Disease
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Charity Dean has been in the national spotlight lately because she was among a group of doctors, scientists and tech entrepreneurs who sounded the pandemic alarm early last year and who are featured in a new book by Michael Lewis about the U.S. response, called The Premonition.
It’s no wonder the press — and, seemingly moviemakers, too — are interested in Dean. Surgery is her first love, but she also studied tropical diseases and not only applied what she knows about outbreaks on the front lines last year, but also came to appreciate an opportunity that only someone in her position could see. Indeed, after the pandemic laid bare just how few tools were available to help the U.S. government to track how the virus was moving and mutating, she helped develop a model that has since been turned into subscription software to (hopefully) prevent, detect, and contain costly disease outbreaks in the future.
It’s tech that companies with global operations might want to understand better. It has also attracted $8 million in seed funding Venrock, Alphabet’s Verily unit, and Sweat Equity Ventures. We talked late last week with Dean about her now 20-person outfit, called The Public Health Company, and why she thinks disease-focused risk management will be as crucial for companies going forward as cybersecurity software. Our chat has been edited for length; you can also listen to our longer conversation here.
TC: You went to medical school but you also have a master’s degree in public health and tropical medicine. Why was the latter an area of interest for you?
CD: Neither of my parents had college degrees. I grew up in a very modest setting in rural Oregon. We were poor and by the grace of a full ride scholarship to college I got to be premed. When I was a little girl some missionaries came to our church and talked about disease outbreaks in Africa. I was seven years old, and driving home that evening with my parents, I said, ‘I’m going to be a doctor, and I’m going to study disease.’ It was outrageous because I didn’t know a single person with a college degree. But . . my heart was set on that, and it never deviated from it.
TC: How did you wind up at the Santa Barbara County Public Health Department, instead of in private practice?
CD: It’s funny, when I was finishing up my residency — which I started doing general surgery, then I pivoted into internal medicine — I had a number of different doctors’ private practices come to me and try to recruit me because of the shortage of women physicians.
[At the same time] the medical director from the county public health department came and found me and he said, ‘Hey, I hear you have a master’s in tropical medicine.’ And he said, ‘Would you consider coming to work as the deputy health officer, and communicable disease controller, and tuberculosis controller, and [oversee the] HIV clinic and homeless clinic?’ And . . . it was, for me, a fairly easy choice.
TC: Because there was so little attention being paid to all of these other issues?
CD: What caught my attention is when he said communicable disease controller and tuberculosis controller. I had lived in Africa [for a time] and learned a lot about HIV, AIDS, tuberculosis, vaccine-preventable diseases — things you don’t see in the United States. [And the job] was so in lockstep with who I was because it’s the safety net. [These afflicted individuals] don’t have health insurance. Many are undocumented. Many have nowhere else to go for health care, and the county clinic truly serves the communities that I cared about, and that’s where I wanted to be.
TC: In that role — and later at the California Department of Public Health — you developed expertise in multi-drug-resistant tuberculosis. Was your understanding of how it is transmitted — and how the symptoms present differently — what made you attuned to what was headed for the U.S. early last year?
CD: It was probably the single biggest contributor to my thinking. When we have a novel pathogen as a doctor, or as a communicable disease controller, our minds think in terms of buckets of pathogen: some are airborne, some are spread on surfaces, some are spread through fecal material or through water. In January [of last year], as I was watching the news reports emerge out of China, it became clear to me that this was potentially a perfect pathogen. What does that mean? It would mean it had some of the attributes of things like tuberculosis or measles or influenza — that it had the ability to spread from person to person, likely through the air, that it made people sick enough that China was standing up hospitals in two weeks, and that it moved fast enough through the population to grow exponentially.
TC: You are credited with helping to convince California Governor Gavin Newsom to issue lock-down orders when he did.
