[HN Gopher] Launch HN: Bristle (YC W21) - At-home microbiome tes...
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Launch HN: Bristle (YC W21) - At-home microbiome test to improve
oral health
Hi Hacker News! We're Danny, Shivam, David, and Brian from Bristle
https://www.bristlehealth.com/. We're developing an at-home saliva
test to detect the earliest signs of cavities and gum disease -
then provide evidence-based recommendations and treatments to help
prevent them. Cavities and gum disease are driven by infectious
microbes, but today's dental care only detects the damage they
already caused. X-rays and observational screenings detect tooth
decay and bleeding gums, which are symptoms, not causes. By the
time they are detected, they've often become serious issues that
require the invasive procedures we all dread - fillings and root
canals. We end up spending billions of dollars reactively treating
diseases that can largely be prevented with good oral health
management. About us: Our backgrounds are on the research and
commercial side of genomics. We have witnessed the rapid adoption
and implementation of new technologies in healthcare enable remote
monitoring of symptoms, early detection of disease, virtual care
delivery, and new generations of therapeutics. Meanwhile, we have
people like my co-founder Brian, who constantly face cavities
despite great oral hygiene (good job, Brian) and get the same
advice as everyone else. Technologies like genomic sequencing and
wearables are being applied to important areas in healthcare
including oncology, rare disease, and NIPT - but aren't being used
for the ones (literally) right beneath our nose. A lot of oral
diseases start and progress from a build-up of specific acid-
releasing or disease-causing bacteria. Working in genomics, we knew
the technology existed to detect these pathogenic microbes at the
earliest stages, when they were most treatable. About our test:
Like other DNA tests (think Color Genomics, Ancestry, etc.), our
test can be taken from home and only requires a saliva sample.
Unlike most DNA tests that look at your personal genome (the
collection of your genes), we analyze the oral microbiome: the
community of microbes (bacteria, fungi, and viruses) living in your
mouth. Imbalance between pathogenic and beneficial microbes can
contribute to your risk of oral disease or signal systemic
conditions. Decades of research have shown causal relationships
between the oral microbiome and preventable gum disease. Most
microbiome companies use a method called 16s, which only provides
the identification and relative abundance of bacteria at low
resolution (often only genus-level). We use shotgun metagenomics to
identify and quantify all of the microbes in your mouth including
viruses, bacteria (over 150 on average), and fungi. Our test
sequences the whole genome of the microbes providing information
like functional profiling and higher resolution at the strain-
level. This means higher sensitivity and specificity while
providing the kind of data needed to develop better oral care
products and therapeutics in the future. Oral health tends to be
overlooked, but is an important component of overall health with
deep connections to the rest of the body. Research has been
unveiling links between oral health and the risk or presence of
systemic diseases, including diabetes, heart disease, and
Alzheimer's (I'll include some links about this below). One of the
more exciting things we'll be able to do as we grow our database is
look for oral microbiome signatures related to other diseases. Such
analysis will only be done on de-identified data, and only go
towards the goal of improving health. Our assay will inevitably
pick up some of your genome - it's impossible to completely avoid.
But our analysis only looks at the microbes from your sample and we
filter out human genome data from downstream analysis. There are
some interesting genomic markers we eventually would like to
investigate (read about some here: https://www.ada.org/en/member-
center/oral-health-topics/gene...) but for now we only look at
microbial data and will obtain consent before analyzing anything
else. About our projects: We are currently running a clinical
research study with a leading dental school clinic, and will be
bringing the test through clinical validation over the coming
months. In the meantime, we're offering a research version of our
test to consumers through an early access program. This program
provides an exploratory (non-diagnostic) lens into your oral
microbiome, including information on your unique oral microbiome
profile and how it relates to health conditions based on current
research. The test is $50, but we won't charge until you're
accepted off the waitlist and we are ready to send your kit. Right
now we only ship in the US. If you're outside of the US you can
register at the bottom of our homepage to stay updated with our
newsletter and be notified as we expand.
https://www.bristlehealth.com/pages/early-access Privacy is
obviously a critical component of all this, and a top priority for
us. We are determined to get it right from the ground up. Although
we are not a HIPAA covered entity, we maintain a HIPAA compliant
infrastructure. In the future, we believe that companies like ours
may fall under a HIPAA designation. Operating that way today is our
way of preparing for this. Most importantly, it protects your data.
