Learn how cancer researchers are “lighting up” cancer by watching our Facebook Live chat with otolaryngologist Baran Sumer, M.D. Dr. Sumer is part of a team that developed a transistor-like nanosensor that can illuminate cancerous cells to assist surgeons.
Hi, I'm Laurie with UT Southwester. Thanks for joining us today today. We'll be chatting with cancer surgeon, Doctor Barons Sumer on the subject of nanotechnology. And uh Doctor Sumer is an associate professor in UT Southwester Medical Departments, Department of Otolaryngology. He's a specialist in head and neck cancer surgery and reconstruction. Doctor Sumer was named director of the head that oncology program at Simmons Comprehensive Cancer Center in 2015. So thanks so much for joining us today. Thanks for inviting me. Sure. Yeah. And as usual, I want to remind everyone to please like and share the conversation and share your questions in the comment section of our stream. We'll take as many of your questions as we can get to. Please remember that doctors cannot comment on individual cases due to patient privacy laws. Ok. Well, let's get started. Doctor Sumer, would you like to give us um a little bit of an introduction to what nanotechnology is. Um nanotechnology is the study of nanoscale um whether that be drugs or or other uh mechanisms for, for providing health care, but it's, it's the nanoscale and, and that's a little bit larger uh than the scale we talk about when we're talking about small molecular drugs. Um And it's a little bit smaller than kind of the cellular scale where we think of things and in that special space and that size, something very remarkable happens, you get cooperatively uh especially between different chemical structures. Uh So a good example of that is a probe that we've been working on for the last several years where it's individual branched polymers that interact with each other at this spec special um size. Uh And they can do things that you can't do with smaller or larger, larger molecules. OK. Well, and how does this apply uh for someone who's being treated? What does, how does that help? So there are many, many applications uh of this fundamental uh chemical process if you will um the, the process that we've been working on is tumor imaging. So, what we've attempted to do is to try to see the cancers better. Uh And as a cancer surgeon or a medical oncologist who's treating patients, it's absolutely essential that we identify every single cancer cell in the body if possible. And nanotechnology offers us some ways of achieving that. OK. Great, great. Well, this sounds really exciting. We've already got a question from Kristen who says, what new technologies have come out to make tumor imaging possible. So, uh one of the uh uh new technologies that have come out is a digital nano probe, which is something that we've invented here at UT Southwester. Um normal medicines, drugs, pretty much anything that you can get over the counter or by prescription. Uh are what we can call analog sensors or, or drugs or um you know, just biotherapeutics. And what I mean by that is the reaction that the uh uh human body has to those drugs is analog or gray scale, meaning you give a little bit more, you get a little bit more of a of an effect um and on and on and on. And then there's this kind of gray scale response that you get to the levels of the medication that you're giving. Um what we were able to achieve was kind of a binary or a digital platform. And what that means is that the imaging device either is all on lights up or is all off. So it's like a light bulb that you turn on and off to illuminate a room. But in this case, instead of illuminating a room, you're illuminating tumor cells. So it sounds like you actually, like we said in our uh promotions for this talk that you're actually lighting up cells. Correct. Right. Yeah. And there are many ways of lighting up cancer cells. So you can for example, target uh a protein that's over expressed only on cancer cells that's found in normal cells at much less concentration. And people have tried that approach. Uh people have tried targeting uh proteins or enzymes that are found in cancers and not found in normal structures. Uh But once again, all of these are analog approaches where you get kind of a increase in the fluorescence gradually as the number or density of tumor cells increases gradually. It's not a yes or no or all or nothing answer. And that's normally what surgeons or other clinicians want is a yes or no answer. Is there cancer present there or not? Uh And that's what this digital probe does. That makes sense because it just makes it a lot more clear for the surgeon, correct? Ok. OK. So we have a question from Sierra. She would like to know are nanoparticles the safest and most effective way to identify tumors. Uh We think so yes. Uh It's definitely the most effective way because once again, you need to cut across the noise, you need to uh make this into a yes or no answer for the surgeon or the clinician who's treating the patient. Um And as far as safety is concerned, a lot of the polymers that we use are biodegradable, biocompatible