Los
Angeles Times Magazine
Sunday,
August 8, 1999 Home Edition/SPAN>
George
and Pam Smith Searched Nationwide for Someone--Anyone-- Who Could Heal Their Dying
Daughter. Then They Met Dr. Richard Gatti
By:
MICHAEL D'ANTONIO
At
the end of the day, George Smith drives to a dream house in Hidden Hills, a
celebrity-filled enclave north of Los Angeles. Just past the security gate await
his gardens, his swimming pool, his tennis court, his horses. Inside, a collection
of modern art--by Hockney, Rivers, Bennevente--glows under tiny spotlights.
A personal trainer prepares for his workout. This life is so much more than
a shopkeeper's son ever imagined. And right now it means nothing. Smith's head
is pounding as he opens the front door. He usually looks 10 years younger than
his 64 years, exuding enormous energy. But today his linebacker-size shoulders
slump. His tie is askew and his face is ashen. "How's Becca?" he asks. "It's
probably just a cold," his wife, Pamela, answers. George falls silent. He takes
off his coat and sighs. <o:p</o:p
"I
need some Advil," he says, disappearing toward the kitchen. <o:p</o:p
A
tension headache in this household is allowed now and then. Every day they fight
a battle for life against an enemy with no soul. Among the demons that can be
produced in the human genome, ataxia-telangiectasia--A-T for short--is one of
the most sadistic. At birth, children with the hereditary disease are as bright
and healthy as any. But over time they grow wobbly and frail. Canes are followed
by walkers and wheelchairs. Uncooperative eye muscles steal the pleasure, and
escape, of reading. Speech becomes garbled. Many children with A-T age prematurely,
looking wizened before they are 20. Immune systems weaken. Most die of cancer
or infection before 30. <o:p</o:p The
discovery in 1982 that her daughter, Rebecca, then 4 1/2, had A-T struck Pam
"like I had actually been hit in the stomach." The Smiths soon learned that
A-T is an "orphan" disease, a disorder so rare that few scientists were interested
in finding a cure. The number of American children known to have A-T is in the
hundreds, not thousands. It never has attracted big research grants. <o:p</o:p
***************************************************************************
<o:p</o:p In
1980, two years before anyone noticed the little imbalance in Becca Smith's
gait, physician Richard Gatti left a promising career path to dedicate himself
to the study of A-T. Help was scarce, and so was money. Just a handful of scientists
worldwide were devoting any time to the disease. <o:p</o:p As
a young doctor, Gatti had worked in Minnesota under Robert Good, a pioneer in
the field of immunology. Gatti was part of a team that established a link between
immune deficiencies and cancer, and, in 1968, he conducted the first successful
human donor bone-marrow transplant in history. (The procedure is now commonly
used to bolster the immune system.) Like all young academic stars, he was looking
for an opening, a promising but neglected area of research where he could distinguish
himself. Then he encountered a group of children--all with cancers not usually
seen in the young and all afflicted with A-T. Gatti was intrigued. The gene
that caused A-T was obviously an important one. A-T affects so many systems
in the body--immunology, neurology, reproduction, even aging--that any clues
to its cause could open the door to understanding a host of diseases, from cancer
to Alzheimer's. <o:p</o:p Gatti
also was deeply moved by the suffering of the children and their families. "I
didn't pick A-T. The children and the disease picked me," Gatti muses. There
was an element of destiny, too, he says. As a boy he had been touched by the
tale of three aunts, his father's sisters, who suffered from a form of ataxia
that had overcome them as young adults. One, a prima ballerina in her teens,
was wheelchair-bound by 28. <o:p</o:p When
Gatti decided to take the risk of retreating to a remote corner of science,
he had no idea of the struggle that lay ahead. He spent four frustrating years
coping with little money and even less professional support. Gatti's first love
had been piano, and he devoted many years to it--even training at Juilliard--before
going into medicine. Now he had given years to an obscure cause. The rewards
had been negligible and the price had been high. He was deeply depressed. His
marriage was in serious trouble because his wife had finally given up competing
with the lab for his attention. <o:p</o:p Then
this: a letter from the National Institutes of Health, from which Gatti had
sought funding. The letter praised Gatti's work but denied him money because,
in the view of officials there, he was unlikely to reach his goal of isolating
the gene responsible for A-T. "The NIH letter said my work was a 'Herculean
task,' and they implied I was never going to complete it. I really was obscure.
