Demystifying DNA

Unraveling the Secrets: Cancer and Genetics in Saliva-Based Testing with Dr. Paul Slowey

• Dr. Tiffany Montgomery (P23 Health) • Season 1 • Episode 13

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Embark on a groundbreaking journey into the innovative realm of disease detection through saliva-based diagnostics. Join us as we welcome esteemed guest Dr. Paul Slowey, who will revolutionize your understanding of non-invasive testing. Discover how a mere drop of saliva is transforming personalized medicine and cancer screening. As a pioneer in oral fluid diagnostics, Dr. Slowey unveils remarkable progress in the field, highlighting the precision of current technologies in detecting diseases with unprecedented accuracy. Imagine a future where a simple saliva sample could replace a doctor's visit.

 Our exploration extends beyond COVID-19, revealing the strides made in saliva testing against a wide array of diseases, including its potential in early cancer detection. We'll explore its applications beyond viral detection, such as identifying risk factors for heart disease and Alzheimer's. This episode pays tribute to the untapped power of saliva in unraveling the mysteries of our health and reshaping our approach to disease prevention and treatment.

 Join Dr. Tiffany Montgomery as she engages in a thought-provoking discussion with Dr. Slowey about the potential of saliva-based testing. This non-invasive method stands on par with traditional diagnostic practices in cancer detection, supported by technological advancements in collection devices that streamline the diagnostic journey. By the end of this conversation, you'll gain insights into the significant role of DNA research and saliva testing in healthcare, inspired by a future where early detection and personalized treatment lead the way in medical innovation.

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Dr. Tiffany Montgomery:

Welcome back to another episode of Demystifying DNA, for go-to podcasts, for unraveling the mysteries of genetics and their profound influence on our lives. I'm your host, Dr. Tiffany Montgomery scientist, epidemiologist and just that curious lady CEO of P23 Health, and today we are joined by a distinguished expert in the field, Dr. Paul Slowey. Dr. Slowey is the founder and CEO of Oasis Diagnostics, a company that specializes in non-invasive saliva testing for a variety of purposes, such as infectious diseases, genetics, nutrition and more. He is also the co-founder of the North American Salabas Symposium, a member of the Oregon Bioscience Association and Life Science Washington and an honorary visiting professor at Central South University in China.

Dr. Tiffany Montgomery:

Dr Slowey has over 32 years of experience in clinical diagnostics and pharmaceutical industries. He has published 45 articles. He has 15 patents, authored seven chapters and has 12 patent applications on various topics related to saliva science. He is widely recognized as a pioneer and a leader in the field of oral fluid diagnostics. He has been instrumental in developing and commercializing several saliva-based products and technologies, such as the ORQIC HIV test, the first over-the-counter HIV test in the US. He is a husband, a father, a grandfather, a friend and a mentor. Dr Slowey is a dear, dear friend, scientist in mind, who has four children and almost eight grandchildren. Dr Slowey, thank you for joining us today.

Dr. Paul Slowey:

Well, thank you for having me. I'm very, very honored to actually be part of this. I wanted to do this for a long time, so I'm really really honored to be here.

Dr. Tiffany Montgomery:

We are thrilled to have you. We love talking science and I love getting excited about something that's so dear to me. Not just science, not just genetics, but saliva. I love making it easy, so this is going to be great. In this episode, unraveling the Secrets Cancer and Genetics in Salava-Based Testing, we will focus on early detection through saliva-based testing, where we'll delve into the fact of the fascinating world of non-invasive diagnostic tools and their transformative role in early cancer detection. From the power of saliva and disease screening to the latest breakthroughs in cancer genetics. Buckle up for an exciting discussion that could alter your perception of disease prevention. Let's kick-start this riveting conversation, dr Sloe. So we talked about the power of saliva. I want you. You're basically like the godfather of saliva.

Dr. Paul Slowey:

No, I'm not the godfather, I'm still a pupil. I have lots of excellent mentors that are right there as well, but I guess, as far as the commercialization side and the applications for saliva, I'm kind of synonymous with that, so hopefully I can address some of the questions and point you to some of the other leaders in the field that could be on a future one of these podcasts.

Dr. Tiffany Montgomery:

This is exciting. So when we talk about the power of saliva, why do you think it's such a revolutionary tool for disease detection?

Dr. Paul Slowey:

But you know we've been in this business or myself have been in this business for 30 years with Orishur saliva diagnostic systems and then my own company for the last 21 years.

Dr. Paul Slowey:

And you know, if you look back in history, you know epitope became Orishur in what I think was 1999 or probably 2000, and saliva at that time was pretty much an upheld Push.

