Nutromics’ CMM technology acts like a ‘lab-on-the-skin’ by tracking multiple targets in the human body through a single wearable sensor. Click here to learn more.
Caldwell Chats is a fireside chat series centered around emerging trends and hot topics in innovation. We have the inside scoop and want to share it. Working alongside pioneering business leaders and cutting-edge machinery and methods, our team members are witness to the next generation of tech shaping the future. We regularly invite top executives from a variety of industries to pick their brain on the latest innovations and IP matters. Our mission is to inform, guide and inspire innovators through this series.
Katie Rubino: Welcome everyone to another edition of Caldwell Chats. This is a series where we like to highlight some really new and cutting edge disruptive innovations. And so today, we are joined by Hitesh and Peter from Nutromics. And so, welcome to both of you. Thanks for coming here. And we’d love if Peter, maybe you can start us off, tell us a little bit about yourself and your background and what exactly Nutromics does.
Peter Vranes: Yeah, sure. My background. I’m a chemical engineer. I’ve been an entrepreneur for 18 years, seems like a long time. I think it’s about 18. So anyway, many years. Mainly in skincare actually and now moved into medical devices. So, what we do at Nutromics, but I’m co-Founder and co-CEO and Hitesh here is also co-Founder and co-CEO. We have a vision with the world with zero preventable deaths as a result of timely molecular data. That’s our vision. That’s what drives us as a company. And and the way we’re after that vision is a wearable device that can monitor any molecular target continuously and in real time. So it’s a small patch similar to a continuous glucose monitor that many people might be familiar with, but instead of just being able to monitor one thing, we can monitor many things, many molecular targets continuously and in real-time, and this isn’t aspirational. We have 12 sensors that we’ve already developed, ten papers have been published on it. So it’s when you can monitor anything, you have an enormous scope to solve, lots and lots of problems in health care, such as therapeutic drug monitoring, which is where we’re starting. But also early biomarkers of fast-moving disease states like sepsis and things like that. So, we’re very, very excited about this technology, about our team, about what we’re about to do with moving really quickly. And you know, we got a, we got a really big vision and we’re going after.
Katie Rubino: It sounds really exciting. Hitesh, would you like to tell us a little bit about yourself?
Hitesh Mehta: Yeah, thanks for having me as well, Katie. I’m so, as Peter said, I’m co-Founder co-Ceo of Nutromics with Peter. My personal background. So I before Nutromics, I was consulting in the healthcare space. So I was part of IBM Watson Health division in a global consulting capacity and that meant a lot of travel and looking at Healthcare systems or across the globe and how we can help improve new models of care. Animals, a service delivery. So did a lot of work in the states with the ACA rollouts up in Minnesota, in the UK working remotely with the government there in Singapore, New Zealand and Australia. And the problems we saw over and over again was just about, “How do you improve access to services? How do you improve coverage? How do you improve models of care, and deal with some of those in efficiencies?” So, a lot of that led me to look at wanting to start my own company and wanting to tackle some of those problems in a more impactful way, which is around when I met Peter. So we are on different journeys at the time and met and had a shared passion and started to collaborate and it moved pretty quickly. You know, when we originally met it was around September 2017, and we pitched the idea of what we wanted to build a med tech actuator program in December and we were accepted in February or January 2018 and started the course in February 2018. And it moved pretty fast from there to where we are today, where it’s no longer just the two of us: we’re fast-growing -we’ve got 20 people on the team now. Rapidly building the technology and getting ready for our first in human trials with the technology.
Katie Rubino: That’s really exciting. Now the focus of your company here, it’s centered around patient molecular monitoring and one of the first areas you are diving into is this idea of therapeutic drug monitoring, specifically around the drug Vancomycin, which is a very broad spectrum, antibiotic that has a very narrow therapeutic window. So traditionally when someone is started on that, you know, Just prescribe this standard dose of 1 gram, every 12 hours. So what exactly is wrong with that picture? And what do you aim to help resolve with that? So Hitesh, maybe we’ll start with you on that one.
