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A Young Mississippi Woman's Journey Through A Pioneering Gene-Editing Experiment

Dec 25, 2019
Originally published on January 8, 2020 1:31 pm

When Victoria Gray was just 3 months old, her family discovered something was terribly wrong.

"My grandma was giving me a bath, and I was crying. So they took me to the emergency room to get me checked out," Gray says. "That's when they found out that I was having my first crisis."

It was Gray's first sickle cell crisis. These episodes are one of the worst things about sickle cell disease, a common and often devastating genetic blood disorder. People with the condition regularly suffer sudden, excruciating bouts of pain.

"Sometimes it feels like lightning strikes in my chest — and real sharp pains all over. And it's a deep pain. I can't touch it and make it better," says Gray. "Sometimes, I will be just balled up and crying, not able to do anything for myself.

Gray is now 34 and lives in Forest, Miss. She volunteered to become the first patient in the United States with a genetic disease to get treated with the revolutionary gene-editing technique known as CRISPR.

NPR got exclusive access to chronicle Gray's journey through this medical experiment, which is being watched closely for some of the first hints that changing a person's genes with CRISPR could provide a powerful new way to treat many diseases.

"This is both enormously exciting for sickle cell disease and for all those other conditions that are next in line," says Dr. Francis Collins, director of the National Institutes of Health.

"To be able to take this new technology and give people a chance for a new life is a dream come true," Collins says. "And here we are."

Doctors removed bone marrow cells from Gray's body, edited a gene inside them with CRISPR and infused the modified cells back into her system this summer. And it appears the cells are doing what scientists hoped — producing a protein that could alleviate the worst complications of sickle cell.

"We are very, very excited," says Dr. Haydar Frangoul of the Sarah Cannon Research Institute in Nashville, Tenn., who is treating Gray.

Frangoul and others stress that it's far too soon to reach any definitive conclusions. Gray — and many other patients — will have to be treated and followed for much longer to know whether the gene-edited cells are helping.

"We have to be cautious. It's too early to celebrate," Frangoul says. "But we are very encouraged so far."

Collins agrees.

"That first person is an absolute groundbreaker. She's out on the frontier," Collins says. "Victoria deserves a lot of credit for her courage in being that person. All of us are watching with great anticipation."

This is the story of Gray's journey through the landmark attempt to use the most sophisticated genetic technology in what could be the dawn of a new era in medicine.

The study took place at HCA Healthcare's Sarah Cannon Research Institute and TriStar Centennial Medical Center, in Nashville, Tenn., one of 11 sites recruiting patients for the research in the U.S., Canada and Europe.
Meredith Rizzo/NPR

Life filled with pain

When I first meet her, Gray is in a bed at the TriStar Centennial Medical Center in Nashville wearing a hospital gown, big gold hoop hearings and her signature glittery eye shadow.

It's July 22, 2019, and Gray has been in the hospital for almost two months. She is still recovering from the procedure, parts of which were grueling.

Nevertheless, Gray sits up as visitors enter her room.

"Nice to meet y'all," she says.

Gray is just days away from her birthday, which she'll be celebrating far from her husband, her four children and the rest of her family. Only her father is with her in Nashville.

"It's the right time to get healed," says Gray.

Gray describes what life has been like with sickle cell, which afflicts millions of people around the world, including about 100,000 in the United States. Many are African American.

In July, Gray was recovering after a medical procedure that infused billions of her own bone marrow cells back into her body after they had been modified using the gene-editing technique CRISPR. Her father, Timothy Wright (right), traveled from Mississippi to keep her company.
Meredith Rizzo/NPR

"It's horrible," Gray says. "When you can't walk or, you know, lift up a spoon to feed yourself, it gets real hard."

The disease is caused by a genetic defect that turns healthy, plump and pliable red blood cells into deformed, sickle-shaped cells. The defective cells don't carry oxygen well, are hard and sticky and tend to clog up the bloodstream. The blockages and lack of oxygen wreak havoc in the body, damaging vital organs and other parts of the body.

Growing up, Victoria never got to play like other kids. Her sickle cells made her weak and prone to infections. She spent a lot of time in the hospital, recovering, getting blood transfusions — all the while trying to keep up with school.

"I didn't feel normal. I couldn't do the regular things that every other kid could do. So I had to be labeled as the sick one."

Gray made it to college. But she eventually had to drop out and give up her dream of becoming a nurse. She got a job selling makeup instead but had to quit that too.

The sickle-shaped cells eventually damaged Gray's heart and other parts of her body. Gray knows that many patients with sickle cell don't live beyond middle age.

"It's horrible — knowing that I could have a stroke or a heart attack at any time because I have these cells in me that are misshapen," she says. "Who wouldn't worry?"

