
Bikanta’s (YC S14) Tiny Diamonds Find Cancer Before It Spreads - paul
http://techcrunch.com/2014/08/07/bikantas-tiny-diamonds-find-cancer-before-it-spreads?v=2
======
bcjordan
From the article:

> these nanodiamonds can detect molecular abnormalities at a much earlier
> stage, essentially stopping cancer from spreading any further

> Current methods are unable to detect small tumors or breakaway tumor cells
> that lead to something called micrometastatic tumors, which can go
> undetected at the source and lead to the spread of cancer throughout other
> areas of the body.

From pg's essay Frighteningly Ambitious Startup Ideas[1]:

> It will seem preposterous to future generations that we wait till patients
> have physical symptoms to be diagnosed with cancer. Cancer will show up on
> some sort of radar screen immediately.

> (Of course, what shows up on the radar screen may be different from what we
> think of now as cancer. I wouldn't be surprised if at any given time we have
> ten or even hundreds of microcancers going at once, none of which normally
> amount to anything.)

[1]:
[http://www.paulgraham.com/ambitious.html](http://www.paulgraham.com/ambitious.html)

~~~
salgernon
As someone that has just been diagnosed with stage iv colon cancer, I'm a bit
dismayed that a blood test done after the diagnosis (via colonoscopy and ct
scan) shows an abnormal result - but that simple blood test was never
performed before. If it correlates with the cancer, why isn't it done as a
matter of course during routine health checkups? If there a dozen such tests
for a dozen different cancers, I'm willing to give a liter of blood per year
for testing.

The test in question is CEA, carcinoembryonic antigen, where a standard range
is 0.0 to 2.5ng/mL and mine is 8.0. What if I had had this test a year ago?

~~~
seesomesense
The CEA is useful for prognosis, staging and follow up. It is useless for
diagnosis.

"The CEA test has a specificity of between 30-80% and it is not recommended by
the National Institute for Health and Clinical Excellence (NICE) for the
diagnosis of early colorectal cancer"
[http://www.patient.co.uk/doctor/carcinoembryonic-antigen-
cea](http://www.patient.co.uk/doctor/carcinoembryonic-antigen-cea)

Causes of false postive CEA include but are not confined to:

"Inflammatory Bowel Disease.

Pancreatitis.

Liver disease.

Tobacco use can lead to elevated CEA levels. (CEA is elevated in 19% of
smokers and only 3% of the non-smoking healthy population.)

Diverticulitis.

Hepatitis.

Peptic ulcers.

Hypothyroidism.

Cirrhosis of the liver.

COPD.

Lung infection.

Pleural effusions.

Biliary obstruction.

Treatment with oral 5-FU.

High serum glutamic-pyruvic transaminase (sGPT) levels.

Non-malignant liver disease, including cirrhosis, chronic active hepatitis.[6]

Chronic kidney disease.

Pancreatic disease.[7]

Inflammatory bowel disease, diverticulitis, irritable bowel syndrome.

Respiratory diseases, eg pleural inflammation, pneumonia.

Smoking.

Ageing.[8]

Atherosclerosis

"[http://www.kantrowitz.com/cancerpoints/tumormarkerfalseposit...](http://www.kantrowitz.com/cancerpoints/tumormarkerfalsepositives.html)

~~~
clarkevans
Gosh : many of these are just as scary. Wouldn't it still be useful to have
the screen taken, compare it with previous years, and see if anything changed?
If you've got a change, then, you could start asking why?

~~~
salgernon
This was my thinking exactly. These are data points and while the test itself
in isolation may not be conclusive, when combined with other factors that may
be measured, inferred or analyzed as trends over time, this may have had me
tested years ago. Standard for colonoscopy screening is to start at age 50.
I'm 44.

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Bikanta
Hi everyone! I'm Ambika, one of the founders of Bikanta and inventors of this
technology. I'd love to answer any questions that you may have. Here is also a
link to our website: www.bikanta.com

Thanks for the share from PG's article. We are definite believers that it is
possible to detect cancer significantly before symptoms begin to appear!

~~~
mbesto
Out of curiousity - why YC?

My general understanding in health startup world ("real" health startup - not
just a new mobile app that measures vitals) is that if you have a truly
compelling product that is clinically proven (sounds like this is?) then the
venture/acquisition/funding landscape is pretty straight forward and has high
returns - something that doesn't generally characterize the path of the
AirBnB's, Heroku's, Homejoy's, etc. of the world.

~~~
Bikanta
I'm glad you asked! I would encourage you to look at this article where YC
recently announced how it will be backing bitechs:
[http://www.nature.com/news/start-up-investor-bets-on-
biotech...](http://www.nature.com/news/start-up-investor-bets-on-
biotech-1.15096). We are excited to see this shift in attitude towards biotech
investing and wanted to jump on board early. What makes us a a fit for this is
our business strategy that is a closer fit to the "style" of companies that
come through YC. For a typical biotech with clinical targets in mind, to bring
those to market after FDA approval and clinical trials is a long process with
returns being 7-12 years down the line. In our case, there is an identified
research tools market that we can tap into first that would make us profitable
by next year. By establishing an early source of revenue, we mitigate risk for
our investors. Through YC we have a platform and the opportunity to reach
wider umbrella of investors to share our story and strategy with.

~~~
TheBiv
Any particular reason why you didnt fundraise first?

