Maneesh Jain - Mirvie - Part 2

Company Size & Innovation | Supply Chain Learnings from Other Industries | Scaling Go-to-Market Strategies | Culture’s Interaction with Mergers & Acquisitions

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Show Notes

Part 2 of 3. My guest for this week’s episode is Maneesh Jain, CEO and Co-Founder of Mirvie, a life science company that predicts pregnancy complications before they happen by revealing the underlying biology of pregnancy health. Mirvie is dedicated to shaping the future of pregnancy health through simple, personalized blood tests.

Before Mirvie, Maneesh was a founder, CEO, or executive of five successful start-ups, which include Parallele Bioscience, Auriphex Bioscience, Ion Torrent, Butterfly Network, and Cirina. All of the businesses successfully exited or commercialized to the likes of Affymetrix, Illumina, Life Technologies, the FDA, and GRAIL, respectively. Join us as we sit down with Maneesh to talk about having the confidence to learn new things outside your comfort zone and how it is likely to be a core skill for future generations. Maneesh also discusses leveraging learnings from the semiconductor industry's supply chain to find new paths to innovation. Lastly, we cover his thoughts on how to maintain culture when going through mergers and acquisitions, and how using the power of liquid biopsies led to his success at Cirina and later Mirvie.

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Maneesh Jain is the CEO and Co-Founder of Mirvie, a life science company that predicts pregnancy complications before they happen by revealing the underlying biology of pregnancy health. Mirvie is dedicated to shaping the future of pregnancy health through simple, personalized blood tests. Prior to Mirvie, Maneesh has been a founder, CEO, or executive in five successful start-ups which include Parallele Bioscience, Auriphex Bioscience, Ion Torrent, Butterfly Network, and Cirina, all of which successfully exited or commercialized to the likes of Affymetrix, Illumina, Life Technologies, the FDA, and GRAIL, respectively. Before his time as an entrepreneur, Maneesh was a scientist working at the Stanford Genome Technology Center.

Transcript

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Intro - 00:00:00: Welcome to The Biotech Startups Podcast by Excedr. Join us as we speak with first-time founders, experienced scientists, serial entrepreneurs, and Biotech investors about the challenges and triumphs of running a Biotech startup. Gain actionable insight into navigating the life sciences industry in each episode as we explore the business of science from pre-seed to IPO with your host, Jon Chee. 

Disclaimer - 00:00:31: The purpose of The Biotech Startups Podcast is to provide general insight into the ever-changing world of life sciences through the experience of a variety of guests. The use of information on this podcast or materials linked from this podcast are at the user's own risk. The views expressed by guests and any employee of Excedr on the podcast are their own and do not necessarily reflect the views of Excedr or content sponsors. Any appearance on the program does not imply an endorsement or recommendation of any product, service or entity referenced in the podcast by Excedr or by its guests. 

Recap - 00:01:10: In our last episode, we spoke with Maneesh Jain about his childhood and how entrepreneurship provided a focused way to make societal impact. If you missed it, be sure to go back and give Part 1 a listen. We continue our conversation in Part 2, diving into Maneesh experience bootstrapping a startup, scaling go-to-market at Ion Torrent and how Cirina leverages the power of a simple blood draw.

Jon - 00:01:38: And so after Affymetrix, when did you know it was time to leave? And what got you to want to start another company? I know you started Auriphex Biosense.  

