Taeho rose to his feet, clenching his fists. But soon a practical problem came to mind, and he sat back down. As his excitement subsided, the cool judgment of a physician returned.
“Wait. Rema, can fucoidan be administered intravenously? Look up its safety profile for me.”
-Searching…
Rema’s answer came later than usual.
-1,247 papers found related to intravenous administration of seaweed extracts.
-Analyzing clinical cases…
-It is a complicated issue. The safety of oral fucoidan administration has been proven, but intravenous administration is a problem on an entirely different level.
A holographic screen unfolded before his eyes, and various research data appeared.
-First, there is the issue of molecular weight. Fucoidan is a high-molecular-weight polysaccharide, with a molecular weight ranging from 10,000 to 100,000 daltons. Administering such giant molecules directly into the blood vessels carries the risk of thrombosis or embolism.
Taeho pressed a hand to his forehead.
“Right. How did I miss something so basic?”
-Second, there is the immune response. If seaweed protein impurities are included, there is a possibility of anaphylactic shock. In particular, the patients’ immune systems are already activated due to infection.
“I expected that much.”
-Third, there are concentration and dosage. With oral administration, the absorption rate is naturally regulated during digestion, but intravenous administration is reflected one hundred percent in blood concentration. Calculating the proper dose would be extremely difficult.”
Taeho clutched his head. It felt as though the hope that had briefly shone bright had crashed into the wall of reality.
“Then are you saying there’s no way?”
-Searching further.
Another long silence passed. This time, it took nearly two minutes.
-I have found some possibilities. In 2019, a research team at Pusan National University in Korea attempted intravenous administration in an anticancer study using low-molecular-weight fucoidan.
The light returned to Taeho’s eyes.
-However, they used medical-grade fucoidan that had undergone a special purification process to reduce its molecular weight to below 5,000 daltons and completely remove endotoxins. They also administered it only at a highly limited dose of 50 mg per kilogram of body weight.
“You mean the manufacturing process is complicated?”
-Yes. It is impossible with ordinary fucoidan extract, and it would require at least seventy-two hours of purification in a GMP facility. The estimated cost is about five million won per patient.
Taeho gripped his head and let out a groan.
There’s far too little time and money.
After remaining that way for a moment, Taeho suddenly raised his head as if something had occurred to him.
“Is there another method besides intravenous administration? You said oral administration would be too slow to absorb, right?”
-Yes, judging by the patients’ condition data, that is the case.
-Then what about rectal administration? The rectal mucosa is rich in blood vessels, and because it bypasses hepatic metabolism, its bioavailability is high. Besides, it’s safer than intravenous administration.
-Reviewing rectal administration…
-Searching research data on rectal absorption of fucoidan…
This time, the answer came after about a minute.
-It is highly promising. According to a 2021 study by the Japanese Seaweed Research Institute, rectal administration in the form of fucoidan gel showed a blood concentration 3.7 times higher than oral administration. The only reported side effect was mild rectal irritation.
Taeho’s face brightened.
“But to manufacture it in gel form…”
If they had been in Samcheok, where the Geumsan Research Institute was located, they could have made it quickly, but this was Brest, France.
“Let’s ask the hospital pharmacy first. Whether they can make it on the spot here.”
Taeho ran down to the emergency room on the first floor.
The emergency room was utter chaos. It was because of the twelve additional food-poisoning patients.
“Start an IV line on Bed Two!”
“His oxygen saturation is dropping!”
“This patient’s blood pressure has fallen below eighty!”
The nurses were rushing about frantically, trying to care for multiple patients at once.
Professor Durand was at the central monitoring station in the emergency room, checking several monitors at the same time as he directed the staff. As expected of someone with thirty years of experience, he did not lose his composure even in such a chaotic situation.
“Marie, triage the severe cases first. Send the mild cases upstairs first!”
“Yes, Professor!”
Taeho pushed through the chaos and approached Professor Durand.
