Subscribe
Share
Share
Embed
Welcome to BIOTECH NATION !!! With understandable interviews requiring no background in science, BTN attracts a wide global audience. From everyday people looking for hope in treatments in development, to bioentrepreneurs interested in the experience of their fellow travelers, to venture capitalists looking for possibilities in cutting-edge breakthroughs, to scientists simply interested in the work of others, BioTech Nation is the voice of human endeavor, driving science to new realities for everyone. These interviews are drawn directly from the public radio program, "Tech Nation", which also can be heard in numerous global radio and podcasting venues.
BioTech Nation interview Dr. Lishan Aklog, CEO of Lucid Diagnostics, February 2024. From everyday people of average weight who don't smoke or drink, eat a healthy diet, and yet have suffered from heartburn or its more technical name, GERD. To those of us with particular attributes, such as being male or perhaps past the age of 40, maybe you're a heavy smoker or a heavy drinker. Perhaps you're obese or at least overweight or have worked in certain occupations, which expose you to unhealthy substances, such as being a firefighter. The more boxes you check, the more likely you are to develop esophageal cancer. Normally only diagnosed in its very advanced state, Lucid Diagnostics has developed a 2 minute test which can detect these cancers when they are precancerous.
Moira Gunn:Doctor Lishan Aklog is Lucid's CEO. Doctor Aklog, welcome to the program.
Doctor Lishan Aklog:Great to be here, Moira. Thanks for having me.
Moira Gunn:You'd be hard pressed to find an adult, especially as you get older, who has not had heartburn or GERD, or where someone close to them hasn't complained of heartburn or GERD. What is this, and how common is it?
Doctor Lishan Aklog:You're You're absolutely right. It is extremely common. So we use the term heartburn. It's not a great term because it be it it implies it has something to do with your heart, and heartburn has nothing to do with your heart. It's a sensation after eating, and in other situations where people just get this pain in the middle of their chest that, that, is is a result of a problem in the stomach and in the esophagus.
Doctor Lishan Aklog:The official medical term for it is, has the initials GERD, g e r d, and the fancy medical term is gastroesophageal reflux disease, but it's most commonly known as GERD. And it's extremely common. About 1 in 4 adults in America have what we call what we would consider significant GERD, which is symptoms of at least once a week. And they take medications over the counter like Prilosec and Nexium to try to control those symptoms. And so it's a very very common, a very big issue for for many many people.
Moira Gunn:Now you're talking about stomach contents and stomach acid getting up above your stomach into your esophagus. Stomach acid has to do some damage to the esophagus, does it not?
Doctor Lishan Aklog:So the acid in the stomach is meant to be there. It's meant to stay there in the stomach. It's not meant to go elsewhere. And it's in the stomach for obvious reasons to help us digest our food and so forth. The esophagus is a food tube that drains into the esophagus, so allows our food to to to enter the esophagus.
Doctor Lishan Aklog:But the the acid is intended to stay within the stomach. So when when the contents from the fluid in the stomach, and acid and actually other things, bile and other things in the stomach, find their way into their into the lower esophagus, that's not a good thing. It's not supposed that that fluid is not supposed to be there. The esophagus is not used to it, and it can cause havoc. It can cause symptoms of heartburn.
Doctor Lishan Aklog:But more concerning is it can cause changes in the cells in the lower part of the esophagus, that can ultimately lead to precancerous conditions and to cancerous conditions. And so that's that's the you know, that's that's really where the the where the where the where the damage can happen and what we're what's the really serious of GERD, which many people don't realize. Most people think heartburn. Yeah. I take, you know, I take my Tums.
Doctor Lishan Aklog:I take my Maalox or I take my Prilosec, and as long as my symptoms go away, I'm good to go. And it it's not that's not the case. It can actually lead to serious problems down the road.
Moira Gunn:You mentioned that a lot of people take antacids and, some of them actually rise to a prescription level. Won't that help you avoid this esophageal cancer?
Doctor Lishan Aklog:No. This is the actual answer there. Surprisingly, no. So you're right. You know, we have pretty good medications right now to treat heartburn.
