Chapter 148: Ministry of Food and Drug Safety (3)

Song Jong-Ho was a year younger than Song Ji-Hyun. Their father was an executive at SG Group, and their mother had a doctorate in economics, but she quit her job to be a stay-at-home mom. They had nothing but happy memories of a warm and stable childhood in a prosperous middle-class family. Song Ji-Hyun was also famous for her beautiful looks, but Song Jong-Ho was even more famous; he was a celebrity among the moms in the neighborhood.

Oh, Jong-Ho is a boy, but hes still so much prettier than girls.

Hes going to break some hearts when he gets older.

Everyone who saw Song Jong-Ho said he was handsome, praised him, and loved him. In fact, he became a good student who was smart, well-spoken, athletic, and studious, just like his sister.

Then, it began when Song Ji-Hyun was a freshman in high school.

You got all of that today? Song Ji-Hyun asked in surprise when she saw Song Jong-Ho pouring something out of his bag after returning from school.

It was a bunch of chocolate.

Yeah.

Can I read the letters?

Not the letters.

Then can I have some chocolate?

Yeah. You can have all of it.

I think some of them are handmade Are you sure you dont want it?

I dont like sweets anyway. And you always have a sweet tooth. You even named your dog Cream. How could you name a golden retriever Cream?

When she grows up and has puppies, Im going to name them Brownie, Song Ji-Hyun said as she picked up one of the chocolates. Are you sure? Im going to have them all.

Yes, Im sure.

You only like me, your sister. What am I going to do about you? Song Ji-Hyun said as she unwrapped a piece of chocolate.

Youre the only one I like.

Gross. Stop being so ridiculous.

Its true Song Jong-Ho said. So you cant hate me.

Youre the most popular person at school. Who would hate you?

No. There are a lot of kids who hate me. A lot of them

Says the person who just poured out forty letters and chocolates out of his bag.

Its true. They talk crap about me all the time. I can hear all of it. Its gotten to the point where its almost traumatic. I feel like I can hear them telling me to fuck off and calling me an asshole. I think Im being bullied.

Stop being silly. You dont think I know you? We went to the same school just a few months ago, Song Ji-Hyun replied as if he was being ridiculous.

Theres no one I can trust at school now that you went to high school

Surprisingly, there was a tear in Song Jong-Hos eyes.

Song Ji-Hyun was surprised to see him wipe away a tear from his eyes.

Are you crying?

Never mind.

Song Jong-Ho ran into his room.

What the

Shocked that Song Jong-Ho was in tears, Song Ji-Hyun contacted someone she knew in their junior high. It was a junior she had become friends with in literature club.

Na-Eun, youre in the same class as Jong-Ho, right?

Yes. Its been a while! How is high school?

Yeah. Do you know how Jong-Ho is doing in school nowadays?

Jong-Ho? Hes great. Hes the only celebrity at Sungseo Junior High now that youre gone.

Okay Hes not getting bullied or anything, right?

Whaat? Bullying? No way.

...

Jong-Ho is more popular amongst the guys because hes good at soccer and the girls give them attention when theyre with Jong-Ho. Among the girls Ask him how much chocolate he got today. I heard that he has to take a little every day because it doesnt fit in his backpack.

... Okay, thanks.

Song Ji-Hyun came out of her room and walked past Song Jong-Hos room. Cream, their small golden retriever that was around three months old, came and licked her toe. She hugged Cream and calmed down her strange sense of anxiety.

Five months later, Song Ji-Hyun heard that Song Jong-Ho got into a fight with his friends. She heard that her brother, who had never fought with anyone, let alone raise his voice, had punched someone.

Hey, Jong-Ho is acting a little strange nowadays

Na-Eun said to Song Ji-Hyun on the phone.

Hes a little sensitive to coughing noises or sniffles, but hes been lashing out lately. Thats how he got in a fight.

Really?

He said that he feels like people can see his thoughts leaking out because his head is wide open. Saying that he cant take his mind off of it

* * *

We went to get examined, and they said it was schizophrenia, Song Ji-Hyun said.

And hes been getting treatment regularly? Young-Joon asked.

