Viewed Someone with Normal Vision and Advanced Diabetic
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DEVELOPMENT AND COMMERCIALIZATION OF FUNCTIONAL, NON-INVASIVE RETINAL IMAGING DEVICE UTILIZING QUANTIFICATION OF FLAVOPROTEIN FLUORESCENCE FOR THE DIAGNOSIS AND MONITORING OF RETINAL DISEASE by ERICH HEISE Submitted in partial fulfillment of the requirements for the degree of Master of Science Department of Biology CASE WESTERN RESERVE UNIVERSITY May 2016 We hereby approve the thesis/dissertation of Erich Heise candidate for the Master of Science degree*. Christopher Cullis, PhD (chair of the committee) Jessica Fox, PhD Leena Chakravarty, PhD Ryan Martin, PhD March 14, 2016 *We also certify that written approval has been obtained for any proprietary material contained therein. 2 Table of Contents Introduction ........................................................................................................................... 13 STEP Program – Entrepreneurial Biotechnology Track ................................................... 13 Cellular Energetics ......................................................................................................................... 14 Glycolysis ......................................................................................................................................................... 16 Citric Acid Cycle ............................................................................................................................................. 18 Oxidative Phosphorylation ....................................................................................................................... 20 Retinal Diseases .................................................................................................................... 21 Diabetes ............................................................................................................................................. 21 Gestational Diabetes .................................................................................................................................... 22 Ocular Manifestations of Diabetes ........................................................................................................ 23 Impact of Diabetes ....................................................................................................................................... 25 Glaucoma ........................................................................................................................................... 27 Impact of Glaucoma ..................................................................................................................................... 28 Age-Related Macular Degeneration ...................................................................................................... 28 Current Practice .............................................................................................................................. 30 Optical Coherence Tomography (OCT) ............................................................................................... 31 Fundus Photography ................................................................................................................................... 32 Visual Acuity ................................................................................................................................................... 33 Flavoprotein and Its Fluorescence ................................................................................. 34 Flavoprotein (And Its Function) ................................................................................................ 35 Fluorescence Spectroscopy ......................................................................................................... 37 Flavoprotein Absorption and Fluorescence ...................................................................................... 38 Role of Flavoproteins in Cellular Respiration ...................................................................... 40 3 OcuSciences Inc. .................................................................................................................... 44 Flavoprotein Fluorescence and Retinal Diseases ................................................................ 44 Flavoprotein Fluorescence In Vitro ...................................................................................................... 44 Flavoprotein Fluorescence in Diabetes-Related Complications .............................................. 47 Flavoprotein Fluorescence in Glaucoma ............................................................................................ 51 Flavoprotein Fluorescence in Dry Age-Related Macular Degeneration ............................... 51 Flavoprotein Fluorescence in Glaucoma ............................................................................................ 51 Flavoprotein Fluorescence in Age-Related Macular Degeneration ........................................ 53 Business Plan ......................................................................................................................... 56 Need .................................................................................................................................................... 57 Market Opportunity ...................................................................................................................... 60 FPF Testing ....................................................................................................................................... 62 OcuMet Beacon .............................................................................................................................................. 62 Dynamic ............................................................................................................................................................ 63 Quantification ................................................................................................................................................. 64 Test Time .......................................................................................................................................................... 64 Drawbacks ....................................................................................................................................................... 64 Marketing and Sales ...................................................................................................................... 65 Target Market ................................................................................................................................................. 65 Marketing and Sales Plan .......................................................................................................................... 69 Intellectual Property ..................................................................................................................... 72 Regulatory Requirements ........................................................................................................... 72 Capital Requirements ................................................................................................................... 73 Exit Strategy ..................................................................................................................................... 74 Risk Management Plan ................................................................................................................. 75 4 Bibliography ........................................................................................................................... 77 5 List of Tables Table 1. Mean average intensity and average curve width in diabetics and controls, by age .................................................................................................................................................. 51 Table 2. Selection of patients for glaucoma retinal metabolic analysis study .............. 52 6 List of Figures Figure 1. The reactants and products of cellular respiration .............................................. 15 Figure 2. The chemical reactions that constitute cellular respiration ............................. 15 Figure 3. The reactants and products of glycolysis .................................................................. 16 Figure 4. The enzyme-mediated reactions of glycolysis ........................................................ 17 Figure 5. The reactants and products of pyruvate decarboxylation ................................. 18 Figure 6. The reactants, enzymes, and products of the citric acid cycle ......................... 19 Figure 7. The overall equation for the citric acid cycle ........................................................... 19 Figure 8. The five main protein complexes involved in the electron transport chain ............................................................................................................................................................... 20 Figure 9. Same scene as viewed someone with normal vision and advanced diabetic retinopathy ...................................................................................................................................... 24 Figure 10. A fundus image displaying microaneurysms and microhemorrhaging associated with diabetic retinopathy ................................................................................... 25 Figure 11. The prevalence of diabetes worldwide ..................................................................