Interview with Uri Geiger, exalenz’s CEO.

Press Release

אורי גייגר

Imagine, your going to your doctor, suffering from a liver illness, or problems in the GI. Instead of sending you to a complicated biopsy, your doctor asks you to sit comfortably, drink a medicine, and breathe into a device, for half an hour.

Now stop imagining – it’s here. The new technology, developed by exalez, from Modiin, Israel, can provide accurate, real time information of liver and GI function.

I met Dr. Uri Geiger, exalenz’s CEO.

Tell us shortly about the exalenz
Exsalenz is a company that develops and sells a devise that enables diagnosis and supervision of variety of illnesses of the liver and GI. It is an independent company for two years already, but it’s based on the technology developed in Oridion, Jerusalem, over 7-8 year, and 30,000,000$ investment. Today, the company is out of Oridion (spin out), and the mother company own only 11% of it.


The company has already completed the developing process of the BID (Breath ID) device, and its regulatory approval in many territories (SFDA, CE & FDA). The BID is designed to analyze the patient’s exhale, before and after drinking a marked substrate, and give the doctor graphs and numbers that assess continuous real-time liver function. In order to do so, the patient is connected to the device that monitors his breath (for a baseline), then he drinks a (non radioactive) 13C marked substrate. Different illnesses have different substrates since each organ has different metabolic/biochemical process. The device continues monitoring the patient’s breath and measure the 13Cs concentration for 20 min – 1 hr (depending on the illness and the patient’s situation). The results are immediate, given in graphs and numbers doctors know how to analyze (see figure 1). It’s a non invasive, painless, routinely used procedure.

The company also synthesizes the marked substrates for the BID device. Each organ and each illness needs a different substrate, there is no “magic drug” that can track all the organs in the body, and there is a lot of work in synthesizing all the substrates. Today we have over 60 patents on drags and device parts. After we synthesize the substrate, they are produced in other companies (like Sigma Aldrich and Teva).

Why is the BID better than other procedures in the market?
The BID enables us, for the first time, to see how the organ’s functioning. Not imaging – like endoscopy or capsule, not histology – as we get in biopsy, but real time monitoring of the function of the liver (or other organs) – which is most important to the doctor – and that what makes the BID so unique. The doctor can see how much damage was made to the liver (which we also get in a biopsy), but at the same time he can see how good the organ is functioning, and for long term, whether the treatment given to the patient was successful or not, and how well the organ recovered.

It is also important to understand that this is a safe procedure for the patient. Unlike Biopsy, that can be made only once every two years and is very risky to the patient, the BID test has no time limit, and enables the doctor to check the liver and GI situation regularly. It is also a relatively inexpensive test (130$ - 202$ to the patient)

In the end, it is a fast, non invasive, safe and relatively inexpensive check, that fits a variety of illnesses and situations in the liver and GI.

What is special in the substrates you synthesize?
We give the patient a molecule that is based on the known ‘over the counter’ Ibuprofen molecule, with targeting changes and 13C marking. We chose this molecule, since it absorbed in the digestive system, but body tries to get rid and of it as fast as it can. The material “runs” to the liver, and metabolized there. A healthy liver will metabolize this molecule very fast, and in less than 20 minutes it reaches the peak of metabolism, but a sick liver the metabolism is slowlyer and the graph’s digits and shape are different.

What is the technology you use in the BID?
The device is testing how fast the organ metabolizes the substrate, by measuring the 13C/12C ratio. The non radioactive isotope 13C, is 1% of the atmosphere’s C molecules. The substrate we give the patient is marked by 13C, and is metabolized by the target organ in a normal biochemical process. The products, 13CO2, can be found in the breathing examples taken by the BID, in different concentration according to the metabolism.

BreathID’s molecular correlation spectroscopy (MCS ™) is a laser-like technology. MCS™ creates an infrared emission precisely matching the absorption spectrum of CO2 (one for each isotope, 13C and 12C). Breathing samples are taken by a capnograph (developed by Oridion). The photons emitted (in two different wavelengths) are recorded by 2, very sensitive, detectors. They are able to measure 13CO2/12CO2 in exhaled breath in accuracy of parts per million (way more than the concentration in the atmosphere, so it can tell the accurate number of the emitted photons). Using this data, a graph is made and printed. (See figure 2)

The results of each test are unique to the certain patient at the time of the test, since baseline is taken in the beginning of each test. A special algorithm developed in exalez can also provide a number that indicate how the liver function (known as HIS in), and can also predict quite accurately when would the liver stop functioning if it wont be treated.

What are the results the doctor can get?
The doctor gets the whole graph. The graph shows the 13C/12C ratio throughout the test. When the liver is healthy, the graph is nice, the slope is clear, it reaches fastly to the peak, and decreases normally ( see graph 1, Normal). Parameters like the peaks location on the graph, the slope, the decreasing and the time of test are affected by the liver’s function and shown by the graph (see graph 1)


In addition, the doctor gets a number. In the H. Pylori test, it means positive or negative result, but in a liver test it means Hepatic Impariment Score – HIS. HIS is known as a number that indicates how well the liver functions. It is enables the doctor to correlate it with the answers of biopsy (how much damage the liver suffers), follow the treatment’s results (whether the liver recovered, deteriorate, or is the same), and also predict, in severe cases and no treatment, when would the liver stop functioning.

גרף 1 – גרף המייצג את תפקוד הכבד במקרים שונים

Who will buy the BID?
The vision is to put the BID in every clinic, clinical center and hospital. In hospitals, the BID enables the doctors to supervise the patient’s condition, in order to know when do they have to operate, or see, after an operation or other treatment, that he gets better. (see graph 2) In a privet clinic, the BID can replace the biopsy. When the doctor asks for a biopsy, he looses the patient to the hospital. If he will have a BID device, he will prefer to make a short, non-expensive test that can give him all the information he needs.


Who are the workers in the company?
The company had grown from 4 workers, in 2006 to 36 workers today. Most of the workers are from Israel, but now, in the marketing stage, we recruit more workers abroad (U.S. A and Asia). Today, most of our workers deal with marketing and Pharma. We cooperate with Hadassa in Israel, and other hospitals and universities in the U.S., where the experiments are made.

What do you see in the future?
Today we have 11 applications in clinical tests that suppose to get to the market during the next 5 years. The device is already developed; we are not trying to develop more features of the device, but focus on the marked substrates. We develop substrates for a large range of liver and GI illnesses and even try to predict who will get diabetes. We collaborate with Pharma companies that also finance half of the experiments.

The choices are endless, for every cell in the body, you need to find the certain material which is exclusively metabolized by it – and in the far far future, who knows, we might be able to analyze how well the hart or brain function.

We want to see the BID in every hospital, and every clinic. And be able to help people and serve them well. We want to succeed financially, and raise our value in the stock market, but it is always feel better if we help people in the way.

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