Dr. Paul Feorino

CHAMBERLAND: This is Dr. Mary Chamberland, and I'm here with Dr. Paul [M.] Feorino. I'm interviewing Dr. Feorino in his home in Clarksville, Georgia. Today is Thursday, May 10, 2018. I'm interviewing Dr. Feorino as part of an oral history project to document CDC's early response to the AIDS epidemic. I'm also joined by Dr. Harold [W.] Jaffe, who is serving as an advisor to the project. Dr. Feorino, welcome to the project. Do I have your permission to interview you and to record the interview?

FEORINO: Yes. Yes.

CHAMBERLAND: Thank you. Dr. Jaffe, do I have your permission to include you in this interview as well?

JAFFE: Yes.

CHAMBERLAND: Paul, you first came to CDC in 1957 as a Research Microbiologist in the Virology Section's Enterovirus Unit. You worked some 24 years before the first cases of what would become known as AIDS were reported in the June 1981 00:01:00Morbidity and Mortality Weekly Report [MMWR]. AIDS then became the focus of the last ten years of your CDC career. However, before we talk about all this, let's start at the beginning. Could you tell us where you grew up and about your early family life?

FEORINO: 1929, February, Brooklyn. It was before the Great Depression. That came later, in the months of October-November. It was while they still had Prohibition, although in New York City in Prohibition, we probably had over 1,000 speakeasies in Manhattan. You had a lot of immigrants at that time, none of whom were against drinking, and I don't know anyone who really didn't 00:02:00[drink]. Grandpa made wine before, during and after [Prohibition]. Made pretty good wine, good table wine.

I grew up [with] immigrants, of course, second and third generations, and it actually was a very good place to grow up. The neighborhood was stable. All my friends had parents, and during the Depression, they had a job, so we weren't at the lowest strata.

New York City schools were great. During the Depression, getting a job as a solid -- teacher, a good solid job, that was priceless. High school, they had 00:03:00special high schools. The Bronx had the School of Science, and the school I went to majored mostly in math. We had Ph.Ds. teaching, and they didn't have Ph.Ds. in education. Dr. Dinsmore had [a degree in] chemistry, and he wrote the chemistry book. Dr. Wyrak was the biology teacher. The physics teacher had a degree from Freiburg [Albert Ludwig University of Freiberg], and he had a dueling scar. The history teacher had a radio program as a news commentator. So, you really had very good teachers, and of course, you had good kids and concerned parents. The kids' health was important, but after that it was school, 00:04:00and there was nothing second. You had to do good in school, and that was the way out.

CHAMBERLAND: Paul, after what sounds like a very interesting time growing up in New York City in Brooklyn, where did you end up going to college and graduate school, and what did you study there?

FEORINO: First of all, in our neighborhood, people didn't get sent to college. It was a very low percentage. But at that time the government had the GI Bill, 00:05:00and so I joined the Army. I was a little ahead [in school], so as soon as I turned 17 after high school, I joined the Army, and that's the way I got the GI Bill. While I was in the Army, when you came out, they had a program. If you scored more than 140 on some test, the AGCT [Army General Classification Test] -- I don't know whether it was an intelligence test, although intelligence and the Army don't quite go together [LAUGHTER] ---but if you scored over 140, your regimental commander could recommend you for West Point. But you had to join one-year pre-post, four years at the Point, three years post. It would be eight 00:06:00years, and the two or three years I had already would have-- so, I inquired, and they said, "Oh, yes."

They were interested in tropical medicine at that time, and possibly I could be sent to medical school or to graduate school, but [it would take] ten, eleven years. Also, when I joined up, I had signed up for the Airborne, because jump pay was fifty dollars. Hell, for a hundred I would have jumped without a parachute [LAUGHTER]-- but that would be about four hundred, five hundred dollars now. I mean, money was important during the Depression. Okay, the Army then decided they needed warm bodies. I took pre-jump training in Fort Knox, [and then] went to [Fort] Benning and took the first couple of weeks. Then Korea 00:07:00got kind of funny, and they decided-- they made the sign of the cross and you became infantrymen. I figured when I finished my Point, West Point, I would have applied for medical school or graduate school. If they had too many [docs], they would have stuck me wherever they pleased.

I got mobilized out, and I looked for college in New York City, because then I could live at home and save money. I tried St. John's [University] and Columbia [University]. I got accepted to both of them, but St. John's was two hundred dollars a year less and closer to where I could get a job, so I went to St. John's. I usually got through by 5:00. Then there was a racetrack near my home, 00:08:00Roosevelt Racetrack, and I got a job there. That started at 6:00 and went to 11:00, so every day I went -- I'm the only college student who went to the racetrack every day. We did light maintenance and clean-up. If something broke while it was going on, the major work got done during the day. So that's how I got through St. John's and worked at the racetrack. That was from April through November. In December, I worked at the post office.

Then there was an opening up in Albany, [in the] Division of Laboratory and Research, and we took a test for that. Two of us, me and [Dr.] Fred Rapp, who 00:09:00was a well-known herpes virologist for years -- he died a little early of stomach cancer. I went up to work there, and I worked in the bloodwork lab for about three months. Dr. [Gilbert] Dalldorf, who was the discoverer of Coxsackie virus, put me on his staff. At that time, the only way of passing polio [virus] was in chimps and IC [intracerebral]. A few years before, Dr. [John F.] Enders with [Dr. Frederick C.] Robbins and [Dr. Thomas H.] Weller had written that you could transfer polio in human or monkey fibroblasts. The field would not have 00:10:00been possible without that. They got the Nobel Prize for that. Okay.

Also New York had a program [that] if you were a [veteran] vet, each county could get a scholarship for graduate work. I took it, and I got it. It was $1,400 for four years. They covered four years, $350 a year. There's been somewhat inflation. Anyway, I was very lucky because I got to do tissue culture, and that was the first -- that was one of the big changes in the field.

JAFFE: Where was it that you went to graduate school?

