*Research rears it's complicated head again...and Caleb's solution is based on a real genetic discovery, that I happened upon by accident. There are so many promising things happening in the world of medicine.
Last night had been one of the only times in Donatello's remembrance that he'd actually drugged himself to get some sleep. He was against using the formulas for the function, except when it was absolutely necessary. If he didn't get some rest, the docs would forbid him from continuing to assist with Michelangelo.
Not that I'm actually able to help him, he thought bitterly. I can't do anything but wait, and hope he'll hang in there long enough for the cells to mature. The prospect of Caleb throwing that many iPs cells at his youngest brother at once was terrifying, and the purple-masked turtle hadn't hesitated to say so when the man asked for his opinion on the matter. But what other choice do we have? The ventilator is helping some, but it can't reverse what's happening to his lungs. He won't last on that machine indefinitely, not with how weak he is.
As he slipped his legs over the side of the bed, Jenna immediately sat up.
"Are you going to Mike?" she asked.
He nodded mutely.
"I'll fix you something to eat, and bring it up in a few minutes." Jenna probably meant for it to sound like an offer, but there was a firm quality behind her tone that hinted at not taking no for an answer.
"All right, Jen." He turned to gaze at her before rising. "Did you sleep okay?"
"As well as I could," she answered. "Will it bother you if I join you for a while in the Lab today?"
"You don't have to ask my permission to see Mike, Jenna. You're free to hang out there."
"I want to be there for both of you," she clarified.
Donatello heard the implied question without her being forced to ask. Are you going to let me near you without a fight?
"Whenever you're ready, you can c'mon up," he told her.
As he left the room the hallway felt cold and silent, far removed the environment it had been only a few days ago over Thanksgiving. Donatello took a moment to collect himself from the emotional state that was threatening, hesitating at the bottom of the stairs that led to the third floor. He ascended to the Lab, leaning heavily on the banister as he made his way up the stairs.
He peered into the room at the top, and saw Luke sitting at the desk. The man wasn't actively working; he simply appeared to be watching over Mike and a sleeping Rebecca. The turtle silently entered the Lab, raising a hand to greet Luke. Donatello stopped at the fridge to grab a bottle of water to slake his thirst, and headed toward the desk.
Luke's probing gaze took him in for a couple of seconds before the man softened. "You look better today," he commented.
Don nodded, right before downing nearly three-quarters of the water at once. Sedation usually had the effect of drying him out, and leaving the turtle with an excessive thirst afterward.
"Did you drug yourself?" Luke asked knowingly.
"It was the only way I could stay asleep," he admitted. Donatello had been exhausted enough to fall asleep, but remaining that way had been problematic.
"I think it was a good call," Luke agreed. "Have you eaten?"
"Jen's going to bring something up. How is everything in here? Do we know anything new about Mike?"
"His oxygen content is at 90% this morning."
"Which is considerably better than 70%," Don allowed. "But it's still in a life-threatening range. Do you think that's why the coma is persisting?"
"I don't know. If I had to guess, I'd attribute it to his blood oxygen level, but there's no way to be sure, Donny. We're still in unchartered waters, flailing our arms and just trying to stay afloat."
Donatello looked over his shoulder at the depressing image of his younger brother underneath the ventilator. There were more things that he wanted to ask Luke, but he wasn't sure how to express them in the best way. In the end he broke away from Mike without saying anything, and focused on Rebecca instead.
"How's Becky been?"
"She was asleep when I got here, Don. I see that as being a good thing. She's also going to need to eat and do other things eventually."
"I can ask Jen to get on her. She's pretty good at getting people to do things," Donatello offered.
"Why don't you do that?" Luke looked at the young woman briefly, and lowered his voice further. "I was worried about how the stress might affect her for the baby's sake, but we couldn't very well kick her out of the Lab, could we?"
The turtle shook his head. "Not that I can see. Why don't you go check in with your girls, Doc? I'm here to man the fort."
