[HN Gopher] Launch HN: Iollo (YC S22) - At-home metabolomics tes...
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Launch HN: Iollo (YC S22) - At-home metabolomics test to extend
healthy lifespan
Hi Hacker News! We're Dan, Jan, and Brent from iollo
(https://www.iollo.com/). We're developing an at-home metabolomics
test that measures hundreds of "metabolites" in blood, which
studies have shown can inform about health status, disease risk,
dietary patterns, and physical activity. We will then provide
evidence-based dietary, behavioral, and therapeutic treatments to
help extend the number of years you're disease-free (your
"healthspan"). Today's healthcare system is reactive, meaning
diseases are treated only after symptoms are present. By the time
they are detected, they're often already serious issues that
require irreversible interventions, like taking lifelong
medications and living with their side effects. Collectively, we
end up spending trillions of dollars treating diseases reactively
that can often be prevented with good health monitoring and
management. Also, a lot of age-related diseases develop as a result
of molecular imbalances that accumulate over years. One scientific
field where many of these molecules can be measured is called
metabolomics. Having worked in this field for more than a decade,
we know that the technology exists to detect potential signs of
chronic conditions at the earliest stages, when they are most
actionable. Dan has a PhD and did his postdoctoral research at
Stanford in computational biology and metabolomics. His work covers
healthspan extension, lifespan extension and machine learning-based
tools for drug repurposing. Jan, who was Dan's PhD thesis
supervisor, is a professor of computational biomedicine and
metabolomics at Cornell. He has published over 90 metabolomics-
related papers, with a focus on age-related chronic diseases, such
as cancer, type 2 diabetes, and Alzheimer's disease. Brent was the
co-founder of Circle Medical, a primary care provider via video and
in-person. The "metabolome" is defined as the complete set of
small molecules found in biological organisms with a size of <1,500
Dalton, also known as metabolites [1][2]. This comprises
biochemical substances such as amino acids, nucleic acids, fatty
acids, vitamins, and hormones, as well as external chemicals like
drugs, environmental contaminants, food additives, toxins [3][4]
and metabolites produced by the gut microbiome. As of 2022, over
200,000 metabolites have been identified in nature, 40,000 of which
are in blood, and over 1,500,000 are expected to still be
identified (what we call the dark metabolome) [5]. The same way
that fasting glucose has a baseline, other metabolites in blood,
like the ~600 that we measure, also have their own baseline and
deviations from these baselines have implications for your overall
health and aging [6]. Compared to genetic testing, which tells
people what might happen to their health, metabolomics tells us
exactly what is happening in a body right now. Recent studies have
shown links between blood metabolites and the risk or presence of
various systemic diseases, including diabetes, heart disease, and
Alzheimer's disease; see for example [7]. Here are a few examples
of what the first generation of iollo reports will include: (1)
The food a person eats and what actually ends up in their blood are
not always the same thing. This is related to the concept of
"bioavailability", which differs from person to person. For
example, people with impaired sugar transporters in the gut will
not experience the same spike of blood sugar as people with a
normal receptor (side note: this is not always a good thing, since
sugars that remain in the gut lead to IBD-like problems). Our
technology measures various markers of food intake, for example of
red meat and plant-based diets, that can show what actually ended
up in your blood. This can help guide dietary recommendations and
healthy lifestyles. (2) Your personal rate of aging. Research has
shown that there is a "biological age", which might differ from a
person's actual, chronological age. People who are biologically
older than their real age tend to develop more health-related
issues and age-related problems compared to people who are
biologically young. Our platform will provide the users with
estimates of their biological age, as well as their personal rate
of aging across repeated time points and potential recommendations
to slow down this rate. (3) Our technology measures so-called
"polyamines", a group of molecules that regular lab tests do not
capture today. Polyamines have been shown to improve the immune
system in aging individuals, and appear to have protective
properties against various diseases. Moreover, recent studies have
demonstrated that a long-term, polyamine-rich diet can increase
blood levels of these molecules. Hence, polyamines provide an
interesting angle of dietary interventions, and the success of this
intervention can be monitored with our technology. (4) We also
find some interesting, unexpected metabolites in certain people.
For example in one of our pilot studies, one of our participants
had a high level of phthalic acid, which can be found in plastics
and cosmetics and is a chemical known to disrupt hormones in the
body. The next generation of our technology is expected to provide
additional information about mental health markers, metabolic
disorders, inflammation and allergies, and many more. How it
works: We send you a blood collection device, the same one we use
at Stanford for research studies. After an overnight fasting
period, you stick this device to your arm and press a button. A
vacuum forms and a lancet (virtually!) painlessly pricks the
surface of the skin to collect a small amount (~80uL) of blood over
a couple of minutes. The faint feeling is similar to when you
attach the new generation of glucose monitors, if you've ever used
one. The device contains a sponge designed to stabilize the
biochemical molecules in blood at room temperature. You package the
device with a prepaid return label, and it gets express-shipped
directly to the metabolomics lab. As soon as we receive your
sample, we store it at -80degC. Samples are defrosted, centrifuged
to collect the desired blood extracts, and the extract is then
dried under liquid nitrogen. These blood extracts that contain
metabolites are then subjected to two different mass-spectrometry
analysis step: first through an ultra-performance liquid
chromatography coupled with tandem mass-spectrometry (UPLC-MS/MS),
and second through a flow injection analysis tandem mass-
spectrometry (FIA-MS/MS) on the same instrument to specifically
extract lipids. The measured mass-spectra from the machines are
then analyzed using specialized software to obtain quantification
values of all metabolites. Here is a short video of our lab
process: https://youtu.be/Jm3mCfHJjX8 The resulting data is then
securely sent over to us (we're HIPAA compliant), and we perform
statistical analysis and machine learning to generate an
individualized report. Depending on the number of tests you do, the
same procedure is repeated after a few weeks or months. This allows
the user to build their own, individualized longitudinal metabolic
monitoring. We will associate metabolite profiles with wearables
data, diet, supplement and medication intake, and potentially
health conditions based on current research, and provide
recommendations based on these. This process also shows the
difference between us and the infamous Theranos (a common question
we get!) Instead of building our own machines that might end up not
working, we rely on decades of research in the mass-spectrometry
field and work with established metabolomics labs to ensure the
quality of our measurements. Moreover, every bit of information
that we communicate to the users will be heavily backed by
scientific evidence which we disclose in the delivered reports.