“Professor Durand!”
Professor Durand briefly raised his head. His face clearly showed fatigue and tension.
“Dr. Kang, you’re here. All the patients here have the same symptoms. They say they attended the academic conference banquet.”
“Professor, I found a treatment.”
Just then, a nurse hurried over.
“Professor, the patient in Bed Three’s level of consciousness is dropping rapidly!”
Professor Durand immediately got up and ran to the patient. Taeho followed him.
The patient was a man in his forties, and he was already losing consciousness. The moment Taeho saw him, he knew instinctively.
‘This patient has the same virus too.’
Professor Durand checked the patient’s pupils with a penlight and gave instructions to the nurse.
“Send him for an emergency brain CT, and run blood tests STAT!”
“Yes! Understood!”
At that moment, another nurse came running.
“Professor, the patients in Beds Seven and Eleven are becoming confused as well!”
Professor Durand’s face hardened. Several patients were deteriorating at the same time.
Taeho seized the opportunity.
“Professor, CT scans and blood tests won’t find the cause in these patients. I’ve found a way to make a treatment.”
“A treatment?”
“Yes. I can make it within two hours.”
Professor Durand frowned and hesitated for a moment. If he had been his usual self, he would never have made such a reckless choice. But the patients were only getting worse, and no matter what method they tried, there was no improvement.
Above all, this was Kang Taeho. The man who had treated President Ibrahim of Gambia by a method no one else had imagined.
“All right. Start immediately. But it cannot be administered to patients without consultation with the pharmacy department.”
“Understood.”
Taeho immediately made a call.
“Gihwan, where are you right now?”
“I’m at the hotel. I was already waiting for news from you, Director.”
“Come to the emergency room at Brest University Hospital right now. When you come, bring every fucoidan sample from the Geumsan Research Institute that we brought with us!”
“The samples?”
“It’ll take too long to explain. Just hurry over first!”
“Yes!”
Fifteen minutes later, Gihwan got out of a taxi with a bag slung over his shoulder. He hurried into the emergency room entrance.
“Gihwan, did you bring the samples?”
Gihwan opened the bag and showed him several vials.
“Yes. They’re GMP-grade Fucoidan-5K that I received from the Geumsan Research Institute for the presentation. But why this…”
Taeho quickly explained the situation. Gihwan’s expression grew increasingly serious.
“Is that true? The virus targets dopamine receptors?”
“Yes. That’s why we need fucoidan. We can make a treatment with this.”
Gihwan examined the vials.
“They’re samples, but there’s enough in terms of quantity.”
“Good. Let’s go to the pharmacy department right now. We don’t have time.”
In one corner of the emergency room, another patient was losing consciousness.
Taeho tried to calm the urgency that kept rising within him.
The pharmacy department at Brest University Hospital.
Sophie Leclerc, the pharmacist on night duty, hurriedly opened the door for them. Since it was the first time so many people had suddenly crowded into the normally quiet nighttime pharmacy department, she was extremely tense.
“You’re Dr. Kang, right? I was contacted by Professor Durand. I’m Sophie.”
“Yes. Hello. This is Dr. Seong Gihwan, who came with me.”
Sophie and Gihwan quietly exchanged greetings with their eyes. It seemed that Sophie, like Gihwan, was extremely introverted.
Taeho spoke.
“The patients’ conditions are continuing to worsen, so we need to make a special treatment immediately. Gihwan, please take out the vials.”
“Yes.”
Gihwan answered in a barely audible voice and took the vials out of the bag, handing them to Sophie.
Sophie took a vial and read the label.
“Fucoidan-5K, GMP grade… What is this?”
“It’s a specially purified fucoidan developed by the Geumsan Research Institute in Korea. It’s been refined to medical grade.”
Gihwan explained in a voice as small as a mosquito’s.
Taeho immediately asked.
“Sophie, can we use the compounding room right now?”