CD: Everything I’ve done is as part of a team. In March, some amazing heroes parachuted in from the private sector, including [former U.S Chief Technology Officer] Todd Park, [famed data scientist] DJ Patil, [and Venrock’s] Bob Kocher, to help the state of California develop a modeling effort that would actually show, through computer-generated models, in what direction the pandemic was headed.
TC: How did those efforts and thinking lead you to form The Public Health Company last August?
CD: What we are doing at The Public Health Company is incorporating the genomic variant analysis — or the fingerprint of the virus of COVID virus as it mutates and as it moves through a population — with epidemiology investigations and [porting these with] the kind of traditional data you might have from a local public health officer into a platform to make those tools readily available and easy to use to inform decision makers. You don’t have to have a mathematician and a data scientist and an infectious disease doctor standing next to you to make a decision; we make those tools automated and readily available.
TC: Who are your customers? The U.S. government? Foreign governments?
CD: Are the tools that we are developing useful for government? Absolutely. We’re engaged in a number of different partnerships where this is of incredible service to governments. But they are as useful, if not even more useful, to the private sector because they haven’t had these tools. They don’t have a disease control capability at their fingertips and many of them have had to essentially stand up their own internal public health department, and figure it out on the fly, and the feedback that we’re seeing from private sector businesses has been incredible.
TC: I could see hedge funds and insurance companies gravitating quickly to this. What are some customers or types of customers that might surprise readers?
CD: One bucket that might not occur to people is in the risk management space of a large enterprise that has global operations like a warehouse or a factory in different places. The risk management of COVID-19 is going to look very different in each one of those locations based on: how the virus is mutating in that location, the demographics of their employees, the type of activities they’re doing, [and] the ventilation system in their facility. Trying to grapple with all of those different factors . . .is something that we can do for them through a combination of our tech-enabled service, the expertise we have, the modeling, and the genetic analysis.
I don’t know that risk management in terms of disease control has been a big part of private sector conversations, [but] we think of it similar to cyber security in that after a number of high-profile cyber security attacks, it became clear to every insurance agency or private sector business that risk management had to include cyber security they had to stand up. We very much believe that disease control in risk management for continuity of operations is going to be incredibly important moving forward in a way that I couldn’t have explained before COVID. They see it now and they understand it’s an existential threat.
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Immune intelligence startup Serimmune hopes to better understand the relationship between antibody epitopes (the parts of antigen molecules that bind to antibodies) and the SARS-CoV-2 virus.
The company’s proprietary technology, originally developed at UC Santa Barbara, provides a new and specific way of mapping the entire array of an individual’s antibodies through a small blood sample. They do this through the use of a bacterial peptide display — a sort of screening mechanism that can isolate plasmid DNA from antibody-bound bacteria in the sample. This DNA can then be sequenced to identify epitopes, which provide information about which antigens someone may have been exposed to, as well as how their immune system responded to them.
“It’s a very highly multiplexed and exquisitely specific way of looking at the epitopes found by antibodies in a specimen,” said Serimmune CEO Noah Nasser, who has a degree in molecular biology from UC San Diego and has previously worked for several diagnostics companies.
This week, Serimmune announced the launch of a new application of their core technology to help understand the disease states of and immune responses to SARS-CoV-2, the virus that causes COVID-19.
“So what we do is we take these antibody profiles we build, and we’re able to then map those back with about a 12 amino acid specificity to the SARS-CoV-2 proteome,” said Nasser. “And what we find is that antibody expression is highly correlated to disease state, so we can distinguish mild, moderate, severe and asymptomatic disease on the basis of antibodies that are present in the specimen.”
The more patient data Serimmune can collect, the better its core technology becomes at finding patterns across different antigen exposure and disease severity. Noticing those patterns sooner won’t only help physicians and researchers to better understand how the SARS-CoV-2 virus operates, but can also inform new approaches to diagnostics, treatments and vaccines for any antigen.
Serimmune’s launch of its new COVID antibody epitope mapping service is a way of making this data more accessible to customers like vaccine companies, government agencies and academic labs that have shown interest in better understanding the immune response to SARS-CoV-2.