One of the more exciting things we'll be able to do as our
metabolomics database grows is to look for new signatures of age-
related diseases at earlier and earlier stages. (Such analysis will
only be done on de-identified data, only with consent, and only for
our work towards extending healthspan.) One example of this is
being able to detect early signatures of type 2 diabetes with
metabolomics data, up to 12 years in advance, even when someone has
a normal fasting glucose [8][9]! Once we're able to detect these
early disease signatures, it is much easier to find interventions
to treat them and extend healthy lifespan, especially if they are
still very early in development. We are currently running an
internal pilot and taking preorders: https://www.iollo.com/plans.
We will be offering a beta version to users who've signed up in the
coming months. Tests can be pre-ordered at $50, but we won't charge
the full subscription, which is around $212-$276 per test, until
your first kit is shipped to you. If you decide to pre-order, we'll
additionally provide you with your entire metabolomics data so that
you can run your own association experiments. Just type in the code
HNLAUNCH with your pre-order so that we can send you your data.
Right now we only ship in the US. We believe we have a real chance
to change the standard of care in health while developing more
understanding of human health, physiology, and aging. We hope to
expand metabolomics test access to users and patients, and give
providers a new way to help treat age-related diseases. We really
look forward to your questions and comments and feedback! Thanks
everyone! - Dan, Jan, and Brent.
Author : danielgomari
Score : 84 points
Date : 2022-08-03 15:56 UTC (7 hours ago)
| renewiltord wrote:
| Clicked through with intent to buy. Abandoned on recurring charge
| and too many offerings.
| danielgomari wrote:
| I'd be happy to cancel it for you. The reason we have a
| subscription model is that most value can be derived from the
| metabolite trends rather than a single snapshot.
|
| We understand it's not for everyone!
| https://news.ycombinator.com/item?id=32285242
| base3 wrote:
| This sounds like the pitch I got from a friend who drank the
| Theranos kool-aid.
| bckr wrote:
| Theranos contained the seed of a good idea. That it was a toxic
| cult run by psychopaths is unfortunate.
| danielgomari wrote:
| danielgomari wrote:
| raylad wrote:
| I was interested in signing up, but then saw that you get raw
| data for metabolites only with the $160/month plan.
|
| This seems as if it costs you actually $0 to provide since you
| have that data as a prerequisite for doing anything. Why would
| you not provide that for every plan?
|
| Also "get basic tips" on the lowest cost plan doesn't provide
| enough information to know whether it will be anything
| interesting or usable.
| margalabargala wrote:
| The data you refer to is almost certainly covered under HIPAA
| and required to be released to the patient upon request. See
| this on genetic tests, something similar:
| https://www.hhs.gov/hipaa/for-professionals/faq/2048/does-an...
|
| So there are a couple of options here:
|
| - They won't provide raw data to the lower tiers at first, get
| sued, face consequences for HIPAA violations, and provide raw
| data to all tiers thereafter
|
| - They are being sneaky with their marketing, calling attention
| to the fact that raw data is provided with their expensive
| plans, while being quiet about the fact that they also have to
| provide it with the cheap plans.
| ForrestN wrote:
| I have no insight into the actual company's thinking, but in
| general there's not necessarily any relationship between the
| cost to provide a feature of software and the amount that is
| charged to use it. It's usually more about willingness/ability
| to pay. If most of the people who need access to the raw data
| have a certain use case that means they're willing to pay for
| the expensive plan, that's a good reason to charge for it,
| assuming your goal is to make money as a business.
| danielgomari wrote:
| In fact, valid point on the data download. After the feedback
| we have received, we will change this and everyone will get
| their data. Regarding the basic tips, we are working on an
| example report so users can see what they are getting.
| hn_throwaway_99 wrote:
| In 2013 FDA shut down 23andMe's direct-to-consumer reports
| because they said consumers would misunderstand genetic
| information and "self treat". FWIW I thought this was a dumb
| decision and feel lucky that I was grandfathered in to some
| helpful reports before the FDA put the kibosh on them.
|
| Do you think this is a risk to you? How will you deal with the
| FDA?
| danielgomari wrote:
| In general, it's good that the FDA is holding companies to a
| certain standard. We're currently running our tests under an
| IRB and this is actually one of the first steps for us to have
| enough data to start our application to the FDA.
| lancesells wrote:
| > At no time shall your Personal Information, including blood or
| metabolomic data collected from you in accordance with this
| Privacy Policy be deemed to be an electronic health record or an
| electronic medical record for any purpose, including without
| limitation for the purpose of compliance with the Health
| Insurance Portability and Accountability Act of 1996.
|
| Does this mean you other medical professionals can't get the data
| / records of these tests?
| danielgomari wrote:
| It just means that you are the owner of the data.
|
| If you want to have your data, you can download them at any
| time and share them with anyone you want.
|
| If you want us to delete the data, we will do that.
|
| If you don't say anything, we will never share your data with
| anyone.
| chaostheory wrote:
| This is what I was looking for
| WaitWaitWha wrote:
| I appreciate what you are trying to say (I think) but the way
| this is presented seems to contradict previous statement.
|
| > The resulting data is then securely sent over to us (we're
| HIPAA compliant)
|
| So the material is considered and under the protection of
| HIPAA.
|
| > At no time shall your Personal Information, including blood
| or metabolomic data collected from you in accordance with
| this Privacy Policy be deemed to be an electronic health
| record or an electronic medical record for any purpose,
| including without limitation for the purpose of compliance
| with the Health Insurance Portability and Accountability Act
| of 1996.
|
| This reads like 'because we do not consider your data to be
| PHI, therefore it is not under HIPAA.' ergo, lose all HIPAA
| protection.