Everyone thought I was wrong to put so much into this." <o:p</o:p
Without
the NIH money, the future of his lab was in doubt. <o:p</o:p *****************************************************************************<o:p</o:p
George
Smith was constitutionally unable to shrink from the challenge of his daughter's
disease in 1984. His life experiences simply wouldn't allow it. <o:p</o:p
Smith
was raised in the gritty Rego Park neighborhood of Queens, N.Y. His mother was
the daughter of an orthodox rabbi who had barely been able to feed and clothe
his children. George's parents wanted more for their son, and they made their
expectations clear. "There was a lot of pressure on me," he recalls. "I was
expected to be successful, and I really learned that lesson very well." <o:p</o:p
As
a boy, Smith showed extraordinary aptitude for numbers, which came in handy
as he obsessed over the stats of his favorite New York ballplayers. After his
family moved to Los Angeles in 1948, he parlayed his skill with numbers into
an engineering degree at UCLA before moving on to Harvard Business School. He
became a real estate banker. <o:p</o:p Through
several booms and busts in California real estate, Smith stuck to a sleep-on-the-office-sofa
work ethic, eventually creating one of the largest deal-making firms in the
West. Today George Smith Partners puts financing together for complex, multimillion-dollar
housing, commercial and industrial developments on the West Coast. <o:p</o:p
When
Smith learned that his daughter had A-T, he behaved as he always had when dealing
with seemingly insurmountable problems. "I contacted everyone I knew who might
have some idea of what is going on with medical research. No one knew much of
anything. But I did eventually network my way to Dr. Michael Swift in North
Carolina, who was working on A-T." Smith soon learned, however, that Swift was
studying the patterns of A-T's occurrence in families, not working to find a
cure. <o:p</o:p Desperate,
the Smiths flew to the NIH in Washington, D.C., where they heard more bad news.
The NIH had provided precisely zero dollars to fund A-T research, and the institution
had little interest in the disease. Before the Smiths left, however, one of
the people they met asked if they had checked for researchers at UCLA. After
all, they were told, Dr. Elena Boder, who originally named A-T back in the 1950s,
had been affiliated with UCLA. Maybe someone at the school was still interested.
<o:p</o:p Someone
was. Gatti had moved to Los Angeles years earlier and was running his tiny lab
at UCLA Medical Center. <o:p</o:p ***************************************************************************Looking
at Becca, 21, seated on the bed in her room, it is possible to forget her disability.
She is pretty, with blue-gray eyes and a perfect, shy smile. It is only when
she must command her muscles--to walk, or talk, or pick something up--that Becca
seems different. <o:p</o:p Her
deterioration has been slow but relentless. Still, Becca's health is better
than most. Every few months, it seems, an A-T child the family knows gets pneumonia,
or cancer, or dies. Becca exercises to maintain her muscles and coordination.
She eats carefully and gets ample rest. <o:p</o:p But
vigilance and good health do not mean an escape from A-T. For most of her life
Becca has known she is different from other children, and she has imagined the
future in small measures. "I do not have this the worst," she says. "For me,
the big thing is the balance problem. But I can still be with my family and
communicate. Of course, I have always known that I am different. I have tried
not to dwell on it. But how could I not know?" <o:p</o:p It's
the kind of difference that children never overlook. "In middle school we had
an assembly, an open forum, for the entire school where they could ask questions
about A-T and me," Becca recalls. "My father came and he did a lot of the talking.
The real thing we wanted people to understand is that they could treat me like
any other kid." <o:p</o:p Her
brother, Matthew, 17, certainly does. He says he's never thought about Becca
dying because she doesn't act as if she's ill. Becca's need to be treated like
any other person, even as her disease made her ever-more different, creates
a paradox. She needs help with such mundane tasks as dressing and bathing, and
every trip out involves a wheelchair and a search for special parking spaces.