“The key was to zero in on the information that researchers wanted to know and standardize that,” said Nasser. “We can actually now provide these results back in as few as two days from sample receipt.”
Beyond this new service, Serimmune also has plans to launch a longitudinal clinical study on immunity to SARS-CoV-2. Using a painless at-home collection kit, study participants send in small blood samples to Serimmune, which then uses its core technology to outline an individual immunity map.
“We provide their results back to them in the form of a personal immune landscape to COVID,” said Nasser. “And what we’re trying to do is to understand over time how that immune response changes, and what happens to that immune response on repeated exposure to COVID.”
The mapping technology is now so specific that it can tell whether a patient has antibodies from natural exposure to the SARS-CoV-2 virus or from a vaccine, he added.
While the primary focus for Serimmune remains these applications to the COVID-19 pandemic for now, Nasser also mentioned that the company has plans to move into personalized medicine, potentially offering their mapping service directly to interested patients.
“We believe that this has value to individual patients in understanding their immune status and what antigens they’ve been exposed to,” he said. Until then, Serimmune plans to continue growing its database with more patient samples.
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Right now the world is at war. But this is no ordinary war. It’s a fight with an organism so small we can only detect it through use of a microscope — and if we don’t stop it, it could kill millions of us in the next several decades. No, I’m not talking about COVID-19, though that organism is the one on everyone’s mind right now. I’m talking about antibiotic-resistant bacteria.
You see, more than 700,000 people died globally from bacterial infections last year — 35,000 of them in the U.S. If we do nothing, that number could grow to 10 million annually by 2050, according to a United Nations report.
The problem? Antibiotic overuse at the doctor’s office or in livestock and farming practices. We used a lot of drugs over time to kill off all the bad bacteria — but it only killed off most, not all, of the bad bacteria. And, as the famous line from Jeff Goldblum in Jurassic Park goes, “life finds a way.”
Enter Felix, a biotech startup in the latest Y Combinator batch that thinks it has a novel approach to keeping bacterial infections at bay – viruses.
Phage killing bacteria in a petri dish
It seems weird in a time of widespread concern over the corona virus to be looking at any virus in a good light but as co-founder Robert McBride explains it, Felix’s key technology allows him to target his virus to specific sites on bacteria. This not only kills off the bad bacteria but can also halt its ability to evolve and once more become resistant.
But the idea to use a virus to kill off bacteria is not necessarily new. Bacteriophages, or viruses that can “infect” bacteria, were first discovered by an English researcher in 1915 and commercialized phage therapy began in the U.S. in the 1940’s through Eli Lilly and Company. Right about then antibiotics came along and Western scientists just never seemed to explore the therapy further.
However, with too few new solutions being offered and the standard drug model not working effectively to combat the situation, McBride believes his company can put phage therapy back at the forefront.
Already Felix has tested its solution on an initial group of 10 people to demonstrate its approach.
Felix researcher helping cystic fibrosis patient Ella Balasa through phage therapy
“We can develop therapies in less time and for less money than traditional antibiotics because we are targeting orphan indications and we already know our therapy can work in humans,” McBride told TechCrunch . “We argue that our approach, which re-sensitizes bacteria to traditional antibiotics could be a first line therapy.”
Felix plans to deploy its treatment in those suffering from cystic fibrosis first as there is no cure for this disease, which tends to require a near constant stream of antibiotics to combat lung infections.
The next step will be to conduct a small clinical trial involving 30 people, then, as the scientific research and development model tends to go, a larger human trial before seeking FDA approval. But McBride hopes his viral solution will prove itself out in time to help the coming onslaught of antibiotic resistance.
“We know the antibiotic resistant challenge is large now and is only going to get worse,” McBride said. “We have an elegant technological solution to this challenge and we know our treatment can work. We want to contribute to a future in which these infections do not kill more than 10 million people a year, a future we can get excited about.”