~~~
veemjeem
I think anyone could answer this question -- fundraising is extremely time
consuming, which means less time for actual product development. YC is the
fundraising strategy since the demo day blasts lots of investors with the same
chunk of information which is more efficient than individually pitching to
each investor through typical fundraising processes. Investors are typically
picky on who can pitch them, so unless you have an intro, it's hard to do a
cold-call pitch. YC is a fast way to get an intro to everyone in the valley.

~~~
TheBiv
Howdy! I definitely understand your comment and the reason why I ask is bc
typically biotech firms don't fit the early stage model, so I was just trying
to get more info on why he chose the early stage model (past his stated
reasons of not having a long time to market)

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rgejman
I am very pessimistic about the likelihood of this being a non-toxic
visualization strategy in mice or men. These "microdiamonds" are unlikely to
clear the kidneys, leading to kidney toxicity. This is the problem with all ≥
nanoscale molecules, with the exception of very long ones such as nanotubes
which can pass longitudinally through the kidney slit diaphragms.

Many a great drug (and visualization agent) has failed because of kidney
toxicity.

It's surprising that there are no MDs on the team.

~~~
dbcooper
Non-invasive circulating cancer cell (CTC) screening from blood samples seems
to have the most promise.

(disclaimer: I run a project in this area)

~~~
ihodes
Which project? CTC screening is fascinating. Could you please point me to some
good introductory papers/reading?

~~~
dbcooper
I am on vacation right now, without my literature archive in arms reach, but
from recent publications you may be interested in the whole-exome single cell
sequencing work from Lohr et al.

[http://www.nature.com/nbt/journal/v32/n5/abs/nbt.2892.html](http://www.nature.com/nbt/journal/v32/n5/abs/nbt.2892.html)

There is also an overview editorial in that issue of Nature Biotechnology.

[http://www.nature.com/nbt/journal/v32/n5/full/nbt.2897.html](http://www.nature.com/nbt/journal/v32/n5/full/nbt.2897.html)

I remember seeing reviews in Lab Chip and Nat Rev Clinical Oncology recently.

[http://pubs.rsc.org/en/Content/ArticleLanding/2014/LC/C3LC50...](http://pubs.rsc.org/en/Content/ArticleLanding/2014/LC/C3LC50644D#!divAbstract)

[http://www.nature.com/nrclinonc/journal/v11/n3/full/nrclinon...](http://www.nature.com/nrclinonc/journal/v11/n3/full/nrclinonc.2013.253.html)

The introduction sections of those papers should give you plenty of references
to read. It's a good idea to look into the devices/methods used to enrich CTCs
from blood prior to screening; Toner's devices based (in part) on EPCAM
expression, and the CellScreen device (size/morphology), in particular.

~~~
ihodes
Thanks!

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mikexstudios
Interesting! The article was weak on the science so I found some papers about
the "nanodiamonds":

[http://pubs.acs.org/doi/full/10.1021/ja0567081](http://pubs.acs.org/doi/full/10.1021/ja0567081)
[http://pubs.acs.org/doi/abs/10.1021/ja4016815](http://pubs.acs.org/doi/abs/10.1021/ja4016815)
[https://www.opticsinfobase.org/boe/abstract.cfm?uri=boe-5-4-...](https://www.opticsinfobase.org/boe/abstract.cfm?uri=boe-5-4-1190)

Question (I know almost nothing about medicine/biology): I can see how
nanodiamonds are useful for general imaging, but how will it help
differentiate cancer cells from regular cells? Do the nanodiamonds bind to
anything or is it just a emission light source? Thanks.

~~~
Bikanta
It's an emission light source or probe that can be directed to specific cells
with targeting agents. On our website (www.bikanta.com) you can find links to
some of our publications and if you would like more literature and information
about nanodiamonds, we'd love to share with you. Email us at info@bikanta.com

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WhitneyLand
Don't see how this pays off. Hard to imagine nanodiamonds being added to
someone's body if there is not an unusual risk. If there is an unusual risk
it's worth doing blood and tissue work. What scenario am I missing?

~~~
adamnemecek
> Hard to imagine nanodiamonds being added to someone's body if there is not
> an unusual risk.

Why is it hard to imagine?

~~~
mbreese
Because you don't treat someone for a disease that they haven't been diagnosed
for. The idea that you'd prophylactically give someone these nanodiamonds is a
big stretch at this point... especially when the PR is that "It’s like having
a flashlight inside your body that basically lasts forever." You really want
to have a method for turning off the flashlight when you don't need it.

Now, if you have a patient that has been already diagnosed with cancer, and
the nanodiamonds are used to monitor tumor progression or watch for
metastasis, then that's a different story.

Note: these aren't the same as vaccines, since cancer isn't a communicable
disease (largely).

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ph0rque
The song I've been listening to lately has strangely appropriate lyrics, in a
literal way:

 _Your love is

like radiant diamonds

bursting inside us..._

~~~
Bikanta
:-) Thanks for that share!

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obvious_throw
Ok, I've read the article twice and I am missing something here.

I get how these can be used to help imaging, but I'm not clear on how exactly
they target cancerous cells in particular. Are they attached to antibodies
that seek out specific antigen markers of cancerous cells?

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nicholas73
How do the microdiamonds highlight abnormalities, and not just whatever it
rests on? That is, wouldn't you simply get the same signal to noise ratio as
before? Not only that, wouldn't the signal strength be a function of blood
supply to that area?

Thus, how big does the abnormality have to be before its conclusive using this
technology?

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mikkom
How safe is it to "insert" these nanodiamonds to your body? Can it be
guaranteed that don't cause some kind of internal damage?