At the same time, as the Smiths work doggedly to raise money for a cure, at
home they talk very little about the disease, or the future. <o:p</o:p
"The
idea is for Becca to go as far as her abilities, especially her mind, can go,"
Pam Smith says. She learned the depth of her daughter's determination when Becca
was in elementary school and came home declaring she would play the recorder
in a school recital. Pam had visions of her daughter falling, or being unable
to control the instrument and suffering the jeers of her classmates. Becca saw
it differently, and she hid under the kitchen table until her mother agreed
to let her perform. <o:p</o:p At
the recital, Becca propped herself against a chair and played "Twinkle, Twinkle,
Little Star" flawlessly. Pam Smith watched in tears. Since then she has helped
make other academic achievements possible for Becca, including her graduating
from high school with honors and taking classes at Moorpark Community College.
<o:p</o:p This
spring Pam and Becca rented a store on the south side of Ventura Boulevard in
Woodland Hills. A little remodeling, most of it donated by local craftsmen,
and barely used clothes from scores of wealthy supporters turned the space into
Becca's Chic Boutique, a designer resale shop. Profits go to A-T research, but
the boutique also provides an outlet for Becca's creativity and energy. She's
there almost all the time, running the place from her wheelchair, parked behind
a specially made customer counter. <o:p</o:p "I
just keep going," Becca says. "I don't worry too much about me. But lately I
have worried more about my mom dying. I'm so dependent on her. Other kids don't
need someone to help them bathe and get dressed. I do." <o:p</o:p
*****************************************************************************
The Richard Gatti who met George and Pam Smith for lunch at the UCLA Faculty
Club in 1984 had flecks of gray in his curly dark hair and lines of age and
anxiety creeping across his face. The NIH had just denied his funding. "I remember
that as I went to meet George for the first time I was thinking about the NIH
letter," he says. Over their buffet meal, the two men bonded quickly, discovering
they had grown up just a few miles apart in New York. As youngsters, they had
listened to the same ballgames on the radio, nursed similar dreams of success.
<o:p</o:p Gatti
explained the research that had established the cause of A-T as an inherited
mutant gene. He had conducted important elements of this research, including
traveling to an Amish community in Pennsylvania where A-T was prevalent to coax
blood samples from farmers. He also explained that the A-T gene seemed to be
involved in the control of the immune system. He believed that it signaled the
body to repair damaged DNA, which otherwise might cause cancer. <o:p</o:p
If
he could find the A-T gene, he might then find ways to overcome the mutation
that caused Becca's disease. Along the way, he might also help millions of patients
suffering from various forms of cancer. <o:p</o:p Smith
had trouble understanding some of the medical explanations. <o:p</o:p
But
he knew two things. First, he was looking at the only person he knew trying
to find a cure for his daughter's disease. Second, the man needed money.<o:p</o:p
"How
much will it take?" he asked. Gatti estimated $300,000 a year, minimum, to keep
his lab running. Smith was wealthy, but not that wealthy. He made a promise.
He would put up at least $100,000 of his own money, every year, and raise the
rest through a foundation he would form immediately. <o:p</o:p
Gatti
left lunch convinced he had met the Medici who would finance his work. <o:p</o:p
Smith
left wondering how he would raise the cash. Having spent a lifetime solving
other people's money problems, he had never needed other people's financial
help. Suddenly he had to learn to ask for it. So he dove in. Whenever an opportunity
presented itself, he talked about Becca and other kids with A-T, and asked for
money. He turned to developers, bankers, real estate moguls and others. "I wrote
this very emotional letter," he recalls. Friends and business associates who
received it helped him keep Gatti going for another year. <o:p</o:p
There
was also his neighbor, recording mogul Jerry Moss, who decided to renovate his
house in Bel-Air, where the Smiths lived at the time. "He had this construction
project going for a long time, and there was a big pile of earth sitting there
uncovered," Smith says. "Every time the wind blew, the dust covered our house.
