The State of Autoimmunity 2016 — A Progress Report: Part 2 (re-posted from Tincture)

arched bridge metaphor for bridging gaps in autoimmune care

In Part 2 of The State of Autoimmunity 2016, we will examine how established and emerging companies are utilizing advances in technology. More importantly, we describe how these companies and chronic disease management platforms can help create individualized autoimmune care. In Part 1, we discussed autoimmune disease as an untapped market opportunity. We also analyzed activism trends by patients and advocates. And then we reviewed advances in technology that enable digital clinical care tools.

Technology advances provide tools and platforms for data analytics, research and digital clinical care (continued)

3. Big companies apply computational power to improve understanding of health and disease

Sailing on the latest wave of technology and capital, corporate giants like Google, IBM, Apple, and others are entering healthcare. Along with other tech companies, they are bringing unprecedented computational and market power to healthcare.

IBM Watson Health and the Watson Health Cloud process huge amounts of health data using IBM’s supercomputer technology. For example, they have created algorithms to personalize cancer treatments. Just as discoveries in immuno-oncology can be applied to autoimmunity, Watson could help personalize autoimmune care.

On the data collection front, Apple’s Researchkit is an open source framework where researchers write apps to collect data from patients’ mobile phones. Such participant-centered research can aggregate individual data to better understand population trends and establish more personalized treatment protocols. This new approach could help us better understand how lifestyle modification can modulate autoimmunity.

To better understand human health, Google’s life science research organization Verily is working on a number of projects that use technology to help understand human health. Their Baseline Study follows 10,000 volunteers over 5 years to map the healthy human body as a reference for studies focused on prevention rather than disease.

Qualcomm Life’s Ecosystem (link updated to 6/12/20 announcement) securely manages near-realtime medical device and therapy data, enabling patient information to be collected anytime and anywhere. This approach allows connectivity from hospital to home as well as more convenient and accurate data collection for clinical trials.

Some large healthcare players such as Aetna, Kaiser, and Optum are using technology to advance medical care and delivery. We see similar trends in the growing interest of big healthcare companies in new technologies and approaches beyond financial management.

4. Small Companies Emerge from Convergence of Tech with Grassroots Efforts

The new technology infrastructure, coupled with advancements in data management, predictive analytics, machine learning, and artificial intelligence, supports emerging platforms that support patient-provider connections. These smaller enterprises employ coaching, coordination, telehealth, and telemedicine platforms to improve patient engagement, modify behavior, and track results.

Personalized genetic and genomic companies bring new, affordable services to consumers.

23andme is a genetic testing service generating data on ancestry and health.

Nutrigenomix offers a genetic test to identify how seven specific genes affect users’ responses to certain foods and drinks.

Vitagene applies DNA testing of customers to develop individualized nutrition, exercise and supplement plans for them.

TeloYears provides chromosomal telomere length testing to capture how users are aging on a cellular level. The company has recently pivoted to include COVID-19 rapid testing.

Microbiome therapeutic companies develop new categories of probiotics, prebiotics, symbiotics and medicinal foods.

Enterome is developing drugs and diagnostics to support personalized medicine for microbiome-related diseases with a focus on IBD.

Avidbiotics is developing precision antibiotics that spare the commensal GI microbiome, plus food safety and animal health products. In 2017 the company executed their long-planned split into two companies, one focused on cancer, the other on the microbiome.

Miomics Biotherapeutics is developing oral microbiome drugs for the treatment of autoimmune diseases.

Seres Therapeutics is pursuing microbiome discovery efforts to treat microbiome dysbiosis. Leading their pipeline are treatments for C. difficile infection (CDI), IBD and ulcerative colitis.

C3J Therapeutics is developing pathogen-specific antimicrobials to treat dental caries and C. difficile.

Personalized nutrition & food-as-medicine apps build on -omics & IT advances

DayTwo applies a proprietary algorithm along with users’ sequenced microbiomes to make personalized nutrition recommendations.