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One of the more notable startups using artificial intelligence to understand and fight cancer has raised $45 million more in funding to continue building out its operations and inch closer to commercialising its work.
Paige — which applies AI-based methods such as machine learning to better map the pathology of cancer, an essential component of understanding the origins and progress of a disease with seemingly infinite mutations (its name is an acronym of Pathology AI Guidance Engine) — says it will be use the funding to inch closer to FDA approvals for products it is developing in areas such as biomarkers and prognostic capabilities.
It also plans to use the funding to continue developing better ways of diagnosing and ultimately fighting the disease, as well as exploring further commercial opportunities for its work, specifically within the bio-pharmaceutical industry.
This round is being led by Healthcare Venture Partners, with previous investor Breyer Capital, Kenan Turnacioglu and other funds participating. The company is not disclosing its valuation, but PitchBook noted that a first close of this round (when it raised $33 million) put the valuation at $208 million. That would value Paige now at about $220 million with the $45 million close, more than three times its valuation in its previous round.
Paige first emerged from stealth back in 2018 — with a bang.
Paige.AI — as it was known at the time — was hatched inside the Memorial Sloan Kettering Cancer Center, one of the world’s foremost institutions both for working on cancer therapies and treating cancer patients, and along with a $25 million investment led by Jim Breyer, Paige had secured exclusive access to MSK’s 25 million pathology slides as well as its intellectual property related to the AI-based computational pathology that underpinned its work. These slides make up one of the biggest repositories of its kind in the world, and as all solutions and services built on machine learning are only as good as the data that’s fed into them, they were critical to the startup’s beginnings.
The startup also launched with some serious talent behind it.
Much of the computational pathology being used by Paige had been developed by Dr Thomas Fuchs, who is known as the “father of computational pathology” and is the director of Computational Pathology in The Warren Alpert Center for Digital and Computational Pathology at Memorial Sloan Kettering, as well as a professor of machine learning at the Weill Cornell Graduate School of Medical Sciences.
Fuchs co-founded Paige with Dr David Klimstra, chairman of the department of pathology at MSK, and Fuchs had originally started out as the CEO of Paige, but was replaced earlier this year by Leo Grady, who joined from another bio-startup, Heartflow (another company backed by Healthcare Venture Partners). Fuchs is still supporting the company, but no longer in an executive role.
In the nearly two years since it launched, there have been some milestones reached. The company, which has around 30 employees today, has been the first to get an FDA breakthrough designation (which helps expedite the long process of drug approvals in urgent areas where there are few or no other options for patients) for using AI in oncology pathology. It’s also the first to get a CE mark in the same category, which opens the door to working in Europe, too. Paige has so far ingested 1.2 million images into its slide database and is using them — in algorithms that also take in genomic data, drug response data and outcome data — to work on developing diagnostic solutions.
But as with all new medical products, progress is not measured in quarters as it might be with a more typical tech startup. Moving fast and breaking things is something to be avoided. So even with all of the above advances, there has yet to be any commercial products launched, nor is Grady giving any specific time frames for when they will. And when the company came out of stealth in 2018, it said it would be focusing on breast, prostate and other major cancers, although today it’s not as quick to specify what its targets will be when it does launch commercial products.
Similarly, it’s also expanding its remit from primarily clinical environments to pharmaceutical ones.
“The clinical side is still our focus, but this is an expansion and realisation that this has a broader impact, and that includes pharmaceutical customers,” Grady said.
And the dropping of the .AI in its name was also intentional, in part a reaction it seems to how much AI gets thrown around today.
“There is a fundamental misconception, which is thinking of AI as a product and not a technology,” said Grady. “It’s a technology set that can allow you to do many things that could not have been done in the past, but you need to apply it in a meaningful way. Developing a good AI and putting that on the market will not cut it in terms of clinical adoption.”
The funding round, Grady said, saw a lot of interest from strategic investors, although the company intentionally has stayed away from these.