and have proven to be very, very safe and are used clinically every day. So pe G for example, is a long polymer that we use clinically. Uh And it's in a lot of drug formulations and it's absolutely safe to, to use in, in, in patients. So, can you tell us a little bit about how long this has been in development and what's gone into that. Um So the way this started was about 10 years ago when I started collaborating with Dr Gao, who's a phd scientist uh also at UT Southwester and our labs uh are together uh right down the hall and we've been working on this technology for the last decade. Um I came to him with this problem because I'm a head and neck cancer surgeon. And what I do uh during the day, my day job is removing tumors from patients who have throat cancer or head and neck cancer. And I was described uh to, to people that, you know, head and neck cancer is the most intimate of cancers, even though we don't think of it that way because the first thing that you do when you meet somebody is you look at them and the most visible part of the body is the face and the neck. And that's the first thing you notice. Um the second thing you notice is their voice, how are they speaking? And they talk. Um And then the third thing you do once you've talked to somebody and you know, interacted for a little bit is you go out and have lunch or dinner. Um And that's the next thing that happens. All three of those functions, your appearance, uh your speech and then your swallowing or your ability to eat are affected by head and neck cancer. So it's a very, very intimate cancer. And when cancer surgeons remove tissue. We're always trying to remove all of the cancer but trying to preserve that normal structure, that normal function, that normal appearance. Um and that balance between trying to remove all the cancer, but leave the normal tissue behind is what led me to Doctor Gao, who uh basically, I tasked with trying to come up with an invention from a nanotechnology perspective to help us with that task. And he came up with an idea where we can get tumors to fluoresce and light up so we can cut them out and identify them more accurately. That sounds fascinating. And we do have another question that's come in from the Peter o'donnell Brain Institute here at UT Southwester. Uh The question is what could this technology do in the future? So there are many, many applications to this technology because that binary switching mechanism that I described is a generalized phenomenon. So in this particular case, we've taken an analog signal. In this case, the tumor acidity or you know, the ph of the tumor and we've converted that into a yes or no binary light signal or fluorescence signal. But one can imagine that this process of digitizing that biologic signal can apply to other signals as well. And you can have different inputs and different outputs. So this is analogous to a digital circuit in your computer or your iphone where you have a voltage coming in and you can turn that on or off with a different voltage gate. But in this case, we can actually have different inputs and different outputs. So uh this is coming from the brain institute. So you can imagine many, many applications uh for for neurological uh neurologic disorders, uh metabolic problems that 1 may have. Uh you know, so the sky is the limit with respect to how this technology can be used just because it's so unique. That's very exciting. I did have another question that I was looking at. It was about head and neck cancer just in case we're not familiar with that, some of the audience members, what types of cancer might fall on to that? So, head and neck cancer is an interesting uh uh field uh mainly because it's been described as uh a a whole bunch of different very rare tumors lumped together by virtue of the fact that they all occur in that space. And basically, it's everything above the clavicles, excluding the brain. So that's the way I think of it. Uh And that is a whole, very, very diverse set of tumors. Uh It can include salivary gland cancers. So you have big salivary glands, your parotid gland in front of your ear and your submandibular gland under your jaw. Uh So those are areas where tumors can form your thyroid gland, which is a gland that sits in your neck, in the front part of your neck, right around here is in area, the type of cancer that we deal with. Um, and then the more common types of cancers we, we deal with are throat cancers, uh, or pharyngeal cancers. Tongue cancers that are mainly related to smoking and drinking. And sometimes, and increasingly due to HPV, uh, which is, uh, uh, a sexually transmitted virus found in this area and, and those are the other cancers that we deal with. So, it's a whole series of rare tumors. Ok. I'm, I'm glad you brought up HPV because it sounds like there might be some ways to prevent some of these cancers. Correct. A lot of the uh um oropharyngeal and uh upper air digestive tract cancers as we call them um can be prevented. Uh the, the, the traditional way we think about these cancers is that they're related to smoking and drinking. And there's a very strong