Gray says she understands the risks involved in the treatment. "This gives me hope if it gives me nothing else," she says.
Meredith Rizzo/NPR

Gray married and had children. But she hasn't been able to do a lot of things most parents can, like jump on a trampoline or take her kids to sporting events. She has often had to leave them in the middle of the night to rush to the hospital for help.

"It's scary. And it affected my oldest son, you know, because he's older. So he understands. He started acting out in school. And his teacher told me, 'I believe Jemarius is acting out because he really believes you're going to die,' " Gray says, choking back tears.

Some patients can get help from drugs, and some undergo bone marrow transplants. But that procedure is risky; there's no cure for most patients.

"It was just my religion that kind of kept me going," Gray says.

An eager volunteer

Gray had been exploring the possibility of getting a bone marrow transplant when Frangoul told her about a plan to study gene editing with CRISPR to try to treat sickle cell for the first time. She jumped at the chance to volunteer.

"I was excited," Gray says.

CRISPR enables scientists to edit genes much more easily than ever before. Doctors hope it will give them a powerful new way to fight cancer, AIDS, heart disease and a long list of genetic afflictions.

"CRISPR technology has a lot of potential use in the future," Frangoul says.

To try to treat Gray's sickle cell, doctors started by removing bone marrow cells from her blood last spring.

Next, scientists used CRISPR to edit a gene in the cells to turn on the production of fetal hemoglobin. It's a protein that fetuses make in the womb to get oxygen from their mothers' blood.

"Once a baby is born, a switch will flip on. It's a gene that tells the ... bone marrow cells that produce red cells to stop making fetal hemoglobin," says Frangoul, medical director of pediatric hematology/oncology at HCA Healthcare's TriStar Centennial Medical Center.

The hope is that restoring production of fetal hemoglobin will compensate for the defective adult-hemoglobin sickle cells that patients produce.

Patients with sickle cell disease have blood cells that are stiff and misshapen. The cells don't carry oxygen as well and clog up the bloodstream, resulting in periodic bouts of excruciating pain.
Ed Reschke / Getty Images

"We are trying to introduce enough ... fetal hemoglobin into the red blood cell to make the red blood cell go back to being happy and squishy and not sticky and hard, so it can go deliver oxygen where it's supposed to," Frangoul says.

Then on July 2, after extracting Gray's cells and sending them to a lab to get edited, Frangoul infused more than 2 billion of the edited cells into her body.

"They had the cells in a big syringe. And when it went in, my heart rate shot up real high. And it kind of made it hard to breath," Gray says. "So that was a little scary, tough moment for me."

After that moment passed, Gray says, she cried. But her tears were "happy tears," she adds.

"It was amazing and just kind of overwhelming," she says, "after all that I had went through, to finally get what I came for."

The cells won't cure sickle cell. But the hope is that the fetal hemoglobin will prevent many of the disease's complications.

"This opens the door for many patients to potentially be treated and to have their disease modified to become mild," Frangoul says.

The procedure was not easy. It involved going through many of the same steps as a standard bone marrow transplant, including getting chemotherapy to make room in the bone marrow for the gene-edited cells. The chemotherapy left Gray weak and struggling with complications, including painful mouth sores that made it difficult to eat and drink.

But Gray says the ordeal will have been worth it if the treatment works.

She calls her new gene-edited cells her "supercells."

"They gotta be super to do great things in my body and to help me be better and help me have more time with my kids and my family," she says.

Gray was diagnosed with sickle cell disease as an infant. She was considering a bone marrow transplant when she heard about the CRISPR study and jumped at the chance to volunteer.
Meredith Rizzo/NPR

Concerns about risk

Other doctors and scientists are excited about the research. But they're cautious too.

"This is an exciting moment in medicine," says Laurie Zoloth, a bioethicist at the University of Chicago. "Everyone agrees with that. CRISPR promises the capacity to alter the human genome and to begin to directly address genetic diseases."

Still, Zoloth worries that the latest wave of genetic studies, including the CRISPR sickle cell study, may not have gotten enough scrutiny by objective experts.

"This a brand-new technology. It seems to work really well in animals and really well in culture dishes," she says. "It's completely unknown how it works in actual human beings. So there are a lot of unknowns. It might make you sicker."

Zoloth is especially concerned because the research involves African Americans, who have been mistreated in past medical studies.

Frangoul acknowledges that there are risks with experimental treatments. But he says the research is going very slowly with close oversight by the Food and Drug Administration and others.

"We are very cautious about how we do this trial in a very systematic way to monitor the patients carefully for any complications related to the therapy," Frangoul says.

Gray says she understands the risks of being the first patient and that the study could be just a first step that benefits only other patients, years from now. But she can't help but hope it works for her.

Dr. Haydar Frangoul, medical director of pediatric hematology/oncology at HCA Healthcare's Sarah Cannon Research Institute and TriStar Centennial Medical Center, is leading the study in Nashville.
Meredith Rizzo/NPR

She imagines a day when she may "wake up and not be in pain" and "be tired because I've done something — not just tired for no reason." Perhaps she could play more with her kids, she says, and look forward to watching them grow up.

