Not only is Bob Geho a fellow type 1 diabetic, but he likes to refer to himself as a "liver evangelist" when it comes to how glucose and insulin work inside the body.
Or more accurately, how they don't currently work together the way they should in people with diabetes.
Bob is a 46-year-old from Cleveland, Ohio, who was diagnosed with type 1 as a young adult in the early 90s, a life-changing moment that shifted not only how he thought about his own health and daily routine but also altered his career trajectory, putting him on a path his father had paved before him.
Today, Bob is known as a diabetes advocate and leader in the D-tech world; he is CEO of the Cleveland-based startup company called Diasome Pharmaceuticals, which is developing nanotechnology known as HDV Insulin, that would essentially change how glucose works in our pancreatically-challenged bodies by allowing it to be stored in the liver for longer periods of time. The HDV compound would be injected or swallowed as a pill where it would attach to insulin, causing the insulin to be better absorbed into the liver's metabolic cells before being released back into the bloodstream.
In short, this could be an insulin delivery game-changer -- because while insulin obviously saves lives, getting the dosing right is a huge challenge, fraught with guess-work and risks.
"The revolution that has to happen, and the one that I view we're the vanguard of, is a need for this kind of (more precise and predictable) insulin therapy," Bob says. "It's not generally well understood either in the pharmaceutical industry or in routine clinical practice why insulin doesn't work in the liver like it should, and we think this would dramatically change the day-to-day of insulin therapy. We want to turn this whole thing upside-down."
Like Father, Eventually Like Son
Bob never dreamed he would follow in the footsteps of his famous medical researcher father, Dr. W. Blair Geho. His dad entered medical school in the early 60s and was taken under the wing of the great pharmacologist Dr. Earl Sutherland Jr., who won a Nobel prize in 1971 for his work on protein chemistry and was part of the team that identified "the mystery protein of glucagon" in the 70s.
Studying under Sutherland's guidance, the elder Geho learned the foundation of knowledge that he'd go on to use in developing liver-specific insulin many years later. Geho joined Procter & Gamble in the 60s and developed the company's pharmaceutical research division, which his son says gave him more insight into the body's chemical process than those working in Pharma because of P&G's research on Crest toothpaste, that delved into bone metabolism. While at P&G, Blair Geho also led the development of Didronel, the first bisphosphonate drug approved for human use, and Osteoscan, the first bone imaging agent.
His dad didn't have any personal connection to diabetes, other than family members with type 2, but his research led him down the path of liver-specific insulin. In the early 90s, he would go on to found the tech-startup SDG Inc. in Cleveland as a way to continue his work developing techniques for improve insulin delivery for diabetics.
Right around that time in the early 90s, Bob was studying music and planning to become an orchestra conductor. But a routine physical led to a type 1 diagnosis (during his years in graduate business school, which he went into as a "fallback" if music didn't materialize), and the first call after seeing his own doc was to his father. And from that point, diabetes became his world -- personally and professionally.
"My father was just starting SDG and continuing his odyssey of creating an insulin therapy device, and so I went there and got my feet wet... the rest, as they say, is history," Bob says. "I jumped ship from the music world and got very intrigued by (my father's) mindset and that kind of diabetes research."
The two have been on a joint path ever since, at the helm of several startups all aiming at the same goal: to get this HDV oral and injection insulin therapy through the research phases and onto the market. The 1994-created SDG holding tech company is now in its 20th year, and the father-son team also founded Diasome Pharmaceuticals, now in its 10th year. After a down-period a few years ago, Bob stepped back in as CEO and director of Diasome about two years ago and his father serves as chief science officer.
Their mission hasn't changed, and Bob tells us they're getting closer than ever before.
The Science Behind It
Really, the idea behind the science of HDV tech (Hepatocyte Directed Vesicles) is pretty simple to understand: making insulin work in your body the way it should, as it does in those without diabetes.