Doctor Lishan Aklog:I mentioned Nexium, Prilosec. These are a category of drugs called PPIs that can be available over the counter or by prescription. And they're very good at suppressing the acid and preventing the symptoms. And that's frankly one of the reasons why we treat GERD and heartburn as sort of just more of a nuisance than anything, serious. That's the common common, feeling amongst patients and and their doctors.
Doctor Lishan Aklog:But that's just not true that when you treat the symptoms, you're just basking it. The process of the cells of the lower esophagus being exposed to the stomach contents and undergoing these changes into precancer continues unrelented. And it's actually, it can just it can be sort of dangerous because people feel a sense of, that that that, a sense that they're,
Moira Gunn:They have it under control.
Doctor Lishan Aklog:Yeah. It's really masking an underlying process that could actually, progress to more serious conditions.
Moira Gunn:So for some of these people, it will lead to esophageal cancer. How common is that? And who is at risk?
Doctor Lishan Aklog:So so that's true. So you can develop people with heartburn and with reflux can develop the a precancerous condition and a subset of those patients can, it can evolve to a late precancer and then ultimately to full blown esophageal cancer. Esophageal cancer, the diagnosis of esophageal cancer is made about in about 20,000 Americans a year. By the time we're done with this conversation, about a dozen about a dozen Americans will get that diagnosis. And the tragedy is that in nearly all those cases, it's a near death sentence.
Doctor Lishan Aklog:About 80% of people who are diagnosed with cancer will be dead in 5 years. So it's one of our worst, most lethal cancers out there. It's up there with pancreatic cancer and liver cancer. It's kind of the big three most deadly cancers. About 16,000 people will die every year.
Doctor Lishan Aklog:And, look, all deaths are tragic. All cancer deaths are tragic, but those 16,000 are particularly tragic because we know how we know the evolution. We know where it came from. We know how to identify it early, and we know how to prevent it. And, we're just not doing so.
Moira Gunn:Let me just stay with this for a while. Is there a profile of people who tend to develop into esophageal cancer?
Doctor Lishan Aklog:Yeah. So it's, the best place to start is to is who's at risk for having the precancer? Because once you have the precancer, then you have a very, very high, possibility through your lifetime of dev of it evolving into later stage, precancers into cancer itself. So there are very well established we know who's at risk for that. Anybody who has GERD or or or chronic heartburn, that's a sub that's a major risk factor.
Doctor Lishan Aklog:And then a few other demographic, characteristics, such as people over 50, people, white race, men, smokers, obese people, and those who have a family history. So those are that's GERD plus 6 other risk factors, and anyone who has 3 of those 6 risk factors has a about a 10% chance of having the precancerous condition, and it's and, that needs to be identified as well. I think we'll talk about it in a second because we don't want to wait until the cancer develops.
Moira Gunn:Now let me ask you this, we're not gonna be talking about a cancer test. We're going to be going after the precancerous. And today, there is no precancerous test. Is that right?
Doctor Lishan Aklog:There's no test that's easy to perform that's wild that's widely utilized. You you can do endoscopies, you know, where you take a camera and you go to you go to the to, endoscopy center and 2 people take the day off of work and you're under anesthesia and they put this big tube in your in your esophagus, in your stomach, and, sure, you can pick it up that way. And, actually, that test is recommended, but almost nobody gets it. Only about 1 in 20 of the tens of millions of people who are recommended for testing, who should be getting tested, ever get that. So so you're right.
Doctor Lishan Aklog:There there has not been a simple, straightforward test that could be utilized on a widespread basis to identify those patients who have this precancerous condition that can be addressed to prevent the progression to cancer.
Moira Gunn:Now you're talking about, you know, the search for precancerous cells, and women hear this a lot. They get a they get a pap test, and they say, well, we're looking for precancerous. And it sounds very vague. I mean, you're like, okay. Go look.
Moira Gunn:We're not really sure what it means. What does it mean, this precancerous, and and how specific is it?
