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Chapter 1: What is the main topic discussed in this episode?
For those who know that questioning everything includes questioning this show's existence. The Last Show with David Cooper. Cancer research usually involves microscopes and molecules and not toilet humor. But what if one strange little capsule could boost immunotherapy, cut side effects, and change how we fight cancer forever?
A promising new treatment now in clinical trials, and that treatment is poop therapy. Pills. We're going to tell you about them with someone who's working on them. He's an immunologist and associate professor at Western University in Ontario, Canada. His name is Dr. Saman Malaki. Saman, welcome to the show. Thanks for having me, David. A topic for my heart, a poop pill. Let's start here.
What is inside it? What is not inside it? And what is it? Yeah, yeah. I appreciate the enthusiasm. So it is derived from poop. So we have healthy donors.
Chapter 2: How does poop therapy work for cancer treatment?
These are heavily screened, often college students that we screen to make sure that there is no infectious diseases. They are healthy. Everything's top notch. And then we get the poop. And the poop gets actually processed pretty much to its microbial components. And then it gets packaged in three layers of capsules. And you might have seen pictures of me holding the capsules on the internet.
And then so the capsules gets frozen until a patient who is participating in one of our clinical trials identified that's eligible to take the poop pills. The patient undergoes a bowel prep, which is similar to all the folks know this if they have done a colonoscopy. I'm about to do my first one. I'm turning 40 soon. So that's exactly what our patients go through. So they do a bowel prep.
They flush their native microbiome out the day before the treatment. And then they come to the clinic. Capsules get defrosted. There is no taste. There is no odor. And they take about 35 to 40 of those capsules in about an hour. It's a lot. But that's about 80 to 100 gram equivalent of fresh stool that we got from a donor.
And what we are hoping to achieve with that is to transplant the donor's microbiome, the bugs that live in the donor's naturally microbiome, into the patient, into the recipient. And that changes the person's microbiome. Now they have a fresh biome. And we can get into details why that is and what it does. Yeah, let's do that.
The gut microbiome, for those listening, it's the community of microbes and bacteria in your stomach. It is so important for your health. I heard one person call it the forgotten organ. It's as important to your health as like other organs, like the liver or your heart.
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Chapter 3: What is inside the poop pills and how are they made?
What is so important about it? What does our gut microbiome do for us? That's a great question. And it is truly a forgotten organ. So these bacteria, these microorganisms have evolved with us for millennia. They have been living with us. In fact, when you have food every day, most of that food goes to feed these bacteria.
believe it or not, and that they produce a whole bunch of metabolites and molecules that supports the rest of our bodies. So the metabolites that they're producing crosses from our intestine, gets into the blood, and through the bloodstream, it gets to different organs. You might even have heard of the term gut-brain axis. So your microbiome can control your mood.
It can do a lot of things that affects your brain function, and that's only one of the organs. Another organ that it actually affects or gets affected quite a bit by our microbiome is the system that we call the immune system. So the gut is the largest immune organ in our body because we have trillions of bugs living in the gut and they have the largest number of immune cells living there
to effectively, they're regulating each other. They're constantly communicating. The virus producing is metabolized. That regulates the immune system. Immune system is there to make sure everything's clean, everything's organized, nothing's getting on the other side to cause infections. So they're in constant cross-talk.
And then when someone has cancer or an inflammatory condition or a disease like chronic condition, so that microbiome, the gut microbiome doesn't look normal or healthy anymore. For most part, it actually looks diseased. It's not doing its function that well. So and then what happens, the idea here is that what happens if we reset the microbiome? We take somebody's
Healthy microbiome, it's like a kidney transplant, if you will. Get somebody's kidney, put it in somebody else's body who needs a kidney, and then you're hoping that the body accepts it. That actually happens again with our transplants as well. The process is the scientific term for it is fecal microbiota transplant, which is a mouthful, or FMT.
Exactly meaning that you're getting stool from someone, processing the microbiome, putting it in somebody else. Now, if that new microbiome takes, now what happens is that it starts to communicate with the immune system. And why that is important in cancer patients? Because a lot of drugs we are using today for cancer treatment work through the immune system, through activating the immune system.
They don't directly cure cancer cells like chemotherapy drugs used to do. They actually go activate the immune cells, and the immune cells go and fight cancer. Now, these drugs are called immunotherapy. And now when you give somebody a new microbiome, that microbiome jumpstarts the immune system's function. And now you're giving it immunotherapy as well.
And that helps to go be more efficient in the fight against cancer. It sounds almost science fiction-like, like a healthy poop donor helping your immune systems better attack cancer. What even gave you this idea? Like, how did you stumble upon this? Yeah, that's remarkable, actually. This is a bit of a long story, but I was a postdoc back in 2015 and 16 when I initially came up with this idea.
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Chapter 4: What does the bowel prep process involve for patients?
It's malleable. We can change it. And I was like, we've been changing the microbiome forever. but why not do it in the context of cancer treatment? You can change some of these microbiomes through exercise. You can change it through diet. You can change it through, effectively, antibiotics, which harms the microbiome quite a bit. But you can also change it through FMT.
And we have been doing FMT here in Canada, specifically for patients who have C. diff infections for many years. That was the initial idea for me to go and talk to my colleagues in the infectious disease department, saying that, can we do this in cancer patients? And they were like, Wow. Nobody has asked us to do this in cancer patients. So I maybe have cancer, regrettably.
I take a poop pill from your clinical trial. How likely is it to work? What are the results? Yeah, that's a great question. So, so far, we have treated across different cancer sites that we've treated patients in different clinical trials. I can tell you that we've treated over 100 cancer patients.
And what one, you may call the biomarker or hint that we have that this works is that the patients who can take this and keep it in their microbiome over time, that means their microbiome becomes like the donor microbiome, they do tend to do better. In the initial study that we published in HR Medicine in melanoma patients, that's a deadly form of skin cancer a couple of years ago,
We showed that there are certain characteristics in the patients that we are still studying that actually determines if they can be a host that can keep the donor microbiome. It's like, if you will, that the kidney transplant is not getting rejected.
So one of them was that if they're alpha diversity, that means the shape of their microbiome was actually more diseased than normal, believe it or not. And the reason for that, we think, is that when somebody's microbiome is actually less healthy, it's easier to change it. So we have good evidence in the CD4 as well, rather than somebody's microbiome who's healthy.
You look pretty healthy, so it might be more difficult to change your microbiome. Well, thank you. Okay, we just have a few moments left. These results are promising, amazing. I love it. But it's clinical trials, not widely available. How soon will it be I go to an oncologist, a doctor, and I get a prescription for poop to help me out? Yeah, that's a great question.
And that's something that we are working on right now. We are building two randomized clinical trials, one in melanoma in 128 patients in Canada. And we just got funded to do the largest FMT trial with healthy donor poop in lung cancer, 160 patients. And hopefully when that's positive, we can go to the FDA and Health Canada and make it available to everybody else.
Dr. Saman Maleki is an immunologist and associate professor at Western University in Toronto. Saman, I have enjoyed the chat. Thank you for educating us about this amazing poop pill. I don't know, technology, medicine, whatever you want to call it. Thanks, David. I really appreciate having you. Welcome to Survivor 50. February 25th on Global.
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Chapter 5: How does the gut microbiome affect health and cancer?
The twist is going to open a Pandora's box. Now I see Zach Brown on Survivor. Welcome to Survivor. Mr. Beast. Feels a little like a high school reunion meets a massacre. Survivor 50th season. Wednesday, February 25th on Global. Stream on Stack TV. Thank you.