Welcoming Syrian Migrants

Keith Jarvi

Semen is the underrated biological fluid compared to blood and urine. Keith Jarvi, the Director of the Murray Koffler Urologic Wellness Centre and Head of Urology at the Mount Sinai Hospital, said: “in our early studies, we had focused primarily on infertility, where production and plumbing are the two categories of efficiency. We have to biopsy to make a diagnosis. We have looked at men with production and plumbing problems for markers. We found three that together are 98% sensitive and 100% specific. The Koffler Foundation funded preliminary studies that were promising. Once I had proof of principle, I entered ‘the valley of death’ that precedes licensure (see also our previous article on Michael Tymianski). MaRS came through with funding to get me across. We are now licensed in China and the United States through MaRS Innovation. Men are still getting biopsies in many jurisdictions, but I am slowly putting my urology colleagues out of this line of work.

“I am now working on refining prostate cancer markers. Years ago, we started looking for markers of prostate cancer. PSA, the commonest marker for prostate cancer, was found in semen at 10,000 times higher concentration than in blood. Prostate cells appear in semen. We look for the cells, and proteins and we more recently are looking at the DNA in the semen as markers for more aggressive cancers. We can identify a better prostate cancer marker, but we are 2 years from licensure. Testicular cancer marker studies are in their infancy. We are looking at DNA in semen. We consider ourselves world authorities in the study of semen, the forgotten biological fluid. We have 8,000 proteins in our database on semen and seminal proteins. With our predictive studies, we will be able to freeze sperm for young men before they eventually become infertile from disease or treatment. This will be important as testicular cancer is increasing in Europe as is the rate of infertility.

“I started the prostate cancer markers studies by surveying 500 patients. 80% of men were willing to donate samples. I am now working with Laurie Klotz, looking at his repeat biopsy cohort in the Active Surveillance Study (see previous Spotlight article). We have collaborators in Montreal, Calgary, London, and 2 Toronto sites - PMH and Sunnybrook. For the testicular cancer studies, we have collaborators in Copenhagen and for fertility studies in San Francisco, Cornell New York Hospital, McGill and Calgary. Tony Finelli, Neil Fleshner, Laurie Klotz send samples. We have 280 specimens from Calgary. It all started with funding from the Koffler family. Now one half of our Koffler Center is for research, and one half for clinical work. We have regular meetings with epigenetics expert, bioinformatics expert and mass spectrometry expert. The physical proximity that brought us all together in the Koffler Center has been highly productive. We have grants from CIHR, Prostate Cancer Canada, industry and MaRS Innovation. MARS came through when they saw the commercial prospect. This is a great example of a basic science/ clinician team concept. We have done over 1,000 patients - 350 of them prostate cancer patients. The goal is to avoid needle biopsy in trying to identify high risk prostate cancer, because 4% of cancer biopsies lead to hospitalization.

“The technology now is amazing because of mass spectrometry. Protein analysis that once took lots of time is fast and massive now. The technology is racing ahead of the clinical work. Eleftherios Diamandis is my alter ego, a world authority on PSA. We have worked together for 7 years with 8 postdocs, 4 graduate students, 3 - 4 MSc students, 10 summer students and numerous Centre for Research in Environmental Microbiology (CREM) students, 6 fellows and 4 residents, all funded by grants from PSI, Prostate Cancer Canada, CCSRI, MaRS Innovation, CIHR and various companies.

“A secondary goal is to build a male contraceptive - the reciprocal of the fertility goal. We can knock fertility out in mice. We do thousands of semen tests per year, 1,500 of them from Mount Sinai Hospital alone. We hope to have a predictive marker for testicular cancer 10-20 years before it becomes clinically evident. The male contraceptive study is an option. Our nanofluidics engineer is Sinton. The IVF market in Canada performs 125,000cycles per year at $10,000 per cycle. We have a $30 chip, which measures visco- elastic drag in Reynolds units. A home test is in development as an IPhone app. The University of Toronto is an amazing place to work, with experts in everything. The engineers are keen to get involved in these important biologic problems.

“My background was in math and I intended to become a theoretical mathematician when I was a student at Queen’s. I later decided I could be at the frontier in medicine if I applied my math- computer background to biological problems. I began with Mike Jewett at Wellesley who took me into the lab measuring sperm motility. I did time lapse cinematography, then went to PMH computer experts to develop a digital analyzer. After 6 months of work, I found that a computer analyzer had already been invented, hit the market, and was sweeping the world.

“I do 50% lab and 50% clinical work - largely on infertility, including microsurgery for obstruction or reconstruction of the vas deferens, microtesting, and treatment of varicocele or undescended testicles.

“My wife Patricia Lee is an ObGyn doctor at Sunnybrook. We have 3 children: our 18 year old son is studying computer science at the University of Toronto and is planning to study medicine. Our teenage highschool girls are at Toronto French School. We enjoy biking, hiking, skiing and other outdoor activities together as a family.”

M.M.