Doctor Lishan Aklog:Yeah. So that's a great analogy, that what we're talking about in the in the esophagus is very similar to what we talk about with PAP testing. And so precancerous changes are abnormalities to otherwise previously normal cells that can be detected in a variety of ways, that indicate that a process has begun that can head towards, later stages and then ultimately to cancer. And so what's exciting in the esophageal space, we've had pap testing for for for decades now, and it's had a big impact on on on saving lives, and preventing deaths from cervical cancer. We now have the same opportunity in esophageal cancer, where technology that was funded by the National Cancer Institute out of, Case Western Reserve University and other, academic medical centers have been developed that allows us to identify 21 sites on 2 very specific genes where these early abnormalities can occur to the DNA at those at those, 21 sites and can indicate at the very earliest stage that that process has begun and can progress to later stages.
Moira Gunn:Lucid Diagnostics has not just created a test for identifying these cells, they've also created a way to collect those cells. Tell us about that, how you go and collect these esophageal cells.
Doctor Lishan Aklog:Yeah. It's great. They really go hand in hand. I mean, the science behind these 21 sites on 2 genes is absolutely remarkable. It's cutting edge.
Doctor Lishan Aklog:The way we can identify that is amazing in the laboratory. But in order to in order to do that work, in order to do that molecular work, you have to get the cells where the abnormality is. And as you said, the abnormalities that are occurring here are subtle, and they occur at the very end of the esophagus just before the stomach. So that's that's a good ways down. It's a couple of feet from your mouth to that point.
Doctor Lishan Aklog:And so how do you collect cells like that without having to undergo this invasive procedure? And so what was developed by the same, the same brilliant scientists was not just the molecular test, but a way to collect those cells in a very simple way that can be done in an office setting. So how is it done? There's a the the tool is quite simple. There's a capsule that's about the size of a vitamin pill.
Doctor Lishan Aklog:It's attached to a, silicone catheter, which is basically like a little piece of spaghetti, a thin piece of baby angel hair spaghetti. And on the end of the capsule, there's a balloon, that can be inflated or deflated. And so what the patient does is the patient swallows that capsule. It's tethered still to this to the, little piece of spaghetti. And that cap the capsule works its way down into the stomach.
Doctor Lishan Aklog:And the person who's administering the test, will inflate the balloon and pull back just at the, where the stomach meets the esophagus. And so remarkably, without any cameras or any other, other sort of fancy technology, just with a fairly simple device, we know where the balloon is because it's right at that at that juncture between the stomach and the esophagus. And then it just gently, swabs or collects the cells just like you would in any other, other kind of swab test. It picks up those cells, and then with the balloon deflated, those cells get pulled into the capsule, and the it gets removed.
Moira Gunn:Pulled right out. Pulled right out of your mouth.
Doctor Lishan Aklog:Pulled right out of your mouth. And the whole thing takes a couple of minutes. No anesthesia, and no other intervention can be done in a in a doctor's office. And, again, what's remarkable at that, that from a physician's point of view is, like, wow, we can actually collect cells exactly where the problem is in a very targeted way without exposing the sample to other cells anywhere else in the body and be able to send those cells off to a fancy laboratory that can do this fancy, molecular genetic testing.
Moira Gunn:And no other appointments in another building. Just sit over here. Nope. Sit where you are. We got you.
Doctor Lishan Aklog:No IVs. No nothing.
Moira Gunn:Now the whole idea that I am swallowing this thing, and even though there's this, it seems like, oh, it's small. It's like angel hair. It's following it down. I'm like, how do I get it down? I keep thinking I'm gonna gag on this.
Moira Gunn:Have you have you done this?
Doctor Lishan Aklog:I've done it myself. It's sort of a requirement that everybody in the company is. We had a board meeting this week, and we forced a couple of the board members to have the test done. And, so, yeah, there there's an there's our team is incredibly well trained on how to do this, and it it people do sort of look at something as like, I don't know. Can I swallow that, and will that go down?