“Yes, but this is my first time with something like this, so I’m not sure what formulation we should make…”
When Sophie hesitated, sounding unsure of herself, Gihwan stepped forward.
“I’ll help you. I researched drug delivery systems in graduate school.”
“Oh, really? Then let’s try it together. Let’s go to the compounding room first.”
Sophie looked relieved, as if a weight had been lifted from her shoulders.
When they entered the compounding room, Gihwan’s eyes sparkled. The pharmaceutical equipment at the French university hospital, lined with the latest devices, was far better than he had expected.
“Wow, the equipment here is really good. There’s even a rotary evaporator, and the latest freeze dryer…”
“We don’t have time to be impressed right now. First, we need to check the concentration.”
When Taeho spoke urgently, Gihwan tapped his own head with his hand.
“Yes. Let’s begin.”
Gihwan quickly took a small amount from a vial with a pipette and placed it in the spectrophotometer.
“Hmm. The concentration is 50 mg/ml, Director.”
“Then, assuming the patient weighs sixty kilograms, we’ll need about 300 mg per dose.”
As Taeho calculated the dosage, Sophie, who had been listening beside him, quietly raised her hand.
“We’re making it into suppositories for rectal administration, right?”
“Yes, that’s right. Do you have a PEG base?”
“We do. PEG 1000 and PEG 4000.”
“We’ll need both. We have to adjust the ratio to match the melting point.”
Gihwan began preparing the materials together with Sophie. Perhaps because they were both suited to laboratory work, they coordinated smoothly.
Taeho was more worried about how quickly the patients’ conditions might deteriorate.
“Gihwan, can you do it within two hours?”
“Don’t worry. I’ve done this kind of work hundreds of times in the lab.”
Gihwan placed PEG on the electronic balance and measured it precisely.
“PEG 1000 at sixty percent, PEG 4000 at forty percent. With this ratio, it should melt at body temperature and maintain a solid form at room temperature.”
Watching him, Sophie clasped her hands in front of her chest in admiration.
“You really are an expert. We usually use ready-made bases, so we don’t calculate it this far.”
“It’s an emergency, so we have to optimize it.”
As Gihwan melted the PEG mixture in a water bath, Sophie prepared the fucoidan solution.
“Fucoidan might be heat-unstable, so we can’t let it go above sixty degrees.”
“It’s fifty-five degrees.”
“Perfect.”
Gihwan slowly added the fucoidan to the melted PEG and mixed it evenly.
Sophie prepared the suppository molds.
“I’ve prepared twenty two-gram molds.”
“Good. The mixture temperature has dropped to forty degrees. We can pour it into the molds now.”
Gihwan carefully poured the mixture into the molds. The amount had been calculated so that each suppository would contain exactly 300 mg of fucoidan.
“Now we just need to cool them in the refrigerator for thirty minutes.”
While they were cooling in the refrigerator, Gihwan separately prepared a sample for quality testing.
“Sophie, can we do a dissolution test?”
“Of course. Let’s test the dissolution in artificial body fluid.”
“Great!”
When they placed the sample in artificial body fluid at thirty-seven degrees, it dissolved completely in just fifteen minutes.
“It came out well.”
“It looks like it’ll dissolve quickly inside the body.”
Gihwan and Sophie looked at each other, delighted. The two of them had grown close in no time, as if they had never been awkward with each other.
Thirty minutes later, they took out the completed suppositories. They had been molded into neat cone shapes.
“Complete!”
Gihwan said proudly.
Sophie picked one up and looked at it with shining eyes.
“It was made really professionally in such a short time. It’s not much different from a commercial medicine. Amazing.”
Taeho nodded.
“You both worked hard. Shall we try using them on the patients now?”
Just then, Taeho’s phone rang. Professor Durand’s urgent voice came through.
-Dr. Kang! Come here right now. Professor Yamada’s condition is deteriorating rapidly!