We will publish our data protection protocols on our website soon.
We believe we have a real opportunity to change the standard of
care in oral health. We hope to expand access to patients and
users, and give providers a new tool to help treat disease. We look
forward to your feedback and questions - so please reach out or
leave us a comment! Thanks everyone, Danny, Brian, Shivam & David
Author : dannygrannick
Score : 84 points
Date : 2021-03-08 15:22 UTC (7 hours ago)
| donclark wrote:
| Is there a "best time" for someone to provide saliva? Is this
| dependent on schedule and/or age? And is this different if you
| are doing intermittent fasting?
| david_l_lin wrote:
| This is a great question! We are actively looking into
| circadian oscillations of the oral microbiome, but don't
| currently have any recommendations around specific times for
| sample collection. The same goes for intermittent fasting! We
| only recommend that users don't eat or drink for at least 30
| minutes prior to sample collection.
| dannygrannick wrote:
| A few resources:
|
| The Economist, "Microbial ecosystems in the mouth and gut are
| linked to many ills": https://www.economist.com/science-and-
| technology/2021/02/10/...
|
| Personal health care expenditures, by source of funds and type of
| expenditure: United States, 2007-2017:
| https://www.cdc.gov/nchs/data/hus/2018/fig18.pdf US Dental care
| expenditures 2017:
| https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI...
|
| Healthcare expenditure trends in the US:
| https://www.cdc.gov/nchs/data/hus/2018/044.pdf
|
| US Surgeon General Report on Oral Health (2000):
| https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1oc...
|
| The human oral microbiome in health and disease: from sequences
| to ecosystems:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074908/
|
| Oral microbiota of periodontal health and disease and their
| changes after nonsurgical periodontal therapy:
| https://www.nature.com/articles/s41396-017-0037-1
|
| ADA Periodontitis stats: https://www.ada.org/en/publications/ada-
| news/2018-archive/ju...
|
| The "Gum-Gut" Axis in Inflammatory Bowel Diseases: A Hypothesis-
| Driven Review of Associations and Advances:
| https://www.frontiersin.org/articles/10.3389/fimmu.2021.6201...
| dflock wrote:
| > detect the earliest signs of cavities and gum disease - then
| provide evidence-based recommendations and treatments to help
| prevent them.
|
| What preventative treatment is this? If it isn't just "brush &
| floss", then what is it? If it's so great, why not just tell
| everyone about it now - why do you need a microbiome test?
| carabiner wrote:
| There's Cavibloc, which is supposed to reduce cavity-inducing
| bacteria. It was developed at UCLA. There's also CloSYS, which
| is basically a highly diluted bleach that clears your mouth of
| bacteria. It is ADA approved. There's also Xylitol, which is
| also supposed to help reduce bad bacteria. I've been using all
| of these for the past year, and my most recent dental cleaning
| had almost no tartar buildup, which is really unusual for me. I
| have poor flossing habits. You can look into the book "Kiss
| your dentist goodbye" by Dr. Ellie Phillips for more info. FYI
| she's not a quack, but some of her claims have been
| controversial among other dentists.
| david_l_lin wrote:
| Each microbiome is unique, and preventive measures against
| bacteria that cause gum disease may not be effective against
| bacteria that contribute to cavities and vice versa. The
| solutions (such as prescription-strength fluoridated
| toothpastes, antimicrobial mouthwashes, or personalized
| probiotics) that we plan to recommend may require a
| prescription that we anticipate we will be able to fulfill only
| after a diagnostic evaluation. This provider-mediated solution
| is critical to avoiding unnecessary and potentially harmful
| prescriptions, while also preventing disease.
|
| We're working on building a knowledge base, as there are
| several pseudoscience wellness recommendations that have no
| clinical validity, and will share these on our blog that you
| can find on our website. A Bristle mission is to also develop
| more effective personalized therapeutics and oral care products
| that effectively treat microbiome dysbiosis to prevent disease
| prior to the onset of symptoms and irreversible disease.