Doctor Lishan Aklog:And 99% of the time, it works just fine. There's a few people here and there who have trouble swallowing pills, who have a hard time getting it down, but that's like 1 in a 100. And, just with the proper training and with the proper coaching, it's over in the blink of an eye. And, it's actually quite comfortable and not, and really not an issue at all. And we've done that, you know, 10 tens tens of thousands of times.
Moira Gunn:And so many people, you know, they think about, okay. How can I get this to them? And once you get it sort of just swallowed, your body kinda takes it the rest of the way. Right?
Doctor Lishan Aklog:Yeah. Exactly. It's just like swallowing a pill. Right? With the if you're swallowing a vitamin pill, once it's you only have to swallow until it's past the back of your throat.
Doctor Lishan Aklog:And that's what your esophagus does. Your esophagus contracts and relaxes and basically can move food and pills, and in this case, our our capsule, into the stomach, just like it like it would a a pill or a fruit.
Moira Gunn:And then somebody pulls it out. How tough is that?
Doctor Lishan Aklog:Piece of cake. Yeah. That happens for clean. You hardly notice. Honestly, just to be in in all seriousness, the part that people concern themselves more is with the swallowing part.
Doctor Lishan Aklog:Once you've swallowed it, the rest of the procedure is, is, is really quite straightforward and and been very comfortable.
Moira Gunn:But I like this. After the test, they give you a piece of cake. I think that would be that's a good marketing plan, but we won't talk about that. I think so. We won't.
Doctor Lishan Aklog:We won't talk about that. But, you know, what peep what the patients appreciate is the they know what the alternative. And we we we we actually track this data, like patient satisfaction. It's very important that we know, that we get feedback from patients, and what they appreciate is the opportunity to get an answer as to whether they're at risk for developing this horrible cancer and that that answer can be obtained with such a simple a simple, cell collection procedure that can be done in an office setting. So we have a lot of gratitude, particularly those whom we find an abnormality where they didn't where they didn't suspect it.
Moira Gunn:Do we have procedures to treat it at the precancerous stage?
Doctor Lishan Aklog:Yeah. So yes. Exactly. So there's no the reason why early detection, whether it's what we're doing, which is precancer detection or early detection of cancers like breast and colon and stage 1, The reason the only reason that can that's useful is if you can do something about it, after you've picked it up early. So that's a necessary part of having successful program, successful early detection program, not only has to that it's not only that you have to be able to detect the problem, but you have to be able to do something about it that alters the course, for that particular patient.
Doctor Lishan Aklog:So, and that's why those other early detection programs have been wildly successful at decreasing. That's deaths from breast cancer, deaths from colon cancer, deaths from cervical cancer are all substantially lower, 50% or more lower because of early detection programs. So for this to be a a successful early detection program, it's it has to leverage the fact that once we identify the precancer condition, then then the patient those patients who have a positive result, will get an endoscopy, and that endoscopy will determine where along the spectrum they are they at the earliest stage of precancer, or perhaps did we were we fortunate to pick up a late precancer before it developed into cancer? And then the appropriate management follows. So if somebody's in a very early stage precancer, that just requires surveillance.
Doctor Lishan Aklog:So you come in, just like you get people get a colonoscopy on a regular basis, you would come in typically every 3 years and get a get another, endoscopy to determine whether to catch it to see if it progresses from one to the other. If at the beginning or through later surveillance, you could you detect that that it's progressed to the later stage cancer, but still before cancer, then you have the opportunity and and the need to intervene. And the intervention there is what's called an ablation procedure where you can go in with the, the very minimally invasive way you can eliminate those abnormal precancerous cells and reliably prevent them from progressing to cancer, and actually prevent the cancer. So exactly right. That's that's the whole point of picking these things up early and so you can monitor and treat them, to prevent them from developing into cancer.
Moira Gunn:So it's not unlike the colonoscopy saying, well, we found this, we found that. We we took this out. We took this polyp out. We did this. And and we're gonna watch you.
Moira Gunn:We're gonna keep coming back with this to make sure Yes. That it doesn't develop.