Pretty soon we had spores growing on our roof, and that can cause all kinds
of health problems. I called him, and he set up a breakfast at the Hotel Bel-Air
for us to meet and talk." <o:p</o:p Smith
went not knowing what to expect. He found an amiable man who wanted to be a
good neighbor. When Moss asked what he could do, Smith told him: cover the excavated
earth, delay the start of each workday until 8 a.m. and write a $10,000 check
for the A-T Medical Research Foundation. Moss did it all, and continued sending
checks on a regular basis. That kind of largess was repeated again and again
by the wealthy people Smith knew. <o:p</o:p But
as successful as he was raising money one check at a time, he knew that the
foundation would not thrive on personal arm-twisting. Pam Smith began organizing
parties. In 1986 she held a women's luncheon at the Regency Club that yielded
about $30,000 for the lab. For more than a decade, the annual luncheon and small
parties kept the research going. Still, Smith kept looking for a way to increase
the cash flow. In 1996 an associate in Smith's office suggested an annual luncheon
for the region's real estate industry, during which the audience could listen
to a big-name speaker and make donations. The response was so strong that Smith
moved the event to a bigger banquet hall to meet the demand for $150 seats.
Since then, the George Smith Partners Luncheon has become the largest real estate
industry gathering in California, drawing 1,500 people and generating $300,000
a year for the foundation. Last year's speaker was businessman Jerry Reinsdorf,
owner of the Chicago Bulls. <o:p</o:p *****************************************************************************<o:p</o:p
With
the Smiths taking care of the money, Gatti's research team grew, acquired expensive
equipment and moved into a new laboratory at UCLA. The Smiths funded two small
conferences to bring together the dozen or so experts in the field. In 1987,
Dr. Swift in North Carolina supported Gatti's thesis that A-T and cancer are
linked. In the New England Journal of Medicine, Swift wrote that women with
a defective A-T gene are five times more likely to develop breast cancer. <o:p</o:p
Not
long after, Gatti called Smith and told him to come to the lab right away. Smith
arrived as a noisy computer printer was screeching out a massive document. The
data proved that Gatti had tracked the A-T gene to a region on chromosome 11.
"It's like we were looking all over the world for a certain location and had
narrowed it to Southern California," Gatti told Smith. "We were getting much
closer." His task no longer seemed Herculean. The U.S. Department of Energy,
which was interested in the effect radiation has on A-T carriers, granted funds
to accelerate the research, freeing some cash from Smith's foundation. So Gatti
suggested that Smith look up a scientist at the University of Tel Aviv in Israel.
<o:p</o:p The
Israeli was Yosef Shiloh, and he had been drawn to A-T through patients he first
discovered in the Palestinian community in the 1970s. Hidden away by their families,
the children displayed so many different symptoms that Shiloh was baffled and
moved by their plight. <o:p</o:p He
wanted to help. Shiloh's commitment was obvious to Smith, who invested in his
work and, in effect, helped create a competitor for Gatti. Gatti's success also
led to a groundswell of research elsewhere. Soon scientists in Seattle, Canada,
Holland and England were in the hunt. All agreed to share information that would
speed the search for the exact spot on the chromosome where the A-T gene lived.
<o:p</o:p By
1994, about 10 researchers were focused on chromosome 11 in the search for the
gene. In calls from laboratory to laboratory, the gene hunters traded reports
on the territory they had covered, and excluded. Gatti reveled in the progress,
certain that at any moment the prey would be cornered. <o:p</o:p
Suddenly
all the talking stopped. A basic human impulse had set in. As they moved tantalizingly
closer to their target, the scientists began to realize that one of them would
get there first. Someone would be credited with a breakthrough. Trust suffered.
"At some point Yosef heard something that made him think we had found it, but
that we weren't telling him," Gatti says. "That wasn't true. But all of a sudden
no one was sharing anything. I knew we had narrowed it down pretty far, and
I knew that someone would get there within a few weeks." <o:p</o:p
Smith
could hear Gatti's anxiety as he explained that the other researchers had fallen
silent. He felt a deep affection for his old friend, the man who had been his
first and only hope at the beginning. But in this race, Smith was merely a spectator.