FEORINO: Siena [College]. I worked from 8:00 to 5:00, 5:30 actually; 6:00, 00:11:00Siena, 6:00 to 11:00 every day. You got to do the tissue culture for the first time, and at first -- it was before HeLa cells -- so you used either primary monkey, or in our case, we didn't have an animal facility, we didn't have any of that, so I used human tissue. I got some hysterectomies from across the street at Albany Medical [Center], and I put plasma in the bottom of a little T-75 tube with enough heparin to just barely keep it from clotting. Then you minced up the 00:12:00uterine tissue, and that's hard tissue, and--

CHAMBERLAND: Very muscular.

FEORINO: -- put that into tissue culture fluid with extracts. Then you put it in with a bent eyedropper and put it along the bottom of the tube, and the extract causes it to go into a clot. Now you have little bits of maybe 2-3 milliliter (mL), and it stuck. Then you put tissue culture fluid in it, and then you look at it with a microscope. First the epithelial cells come out, and they die off, but then fibroblasts start coming out. Polio and some other of the enteroviruses will kill it, and you've got a cytopathogenic effect, CPE. This allowed us to 00:13:00take and study eighty, one hundred, two hundred patient entities instead of two hundred chimps you couldn't have done it. And that's the way we started. Then later we got the monkey facilities, and we switched over to monkey kidneys, and you could get about 1,500 tubes out of a monkey.

CHAMBERLAND: It sounds like a real art form.

FEORINO: Oh, it was, it was. I was also lucky. [Dr.] Dalldorf got one of the first ultracentrifuges, a diagnostic ultracentrifuge; not a two-tenths of an mL but you could put 100 mL in. It was a Spinco. They got bought out by Beckman [Instruments]. But for $3,000 you got three rotors and the machine. They were 00:14:00aluminum, so they weren't bad. There wasn't any tungsten at that time. We could spin down the pure virus, and I did some sizing. Depending upon the velocity of the particle coming down, you can measure it. All the Coxsackies I did were 20 to 30 [millimicrons or mμ], except this one kept coming out wrong. It turned out it was [echovirus] echo 10. It was a hundred [millimicrons]. I did that seven times before I realized it was rhinovirus. Okay. While [I was] there, I got one promotion. Oh, I worked for the magnificent sum of $3,291.

CHAMBERLAND: That was your salary?

FEORINO: Per year. Now, [with] inflation, probably about six, seven, so that's about $20,000. At that time, I had already had a couple of kids. I went to the office-- I saw it on a bulletin board, CDC was starting the polio program. I applied for that, and, typical government, I applied in August, and I heard not a word until June. They called up and said, "Can you come next week?"

CHAMBERLAND: That does sound typical!

FEORINO: I didn't feel that was right. I had to give the people up in Albany at least a month [notice]. I came down, and I was hired by [Dr. Seymour S.] Sy Kalter.

JAFFE: What year was it that you came to CDC?

FEORINO: '57 actually, and [Dr.] Morris Schaeffer and the virology were all down in Montgomery. There was no virology up in Atlanta at all.

CHAMBERLAND: Montgomery, Alabama?

FEORINO: Montgomery, Alabama.

CHAMBERLAND: Was where CDC's virology labs were located?

FEORINO: Yes, that was the lab down there. They had a few things up here, but the virology lab was down there. So, I get hired, and I said, "What do you need?" What they wanted me to do was make reagents for all 48 states, 48. I needed antigen and antibodies so they could test out the vaccine. The only test 00:17:00that most labs could do at that time was a complement fixation test, which consisted of the wing of a bat and the eye of a newt [LAUGHTER}, and you stirred it. What you did was, you took the purported antigen and antibody, and if there was an antigen-antibody complex, it would fix complement, and you'd put a certain amount of the complement in. Okay, then you took a second system, you took sheep cells, anti-sheep cells, and that would lyse in the presence of complement. If you used up all the complement, it wouldn't lyse. If you hadn't used it, it would lyse. That's the way you measured. If you made really good 00:18:00antigens, you could use them 1 to 4, 1 to 8, as opposed to doing the IFA [indirect immunofluorescent antibody] test. At least it was 50 to 100.

Okay, we made it; we'd go out to -- let me go back. Up in Albany we had a building with wood paneling, granite lab slabs, and they had gardens outside with a gardener who clipped. I come to CDC figuring it's going to be more magnificent than that. I go out, and it's Lawson General Hospital -- in 1945, they shut it [down]. It had been a hospital for patients, I think, who were like 00:19:00convalescent, and they had a bunch of bungalows with covered runways. Then nothing is [as] immortal as a government agency. When that ended, they found a use for that building, and then CDC had some people out there.

Dr. [Ralph B.] Hogan was in charge of the whole group, but there was no building for virology. I went there one Sunday to find a place, and I got a key and went in, and it was all dirty and the flowers [were] growing up through the floor. I washed my hands, and my legs got wet because they'd taken all the traps out, and they had brine lines for air conditioning. The brine will find a way out. It 00:20:00broke down. Every couple of months the brine lines leaked, and if you were lucky, it didn't go on your equipment.

CHAMBERLAND: This former Lawson General Hospital is in Montgomery?

FEORINO: No, no, this was up in Atlanta.

CHAMBERLAND: Now you're in Atlanta.

FEORINO: Yes. I was hired for Montgomery, but then I came up here. Peachtree and Seventh Street.

JAFFE: What year was it that you moved to Atlanta?

FEORINO: '57.

JAFFE: You were not in Montgomery for very long?

FEORINO: Oh, no. I just went there to see Kalter and Morris Schaeffer, and they just shipped me back up. I didn't work there. That's where I had to go see them.

CHAMBERLAND: Oh, I see. Okay. So, the lab facilities were in Atlanta, [at] 00:21:00Peachtree and Seventh?

FEORINO: Yes. The headquarters was at Peachtree and Seventh, and we had this little thing out on Buford Highway.

CHAMBERLAND: Was that actually where the virology lab was, on Buford Highway?

FEORINO: There was nothing virology up in Atlanta at all.

CHAMBERLAND: Oh.

FEORINO: But there was some sort of facilities.

CHAMBERLAND: Okay.

FEORINO: There were some people who were up there.

CHAMBERLAND: This Lawson General Hospital, that was where --

FEORINO: The precursor to what we got out on Buford Highway, that was World War II.

CHAMBERLAND: Okay. Okay.

FEORINO: I'm sorry.