Dr. Paul Slowey:

And I think the reasons that I can look back on and say why that's the case is that you know Salivar is typically present in either the biomarkers that you're looking for in saliva whether they they be DNA, protein, rna they're usually present in smaller quantities. For, for instance, I think HIV is like 1400 times lower HIV antibodies in saliva than in blood. However, nowadays we have the much more sensitive technologies that can actually detect those biomarkers. So you know, in proteins, for instance, you got mass spectrometry. You know very, very high resolution mass spec. You've got next generation sequence and you've got lateral flow that can use fluorescence based particles instead of either colloidal gold, so you can actually get down to much lower levels and lower limits of detection. So I think that and Put together that with the 23 and me's of this world, the ancestry comm, and then the advent of COVID, where saliva became Kind of the mainstay, if you like, for for sampling. I think those things have really pushed saliva forward and it's really an exciting time to be in the saliva world, to be honest.

Dr. Tiffany Montgomery:

Now, when you think about what we're able to detect in saliva, are there any doubts in your mind when it comes to the sensitivity or the accuracy of testing when you compare, say, a nasal swab or blood sample to a saliva sample?

Dr. Paul Slowey:

I think, if you take each one in turn, you know there's there's cases for a swab test, there's cases for saliva. But I think, if you look back and use the COVID pandemic as an example, when, when the shortage of swabs happened randomly at March 2020 and I talked to a very large company, a 25 billion dollar company at the time, we, which shall remain nameless, but they had a back order of 37 million nasal swabs on that nasal pharyngeal swabs. We couldn't get swabs anywhere and that's kind of the time when saliva became either the that the saliva was that tool of choice, but it took a little while. The first publications that came out were kind of iffy. But, over everything, if you look back on the publications from now Back to 2020, you'll see that probably saliva is now edged in front of nasal pharyngeal swabs.

Dr. Paul Slowey:

And I can point to a study that was done in Europe on 11 different pathogens and on day one, saliva and swab were basically equivalent in terms of sensitivity, but after day one, the saliva basically took over in terms of being a better and more sensitive tool for for that particular. You know, and it was multiple pathogens, it wasn't just COVID, it was RSV and flu A, flu B, etc. So, yeah, I think it's it's become a really really good tool of choice and you know it's a good area to be in and I'm really glad that you're in this area as well already.

Dr. Tiffany Montgomery:

Thank you. It is exciting and I think that initially there were a lot of doubts and one of the biggest problems that we face Were that the people who were doing the validations and you had the ability to really convince instead of writing papers. We were doing the work. We were trying to get the EUA as we were trying to educate our scientific community so more people could use the technology so that we Be useful and helpful, especially with the shortage, and I think, even Internally inside of the scientific community. It took so convincing between scientists to even get scientists to understand hey, we can do this with something other than a nasal swab.

Dr. Paul Slowey:

Right. I think the thing that makes me really excited and this typically you mentioned in North American saliva symposium we haven't had one since COVID started but I intend to have one this year but the goal of that was literally to bring together the commercial sector involved in saliva, like 23andme, ancestrycom, thermo Fisher, et cetera all these big companies and then bring in the researchers that are developing the next biomarkers for diseases all over the place At that particular meeting. As much as I'd love to talk about what I do, I don't talk very much. I introduce the subject. I spend 15 minutes introducing the field and then I go out on other meetings like that. There was a meeting in Australia recently called the Salsa meeting, which was saliva liquid sampling Australia meeting in May and I made a I think it was a 30 minute presentation. I didn't talk about anything we did. All I wanted to talk about was the new applications that are so exciting.

Dr. Paul Slowey:

You can determine your biological age. You can detect pregnancy either. There's a luminescence test for COVID, I mean there's, just you name it. We're talking to people that are developing tests for congestive heart failure that will detect for risk biomarkers for congestive heart failure and be able to tell you in 30 minutes that, yeah, you have a much higher risk. We provide devices to the Alzheimer's associates for ApoE genotyping. That tells you whether you got a higher risk of having Alzheimer's. And you know, my wife's father died of Alzheimer's so we were very quick to have her tested. Fortunately, she doesn't have the ApoE4 gene, she's ApoE3. So she's a much lower risk than people who have the ApoE4 gene. So there's not many things that I can think of where you know saliva is not going to play a role. To be honest, and that's exciting.

Dr. Tiffany Montgomery:

I think that you get something that was key because we have to make sure that we continue that education within our scientific community as well. I really push and forge that innovation, I think for sure. We've talked about your symposium. I'm excited P23 Labs and P23 Health will be attending.

Dr. Paul Slowey:

Okay, good, good, good. So I'm excited.

