"All disease begins in the gut." - Hippocrates

Until recently, there has been little insight into the root cause of metabolic disease and, as a result, advancements to address the resulting conditions have been incremental at best – addressing only symptoms, with little impact on patient outcomes. At Fractyl, we are applying new scientific insights in intestinal biology to advance treatments and potential cures for metabolic diseases.


Our product pipeline leverages our proprietary procedural therapy, which is designed to rejuvenate the lining of the duodenum to improve patient health, and initially targets patients with metabolic conditions resulting from insulin resistance, including type 2 diabetes (T2D), nonalcoholic steatohepatitis (NASH), and polycystic ovarian syndrome (PCOS).


The intestinal lining (duodenal mucosa) is our body’s largest hormone-producing (“endocrine”) organ, the largest nervous system outside of the brain, an important line of defense against infection, and host to a complex microbiome.


Our research has demonstrated that insulin resistance is caused by an overgrowth (hyperplasia) of the duodenal lining that results from years of diets high in fats and sugar. This hyperplasia leads to changes in the amount of key hormones produced and key nutrients absorbed in this section of the gut. These changes affect both insulin production by the pancreas and the body’s responsiveness to that insulin. Because of these hormonal signals, when the mucosa becomes hyperplastic, patients become predisposed to insulin resistance and metabolic disease.





The intestinal lining (duodenal mucosa) is our body’s largest hormone-producing (“endocrine”) organ, the largest nervous system outside of the brain, an important line of defense against infection, and host to a complex microbiome.


About Type 2
Diabetes (T2D)

A metabolic disease characterized by hormonal changes leading to insulin resistance, poor pancreatic function, and elevated blood sugar levels (hyperglycemia)


T2D affects 400 million people worldwide, 30 million in the US


More than 50% of patients have poor blood sugar control


Annual cost estimated at $245 billion in the US from disease


No current treatment for underlying cause


For more information:
American Diabetes AssociationCenters for Disease Control and PreventionInternational Diabetes Federation

About Nonalcoholic
Steatohepatitis (NASH)

A severe type of nonalcoholic fatty liver disease (NAFLD), NASH occurs when a buildup of fat in the liver leads to inflammation and damage


In the US, an estimated 80 million people are living with NAFLD, and about 30 million of them have progressed to NASH, but both conditions are believe to be underdiagnosed


More than 50% of NASH patients also have type 2 diabetes; these patients represent the highest cost to the healthcare system, are at the highest risk of diabetic complications, and have a ten times higher risk of liver/pancreatic cancer


No current treatments


For more information:
American Diabetes AssociationNational Institute of Diabetes and Digestive and Kidney Diseases

About Polycystic Ovarian
Syndrome (PCOS)

Increasingly recognized as a metabolic disease, PCOS is a variable disorder marked by amenorrhea, hirsutism, obesity, infertility, and ovarian enlargement


A leading cause of female infertility due to insulin resistance and other hormonal dysfunction


Estimated to affect 5-7% of women worldwide with the highest rates of occurrence in the Middle East


No current treatment for underlying cause


For more information:
U.S. Department of Health and Human ServicesPCOS Awareness Association