Maneesh - 00:01:46: Yeah, so I was at Affymetrix for about three years. And I think, like I said, incredible experience, and then definitely an incredible perspective, like not only is academic, but pharma and it's global. And so really just amazing that way. But I think what comes with scale sometimes is the sacrifice of innovation. And that really started to merge Affymetrix towards the later part. And that just left me missing something. Once I had kind of learned all these other areas, which are really important for scalability and growth and essentially getting your real world MBA, then I was like at heart missing something. And it was really just taking innovation and making products to change lives. So what brought me away from there and to Auriphex was realizing, well, now we have pretty amazing technologies like with microarrays and sequencing starting to emerge, but we really haven't addressed key applications yet. So what Auriphex tried to do was look at things like circulating tumor cells and circulating fetal cells. So cells which may be circulating blood, but if you can enrich those, then you could get a lot of information about the tumor or about the baby. And those seemed like, I think that's a true line you'll probably see through my journey is the prenatal and the cancer applications have been really important in this field because people care a lot about they're really important points in people's lives, kind of the bookends of life, if you will. You have everybody's attention and innovation really matters in terms of being useful. So I think that's partly why those two have been so front and center in the development of genomics. With Auriphex, we found a way, the problem was when you capture those cells with high sensitivity, you have very poor specificity, you capture a whole bunch of other cells. And so it's not very useful. Whereas if you try to be very specific, then you miss most of the cells and they're kind of rare. So you can't really miss most of them. So it was kind of this dilemma that had plagued the field. And this technology also out of the genome center, which my co-founder had developed, that was able to do both high sensitivity and specificity. So we got that going now, it was 2008.

Jon - 00:03:37: I was going to say, I see a theme there too, where it's like you had 2000 and then oh wait, this like full cycle.

Maneesh - 00:03:44: Yes, indeed. So it was definitely adversity. And I think what we realized is that we needed to bootstrap this one and just do it as much ourselves as possible. It was going to be impossible to raise venture money for this, or at least in a way that was reasonable for founders. And so we did mostly try to bootstrap this company. And it turned out that Illumina was doing a bunch of Parma projects, and this was going to be a fit for what they were doing. And so it was a pretty early exit, maybe too early in different times. I think we might've waited longer and venture funded and grown it to a much bigger company. But I think that's kind of, it was a pretty early stage exit. But what came out of that was really, I think in my mind, this transition from, okay, these technologies are very cool, but now we can actually start to do things we all really care about, finding circulating tumor cells, circulating fatal cells, and saying more about your cancer, if you are diagnosed or about your baby. And that is really important information. So a pretty good experience from that perspective.

Jon - 00:04:38: I mean, for 08 and during the 08 recession, even having an acquisition and bootstrapping it is a feat in itself. So I think that's an incredible outcome. You mentioned that Illumina was kind of in your adjacency. How did that merger acquisition take place and what led up to that?

Maneesh - 00:04:54: I think the initial introduction was because one of my founders at ParAllele, Mostafa Ronaghi, was now at Illumina. He had started another company, Avantome, which became part of Illumina. And so that was how we had the initial introduction. But I think learning more about their services, business and the pharma customers who really wanted to isolate and identify these types of cells. So then they could use Illumina technology on those cells to do profiling, genomic profiling was a pretty good fit. It was kind of a sample platform for Illumina to use their genomic profiling tools. So that was a pretty good strategic fit.

Jon - 00:05:23: For now, just kind of like seeing the journey, going to the talk and then joining the genome center just kind of had this Cambrian explosion of this incredibly exciting paths that you can go down, what I can take away from it in my own experience too, is just like, “don't be so shy, Jon, go out there and get exposure and go experience, get out of your comfort zone”. And you know, you're in physics, but then you went into life science and not be too hung up on not having the prerequisite background. Cause I think who can make that call that someone that you work with, the genome center would end up at Illumina and then boom, it comes full circle again.

Maneesh - 00:05:58: It's increasingly important, I think for the next generation, right? So for us, it was a leap of faith to kind of switch and it was a pretty big risk. And thankfully it all worked out and you know, it's been an amazing journey, but I think be willing to take those risks. And I think as we look at younger people now, and certainly the next generation, our kids, I think they'll, they'll be switching fields quite frequently. And so the ability to have the confidence to learn something new and apply what you know before to this area and then expand that is a pretty core skill set, I believe overall. So I've done some of it, but I think increasingly there'll be more people doing a lot more of it.

Jon - 00:06:28: Absolutely. So after the Illumina acquisition, I know you made your way to Ion Torrent and I know Illumina, Ion Torrent there kind of were bowing head to head. How did you make your way over to Ion Torrent?