Doctor Lishan Aklog:Yeah. And if they and if you find, an abnormality, you remove it. Very similar the the the similar prospects. So that's that's how you prevent it from developing into cancer. And that's what's great here is that it's actually well established on how you do that.
Doctor Lishan Aklog:We just haven't been finding those patients. So it goes back to what I said at the beginning, Ora, which is that every esophageal cancer death is particularly tragic because we know what to do. We know if we find the precancer early, we know how to prevent the cancer. And so that's nobody should be dying of esophageal cancer because we we know who should be tested, and we know if we test them, we can pick up these early conditions and, monitor and intervene in a way to prevent them from developing cancer.
Moira Gunn:Now I wanna mention this. We talked about the pap test and I noticed that the vice chair of your board and the strategic advisor is, Stan Lapides. And it was Stan Lapides that developed both the modern Pap test that we all use now and Cologuard, which we're all aware of. He's an engineer.
Doctor Lishan Aklog:That's right. So you're right. We're very fortunate to have, Stan Lapides as our vice chairman and a close close advisor to me and to the company. And Stan is, a legend in this space, and he's had such an incredible impact, first with cervical cancer. He invented the thin prep device, which is the way the modern pap test is done.
Doctor Lishan Aklog:As you said, he's an engineer. The original prototypes of that are actually on display at the Smithsonian Institute, and it's been estimated that about a 1000000000 women have undergone PAB testing using his technologies and, that that that has led to them, saving millions of lives. What a what a what an impact for an individual. And he's he's done the same thing. He was the cofounder and inventor co inventor of the, of the Cologuard STOL DNA test.
Doctor Lishan Aklog:And, this is the 3rd cancer that he's that he's working on with us because he understands the value of early detection and, cancer prevention, and, believes our technology has the opportunity to do to do the same thing, for esophageal cancer that, the ThinPrep and Cologuard have done for cervical and colon cancer, respectively.
Moira Gunn:And one last thing I wanted to note is that we talked about, who in the general population was susceptible, more susceptible, that profile. But there's another group of people who are especially susceptible and that's firefighters.
Doctor Lishan Aklog:That's correct. So, you know, firefighters, they're our heroes. Right? They go in and literally walk into burning buildings, to to, save us and and and others. And in the process of doing that, they're exposed to a variety of toxic substances.
Doctor Lishan Aklog:Firefighters have an overall elevated risk of cancer. A large percentage of firefighters die of cancer. And if you list all the cancers that have that they have a particularly increased risk of, esophageal cancer is numb is the second most, the second greatest, about, 60 to 70% increased chance of developing esophageal cancer compared to compared to average, the average population. So we've embraced that, and we've you know, there's a lot of attention within the firefighter community at Cancer Prevention. There are a lot of programs, and we've embraced that.
Doctor Lishan Aklog:And we've engaged now in dozens of firefighters across the country where we have health fair events, where we come on-site and identify those who are at risk, and, and we test them. We we do the cell collection and test them for esophageal precancer, and we found dozens of cases of that, and we're, helping to have that kind of impact. And it's particularly gratifying in that population because of the, yes, with the heroic work that they do.
Moira Gunn:Now if you are a a fire department somewhere in the country, can you partake in that program?
Doctor Lishan Aklog:Absolutely. Yeah. We we love hearing from fire departments and, as I said, most have an interest in cancer prevention, and we've been able to work closely with the fire departments and the and the and the chiefs that are focused on this to bring programs on-site, sometimes with the, the active, but often even with with with the retired firefighters from that department so we can test everybody who who has potential risks. So, yeah, that's a partnership that we've been expanding across the country, and we would we would look forward to hearing from any that any any departments that would like to participate in that.
Moira Gunn:Well, doctor Aklog, thank you so much for joining us. I hope you come back and see us again.
Doctor Lishan Aklog:This has been great. Thank you, Moira. I really appreciate it. Doctor Lishan Aklog is the CEO of Lucid Diagnostics. More information is available on the web at luciddx.com. That's luciddx.com. BioTech Nation interview Dr. Lishan Aklog, CEO of Lucid Diagnostics, February 2024.