Here are 1-2 brief analogies to describe Fractyl Health:

• Fractyl Health is like a Merck or Moderna developing a 'vaccine' for type 2 diabetes and obesity, aiming for durable disease modification that reduces or eliminates the need for chronic medication.
• They're also like a gene therapy company such as Sarepta or Spark Therapeutics, but entirely focused on developing long-term, potentially curative treatments for widespread metabolic diseases.

• Revita DMR System (Revita): An outpatient procedural therapy that uses hydrothermal ablation to durably modify duodenal dysfunction, aiming to improve glycemic control and aid in weight maintenance for patients with type 2 diabetes and obesity.
• Rejuva: A novel pancreatic gene therapy (PGTx) platform designed to enable long-term remission of type 2 diabetes and obesity by durably altering metabolic hormone function in pancreatic islet cells.

• Healthcare Providers: These include hospitals, clinics, and outpatient centers that acquire the Revita DMR System to perform the procedural therapy on their patients. Fractyl Health initiates commercial launches with these providers, as seen with its pilot commercial launch in Germany.
• Healthcare Payers: This category encompasses government healthcare systems (e.g., national health services) and private insurance companies that provide reimbursement for the Revita DMR Procedure. Securing reimbursement, as mentioned with Revita Germany, is a critical step for making the therapy accessible to patients and financially viable for providers.

Harith Rajagopalan, M.D., Ph.D. Co-Founder and Chief Executive Officer

Dr. Harith Rajagopalan is the Co-founder and Chief Executive Officer of Fractyl Health, a company he started while serving as an Entrepreneur-in-Residence at General Catalyst Partners, a venture capital firm. Prior to founding Fractyl Health, he worked as an academic cardiologist and physician-scientist. Dr. Rajagopalan earned his B.S. in chemistry from Stanford University and later obtained M.D. and Ph.D. degrees from Johns Hopkins School of Medicine, where he conducted award-winning research on intestinal cancers. He completed his training in internal medicine and clinical cardiology at Brigham and Women's Hospital and a research fellowship at Harvard Medical School.

Lara Smith Weber Chief Financial Officer

Lara Smith Weber was appointed Chief Financial Officer of Fractyl Health, effective January 12, 2026. She brings over two decades of financial leadership experience from the medtech, biotech, and other growth-oriented industries. Ms. Smith Weber has a strong background in building financial organizations, managing transitions to commercial-stage operations, and guiding companies through periods of operational growth and public-market complexities. Most recently, she served as Chief Financial Officer of Inari, where she oversaw multiple financings and enhanced the company's capital structure. Her previous roles include Chief Financial Officer of ONWARD Medical, a publicly traded medtech company, and U.S. Chief Financial Officer and Head of Commercial Finance at MorphoSys.

Jay Caplan Co-Founder, President, and Chief Product Officer

Jay Caplan is a Co-Founder, President, and Chief Product Officer at Fractyl Health, with more than 20 years of leadership experience in the medical device sector. Before co-founding Fractyl Health, Mr. Caplan was the Chief Operating Officer of Candela Corporation, a prominent company in aesthetic devices. He also served as Chief Technology Officer and Vice President of Research and Development at InfraReDx, Inc., a venture-backed startup focused on cardiovascular imaging systems. Earlier in his career, he was Vice President of Operations for Thermo Cardiosystems, where he led the development of the HeartMate II left ventricular assist device. Mr. Caplan holds a B.S. in electrical engineering from M.I.T. and an MBA from The Wharton School of the University of Pennsylvania.

Len Rosberg Vice President of Manufacturing

Len Rosberg serves as the Vice President of Manufacturing at Fractyl Health. He has over 20 years of experience in supply chain management and manufacturing engineering within major medical device companies. Prior to joining Fractyl Health, Mr. Rosberg was the Vice President of Operations for Candela Corporation. His extensive industry background includes positions at Boston Scientific, Thoratec, and Baxter International. His technical expertise covers reliability engineering, design for manufacturability, and the implementation of scalable manufacturing processes.