Maneesh - 00:06:40: Yeah. So that really came about because the head of sales at Affymetrix, Gregg Fergus, he had left, I think, around the same time as I left Affymetrix, maybe a little bit before. He'd been there from the 90s and built the company from zero to like 400 million or something like that in revenue. And so he was looking for the next exciting thing. And so we both got introduced to Jonathan Rothberg. And he had this idea, which was, of course, his claim to fame was he did the first next gen sequencer with 454. But he had this idea where in the life sciences, we've always built our own supply chains. So we build it all ourselves. Whereas when you look at people doing work in the semiconductor industry or you look at apps, people leverage either open source code or they leverage fabs like TSMC and other semiconductor fabs. So they leverage these existing supply chains and they sit on top of that. So it allows them to build applications much faster. And so his idea was, well, instead of building our own supply chain, which again, Affymetrix built their own factory from scratch, literally from scratch every bit. Illumina built all the oligo stuff and all their sequencing stuff from scratch, right? Built the whole supply chain and takes about a decade to do that really well.

Jon – 00:07:45: And a lot of capital.

Maneesh – 00:07:46: A lot of capital. And so the idea that was really compelling here is we knew sequencing was a killer application, but could we leverage a supply chain to sit on top of, in this case, a semiconductor supply chain? And so essentially do sequencing on semiconductor wafers. And the advantage would be much lower cost. And it turned out also that much faster turnaround time. And so the problem we were trying to solve then is that sequencing in that day, 2009, was these big floor standing devices, instruments, which are like million dollar devices.

Jon – 00:08:11: I remember those. Yeah.

Maneesh – 00:08:12: Three to 400 labs around the world who could afford one and could then actually run it, have the expertise to run it. But many, many tens of thousands of labs wanted to do sequencing and they didn't always want to do the whole human genome. They sometimes just wanted to do targeted sequencing and get some information on their project. And so the specs for Ion Torrent made it exciting as well. They could build a benchtop device for close to 50,000 bucks instead of a million. We could have a turnaround time, which is about a day instead of a week. And we would deliver more targeted solutions, not the whole genome, at least initially. And that felt really exciting and worth the leap. So decided to jump into Ion Torrent. When I first joined, we wanted to do the human genome as our eventual goal, but I think we could do half a base initially.

Jon – 00:08:56: So that was quite a leap of faith.

Maneesh – 00:08:58: Yes, we could do A's, B's, C's, had some noise and wasn't quite. But again, I think we knew that if we could solve the problem to do all the four bases really well, the semiconductor platform would scale very readily. So big leap of faith again, but I think it felt like a technology in the right direction. And of course, having Jonathan Rothberg having built 454, that was promising as like he knew a thing or two about sequencing technology. And so we kind of knew the application space was pretty wide open for a benchtop device that could be rapid sequencing in a more targeted application. And the technology felt like a good skill. So yeah, a little scary for the first year there, because we had a lot of big milestones to open. But then things started to really hum along. And then 2010 to 2012 was really just a period of very rapid growth for the company. And we grew to about 400 people and had a lot of success in the market. So that was very exciting to kind of take into this whole cycle of sort of technology from technology development to early market development to then I think broad adoption in the market was super fun.

Jon - 00:09:58: Just to go back to your like this leap. I know you were the first commercial hire there. And what was it like outside of product development to like scale up a team of using you mentioned like 400 people and then design like a ggo-tomarket and all that like you obviously had Affymetrix had your kind of like portable MBA. What was your experience as a first commercial hire? I guess is what I'm asking.