CHAMBERLAND: No, no.

FEORINO: It's very clear to me.

JAFFE: We don't know the history.

CHAMBERLAND: We're very bad, obviously, in knowing the details of CDC's early history. And this is really early history.

JAFFE: CDC took over an old army hospital and converted it for your virology laboratory?

FEORINO: No, not only for virology. They took it over, and there was some 00:22:00science [that] was going on up here, but the virology was being done in Montgomery, Alabama. I was [one of] the first people up here. Me and [Dr. Milford H.] Pete Hatch. He got sent up here very early. Kalter stayed down in Montgomery, and then he would come up, and Morris Schaeffer would come up and visit, but basically, I was on my own.

CHAMBERLAND: You were being tasked with making reagents.

FEORINO: Yes, and I had no virus, no antibodies, no equipment. I went to Hank Talbot, who had the equipment, basic equipment, racks, rubber tubing, [and] 00:23:00Bunsen burners. He was an old army quartermaster, and he was very helpful. When you walked in the door, his head was shaking "No" before you asked him. I could see the equipment. They had a whole warehouse full. This was a Friday, and he said he didn't have anything, so I went home on Friday. On Saturday, I went to Sears, and I got a cart. On Saturday I took my jimmy bar and busted his lock. I spent all day Saturday bringing equipment into my lab.

JAFFE: Oh, my gosh.

FEORINO: After I finished that, Monday Dr. Hogan came in and said, "Did you get everything you needed?" I said, "Yes, sir." And he said, "Don't do it again." [LAUGHTER] And that was the way I equipped the lab. I had to get tissue culture 00:24:00bottles --

CHAMBERLAND: You're setting up shop on Buford Highway?

FEORINO: On Buford Highway, building 58.

CHAMBERLAND: Building 58, okay.

FEORINO: Then I hired a couple of people, and we had to make reagents.

CHAMBERLAND: Okay. The reagents, were they just for the poliovirus, or were they for other viruses?

FEORINO: I made some for all the enteroviruses, but basically the bulk was for polio. I made some good rabbit and monkey antibodies, and I had some human, but that was limited. We needed good human positive sera. Pete Hatch had a good titer against [poliovirus] type 1. Lloyd Sellers, a tech, had a good titer against [poliovirus type] 2, and I had a good titer against [poliovirus type] 3. 00:25:00Dr. Marian Candler took blood from us.

CHAMBERLAND: Who is Dr. Candler?

FEORINO: Yes, she was one of the Coca-Cola Candlers and a pathologist at CDC. Did you ever meet her?

CHAMBERLAND: I don't think so.

JAFFE: No.

FEORINO: Oh, God, she'd talk your ears off. A good pathologist but talked more than me, for God's sake, if possible. All right. We did that, and then we followed up with studying the effects of the vaccine. About that time, about 1960, we moved into building 7.

JAFFE: This was on the Clifton Road campus.

FEORINO: Clifton Road, yes. The building had been set up for arbovirus and a 00:26:00whole bunch of things, but we made do. [Dr.] Henry [M.] Gelfand was the head of the unit, and I did most of the tissue culture, IFA and all that. The next year or so we did vaccine evaluation. You give one hundred thousand small kids a shot of anything, and next year you've got three hundred thousand cases of something. My job was to sift out what was [related to] the vaccine and what wasn't the vaccine.

CHAMBERLAND: Looking for contaminants that were causing problems?

FEORINO: No, no, no. Just the kids. They got Coxsackie virus, they got adenovirus.

CHAMBERLAND: Oh, I see what you're saying. They came down with other illnesses.

FEORINO: Yes, and we would get--

CHAMBERLAND: --that were close in time to the vaccine.

FEORINO: Some of the enteroviruses looked kind of like polio, and polio doesn't always present with paralysis. So, we were doing that, and the vaccine was pretty good. We reported a couple of times and worked with [Dr. Albert B.] Sabin. And Dr. Sabin -- this one week we were reporting them, and all week long -- and you know, I was like a second lieutenant and he was a field marshal -- and Monday, Tuesday, Wednesday, Thursday I showed this could not be a vaccine. It grew in monkeys; it grew in baby mice -- it's a Coxsackie. Okay, Friday came, 00:28:00and [Dr. James H.] Jim Nakano and I had worked. There were about six of them that possibly were a vaccine, and more or less he said, "How can you be so stupid?" "Dr. Sabin, you've been patting me on the head all week long, what the hey." Henry Gelfand was part of that. He shouted--he said, "Now, come on, you know, cut it out." And he was friends with Sabin. But really it was a good vaccine, it was only a few [vaccine-related cases], but Sabin wouldn't even allow us a couple.

CHAMBERLAND: These were a live virus, a live[-virus] vaccine that may have transmitted the disease to a small number of children.

FEORINO: Yes. He kept saying, "Come on, Albert, cut it out." Then he said, 00:29:00"We'll try putting into chimps and see." I'm saying, "Yes sir, yes sir." Henry said, "Let's see, you put it into chimps, and [if] it makes the chimps sick, it gives them -- that's obviously not the vaccine, and if it doesn't, it can't cause disease."

CHAMBERLAND: I had no idea that CDC worked so closely with Sabin.

FEORINO: I'm sorry?

CHAMBERLAND: I had no idea that CDC worked closely with Sabin on some of these--

FEORINO: Some of them, yes -- with Sabin. Actually, in the beginning, there were maybe 15 labs that did enterovirus when I started with Dr. Dalldorf. There were [Dr. Joseph L.] Melnick, [Dr. Hilary] Koprowski, Sabin, [Dr. John] Fox, [Dr. Edwin H.] Lennette. There was a very small community.

CHAMBERLAND: I was going to say, that's very small.

FEORINO: I met [Dr. Jonas E.] Salk, but I worked with Sabin. I saw Sabin at NIH [National Institutes of Health] just before he died, and I went up to him and said, "Excuse me, Dr. Sabin, I'm sure you don't remember me." You know, I remembered Sabin. He looked -- I had my badge on -- and he said, "Of course, Paul, I remember all the old friends."

CHAMBERLAND: Along the time that you were working at CDC in the early-mid '60s, you got a Ph.D. from Emory.