Key Risks to Fractyl Health

1. Clinical Development and Regulatory Approval Risk: Fractyl Health's success is heavily dependent on the successful completion of ongoing and planned clinical trials, particularly for its lead product candidate, the Revita DMR System, and its earlier-stage Rejuva gene therapy platform. The company anticipates completing enrollment for its pivotal Revitalize-1 study in the first half of 2024 and expects to report topline data in the fourth quarter of 2024. Additionally, it plans to submit an IDE for the potentially pivotal Remain-1 study in the first quarter of 2024 and to initiate a first-in-human study for its Rejuva GLP-1 pancreatic gene therapy candidate in the first half of 2025. Failure to achieve positive results in these trials, experience delays, or obtain the necessary regulatory approvals (such as FDA approval, despite Breakthrough Device designation for Revita) would significantly jeopardize the company's ability to bring its products to market and generate revenue.
2. Commercialization and Market Adoption Risk: Even if Revita receives regulatory approvals, the company faces significant challenges in commercialization and market adoption. While Revita is approved for inadequately controlled T2D in Europe and a pilot commercial launch has begun in Germany after securing reimbursement, broad market penetration and financial success will depend on securing widespread reimbursement in other key markets, demonstrating compelling real-world evidence, and achieving acceptance among physicians and patients for a novel procedural therapy. The company's ability to effectively market and distribute Revita and overcome potential resistance to a new interventional approach will be critical.
3. Competition from Existing and Emerging Metabolic Therapies: Fractyl Health operates in a highly competitive landscape with established and rapidly evolving treatments for type 2 diabetes and obesity. The company acknowledges the availability of "highly potent drugs in the GLP-1RA class" that lower blood sugar, lower weight, and prevent cardiovascular mortality. Although Fractyl aims to address the unmet need for durable metabolic health maintenance without chronic pharmacotherapy, the continued development of new or improved GLP-1RAs, or other novel pharmaceutical, procedural, or gene therapies, could diminish the competitive advantage or market opportunity for Revita and Rejuva if they offer comparable or superior long-term benefits or convenience.

1. U.S. Regulatory Approval and Commercial Launch of Revita for Post-GLP-1 Weight Maintenance: Fractyl Health is actively pursuing U.S. Food and Drug Administration (FDA) approval for Revita to address weight maintenance in patients discontinuing GLP-1 receptor agonist (GLP-1RA) therapies. The company anticipates submitting a Premarket Approval (PMA) application in the second half of 2026, following the expected topline 6-month randomized data from the pivotal REMAIN-1 study. Successful approval and subsequent commercialization would open a significant new market for the company.
2. Expanded Adoption and Market Penetration of Revita in European Markets: Revita is already approved for patients with inadequately controlled Type 2 Diabetes (T2D) in Europe, with commercial availability and reimbursement secured in Germany since the first half of 2023. While the company has paused investment in Revita for T2D clinical trials in favor of weight maintenance, ongoing commercial activities and real-world registry studies in Germany continue to contribute revenue. Future growth could also come from expanding the Revita system for the post-GLP-1 weight maintenance indication into European markets following further clinical validation.
3. Positive Clinical Data Readouts and Progression of Revita's REMAIN-1 Program: The ongoing REMAIN-1 pivotal study is crucial for demonstrating Revita's efficacy and durability in maintaining weight loss after GLP-1RA discontinuation. The company expects to report 6-month primary endpoint data from the REMAIN-1 Pivotal Cohort in the second half of 2026 and 1-year data from the Midpoint Cohort in the third quarter of 2026. These positive data readouts are essential for supporting regulatory submissions, securing favorable reimbursement, and driving broader clinical adoption, thereby fueling revenue growth.
4. Advancement of the Rejuva Gene Therapy Platform into Human Clinical Trials: Fractyl Health's Rejuva gene therapy platform, designed for long-term remission of T2D and obesity, is progressing towards clinical validation. The company completed Clinical Trial Applications (CTA) for its lead candidate, RJVA-001, in the EU and Australia in the second half of 2025, with expectations to dose the first patients and report preliminary data in the second half of 2026. While direct product sales from gene therapy are unlikely within 2-3 years due to the early clinical stage, successful progress in human trials could significantly enhance the company's valuation and attract strategic partnerships or licensing deals, potentially generating revenue through upfront payments or milestone achievements.

Share Issuance

• Fractyl Health completed its Initial Public Offering (IPO) in February 2024, pricing 7,333,333 shares of common stock at $15.00 per share, resulting in approximately $110.0 million in gross proceeds.
• In August 2025, the company completed an underwritten public offering of common stock and accompanying Tranche A and Tranche B warrants, generating gross proceeds of $20 million.
• Fractyl Health announced the pricing of an underwritten offering of 60 million shares of its common stock in September 2025, with expected gross proceeds of approximately $60 million.
• The exercise of Tranche A warrants from the August 2025 financing resulted in $23.0 million in gross proceeds, with an additional $4.1 million received by January 2, 2026, totaling $27.1 million from warrant exercises by early 2026.

Inbound Investments

• Notable institutional investors, including Nantahala Capital, ADAR1 Capital Management, Second Line Capital, 683 Capital, and SilverArc Capital, participated in Fractyl Health's underwritten public offering in August 2025.

Capital Expenditures

• Fractyl Health reported capital expenditures of $1.8 million, which consumed a significant portion of its operating cash flow in a recent period.