Hitesh : Yeah. So the challenge there is that this is a very fast-moving disease where you often dosing vancomycin. And the doctors are only getting a picture of how the dosing is going when they take a trough dosing every 12 hours as you mentioned. And there’s a number of factors that can change: The levels were patient – It can be based on the sex, the age, the level of their severity of the disease, the renal clearance rate. So it needs to really be personalized monitoring, which isn’t today. Today, the approach is that “We’ll we’ll take a measurement once every 12 hours” and sometimes that measurement can be missed, you know, in a busy ward, nurses may forget to take the doses, exactly, 12 hours later. So, they try and aim for plus, or minus to our windows and all that results in is, you know, you often having a lot of discomfort for the patients, you’re prolonging the progression of the disease, so you’re not able to actually treat them properly. The doctors may under-dose them because they’re worried that they haven’t got the levels and the results back from pathology. So let’s maybe go for a smaller dose or you may find that you’ve actually ended up with the toxic dose. So the patients have a good quite acute kidney injury or further complications and you’re trying to then walk it back. So all of this culminated last year where the guidelines for Vancomycin dosing actually changed to recommend area under the curve based dosing, and currently approximately 84% of the hospital, still don’t follow those guidelines just because it’s so difficult to do because to follow the guidelines. That means you have to take a lot more blood draws than what you do today, or you have to try and use complex software to try and predict whether levels are going to be for a patient. So all of that means that today, 60% of the dosing decisions are not in the right therapeutic window and ten to twenty percent of patients, end up with acute, kidney injury and further complications.
Katie Rubino: Yeah, that’s a very troubling problem. Now at this can also, if we don’t do this drug properly Peter, its this can also lead to some increased antimicrobial resistance in the community too and these drugs won’t work as well for future infections, Is that a problem here too?
Peter: It is a – AMR is massive problem. A huge problem, that one of the drivers is the inability to dose the drug -to personalize the dose of that drug. So what happens now, it looks look at sepsis as an example. So patient will come in and sepsis is a fast-moving disease, state in the later stages for every one hour treatment is delayed, the risk of death, goes up 7%. So this is something that is urgent and acute and clinicians need to make decisions quickly. And so, what they need to do is identify what the drug is and what the bacteria is and to know what antibiotic to provide that takes time. So what happens then is that they get a cocktail of antibiotics because you it’s like a shotgun approach. And so what happens is that you get people are patients that are getting huge amounts of antibiotics all different types because the clinician rightly is trying to save their life because they don’t know what the bacteria is. So we have this widespread use of lots of different antibiotics for lots of people, and a lot of it is redundant, unnecessary, but no one knows that at the time, they’re trying to save their life. So, when you do that enough, you get antimicrobial resistance because you just have a plethora of the use of certain drugs, and that’s one of the major drivers of resistance. When you can personalize, a dose of a drug to an individual, that changes the game, so, where we’re heading as a company is early diagnosis of fast-moving disease states. Because we can monitor any molecular target, we can then start to resolve this chicken and egg scenario, where we don’t, we don’t have a consensus on what are some of the early biomarkers of these disease states. We have an idea, it gets debated. My procalcitonin might be other molecular markers, but once we have the technology that can monitor multiple molecular targets we can start, to have a true bona fide, a range of molecular targets that will now accurately be able to diagnose these disease states earlier, which means that they can give treatments targeted earlier. They’re not giving the cocktail of drugs. And so that’s going to go a long way to improving antimicrobial resistance, which is that huge problem. So that’s one of the ways. There’s a whole range of different things, it’s not just you know one one-shot wonder here, but but it is a big step in the right direction to to resolving this huge problem. That’s actually getting worse. It’s getting its a, we’re going to be hearing a lot about a lot more about AMR, are in the future just because it’s just such a major problem.
Hitesh: Just adding adding to that, just adding to that as well. Just the fact that we will be able to help resolve under-dosing problems by making it at more accurate for the clinicians to keep the patient at the right level means that you’re not giving the the bacteria, the time to develop that resistance to the to the dosing. So a big pro issue with the AMR is that clinicians are under dosing and that gives time for the the bacteria to develop resistance to the drugs in the first place. And the reason why they’re under dosing is because they can’t get the right monitoring information in front of them to manage that dosing.
Katie: Yeah, that’s an excellent point. Now, can you maybe walk us through, Hitesh, about how does, your continuous molecular monitoring patch work?
