Natalie Smith learned how blood cells function when she was only 6 years old: a nurse taught her using Red Hots candy. That’s because young Natalie was in the hospital being treated for acute myeloid leukemia.
She remembers a lot about her cancer experience, both good and bad, including her relapse and subsequent allogeneic bone marrow transplant two years later: how the nurses wore costumes for Halloween, how a pediatric oncology fellow taught her to use a stethoscope. She recalls a scary ride in an ambulance to a center where she received total body radiation, the chemotherapy-induced nausea, and the excitement she felt when she learned her big sister was on her way to visit.
“I have a lot of memories of the doctors and nurses who would spend time with my family and me and describe things to us in ways we could understand,” says Smith, now 25. “I think there’s a level of compassion and care that goes beyond medical and scientific training that pediatric oncologists and staff have. These providers just made a huge impact on me.” The effect was so great, in fact, that Smith decided at a young age to become a pediatric oncologist and researcher.
Researching Microbiome and Blood Cancers
After graduating from Georgetown University a few years ago, where she studied English and biology, the Seattle native searched the internet looking for potential research positions. That’s when she came upon the work of Marcel van den Brink, M.D., Ph.D., president of City of Hope Los Angeles and City of Hope National Medical Center, and his research on the microbiome and hematologic malignancies. She “cold-emailed” Dr. van den Brink and was surprised to get a swift response.
“He made time to interview me almost immediately,” she recalls. “He brought me onto his team and introduced me to the field of the microbiome and nutritional research in cancer.”
“She is an amazing young woman,” says Dr. van den Brink, also the chief physician executive and the Deana and Steve Campbell Chief Physician Executive Distinguished Chair in Honor of Alexandra Levine, M.D. “Very hardworking, very smart, a very good collaborator. I took her in knowing that she had no real qualifications or medical background. The only qualification was her personal story and motivation. And that was enough. It has worked out beautifully.”
“She was so hungry, so excited. She stood out. She had potential. We knew it,” says microbiologist Jenny Paredes, Ph.D., Smith’s supervisor.
The plan at first was to have Smith analyze data, but “very quickly we noticed that she has a beautiful personality,” Dr. Paredes says. “She’s so sweet and kind. She’s soft-spoken, she’s polite, very charismatic but without being pushy.” So Dr. Paredes had Smith start interacting with patients, both getting their consent to participate in the team’s research as well as gathering information about what they were (and weren’t) eating. “All the patients loved her. I could tell that it was the highlight of the morning for the patients to have Natalie visit.”
When Dr. van den Brink moved his lab from his previous institution to City of Hope, Smith came with him. She is now setting up microbiome and dietary databases here similar to the ones she developed at the lab’s previous home. This involves keeping detailed daily records of the foods transplant patients and CAR T cell recipients eat as well as the microbes that make up their gut microbiome (assessed via stool samples), which has been found to affect immune response. Lab researchers use the information in the database to analyze the effects of various macronutrients, such as protein, fat and sugar, on the composition of the microbiome and the impact diet may have on treatment efficacy, side effects and overall outcomes.
Building a Diet Database
“Natalie has created by far the best diet database in order to correlate that information with microbiome data that anyone has ever done,” Dr. van den Brink says.
“The data set that we created is very versatile and dynamic. It allows different people to ask different questions,” Smith says. Indeed, the data can be sliced and diced myriad ways to uncover connections between diet, the microbiome and clinical outcomes. For example, Dr. Paredes used the data to examine the effect of dietary fiber on side effects and outcomes in bone marrow transplant patients. Her abstract was recently selected for an Outstanding Abstract Achievement Award at this year’s American Society of Hematology conference — and Dr. Paredes’ compelling research was selected for a press briefing.
Smith herself was chosen to receive the 2024 ASH Abstract Achievement Award, which celebrates the accomplishments of hematologists-in-training. She was also invited to present a poster on her study.
“This recognition is not just about my research,” says Smith, who plans to apply to medical school in the spring. “It's also a profound validation of my personal journey as an acute myeloid leukemia survivor. It reminds me every day that resilience and passion can drive meaningful contributions in science and offer hope to others fighting similar battles.”
Smith herself has benefited from City of Hope’s research study for childhood cancer survivors, which assesses them for risk of developing secondary cancers and monitors them for treatment-related side effects. Oncologists in the program recently set up a personalized screening plan for Smith based on her treatment history, which included an echocardiogram and annual skin check.
But it is her work to improve standard-of-care therapies and cancer outcomes for others that inspires her, she says, and “reminds me that my life is a gift.”
“To get people like Natalie coming to my lab, with that kind of motivation, that kind of story, and then doing these kinds of amazing things, that is one of the nicest parts, maybe the best part, of my job,” Dr. van den Brink says.
“I’m excited about what the future holds and looking forward to continuing my training,” Smith says. “I know I’ll always have Marcel and his lab in my corner. I’m very lucky lucky, and I’m very thankful.”