FEORINO: Yes.

CHAMBERLAND: Were you simultaneously working on your Ph.D. while doing all this work?

FEORINO: I took no vacation for quite a few years and worked fifty, sixty, 00:31:00seventy hours [per week]. Yes, it was interesting. I took the first two years of med school at Emory. I took bacteriology, anatomy, physiology and all. I also taught in bacteriology, and Emory charged me full price anyway. They were a bunch of money grabbers. Yes, and it took me seven years.

CHAMBERLAND: To get the Ph.D.

FEORINO: Yes.

CHAMBERLAND: Was your doctoral thesis on work you were doing at CDC?

FEORINO: Yes. Luckily, I was trying to find out the genetic analysis of the enterovirus. I was trying to see if there was any common grouping, so we wouldn't have to use 50 antisera. I found some crosses I called 1-8-11, but 00:32:00nothing that was usable. That was so primitive compared to -- I mean, before I retired completely, you made a DNA [Deoxyribonucleic acid] prep, you put it in a machine, and it told you each amino acid. The way I was evaluating how closely [related] they were to each other was, you grew the virus up--You made high-titer serum, then you did a plaque reduction test and found the slope of inactivation and then measured the value of inactivation. I mean, come on. Then you looked at the color of their eyes. [LAUGHTER]

CHAMBERLAND: Clearly, your career just spanned a time when virology was 00:33:00evolving, growing by leaps and bounds.

FEORINO: Oh, it was extremely primitive. Then we saw polymerase [chain reaction, PCR], which changed everything again. Tissue culture changed the diagnostic virology tremendously. Polymerase changed the DNA. It wasn't the same again.

CHAMBERLAND: How was that?

FEORINO: It enabled you to grow very little virus. I mean, I was working on hepatitis, and I'd spin down huge amounts of serum, hopefully. Then I'd put them into bags where we dialyzed the water out, and you did thirty-seven steps to get 00:34:00it. Then with the polymerase, you could take HIV [human immunodeficiency virus], which is not very much compared to the other viruses, and you can make it. I did some of that type of work when I was in graduate school. You put all the reagents in, you put in the enzyme, and then you heat it up, and the enzyme died. Then you repeated it with a new enzyme, and you had to put enzyme in each time, and you'd do that 30 times. It's expensive as hell and time-consuming, whereas now the enzyme doesn't go away.

CHAMBERLAND: Doesn't go away.

JAFFE: This is PCR.

CHAMBERLAND: For PCR, polymerase chain reaction.

FEORINO: Yes.

CHAMBERLAND: You mentioned AIDS, so maybe it's a good time for us to get into 00:35:00the AIDS era. Twenty-four years working on a variety of other viruses, and as I mentioned, in 1981 the MMWR comes out, talking about this cluster of unusual cases of Pneumocystis pneumonia in homosexual men. That's June 1981. How and when did you start to get involved in the laboratory work related to the new disease?

FEORINO: I'd been doing white blood cell lymphoma and mostly working with EBV [Epstein-Barr virus] and Burkitt lymphoma. I'd been growing white blood cells, and I truthfully don't know when I got switched over. I don't know when [Dr. James] Jim Curran did it. I never saw any paper[work] that I [had] transferred. All I know is, I ended up -- and it was probably around '82.

This outbreak was different from anything I remembered. I mean, most outbreaks, you trace the patients. Patient A gives it to patient B, and patient B gives it to patient C. With the AIDS, there was none of that. Your [Harold Jaffe's] paper in '85 showed up to five years, and it [was] open-ended. So, he gave it to him and then five years later he gets sick. How can you --

CHAMBERLAND: Long incubation period.

FEORINO: Yes. It doesn't show up in the epidemic. Then you have Ebola, and you get a disease. You get various aspects of the disease. But with this, you get 00:37:00Pneumocystis, you get Kaposi's [sarcoma], you get thrush, you get hepatitis B, you get hives. So, we didn't have a disease, and we didn't have a patient to patient [transmission]. The other thing we didn't have is -- you have a flu outbreak, and it stops when the summer comes on -- this kept going. Polio was a summer disease. There was no stop [seasonality], so it was continually going. It's a good thing we had a well-developed epidemiological [epi] group who had a lot of experience, a lot of contacts, and we had a good -- the best in Atlanta 00:38:00and then outliers. We were the best trained for that outbreak. At first, it looked like it had to be something like poppers, because where you can't see the transmission, the only thing we had was that they were gay. So maybe something gays do, you know?

CHAMBERLAND: You come onboard maybe sometime within six months of that first MMWR case report, and you're obviously tasked with trying to find what's causing this. What did you do? What were your initial thoughts? Were you thinking this could likely be a virus?

FEORINO: I actually have my original notes.

CHAMBERLAND: You do?

FEORINO: Yes. We had a meeting with [Dr.] Walter Dowdle and [Dr.] Ken Hermann, 00:39:00and I outlined how I would go about an unknown, okay, because that's what my life had been -- unknowns, white blood cells, etc. By the time '83 came around, [Dr. Robert] Gallo had insisted that it was HTLV-II [human T-cell lymphotropic virus] and this was already limiting -- I'm beginning to catch a little hell for not isolating it. It didn't make a heck of a lot of sense, because when I had a leukemia specimen, you get a tube this big, you get a white blood cell plug this big. You just put it on the ledge, and the white blood cells are that much, so 00:40:00[it's from] a leukemia patient. But these people, they've got HTLV-I, but I can't find the white blood cells.

CHAMBERLAND: Right, because the HTLV-II is a leukemia virus that Gallo and his associates had discovered.

FEORINO: About '83 I went to a meeting in Cold Spring Harbor, and Luc [A.] Montagnier said that this funny virus, a lentivirus, was probably the cause. Gallo and his minion [Dr. Myron "Max"] Essex kind of poo-pooed it. They were not very nice. Then Max Essex developed a fluorescent membrane test which showed that it was HTLV-I. I went up to Harvard, and the test was lousy. The controls 00:41:00were poor.