|
| Might want to re-write this if that is not what you meant.
| danielgomari wrote:
| The legal language here can indeed be confusing. EHR and
| PHI are not the same thing. What is important is that your
| personal information will not be shared with anyone. We
| will make sure that the language on our webpage is more
| concise, thank you for pointing this out.
| hinkley wrote:
| I also read that as "we can sell this data".
|
| The thing you need to remember with consumer protection is
| that a failing company will abandon everything including
| ethics in order to pay the piper. Especially after they
| have laid you off.
|
| There's a reason some capital E ethical companies put
| poison pills or time bombs in their charter. Booby traps of
| this sort actually instill trust in people who have heard a
| line of bullshit so often they can see it a mile away.
| bearjaws wrote:
| I've seen this literature used before, you can make such a
| claim if you are a transmitter of data, e.g. a SMS carrier.
| However this would certainly fall flat on its face if you
| were a actual EHR / EMR.
| ryanSrich wrote:
| HIPAA only covers business associates, covered entities and
| subcontractors. I'm guessing this company is neither of
| those three. Therefore the "PHI" you provide to them, is
| not "PHI" under HIPAA since you are providing the data, and
| not a covered entity.
| diydsp wrote:
| Great idea. Huge longevity freak here. But why are you developing
| _two_ things? 1. the blood extractor and 2. the test data
| processing. Seems like the blood extractor is way riskier
| /complex and unnecessary part of the main point. Unless your main
| point is blood extraction for numerous other tests.
| danielgomari wrote:
| Thanks and great question. The extractor already exists. It has
| already been developed and is actively being used in studies at
| Stanford, Cornell, pharma and other institutions. We are using
| this collection technology to obtain blood in a pain-free and
| stable way. Our main R&D is in the data extraction, processing,
| and analysis.
| hinkley wrote:
| As I watch younger people struggle with basic stuff I think
| getting old is not so bad and I wish people weren't so afraid of
| it.
|
| Then I get out of a chair on a bad day and make grandpa noises.
|
| I think if someone invented medical tech to repair and prevent
| joint injuries, and to retain cardiac function, I would sign up
| for those and boycott the rest.
|
| I don't need to live forever. I'm pretty sure I don't have the
| stamina for it. I don't think most of the rest of us do either. I
| stopped reading Ann Rice before Armand, but if you ignore the
| other weird stuff, that's practically the main thesis of the
| books. People think they have the stamina for forever. Anyone who
| actually does is very very special.
|
| Blue Mars and Green Mars dip into this too, but also consider
| Progress instead of the supernatural. Sometimes people have to
| step aside for new ideas to flourish.
| SoftTalker wrote:
| > I don't need to live forever.
|
| Nobody does. Death is part of the health and evolution of of
| any ecosystem. Old people, and old ideas, need to gradually
| make way for the next generation. This must however go along
| with a robust education in history, as we are prone to making
| the same kinds of mistakes over and over.
| guzik wrote:
| Maybe let's create an alternative to death in the first
| place, so you can decide if you would rather die or not. I
| bet for the latter.
|
| _" We don't need cars, all we need are more horses!"_
|
| _" We don't need cure for the cancer, dying from it is all
| natural!"_
|
| _" But curing death is different, it disturbs healthy
| evolution process!"_
|
| We would figure it out how to boost the progress without
| having to let go of the people we love. We shouldn't have to
| accept death as this necessary thing we all have to go
| through.
| hinkley wrote:
| Have you considered a career as a pharmaceuticals lobbyist?
|
| "Let's fuck around and find out."
|
| Counting on people to act responsibly is, from a civics
| standpoint, one thing. Creating the attractive nuisance,
| distributing it, and then still expecting people to act
| responsibility is, if someone is feeling charitable,
| chaotic neutral behavior at best. And if not, top-shelf
| mischief-making that would make Loki's mouth water.
| tdaltonc wrote:
| Do you estimate the analyte levels and then use those to
| calculate your summary statistics (bio age, polyamines level,
| etc) or do you estimate the summary stats directly from the spec
| data?
| danielgomari wrote:
| We estimate summary stats directly from spec data.
| tdaltonc wrote:
| Dope. I've very optimistic about the new paradigm of
| spectrometry + ML for metabolic biomarkers. I don't care
| about the level of any one analyte! I want to know the
| overall picture of my metabolic health inferred from 100's of
| weak signals.
|
| The ML model is also very defensible, so congrats on that.
|
| I've been told by people who would know that bio_age
| estimation via transdermal Spectrometry isn't going to happen
| this decade. Do you agree?
| investor382718 wrote:
| Do you think the subscription value proposition in your lower
| tier offers compelling value to consumers? What research have you
| done to make ensure your pricing tiers are market-appropriate?
| nonameiguess wrote:
| The idea certainly excites me.
|
| Given the possibility that some findings might lead to the need
| for medication, are you going to have MDs or PAs or whoever on
| staff who can prescribe those?
|
| For metabolites found in very low concentrations where draw-to-
| draw variance is high, how do you deal with that when a person is
| only sending you one sample at a time?
|
| Is there ever going to be any effort to have this payable by
| health insurance?
|
| Are you doing anything with the feedback data? As in, someone
| sends you a sample, you tell them to make a behavioral change,
| does your advice change if future samples don't show a positive
| intervention effect? How do you know if patients comply with your
| recommendations?
|
| Are you going to offer genetic testing so, say, someone with high
| LDL or whatever can know if that's due to diet or they just lost
| the genetic lottery and nothing but statins can possibly help
| them?
|
| I think LDL is not a metabolite but since your "what's measured"
| page ends with "more published below" and then there is nothing
| below, I'm not sure what the full extent is of what you're
| testing for. If not LDL, presumably something you're testing for
| can have many sources, including genetic propensity, diet, and
| other environmental factors. How do you determine which of those
| is most causally relevant before prescribing an intervention?