Hitesh: Yes, so it’s really exciting technology and it’s really two key technologies coming together: One is a microneedle based array, which allows us to build a wearable ‘lab on the skin’ as we call it. And that is about 1 millimeter long needles, which we can functionalize for different targets of interest. The other is in, this is the core of our technology is what’s called an aptamer system. So, this is a DNA based technology that allows us to build these sensors, the biosensors, quite rapidly and this is quite revolutionary in the space, you know, typically the approach has been to build an enzymatic based sensor for biochemical monitoring, or to look at antibodies and so forth. They all have different challenges. Aptamers work really well in the body for continuous in vivo real-time detection and it’s the true platform capability because ultimately it works the same way biology works in our body for continuous monitoring. That was what the light bulb that led Professor, Kevin Plaxco is the inventor of the technology, to develop this platform. And the proof is as we say in the pudding where today – it took him 10 to 15 years to build a base platform and demonstrated for the first target in a living body. And in four years after that, he’s demonstrated 12 different targets and 10 of those have already been published in journals. So it’s a scalable platform and that’s what allows us to start to look at being able to apply that onto a wearable microneedle patch and and ultimately deliver a patch that works for every patient that can have multiple sensors being measured multiple targets, being measured with multiple sensors, continuously in real time on a single patch, that’s about the size of a twenty cent coin.
Katie: Wow, incredible. And what would it feel like for the patient to be wearing this patch? Or they going to notice that you know, like an insulin pump, you know you it’s always noticeable when somebody has one or is this very, you know, you say it’s very small – is it discreet? The patient won’t really feel much of it?
Hitesh: Yeah, the latter so part of the reason for choosing microneedles is because it gives us access to interstitial fluid which correlates strongly with the blood for number of markers. And glucose monitoring the continuous watching technology, for example, works in the subcutaneous space as well, which is where the microneedles also go. The key difference they’re not as long as CGM needles. It’s about 1 millimeter. So the usability, the form factor. The the patient experience is a lot better. You don’t feel as much pain. In fact, it’s classed as pain-free approaches.
Katie: That’s fantastic. Now Peter, can you maybe walk us through some other healthcare settings that this biosensor might be applicable to in addition to you know, therapeutic drug monitoring of antimicrobials?
Peter: Yeah. Sure. So yeah, there’s about 40 drugs, indicated for tedium therapeutic drug monitoring. So that’s that’s a vertical we’re going down in a major way. We call that a kind of low-hanging fruit, but there are there are literally dozens, dozens of problems that we can solve in healthcare. I’ll give you a couple of examples. So one is people have heart, attacks are after their first heart attack. They’re at high risk for a second heart attack. And they stay at home, and there is basically no monitoring. They’re looking for symptoms, like chest pains and that creates a lot of anxiety for these patients. Because as you can, imagine, you’ve just had a life-threatening event and you’re waiting for a second acute life-threatening event, which may or may not come and every little twinge and every little thing that happens in your body anxiety goes through the roof because you thinking is just my next heart attack coming and and I’ve had personal experience with out with my sister who literally a few weeks ago, completely healthy had a heart attack survived, flatlined, but survived, luckily and then was sent home and and was in a real state because she was just with anxiety, which is a vicious circle because that level of anxiety, it can actually trigger more second that creates more stress on the heart and so that’s not something, obviously you want your patient who’s just had a heart attack to be going through high-stress moments like that. So biomarkers like troponin and BMP provide an early warning of an impending heart attack. It would provide enormous comfort for For the 800,000 people that have heart attacks in the US, every year that get no monitoring whatsoever. So you can imagine, if you’ve had a heart attack and you get to wear a device and you get a warning that you that that twinge use actually bona fide and you need to go straight to hospital, that would be incredibly valuable for those people, but we don’t have it now because we don’t have a technology that’s in the market that can monitor troponin and BMP. That’s what we’re working towards. So so that’s that’s that’s one use case that’s going to be extremely valuable for lots of people. Another one is kidney transplant. So the most common organ transplant is kidney and when you have a kidney transplant, you need to have regular creatinine monitoring. So creatinine is the gold standard for kidney health essentially. So what a lot of people who have kidney transplants have to do, they’ve just had a major life experience, major, you know, it’s a huge thing to have an organ transplant obviously. And now what a lot of them do is they have to move home if they’re, if they’re not close to a hospital because they need to be close to hospital to have these regular blood tests that monitor their creatinine levels. So, it’s a huge disrupter in their life. We now have a creatinine sensor. So imagine now that same person who had to move home – it’s a huge disruption- and they can be sitting in the comfort of their lounge room and a clinician can get on their monitor any real time, they can monitor their creatinine level at any moment at any point in time 24/7. That’s what we’re talking about here. So that is that is that is not evolutionary, that’s that’s a revolutionary shift in what we’re talking about. And these are just a small number. When we think about the, the applications. We see it like a pyramid, the known applications are at the tip, right? These are things. We know we can do, but this technology will uncover applications that we’ve never even dreamed about. It will be researchers that we use our technology and discover things that that that we just don’t know about, that’ll be transformative. So that’s the type of technology this is; it’s an enabler. It will solve real-world problems now, but it will solve many more problems in the future, and that’s the thing that’s super exciting. Is almost the known is exciting. The unknown is possibly even more exciting, depends on how you look at it.