“We were approached by all of the scanner vendors and some of the biopharmaceutical companies,” he said. “But we made the decision to not take a strategic investment with this round because we wanted to be neutral with hardware vendors and not be too tied with any one.”
He also pointed to the challenges of talking to investors when you are working in a cutting-edge area (a challenge that has foxed many an investor also into backing the wrong horses, too, such as Theranos).
“We’re at the intersection of three areas: tech, medical devices and clinical medicine, and life sciences and biotech,” he said. “Many investors sit squarely in one and don’t feel comfortable in others. That makes the conversations challenging and short. But there has been an increasing blend between those three sectors.”
That’s where Healthcare Venture Partners fits into the mix. “Paige exemplifies the benefits of digital pathology and represents the bright future of AI-driven medical diagnosis,” said Jeff Lightcap of Healthcare Venture Partners, in a statement. “As hospitals embark on digital transformations, they will face challenges associated with these transitions. We believe Paige addresses many of these issues by enhancing the ability of clinical teams and pathologists to collaborate. We’re confident in Paige’s future and believe they will continue to develop cutting-edge technologies that enable pathology departments to transform their practices, which have changed little in the last century.”
“We applaud Paige’s commitment to building clinical AI products that will improve the diagnostic process and patient care,” added Jim Breyer of Breyer Capital, in a statement. “This is a critical time for Pathology, as pathologists are carrying a heavier workload than ever before. Paige understands their needs and the team has built cutting-edge technologies to address them. Paige represents the future of computational pathology and we look forward to their continued growth and success.”
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Why is tech still aiming for the healthcare industry? It seems full of endless regulatory hurdles or stories of misguided founders with no knowledge of the space, running headlong into it, only to fall on their faces.
Theranos is a prime example of a founder with zero health background or understanding of the industry — and just look what happened there! The company folded not long after founder Elizabeth Holmes came under criminal investigation and was barred from operating in her own labs for carelessly handling sensitive health data and test results.
But sometimes tech figures it out. It took years for 23andMe to breakthrough FDA regulations — it’s since more than tripled its business and moved into drug discovery.
And then there’s Oscar Health, which first made a mint on Obamacare and has since ventured into Medicare. Combined with Bright, the two health insurance startups have pulled in a whopping $3 billion so far.
It’s easy to shake our fists at fool-hardy founders hoping to cash in on an industry that cannot rely on the old motto “move fast and break things.” But it doesn’t have to be the code tech lives or dies by.
So which startups have the mojo to keep at it and rise to the top? Venture capitalists often get to see a lot before deciding to invest. So we asked a few of our favorite health VC’s to share their insights.
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As studies show that early diagnosis and preventative therapies can help prevent the onset of Alzheimer’s, startups that are working to diagnose the disease earlier are gaining more attention and funding.
That’s a boon to companies like Neurotrack, which closed on $21 million in new financing led by the company’s previous investor, Khosla Ventures, with participation from new investors Dai-ichi Life and SOMPO Holdings.
Last year, the Japanese life insurance company Dai-ichi Life partnered with Neurotrack to roll out a cognitive assessment tool to the company’s customers in Japan.
And earlier this year, the Japanese health insurer SOMPO conducted a 16-week pilot with Neurotrack, where more than 550 of SOMPO’s employees took Neurotrack’s test and followed the Memory Health Program for four months. Neurotrack and SOMPO are now working to deepen and extend their partnership.
“As the global crisis around Alzheimer’s continues to grow, the private sector is joining government and nonprofits to address the problem in their markets. In Japan, for example, traditional insurance companies are developing novel solutions that incorporate Neurotrack’s products to advance better memory health among its population,” said Elli Kaplan, Neurotrack co-founder and CEO. “These partnerships are innovative models that we hope to replicate in other markets, enabling traditional insurance companies to create new markets while helping to address the Alzheimer’s crisis. And now they’re also investing in our company, so these companies have two ways of doing well by doing good.”
Neurodegenerative disorders are becoming a more serious issue for the island nation — and the rest of the world. In fact, over the weekend the G20 first raised the possibility that aging populations could be a global risk.