Here's the question, as Bob poses it: "Why can we inject twice as much insulin as a healthy, non-diabetic, but still have high blood glucose levels?" And the answer is simple, he says: "Insulin doesn't work the way it should in the body."
This shows that there's a need for therapy beyond just getting the insulin into our bodies.
In those without diabetes, food triggers insulin from the pancreas but it first goes into the liver, where about 65% of the glucose is stored. But for us PWDs, the subcutaneous insulin we take is used first by fat and muscle cells and not the liver. So when we're taking insulin at the time of a meal, instead of the liver storing as much as two-thirds of the glucose we eat, almost all of it goes through the liver and into the blood. Only the hepatocytes in the liver can both store and then release the glucose, but that's not what happens with the insulin we're using.
"At a certain level, people should be outraged because the insulin companies aren't telling us this story," Bob says. "Every high school student learns that the liver stores glucose, but for some reason the Pharma insulin-makers don't seem to realize that. It's puzzling."
He goes on to say: "Now, I love being able to inject 15 minutes before a meal, rather than longer times before that, and I appreciate that and love what these companies are giving us to do that. But it's a terrible product from a day-to-day aspect. You really couldn't design a worse product. That's the reason we exist, to change that and develop a tech that allows our insulin to understand glucose metabolism."
Bob even says that new, faster insulins being developed would face the same challenge because they won't solve the issue of going into the liver.
Their HDV tech is in late-stage clinical trials, and as far as a prototype Bob does have a vision in mind of what a product could look like.
It could be a pen or vial where the PWD would inject 20 nanometers into the vial of whatever insulin they are using (not into their body directly). That HDV nanotech would attach to the insulin and allow a certain portion of it, when injected into the body, to go into the PWD's liver. Nothing about the insulin structure would change, so it's simply an add-on for the life-sustaining meds we already use each day.
The HDV solution could be sold in conjunction with insulin, or it could be added into the pens, vials or pump cartridges at some point, Bob says. But it's more likely to be sold as a separate add-on product, since insulin developers may not be keen to coupling it with their products, Bob says. They are also developing an oral capsule form, which contains as little as five units of these HDV insulin molecules.
"It's almost an alarmingly simple idea," Bob says, "and the FDA has told us in writing that they love the idea as it's an inexpensive and safe way to use already-approved insulins."
As of now, the research continues.
Bob tells us Diasome has been given the green-light for Phase 3 human trials, following up on past research in humans that's shown HDV tech to be very effective in lowering blood glucose levels in both type 1 and type 2 PWDs who use low amounts of insulin.
If everything goes as planned, they would be looking at early 2015 for Phase 3 human trials that could take from 12 to 16 months to include the 500 patients for a six-month research process. A tentative timeline: maybe seeing regulatory approval by end of 2016 with possible FDA clearance in 2017.
"We've been very low-key over the past several years, and were restricted on what we could say publicly. But as a board and company, we've decided that this is a story that patients and clinicians need to hear. Eventually, we hope Pharma will start responding to this."
More recently, as Diasome is developing this nanotech, Bob's been stepping more into the limelight in the diabetes advocacy world. About a year ago, he joined the Diabetes Hands Foundation as a board member, and coming up on May 22, he'll be doing a live interview on TuDiabetes. He's been very intrigued by the diabetes blogging world and looks forward to helping to tell the Diasome story more broadly, while advocating for the community.
The science and concept is very intriguing, something all of us can certainly appreciate when we think about our post-meal high blood sugars and those lows we sometimes feel if the insulin works more quickly than the food. It will be interesting to watch Diasome and this HDV therapy move forward.
Oh, and does Bob still have any music in his life?
He laughs, and tells us all four of his kids play the piano but for the most part music is now a strictly personal way to help clear his head when needed. The main orchestra he's conducting this days is all about insulin therapy, and the hope is that it turns out to be for the diabetes community what Mozart was to the music world.