Katie: Yeah, that’s so powerful and so exciting too. Now we those of us watching here in the US, we can hear your accents, we know you’re an Australian based company. So who is your intended market for this product? Are you only launching in Australia? Are you going to be launching in the U.S.? What’s kind of your reach of this technology? Hitesh, maybe we’ll go to you for this one.
Hitesh: Yeah, look this, this technology has Global applications and rebuilding it for global use. We are looking to launch in the US as our first market. So we’re aiming to enter the US by 2025 and are currently looking for partners and investors to help support that operation and that set up and scale up for the US market. And we’re starting to now engage with the FDA in the pre sub-processes. Well, to prepare for entry into the US market, but beyond that it is a it is going to be a global approach for us. We will start to then look at other markets like Europe and Asia and so forth.
Katie: Yeah, that’s fantastic. Now Peter. Can you maybe tell us you said earlier that you started your business around 2017, you know then COVID hit. What effect has the covid-19 pandemic had on the growth of your company?
Katie: That’s a great question. There are some things that you can control and some things you can’t. COVID is especially one that we had to deal with as best we could. And we were talking before we started recording this session and we’re from Melbourne and Melbourne has the unenviable distinction of being the most lockdown city in the world and we’ve got a med tech company that’s building a product growing rapidly in the most lockdown city in the world. So, you know, it’s challenging as it is. It’s doubly as challenging when under those conditions. It didn’t didn’t really hamper us as much as perhaps we would have thought. And the reason being is that with our development, we were able to get exemptions to allow us to continue to get into the lab. So that was, that was fortunate that we were able to do that. If it wasn’t for that, it would have put us back months months months. But but we were able to get into the lab, the it’s still continued. Probably the biggest impact and one that we still see, now a little bit is getting deliveries. Now, you’re getting Australia’s on the other side of the world, right? So getting deliveries is, you know, geographically challenging, right? But with the supply chain issues, I think everyone saying, but we’re probably fit more pronounced here in Australia that’s a little frustrating. It just takes longer. We’ve got a we’ve got to order things here earlier and things like that. But but the, the long story short, it’s we have grown rapidly despite the the pandemic. And in some ways, the pandemic is benefited us. Asks, it’s been a tragedy the world over but one thing it’s done is that the world is appreciated remote patient monitoring. The advantage of being able to effectively look after patients outside of a hospital setting was a trend that was always happening and it’s just been put on steroids and so it’s probably going on ahead ten years out of necessity. But and what we do is a technology that enables remote patient monitoring – that’s what we do. So that’s been, that’s been a big shift in our favor. And also wearable medtech is extremely hot in terms of investment. This is a market. You look at Dexcom’s market capitalization, for example, you know, there are $55 million. They just do CGM’s. And there’s a whole range of examples of of a shift towards, you know, where will technologies go ? So, yeah, so, in a way, there were challenges, but in another, in another respect, possibly greater benefits that we’ve had, as a result of COVID.
Katie: Interesting now, Hitesh, can you maybe tell us, do you have any advice for startups that are looking to enter the medtech space? Any words of wisdom, you wish to share?