“Most of the G20 nations already experience or will experience ageing,” Bank of Japan governor Haruhiko Kuroda, told reporters from Agence France Presse. “We need to discuss problems that arise with societal ageing and how to deal with them.”
In the U.S., the estimated cost of caring for Americans with Alzheimer’s and other dementias was an estimated $277 billion in 2018, according to a study cited by WebMD. Roughly $186 billion of those costs are borne by Medicare and Medicaid, with another $60 billion in payments coming out-of-pocket. That number could top $1.1 trillion by 2050, according to the same report.
Neurotrack uses cognitive assessments that follow eye movements using the camera on a computer or mobile phone to create a baseline for cognitive functions. The company then uses a combination of brain training and diet, exercise and sleep adjustments to try to improve cognitive function and health.
Its technology is one of several different approaches startups are taking to try to provide early diagnoses and potential preventative measures against the disease.
MyndYou, another company tackling neurodegenerative diagnostics, uses an app to monitor movement among its users. The company assesses that data to determine whether there may be any issues related to cognitive function. It recently partnered with the Japanese company Mizuho to test its efficacy among Japan’s aging population.
Then there’s Altoida, another startup that launched recently to tackle the cognitive assessment market. It uses augmented reality and a series of memory tests to assess brain function and attempt to detect neurodegeneration.
Neurotrack’s technology, based on research from Emory University, has managed to attract more than just Japanese corporations. Previous investors like Sozo Ventures, Rethink Impact, AME Cloud Partners and Salesforce founder Marc Benioff have also thrown cash behind the company.
To date, the company has raised more than $50 million, including $6.8 million in grants from the National Institutes of Health and National Institute of Aging.
The company said its new investment will be used to develop new partnerships in additional global markets and continue research and development.
“One can now feel empowered to test for potential memory decline, given that Neurotrack’s Memory Health Program can help stave off cognitive decline. This fully integrated platform enables users to assess the state of their memory, reduce future risk for decline, and monitor progress in order to take better control of one’s memory health. We combine these tools with deep analytics to further target and personalize, creating a very powerful precision medicine solution,” said Kaplan. “Just as when you go on a diet, you use a scale to provide evidence that you’re losing weight. Neurotrack now has the equivalent of both a scale to measure and the Memory Health Program for cognitive health. This is a game-changer for dementia risk.”
Japan has national efforts targeting a reduction in the onset of dementia in 6% of people in their 70s by 2025 (the country has the world’s largest population of the elderly, with more than 20% of the country over the age of 65). Roughly 13 million people are expected to develop Alzheimer’s in Japan by 2025.
Part of the company’s success in fundraising comes from the results of a preliminary study that showed improved cognitive functions for people diagnosed with some decline in cognitive function after a year of using Neurotrack’s Memory Health Program. The company claims it has the the first fully integrated, clinically validated platform that can assess a person’s cognition through its cognitive assessment — which can predict conversion from healthy to mild cognitive impairment (MCI) or MCI to Alzheimer’s disease within three years at 89% accuracy, and within six years at 100% accuracy.
While that kind of assessment is good, Alzheimer’s symptoms can begin to appear as early as 25 years before the onset of the disease. So there’s still work to be done.
“Neurotrack has built an incredible integrative platform that is transforming our battle with Alzheimer’s,” said Jenny Abramson, founder and managing partner of Rethink Impact. “Elli’s two decades of experience in the private sector and in government are helping her scale this solution to the millions of people suffering from cognitive decline around the world. We couldn’t be more excited to continue to support Neurotrack, given both the financial opportunity and the impact they are already having on this critical disease.”
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Every day spent with late stage cancer matters — that’s why it’s so important to get treatments right the first time. Unfortunately, despite having dozens of cancer treatments available, we don’t have great processes for determining what treatments to prioritize. The consequence of this is that we often miscalculate and waste critical time pursuing the wrong path.… Read More
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