Yes. We thought he was cured once, but it came back. Since then, weve been coming to the hospital for medication.

... It must be hard.

Schizophrenia is a difficult disease that is often called the cancer of the mind. You have endless hallucinations, delusions, and sometimes you lose consciousness, too, Song Ji-Hyun said. Some people, like my brother, are lucky enough to catch it early on, but its still dangerous.

...

Recently, our data took him to the hospital and while he was gone, Jong-Ho tried to hurt himself. He tried to jump out of a window.

Really?

Young-Joon felt a little put on the spot.

Yes. But thankfully, a man who was there stopped him and was able to prevent the accident.

Oh Thats a relief.

Hes not usually violent, but hes become like this recently, so After some thought, we moved to the Next-Generation Hospital. Its not like the Next-Generation Hospital will be able to cure schizophrenia like Alzheimers, but they have good doctors, so we came here to see if he will get better, Song Ji-Hyun said.

That was when a nurse shouted from the doctors office.

Song Jong-Hos guardian? Please come into the doctors office.

Alright, Song Ji-Hyun said as she raised her hand.

As she walked away, she said to Young-Joon, I think hes done. Im going to go talk to the doctor. See you around.

* * *

Schizophrenia is an incurable disease, said Shin Jung-Ju, Song Jong-Hos doctor.

Shin Jung-Ju, who used to work at Yeonyee Hospital, recently moved to the Next-Generation Hospital.

How is Song Jong-Ho? Young-Joon asked.

You should know better, Doctor Ryu. I dont talk about patient information to anyone.

... Professor Shin, could you teach me a little about schizophrenia?

Are you going to develop a schizophrenia cure?

If I can.

It wont be easy, Shin Jung-Ju said. Doctor Ryu, understanding schizophrenia is much more difficult than understanding cancer. The reason is because we dont know the cause.

I dont know a lot about it, but Ive heard that its not the disease of the mind but of the brain. If so, I think biology will be able to find a way, Young-Joon said.

Hm.

Shin Jung-Ju stroked her chin and thought for a moment.

Doctor Ryu, how high do you think the incidence rate for schizophrenia is?

I dont know, maybe one in a hundred thousand people?

Its one in a hundred.

Young-Joons eyes widened.

One in a hundred?

Yes. The incidence rate is one percent. And it is the most typical modern disease, with urban patients having more severe symptoms, Shin Jung-Ju said. Its what the WHO calls the schizophrenia paradox. Usually, the outcome of diseases is better in developed countries because they have better healthcare systems. But with schizophrenia, its the opposite. Compared to patients in underdeveloped countries with predominantly agrarian societies, patients living in cities have more severe symptoms and a worse prognosis.

...

I think its going to be an increasingly dangerous disease since the world is being more urbanized. But there is so little research, Shin Jung-Ju said. Theres also a growing view that it is not a single illness. Cancer is also not a single illness. Like how lung cancer, pancreatic cancer, and breast cancer are completely different, schizophrenia should also be divided into several different diseases. But the medical community doesnt know that, so they are lumping it together as schizophrenia.

I see.

Even if you develop a drug, Doctor Ryu, its unlikely that it will cure all kinds of schizophrenia. However, if you catch even some of it, a lot of people will have hope, and it will be a huge step in the research. I will tell you what I know.

The symptoms of schizophrenia were the definition of what people thought of as a crazy person. Even in primitive clan societies, there were people who suffered from visual and auditory hallucinations because of schizophrenia. As societies developed, they became madmen, shamans, or prophets. They also became people who were possessed or people who received divine revelations.

Mental asylums appeared in the Middle Ages, but they were more for the isolation and confinement of people with schizophrenia rather than treatment. Also, patients were often assaulted to make the demons leave the body; beatings and assault were considered treatment.

It was a doctor named Philippe Pinel who changed that barbaric paradigm.

Treatment of people with schizophrenia cannot be achieved by abusive methods.

Pinels arguments and movement, along with his followers, were the first to systematize psychiatry, and he succeeded in making mental illness a medical concept. And after Freuds psychoanalysis swept through the psychiatric community, the name schizophrenia was given to the condition.

