Like most twins, Gillian Sandler and her sister shared the same upbringing: same house, same foods, same school. Yet, for reasons unknown, her sister was afflicted with an autoimmune disease that manifested as asthma and eczema when she was a child and evolved into rheumatoid arthritis as an adult. Her sibling’s struggle put Sandler on a quest to try to find answers. Today, as Managing Partner of New York City-based Galapont Ventures, which invests in promising science and technology startups specifically in healthcare, Sandler is a passionate advocate for companies that address autoimmune diseases, including Mymee, a digital care solution that helps autoimmune patients reduce instances of flare-ups. Cure recently sat down with Sandler to hear more about her personal journey to help her sister and why Mymee might be the catalyst for a new healthcare model for treating complex illnesses.
Cure: Tell us about autoimmune conditions. What are they and how do they impact people?
Sandler: In the simplest terms, an autoimmune condition is when someone’s immune system, which is designed to protect us, recognizes certain cells as foreign invaders, so it attacks the body’s own cells. There are many autoimmune diseases, and the differences between them stems from what type of cell is the target of the attack and how that manifests for people. It can be lupus, psoriatic arthritis, multiple sclerosis, rheumatoid arthritis — there are a lot of different autoimmune diseases. And these diseases are very complex because they are really dependent on the individual.
Cure: How many people does it impact and what are the challenges in treating these diseases?
Sandler: The last census in the United States conducted by the NIH was back in 2012. At that time, they counted people that have auto antibodies, which are a biomarker seen prior to the development of an autoimmune disease as well as during an autoimmune disease. They found around 40 million people had auto antibodies.
Cure: What’s the current standard of therapy?
Sandler: All of the therapeutic approaches are based on inhibiting your immune system from attacking you. You’re essentially dialing down your immune system. Some people have very good reactions to the drugs and they help them have fewer responses to their environment — autoimmune diseases are flare-driven diseases, so if the drugs can help reduce people's responses to their environment, they can be very productive. However, many people have an inadequate response to those drugs.
Cure: And what happens in those cases?
Sandler: For people who are non-responders, the current standard of care is to add other drugs. The data shows that over 50% of people are on four or more drugs. As[su2] you can imagine, that causes confusion over what is working and what is not working, not to mention some of these drugs cost $50,000 or $100,000 dollars a year. We need to greatly expand the therapeutic approaches that we have on the market. We need much bigger budgets to fund the discovery of new drugs and change the approach to the trials to assess the drugs.
Cure: Your twin sister suffers from autoimmune disease. Tell us a little bit about your personal story.
Sandler: She’s my fraternal twin. And we grew up in the same house, we ate the same foods, went to the same school. But from a young age, my sister would have strong reactions to her environment. She was diagnosed with asthma and eczema — these were entry conditions. Later, after having three children, she was diagnosed with RA (rheumatoid arthritis). She’s one of the people who, unfortunately, doesn’t have full response to available drugs. So she went through a very long period of trial and error, which was very challenging for her. Her disease morphed into lupus, which is typical — people evolve in their disease over time. Now she has a mixed presentation of autoimmune disease.
Cure: And you went on a quest to try to help her.
Sandler: Yes, I spent a lot of time looking for next generation therapeutics for her. Unfortunately, the clinical trials were very narrow and my sister wasn't well suited to the pipeline. So I thought, we might be 20 years away from a drug that could help her. But another thing I discovered was there were a lot of people who had solved their own case — people who had spent years trying to figure out what drove their disease and ultimately were able to get their own disease and symptoms under control.
Cure: And Mette Dyhrberg, the founder of Mymee, was one of them. You are the Board Chairperson for Mymee. Tell us a little bit about the company and why it’s different?
Sandler: Mette Dyhrberg, a Danish woman who now lives in New York, was a non-responder to Humira. She had gone through the same story of trial and error. Experimenting with what drugs to take. Trying to identify what created her flare-ups in terms of diet. To no avail. So Mette decided to merge technology with some disciplines related to clinical trials, where you isolate variables and create a controlled environment. The protocol she created helps people isolate their symptoms and directly correlate them to whatever is within their environment that’s triggering them. It took her years to develop this and then many years to test it. Her first patent was filed 10 years ago. She came to us as investors when she was trying to identify the research that would support the development of an economic model to cover the market. There's no model to cover programs like Mymee. It takes a lot of economic data to start to understand how this fits into the healthcare system.
Cure: So where does that stand at this point?
Sandler: They just completed a multi-year study in October that is critically important. It was a partnership with an insurer to match the data of the healthcare record and the cost structure with the efficacy of the program. One of the critical things that came out of this study is the data showed that not only can you get off of drugs that aren’t working, but the total healthcare costs — not just the drug costs but the total healthcare costs — are much lower. The data is there now for the dialogue to start about what is inadequate response. We have 719 startup companies in the market that are adherence tech, which tackle the significant problem of getting people to stay on their drugs. But we cannot only have adherence tech. We also have to have the support system so that when people go off a drug, they can do it safely.
Cure: Right. That is really important. And it’s very exciting that we’re moving in that direction. So one last question. What do you think the future looks like for life sciences start-up companies? Is there enough innovation threshold left for people to invest in them?
Sandler: I think there has to be some catch up between the life sciences tools and technology, and research capabilities and the reduction in cost structure. That's our biggest challenge right now. Once you get out of the standard of care, you've got tens of millions of people, each person is an orphan disease. So how do we start to think about these things and deliver on much lower cost, higher outcomes, and faster time to market? It’s starting to happen — you see it in the prize that Cure is sponsoring [through the Cure Xchange Challenge], where really talented people are not just focusing on innovation or a new target, but asking the question of how do we innovate in a way that's going to dramatically reduce the cost and increase the possibility set to make precision affordable? That is what we need to get capital in the market again.