Hitesh: Yes, it look, this is a very challenging space to enter, right? If you if you want to build a company. This is one of the hardest areas to build a company to be honest, but it’s also one of the most exciting spaces to build a company and that’s because you can have such a huge impact in in law saving lives or in helping people live healthier for longer. They’re just so many challenges that innovators and entrepreneurs can solve in the medtech space. So it is really exciting from that perspective and it gives the company a bold vision and a mission for any medtech startup. That makes the team proud to do what they do to come in every day to tell their kids you know, “I work in a company that helps to save lives” is very powerful, and it brings a lot of people together to help solve this collective challenges, but you also can’t do it in isolation. So if you’re going to look to be successful in the medtech space, you need to collaborate, you need to be resourceful, not just be focused on what resources you have internally and you have to look to build a strong ecosystem to survive or partner with an ecosystem that’s existing. So the key aspect there is knowing what problem you want to solve just because there are so many and focusing on that niche to focus on that challenge build the right ecosystem to support the company and solve that challenge and that in turn means you’ll actually make a real impact in a space that desperately needs it.
Peter: To add to that, we’re going through this period called the Great Resignation at the moment. I think a lot of people have heard of it. I just read an article Scott Galloway and there has been more people in the US that’s resigned last month than ever in the history of the country, right? So, and the question is why? Why are they resigning? And they’re in the, the the thinking is there, resigning because they, they they’ve gone through everyone’s gone through this and unique period, where they’re re-evaluating their life and things that, you know, think what they’re doing with their life and a lot of people I think, and we can all relate to this, I think, to some degree are looking for more meaning. So if you’re an entrepreneur and you’re, you know, one of your the things you need to do is find talent. You need to have great technology, need to have great people and have great culture. They the three the three key keys to a great company, but we’re in a time where where, where anyone in this sector, there are a lot of people looking for jobs with meaning and if you’re in med tech, you’re ticking that box many times over. So it is a you have a unique opportunity right now to to, to ride that wave and really build a great team because you can get access to some great people.
Katie: It really seems like really make a difference in the world and in the work that you’re doing day in and day out.
Katie: Yeah, that’s that’s really motivating and encouraging now just on a closing note here just to kind of look ahead to the future: What does the future of this continuous monitoring, and maybe even the medtech space, what does the future of it look like, you know, 10, 20 years down the road?
Peter: Yeah, I’m going to use us as an example here, but you know, so monitoring our molecular targets, you know, this is there’s the, what does that mean? You know? Okay, so you can do that. But how does it benefit Society? So we talked a bit about some of the benefits and so therapeutic, drug monitoring is a huge one. Early biomarker Discovery is another huge one where, you know, I I think we’re going to go with this technology where that’s super exciting. You know, we we talk about Precision medicine and it’s a term that we’ve talked about for years. But what does that actually mean? And it’s about personalizing treatments and drugs to an individual and not saying you’re like a millions of other people, we’re going to treat you, you all the same because that’s all we can do right now. We’re going to say, Katie your unique and and we’re going to treat you based on you, what’s optimal for you, personally. Not as a average of millions of people and we can do that with closed-loop systems and the best example is the artificial pancreas. So the artificial pancreas is is basically for those who don’t know, it’s monitoring glucose and dosing insulin automatically optimized. So right now, you know, diabetics prick, the finger, they measure their glucose levels. They do some calculations, they work out what insulin they need and they give themselves through an insulin pump or however an amount of insulin, right? It’s clunky. It’s non-sophisticated and certainly not optimal and the artificial pancreas basically automate that whole process. So it’s monitoring constantly and those seen constantly, so you get an optimal delivery of insulin in that case, but we can expand that to lots and lots of things. So, for example, Vancomycin, you know, if you go in and you need a antibiotic because you’re going to bacteria that could potentially kill you, you want to get into that therapeutic state super fast and you want to stay there. So the ability to dose to monitor and dose automatically is the fastest and best way to do that. So that’s an example of a closed loop system, but there are dozens and dozens of closed loop systems. That is the promise of precision medicine. So we get safer, treatments that a far more efficacious, when we can do that. That’s that’s optimal. That’s the optimal treatment of a patient. So that’s where but the first step is monitoring, the can’t monitor the thing. You can’t, you can’t have a closed loop. You kind of the therapeutic part, the second boot. So that’s, that’s what what I reckon where I think we’re going to go and, and that’s super exciting. I mean, you know, talking about saving lives. I mean, you can imagine, what is that when you, you know, if you can really expand your mind to think about what that really, Really means for healthcare. That’s, that’s huge. That’s such a significant thing. So that’s that’s what it I get, real super excited about in terms of, you know, 10, 20 years down the track.