| droningparrot wrote:
| Since you mention prescriptions and providers, does this mean
| you intend to distribute the product through dentists?
| david_l_lin wrote:
| Forgoing the details, from the user perspective, the
| product is almost entirely direct to consumer, and the
| Bristle platform provides users the opportunity to both
| request a test and further consult with a dentist.
| Prescriptions and interventions will be physician-mediated
| upon interpretation of test results.
| dpflan wrote:
| Is one test sufficient to really be valuable to a customer? The
| oral biome seems pretty wild and varying, even just with changes
| in diet. It seems one test may be useful, but it seems that many
| tests at some interval are more useful (assessing change,
| intervention outcomes, etc.). It seems like you would want your
| initial customers to be people with chronic issues or genetic
| history predisposing them. Wouldn't a single test result be more
| of personal trivia to the average person?
| david_l_lin wrote:
| Great question! We recommend a cadence similar to that of a
| dental checkup (at least every 6 months) depending on your oral
| health status. We will eventually provide insight into whether
| applied interventions are effective at improving your oral
| health, and can prescribe personalized recommendations based
| around your oral microbiome. A single test can provide unique
| insight and objective data to users about their oral health
| status, and in the near future we hope to be able to provide a
| complete end-to-end solution (from test to diagnosis to
| treatment) even after just your first test.
| ipaddr wrote:
| Focusing on oral seems like a strange strategy.
|
| Ubiome offered 5 kinds of tests including oral. The vast majority
| of test purchases were poop related.
|
| What size of a market do you envision? Are you trying to grow to
| ubiome's level or stay niche?
| david_l_lin wrote:
| Regarding the oral focus: Our core technology is based around
| the oral microbiome for a number of key reasons.
|
| 1. decades of research have shown causal relationships between
| the oral microbiome and preventable gum disease. 2. the oral
| microbiome is much lower in diversity than the fecal
| microbiome, granting the opportunity for the development of
| relatively low-cost diagnostics that leverage the microbiome.
| 3. new and exciting studies have shown correlations between the
| oral microbiome and a number of systemic health indications,
| which we hope to continue to uncover with our platform.
| shivampatel9 wrote:
| Oral diseases like cavities and gum disease are some of the
| most prevalent in the world and are largely preventable if
| detected early enough. Current tools like x-rays and
| observational screenings only detect symptoms once they have
| manifested. We can use genomics and the oral microbiome to
| realize earlier detection and ultimately, reduce disease
| progression.
|
| There is a large portion of the population that actively avoids
| dental visits out of inconvenience or fear/anxiety (60-80MM).
| We provide a non-invasive, low-cost way for these individuals
| to understand the status of their oral health from the
| convenience of their home.
| elil17 wrote:
| It seems really weird to me that you're selling a "non-
| diagnostic" early access test but also claiming on your website
| that "Bristle analyzes your oral microbiome to _detect oral
| diseases_. " I've seen early access in video games, but never
| before in a medical device. I'm sure you have lawyers who told
| you this was okay, but I feel like the whole reason that you have
| to do clinical trials before selling a product (the spirit of the
| law, so to speak) is that many consumers will believe that the
| test you're giving them is producing valid results, even if you
| have a fine print disclaimer saying that it is for "medical
| purposes." If someone took this test and wrongly assumed that the
| results meant they were safe from oral diseases, that could have
| a really negative impact for them.
| david_l_lin wrote:
| Thank you for your input, that's completely understandable.
| We're describing in our website the product that is undergoing
| clinical validation, but want to provide consumers an
| opportunity to gain insight into their oral microbiome, as
| there are no equivalent comprehensive oral microbiome tests.
| The "early access" test is a limited offering that provides
| novel data to users.
|
| We are making it clear to users during on-boarding and in the
| microbiome report that our test is currently for educational
| and research purposes only. You are right, there are health
| implications behind results of the test, and we hope that the
| data we provide empower users to make impactful positive
| decisions around their oral health.