Now, I've been doing assays since the '50s, when we made the conjugate with cyanide. It was before the isothiocyanates, and Dr. [Irving] Gordon stood on the other side of the door looking through the window in case I went down. [LAUGHTER] Luckily, we had good chemicals, but the biohazard hoods were lousy, but okay, I'm used to doing it. When I was doing the EBV, I was doing fifty thousand FAs [fluorescent antibody tests] a year. Okay, I came home, and instead of testing the test with AIDS patients, I put in rheumatoid arthritis patients and I put in mono patients, and I got a much higher percentage of positive than 00:42:00HIV. Nonspecific antibodies, just anti-cells or something. The test was not valid, and [Dr. Robert C. Gallo] Bob was wrong, period. And then [they called it] an "HTLV-I-like" [virus].

CHAMBERLAND: Yes, I remember reading that terminology of calling them HTLV-I-like viruses, [and that] might be the cause of AIDS.

FEORINO: Yes. [Jean-Claude] Chermann, who worked in Luc Montagnier's lab, was at CDC, and he came over to my lab. We were all excited because we said, "It killed the goddamn white cells." Everyone jumped. In '83 we wrote a paper on pairs, [blood] donor-recipient [pairs], blood donor or patient, okay, transmitting it. 00:43:00Luc tested the virus we found, and it was indeed [lymphadenopathy-associated virus] LAV. He was on the paper, Chermann, and [Françoise] Barré-Sinoussi; I never met her, but I was pretty good friends with Chermann. Okay--

CHAMBERLAND: Let me just back up a little bit, because I wondered if you could elaborate a little bit more. You said you were catching heck for not finding the cause, and I wanted to have you tell us a little bit more about some of your early experiments. You alluded to them, but you would get material from patients, AIDS patients, and you would do what you usually do, if I understand correctly: try to isolate a virus from a tissue culture process.

FEORINO: Finally, about the beginning of '84 we had a lady who had an operation in San Francisco. She had a couple of units of blood, and I said, "To hell with this, it's killing the virus, it's not proliferating. And that was specimen number 151."

CHAMBERLAND: Do you mean the virus was killing the white cells?

FEORINO: Yes.

CHAMBERLAND: Yes. Which is the exact opposite, as you said, of what would happen if it was a cancer virus? A cancer virus would transform and make the cells grow.

FEORINO: Yes. I mean, EBV -- in general, all my experience was to try to grow the white blood cell line and --

CHAMBERLAND: But the white cells were getting killed off.

FEORINO: There were no white cells to begin with. It's sort of like "Where the hell?"

CHAMBERLAND: Very unusual.

FEORINO: Yes. That was CDC experiment number 151. But by then it was apparent that Luc -- that it was LAV. Okay.

CHAMBERLAND: Yes, because he published, I think it was in May of '83.

FEORINO: '83, Okay. To test to see if indeed LAV and HTLV-III was right, Luc sent some virus to Gallo's lab. Then [Ms. Rosemary] Ramsay and [Dr. Linda] Martin tested both viruses, and they genetically turned out to be identical. Now, this would not be too unusual for most viruses, but [with] HIV, every 00:46:00single virus is different. I worked with Martin and [Dr. Steven] Benn. I grew ten [HIV] specimens from Zaire and tested ten [HIV] specimens from Atlanta, and every one was different. Every single sample I have ever gotten has been different. In fact, if you test someone sequentially, it changes, too.

JAFFE: Paul, it sounds like you actually, in your own laboratory, had evidence of a retrovirus from AIDS patients. When did that happen?

FEORINO: Probably the end of '83, beginning of '84.

JAFFE: What was it that you saw that made you think you had it?

FEORINO: It was killing them, killing the white blood cells, which is consistent 00:47:00with the disease. It looked like LAV virus, and I'd seen pictures by that time from Montagnier.

JAFFE: This was before Gallo described his virus?

FEORINO: Yes. I would guess, yes. I know of no evidence that he had it before then. Now, he found LAV right after he received the virus from Montagnier.

CHAMBERLAND: That's right: the French did share samples both with NIH and CDC.

FEORINO: Yes, but I think my sample was genetically different from the French.

JAFFE: You had the French virus in your lab as well, though?

FEORINO: Not until later.

JAFFE: You didn't have it.

FEORINO: No. We sent our viruses out to Montagnier to test.

JAFFE: What did Montagnier find when he tested them?

FEORINO: He found that they were indeed LAV.

JAFFE: Wow, wow.

FEORINO: That was the paper, the first Science paper, [blood donor-recipient] pairs--.

CHAMBERLAND: I think, actually, Harold Jaffe, you were on this paper as well.

JAFFE: Right.

CHAMBERLAND: That looked at three samples from a recipient who got the donor's blood.

FEORINO: I think we did IFA and we did EM [electron microscopy].

CHAMBERLAND: Yes, and Montagnier and his group were coauthors on that paper. It was because -- just to make sure I understand it correctly -- CDC isolated a virus from this donor-recipient pair, and then you sent that to Paris for them to --

FEORINO: I think so, yes.

CHAMBERLAND: -- do validation or --

FEORINO: Yes, it was indeed--

CHAMBERLAND: The LAV virus.

FEORINO: I gave pictures and did IFA, but he [Montagnier] still checked them.

JAFFE: Really, this was the first paper that showed transmission of this virus from donor to recipient.

FEORINO: I don't know. The first blood donor was [in] that paper in '83, '84.

CHAMBERLAND: The donor-recipient pair was published in July 1984. Your early observation -- which the French also observed, that this virus was not behaving like a typical cancer virus in that it was killing off the white cells -- when you were observing this in your own laboratory, when you would speak to other laboratorians at CDC, what kind of reaction did you get? I presume that you told 00:50:00people, "I'm stumped here. This is not behaving like a cancer virus."

FEORINO: Very lukewarm.

CHAMBERLAND: What do you mean by that?

FEORINO: It was felt to be HTLV-I.

CHAMBERLAND: Already the drumbeat out there in the wider community was to follow Gallo's [lead], at that time, thinking that it was likely to be a cancer virus, his cancer virus.

FEORINO: I would guess that he cost us six months to a year.

CHAMBERLAND: Because people started to focus on trying to make his view fit their data, but the data weren't fitting, as you describe it, from what you saw in the tissue culture isolation efforts.

FEORINO: Yes.