Recently, there was a paper published in

Nature

that found one hundred eight genes associated with schizophrenia.

Shin Jung-Ju found the paper on her computer and printed it out.

I think youd be interested. Take a look.

* * *

It was late at night, and Young-Joon was reading the paper. Before Young-Joon used Rosaline to find the correct answer, he wanted to see where medicine was in conquering this disease.

Rosaline, can you fact-check this for me? Young-Joon asked.

Yes, go ahead.

Schizophrenia has a strong genetic component. If one twin is diagnosed with schizophrenia, theres a fifty percent chance that the other twin will be diagnosed as well. If both parents have schizophrenia, theres more than a ten percent chance that the child will have schizophrenia as well.

Thats right.

Rosaline replied.

Genes dont determine schizophrenia in isolation. Its not like if someone has this genetic information, they will definitely get schizophrenia. Its more like if someone has this genetic information, they will have a very high risk of getting schizophrenia.

It says that in most cases, the brain produces too much dopamine and it gets out of control.

Its not just dopamine, its the interaction of three neurotransmitters: dopamine, serotonin, and glutamate.

...

And neuropathologically, theres a reduction in the volume and cross-sectional area of the hippocampus and amygdala, disabilities in the neurofilaments and the fiber arrangement in the prefrontal-temporal region, and a disruption in the cavum septum pellucidum. Those things play a role as well.

Then does brain damage cause schizophrenia?

No. It starts with the overexpression of neurotransmitters. That damages the brain, the symptoms get worse in the damaged brain, and the overexpression of neurotransmitters gets worse. Its a vicious cycle.

Can we target the brain like were treating genes with Cas9?

Are you going to send the Cas9 to the brain in a virus?

The dendritic cell bypass can be used to send Cas9 to immune cells, but not brain cells.

But if you use a virus, you will have to use the adeno-associated virus, and you cannot edit one hundred genes at once.

What if I put in normal genes?

Same thing, you cannot put in one hundred genes in a virus.

...

Young-Joon pressed the [Advice] button.

Give me any idea, even a crazy one.

Lets put the genes in the mitochondria and put it into the brain.

The mitochondria?

The energy-producing organelles in the cell. And it is also a type of bacteria.

Right.

The mitochondria was a part of the cell that was inside the cell. It was an organelle that produced power, like a generator in a factory. In the strange microscopic world, the definition of a single organism became blurry, and that was exactly what the mitochondria was. It was a bacteria that had invaded the interior of an eukaryotic cell and become symbiotic billions of years ago. It was a primitive organism that had become part of the cell. Now, it was unclear whether it was a separate living or nonliving entity that could be distinguished from human cells.

Mitochondria have their own genes. They are also quite large, so they can carry about a hundred extra genes. Take a mitochondrion, isolate it from a patients cell, and grow it. Turn it back into a primitive bacterium. And then insert a hundred genes into it.

Rosaline said.

Inject that into the nasal passages and send it to the brain so that it enters the brain cells.

I know that I said that even a crazy idea was okay, but this is

Mitochondria are a part of human cells, so it is safe. But since the genes have been edited, the biomaterials produced from it will be different.

Rosaline said.

That could cure schizophrenia.

𝗳𝚛𝚎𝚎𝘄𝕖𝕓𝕟𝕠𝚟𝚎𝕝.𝗰𝕠𝐦

I was talking about whether I was going to get approval for probiotics on the plane, but this is much harder.

The Ministry of Food and Drug Safety could call Young-Joon insane for proposing to put in a genetically engineered bacteria into the intestines. But putting in a bacteria with one hundred edited genes into someones brain?

Phew Young-Joon let out a deep sigh.

Clara's Thoughts

Ryu Young-Joon is back to making drugs! Honestly, I kind of missed him doing this kind of work. Cultured meat was fun, but this is his specialty! Just a note that I am using patients/people with schizophrenia when referring to them as a narrator, but I will sometimes use schizophrenics in speech to show contempt and negative emotions toward people with schizophrenia! Person-first language is usually how people with mental health disorders, such as schizophrenia, like to be addressed :)