| danielgomari wrote:
| > Given the possibility that some findings might lead to the
| need for medication, are you going to have MDs or PAs or
| whoever on staff who can prescribe those?
|
| Yes, for when we enter the diagnostics phase of our tests, we
| will be working with MDs and PAs who can prescribe medication.
|
| > For metabolites found in very low concentrations where draw-
| to-draw variance is high, how do you deal with that when a
| person is only sending you one sample at a time?
|
| We will have a reference cohort in place to which your
| measurements will be compared. Thus, even for a single
| measurement, we can make statements about values that are out
| of range. The most benefit will come from longitudinal
| sampling, where we can see how your blood metabolite levels
| move over time.
|
| > Is there ever going to be any effort to have this payable by
| health insurance?
|
| Yes, it's on our roadmap. We're also now working on having our
| tests HSA/FSA eligible.
|
| > Are you doing anything with the feedback data? As in, someone
| sends you a sample, you tell them to make a behavioral change,
| does your advice change if future samples don't show a positive
| intervention effect? How do you know if patients comply with
| your recommendations?
|
| We are. And you're exactly on point in that if the
| interventions have 0 effects on a person, it will be omitted in
| subsequent reports. Though, we usually see effects on the
| metabolome with interventions and it becomes a matter of
| adjusting them. Which ties into our recommendations getting
| better and better for a person as they continue testing and
| acting on those recommendations. In terms of how we know if a
| person complies with recommendations, based on our database, we
| know of metabolic patterns that would indicate compliance,
|
| > Are you going to offer genetic testing so, say, someone with
| high LDL or whatever can know if that's due to diet or they
| just lost the genetic lottery and nothing but statins can
| possibly help them?
|
| Currently not, but one feature that we will be implementing
| soon would be the ability to upload genetic information and
| we'll integrate that into our analysis.
|
| > I think LDL is not a metabolite but since your "what's
| measured" page ends with "more published below" and then there
| is nothing below, I'm not sure what the full extent is of what
| you're testing for.
|
| We were not sure where LDL was coming from here? Regarding our
| webpage, the "more published below" refers to the Nature
| Medicine paper, we cite further down on the page.
| https://www.nature.com/articles/s41591-021-01266-0
|
| > If not LDL, presumably something you're testing for can have
| many sources, including genetic propensity, diet, and other
| environmental factors. How do you determine which of those is
| most causally relevant before prescribing an intervention?
|
| That's a good question and will be decided case by case. As an
| example, if your glucose levels are elevated and you have
| diabetes, it doesn't really matter why that happened, the
| consequences are the same. But indeed, there are special cases
| especially of genetic variants that need special attention. We
| will work on those and present the data accordingly in the
| reports.
| humanlion87 wrote:
| This sounds very interesting and I am tempted to sign up. But the
| biggest worry for me is the privacy of the data. There is a
| mention on the website that data isn't shared without consent.
| But that can always change in the future once VCs get involved
| and they are trying to maximize revenue. Or the business model
| changes.
| danielgomari wrote:
| This is actually not possible. There is a set of laws called
| the "Health Insurance Portability and Accountability Act" or
| HIPAA. This prohibits us and anyone else to misuse your data
| and share them without your consent.
| vorpalhex wrote:
| > Many people don't realize that the Health Insurance
| Portability and Accountability Act (HIPAA) actually enables
| information sharing. HIPAA (specifically the HIPAA Privacy
| Rule) defines the circumstances in which a Covered Entity
| (CE) may use or disclose an individual's Protected Health
| Information (PHI). HIPAA provides many pathways for
| permissibly exchanging PHI, which are commonly referred to as
| HIPAA Permitted Uses and Disclosures.
|
| https://www.healthit.gov/topic/interoperability/how-hipaa-
| su...
| danielgomari wrote:
| You are absolutely right. What it comes down to, however,
| is consent by the individual. Data will not be shared
| without your permission. We will make sure our legal
| language is clearer here.
| deegles wrote:
| I think what people are getting at is that the legal
| language can be changed after an acquisition and our
| previously-safe data is now owned by a less scrupulous
| entity.
| danielgomari wrote:
| References:
|
| [1] Wishart DS. Metabolomics for Investigating Physiological and
| Pathophysiological Processes. Physiol Rev. 2019 Oct
| 1;99(4):1819-75.
| https://journals.physiology.org/doi/full/10.1152/physrev.000...
|
| [2] Wishart DS, Tzur D, Knox C, Eisner R, Guo AC, Young N, et al.
| HMDB: the Human Metabolome Database. Nucleic Acids Res. 2007
| Jan;35(Database issue):D521-526.
| https://academic.oup.com/nar/article/35/suppl_1/D521/1109186
|
| [3] Wishart DS. Current progress in computational metabolomics.
| Brief Bioinform. 2007 Sep;8(5):279-93.
| https://academic.oup.com/bib/article/8/5/279/217981
|
| [4] Nordstrom A, O'Maille G, Qin C, Siuzdak G. Nonlinear data
| alignment for UPLC-MS and HPLC-MS based metabolomics:
| quantitative analysis of endogenous and exogenous metabolites in
| human serum. Anal Chem. 2006 May 15;78(10):3289-95.
| https://pubs.acs.org/doi/10.1021/ac060245f
|
| [5] Wishart DS, Guo A, Oler E, Wang F, Anjum A, Peters H, et al.
| HMDB 5.0: the Human Metabolome Database for 2022. Nucleic Acids
| Research. 2022 Jan 7;50(D1):D622-31.
| https://academic.oup.com/nar/article/50/D1/D622/6431815
|
| [6] Ahadi, Sara, et al. "Personal aging markers and ageotypes
| revealed by deep longitudinal profiling." Nature Medicine 26.1
| (2020): 83-90. https://www.nature.com/articles/s41591-019-0719-5
|
| [7] Pietzner, Maik, et al. "Plasma metabolites to profile
| pathways in noncommunicable disease multimorbidity." Nature
| medicine 27.3 (2021): 471-479.
