Nate Baker

Chawkat 3
Independent Research GT
22 January 2018

Transcribed interview by Nathan Baker with Dr. Shay Bracha on the advantages and uses of
biological marker benchmark diagnosis of Transitional Cell Carcinoma

Nate Baker (A)

Dr. Shay Bracha (B)
A: Hello Dr. Bracha how are you today?
B. I am good how are you?
A. Thank you for taking time to answer my questions today. In this interview I will be asking
you about the advantages of using biomarkers to diagnose Transitional Cell Carcinoma.
Does this sound ok and do you have any questions?
B. No that sounds good
A. Do you mind if I record this interview so I can document it for my class
B. Sure that is fine
A.My first question is are there any advantages other than invasiveness why biomarkers should
be used to diagnose TCC rather than biopsies or other forms of testing?
B. Yes obviously so invasiveness an advantage over a biopsy. With actually identifying specific
markers we can actually see how cancer will respond to certain treatment. So ideally we can
find the biomarkers and see how we should treat each patient. This will tell us how well certain
treatments will do under different treatments
A. How would the expense compare between these two forms of testing?
B. With a refined classic proteomic test when selecting 3 or 4 proteins to use an ELISA for
that to show if the proteins are present by staining a specific color. Those are fairly
cheap you are looking at a significant difference from a biopsy because they are much
more involved and require an endoscopy so differences in thousands of dollars
essentially.
A. Ok, so TCC is very difficult to cure in its late stages, but is there any difference in treatment
for early stage cancer before metastization and late stage cancer after metastization.
B. In dogs we almost always see it in its late stages, it is rare to see it in its early stages
because they can't communicate as well as humans. Treatment is mostly less invasive;
immunotherapy, less chemotherapy. Also the prognosis is much better and survival is much
longer with early detection. But, when we have a more aggressive disease which attacks more
layers of the bladder, it is more likely to metastasize to other organs and in that case it is very
hard to control and the treatment is more chemotherapy based and radiation if needed and so
on
A. I told you about the idea I had with the pad that would change colors if it reacted with
any of these biomarkers. Another idea I had was is actually having the antibodies for
each protein biomarker and look at chemical property changes would occur caused by
 the bonding of the antibodies and biomarkers. Do you think either of these sound
feasible or effective in your opinion?
B. So since you mentioned antibodies that is the only way to detect protein biomarkers in a
benchtop essay which means putting fluid on a pad and looking for a change that is
ELISA I can send you more information on that. The biomarkers are designed to bind
with the antibodies, they can detect with colors so actually both of you ideas are pretty
much the same. The problem is most of these antibodies are not commercially available
for dogs. That is the problem unless you find biomarkers that have available antibodies
(gives me colleagues Vincent Ramshow information and talks about his expertise in
microfluidics) So basically what you do is look for proteins unique for the cancer and the
way you detect them on a benchtop assay is with the antibodies
A. ​Are there any downsides to using biological markers over other forms of testing?
B. yes there always downsides they sometimes give you false positive and negatives because
cancer are different in every patient so the biomarkers are not always uniform in every patient
that's why they use lots of testing and statistics these tests are about 80 - 90 % accurate
meaning we miss a block of patients. This makes them great for screening testing because we
can screen many patients regularly very fast and cheap with more accuracy than other
screeners and if enough evidence is present then more expensive test can be run like a biopsy
or whatever you need.
A. Are there any significant factors that can skew these tests that explains that margin of
error?
B. Yes For example, (explains BTA test and its flaw) If the protein biomarker you are using
is also found in the blood and there is an infection where the blood enters the urinary
tract the tests will result positive when it is really negative.
A. So that would be something like a Urinary Tract infection?
B. Yes, so just the presence of blood in the urine can give you a false positive
A. OK thank you so much for your time
B. No problem, I will check with my colleague if there are any labs in your area that can
work with you, but in the meantime we can keep in touch
A. Thank you very much
B. Good Bye
A. Good Bye
1. I think the interview went very well, I learned a lot about proteomic assays like how they

work and how they need to be improved. In addition I learned a lot about benchmark

assays and their advantages and disadvantages. This interview helped me get more

comfortable talking to professionals so my next interview will probably be less awkward

in the beginning.
2. Next interview I will ask more questions like “so basically what you are saying is…” so

the interviewee will know I am paying attention, know that I am interested, and so they

can build off of my question and explain anything I misunderstood. I don’t think this had

an extreme effect on my outcome, but I could have done it a few more times especially

at the beginning to ease the tension.

3. The interview process had some easy and some hard areas. I think the easiest area was

thinking of questions because with such a complicated and new study area I had so

many questions on how most things worked. The hardest part was setting up and

completing the interview. Because I am communicating with a very busy professional,

even though I had been emailing him for weeks my interview only happened on the due

date. Also the beginning of the interview was a little awkward because I was having a 20

minute long conversation with someone I have never even seen, but after the greeting

and introduction I think both Dr. Bracha and I felt comfortable.