Dr. Tiffany Montgomery:

I want you to bring that back, so keep us posted on that. With saliva, we talk about it a lot. With infectious disease, we've talked about COVID and RSV. You've mentioned briefly the broad areas that it applies to, but I want you to tell me a little bit in particular how saliva will play a role with early cancer detection.

Dr. Paul Slowey:

I think this is the thing that I am so excited about, and the reason is that I think we all know that when a tumor forms, you know circulating tumor DNA is kind of released into the blood stream very quickly and a lot of companies like Foundation Medicine, garden Health and others have kind of picked up on that and developed cancer-based diagnostics based on a blood liquid biopsy, which, by the way, they like to call a non-invasive specimen which kind of drives me up the wall, because blood, in my opinion, was never a non-invasive specimen, but that's a side subject. Companies like ours and others developed what we call saliva liquid biopsy, if quantities. So you may have to basically enrich the sample, but we have one application that's reported by the National Cancer Institute for lung cancer particularly, and with one drop of saliva in non-purified form you don't even have to purify the saliva, go straight on a machine. 30 minutes later you can diagnose lung cancer.

Dr. Paul Slowey:

Looking at a couple of mutations in the EGFR gene, one of which is the Exon 19 deletion, the other is the L858R, and to me that's just kind of the proof of concept for multiple cancer tests to be developed, providing that the biomarkers are available, and we're not a biomarker company, so we literally provide tools that can collect saliva. We still need companies that have the biomarkers to basically partner with to bring these new applications to market. And I forgot to mention, in this particular case, which is reported widely it's been around for about 10 years the correlation that you get between the saliva liquid biopsy specimen is actually better. With tissue, just tissue, obviously being the gold standard. The saliva sample is much more well correlated to tissue than blood or plasma. So I mean, in this case you're saying saliva is a better specimen, it's not just equivalent, it's even better.

Dr. Tiffany Montgomery:

That's impressive, not just that it's a viable specimen, but that it's better because it correlates closer to the tissue.

Dr. Tiffany Montgomery:

That is correct, and I think that's because saliva circulates right. We have the proteins there, we have the circulating tumor DNA or CT DNA. We have metabolites, we have mRNA and for us we are looking at saliva to detect various types of cancer like oral, lung, breast, pancreatic and prostate cancer, all using saliva. So I think it's important to educate not just consultants, not just health enthusiasts, but also other scientists about the possibilities and really help to get that research out so that it can be accepted, understood and utilized. Because when you think about saliva-based testing and we go into the future of true noninvasive testing not something that we're saying, oh, this is just a finger prick, well, it's just a little bit of blood. So I'm not the false definition, but if we're truly thinking about noninvasive diagnostics, where would you see the future taking us?

Dr. Paul Slowey:

us. Well, I'm really excited by what you said there, because most of those tests that you're working on for breast and prostate the tests that are available are reasonable, but sometimes they're very poor. I mean, in the case of prostate cancer, psa I get my PSA tested twice a year. I have biopsy once a year. The tests are terrible and we need something that's going to be an early detection tool for those people that currently don't have cancer but may well progress to cancer. So I think you're exactly in the right realm and saliva will play a big role in all of these particular cancers.

Dr. Tiffany Montgomery:

Not only that, but it gives us the opportunity to take the product global. Saliva can be inactivated. It's not as infectious as blood or tissue. It can be stabilized for a longer amount of time. We were looking at stability studies up to 30 days, right right. It really puts us in a position to break down those barriers, which include access to screening tools. So when you're thinking that I know you work globally, tell me how you think Saliva will play in that global market.

Dr. Paul Slowey:

One thing before we move on to that, because I think another area that we didn't mention is the area of exosomes, because exosomes literally are the carriers that carry everything around the system. And yeah, saliva is rich in exosomes and we've done a lot of work on EVs ourselves and characterize some of the particle sizes that you get, size distribution, etc. So that's something we should add to our conversation. As far as global is concerned, when I was with AuraShure, my role was basically international market manager. We launched AuraQuick into South Africa in the year 2000, and I spent a lot of time in Uganda, kenya, egypt, in various other countries in Africa. Saliva you can collect it anywhere. I mean that's the thing. You collect it, you can stabilize it.

Dr. Paul Slowey:

People, even in places like Africa where they consider blood to be a taboo matrix, they don't want to give blood because it's considered to be part of their body, like Jehovah Witnesses here. They don't want to take a blood sample either. So in those cases saliva is preferred specimen, and when you show somebody, they have a saliva collection kit that's going to collect saliva from them in a couple of minutes, rather than sticking a needle in their arm, I mean, they just jump up and down. It's wonderful Children as well. I mean the devices that are available go down to. You can collect from two year olds and above. So in maybe in Uganda, in the jungle areas and things like that. This is going to be ideal Any day. You don't have to actually do the test there, as long as you can collect the specimen and stabilize it at the point of collection. Then you get it back to the lab and you can process it in some of the main labs in the cities like Kampala and all the cities like that.