| https://www.nature.com/articles/s41591-021-01266-0
|
| [8] Merino, Jordi, et al. "Metabolomics insights into early type
| 2 diabetes pathogenesis and detection in individuals with normal
| fasting glucose." Diabetologia 61.6 (2018): 1315-1324.
| https://pubmed.ncbi.nlm.nih.gov/29626220/
|
| [9] Wang, Thomas J., et al. "Metabolite profiles and the risk of
| developing diabetes." Nature medicine 17.4 (2011): 448-453.
| https://www.nature.com/articles/nm.2307
| tdaltonc wrote:
| How stabile is your "biological age" stat? Is this more like
| blood glucose (can change dramatically in minutes) or A1C (takes
| weeks to move significantly) or is it even more stable than that?
| Said another way: In the extreme case where you had a subject
| that was chrono_age = 60yrs and bio_age = 70yrs and they were
| perfectly compliant to your recommended interventions, how fast
| could you get the bio_age measure down to 50yrs?
| danielgomari wrote:
| The biological age takes months to move. After a certain number
| of tests, we'll be able to model how your bio_age responds to
| the recommendations and consequently make them better and
| better for you.
| LinuxBender wrote:
| _We're developing an at-home metabolomics test that measures
| hundreds of "metabolites" in blood, which studies have shown can
| inform about health status, disease risk, dietary patterns, and
| physical activity._
|
| Just for my own clarification, when you say _at-home_ do you mean
| that the kit will diagnose the patient at home, or that they will
| gather samples at home and mail them to you?
| neonate wrote:
| Clearly the latter, from the text above:
|
| _How it works: We send you a blood collection device ... and
| it gets express-shipped directly to the metabolomics lab._
| llaolleh wrote:
| ^. What they wrote is kind if misleading. You still have to
| send it over.
| danielgomari wrote:
| By at-home we mean that the person will gather samples at home
| and mail them to us.
| toomuchtodo wrote:
| I'm having an annual physical this month where blood samples
| are taken from my arm at my medical system's lab attached to
| the PCP's office. Could I have additional blood drawn during
| my physical and send it with the process you have? Or would I
| have to specially use your collection device?
|
| (Interested in purchasing your service and sending in a
| sample from my physical)
| danielgomari wrote:
| Unfortunately, it has to be through our collection device.
| Blood usually has to be cooled on ice to be shipped. At
| room temperature (in the mail), you need the stabilizing
| sponge that our blood device has.
| LinuxBender wrote:
| Thank you for the clarification. As neonate mentioned I
| should have figured that out from further down the post. I
| get a little excited when I see these posts because I have
| been waiting for smaller and less expensive diagnostic
| devices in this field.
| tdaltonc wrote:
| Have you tried this: https://thecor.com/ ?
| gfodor wrote:
| Pricing is too steep to pull the trigger on something so novel
| and whose utility, quality, and accuracy won't be obvious (or
| not) until a few tests are done. I'm not sure how to solve this
| other than to lower them for early adopters while you establish
| your brand and reputation.
| danielgomari wrote:
| This is the only pricing model we can offer at the moment.
| We're actively working on reducing our costs to be able to
| offer the tests at a more affordable price in the future.
| sniperjoe360 wrote:
| Hi guys, first great effort and as someone who worked in a
| metabolomics lab I know how amazingly sensitive and rich the
| information one can gather even from a small amount of blood.
|
| That said, the million dollar question you have to answer in
| healthy persons is "how is this better than normal lab tests?
| (CBC, CMP, TSH, UA)?" For example regarding diabetes - there is
| HbA1c and microalbuminuria, both of which can detect abnormal
| glucose years before diabetes and prevent it.
|
| If you can prove that these tests add value to the battery of
| already very cheap and ubiquitous tests, then you will have
| widespread adoption.
|
| Clinical metabolomics is a very nascent field and best of luck to
| you!
| _TheoMaxwell_ wrote:
| Couple of questions:
|
| - Do you have an example of what a report looks like?
|
| - What's your turnaround time?
|
| - Do you have an option to do one test if we're unsure we want to
| commit to a year?
|
| - Can we do anonymized user information from the start, ie not
| providing name, address, etc (given recent supreme court
| decisions, it's not off the table that one day insurance
| companies would be allowed to access this data)
| danielgomari wrote:
| EDIT: here is a link to single-kit orders:
| https://bit.ly/iollo-single-kit
|
| To answer your questions:
|
| - Thanks for the suggestion, we're currently working on the
| example reports with our pilot users and will publish some of
| them soon.
|
| - Our turnaround time is currently 2-3 weeks, but we're working
| to significantly reduce that.
|
| - Given this feedback we're receiving, we'll implement that
| option shortly. For now if you want to try it, you can get the
| one test plan and I'll cancel the subscription for you.
|
| - This is a good question, and we have to look into this. Data
| privacy is a big topic for many people. We have to mail the
| package somewhere, but maybe there are options.
| _TheoMaxwell_ wrote:
| On the last point, I don't think that is a huge problem. If
| you are doing one-off tests, then you could just
| automatically send them as "gift wrapped" which leaves it
| open to interpretation whether they used it or someone else
| used it (as long as you don't store PII)
| apostate wrote:
| The HNLAUNCH promo code is showing as invalid for me.
| danielgomari wrote:
| Thanks for catching that. Should work now.
| apostate wrote:
| Confirmed, thanks!
| urlwolf wrote:
| Pity this is US only; Any idea when/if it will be available in
| Europe? I'm in Germany.
| danielgomari wrote:
| We have to get it to work here in the US first, but if you join
| the waitlist and tell which country you're in, then it'll help
| us know where to go next!
|
| Also, Jan and I are from Germany, and Brent lives in
| Switzerland. Those countries will definitely be on the top of
| our list!
| thomasfedb wrote:
| Do you have concerns about over-diagnosis, turning people in
| patients unnecessarily? Can this information creating outsized
| worry and psychological impacts that exceed the potential problem
| that may or may not eventuate? In the US I imagine there are also
| insurance implications.