"That means the world to me," Gray says.

It could be many weeks or even months before the first clues emerge about whether the edited cells are safe and might be working.

"This gives me hope if it gives me nothing else," she says in July.

Heading home at last

About two months later, Gray has recovered enough to leave the hospital. She has been living in a nearby apartment for several weeks.

Enough time has passed since Gray received the cells for any concerns about immediate side effects from the cells to have largely passed. And her gene-edited cells have started working well enough for her immune system to have resumed functioning.

So Gray is packing. She will finally go home to see her children in Mississippi for the first time in months. Gray's husband is there to drive her home.

"I'm excited," she says. "I know it's going to be emotional for me. I miss the hugs and the kisses and just everything."

After living for months in Nashville, where the study was taking place, Gray packs her bags to finally go home — to her kids and family in Forest, Miss.
Meredith Rizzo/NPR

Gray is wearing bright red glittery eye shadow. It matches her red tank top, which repeats "I am important" across the front.

She unzips a suitcase and starts pulling clothes from the closet.

"My goodness. Did I really bring all this?" she says with a laugh.

Before Gray can finish packing and depart, she has to stop by the hospital again.

"Are you excited about seeing the kids?" Frangoul says as he greets her. "Are they going to have a big welcome sign for you in Mississippi?"

Turns out that Gray has decided to make her homecoming a surprise.

"I'm just going to show up tomorrow. Like, 'Mama's home,' " she says, and laughs.

After examining Gray, Frangoul tells her that she will need to come back to Nashville once a month for checkups and blood tests to see if her genetically modified cells are producing fetal hemoglobin and giving her healthier red blood cells.

"We are very hopeful that this will work for Victoria, but we don't know that yet," Frangoul says.

Gray will also keep detailed diaries about her health, including how much pain she's experiencing, how much pain medication she needs and whether she needs any blood transfusions.

"Victoria is a pioneer in this. And we are very excited. This is a big moment for Victoria and for this pivotal trial," Frangoul says. "If we can show that this therapy is safe and effective, it can potentially change the lives of many patients."

Gray hopes so too.

"Not just for me, but for other people, this would be mind-blowing," Gray says. "Oh my God. I can't imagine the lives that could be saved if this thing actually works."

Before she leaves, Gray has to let the nurses take a big blood sample for the study she is in. The trial is being conducted by CRISPR Therapeutics in Cambridge, Mass., and Vertex Pharmaceuticals in Boston. The project will eventually involve dozens of patients in the United States, Canada and Europe.

As the nurses fill one big vial after another, Gray talks about how she feels about having modified cells circulating in her body.

"I'm just genetically modified now," she says with a giggle. "I'm a GMO. Isn't that what they call it?"

Gray knows she's about to start a limbo period of waiting to find out if her edited cells are working.

"I'm spiritual. And it's something I prayed about," she says. "And just the way everything happened for me, I just feel like it was fate for me to be here. So I just believe that God is doing this for me."

The big reveal

It's a foggy morning a few weeks later. Gray steps out of her car in a parking garage at the hospital. She just drove back to Nashville after spending about a month at home in Mississippi.

"I feel good," she says. "I'm hoping to get some good news today."

Frangoul should have some results from her latest blood tests about whether her genetically modified cells are working.

Gray says she's not nervous, except "about the needles." She will have to go through another big blood draw today.

Nurses Bonnie Carroll (left) and Kayla Jordan draw vials of blood from Gray.
Meredith Rizzo/NPR

For this visit, Gray is wearing a black sweatshirt with big letters that spell out "Warrior."

"They call sickle cell patients warriors, and I saw this shirt at Walmart so I had to get it," she says as she heads over to give her blood sample.

As the nurses fill one big tube after another, Gray describes her homecoming a few weeks earlier.

"It was emotional for me, because I love them so much," she says, stifling tears. "I did this for them. So it's worth it."

The nurses are finally done. Gray heads over to see her doctor.

"I'm terribly excited about your bloodwork today," Frangoul says.

After a quick physical exam, Frangoul shows Gray what she'd been waiting for: The results of some of her blood tests.

"So look at this," says Frangoul, smiling, as he hands her a sheet of paper. "This is very exciting. I am super-excited about your results today."

Gray's CRISPR-edited cells seem to be working.

"It looks like there are signs that you are starting to make fetal hemoglobin, which is very exciting for us," Frangoul says.

Nearly half the hemoglobin in Gray's blood is now fetal hemoglobin, which is more than doctors think is needed to help alleviate the complications of sickle cell. And the level of that protein seems to be continuing to rise.