Maneesh - 00:10:16: Yeah, so that scaling was over five years, right? So it wasn't overnight. At first, we were super thoughtful. So we had, I think, I want to say 20 ish people, 18 to 20 and aren't even a join. And so the first thing was kind of say, okay, let's point the technology in the right direction. What's the product roadmap? You have a technology roadmap, which is great, but what is going to be the product roadmap and what are going to be the key applications? And that led to some interesting choices, right? At first we were like, “well, we can do microbial sequencing. Microbial genomes are small. And since initially we have a lower capacity chip, that's the perfect application. And that was great”. But then while we were doing market research on that and talking to early customers, a lot of them came back and said, well, “I want to do targeted sequencing of human genomes. Like, so microbial is great, but what if I could do a hundred exons, right? Or 10 megabases of sequence that I could sequence more deeply the regions I care about, because I want to look at mutation profiles”. So that took us down the road of saying, “okay, that actually is going to be the killer app. Because as we started to bring the microbial sequencing to market, we kind of realized all this demand”. And so we actually had to do multiple inventions to serve that. And this kind of gets to the whole product solution. Like when you're solving a problem, it's much better to solve one problem completely than to solve all problems. But having a sequencing platform that is low cost and rapid turnaround is partially solving all problems. But saying, “hey, for targeted human sequencing, we have a complete solution”. So we needed a front that would go to human sample and produce the libraries for sequencing and needed data analysis backend that would tell you about mutations and accurately quantify those. So the front and backend had to be kind of pieced together. So that was a lot of innovation. And then I think, again, as we looked at the market, the commercial opportunity to turn out with life technologies, because they had a great sales team in this area. And we're like, well, we could build our own or we could partner with them. And that seemed really promising. That was also classic because the CEO then Greg Lussier had, I think, a great mindset of saying, well, we don't just acquire technologies, we also acquire people. So they actually left Ion Torrent alone for about two years. We had an R&D budget, we had commercial deliverables, like revenue and budget. But they were like, you can recruit from within life tech, the people who you think are most helpful, as long as they want to come and join you guys, as we'll get this budget to do R&D. And then you have to deliver these things. And beyond that, it was fairly independent. And that was fantastic, because what it allowed us is through this early stage of the company, really keep the team cohesively together with very clear goals, but working as a kind of startup and steroids, if you will, right, a bigger sales team, but still that startup culture. And that's pretty powerful. So I think that's one little bit of advice when it's possible, not always possible, but in M&A's, if you can try to keep that team together as part of the contract, so that the team can have deliverables that make sense to the bigger company, but can really stay cohesive with expanded resources, that can really help get that cycle of the full potential of the technology. Because often what happens is companies will acquire companies for product. And then they put people into all these different units. And so the culture is broken up, and the technology doesn't progress as fast and people wonder what happened. And what actually happened is you broke the will to push the technology to its limits and achieve its full potential. And so that's kind of important to not do that.

Jon - 00:13:30: You mentioned this is something that, as you're exploring an acquisition or a merger, is that something you need to set out in the contract? Is this a tall ask of a company when you're joining a larger company? Or is this something that is fair game, something that is a discussable term of an acquisition to keep this culture intact and remain autonomous? 

Maneesh - 00:13:50: I think it depends on what the founders and investors want. If they're just looking for an exit, then you really can't make asks like that, because then you're looking for the buyer. But I think if you're looking to have the maximum impact with their technology, and the partner is a great partner because they have the commercial resources and they just have additionally resources and they really believe in this piece, then it's a very reasonable ask because it's a no-lose proposition in some ways. I think what would be not reasonable for the buyers to say, “well, give us a bunch of resources and we'll see how things do”. That's not reasonable. You say, here are the resources we need to bring this to its full potential, and here's the commitments we make on revenue or other things, and here's what we need from you guys to do this. Then I think it can be a pretty good win-win situation. And so over time, I think it'll be inevitable that bigger companies will want to fully integrate small companies. But I think having that period where it can realize its potential, that's really key. And so I think if your heart's in the right place, which is, I want to maximize the potential and make this available to as many customers as possible, then I think you can find that synergy.

Jon - 00:15:00: Absolutely. Just knowing that you can have that conversation for anyone, if you don't ask, you don't get. So I think that's something that is always worth remembering too. They can say no, they reserve the right to say no, but it's always worth asking. And obviously, when you ask, have a well thought out formulation of why you're making the ask. And it sounds like magic can happen and you can have the war chest of life technologies to kind of go forward with Ion Torrent. And so after joining Life Technologies, you mentioned that Ion Torrent was independent for two years. After that two year mark, was that when you decided to leave Life Technologies and join Butterfly Network?