| danielgomari wrote:
| Yes, we are taking this topic very seriously, especially in the
| light of recent genetic testing controversies. We will work
| hard on not only making the science behind our reports solid,
| but also making sure that the reports are communicated clearly.
| Early generations of the technology will mostly focus on
| overall health status and fitness. As for disease diagnosis,
| every single case will be worked out individually, will be
| tested, and will also be subject to regulatory scrutiny.
| thomasfedb wrote:
| Some of the (?indicative) screengrabs on your website also
| seem to suggest that your app will advise a 'dietary source'
| when some level is low - is this actually your intention?
|
| Because it's far from obvious that dietary supplementation of
| X is going to have a causal link to a reduction in problem Y,
| where Y is associated with low levels of X.
|
| For example, a low ferritin isn't always best treated with
| iron supplements - certainly they won't treat the bowel
| cancer that could be the underlying cause.
| closedloop129 wrote:
| > Moreover, every bit of information that we communicate to the
| users will be heavily backed by scientific evidence which we
| disclose in the delivered reports.
|
| Will it be possible to contact people with similar profiles to
| create new scientific evidence? E.g. if some marker is too low,
| it would be nice to work with others with the same problem to
| figure out how to increase the value.
| danielgomari wrote:
| This is an excellent idea. Community engagement is something we
| have definitely thought about and is now part of our roadmap.
| Matchmaking between people could add an interesting level of
| communication and exchange. We will need to make sure to
| address any possible privacy concerns, and we'll be working on
| it.
| WaitWaitWha wrote:
| Congratulations on the launch.
|
| Why 1, 3, 6, or 9 tests per year? (Seems odd considering 52
| weeks, or 12 months for periodicity. Only 6 divides into 12.
| Maybe 1, 2, 4, 6, and 12?)
|
| > 30-min call with Stanford/Cornell scientist to go through
| results
|
| 9 times, or once? I have seen other industries (e.g financial,
| hotel, airline) attempting to sell 'high touch' service as an
| upgrade. I have yet to see one that is worthwhile or is
| profitable.
|
| > Integration with wearables and diet tracking apps
|
| Can you describe what wearables and what diet tracking apps?
|
| As others have asked, a sample report would be lovely.
|
| > You must live in the US, be 18 years or older, and not pregnant
| to be participate.
|
| I think you are looking for 'Have US address'. Or, you are
| looking for US address _and_ US funds?
| danielgomari wrote:
| Thanks.
|
| - We've seen that people want different levels of granularity
| of their metabolomic trends, and these are the test frequencies
| where we could accommodate for those granularity levels.
|
| - Regarding the calls: In the beginning, we will offer guidance
| for every measurement, if they request it.
|
| - For the wearables, we're including Fitbit, Garmin, Apple
| Watch, Whoop, and Aura, and for the diet tracking app it'll
| initially be myFitnessPal, and Cronometer.
|
| - Right now we can only ship our tests inside the US, so anyone
| currently in and with an address in the US.
| neonate wrote:
| I have a question based on what you said here:
|
| > one of our participants had a high level of phthalic acid,
| which can be found in plastics and cosmetics and is a chemical
| known to disrupt hormones in the body
|
| Does this mean that if elevated levels of some weird metabolite
| are found in my blood, you'll let me know? You say you measure
| 600 of them - does that mean you check for weird/high levels of
| all 600, and if you find some, they'll be in the report?
| danielgomari wrote:
| That's 100% correct.
| troysk wrote:
| Congrats on the launch! We need more folks trying to bring the
| tricoder to reality. I knew about DNA-methylation but this novel
| way seems more apt for scale.
| danielgomari wrote:
| We're working on it captain!
| duncancarroll wrote:
| This looks awesome! I recently did a 2x/mo metabolomics
| experiment (https://smm-data.herokuapp.com/) and I've been
| wishing someone would do something like this ever since.
|
| Best of luck!
| danielgomari wrote:
| Thanks so much!
| llaolleh wrote:
| This is exciting technology. Something I want but that does not
| exist is being able to test your blood with your own personal
| device without sending any of the data or blood over to private
| corporations. The corporations only sell the software.
|
| You'd be able to download different programs that analyze your
| current health state from blood, or any other marker. The device
| would be able to tell if you are at risk for any disease just
| from a common set of samples.
|
| I know this is kind of unrealistic, because to make better
| programs you need data from people. But who knows. Maybe one day
| we'll get there.
| secretwho wrote:
| This may be what you are looking for:
| https://www.bloomdiagnostics.com/
| gwillen wrote:
| Their site says they will only ship to Austria, Germany, or
| Italy, and you have to promise you're a medical professional
| to even get to checkout (I don't know whether it's further
| enforced if you do have an address they ship to.)
| foolinaround wrote:
| 1) Providing raw data at the lowest plan would evince more
| interest. It would not cost you any more.
|
| Also, the plan should allow for ad-hoc testing at a slightly
| lower price as a repeat customer.
|
| This way, I might set a baseline, and after I go through a bout
| of illness, I can measure myself incrementally.
|
| 2) A page with markers you provide related to a specific
| condition would be helpful, for example, I am genetically
| disposed to heart disease, and would like to keep track of those
| that can impact it.
| danielgomari wrote:
| EDIT: here is a link to single-kit orders:
| https://bit.ly/iollo-single-kit
|
| 1) You are right. We have repeatedly received this feedback
| now. We will make the data available for all plans, and we will
| add a one-kit purchase option.
|
| 2) Yes, this is the kind of report presentation we are working
| on and we will work with the community as much as possible to
| design these reports.
| mdaniel wrote:
| please don't use link shorteners:
| https://buy.stripe.com/8wMeYY3SM9B7fgkaEJ
| rngname22 wrote:
| "Your personal rate of aging. Research has shown that there is a
| "biological age", which might differ from a person's actual,
| chronological age. People who are biologically older than their
| real age tend to develop more health-related issues and age-
| related problems compared to people who are biologically young.
| Our platform will provide the users with estimates of their
| biological age, as well as their personal rate of aging across
| repeated time points and potential recommendations to slow down
| this rate."