Luke's eyes lingered on the orange-masked turtle, then looked toward the door. It was clear he didn't want to leave. "We're pumping as much oxygen into him as we can, Don. I really don't know what else to do except wait. We need to get the new stem cells implanted, and hope for the best result."
"And it doesn't 'take' right away," Donatello said softly. "Even once the cells are in place, they have to acclimate, they need time to transform...there are so many steps to fulfill." He clenched a hand tightly against his temples. "Do you think he's strong enough to hold on?"
It was the one thing he'd wanted to ask Luke from the beginning of the episode, but he could barely bring himself to speak the words out loud. He felt guilty for even bringing the question to Luke, and forcing the man to give him a completely honest prognosis.
Luke had been on the verge of rising, but now he settled further into the chair. He was quiet for a few moments before he answered him. "From a professional's stand-point, it doesn't look good, Don. You already know that. When the lungs shut down, many times the rest of the body follows. We're dealing with a case where we're a little helpless, because we can't complete the gas exchange in his lungs. He could stop breathing entirely, even though he's on the ventilator. It's not a long term solution for him.
"If I was only thinking along the lines of a doctor with a random patient, I would tell the family that they need to be prepared for the likelihood that their loved one might not be coming around again. That being said, I've seen you guys come back from more disasters than a normal person could ever survive. The first night I ever saw you, I didn't think you were going to make it, Donny. But you proved me wrong, and all of you have consistently beaten the odds ever since. I don't know what's going to happen with Mike, but I know your brother wants to live. That tells me he's not going to quit if he has any say in the matter."
"I don't want to stop believing he'll make it either, Doc, I guess I'm just..." Don cut off when he noticed Rebecca stirring. As she turned her head toward him, he saw the young woman grimace in pain.
Luke rapidly got to his feet and went to her side. "Becky, are you okay? Can you sit up?"
"I'm fine," she said softly. "My back is hurting again."
The young woman brushed wild curls off to the side of her head as she scooted to the edge of the mattress.
"You need to get out of this room for a while, Becky," Luke said carefully. "The cot isn't doing you any favors, and you need to eat a real meal. You can come back, I promise."
"I want to be here if he wakes up..." she faltered.
"Becky, none of us can stay on his shell constantly, and you shouldn't either," Don told her. "The added stress and pain isn't good for you or the baby. You're carrying another life that's being impacted by everything you're experiencing."
Becky nodded. "I guess...I have to take care of myself a little bit, don't I?"
Donatello heard distinct footsteps, and instantly recognized them. Jen's got good timing, he thought inwardly.
As it turned out, the raven-haired woman wasn't alone. Luke shook his head as Caleb meandered over to the desk.
"I really don't think you could have gotten enough sleep," Luke chided the older man.
"I got an idea, and I have to get to work on it," Caleb replied.
Donatello studied the older man with interest, recognizing the excitement he was fighting to contain. "Tell us," Don said immediately.
"I'm not there yet, Donatello. I have to check some things before I'm even sure-"
"Bounce it off us anyway," Luke interrupted.
Jenna laid a hand on Rebecca's shoulder, tugging the young woman to her feet. "Let's get something to eat, Becky. Then you can get a shower, and come on back."
Jen had also left breakfast for the purple-masked turtle on the desk, but he was much too wrapped up in what Caleb could be on the verge of to think about food.
"I've realized something about these mutated cells," Caleb said slowly. "All along I've been treating Mike as if this was a defect that only concerned your particular genetic structure, not even taking into account how much you have in common with humans. When I made that connection, it occurred to me that a similar type of event can affect human stem cells when they're becoming cancerous. Numerous studies have indicated that cancer in the lungs isn't the result of a sudden transformation in cells, but a multi-step process in which a series of molecular changes influence the gene, and cause morphogenesis.
"We don't understand very much about the actual sequence yet, but in recent years several researchers have been paying a lot of attention to the Wnt signaling pathway in the lungs. The pathway plays a crucial role both in the development and regulation of adult stem cells. A variety of cellular processes are controlled by the pathway, such as signaling the cells to proliferate, among other things.