Researchers caution that Gray's good results must still be considered preliminary — it's early days yet, and this is just one patient. Much is still unknown, including whether the treatment will make a lasting improvement in Gray's health and whether it will be safe in the long run for her and other patients.
Meredith Rizzo/NPR

"Oh my goodness," Gray says.

The treatment also still seems safe, so far. There have been no signs of any ill effects from the modified cells.

In addition, there are clues that the cells could already be helping Gray. She hasn't needed any blood transfusions since she got the cells, hasn't had any pain attacks and hasn't had to rush to the hospital for help.

"That's good. Excellent. Perfect," Frangoul says. "This is extremely encouraging."

Typically, Gray says, she would have had another pain episode by now.

"I would have had at least had something," she says.

"It's special, especially coming up on the holidays — because sometimes I would be in the hospital on Christmas," Gray says. "So I'm looking forward to a whole new life for all of us."

Other hopeful signs

The same kind of CRISPR gene-edited cells seem to be helping a patient who received them in Germany for a related genetic blood disorder called beta thalassemia.

But Frangoul knows he still must remain cautious.

"It is still too early to celebrate. I just want to make sure this is something we watch very carefully every visit and see how things are going," he says.

Doctors will have to follow Gray for years and study many additional patients to answer the most important questions: Are the cells really helping patients live healthier lives? Will they keep working? Will they keep working safely? And will the cells actually help patients live longer?

"This would be life-changing, not only for Victoria but for many sickle cell patients," Frangoul says. "Because if this is determined to be safe and effective, I think it can be transformative for patients with sickle cell disease."

Other genetic therapies are also showing promise for sickle cell. So researchers have already started to try to make such expensive, complicated treatments practical and affordable, especially in poor countries. That's where diseases such as sickle cell are most common.

"The progress that we've seen for sickle cell disease, including Victoria Gray and her involvement in this, made it clear that if this is starting to work, we need to get busy and figure out how to take it to the next level," says Collins, the NIH director.

Zoloth, the University of Chicago bioethicist, says she's encouraged to see progress for a disease that has long been neglected. But she's still cautious about the research, especially because only one patient has been treated, and so recently. She worries about raising false hope.

"So far so good," Zoloth says. "And of course that's great news. I hope it works. I hope she's free of this disease, and I hope this very, very brave woman has a life of joy and freedom from pain and can raise those beautiful children."

But, she adds, "it's still very early days. We're still waiting for real news — which is, 'This is the definitive cure. This will help many, many thousands of people.' It would be a wonderful thing for humanity."

Other doctors are using CRISPR to try to treat cancer. One team soon plans to try to edit genes inside the body for the first time — modifying genes in retinal cells of the eye to try to restore vision to people blinded by a rare genetic disorder.

Gray knows this is just the beginning. But she's happy things are going well so far.

"It's amazing to have a chance at a different type of life," Gray says. "It's a miracle. When you pray and ask God for something for so long, all you have left is hope."

Gray is hopeful that the treatment will continue to work. "Not just for me, but for other people, this would be mind-blowing," she says. "Oh my God. I can't imagine the lives that could be saved if this thing actually works."
Meredith Rizzo/NPR

Gray has already started doing things she could never do before, such as go to one of her son's football games for the first time.

"I don't really want anything extravagant," she says. "I just want a simple life with my family and the people who I love and people that love me — and just live, you know?" Gray says. "This could be the beginning of something special."

Copyright 2020 NPR. To see more, visit https://www.npr.org.

ARI SHAPIRO, HOST:

We have a special story for you now on this Christmas Day about a revolutionary gene-editing technique that allows scientists to make precise changes in DNA. They can zero in on any gene, cut out mutations or literally rewrite the genetic code. And for the first time in the U.S., this technology is being used to try to treat someone with a genetic disorder - a woman from Mississippi. NPR health correspondent Rob Stein got exclusive access to chronicle her journey. Now Rob brings us a behind-the-scenes look at this remarkable medical experiment and the woman leading the way.

ROB STEIN, BYLINE: It can always be risky to volunteer for any medical experiment. But Victoria Gray of Forest, Miss., she did something extraordinary. She agreed to have her genes modified for the rest of her life.

UNIDENTIFIED HOSPITAL EMPLOYEE #1: Victoria is in room 7.

STEIN: I met Victoria for the first time this summer at the Sarah Cannon Research Institute in Nashville.

Hello. I'm Rob Stein from NPR.

VICTORIA GRAY: Victoria Gray. Nice to meet y'all.

STEIN: Victoria is sitting up in bed in a hospital gown, wearing a big gold hoop hearings and sparkly eye shadow. She's been here for more than a month. It's just a couple days away from her 34th birthday. She'll be celebrating in the hospital, far away from her husband and four kids.

GRAY: My twins, Jaden (ph) and Jadasia (ph), they are 11. Jamarius (ph) is 12. And my stepdaughter, Asia (ph), is 13.