|
| I question whether it's emotionally healthy for all users to have
| a direct measure of their aging to this degree. If I were a
| customer, I'd prefer to receive the actionable advice (the "how
| to decrease this rate of aging") without knowing the exact rate
| or my rate relative to the average. Especially if there were
| aspects outside of my control. If some other thing shows up as
| actionable but there's not really much in the metabolite data
| relevant to aging rate, cool - show me that stuff instead. If the
| data does show there are actions that I should take to reduce
| rate of aging, cool - recommend me those actions.
|
| Certainly not saying one shouldn't be able to get at this data
| from your service, but that perhaps it should be an onboarding
| option to not receive that level of granularity.
| danielgomari wrote:
| Yes, we agree that being confronted with a health issue without
| any way to go forward would be emotionally stressful. For aging
| specifically, the good news is that an overall healthy
| lifestyle (diet, exercise, sleep) appears to slow the
| biological aging process. So, if we report an accelerated aging
| rate to you, this could also serve as a simple wake-up call to
| do something.
|
| The idea of masking certain aspects with different levels of
| granularity during onboarding and according to each person's
| comfort level is excellent. We will take this into
| consideration.
| rngname22 wrote:
| Awesome to hear, sounds like you get that that could be an
| issue for users with feelings of struggling to control their
| health or wanting to optimize it and feeling powerless with
| regards to aging and mortality.
|
| I'll just say, that even IF you can provide actionable advice
| to improve things, I still wouldn't want a number or
| quantifiable thing regarding aging rate. Something like sleep
| quality or weight change is more indirect and I feel fine
| knowing the stats. But with actual aging, not even sure I'd
| want the boolean 'you are experiencing accelerated aging' vs
| 'you are no longer experiencing accelerated aging' or 'you
| aren't experiencing accelerated aging'.
|
| Like, look at something like Apple Health that prompts the
| user to try to get in their daily steps. Or an app reminding
| an elderly person to stand up every hour. Or to look away
| from their screen.
|
| Those reminders could secretly be informed by the patient's
| health markers, but the patient need not think about that or
| their raw score.
|
| I think the value I'd find in a service like Iollo is getting
| targeted advice/actions dependent on my own metabolically
| problematic markers - maybe Iollo's advice changes whether I
| have sleep issues or hormone problems or eating too much or
| am smoking cigarettes - and to have those actions/advice
| change over time dynamically as new input / measurements are
| received by your systems, as opposed to seeing a line graph
| showing me just how much I fucked up my body in April when I
| was grieving a loss of a parent with sleepness nights and
| hitting the whiskey a bit too hard, just yielding more
| anxiety and self-recrimination.
|
| On the other hand - I wouldn't mind seeing congratulations or
| seeing Iollo prove that positive steps I took are resulting
| in improvements. So maybe Iollo telling me that I did a
| stellar job in improving measures of cardiovascular health
| over the last 30-90 trailing days, allowing me to feel like I
| accomplished something by improving habits.
| danielgomari wrote:
| We hear you. You are talking about positive reinforcement
| rather than negative feedback. And about gradual,
| quantitative information rather than hard calls on "good"
| and "bad". Your thoughts are very valuable here, we will
| take all of this into consideration.
| tdaltonc wrote:
| Is "Iollo" pronounced like "YOLO"?
| danielgomari wrote:
| (^*^)
| tdaltonc wrote:
| That's very clever honestly. All those 1's and 0's in there
| makes the wordmark looks "very computers," but it's also a
| meme, and it's also about longevity. A lot packed in there.
| danielgomari wrote:
| A lot thought went into picking this name, glad you noticed
| :)
| lastofthemojito wrote:
| How comfortable do you feel making these kinds of
| recommendations?
|
| I feel like during my lifetime overall nutritional guidance has
| swung on plenty of things. One example would be eggs - "those are
| good for you, no wait they're bad and drive up your cholesterol,
| no wait, the cholesterol in eggs doesn't seem to raise
| cholesterol in humans who consume eggs".
|
| I can see where you'd feel you have an edge by measuring each
| individual's blood over time and you can see how test results
| change after making changes in diet or behavior - except maybe
| you aren't factoring in so many other changes. Maybe I moved
| somewhere colder and I'm getting less sunlight. Maybe I got
| COVID. Maybe I took up swimming. Ok, so now a blood test is
| showing that I'm at a slightly higher risk for a disease - do I
| follow Iollo's dietary guidance? Do I try to get more Vitamin D?
| Do I just write it off as noise?
| danielgomari wrote:
| Regarding your first question on recommendations, and potential
| changes in established interventions (the egg example). In the
| earlier phases, we will mostly focus on established
| interventions that affect the metabolome and health and that
| have already been published by others, such as the DASH diet
| and exercise regimes. As you build your metabolomic trends over
| time, we'll then transition into more of our proprietary
| interventions.
|
| Regarding your discussion of potential confounding factors due
| to changes in lifestyle parameters (swimming, sunlight etc.).
| That's an excellent question and important topic. For some
| metabolites, this does not matter. For example, if your glucose
| or Hba1c levels go above a certain value, you have diabetes,
| and it doesn't matter how it got there. For other metabolites,
| there might indeed be some external factors that influence the
| results. As you said, maybe you move somewhere cold, your
| metabolite levels suddenly switch, and the report says
| "warning". We have two answers for this: (1) For a lot of
| metabolites, these types of environmental factors and whether
| or not they play a role have been investigated in research
| studies and we thus know them. (2) Prior to each test, we will
| ask for as many lifestyle parameters as possible so we know
| that a certain change occurred and we can account for those in
| our analyses. Also over time, as we build our database, we will
| be able to automatically detect these changes for you and
| account for them (similar to Apple Watch's movement detector).
| onlyrealcuzzo wrote:
| > I feel like during my lifetime overall nutritional guidance
| has swung on plenty of things. One example would be eggs -
| "those are good for you, no wait they're bad and drive up your
| cholesterol, no wait, the cholesterol in eggs doesn't seem to
| raise cholesterol in humans who consume eggs".