Habit uses a proprietary algorithm that includes genotype and phenotype data. It also includes personal goals to offer coaching and personalized food choices delivered to your door.

Designer supplements

Nootrobox is selling online natural cognitive enhancing compounds with minimal side effects direct to consumers. Update on ownership here.

Nuritas is using DNA analysis and artificial intelligence to identify bioactive peptides, derived from sustainable sources. These new peptides may help with muscle recovery, management of blood sugar levels, as well as reducing inflammation.

Personalized lifestyle platforms integrate multiple approaches: genomics, microbiomics, nutrition, and coaching.

Viome is a “Wellness as a Service” startup. They collect genomic, microbiomic, and metabolomic data to “generate a picture of your body at the molecular level”. Their “expert AI engine” generates “actionable diet, exercise and nutrient recommendations” as well as “contextually relevant tips” for users’ lives.

Arivale was a “scientific wellness” start-up that collected users’ genetic, microbiomic and lifestyle metrics (physical activity, sleep and heart rate). It created individualized plans that helped users pursue “optimal wellness” through coaching. Before the company closed in April 2019, they had planned to use larger data sets. These included data from the Institute of Systems Biology to uncover new patterns of health and disease. We wonder what became of Arivale’s data sets?

Designed by Human Longevity, Inc (HLI), Health Nucleus “is a new clinical research center harnessing recent advancements in genomics — combined with a comprehensive curated personal health history–to uncover health risks”. It also supports a personalized approach to health. Using data from 10,000 genomes from their sister company, HLI, they hope to find new patterns of health and disease.

5. Applying chronic disease platforms to autoimmune

Digital care coordination and behavior modification

Because autoimmune diseases are chronic, behavior change and lifestyle issues have big impact on disease management.  A number of companies have launched platforms and products to better manage autoimmune disease. The focus is on changing habits through coaching, counseling, and education. Additionally, they use symptom tracking as well as connecting patients to medical practitioners and patient communities.

Omada Health is a “digital behavioral medicine” company. They focus on changing habits that put people at risk for chronic conditions like type 2 diabetes and heart disease. The flagship program is remotely-delivered digital behavioral counseling. It integrates smart technology (pre-synced wireless scale), a curriculum, access to a health coach, and an online peer-support network.

Propeller Health is a digital platform for respiratory health management. By connecting users to physicians and a community, it minimizes the impact of asthma and COPD on users’ daily lives. Using connected inhalers, digital interfaces, mobile spirometers and real-time personalized insights, participants can receive personal guidance and expert direction anytime.

Welkin and Conversa are digital check-up companies aiming to improve population health while reducing healthcare system costs.

Welkin Health improves healthcare organizations’ outcomes and reduces operational costs through engagement, education, and support programs for people living with chronic diseases. Features include a personalized task list for the care team, patient communication tools and integration with existing hardware.

Conversa Health uses data-driven algorithms to generate personalized clinical questions, patient education, reminders and alerts triggered by patient profiles. Their algorithms integrate data from Electronic Health Records (EHR), biometric monitoring devices (i.e., wearables, glucometers), and Patient Generated Health Data (PGHD) derived from Digital Checkup responses. These data are analyzed and fed back into the EHR and care management systems to alert care teams to patients needing guidance, support or other interventions.

Care Delivery and Coverage

New digital therapeutic and digital check-up companies are applying advancing technology to support video calls, online chats, e-prescribing, and health coaching to improve primary care delivery.

Twine Health is a health coach software platform that facilitates direct primary care. Their Health Activation Platform empowers patients to achieve maximum self-efficacy in their health through deep ongoing collaboration with their care teams.

Iora Health is changing primary care from the ground up with a new model that puts patients at the center.

Sherpaa provides online personal primary care doctor services for issues a primary care doctor or urgent care center would treat. Affordable doctors are available 24/7 within minutes to diagnose, order tests, prescribe, treat, refer if needed, and check on patients until well.