correlation with tobacco use as well as alcohol use uh for cancers of the entire upper digestive tract, including the esophagus. So that includes tongue cancers, larynx, larynx, cancers. Um you know, uh ca cancers of your vocal cord uh as well as uh cancers of your oropharynx, including tonsil cancer, invasive tongue cancer. Um More recently, we've recognized uh the human papilloma virus, which is a sexually transmitted virus as being the cause of agent for a lot of cancers that are emerging in the base of the tongue and the tonsil. Ok. Well, that's good information to share, I think from a, from any standpoint. We do have another question from Kristen. He would like to know how is testing going for the new nano sensor? And has it been proven effective? Um So we've done a lot of testing in the lab, preclinical testing uh for this uh in mice and we've tried it out in a variety of different cancers, not just head and neck cancer. And it has worked for 14 or 15 different cancer types that we've tested. Um pretty much all of them uh that we've tried so far. So it is a universal probe that I feel is gonna be applicable to all cancers, not just what I do. Um And, and it's been proven to be safe, at least in animal testing so far. So we're very, very optimistic that when we translate this to the clinics, it's going to be safe and effective in humans as well. Ok, I know this is a trick question in a way, but do we have a sort of timeline as to when that might be available? Um So the timeline for that is uh clinical trials to be completed in the next year or so? Um So the clinical trials are not being conducted by my lab or by Dr Gal's lab. Um So him and I started a company Onco Nano Incorporated, which is a UT Southwester spin off company. And Onco Nano is the company that is responsible for running those clinical trials and they're the ones that will be timing, timing the clinical trials and publishing those results. Ok. So it will still be a little while before we can ask for this. A patient as far as I know. Yes. Yes. Yes. Ok. But hopefully coming. So we've mostly talked about cancer. Um and you did mention it might apply to neurological diseases at some point. So it would be available eventually for use in other areas than cancer possibly. Yeah. Uh Correct. I mean, we've, we've thought of many other applications for this and the applications don't uh uh don't limit the is just a cancer. So we've thought about applications in neurological sciences. We've also talked about trauma patients that may benefit from this in various ways as well as some applications in infectious diseases. So there are a lot of very exciting developments in the lab that are pointing to the universality of this, of this probe and the fact that it may be something that we can leverage and use for other purposes that we weren't even thinking of when we first invented it. That's exciting. Um What about the types of surgery that you do? Are there other types that you do such as noninvasive or, or invasive? So, uh the uh a lot of the surgery that I do is robotic surgery, which is mentally invasive? Ok. Um So we, we call it transoral robotic surgery for head and neck cancer and, and basically, uh what that means is we go through the mouth and remove all of the cancer through the patient's mouth rather than making external incisions or cuts through the neck or other parts of the body. Um And that has really changed our field quite a bit because as you can imagine, there are a lot of nerves and muscles in the head and neck region that are responsible for speech and swallowing as well as your appearance. And we like to preserve all of those and we don't want to cut through all of those normal structures just to get to your tumor. Well, the uh da Vinci Robotic system has allowed us to do that in a minimally invasive way where we can actually go through your mouth, very precisely identify where the cancer is and then very precisely remove that cancer. That's really impressive. It's a lot of fun uh to, to learn how to do the surgery. But then it's also very gratifying because uh patients do very, very well after those procedures. Yeah, I was just about to ask about the benefits for the patient, probably less scarring, less scarring, uh better function, so better swallowing function for the patients. Um and then also more precise removal of their cancer, which is ultimately what they're most interested in. Um because uh when patients come to us with head and neck cancer, their number one goal is to be cured. But then once we say, OK, we can cure you with this, with this operation. Um The number two question is, well, am I gonna be able to function normally after this? Yes. Can I eat? Can I speak? And those are the questions that they have and it's very gratifying to be able to offer them something that's much better than, than anything that was available even 10 years ago. So, it's all about quality of life after that. That's what it's all about. Yeah. Yeah. Well, we have another question here from the Peter o'donnell Green Institute. And then they like a little bit more detail on how does the nano sensor