|
| I feel like the major trend is acknowledging that there aren't
| many singular things which are bad enough for you to materially
| move the needle. Health (especially as you age) has a lot luck
| involved.
|
| Sure, you're not going to fare very well if you're constantly
| stressed, never exercise, eat terribly, do a ton of drugs, and
| have an awful sleep schedule.
|
| But whether or not you put kale or romaine in your green
| smoothie is not going to move the needle in a way that matters.
| Just like whether or not you have some eggs for breakfast most
| days or not is not going to materially move the needle.
|
| It seemed like the "health craze" really started somewhere
| around the early 90s, when people started thinking about all
| these different vitamins they should be taking and foods they
| should be eating. I'm guessing this is just when people really
| started to market and push these products. It probably took 30
| years to undo that and convince people they can settle down and
| there's way more important health decisions one can make than
| whether or not you eat eggs.
| tdaltonc wrote:
| > It seemed like the "health craze" really started somewhere
| around the early 90s
|
| In the 1700's people were literally blowing smoke up their
| asses. In the 1800's the Kellogg brothers invented the
| consumer packaged health-foods market. There's nothing new
| about health crazes. Maybe the 90's is when you entered the
| demo of "possible health craze customer" and you started see
| it?
| JoeAltmaier wrote:
| In Annie Hall(?) a character mentions "Everything our parents
| told us was good for us, is bad for us. Sunshine, red meat,
| college, everything they said was good for us is bad for us!"
| DevX101 wrote:
| Do you have published research demonstrating that the sample
| collection process (and the 80uL specifically) is sufficiently
| precise to detect and quantify these metabolites into clinically
| meaningful ranges? This was the core problem with Theranos IIRC.
| I've quickly reviewed your sources below and they seem to be
| related to the clinical value of metabolites, I haven't seen one
| describing precision of the device itself.
|
| I see you mention Theranos, but to be honest, this won't be the
| last time you get asked these questions. Every partner, news
| interview, and many potential customers will bring it up. So much
| so, that I would create a page specifically addressing these
| issues (in more detail than the FAQ).
| danielgomari wrote:
| Yes, mass-spectrometry-based metabolomics can be performed on
| as little as 20ul in certain cases, and 80ul is certainly
| enough. Below are a few studies from other authors and
| platforms, and there are many more out there.
|
| https://arthritis-research.biomedcentral.com/articles/10.118...
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340475/
|
| Specifications by an academic metabolomics facilty:
| https://www.embl.org/groups/metabolomics/faq/
|
| Regarding your Theranos comment: You are absolutely right. This
| is something we will have to deal with, and where are actively
| working on our messaging.
| nradov wrote:
| The blood test accuracy problem that Theranos ran into wasn't
| so much about the specimen volume, but rather that they drew
| the blood from capillaries too close to the skin and thus it
| wasn't representative of blood circulating in larger veins.
| For some tests where they were just looking for any presence
| of certain substances that was good enough, but it couldn't
| work reliably for any test that needs consistent,
| quantitative results.
| samstave wrote:
| Does one do a benchmark by running the same tests, at
| different volumes with the same blood across multiple testing
| machines/methods, and then compare the results for
| accuracy/variance?
| danielgomari wrote:
| Yes, exactly. We are running internal validation tests to
| (a) compare the quality of the measurements with larger
| amounts of blood collected the "regular" way, and (b)
| validate that the storage and transportation at room
| temperature does not have detrimental effects on the
| measurements.
| mrtweetyhack wrote:
| bmau5 wrote:
| Congratulations on the launch! I've always been fascinated by
| metabolomics, but it felt like such a complex data problem. What
| sort of recommendations will you make based on my results? How
| did you develop the recommendations?
| danielgomari wrote:
| Thanks! Right now, the recommendation we'd be providing will be
| based on published studies that are known to positively impact
| the metabolome and health. We match your metabolomic profile,
| based on the deviations we see, with recommendations that could
| benefit your metabolome the most. For example some well-studied
| interventions that we could match you with include the DASH
| diet [1] (which reduces the risk for heart disease), fasting
| [2, 3], targeted physical activity [4], and soon, statin intake
| [5], metformin [6] medication (which has been shown to extend
| healthspan), and many more. As you build your metabolomic
| trends when you test over time, we'll also be able to train
| personalized ML models for you and give you better and better
| recommendations that you'll actually respond to.
|
| References:
|
| [1] https://academic.oup.com/ajcn/article/108/2/243/5038205
|
| [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412259/
|
| [3] https://pubmed.ncbi.nlm.nih.gov/32931723/
|
| [4] https://www.cell.com/cell/fulltext/S0092-8674(20)30508-0
|
| [5]
| https://www.ahajournals.org/doi/10.1161/CIRCGENETICS.117.001...
|
| [6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8508882/
| investor382718 wrote:
| How can consumers feel confident that the insights they're
| getting are backed by legitimate research? (In other words, how
| are you escaping the perception that this is Theranos 2.0?)
| upupandup wrote:
| Everybody thought Theranos was legitimate too. No way for
| consumers to tell.
|
| There's so much fluff and scams in this industry, YC isn't
| exactly above it either. ex) coinbase
|
| Maybe this is legitimate maybe its not. We have no way of
| knowing.
| danielgomari wrote:
| The difference is that we will disclose and publish as much
| of the science behind the product as possible, while Theranos
| was all promises, no delivery.
| danielgomari wrote:
| Every piece of information reported to the users will be
| presented in a digestible way. This will include both, hard
| scientific evidence but also a lay version of what it means. If
| you want to, you will be able to look up and verify everything
| yourself. We will also make sure to draw the line between
| definitive statements ("this measurement means you are sick")
| and suggestive statements ("this might mean something, go see a
| doctor") in order to not oversell anything.
| investor382718 wrote:
| Thank you for sharing. What marketing strategies are you
| considering to ensure consumer trust is your top value when
| you go to market?
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