|
| We are on-boarding early access users off the wait-list in
| small batches in the hopes of discussing the product 1:1 with
| each of them. Our assay is currently undergoing regulatory
| approval and we anticipate to have a diagnostic offering by the
| end of 2021.
|
| Our goal is to make sure users up front know what they are
| receiving with the early access test, so if you have other
| suggestions or concerns we'd love to chat with you - feel free
| to email us at info@bristlehealth.com
| ihodes wrote:
| I love where we're going as an industry in using the tools we
| have in genetics (and other assays) to better target care and
| understand the causes of medical issues.
|
| For the range of bacteria you can identify, what are some common
| treatments / behavioral that finding them might indicate? Or is
| it more information at this point?
| david_l_lin wrote:
| For our early access product, we will be providing you your
| comprehensive microbiome profile, how you compare to other
| users, and relative oral health scores. We also provide a
| summary of current literature around a number of key microbes
| in the oral microbiome, and their related health associations.
|
| At the moment, we cannot make any health recommendations, but
| in the next few months we plan to expand our product to include
| recommendations and fulfillment of prescription toothpastes,
| mouthwashes, and other preventive tools that we know are
| effective in improving oral health.
|
| Additionally, we learn more from each user that takes our test,
| and can expand guidance around other indications where the oral
| microbiome is implicated to play a role, such as diabetes,
| cardiovascular disease, and possibly even neurodegenerative
| disorders. Eventually, the data we gather will also be used to
| develop personalized therapeutics tailored to treat specific
| microbial profiles in the oral microbiome.
| daemonk wrote:
| Are you guys depleting host or enriching microbial? Are you
| analyzing the data as a composition via log contrasts? Are you
| using available pipelines (kraken, metaphlan, etc) or something
| custom? Any plans on doing a functional pathway analysis (ie.
| humann pipeline) on top of the microbial analysis?
| david_l_lin wrote:
| Great questions! We implement a host-depletion step in both the
| wet lab, to increase sequencing depth of the microbiome, and
| dry lab. You may be concerned about potential bias introduced,
| and we've done some extensive research with our depletion and
| sequencing methods to reduce the cost of the test while also
| maintaining integrity of the microbiome profiles.
|
| Regarding pipelines: we use a custom pipeline that is similar
| in principle to available pipelines you mentioned (part of our
| secret sauce). We are actively working on functional analysis,
| as we hope to eventually develop targeted therapeutics that
| exploit microbial pathways to prevent disease.
| memco wrote:
| Will the early access users get access to the treatment
| recommendations when the ability to give recommendations for
| treatment becomes available or will they have to do another round
| to get that? If I can do the test now and get the updates later
| I'd be a lot more comfortable signing up.
| dannygrannick wrote:
| We'll be continually updating your early access report with new
| discoveries we uncover along the way, but we may not be able to
| provide treatment recommendations from the early access test
| once we flip to clinical. Things like lifestyle, diet, hygiene
| can be provided. Regardless, I'd recommend retaking the test
| when we launch the clinical product since your oral microbiome
| may have changed since the time you took the early access test,
| so the recommendations between now and then might be different!
| jph wrote:
| I'm a Bristle paying customer, and love the entire conceptual
| area of microbiomes and self-directed assays. IMHO microbiome
| science provides a new kind of quantification of health and
| wellness, and suggests new vectors for treatments and feedback,
| and can even help enable discoveries of experimental confounders
| and colliders.
|
| For a good introduction I suggest the paper "Oral microbiome:
| Unveiling the fundamentals" at
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503789/
| bmau5 wrote:
| Thanks so much for your support! You've said it beautifully,
| and we are driven by the potential of the microbiome to better
| guide health and treatment decisions, and ultimately improve
| lives.
| 100kristine wrote:
| Stopped going to the dentist several years ago because I've never
| gotten a cavity in my life. Would be interested to try this just
| to check and make sure my luck isn't running out.
| dannygrannick wrote:
| A huge reason we started Bristle was to answer this exact
| question!
| cperciva wrote:
| I'm reminded of a medical maxim: Never run a test if it the
| results won't affect treatment decisions.
