Two ef­forts to trans­form in­jecta­bles in­to ro­bot­ic pills — a colos­sal mar­ket de­signed to en­hance treat­ment com­pli­ance, di­min­ish the need for physi­cian-led ther­a­peu­tic ad­min­is­tra­tion and pla­cate nee­dle-pho­bic pa­tients — got off the ground last year. Now, one of these ini­tia­tives, led by an in­ven­tor who played an in­flu­en­tial role in pi­o­neer­ing the first FDA-ap­proved au­to­mat­ic im­plantable car­diovert­er de­fib­ril­la­tor (ICD) has tak­en an­oth­er key step in its quest with a suc­cess­ful ear­ly-stage ef­fi­ca­cy and safe­ty study.

Cal­i­for­nia-based Rani Ther­a­peu­tics — un­der chief Mir Im­ran who start­ed his first com­pa­ny while in col­lege and cur­rent­ly holds more than 400 is­sued patents — on Thurs­day said its tech­nol­o­gy, chris­tened the Ra­niP­ill, had per­formed as ex­pect­ed in a tri­al with 58 healthy adult vol­un­teers.

The tech­nol­o­gy is de­cep­tive­ly sim­ple. The cap­sule has an en­teric coat­ing that pro­tects it from the acidic am­biance of the stom­ach, and once it moves in­to the in­tes­tine and pH lev­els rise, the coat­ing dis­solves and a chem­i­cal re­ac­tion takes place which in­flates a bal­loon. Pres­sure in the bal­loon push­es a dis­solv­able mi­cronee­dle filled with a drug — in this case, the com­pound oc­treotide, an off-patent bi­o­log­ic that treats the hor­mon­al dis­or­der acromegaly — in­to the in­testi­nal wall. In­testines don’t have pain re­cep­tors, and the in­testi­nal sub­strate — which is de­signed to ab­sorb nu­tri­ents — is high­ly vas­cu­lar­ized, mak­ing it the ide­al lo­ca­tion for the drug-en­gorged in­jec­tion to de­ploy.

In the tri­al, 52 sub­jects were treat­ed with the Ra­niP­ill ver­sion of oc­treotide, while the re­main­ing 6 par­tic­i­pants were giv­en an in­tra­venous in­jec­tion of an iden­ti­cal dose of oc­treotide.

“This was the first time we were de­liv­er­ing nee­dles from the in­testi­nal wall,” Im­ran not­ed in an in­ter­view with End­points News. “And our hy­poth­e­sis from the be­gin­ning was that you wouldn’t feel any­thing. And of course, that was borne out. And then the sec­ond end­point was bioavail­abil­i­ty, which turned out to be greater than 70%. Which is what ex­act­ly we had seen in our pre­clin­i­cal test­ing.”

The plan is to con­duct a prop­er head-to-head study in the com­ing year and demon­strate equiv­a­lence or non-in­fe­ri­or­i­ty to the in­jectable ver­sion. The ear­li­est Im­ran ex­pects the prod­uct to be avail­able, as­sum­ing all goes well clin­i­cal­ly, is 2022.

This oc­treotide tri­al will be the lit­mus test for its drug-de­liv­ery plat­form, open­ing the door to a pletho­ra of in­jectable treat­ments, from in­sulin to Hu­mi­ra, and across a wide range of dis­eases. But there’s a long road ahead. Each drug loaded in­to the cap­sule will re­quire a sep­a­rate study be­fore Rani can pe­ti­tion the FDA for ap­proval.

The com­pa­ny has a num­ber of such drugs in its pipeline, and ex­pects to kick off Phase I stud­ies lat­er in 2020. Found­ed in 2012, Rani Ther­a­peu­tics has raised $142 mil­lion in fund­ing from a slate of in­vestors in­clud­ing GV (the in­vest­ment arm of Al­pha­bet), and counts No­var­tis and Shire (now owned by Take­da) as its part­ners.

As it ramps up its clin­i­cal de­vel­op­ment, fund­ing is im­per­a­tive. “The fund­ing nev­er stops. We’re con­stant­ly do­ing that,” Im­ran said, adding that an IPO is a “dis­tinct pos­si­bil­i­ty” rough­ly a year from now. The com­pa­ny al­so ex­pects to an­nounce a new li­cens­ing part­ner by the end of the year or 2021, he said.

Trans­form­ing in­jecta­bles in­to pills is hard­ly a nov­el idea, but a string of phar­ma­ceu­ti­cal/chem­i­cal ef­forts to evade the en­zymes that break down the oral drug be­fore it can be ab­sorbed have large­ly hit a wall. Apart from the Ra­niP­ill, last year an an­i­mal study — led by MIT sci­en­tists — cap­tured the spot­light for the po­ten­tial of its blue­ber­ry sized ro­bot­ic pill de­signed to de­liv­er an in­sulin shot in­side the stom­ach.

Rat and pig da­ta on the oth­er ro­bot­ic pill — cre­at­ed by a team of re­searchers at MIT (in­clud­ing the pro­lif­ic drug de­liv­ery mae­stro Robert Langer) and No­vo Nordisk — has an al­ter­na­tive mech­a­nism of ac­tion.

The de­vice, called So­ma, en­cap­su­lates a nee­dle in­side a pill made of com­pressed freeze-dried in­sulin that is de­signed to ori­ent it­self when it comes in con­tact with the stom­ach lin­ing — in­spired by a leop­ard tor­toise, which bran­dish­es a shell that al­lows the African rep­tile to right it­self if it rolls on­to its back.

Up­on con­tact with the wet in­ner lin­ing of the stom­ach (which is al­so de­void of pain re­cep­tors), a sug­ar disk hold­ing the nee­dle in place is dis­solved, mak­ing way for the nee­dle to re­lease its con­tents. The prod­uct is then en­gi­neered to dis­in­te­grate and trav­el harm­less­ly through the di­ges­tive sys­tem and even­tu­al­ly be elim­i­nat­ed, the re­searchers wrote in their re­port in Sci­ence.

“There’s so many patent land­mines that we have placed. So we’re not re­al­ly con­cerned about MIT or any­one else,” Im­ran said.