The State of Autoimmunity 2016 — A Progress Report: Part 2

Applying Technology to Empower Patients: 2016’s trends gave us a glimmer of hope on the path towards crossing the autoimmune abyss and reaching the goal of individualized autoimmune medicine.

By Bonnie Feldman, Ellen M. Martin and Tiffany Simms

In part 1 of The State of Autoimmunity, we discussed autoimmune disease as an untapped market opportunity, analyzed the trends in grassroots activism of patients, advocates, and entrepreneurs around chronic disease, and even reviewed the advances in technology that enable digital clinical care tools and platforms.

As we continue in part 2, we will examine how companies, big and small, are utilizing the new advances in tech, as well as how these companies and current chronic disease management platforms can be applied to create individualized autoimmune care.

Advances in Technology Provide Tools and Platforms for Big Data Analytics, Scientific Advances, and Digital Clinical Care (continued)

3. Big Companies Apply Computational Power to Improve Understanding of Health and Disease

Sailing on the latest big wave of technology and capital growth, Google, IBM, Apple, and other giant corporations are bringing unprecedented computational and market power to healthcare.

· IBM Watson Health and the Watson Health Cloud use IBM’s cognitive supercomputer technology to process huge amounts of health data from diverse sources. 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.
· Apple’s Researchkit is an open source framework within which 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.
· 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 is a longitudinal study following 10,000 volunteers over 5 years to map the healthy human body as a reference database for studies focused on prevention (well-care) rather than disease.
· Qualcomm Life’s Ecosystem 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 and market power 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 at the Convergence of Technology with Grassroots Efforts

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

i) Personalized Genetic and Genomic Companies take advantage of the decreasing cost of sequencing to bring new, affordable personal genetics services to consumers.

· 23andme genetic testing generating data on ancestry and health.
· Nutrigenomix genetic test to identify how seven specific genes affect user’s response to certain food and drinks.
· Vitagene uses DNA testing to develop individualized nutrition, exercise and supplement plans.
· TeloYears provides telomere length testing to capture how users are aging on a cellular level.

ii) Microbiome Therapeutic Companies are developing 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 a portfolio of precision antibiotics that spare the normal GI microbiome plus food safety and animal health products.
· Miomics Biotherapeutics is developing oral microbiome drugs for the treatment of autoimmune diseases.
· Seres Therapeutics is pursuing microbiome discovery efforts to treat microbiome dysbiosis with a pipeline in C. difficile infection (CDI), IBD and ulcerative colitis.
· C3J Therapeutics is developing pathogen-specific antimicrobials to treat dental caries and C. difficile.

iii) Apps for Personalized Nutrition and Food as Medicine build on 
-omics and technological advances are the first personalized nutrition apps, such as:

· DayTwo applies a proprietary algorithm along with users sequenced microbiome to make personalized nutrition recommendations.
· Habit uses a proprietary algorithm that includes genotype and phenotype data plus personal goals to offer coaching and personalized food choices delivered to your door.

iv) Designer Supplements:

· Nootrobox is selling online natural cognitive enhancing compounds with minimal side effects direct to consumers.
· Nuritas is using DNA analysis and artificial intelligence to identify bioactive peptides, derived from sustainable sources. These new peptides may help with muscle recovery, the management of blood sugar levels for type 2 diabetics, as well as reduce inflammation.

v) Personalized Lifestyle Platforms integrate multiple approaches such as genomics, microbiomics, nutrition and coaching.

· Viome is a “Wellness as a Service” startup that collects genomic, microbiomic, and metabolomic data from users to “generate a picture of your body at the molecular level” and uses their “expert AI engine” to generate “actionable diet, exercise and nutrient recommendations” and “contextually relevant tips” for users’ daily lives.
· Arivale is a “scientific wellness” start-up that collects and analyzes users’ genetic, microbiomic and lifestyle metrics (physical activity, sleep and heart rate) to create individualized plans that, through a coach, help users pursue “optimal wellness.” They plan to use larger data sets, including data from the Institute of Systems Biology to uncover new patterns of health and disease.
· 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” and support a personalized approach to health. Using data from 10,000 genomes from sister company, HLI, they hope to find new patterns of health and disease.

5. Applying Chronic Disease Platforms to Autoimmune

i) Digital Care Coordination and Behavior Modification 
Because autoimmune diseases are chronic, advances in managing chronic diseases can provide models, products, and platforms for better autoimmune disease management.

· Omada Health is a “digital behavioral medicine” company focused on changing habits that put people at risk for chronic conditions like type 2 diabetes and heart disease. The flagship program: remotely-delivered digital behavioral counseling that integrates smart technology (including a pre-synced wireless scale), a proprietary curriculum, ongoing access to a personal health coach, and an online peer-support network.
· Propeller Health is a digital platform for respiratory health management to help minimize the impact of asthma and COPD on users’ daily lives and connect them to physicians and community. 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 trying to improve population health and save the healthcare system money.
Welkin Health helps healthcare organizations improve outcomes and reduce 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, which 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. This is analyzed and fed back into the EHR and other care management systems to alert the care team to patients in need of guidance, support or other intervention.

ii) Care Delivery and Coverage
New digital therapeutic and digital check-up companies are applying technology such as 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 continuous 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, provides technology that enables care and makes payment based on outcomes.
· Q’liance has created technology to facilitate effective and efficient personalized primary care anytime and anywhere via a monthly membership fee.
· 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 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 bridges across the autoimmune abyss?

A slew of new companies are offering technology-enabled 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 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, 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 positive impact on cardiovascular and metabolic disease.
With 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 behavior therapy, supplements and even lucid dreaming.
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.

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

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 has created a platform 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 me
1. We are looking for interested individuals who can help us find and create new sources of data and digital tools to treat, reverse, and prevent autoimmunity.
2. 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 in 2017 to expand awareness and pursue the campaign against autoimmune disease.


For full resources and references please visit the full version of the State of Autoimmunity here: http://bit.ly/2kvDoae