"When the normal regulation of the pathway is lost, it's been shown to promote the development of several types of cancerous cells. Some studies have been able to determine that using a targeted inhibitor against the Wnt pathway sending the errant signals to the stem cells can lead to a decrease in the morphogenesis taking place."
"So...what are you saying exactly?" Don asked. "Do you think the Wnt pathway has significance to the cells that are mutating in our case?"
"The theory I'm operating under is that the mutations occurring in your cells aren't happening spontaneously. It's a process that builds over a number of years, through the skewed signals being supplied by the pathway. When enough of the cells have experienced a morphogenesis to wreak havoc on the alveolus, the condition becomes acute. If this theory is correct, it would provide us with the perfect means with which to address the mutating stem cells in the rest of you, before you even get sick.
"I'm guessing that the very receptor blocker that you and Luke designed to trick Mike's t-cells may have the ability to disrupt and inhibit the signals being sent from the Wnt pathway, thereby shutting down the instructions that are ordering cells to mutate."
Donatello literally felt goose bumps rising on the surface of his skin. "If you're right, if this pathway is the source of the errant cells...then no one else would need to go through the stem cell therapy that Mike is receiving?"
"Not if we catch it early enough."
"What about Mike?" Luke interjected. "Could inhibiting his pathway have any effect on the mutated cells that are already in play?"
"I don't know, but it's worth trying," Caleb replied honestly. "All of this is conjecture, mind you...But it seems like it would add up, based on what I've already seen. Your receptor blocker may need some additional tweaking, but I'd like to try directing it toward the Wnt pathway to see how it impacts the molecules." Caleb's brow furrowed, and his eyes widened in a way that indicated he'd just realized something.
"This could be the answer for why the iPs cells died so quickly!" he exclaimed with sudden fervency. "In their free-form state, they would have been vulnerable to the signals coming from the Wnt pathway! The cells that we injected directly into the lining of his lungs had somewhere to put down roots, and a good opportunity to develop into new tissue without the interference of the signals. But our first line of the offensive strike against the mutated cells never even had a chance! We've got to take out the head of the army, the one who's actually calling the shots." The older man slammed his fist against his palm to excitedly emphasize his point.
"That's a brilliant way of putting it, Caleb." Luke was on his feet, unable to sit any longer.
"Saying is easier than doing," he replied. "Are you guys on board with me? The newer sets of iPs cells ought to be ready to be implanted as soon as tomorrow and I'd like to have the receptor blocker in place within the Wnt pathway before then."
"Absolutely," Luke said quickly. "Don and I will get it up to speed." The blond doctor turned to the turtle. "Eat, Donny. We have a lot to do, and you need energy."
Luke didn't have to tell him twice. Donatello was so excited he wasn't sure if he could sit long enough to finish the omelet Jenna had made for him, but he focused on the plate with precision until the food was gone. Part of him wanted to run downstairs and shout to the entire household that they had something new to go on, but Donny forced himself to hold his peace.
Slow down, Don, you have to slow down. Nothing is certain yet. There's a lot to do in a short amount of time, so you need to keep your head on straight and not go off the deep end.
Donatello watched Caleb for a few seconds as the man logged into the special image mapping software that depicted a clearer vision of Michelangelo's lungs. He cast a quick glance at Luke behind another computer, before going up behind the older man.
"Caleb, if you're right about this Wnt pathway being the source of the mutating cells, you're going to need to test the inhibitor against me too," he said quietly. "We can't ignore the evidence of cell growth within Leo or myself, and even Raph, though he has the lowest count of occurrences. It makes sense to use me, since I have the second highest ratio of the cells after Mike."
Caleb looked over his shoulder. "From where I'm sitting it makes sense too, Donatello, and I'll keep it in mind. First we have to get through today and tomorrow with your younger brother."