1/ Engineered biology (like cell + gene therapy) is a powerful tool for TREATING disease. What if biology could be engineered to FIND disease too?

In 2018 I met @Cyriac1 Roeding & Sam Ghambir, a pioneer in early cancer detection. Their company, Earli, proposed to do just that.
2/ Earli’s mission is to detect cancer early so it can be treated.

As a leading cancer physician, and father to a child that succumbed to the disease, it was a deeply personal mission for Sam.

@GoEarli is a testament to his life’s work.

3/ Developed in Sam’s lab at Stanford, Earli’s technology can program bits of biology to force cancer cells to reveal themselves—a “synthetic biopsy” to precisely locate cancer cells inside the body so they can be treated, early.
4/ Earli programs “IF-THEN” functionality into a genetic template that is amplified within cells:

IF: this a cancer cell...
(tuned for specific or pan-cancer)

THEN: ...make this molecule
(reporter for detection or imaging marker for localization—potentially even a therapeutic)
5/ Bio platforms amplify two superpowers:

to *interrogate* biology in unprecedented ways,

to *intervene* in disease using engineered biological systems.

Earli has the potential to do both: program biology to search for—and eventually destroy—cancer.

6/ @a16z led Earli’s seed round in 2018. Earli has raised a Series A led by @KhoslaVentures, adding new investors Perceptive Advisors, Casdin Capital, Sands Capital & others.

The company is preparing to enter human clinical trials later this year.

7/ Sam passed away in 2020. “He spent nearly 40 years masterminding ways to see & study the infinitesimal biochemical & cellular events in living people—something that had never been done before.” He sparked a revolution in cancer & left a towering legacy:
8/ For more on Earli’s team, technology, R&D progress and fundraising:


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More from @JorgeCondeBio

13 Jan
1/ Biotech is a tough business.

There are 10,000+ human diseases out there. How do startups w/ promising platforms choose where to focus?

Choose wisely. @andy23tran @a16z & I offer a framework for finding your Platform-Disease Fit (PDF)

2/ Finding PDF early in life is essential to success.

Your first disease tends to become your adjective: “Acme Co, a cancer company…”.

So what funnel criteria do you use? Image
3/ First step: find your superpower. What’s your platform edge?

It’s not enough to solve a problem; what problem can you uniquely solve?

Can you tackle an unknown or unreachable area of disease biology?

Can you dramatically improve on or leapfrog competitors?
Read 15 tweets
11 Jan
1/ Platforms are the geese that lay the golden eggs of biotech: blockbuster drugs. Yet most platforms produce few, if any, eggs. 🥚

But fertile geese are coming. 🦆

@heyjudka @a16z and I explore how productive platforms will transform biotech. 🧵 👇

2/ Biotech has historically had a multi-armed bandit problem.

Spend each incremental dollar feeding the goose? Or invest it in incubating a golden egg?

Companies tend to starve their platform in order to nurture a potential product. Image
3/ But a new wave of productive platforms changes that calculus.

The shift from bespoke craftsmanship to industrialized drug development will transform what we can make, how (and how fast) we make it, and how the industry is structured.
Read 12 tweets
11 Jan
1/ “The price of a drug should never be the rate-limiting factor to patient access.” — Alexis Borisy, EQRx CEO. @EQRxINC raises $500 million Series B in service of their mission to bring important new medicines to society at radically lower prices.

2/ The Series B investor syndicate includes life science specialists, mutual funds and other generalist funds—as well as payers + health systems that cover more than 20% of insured lives in the US.
3/ Launched just one year ago, EQRx has built a deep pipeline; it has disclosed late-stage cancer programs targeting PD-1, PD-L1, EGFr, CDK4/6. In partnership with health systems + payers, EQRx estimates it could save the US healthcare system 50-70% of drug spend in key diseases.
Read 4 tweets
18 Dec 20
1/ Another big day for COVID-19 vaccines! FDA panel votes to recommend emergency use authorization for Moderna’s mRNA vaccine.

@Moderna_tx CEO @Sbancel shares HOW they made a vaccine *in less than a year* w/ me + @omnivorousread on @a16z Bio Eats World

2/ Within 48 hrs(!) of having a digital copy of the virus genome, Moderna designed a vaccine - the exact version now being shipped - without having access to the physical virus.

This is *the machine that made the vaccine*

We used to grow our vaccines; now we can print them.
3/ The tech works by delivering mRNA instructions for cells to make a protein. In this case, the vaccine is delivering instructions for making the SARS-CoV-2 spike protein (so our immune system learns to attack it).

@sbancel describes it as sorta like making chocolate mousse :)
Read 10 tweets
31 May 19
1/ Recently $NVS announced a $2.1m gene therapy, the most expensive medicine in history. Gene therapies are potentially curative. How should we price them? How will we pay for them? Could a cure be considered a pre-existing condition? 🧬 💊
2/ Rare disease therapies are expensive because: i) they treat devastating diseases, ii) patient pops are small, so biopharma recoups R&D investment w/ high price, iii) payors tolerate because limited risk of many patients in a given plan + limited # of new therapies to cover.
3/ Individually, rare diseases (by definition) affect few people; collectively, 30m Americans (1 in 10) suffer from one of 7000 rare diseases. There are now lots of gene therapies on the horizon for lots of rare diseases; many >$1m therapies in our future. How will we pay?
Read 7 tweets
5 Jan 19
1/ A thought for early-stage bio companies on the eve of the upcoming #JPM19 networking bonanza in SF: Bio entrepreneurs, especially first-time founders, often underestimate the importance of analyzing and selecting potential disease areas
(thread 👇)
2/ Your resources are (probably) finite. Your platform may have broad potential but if your goal is to develop therapeutics (Tx) or diagnostics (Dx), you need a rigorous process/framework for selecting disease indications. It should be an early core competency for your company
3/ This is particularly important given how long, risky and expensive it can be to develop a new Tx or Dx. We’ve written previously on 16 pitfalls to avoid when building a computational Tx startup, many of which touch on this issue (especially #5) a16z.com/2018/04/30/bui…
Read 14 tweets

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