work. So uh the nano sensor is made up of hylic polymers and basically what that means is it's very similar to a soap molecule. So one side of the polymer chain, it's a long chain. One side of the chain is hydrophilic and one side is hydrophobic, which means water loving and water heating. So if you take a whole bunch of these polymers and put them into an aqueous solution or a cup of water, for example, they actually form these balls spontaneously form balls called my cells because the part of the polymer that likes to uh hang out with water molecules, sticks to the outside, they all kind of point out onto the outside of the ball molecule. And the part that actually uh hates water uh stays into the in the core of the mice and, and they form these ball like structures. Um And that happens very, very quickly and in solution, what we can do is we can take those polymers and modify them in ways that they can react to physiologic parameters. So what does that mean? That means that we can take ph or the acidity of, of the solution, for example, and use that as a switch to do something to the polymer. In this case, what we're doing to the polymer is we're getting that ball to either fall apart and, and disperse in water because it senses the acidity of the water or form the ball again. And we can do that very, very quickly. That switching mechanism is the secret sauce if you will to the polymer design and that happens very, very quickly. It happens within milliseconds and that's how we can switch these things on and off. Um And then you can actually do various things with it like the fluorescence, you can turn the fluorescence on and off based on, on that signal. OK. Yeah. So um we've got another question from Sierra and she's speaking to you, she says you're a surgeon. So she's again going through kind of the patient perspective. Um How does this nano cancer help you care for your patients? So uh a lot of times when I'm doing robotic surgery, for example, I struggle with uh seeing where the tumor begins and where um so, I mean, the first thing I do is I look at the patients at the tumor, uh when we have the robot set up and we're, we're looking at it with the, with the endoscope that the robot uses. And a lot of times the difference between cancerous tissue and normal tissue is very subtle. It's not easy to tell the difference between muscle or the normal lining of your throat and a cancer. Um, sometimes it's easy but a lot of times it's not. Yeah. And, and so if we had uh a probe, for example, that can light up the areas that have the cancer that would help me out in my day to day job of removing that cancer more precisely. Um If there's an area of, of cancer that I might not have otherwise noticed somewhere far away, you know, right next to where I'm operating or working uh in the other side of the throat, let's say I'm doing something on the left side of someone's mouth or throat and there's a small cancer on the right side that I might have missed. Well, the fluorescent probe may actually allow me to see that and, and pick up on that and improve outcomes for patients in that way. Um And then finally, a lot of times we're uncertain about the margins of the tumor. So we wanna remove all the cancer. So it's tempting to go in there and remove extra muscle or extra nerves or, or tissues just so that we get a nice safety margin and, and can tell the patient, hey, we got all the cancer out. But as you can imagine if we do that excessively, if we do too much of that, then the patient will have the problems. We talked about swallowing, speaking and their appearance. So if we can back off on that and minimize the the removal of normal tissue, that would be very helpful as well. So those are all ways in which the probe may be able to help our patients. All right. Well, that sounds really effective. And I was, uh, curious as you were speaking, if it, it's also perhaps a bit shorter sur surgery time, if it makes it clearer. Yeah, I mean, right now, uh, the way we ensure that we've gotten all of the cancer out, uh, uh, one of the things that we can do is, uh, send what are called frozen section biopsies during the procedure. And, and what that entails is we, uh, remove normal looking tissue. After removing the cancer, we take out tissue from the tumor bed where the tumor was sitting and we send those to our pathology colleagues who look at that under the microscope while we're waiting in the operating room and tell us whether or not they see cancer cells there. Um, as you can imagine that takes 1520 minutes, uh, every time we do that because they have to process the tissue and the, uh, pathologist has to look at that under the microscope and interpret what they're seeing and that adds considerable amounts of time to the procedure if we do multiple frozen sections, for example, that may add, you know, an hour to the case. So this could be a huge cost savings and time savings. Right. Right. All right. Thank you. And we have a question from Laurie who wants to know has nanotechnology improved outcomes and head and neck neck cancer like that might wait for the clinic. I think