind of special FDA store to buy some special genetically modified pork, just so you could have a bite of some kind of meat.

52:01I mean, it just was like, I don't know. Do you guys ever get into philosophy? You ever? It just like, immediately for me, when you say, oh, they created this pig that you can, that alpha gal people can eat. My next thought is like, what is the meaning of life? Why am I here? Wait, why? Do you think you can close the gap between those two for us a little bit? Like, are there some intermediate steps? Because it's like, well, is that good or bad? Well, I guess it's good for people who want to eat pork, but it's bad for the pig.

52:38It just immediately brings to mind, you know, how to live. Do you live to satisfy your desires and be happy? Or do you live to not harm others? Or why are we even here? Are pigs below us? Are they above us? Is it okay to put a pig first? Like, what if someone's kid is dying of kidney cancer? Well, see that, then now, like, that's now how, like, you know, this question has another whole layer.

53:13Because it's not just that they made a pig for people who got bit by a tick but wish they could still have a hot dog. But they also then, it turns out, made a pig that, like, could maybe have a kidney that could save a life where there's no other kidney available. Or maybe in the future, more and more and more things like that. It's kind of like when you start thinking about breeding animals just for organs for people. It's like re-deciding all over again, like, should we be eating another animal that might be intelligent?

53:48It's like you're just answering all those questions again but for another purpose. Just because, like, you can get, like, kidneys out of other people and they're, it's, like, safe and they're... I mean, yeah, that's a good point. Yeah, and I asked this guy, this doctor about this and, you know, was sort of pushing him on, like, why... Like, you've just opened the door to, like, a whole new way of exploiting animals. And I think his thing, which I'm convinced by, honestly, is, like, look, there are 90,000 people right now, right now, that need a kidney.

54:27And when it comes to, like, making the decision for yourself or, like, for a loved one, if you're, like, they need a kidney and you have the option to put a pig kidney in them, you're, like, that's not even a question. You know, we eat millions of pigs anyway. I guess on balance, I feel okay, you know. I mean, I totally agree with you, but why don't they just, why don't they just make a fake kidney?

54:59Yeah, I mean, I... I mean, if somebody, like, imagine humans did not think, like, oh, it's okay to take, to, like, kill an animal just to get its kidney for someone else. Yeah. It was, like, not even something that crossed their mind. We would have invented a plastic kidney by now, probably. So, at this point in the interview, unfortunately, we actually still had one more thing that we had to tell Amy that we learned from the guys at Revivacore.

55:30I'm going to have to tell you something that you might like even less. What, they named the, they named the pig Amy before they hit it with the hammer? Yeah, yeah, they did. What? Yeah. Are you kidding us? Are you kidding? No, I'm not, I'm not kidding. By the way, the first pig that went to market, we named Amy. After Amy Pearl? Of course. Well, I did in my life. Oh, my gosh. I'm not sure Dave approved that name, but it did. What did they name?

56:00The one who donated the kidneys? No, no. The first one that they... The first one that they slaughtered for me. I see. They named it Amy. And unofficially, but, you know, they did, yeah. I mean, I can see why they picked something that was, like, motivating for them, like, humanizing and motivating in their, their, like, quest to solve this thing that they decided was a good problem to put their thoughts behind.

56:32I mean, I, it can't bother me. I can't let myself think about that.

56:40Poor, poor, poor, poor living creatures that suffer. Yeah, but I do think it's good. I am grateful that, like, you are holding the position of making all of us think twice, including me. Like, I think I've been part of the, like, oh, this is a breakthrough. And look at the pig kidney and the human and the heart is beating and everything is working. It's so cool. Well, and, and I do think that it's really helpful for, that you're reminding me there is a cost to this that we shouldn't ignore and that, you know, that we should challenge our imaginations almost to imagine a world where we don't have to exploit these pigs and find another way.

57:30There could be some young, budding scientist that will listen to this version of the story and come up with an artificial kidney and name it Amy. That would be great. That would be great. Yeah, I think that's the only way to make this right. It's funny to think that there's, like, I mean, how big was this pig at the end? Like, usually pigs, I guess when they slaughter them for meat, maybe they're smaller. But, like, I met a pig in Vermont that was, like, 800 pounds and I gave her a whole watermelon and to her it was, like...

58:03Like a gumdrop? Thanks. Yeah. I mean, it was, she was just giant. I took a hoe. I was, like, scratching her back with a hoe and it just, like, looked like a little toothbrush on her and she was, like, oh, that feels so good. I mean, I wonder if Amy got to be that big. I wonder. 800 pound Amy? Pretty formidable. Watch out. I'm just, like, now I'm wishing I could change places with her and then I'll have done my time.

58:33And, like, I would have now be, like, left the mortal coil and she would be sitting here in this interview with her pig intelligence, which is plenty for this, probably.