|
| I'm that vein: Is this really a medical test, or is it just
| recreational?
| david_l_lin wrote:
| Our early access test is recreational. However, we anticipate
| to provide clinical decisions for oral health in the near
| future. By signing up for the educational test today, you are
| also contributing to scientific discoveries and helping to
| develop future products that can prevent disease.
| chrisallick wrote:
| Can you drop some non legal plain language on what you do with
| data?
|
| Frankly speaking, I 100% would assume you're going to sell my DNA
| and information to huge body of people.
| david_l_lin wrote:
| We do not sell your DNA and do not have future plans to do so,
| in fact we don't currently store your personal genome
| information, and would inform you if this were to change. We
| will ask for consent before doing any analysis on your personal
| DNA, if we were to expand studies to include human genomic
| markers.
| evmar wrote:
| Looks neat! My wife is a dentist so I hear a lot about
| developments in this area.
|
| The first question I have is about the business model -- people
| already sadly often cut the dentist when cutting costs, so it
| seems like it would be hard to get a lot of people paying you
| $50-100 for a test whose outcome is either "you are ok" or "more
| costs incoming". How do you see it working?
| shivampatel9 wrote:
| We couldn't agree with you more about people avoiding the
| dentist when cutting costs, which is always sad to see given
| the long-term importance of oral health. Our test is initially
| designed for the population of Americans who already don't see
| the dentist, value the convenience of at-home care, and are
| interested in incorporating preventive health into their daily
| lives.
|
| There is a large population of Americans (60 - 80MM) who
| regularly avoid seeing the dentist out of fear/anxiety or
| inconvenience, many of whom are millennials in major cities.
| Our goal is to provide these individuals an opportunity to
| understand their oral health in a non-invasive and convenient
| way, and then pair that with treatments delivered directly to
| their doorstep. Many of these treatments such as prescription
| toothpastes or mouthwashes are underutilized, largely because
| they are only effective if diseases like gum disease are caught
| early enough. Analyzing the oral microbiome enables us to do
| exactly that, and then we can remotely monitor patients to
| ensure that disease risk subsides. A major focus area for us is
| educating consumers about the impact of maintaining good oral
| health and preventing early signs of disease from progressing
| in order to avoid expensive procedures like cavity fillings and
| root canals in the future.
| donclark wrote:
| Related (oral related to gut that is)?
|
| Over 140k virus species in the human gut, half of which are new
| to science
|
| https://news.ycombinator.com/item?id=26389397
| donclark wrote:
| FYI - If I click to accept cookies in the middle of filling out
| the form, it wipes the form of any information.
| david_l_lin wrote:
| Thanks for catching that! We'll get it fixed right away!
| eaurouge wrote:
| > What do you do with my data?
|
| > Your privacy is a top priority for us. Our test will pick up
| some of your DNA - it's impossible to completely avoid - but we
| only look at the microbes from your saliva and we take steps in
| our workflow to throw out human data during analysis.
|
| Can you do better than this? What _exactly_ do you do with the
| data? What do you store? How do you store it? What do you throw
| away? When do you throw it away?
| david_l_lin wrote:
| Short of giving away some of our secret sauce and analysis
| pipeline, what we do is sequence the nucleic acids in your
| saliva in a de-identified fashion such that only Bristle
| scientists can match your sequence data with any potential
| identifiers. As data comes off the sequencer, we use a
| bioinformatic pipeline to remove 98%+ of human genetic data
| prior to any analysis such that its impossible to derive
| meaningful genetic information from the sample. The end result
| is that we effectively store only microbiome sequence data and
| not your personal genetic data. We store all of your data in
| accordance with HIPAA guidelines.
|
| Your de-identfiied data (metadata and microbiome data) may be
| used in aggregate analysis to mine for novel biomarkers of
| disease, and to develop novel therapeutics targeting the oral
| microbiome for the treatment of disease.
| jabyess wrote:
| Why not put all this info on the site?
| david_l_lin wrote:
| That's a great suggestion, we'll work on getting this added
| to our list of FAQs.
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