Dr. Tiffany Montgomery:

So when you were talking about saliva collection devices another one that I'm most familiar with is a utom type device You're going to ask a respirator to spit into the tube and stabilize it. Tell us about some different things you can do other than just spitting in a tube. How else can you collect saliva?

Dr. Paul Slowey:

Okay, I mean, yeah, we have devices like that as well and they can. They can a little bit like the you know the origin device, which is probably the market leading product. You spit in the cup and you collect and stabilize it with a stabilizer. We have devices that collect DNA and proteins as well, but they kind of meet you. There's other products like that, like that.

Dr. Paul Slowey:

I think the thing that differentiates certain collections is that they have to be what collects a purified sample, and what I mean by that is you use some sort of absorbent material in the mouth that basically collects a sample and purifies a sample during the collection process.

Dr. Paul Slowey:

During that process as well, you've got sample indication, you know. That tells you look, I've got enough saliva here so that I can actually stop collecting and now I can introduce it into a test, or I can squeeze it into a tube and then send it to a laboratory for testing at a later time. That's pretty critical when you're looking at things like saliva antigen tests for COVID and various other things. Samples that are maybe passive, dual samples, are not really amenable to what I'd call lateral flow tests or point of care tests that look at either antigens or antibodies in bodily fluids like saliva or urine or blood. So if you can purify the sample, you're going to have a much better chance of getting high sensitivity products from that, and that's kind of part of our rationale. And one of the reasons that we're doing quite well right now is that there are companies that are developing these types of tests that require some sort of upfront you know, saliva collection and purification rather than just a sample collection.

Dr. Tiffany Montgomery:

So what you're talking about is actually purifying the sample right at point of collection.

Dr. Paul Slowey:

Yeah, and it could be what's considered a size exclusion type principle, but the materials will literally adhere to what I call the mucinous material all the thick, gooey stuff in your saliva that everything that you want to collect is still in the saliva. And through publication we've shown that these collection tools will actually give you an equivalent sample. All the proteins that you're looking for are still there in the same quantities that you're looking for, but the the passive joule sample is literally 45% lower in protein because they get bound up. The mucins get bound up on the collection tools, so it's a very neat way of cleaning up the sample and getting it ready for for downstream analysis. And that could apply to all diagnostics cancer diagnostics either, hormone testing, all these types of things.

Dr. Tiffany Montgomery:

When you're talking about the future and where we're going, the technology that's out, what we can use it for, how we can take these devices and put them in the clinical setting. It's no secret how we met, like how we, how we really see the, the vision going. I mean it's exciting. But I think that it's important to help our audience understand that the genetics of cancer and understanding the genetics of cancer has led us to this path of looking at the saliva, Help us unravel the intricacies for better health outcomes. I want to be very transparent that using the saliva not only gives us the ability for early diagnostic testing or early diagnosis, because it's just right in line with that tissue. This can help us and improve our health outcomes because it can reduce the mortality and more ability of cancer patients. It can help improve quality of life.

Dr. Tiffany Montgomery:

The fact that it's not invasive screening really is exciting. For different culture, religious, societal reasons, some of us we may not have a religious reason or moral reason or cultural reason that we'd always love. We just don't like it. You might not be able to find the vein, it's uncomfortable, but you want to know. We need people to get involved with knowing and be proactive in their health, because knowing and the earlier that you can detect cancer, the better chance you have of fighting it and beating it Correct Right. I'm excited about that part. I just want to make sure that we are helping people understand that this can increase compliance and accessibility for cancer screening.

Dr. Paul Slowey:

If we can reduce the number of biopsies for lung or breast or prostate, just imagine how much we're going to help people and, secondly, how much we're going to save the healthcare system. Because those things are not cheap, they're invasive and they take time out of people's lives. I had a small surgery done a couple of weeks back, but it's put me out for a couple of weeks. You don't really include that as part of the process because you lose work time as well as having to go in and get the surgery done and that type of thing. If we can save people, those types of things, then I think we're going to save the healthcare system a lot of money. My goal has always been to save lives and help people. If we can do that and save just one life, it's very important.