Katie: Yeah, thank you for that. It seems like too that will also impact just Health Care spending and just so many less adverse drug reactions and just, you know, people who are hospitalized for those events and it just really feeds the whole cycle of the Healthcare System.
Peter: Absolutely. Yeah.
Hitesh: Yeah. Just to add what Peter is saying, you know, the other aspect that’s really exciting. Is the whole prevention aspect, right? So again just drawing on a An experience that happened recently, I had a appendix that perforated, wasn’t picked up, and then became quite severe and I ended up in hospital. And while I was being prepped for surgery, the next day, again, the severity was not picked up until I collapsed on the hospital floor in septic shock. And then I went through the treatment protocol, I was discharged and then I was readmitted because the infection was not killed off. So I to be readmitted for therapeutic drug monitoring again. Now continuous monitoring patches, could have had a completely different experience that, you know, when I collapsed in the hospital, my chances of inpatient mortality will probably somewhere between 50 to 70% – and that’s not unusual. That’s quite common in sepsis. Whereas a patch early on, could have picked up that there was a brewing infection, probably two weeks before I had to be admitted. A patch at the GP’s office could have picked up that there was a severe infection rather than having to do a urine test. And then be told, well, I think something’s wrong. You need to go to Ed a patch at the Ed visit could have picked up that my CRP counts were over a hundred, whereas the average count should be five for a person rather than going to the experience where I was told, “Well, you’re standing and you look healthy enough. So why don’t you take a seat while I deal with some of the other patients?” because the triaging point is very much a visual subjective triaging point and had to wait two hours and all the time. This infection is getting worse and worse and worse. And and you imagine this happens every day in the average household’s, right? People choose not to go to the doctor. They think “I’m well enough, I’ll be fine” and then end up collapsing at home with a heart attack or with sepsis or anything. That’s a brewing. And you just don’t have that visibility today. And then in chronic diseases, space, right? Being able to tell somebody that they’re at risk of diabetes and can actually do something about it before it progresses that far or chronic kidney disease or cardiovascular disease. This is so many things that continuous monitoring can actually impact and truly revolutionize, right? As Peter said, once you have a disease, being able to close that system to be personalized in the medication, the dosing and the treatment protocols, but even before that being able to actually prevent people from having to go into a hospital in the first place.
Katie: Yeah, that’s really impactful. And we’re all really glad to hear you’re recovered from that incident. That’s really some scary things there.
Hitesh: It was a great trial by fire experience in the problem.
Katie: Yeah. Absolutely. Well, we want to really just thank you both so much for joining us tonight and sharing your story. Do you have any closing, thoughts, or comments you wish to share here?
Peter: Oh, look a, I mean, as a company in our DNA, we collaborate broadly – we always have. And we don’t want to, we don’t want to limit the the innovation to within the four walls of our organization that that’s a bottleneck. So we work with a number of universities and researchers. And and we always, you know, when we do these, these sort of things we like to put a call out to anyone who’s listening who has an application at that might have thought you if you could measure X Y or Z. Yeah, there would be an amazing solution to an intractable problem that that I’ve always thought of, and we all hear this often when we talk to two researchers or clinicians, if you feel like that, don’t stay silent, like, reach out to us. We’re really keen to hear from you. We have an open innovation backend of our model where we actively collaborate with. With partners, and that idea may just be that seed that in a few years, time could could actually change a lot of lives. Because it all starts with an idea and it takes someone with courage to make a step forward and say do something. Whether it’s shoot off an email, jump on LinkedIn, whatever it is, but all great ideas that somewhere – there’s a city there, someone who says “I’m going to, I’m going to give it a go and see what happens”, right? And so we would encourage Is anyone listening to do that and to reach out to us, because you never know where that could go could be, it could be life-changing for you, and it could be life-changing for lots and lots of people as well.
Katie: Yeah, that’s wonderful. Thank you so much, and we’ll be sure to share your contact information at the end of this as well. Should anybody be interested in reaching out. So, thank you again for joining us and for everybody tuning in. We hope you enjoy this segment and that it was very informative and educational and we look forward to hearing from you – as many of you as possible.
Peter: Thanks, Katie.
Hitesh: Thanks, Katie.
Katie: Thank you.