Zoom Care has built on-demand retail health clinics in the greater Portland, OR area that use technology to make primary care less expensive and more accessible. Features include affordable transparent pricing, no-wait visits and the ability to schedule via ZOOM’s mobile app. Its Prime clinics use food and movement as a way to prevent and reverse chronic disease.

6. Bridging Gaps: Towards Personalized Autoimmune Care

New understanding in -omics and microbiome science is spurring new approaches to technology-enabled personalized autoimmune care. But there are still gaps. Where are the opportunities to build more bridges across the autoimmune abyss?

A slew of new companies are offering individualized monitoring, coordination, and prevention services (not necessarily for autoimmune, but for chronic and complex diseases) as discussed above and shown in the illustration below.

Conventional medicine has historically been focused on sick care: diagnosing, treating and hopefully curing acute diseases, or ameliorating and managing chronic ones. More recently, conventional medicine is coming to grips with decades of desperate denial of the facts of death by adopting palliative and hospice care for the dying.

On the other side of the arch, well care has generally been the province of consumers themselves pursuing alternative approaches: diet, supplements, exercise, meditation. Fitness enthusiasts, elite athletes, bodybuilders and quantified-selfers seek better-than-healthy goals. Futurists pursue life extension and nootropics, but with a growing focus on chronic disease prevention, healthy aging and beauty enhancement.

In the middle, we see a gap: notwithstanding a couple of centuries of public health efforts ranging from the life-saving (clean water, antibiotics, vaccines) to the merely intrusive (contradictory diet advice, punitive soda taxes), prevention has only recently come into focus for conventional medicine. Recent attempts to reverse chronic disease through weight control, blood pressure and lipids management have had a positive impact on cardiovascular and metabolic disease.

With a growing appreciation of the essential connection of sleep and health, more aggressive sleep apnea and insomnia treatment through pharmaceuticals and devices shades into personal sleep improvement through bedding, lighting, cognitive behavioral therapy apps, supplements and even lucid dreaming practices.

This gap represents a market opportunity for conventional, functional and individualized medicine where technology advances can play important roles.

For autoimmune patients, the gap is an abyss: on the sick care side, slow and inaccurate diagnosis and trial-and-error treatment (starting with the cheapest, not necessarily the most effective, drugs) have frustrated many autoimmune patients and driven them from conventional medicine to alternative, functional and self-care. On the well-care side, only baby steps have been made to identify people at risk due to genetics and lifestyle in order to discover ways to prevent or reverse autoimmune diseases before they destroy lives.

The convergence of technological and scientific advances along with the entrance of large global technology companies to the health arena give us more opportunity to meet the needs of the large and growing autoimmune market and begin shaping a new future of personalized autoimmune care.

Coordination across Conventional and Functional Care

What might this look like for autoimmunity? Early pioneers include:

Open Medicine Institute uses advanced data testing, including genomics, microbiomics and metabolomics, to treat challenging or refractory autoimmune patients.

Helpsy Health and Regeneration Health have created platforms to help patients learn and coordinate the best of conventional and functional medicine.

Cleveland Clinic’s Functional Medicine Center is pioneering clinical trials to show improved outcomes and cost savings associated with a functional medicine approach to treating autoimmunity. 

The time is right to coordinate the best of functional and conventional medicine approaches to help autoimmune patients.

We are seeking collaborations; if you have business opportunities, please contact us.

We are looking for interested people who can help us find and create new sources of data and digital tools to diagnose, treat, manage, reverse, and prevent autoimmunity.

If you are a company working on products and services in chronic disease management that could be tweaked to help autoimmune patients, we want to help bring your work to the autoimmune community.

Please join us to expand awareness and pursue the campaign against autoimmune disease.


For a downloadable version of the original State of Autoimmunity on SCRIBD here: http://bit.ly/2kvDoae

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