STEIN: Wow. You've got your hands full (laughter).

GRAY: I do (laughter). It's the right time to get healed.

(SOUNDBITE OF MUSIC)

STEIN: Victoria has been struggling with sickle cell disease all her life.

GRAY: It's horrible. When you can't walk or, you know, lift up a spoon to feed yourself, it gets real hard.

STEIN: Sickle cell is a cruel genetic disorder that afflicts millions of people around the world, including about a 100,000 in the United States. Many are African American.

(SOUNDBITE OF MEDICAL EQUIPMENT BEEPING)

UNIDENTIFIED HOSPITAL EMPLOYEE #2: Victoria, this one is not going to stop today.

STEIN: A genetic defect turns their red blood cells into deformed sickle-shaped cells. They don't carry oxygen like they're supposed to. They're hard and sticky, so they clog up the bloodstream, wreak havoc in the body. Victoria's mom realized Victoria had sickle cell when she was just 3 months old.

GRAY: My grandma was giving me a bath, and I was crying. So they took me to the emergency room to get me checked out. And that's when they found out that I was having my first crisis.

STEIN: A pain crisis - it's one of the worst things about sickle cell - excruciating, unpredictable attacks of pain.

GRAY: Sometimes it feel like lightning strikes in my chest - and real sharp pains all over. And it's the deep pain. You know, I can't touch it and make it better or do anything to make it better. Sometimes, I will be just balled up and crying, not able to do any day for myself.

STEIN: That sounds just awful.

GRAY: Yes, it is.

STEIN: She often can't get the help she needs when one of those terrible pain attacks hit. One of the things that make sickle cell so hard is doctors refuse to give her enough pain medication. It's not uncommon for doctors to mistake sickle cell patients for people with a drug addiction.

(SOUNDBITE OF MUSIC)

GRAY: You already deal with the pain that you can't do anything about. And then you have to deal with, you know, the hurt of them mistreating you at times. You know? Yeah. So...

STEIN: When she was growing up, Victoria never got to play like other kids. Her sickle cells made her weak, prone to infections. She spent a lot of time in the hospital, recovering, getting blood transfusions - trying to keep up with school.

GRAY: It was hard. You know? Knowing that I wasn't - like, I didn't feel normal - you know, knowing that I couldn't do the regular things that every other kid could do. So I had to kind of be labeled as the sick one, you know?

STEIN: She did graduate from high school on time and went to college to study nursing but had to drop out.

GRAY: That got put on hold for health reasons.

STEIN: Then she got a job selling makeup but had to quit that, too. The sickle cell slowly damaged Victoria's heart and other parts of her body. Victoria knows she's prone to heart attacks, strokes. Many sickle cell patients don't make it past their 40s.

GRAY: It's scary. And it affected my oldest son. He's older, so he understands. So he started acting out at school. And like, his teacher told me, I believe Jamarius is acting out because he really believes you're going to die.

STEIN: I'm so sorry - so sorry.

Some patients can get help from drugs, even try bone marrow transplants. But for most, there's no cure. Victoria's got the most severe form of sickle cell.

GRAY: It was just my religion that kind of kept me going.

STEIN: But then Victoria heard about something new. Doctors were planning to use the gene-editing technique called CRISPR to try to treat sickle cell. Victoria jumped at the chance to volunteer.

(SOUNDBITE OF KNOCKING ON DOOR)

HAYDAR FRANGOUL: Hey, Victoria. How are you doing today?

GRAY: I'm doing OK, Dr. Frangoul.

FRANGOUL: That's great.

(SOUNDBITE OF MUSIC)

STEIN: Dr. Haydar Frangoul is starting this study.

FRANGOUL: How was your last night?

GRAY: Last night, it went pretty well.

STEIN: CRISPR lets scientists make very precise changes in DNA much more easily than ever before. They can actually zero in on any part of the genetic code, so doctors think it may give them a powerful new way to fight cancer, heart disease, even AIDS.

FRANGOUL: CRISPR technology has a lot of potential use in the future, not only in blood disorders, in other genetic disorders to help many other patients.

STEIN: Now here's how CRISPR might help sickle cell patients like Victoria. Sickle cell is caused by a defective protein called hemoglobin. It's what red blood cells need to carry oxygen around the body. So when it's defective, red blood cells don't work. They jam up the bloodstream.

(SOUNDBITE OF MUSIC)

STEIN: Frangoul hopes to solve this problem using something called fetal hemoglobin. It's what fetuses use to get oxygen when they're in the womb.

FRANGOUL: Once a baby is born, a switch will flip on. It's a gene that tells the red blood cell - the bone marrow cells that produce red cells - to stop fetal hemoglobin.

STEIN: So Frangoul is using cells that scientists edit with CRISPR to flip that fetal hemoglobin switch to turn the production of healthy fetal hemoglobin back on.