CHAMBERLAND: The virus was, as you say, killing off the white cells in the 00:51:00tissue culture. Did you ever do any work -- before all those white cells were gone -- was it possible to do any sort of work like reverse transcriptase assays or anything like that or EMs?

FEORINO: I didn't do it.

CHAMBERLAND: You didn't do any of that.

FEORINO: No, I didn't. I don't remember doing any of that.

CHAMBERLAND: Okay. Okay

JAFFE: When you did your own work, you ended up thinking the French were right, that this was a cytopathic virus.

FEORINO: Oh, yes. I was embarrassed it took me so long to realize what the hell was going on.

CHAMBERLAND: It's interesting [that] when the French published their paper in May of 1983, they were a little cautious. I went back and looked at it, and they 00:52:00were a little cautious. They concluded their paper, which they published in the journal Science, by stating, "The role of this virus in the etiology of AIDS remains to be determined." When you read the paper, what was your reaction? Did the methods seem sound, the findings plausible?

FEORINO: I thought that it was good, cautious, appropriate. I mean, you find a virus, but maybe it's -- I mean, I did a lot of herpes work, and I found a lot of herpes [simplex] 2 in cancer patients.

CHAMBERLAND: Had your collaboration with the French -- when did that start? They published in May of 1983. When did CDC -- ?

FEORINO: '84 was the first paper. I had no problems with the French.

CHAMBERLAND: I want to skip ahead to '84, '85. We're now entering the time when we have some serologic tests that start to become available. One was developed at CDC by [Dr. J. Steven] Steve McDougal and others, and you were a coauthor on that, "home brew" if you will. Then obviously by '85, we had a commercially available test. But the antibody test opened up additional opportunities, if you will, to try and answer some key questions. I'm thinking in particular of a paper that you first-authored in May of 1985, which was published in the New England Journal [of Medicine]-- again, Harold Jaffe was a coauthor on that, and many others. But this paper was to look at so-called high-risk blood donors -- 00:54:00donors who developed AIDS or were at high risk because they were gay men or IV [intravenous] drug users -- who had donated their blood to patients, and these patients subsequently developed transfusion-associated AIDS. The purpose of this study was to try and see if you could find evidence of infection in these donors, months, years later after they had donated, and to see whether there was a correlation between infection, meaning viral isolation, and the presence of antibodies. At that time we didn't really know for sure if you had an antibody if you had the virus still, correct?

FEORINO: Yes. I mean, for instance, there are no neutralization antibodies that I ever found in AIDS patients that worked. Okay, [Dr. Alfred J.] Grindon, who was the head of the Atlanta Red Cross, and I think [Dr. John W.] Ward did the 00:55:00assembling of it all, and he gave sixty-seven thousand portions of sixty-seven thousand samples to CDC. Steve McDougal's group, [Charles A.] Charlie Schable, ran the ELISA [enzyme-linked immunosorbent assay] test. Abbott [Laboratories] had an ELISA test, and they did radioisotope gp41, p24, and I got a portion to do tissue culture. I think at that time about 1.8% of the cases were transfusion cases.

CHAMBERLAND: Of all AIDS cases reported in the U.S. --

FEORINO: And [that] probably changed a lot of people's minds, too, about AIDS, because they weren't afraid about --to hell with the gays, to hell with the drug users -- but I think, okay. So, we ran them. The RT [reverse transcriptase] 00:56:00test, you have to spin it down, and you have to grow it in the presence of [phytohemagglutinin] PHA-stimulated cells. Every three days you'd take out a portion, you'd spin it down to 40,000 RPM [revolutions per minute], then you do an isotope type of test looking for RT.

CHAMBERLAND: Reverse transcriptase.

FEORINO: Then you measure that. Okay, this is obviously a perfect test for blood transfusions -- it only takes about a month! We compared all the results, and the ELISA test was 99.82% specific.

CHAMBERLAND: Yes. Yes. I recall that paper. This was, as you say, a paper to 00:57:00assess how well the now commercially available EIA [enzyme immunoassay] test performed in a low-prevalence population, the blood donor population. You were charged with trying to see what the correlation was with virus isolation. I'm thinking back to an earlier paper that you did that was published in the New England Journal [of Medicine]. This was the one that was looking to find out, looked at these high-risk donors who had donated blood, and people were interested in knowing -- so it's now months to years later after the donation -- do they have evidence of infection by viral isolation and antibody?

FEORINO: That was also valuable in that it showed that people who at the time showed no symptoms, could cause [transmit] AIDS, which was a confounding thing. 00:58:00I often wondered if people got a unit of blood, would they come down [with symptoms] quicker than if they had sex? I mean, they got a small amount then. I have no evidence anyway, but, yes, that was a critical paper, because it nailed down the etiology of AIDS. It showed you could get it if the person [donor] did not have AIDS. Even if they looked okay, you go back, and you find, yes, he's positive, and then some of those people [transfusion recipients] developed it.

CHAMBERLAND: So, you were right. It showed that these donors, and then certainly other populations, that people could be infected for a long time without having symptoms, yet still have the virus in their blood, so they could be transmitting 00:59:00it through blood donation or other modes. Seropositivity became equivalent to being infectious, at least at that time.

FEORINO: Yes. I mean before the ELISA test, they did things like ask people whether they were in a risk group, and then for a time they were using hepatitis B as a marker--

CHAMBERLAND: Oh, before the test existed, trying to find surrogate testing. The commercially available EIA was a huge advance for the safety of the blood supply.

FEORINO: Oh, yes. I can only imagine it would have gotten worse. I don't know what it is now, because we did another test after the ELISA, which did sensitivity using the method, RT [reverse transcriptase] method, and it was a hundredfold more sensitive than tissue culture, was the --

CHAMBERLAND: Was this the antigen --

JAFFE: The antigen capture assay.

FEORINO: Yes.

JAFFE: The antigen capture assay.

FEORINO: Yes. And then there was another one where you tested a component that gave us a little better test. Now there's a second, third, and fourth generation [test]. I would guess that very few units [of blood] would get through, as opposed to maybe a few.