Maneesh - 00:15:34: Yeah, exactly. After that, we started to integrate much more fully into Thermo, integrate into Life Tech. But also Life Tech was then going through this acquisition, which became part of Thermo. So when it finally became part of Thermo, then which is a 50,000 person company, then I was like, “Okay, I think I have contributed the most I can, brought it to as far as I can. This has gotten to be a much bigger environment, right? Which others are probably more capable at that point”. Yeah, that was time for me to leave and made that transition. This time was a little bit easier. I think the first couple of times you do that, it's really hard. It's like, what the heck am I doing and what am I going into? I know what I'm leaving, but I don't know exactly what I'm going to, which can sometimes be hard. But I think at this point, I saw much more clearly where the value was and what made sense for me. Now we had gotten much closer to clinical applications. So one of the most exciting things with Ion Torrent was we built a clinical platform for sequencing cancer hotspot genes. You would get the mutation profile for the key genes. And actually, some clear labs would use that to make therapy decisions for their patients. And we would actually get letters from patients whose course of treatment was altered based on the profile. And it changed their life or saved their life. And so I think just to get even a few of those letters is incredible. Like you just kind of feel, oh, wow, we are actually impacting. Doesn't matter how many, but even if it's one person and one letter and you have made that kind of impact somebody's life, that's really meaningful. And so I wanted to continue that sort of theme of clinical applications. And then it was impossible to turn down Jonathan's next idea. Now that the semiconductor supply chains work so well for sequencing, let's see what else we can use it for. And this time was ultrasound. And so instead of doing sequencing on a chip, we were doing ultrasound on the chip. So integrating what are called these MEMS devices on the electronics of a chip. And the idea there was, again, while there's a sort of theme of democratizing technology here, right. So while ultrasound scanners are available in hospitals, they're really a shared resource, like an emergency department. And often the scans going on, you got to wait for somebody else to get to use it. And sometimes you might have an urgent situation or you might be in the field where you need this or rural area where you may not be able to cover such an important shared resource and you just want an individual device. So the idea that you could make a simple handle device that would connect to your iPhone for the readout. Again, sort of the old days of apparently using an assay and using the Affymetrix chip for a readout here, we were like, “Okay, we'll develop the device, but then we'll just use the iPhone for a readout because they have all this great capability and screen and apps”. And why would you not just leverage that whole supply chain? So that was the idea with Butterfly. It was in Connecticut. And so it definitely made it a little harder to hire people, especially when you move from the research to the more development stage. But we, I think, had a pretty compelling mission and were able to get some good people.

Jon - 00:18:18: That's awesome. Did you end up moving to Connecticut or were you living the bi-coastal life?

Maneesh - 00:18:23: Yes, bi-coastal. One of the takeaways from that was really successful. But I think by the time we were getting our FDA approval and things were going pretty well for the company, it raised a good financing and a great roadmap. It was definitely starting to have an impact on my family. And I just remember this one time where we had just gotten back from a trip from India and my daughter had been having this kind of stomach ache. And most people thought of some GI stuff, you know, usually get a bug when you're traveling internationally, third-world countries, whatnot. But it turned out it was appendicitis. Her appendix had actually ruptured. And I was out on this trip to the East Coast and then my wife took her to the hospital and they were like, this is pretty bad. We just caught it barely in time. They are totally skeptic. And so I think that was at that point, I was like, you know, I think I need to be closer to my family. It's my personal life. It all is not adding up. And so I had to make the big decision to transition there. But that was a really exciting journey. And I think there's 40,000, 50,000 devices out there now being used from the U.S. And rural areas to Kenya and so many countries. So it's really exciting to see it being used so broadly.

Jon - 00:19:254: That’s amazing. And I know you guys got it cleared for 13 plus clinical applications with FDA. What was your experience going through? That sounds like a lot of regulatory work that had to be done. What was your experience working with FDA?

Maneesh - 00:19:37: It was a 510K. And so the good thing is that the imaging is there have been so many predicates. Imaging was not novel. We were just doing it in a form factor that was very convenient and much more cost effective. And so while it's never easy to go through a regulatory process, it was reasonably well-charted course. So it was a matter of time in doing and producing the data, but not a huge amount of risk in terms of getting the approval.