FRANGOUL: What we are trying to do here is we are trying to introduce enough fetal hemoglobin into the red blood cell to make the red blood cell go back to being happy, squishy and not sticky and hard - and can go deliver oxygen where it's supposed to.

STEIN: So first, Frangoul gets some of Victoria's bone marrow cells. Next, he sends them off to a lab, where scientists edit a gene in the cells. Then, Victoria gets a grueling round of chemotherapy to make room in her bone marrow for the edited cells.

FRANGOUL: Let's go for it.

STEIN: Finally, Dr. Frangoul infuses more than 2 billion of those genetically modified cells into her body. The hospital recorded the procedure. A nurse hands Dr. Frangoul a big syringe filled with the edited cells.

FRANGOUL: OK. Perfect.

STEIN: He pushes the plunger.

FRANGOUL: All right - almost done.

GRAY: Yeah.

When it went in, my heart rate shot up real high and kind of made it hard to breathe. So that was a little scary, tough moment for me. After that, I cried. But it was happy tears - you know, just kind of overwhelming after all that I had went through to finally get what I came for (laughter).

STEIN: Now, these cells won't cure sickle cell. But the hope is they'll prevent the terrible complications of the disease.

FRANGOUL: And this opens the door for many patients to potentially be treated and have their disease modified to become mild or cause them no long-term side effects from the horrible, horrible side effects of sickle cell disease.

STEIN: Victoria calls her new gene-edited cells her...

GRAY: Supercells - yeah, they got to be super to do great things in my body - you know? - and to help me be better - you know? - and help me have more time with my kids and my family.

(SOUNDBITE OF MUSIC)

STEIN: Other doctors and scientists are excited about studies like this, too. But they're also being cautious. Whenever you try anything so new, it's always risky. Laurie Zoloth is a bioethicist at the University of Chicago.

LAURIE ZOLOTH: This is an exciting moment in medicine. Everyone agrees with that. CRISPR promises the capacity to alter the human genome and to begin to directly address genetic diseases. But no one knows.

STEIN: She worries that this sickle cell study may not have gotten enough scrutiny by objective experts.

ZOLOTH: This is a brand-new technology. It seems to work really well in animals and really well in culture dishes. It's completely unknown how it works in actual human beings. So there are a lot of unknowns. It might make you sicker.

STEIN: Dr. Frangoul knows there are always risks with experimental treatments. But he says the research is going very slowly with a lot of oversight by the Food and Drug Administration and others.

FRANGOUL: We are very cautious about how we do this trial in a very systematic way to monitor the patients carefully for any complications related to the therapy.

STEIN: Victoria says she understands she's taking a chance by being the first patient and that the study may only help other patients years from now. Still, she can't help but hope.

GRAY: Being able to wake up and not be in pain and to just be tired because I've done something - and not just tired for no reason - just be outside and jump on the trampoline with my kids and go to graduations and weddings and see them grow up. That means the world to me.

STEIN: Dr. Frangoul will keep a close watch over Victoria to see what the gene-edited cells are doing in her body, so Victoria will stay in Nashville for weeks, maybe months to recover and get strong enough to go home.

FRANGOUL: So how have you been doing?

GRAY: I'm doing good.

FRANGOUL: This is a big moment, friend.

GRAY: Yes.

STEIN: It's two months later. Victoria's still in Nashville. She's been living in an apartment near the hospital, but her new genetically modified cells have started working well enough to let her leave. She's finally going home to her family in Forest, Miss.

FRANGOUL: Excited about seeing the kids?

GRAY: Yes, I am.

FRANGOUL: Are they going to have a big welcome sign for you in Mississippi?

GRAY: No - because it's a surprise. No one knows I'm coming.

FRANGOUL: Oh, you did not tell them?

GRAY: No.

FRANGOUL: Oh, wow. So they don't know you are coming?

GRAY: No, no, no. I'm just going to show up tomorrow, like, Mama's home (laughter).

FRANGOUL: That's pretty good. OK. Let's check you out.

GRAY: OK.

FRANGOUL: Take a deep breath for me.

GRAY: (Exhaling).

FRANGOUL: Deep breath.

GRAY: (Exhaling).

FRANGOUL: OK.

STEIN: Before she leaves the hospital, the nurses need to draw some of Victoria's blood.

UNIDENTIFIED HOSPITAL EMPLOYEE #3: Ninety-seven-point-nine.

STEIN: This is a crucial part of the study. It's being run by two biotech companies and will eventually involve dozens of patients in the United States, Canada and Europe.

UNIDENTIFIED HOSPITAL EMPLOYEE #3: All right. So how many days have you been here?

GRAY: I think we're in, like, day 80.

UNIDENTIFIED HOSPITAL EMPLOYEE #3: Aw, I can't believe you're really leaving.

STEIN: As the nurses fill one big vial after another, I realize I never asked Victoria something.

