“This is not something that happened overnight,” said Dr. Gerald Gleich, a professor of dermatology and medicine at the University of Utah, about the research he’s done around a relatively new disease called eosinophilic esophagitis.

It all started over 57 years ago in 1965 when Gleich took a job at the Mayo Clinic. “Mayo Clinic provided me an opportunity to be submersed in laboratory research,” he said. His work at Mayo was the backdrop for what would become an innovative method of identifying eosinophilic esophagitis, which can cause difficulty in swallowing and gastrointestinal upset in people of all ages due to inflammation of the esophagus with eosinophils.

“I became interested in this blood cell because my job outside the laboratory was to take care of patients with asthma. And I noted that these patients had a marked increase in white blood cells called eosinophils,” Gleich said. “To make a long story short, we then started investigating the eosinophil.”

Gleich found that eosinophils contain a major basic protein that damages tissue when released by the cell that can lead to inflammation and potentially eosinophilic esophagitis.

When Gleich moved to the University of Utah after over 36 years at the Mayo Clinic, the disease was still little-known and not widely studied, but he connected with Dr. Kathryn Peterson, a U gastroenterologist interested in eosinophilic esophagitis.

At the time, Peterson was seeing patients with the disease and performing biopsies on the lesions of patients with eosinophilic esophagitis. She worked with Dr. Kristin Leiferman in the immunodermatology laboratory who would then analyze the lesions by using antibodies to make the major basic protein fluorescent, resulting in pictures of “brilliantly fluorescent” biopsies, according to Gleich.

“So, the major basic protein is extensively deposited on the tissue,” Gleich said. “While this is interesting, we wondered if we could localize the protein in the patient’s own esophagus. If this were possible, we would have a ‘picture’ of the inflammation in the esophagus itself.”

Taking a picture of inflammation inside the human body isn’t as easy as just clicking a button like you’d do to take a picture on your smartphone. It took Gleich, Peterson and their team five years to develop a method that worked.

"If you want to do something, do something that's different. Why not?"

“We wanted to be able to have the patient swallow an agent that would bind to the inflammation and major basic protein that's deposited and would light up and that had to be a radioactive agent,” Gleich said.

Because they used a radioactive agent, they worked with the university’s Radioactive Drug Research Committee, which helped the team get permission to conduct studies with eight patients.

“The results were really impressive because we were able to identify the inflammation. We were able to see more than the endoscopist sees,” Gleich said. For some patients, most of the esophagus would light up, indicating that there was inflammation, and for others, just parts of the esophagus would show inflammation. This method of diagnosis seemed to be much more effective than previous methods like endoscopies, which are painful and time-consuming, and biopsies that couldn’t give a full picture of the spread of the disease.

“The concept of imaging the inflammation in the way we're doing is truly novel. No one’s ever done this before,” Gleich said. “If you want to do something, do something that's different. Why not?”

Founding NexEos

As Gleich put it, researchers at the U have a few options for what to do when they think they’ve discovered something good. They can write a paper on it and move on, or they can work with PIVOT to license the discovery to another company or start their own company.

Gleich chose the third option.

“In one’s mind’s eye, you conceive of what could be,” Gleich said. “And to achieve that you’ve got to pursue it.”

In 2019, NexEos launched to bring the team’s product to market with the help of his long-time friend Steve Tullman and the PIVOT Center.

The company has received multiple grants and is starting a new trial at the University of Utah and potentially other universities including the University of Pennsylvania and Northwestern. “It’s moving along, and with good luck we could be through with our next study by mid year,” Gleich said.

"In one’s mind’s eye, you conceive of what could be, and to achieve that you’ve got to pursue it."

“If we can probe and confirm what we already have seen, we have a better way of diagnosing eosinophilic esophagitis in adults and likely in children,” Gleich said.

At the same time, Gleich and the NexEos team are also looking for ways to treat eosinophilic esophagitis.

For Gleich, his work is “quite fun,” even after almost six decades. And he has no intention of stopping anytime soon. “If what I have in my mind’s eye for the future has any relationship to reality, you and I’ll be talking again.”