He didn't tell Gatti that days before Shiloh had called to say it was almost
over. "I'm going to get there, George," Shiloh had said. "And I'm going to get
there first." <o:p</o:p Like
a Formula One driver using the draft of a car ahead to slingshot over the finish
line, Shiloh used every bit of knowledge accumulated by the researchers to win
the race to isolate the A-T gene in 1995. Newspapers and TV broadcasts around
the world announced the discovery as a major advance in cancer research even
if, sadly, it was not the answer to curing A-T. Shiloh got his picture in Science
magazine. Gatti had the equivalent of honorable mention. <o:p</o:p
But
the sting of second place didn't last long. Gatti and teams around the world
zeroed in on the gene and began taking it apart. Their findings, detailed in
scores of medical journal reports, make clear that a normal A-T gene transmits
signals that tell many kinds of cells when and how to grow and function, and
how to repair themselves when damaged. This is how the body normally prevents
cancers from developing after DNA has been damaged. What also is clear is that
people who carry one copy of the mutant A-T gene, handed down by their mother
or father, are more susceptible to cancer. People who get the mutation from
both parents are far more vulnerable. They are true A-T patients. <o:p</o:p
More
than 100 laboratories worldwide are now looking into the once-orphaned disease.
Mice that bear the mutant gene have been developed to aid experiments. And last
February, a world conference on A-T drew hundreds of scientists, and presentations
revealed new information on everything from the A-T gene's influence on brain
development to its effect on the risk of breast cancer. <o:p</o:p
The
most promising research is aimed at finding ways to boost the A-T gene's cancer-fighting
mechanisms, Gatti says. Since it would stimulate natural, tumor-fighting responses,
this kind of treatment would be especially effective in attacking late-stage
cancers that have metastasized throughout the body. <o:p</o:p
The
elusive cure for A-T most likely lies in work being done on so-called "neural
stem cells," which produce many types of brain and nerve cells. Already being
tested in patients with Parkinson's disease, stem cell transplants may one day
be used to help A-T patients grow new cells with properly working A-T genes.
Gatti is pursuing this idea in collaboration with Jean DeVellis and other established
stem cell researchers at UCLA. Once again, the Smiths will provide the seed
money for the effort. <o:p</o:p *****************************************************************************
<o:p</o:p Scientists
immersed in laboratory work can feel removed from the suffering caused by the
microscopic mutant they chase like a target in some video game. That is not
the case among A-T researchers. They know Becca Smith too well. At the February
conference, before any of the science was discussed, doctors and investigators
sang happy birthday and presented her a heart-shaped cake. She had turned 21,
no small achievement for someone with A-T, but, of course, they were celebrating
something bigger. <o:p</o:p For
nearly two decades, Becca has allowed herself to be the young face of a terrible
illness. Her mother and, most of all, her father financed the search for a cure
when no one else would, or could. They contributed more to science and medicine
than many highly trained experts do in a lifetime. <o:p</o:p "If
it wasn't Becca who got A-T, and if George hadn't been her father, we wouldn't
have been there at all," Gatti says. <o:p</o:p Yet
for all the advances made in cancer research, everyone who stood to honor Becca
knew that a treatment or cure that would save her life has not yet been found.
And no one knows if that will happen in time. But the Smiths' investment in
research, like the down payment on a good piece of real estate, has leverage.
It has produced a breakthrough in basic science that will benefit all of humanity.
And it has yielded a dividend of hope where none existed before.
PHOTOGRAPHER: Cedric
Angeles
Descriptors: ATAXIA TELANGIECTASIA; MEDICAL TREATMENTS; DOCTORS; FAMILIES; GE
NETIC DISEASES; GENETIC MAPPING; GATTI, RICHARD; MEDICAL RESEARCH; <o:p</o:p
Copyright
(c) 1999 Times Mirror Company <o:p</o:p