Is it weird to have genetically modified cells in your body?

GRAY: No, I'm just genetically modified now (laughter). I'm a GMO. Is that what they call it? (Laughter).

STEIN: Finally, the nurses are done. It's time to say goodbye - for now.

UNIDENTIFIED HOSPITAL EMPLOYEE #4: Good job. You did it.

GRAY: Thank y'all. Y'all going to make me cry.

(LAUGHTER)

STEIN: Victoria will keep detailed diaries about her health when she gets home to Mississippi. Dr. Frangoul wants to know how much pain she's having, how much pain medication she takes - will she need blood transfusions?

FRANGOUL: We are very hopeful that this will work for Victoria, but we don't know that yet.

STEIN: So every month, Victoria will drive more than five hours back to Nashville to get her blood tested to find out if the edited cells are making enough fetal hemoglobin to make her better.

FRANGOUL: Victoria is a pioneer in this. And we are very excited. This is a big moment for Victoria and for this pivotal trial because if we can show that this therapy is safe and effective, it can potentially change the lives of many patients.

STEIN: Victoria hopes so, too.

GRAY: Not just for me but for other people - this would be mind-blowing. And - oh, my God - I can't imagine, you know, the lives that could be saved if this thing actually works.

STEIN: Victoria starts packing. Her husband is there to bring her home.

GRAY: I'm excited, you know? I'm very excited about it. I know it's going to be emotional for me. I miss the hugs and the kisses and just everything.

STEIN: She opens the closet door and starts laughing.

GRAY: Oh, my goodness. Did I really bring all of this? That's one.

STEIN: First suitcase done?

GRAY: Yes (laughter).

STEIN: Victoria is now heading into a period of limbo, waiting to find out if her gene-edited cells are starting to work. I asked her how she feels about that.

GRAY: Well, I'm spiritual, Rob. And it's something I prayed about. And just the way everything happened for me, I just feel like it was fate for me to be here. So I just believe that, you know, God is doing this for me. That's all I can say. So (laughter) - yes, pray.

STEIN: It's a foggy morning about a month later. I'm waiting in a parking garage in downtown Nashville.

GRAY: It's been a while.

STEIN: Yeah, it's been a while.

Victoria has just driven back from Mississippi for her first check-in.

So this is an exciting day for you, huh?

GRAY: Yes, it is.

STEIN: How are you feeling?

GRAY: I feel good. I'm hoping to get some good news today.

STEIN: From her doctor - she'll be getting the results of her latest blood tests.

Are you nervous at all?

GRAY: No, I'm not. No.

STEIN: No?

GRAY: Uh-uh - just about the needles (laughter).

STEIN: Victoria will have to get a ton more blood drawn today.

UNIDENTIFIED HOSPITAL EMPLOYEE #5: Can I help you?

GRAY: Yes, Victoria Gray for Dr. Frangoul.

UNIDENTIFIED HOSPITAL EMPLOYEE #5: Could you go ahead and sign in for me?

GRAY: OK.

STEIN: Victoria's wearing a black sweatshirt with big letters spelling out warrior.

I like your sweatshirt.

GRAY: Thank you. Yeah. You know, they call sickle cell patient warriors. And I saw this shirt at Walmart, so I had to get it (laughter).

STEIN: Oh, I did not know they called sickle cell patients warriors.

GRAY: Yes. Because it's a constant battle, you have to be to deal with it.

UNIDENTIFIED HOSPITAL EMPLOYEE #6: You can go on back now.

STEIN: Victoria finds an empty chair, sits down and stretches out her arm for the nurses.

UNIDENTIFIED NURSE: All right. So you're going to feel a stick on three. OK? One, two, three - stick. All right. So you should be good.

STEIN: As the nurses fill one big tube after another, I ask Victoria about her homecoming a few weeks earlier, when she got to see her four kids for the first time since she spent the summer in Nashville getting her genetically modified cells.

GRAY: My oldest son, when he did his double take and realized I was in the car, he took off running. And he just grabbed me and held onto me. Yeah. And the twins saw me from the inside the house. They knew it was Mama. This is emotional for me, you know, 'cause I love them so much. I did this for them. Yeah. So it's worth it.

UNIDENTIFIED NURSE: OK. All finished. You did great.

GRAY: Thank you.

STEIN: Victoria heads over to see her doctor.

FRANGOUL: How are you? How are you? You're doing all right?

STEIN: Dr. Haydar Frangoul.

FRANGOUL: OK, great. Let's check you out. Take a deep breath for me.

GRAY: (Exhaling).

FRANGOUL: Deep breath.

GRAY: (Exhaling).

FRANGOUL: Good job. Well, you look amazing, Victoria. You look really good.

STEIN: After the exam, Dr. Frangoul shows Victoria what she's been waiting for - the results of some of her blood tests.