CHAMBERLAND: It's interesting, when I was doing some research for our interview today, I came across a quotation from Dr. [Frederick] Fred Murphy, who as you know was CDC's former Director of the Center for Infectious Diseases, a virologist. He was commenting on this study that was published in the New England Journal [of Medicine] looking at these high-risk donors and how long 01:01:00they may have harbored virus. He says, "It took an incredible amount of viral isolation." You can almost hear him feeling your pain because of, as you described, the very tedious nature of the work.

FEORINO: Oh, yes. That took a lot of work, but the ELISA test evaluation, I mean, we did several thousand samples for 28 days, testing every three days. When I explained what we were going to do to my group, they all said, "No, Dr. Feorino, we can't do it, we can't do it." I said, "Of course we can." Then they left, "We can't do it." [LAUGHTER] I stayed from 7:00 to 7:00 every day, six, 01:02:00seven days a week. I had people come in early, and I had people stay late. I split it so we -- the centrifuge was a limiting factor because you could only spin 10 mL. I did a study to show that you could get by with 2 mL, so I could put 5 in, and it made it a little easier. People came in on Saturdays, and people came in on Sundays.

CHAMBERLAND: That was obviously a huge study numbers-wise, but in reality, all those AIDS-related studies, many of them that were being done in the mid-1980's, late 1980's, required a viral isolation component. Looking, for example, at 01:03:00studies to inactivate the virus -- chemical methods or heat -- people would require a viral isolation component. Looking as you did at the performance of a new test, the EIA, or when PCR came along, [it] needed a viral isolation component.

FEORINO: There was a lot of that. Also, I seemed to have gotten involved mostly with the blood. Then some peripheral studies, they found some [HIV] antibody in gamma globulin perhaps; we never found any isolates [of virus]. The hemophiliacs, [Dr.] Bruce Evatt was very interested in that. At first, we found [HIV] antibodies in some batches [of clotting factor concentrate], and we found some with antibody and virus, and some with antibody, virus and these -- I guess when they changed the preparation, they got rid of most of those.

CHAMBERLAND: I think Steve McDougal was very instrumental in coming up in his lab with a heat inactivation process.

FEORINO: Yes, he did a lot of inactivation. Then someone asked me to do the hepatitis B vaccine, because at the time, you know, [HIV] positive patients [had donated plasma to make the vaccine]. What I did was I took first an infected -- then I took infected antigen extract, and there were three steps that inactivated a highly [HIV-] infected [sample]. There was no [evidence of HIV found] -- hepatitis B [vaccine] was fine. There was an outbreak once, I think, in a hemodialysis group, but I only heard of one.

CHAMBERLAND: Who were some of the people you were working with in the lab at the time all this was going on in the '80s? Who were some of your colleagues?

FEORINO: Oh. I did not have a staff. Okay, [Dr.] Erskine Palmer did most of my EM, and I had some very, very, very good techs, Donna Warfield and Mary Lane Martin, she was a perfect tech. She never threw tantrums. She was efficient. I mean, it would have been hard to choose between them. Then because we were starting out, word went out I needed people, so they grabbed some -- of course, everybody gave up their best person. [LAUGHTER] I had people who had never worked -- and I got work out of [them], anyway. [LAUGHTER] Most of my 01:06:00collaboration was with other people at CDC in other units. Steve McDougal's group, all the epi people, [Dr. Thomas] Peterman, [Dr. James] Allen, Harold -- not Jim.

CHAMBERLAND: Not Jim Curran?

FEORINO: I shouldn't say that.

JAFFE: Paul, did you ever actually work in the "AIDS lab," or were you working in your own lab in association with other people? Did you ever work for [Dr. Donald P.] Don Francis, for example?

FEORINO: I worked with these people, but I worked in my lab.

JAFFE: But who was your supervisor when you were doing the HIV work?

FEORINO: I'm not quite sure. [LAUGHTER] For a long time, nobody. Okay, Jim Curran, of course. I don't know where Don Francis fit in. Then where [Dr. 01:07:00Gerald] Schochetman came from I have no idea. I pretty much ran without supervision.

CHAMBERLAND: Were you still in building 7?

FEORINO: Oh, yes. In the sub-basement in building 7, the first building without a parking lot.

CHAMBERLAND: That's right.

FEORINO: I started off with nothing, and I needed an incubator, and parasitology threw away two of them. I cannibalized it and made one. I had it in one small hood- room, and I couldn't get the tanks in there, so I drilled a hole through 01:08:00the wall and ran a tube through it. I had a tank, but I didn't have a monitor. So I put the rubber tube attached and then a pinch clamp and put tissue culture fluid and kept moving the pinch clamp until it looked about 7-1.

CHAMBERLAND: This is a tank of carbon dioxide that you needed for the incubator?

FEORINO: Yes, which I took from the room. Then I looked at the front of it [the incubator], to where it had a little sheen, that probably was enough humidity in it.

CHAMBERLAND: This still doesn't sound like state-of-the-art.

FEORINO: No. At the end we had a whole roomful of incubators. One of my techs could not see the door. It was so filled with equipment because we had no room. 01:09:00So, I bought her a periscope, and she put it over the thing, and when she retired, she took it home with her. [LAUGHTER]

JAFFE: Oh, my gosh.

CHAMBERLAND: As you described in the very early days of your virology career, I see evidence that the artistry of virology stayed with you throughout your career at CDC.

FEORINO: Actually, in "And The Band Played On," they made several mistakes. One was they didn't have Paul Newman play me. That was a bit obvious -- we're both symmetrical bipeds. Okay, but my incubator was in it.

CHAMBERLAND: It was in "And The Band Played On"?

FEORINO: It was infamous. They had [Dr. Thomas J.] Tom Spira in my lab, but he 01:10:00didn't work there.

CHAMBERLAND: Okay. Do you think the AIDS epidemic was a big impetus to advancing the study of virology in general?

FEORINO: Yes, yes, yes. We had a whole cadre of people who had been well trained, who had been working for years. They had the contacts, they had the knowledge, just making up the first -- I mean, [Dr.] Mary Guinan, [Dr.] Martha Rogers, Peterman, Harold, and all the outlying groups. Just how would you ask the first -- the outbreak, oh, look for some weird disease that causes something, and it looks weird. Oh, yeah. Swine flu, might just as well mention that.