Dr. Tiffany Montgomery:

It's worth it. You mentioned something that is key and it's something that P23 really focuses on. It is using those salivary biomarkers to provide information about the molecular characteristics and the response of cancer cells to different therapies such as chemotherapy, radiotherapy, immunotherapy. You can use the saliva to help tailor the treatment to the specific needs and preference of the patient, optimizing the efficacy and safety. Right. Right when you're looking at the potential of Not just detecting but helping to customize that treatment, reduce the adverse drug reaction and helping to drive the appropriate outcome for care, you're no longer Stabbing in the dark. It gives you a very Directed roadmap to how this person will respond with this type of cancer.

Dr. Paul Slowey:

It's true, and there are applications that are already FDA approved which basically set the groundwork for other ones to come through. Pharmacogenomics is enough is very. Saliva's a plays a really, really big role in pharmacogenomics. So you got you look at sip to see nine PGX, 5 fu, for instance your five-flory urus cell. I have a personal interest in that.

Dr. Paul Slowey:

My mother this is a really sad story. My mother was only 70 and she was diagnosed with ovarian cancer and they basically put her on 5f? U but they didn't Test her for whether she responded well or badly to 5f? U at the time and I was kind of furious. But she responded extremely badly and she went into a state of dementia. So they did. The English doctors at the time said well, the only way we can get her out of this dementia is to give her Electric shock treatment. So they give her a lot electric shock treatment which caused a stroke and then a couple years later she died.

Dr. Paul Slowey:

And you know, I think if they'd just done that test that would have saved my mother's life. I I swear that that that's the case and it must be the same for a lot of other people. So the more testing we can do up front to verify and as you said, to also, you know, determine what treatment somebody should get, because 50% the people will respond well to a treatment and the other 50% Will not. You know we get, we have to know which ones and, yeah, you're at the forefront of this, dr Montgomery.

Dr. Tiffany Montgomery:

Oh, no, I'm doing behind you, I'm just a grasshopper and I'm learning your pupil. I'm dead. I'm a junior, junior people, honored to just be a part and really be driving this discussion.

Dr. Paul Slowey:

Do you know? Would you know one thing we haven't talked about and you know, I'm kind of a consultant for another company that's it's working in the Alzheimer's field and I'm a co-chair of a salivary working group which it which sits under the framework of the Alzheimer's Association and it's called a salivary working group for Alzheimer's disease and it Constitutes about 50 people, global people that are the experts in the saliva world that are looking at salivary biomarkers. But the company I'm talking about they're called baseline bioscience. There they have intellectual property that we literally brought to them. We have some of it, they have the others, but they're looking to develop a point of care application for saliva for Alzheimer's disease, looking at, you know, several biomarkers which would be amazing. You know, and you, we can do the same thing with Parkinson's, concussion and sleep disorders. So we, you know, we have intellectual property surrounding those.

Dr. Tiffany Montgomery:

Well, probably we didn't get on that because this episode is about cancer genetics, as some of your Friends we might have. Like a little, I don't know. Panel discussion about Alzheimer's is such a complex topic. It's exciting, it's. It's a part of where we are. As we're living longer and we're creating these longer lives, more people are encountering it.

Dr. Paul Slowey:

I think that is a definite worthwhile conversation to have but I think our job for cancer is to is to Reach out to some of these larger companies that are completely blood-based and, you know, I think they're very Blinkered. They think in one direction, which is blood testing, blood testing, always blood testing, or tissue testing. You know we need to get across the fact that saliva is equally applicable for you know, for the tests that they're developing and you know, eventually, as we said, that's going to be cheaper. You know, because you don't have to have a blood test, is going to help more people. We're going to get more people into into treatment earlier. So we just have to convince them. My voice is very small. I mean, you know you, you give me very nice compliments, but you know, to be honest, you know we need people that have high-power, strong voices that can basically advocate what we're talking about here today.

Dr. Tiffany Montgomery:

We'll continue to build those voices, for sure right.

Dr. Tiffany Montgomery:

I have enjoyed our conversation today. Thank you for coming on. We definitely have to continue this conversation as we draw this enlightening episode of demystifying DNA to a close. Our episode today focused on unraveling the secrets cancer and genetics in saliva-based testing. Dr Paul Slowey and I, Dr Tiffany Montgomery, would like to extend our gratitude for your engagement. Today we've uncovered the critical role the saliva-based testing plays in early cancer detection and the incredible potential it holds in the future of disease prevention. We hope we've broadened your understanding of this cutting-edge field and sparked your curiosity about the incredible potential of genetics to transform health care. Remember, the world of genetic research never stands still consistently unraveling new horizons for our well-being. Continue to explore, stay engaged and join us again on demystifying DNA from more enlightening journeys into the fascinating realm of genetics. Here's a friendly reminder we're with you every step of the way on this journey of discovery. Until next time.

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