Jon - 00:20:00: That makes a lot of sense. I can see like a theme of the semiconductor fabs and then the microarrays. Not to say that like starting from scratch, you know, there's definitely value to that, but also there's also value to having something that's kind of established and then being able to take it to the next level and scaling it to the next level, which again, de-risks it and sounds like the travel East Coast to West Coast was becoming more problematic on you. Then after that, when did you decide to join Cirina? And for those who are unfamiliar with Cirina, could you also let folks know what Cirina's mission and focus was and what you guys thought out to do?

Maneesh - 00:20:31: So I think what Cirina and now Mirvie, which we'll talk about are leveraging liquid biopsies fundamentally. And I think this is just so transformative for the field because as we've gotten to such high resolution and sequencing and counting DNA or RNA, what we've realized is that instead of being invasive and having to get that information from a tissue, which is always what you had to do in the past. Now you can get that just from a blood sample because the blood is circulating through all the cells in your body and sampling all your tissues. And so if you are sensitive enough, then you can pick up information on what's happening in different parts of your body, simply from a blood sample. And that's very powerful as a paradigm shift because now the clinical workflow is really simple, just a blood draw, right? And the information you're getting can be life and death, or it can actually change the course of a baby's development or your cancer's development. And so really powerful information that's available from a simple blood draw. And I think that concept is here to stay. And it is a lot of work to try to get to the levels of sensitivity and specificity you need from just a blood sample. Cause after all, it's sampling your whole body versus a biopsy is picking up something very localized, but that I think was the key concept there. So I think just continuing the theme of clinical applications in genomics. Cirina was very exciting because I think the idea for early cancer detection actually had come up pretty early. So when we were doing Ion Torrent, there were a lot of labs doing non-invasive prenatal tests. So testing for the baby's Down syndrome, essentially if the baby had Down syndrome by looking at the chromosomal abnormalities in a blood sample. And what they found in those early studies that one in a thousand of the pregnancies, they actually found aneuploidies, not just in chromosome 21 for Down syndrome, but they saw a lot of the genome was pretty screwed up. There was massive duplications or copy number changes, other things in the genome. And so at first they're like, “this is some kind of error”, like “what is going on”. And as they looked at the data a bit more, they realized we are actually detecting cancer because one in thousand, roughly of people, younger people, even will have risk for cancer. And so that led to the idea that, “oh, wow, if you can take a blood sample and detect the earliest signs of cancer, it can be just too early cancer detection”. Because I think a lot of work, Rogelstein and others have shown that depends for different cancers, but they're usually developed over the course of a decade or more, maybe 15, 20 years, it's not overnight. And so when you end up getting symptoms, of course, this progresses to stage three or four. And that's typically when you end up having symptom-based diagnosis. But the development has taken many, many years. So in principle, if you can intercept it in the earlier stages, you can do surgical procedures or something much simpler to ideally be curative. And it hasn't spread, so it's very localized and you can kind of cut it out, so to speak. So that potential was very exciting. And so Cirina really started because one of our investors at Ion Torrent, Min from Decheng Capital, he had been really fantastic to work with. And also Denise Lowe, I've known about him from all the works with non-discipline little tests. And we kind of pulled this thing together to get the company going. I think they had kind of created the idea and then actually needed to start the company and have people and actually progress the technology. So I was founding CEO and we got the company going with the idea that we could build the first test for early cancer detection.

Jon - 00:23:48: Very cool. And speaking of travel, I know you guys had also operations in Hong Kong. Did you also have to travel and do that as well? And what was it like building a team on kind of opposite sides of the world?

Maneesh - 00:23:58: Yeah, it's kind of ironic, isn't it? After I basically said the bi-coastal lifestyle doesn't make sense

Jon - 00:24:03: Doesn't make the coastal even, northern coasts.