CHAMBERLAND: Swine flu?

FEORINO: Yes. We had an episode where Dr. [James R.] Herbert and [Dr. John] Beldekas put an article in The Lancet that the cause of AIDS was swine flu. So I had to get reagents from Plum Island.

JAFFE: This was African swine flu.

FEORINO: African swine flu.

JAFFE: Yes, which was a swine disease.

FEORINO: Then I couldn't find evidence of the virus, and I couldn't find evidence of the antibody, and their answer was, it's a strain that wasn't antigenic.

CHAMBERLAND: Oh, my God.

FEORINO: Okay, but the Department of Agriculture said, "Okay."

CHAMBERLAND: Let me ask you one other lab-type question. There was a lot of 01:12:00interest in establishing an animal model to study HIV, and I wondered if you were involved in any of those efforts at CDC.

FEORINO: Oh, yes. Don Frances tried to inoculate some chimps. We had some old chimps that had been used for something else, and we had access to them, and he tried to infect them. It didn't work. I made a batch of just plain tissue culture with [HIV] virus in it, and we brought it over to [Dr. Harold] McClure. He was a vet. Anyway, they put it in, and it worked beautifully. The virus titer went up, and the CD4s went down, but the chimps got better. They shed [virus] for a while, and then they got better.

CHAMBERLAND: That wasn't exactly a good human model, I guess. Were you involved 01:13:00in actually --

FEORINO: Oh, I did all the testing.

CHAMBERLAND: You did all the testing. These must have been chimps that were housed in building 6 in those days?

FEORINO: Manuel and Chesley, they were called.

CHAMBERLAND: The names of the chimps [were] Manuel and Chesley?

FEORINO: Yes. I know, because I caught hell when I sent the report over and said, "Manuel and Chesley are positive." "You're humanizing the chimps." Ooh -- and I caught hell. I should have given them a number. [LAUGHTER]

CHAMBERLAND: Confidentiality and all that.

JAFFE: Right.

FEORINO: The animal rights people were raising hell at that time -- the Chinese curse, "May you live in interesting times."

CHAMBERLAND: I'm wondering if there's anything we haven't covered that you think you should mention about your laboratory adventures as it related to HIV. Did it 01:14:00change you professionally or personally? Certainly personally, you're talking about working seven days a week, long hours. That obviously was tough.

FEORINO: It gave me a whole new area that I learned about. I mean, I'd been raising enteroviruses and poliovirus and herpes and cancer -- and HIV -- it was so big. I mean, I didn't know all the aspects of it. I mean, there was Washington. What was going on at CDC was a lot, let alone -- throughout the whole country, and it changed the attitude of the country. At first, it was "So 01:15:00what? Who cares?" I know when [Dr. James] Mason came in, he was kind of conservative. I worked with him. He's a good man, but I wonder if he wasn't good for us really, because [President Ronald W.] Reagan was, you know, they were religious. Maybe he was better, you know, one of their sort of,-- I mean, with one or two exceptions, most people worked well together and tried. I think CDC did an excellent job.

CHAMBERLAND: Then you continued to work on aspects of AIDS after you left CDC.

FEORINO: Yes, all right. When I retired in '91, I went to Emory Medical School. I was a professor of research, which means that I wasn't bad. [LAUGHTER] You don't have to be good, but you can't be bad. Then you have to bring your own money, pay your own salary, give Emory their big huge cut, which is the maximum that's allowable by the government. Then they put you over in the VA [Veterans Administration] building, so they don't give you space.

Okay, I worked on latency. We developed a model, OM-10.1, and this is a cell that was infected with HIV, and if you hit it with TNF [tumor necrosis factor], 01:17:00it would express the virus. I tried some drugs to see if I could affect latency. We found some that had a little effect.

Then in 1998, I developed a genotyping lab. There was a company, Visible Genetics [Inc.], that had a good machine, and we talked to them about maybe collaborating, and they ended up buying us. Then they actually got bought by Bayer [Pharmaceutics company], so I worked for Bayer. Then Siemens bought them, and at that time my agreement not to compete was with Bayer, so we started up another genotyping lab. We did mostly HIV and Hepatitis B. We worked with 01:18:00Quintiles [IMS Holdings Inc.], a lot of them, a few local specimens, mostly companies. They would try out a drug, and they wanted us to see what happened. Okay, in 2014 some investment group bought 90% of the company, at which time I retired.

CHAMBERLAND: So you're a fairly recent retiree, Paul.

FEORINO: Oh, yes. It's a good thing. Joan broke her hip.

CHAMBERLAND: This is your wife.

FEORINO: Three times, yeah. [She] had a spinal operation and had to have a cage [around the vertebrate] built. Then I developed lymphoma, stroke, and then some gastro problems.

JAFFE: But you're still here.

FEORINO: Yes, here, yes. I used to be 30 pounds more. It went through, and it differentiated. It said, "Fat, leave it alone; muscle, kill it." So, all my arms 01:19:00and shoulders went, and the stomach stayed up.

CHAMBERLAND: Since we're not videotaping this interview, I can say that Dr. Feorino --

JAFFE: Looks very fit.

CHAMBERLAND: Very fit indeed, and not many people can lay claim to a fifty-plus year career. I'd just like to thank you very much for sharing your stories. Again, not many people can tell us about CDC's early history in virology, let alone AIDS.

FEORINO: I was the last of the ones that put mosquito traps up and knew -- they were biologists. It's just so different. Completely different. I mean --

CHAMBERLAND: Not many people get to actually be able to look back over such a long period of time. In that sense, you're in a good position to be able to look back and see, as you said, the many changes that occurred. Thank you so much for letting Harold and me come into your home and do the interview.

FEORINO: You're more than welcome.

CHAMBERLAND: I'm delighted that we were able to do this today. Thank you very much.

FEORINO: The best part is that I can make it up the way I want to now. [LAUGHTER] Most people I worked with are dead. Sabin's dead, Ender's dead--

CHAMBERLAND: You're the long-term survivor.

FEORINO: Yes. I did all the good stuff. [LAUGHTER]

CHAMBERLAND: A little bit of rewriting of history.

FEORINO: Yes. We had a good bunch of people at CDC.

END.

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