FRANGOUL: So look at this. This is very exciting. Are you excited about it?

GRAY: Yes, I am.

FRANGOUL: OK. I am super excited about your results today.

STEIN: That's because, so far, it seems to be working. Victoria's genetically modified cells have started doing what they're supposed to be doing.

FRANGOUL: It looks like there are signs that you are starting to make fetal hemoglobin, which is very exciting for us.

STEIN: So far, nearly half the hemoglobin in her blood is fetal hemoglobin, that protein Dr. Frangoul hopes will help Victoria. And it looks like it's still rising.

GRAY: Oh, my goodness.

FRANGOUL: So I'm very, very proud of you. You are doing really well. Everything looks wonderful. OK?

GRAY: OK.

STEIN: The treatment seems safe so far, and there are clues that the edited cells may already be helping Victoria. She hasn't needed any blood transfusions since she got the cells, hasn't had any of those awful attacks of pain.

FRANGOUL: And you haven't been in the hospital since I last saw you, correct?

GRAY: No, it's...

FRANGOUL: That's good. Excellent. Perfect.

STEIN: And so is that because of the procedure - because of the cells?

FRANGOUL: Well, we are hoping it is. Again, it is too early to figure it out. But this is extremely encouraging. We are very happy that she didn't have any ER visits. She hasn't had any hospital stays since we've done the procedure. So this is really good.

STEIN: And is that unusual? Would you have expected to usually have a pain episode in this period?

GRAY: Of course. Like, with the time that passed by, I would at least have had something. You know?

STEIN: Wow. That sounds amazing.

GRAY: Yeah, it is for me. It's special, especially coming up on the holidays 'cause sometimes I would be in the hospital on Christmas. And so I'm looking forward to a whole new life for all of us.

STEIN: The same kind of CRISPR-edited cells also seem to be helping a patient in Germany who got them for a similar genetic blood disorder called beta thalassemia. But Dr. Frangoul knows he has to be cautious.

FRANGOUL: It is still too early to celebrate. I just want to make sure this is something we watch very carefully every visit and see how things are going.

STEIN: Doctors will have to follow Victoria for years and study many more patients to answer the big questions. Are the cells really helping patients live healthier lives? Will they keep working? Will they keep working safely? And will they actually help patients live longer?

FRANGOUL: This would be life-changing, not only for Victoria but for many sickle cell patients - because if this is determined to be safe and effective, I think it can be transformative for patients with sickle cell disease.

STEIN: That seems life-changing for her, really.

FRANGOUL: Yes, it definitely does - although it is too early to celebrate. So we are observing her very carefully to see how she does.

STEIN: Other kinds of genetic therapies are also showing promise for sickle cell, a disease long neglected by medical science. The problem is they're all complicated and expensive. Will they be practical and affordable - here and especially in poor countries where these diseases are most common? Francis Collins heads the National Institutes of Health.

FRANCIS COLLINS: The progress that we've seen for sickle cell disease, including Victoria Gray and her involvement in this, made it clear that if this is starting to work, we need to get busy and figure out how to take it to the next level. To be able to take this new technology and give people a chance for a new life is a dream come true for those who've waited a long time. And here we are.

STEIN: And Laurie Zoloth, the University of Chicago bioethicist, she still worries, especially when it's just one patient who was only treated a few months ago - and especially when it involves African Americans, who've been mistreated by medical studies in the past. She worries about creating false hope.

ZOLOTH: So far, so good. And of course, that's great news. I hope it works. I hope she's free of this disease. And I hope this very brave woman has a life of joy and freedom from pain and can raise those beautiful children. But it's still very early days. We're still waiting for the real news, which is this is the definitive cure; this will help many, many thousands of people. It would be a wonderful thing for humanity.

STEIN: Other doctors already are trying to use CRISPR to treat cancer. And for the first time, a team is planning to edit genes with CRISPR while they're still inside the body. They hope to restore vision to people blinded by a rare genetic disorder.

(SOUNDBITE OF MUSIC)

STEIN: As for Victoria, she says she knows this is just the beginning. But she's happy it's going well so far.

So your supercells seem to be working.

GRAY: Yeah, they seem to be super after all, huh? (Laughter). Yes.

STEIN: Victoria is already doing things she never did before. Like, she got to go to one of her son's football games for the very first time.

GRAY: You know, the simple things in life - I don't really want anything extravagant. I just want a simple life with my family - you know, people that I love and people that love me - and just live. You know?

(SOUNDBITE OF MUSIC)

GRAY: This could be the beginning of something special (laughter).

(SOUNDBITE OF MUSIC)

SHAPIRO: This story was reported by NPR health correspondent Rob Stein, produced by Jane Greenhalgh with help from Maria Paz Gutierrez and edited by Joe Neal (ph). We'll continue to follow Victoria Gray's journey. Transcript provided by NPR, Copyright NPR.