Maneesh - 00:24:06: Yeah, that would make it a bit more international even. No, I think part of it was that opportunity was really compelling. I think the ability to do blood-based cancer detection, early cancer detection is just really paradigm shifting, right? So it was very compelling. And then actually we built the team first in the Bay Area. So the Hong Kong team was because we knew that the first trials we had done were in Asia and the first cancer we were targeting was more prevalent in Asia. And so the CLIA lab we were going to build in Hong Kong. And so a lot of the R&D work was based in the Bay Area. So the early days of the company was really Bay Area based. And then as we got ready to go to market and build a CLIA lab, then we also built a team in Hong Kong. I was probably there once a month. And so I still travel, but not quite the frequent bi-coastal. But that was very exciting. I think you just see a lot of emphasis on cancer in the US. But of course we know that it's a global challenge for everybody. And there are different cancers that are prevalent in different areas. So I think that was one perspective. Building a startup was quite different in the two places. In the Bay Area, you had many people, I think, who had been part of startups and seen how their equity value grew over time with startups and they would value that piece. And so, you know, a lot of people would say, “hey, we know we need to be capital efficient in a startup. I'll take a pay cut, but I'd like a little more equity as much as possible”. And so that was the typical conversation in the Bay Area. In Hong Kong, it was they had been less experienced with successful startups. And so the typical conversation was, “well, how much pay raise can I get to make this transition, which automatically meant much less equity”. But that's, I think, just a sign of what people are used to and what successes you've seen. And so I think building the teams was pretty different in the two places. In terms of mission, we were completely united and people were highly motivated in both Hong Kong and the US. And we did have people go back and forth to kind of keep the synergies. But it helped that we had a focus on R&D at the Bay Area team and the focus on the CLIA lab with the Hong Kong team. So the skill sets and kind of the responsibilities were deliverable, but slightly different for both the teams.

Jon - 00:25:55: Absolutely. And as you look back on your experience at Cirina, what would you say over like some biggest challenges and triumphs that you experienced during your time there?

Maneesh - 00:26:02: We were very ambitious. So I think that's both exciting and challenging. So we had a lot of data on one particular type of cancer, but obviously we wanted early detection of multiple cancer types. Some of the challenges were really just kind of thinking how you do these clinical studies globally. There had been a lot of work in Hong Kong on the studies and how do you expand that to the US. And how do you think about two indications and how much of that you can take on as a small company versus a bigger company? And ultimately, I think that's really what led to the GRAIL acquisition decision was to realize that to do these trials in the US. As we wanted to expand would be there would be large trials and they just needed a lot of capital and GRAIL was well capitalized and we had proven technology to do early cancer detection. So that seemed like a great fit. But yeah, I think it was the excitement and the challenge of doing this. But it really, I think, brings you back to how do you advance the standard of clinical care? You need large definitive clinical trials that are very rigorous. And that's pretty expensive. And so I think that's where it's interesting increasingly to think about how innovation will impact clinical standards of care and how we can do trials more efficiently over time. I think that's end up being one of the bottlenecks for a startup to think about doing studies that are properly sized and scaled.

Jon - 00:27:15: Absolutely. It's kind of like the elephant in the room. This is that, you know, as you embark on that journey, it's like the goal is to get to the clinic. But then when you're there, you're like, “oh, my goodness, this is such a large endeavor in all facets”. It's like, “how do we go about doing this?” And so I'm super excited to see work being done on how to make that more efficient, reduce the activation energy needed to get it through the clinic and seeing everyone kind of find ways to improve on that process. Because I absolutely do think it's a bottleneck that hopefully we can alleviate over time. 

Outro - 00:27:45: That's all for this episode of The Biotech Startups Podcast. We hope you enjoyed our conversation with Maneesh Jain. To learn more about his journey, tune in to Part 3 of our conversation, where we cover the driving force behind founding Mirvie, Maneesh's thoughts on the maternal health crisis, and his approach to building a holistic company culture. If you enjoyed this episode, please subscribe, leave us a review and share it with your friends. Thanks for listening, and we look forward to having you join us again on the Biotech Startups Podcast for Part 3 of Maneesh's story. The Biotech Startups podcast is brought to you by Excedr. Don't want to miss an episode? Make sure to search for Biotech Startups podcast in Apple podcasts, Spotify and Google podcasts, or wherever you get your podcasts and click subscribe. To learn more about our leasing program, visit our website www.excedr.com We provide research labs with equipment leases on founder-friendly terms to support path to exceptional outcomes. On behalf of the team here at Excedr, thanks for listening.