so. Yeah, I mean, we're very hopeful that it will and I, I, I'm a strong believer that uh five years from now, we will be having a conversation where we can say yes, nanotechnology has definitely improved outcomes for head and neck cancer patients. Um Today, uh I can't say that because we don't have those data yet. Um But I know those trials are coming and it's based on the research that we've done here at UT Southwester. It's very interesting. Can you uh tell us, is this something that's unique to Ut Southwester or? Yes. OK. Yes. So the probe and the polymer was invented at UT Southwester in our labs. Uh and, and it is unique to Ut Southwester. Uh There are other labs after we first reported this several years ago that have been able to replicate our results. Uh groups at uh mit and groups in China have been able to replicate our results. So we know they're robust and, and, and doable uh outside of our lab, but this was where it was invented. That's so exciting. And what year was that? I want to say, 2012, 2013, I don't really remember, but it was a while ago pretty well for you, but it sounds like it's pretty recent. It is pretty recent and it just takes a long time to get the data together to prove what we thought was true is true. OK. Now, I have a note here that this can also be used for reconstructive surgery. You want to tell us a little bit about that. So I think that part of it is, is more on the uh reducing the amount of uh tissue that you've removed. So I do a lot of reconstructive surgery for head and neck cancer as well. Uh Where o oftentimes we've removed so much tissue from a given area that to, to restore the function to that patient, we have to restore the tissue that we've removed and, and that could involve bone, it can involve muscle. Uh It can involve a lot of different types of tissue. It can involve the skin uh on the surface. Um And we have the ability at Ut Southwester to replace all of those tissues uh using reconstructive surgery techniques. And we have a number of uh plastic surgeons in our department, we are able to do that. Um Now, uh with minimally invasive surgery that happens less and less, but it still happens. The NAN probe, I think where that comes in is it can reduce the amount of uh, tissue that we have to remove normal tissue that we remove. Um, and, and that can help make the reconstructive surgery simpler easier and, and better functionally for the patient. Ok. Sounds like some very exciting things going on. Is there anything else that you'd like to tell us about that? We're excited about with this? Uh The one thing I I would say is uh I think the environment here at UT Southwester is why we were able to succeed in, in designing this technology. Um because my partner Dr Gao is a che a polymer chemist and his, his background is in chemical engineering and it's very rare for a surgeon like myself to have the opportunity to collaborate with somebody who's an expert in that field and be able to spend a lot of time with them. And that's what we were able to do at this university. Um I don't think it's some a a and the culture here allowed us to do that and I don't think that's something that you find. Um anywhere else, it sounds very special. I want to remind our viewers that we are wrapping it up in just a couple of minutes. So if you have any last minute questions, this is the time. Yeah. Yeah. Well, tell us a little bit more about that culture because you mentioned being down the hallway from each other. So it just really facilitates collaboration. It just takes a lot of time. Um So these conversations take time. So uh designing uh a probe that can actually um fulfill all the criteria that we wanted for it, which was being able to tell in a black and white manner where the tumor is and where it's not. Um that's not a conversation that you have by email. It's not something that happens overnight. It takes a long term commitment uh to the collaboration. Um which also means that you have to have the resources at the institution to foster that collaboration. And, and we've been lucky enough to have that. Um The other thing is the research that is not um overlapping with what we do, but kind of peripheral to what we do at UT Southwester is also excellent. So for example, if we need help from a molecular biology perspective, we have the world's best molecular biologist on campus. If we need a perspective from genetics, we have the world's best geneticists on campus and on and on and on for every single field that relates to ours, which means that we don't have to, you know, do some sort of search across the country to find an expert in some field that may actually improve what we're doing. We can walk down the hall and talk to one of our colleagues and that is a huge benefit uh to working at a place like this. That's wonderful to hear. Thank you so much for joining us today, Doctor Simmer. And I'd also like to thank everybody out there for joining us. Please make plans to join us this Thursday, March 29th at 11:30 a.m. We'll be chatting about how to get tested for colon cancer and why getting a colonoscopy is so important. Thank you.
