Medsider: Learn from Medtech and Healthtech Founders and CEOs - Why Learning Fast Beats Failing Fast: Interview with Portal Instruments CEO Patrick Anquetil

Episode Date: January 31, 2024

In this episode of Medsider Radio, we had an insightful discussion with Patrick Anquetil, CEO of Portal Instruments, a company developing a novel needle-free drug delivery system. This cutting-edge technology promises to revolutionize how medications are administered, making the process less invasive, more precise, and more comfortable for patients. Patrick brings over 20 years of experience leading bioengineering companies from concept to commercial success. Before Portal, he co-founded two medtech startups, SynapDx and Aretais. Patrick holds a doctorate in Mechanical Engineering from MIT, and advanced degrees from Harvard Business School, ETH Zurich, and the University of Tokyo. His scientific achievements have been featured in top journals and media outlets such as MIT Technology Review, Wired Magazine, PBS, and CNBC.In this interview, Patrick talks about how he landed on Portal’s business model, how their team condenses timelines across key company functions, and why their diverse set of partners is a golden asset to the company. Before we dive into the discussion, I wanted to mention a few things:First, if you’re into learning from medical device and health technology founders and CEOs, and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.Second, if you want to peek behind the curtain of the world's most successful startups, you should consider a Medsider premium membership. You’ll learn the strategies and tactics that founders and CEOs use to build and grow companies like Silk Road Medical, AliveCor, Shockwave Medical, and hundreds more!We recently introduced some fantastic additions exclusively for Medsider premium members, including playbooks, which are curated collections of our top Medsider interviews on key topics like capital fundraising and risk mitigation, and a curated investor database to help you discover your next medical device or health technology investor!In addition to the entire back catalog of Medsider interviews over the past decade, premium members also get a copy of every volume of Medsider Mentors at no additional cost, including the latest Medsider Mentors Volume IV. If you’re interested, go to medsider.com/subscribe to learn more.Lastly, if you'd rather read than listen, here's a link to the full interview with Patrick Anquetil.

If you know they are the answers to your problems at the end of the book, why would you read the whole book? Just go to the last page and just read it. We don't have time for that. This is not academia. We don't need like this academic perfection. We just need answers to our problems. That's all really.

Welcome to MedSider, where you can learn from the brightest founders and CEOs in medical devices and health technology. Join tens of thousands of ambitious doers as we unpack the insights, tactics and secrets behind the most successful life science startups in the world. Now, here's your host, Scott Nelson. Hey, everyone, it's Scott. In this episode of MedSider, I sat down with Patrick and Kutel, CEO of Portal Instruments, who brings over 20 years of experience in leading bioengineering companies from concept to commercialization. Prior to Portal, Patrick co-founded two other MedTech startups. He holds a doctorate in bio-instrumentation from MIT in advanced degrees from

Harvard Business School, ETH, in Zurich, and the University of Tokyo. His scientific achievements have been featured in top journals and media outlets such as MIT Technology Review, Wired Magazine, PBS, and CNBC. Here for the key things that we discussed in this conversation. First, your business model might take time to develop. Until you find the best route, follow the incentives. Seek partnerships with those who have both the resources and a tangible need. Stay adaptable, ready to pivot when necessary, and network extensively. Second, focus on condensing timelines and being practical in every aspect of your startup.

Adapt rapid learning and iterative development. Invest in resources that allow your team to quickly turn ideas into prototypes, fostering a culture of nimbleness and risk-taking. Third, in MedTech, the right collaborations are golden. They bring more than money. They offer insights, resources, and access to new markets. Mix it up with your partners. Think big corporations, venture capitalists, and other relevant players. Every collaborator has their own agenda, so stay flexible and find the sweet spot where your goals align with theirs.

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Visit MedsiderRadio.com for slash premium to learn more. All right, without further ado, let's jump back into the interview. All right, Patrick, welcome to Medsider Radio. Appreciate coming on. Thank you. Thanks for having us here. Yeah, I'm really looking forward to the conversation and not only learning a little bit more about your journey, but also what you're building at portal instruments and kind of where you and your team are headed over the next handful of years. But with that said, I recorded a brief

bio on your background at the outset of this interview, but it was very brief. So let's start there. If you can kind of give us an elevator pitch of your experiences leading up to portal instruments, that'd be great. Sure. Thank you, Scott. As you can tell from my accent, actually, I'm not from the States and from France originally. But really, when I came to the US, actually early on, already as a teenager, actually, I always thought this would be the place for me. I think I was an American all my life.

I just didn't know until I came here. And certainly we actually subsequently became American. And so, yes, in my background, I studied mechanical engineering. In Switzerland, Switzerland has amazing engineering schools that are really on par with MIT, Oxford, Stanford, and so on. And from there, I couldn't stop actually studying mechanical engineering. And I thought, well, the next step would be to do a PhD. I got accepted to do that at MIT, where I studied robotics, material science,

instrumentation, in chemistry, actually. Really loved the idea that it's kind of impugn on us at MIT, which is that anyone can start a company and always wanted to do that. The past for me, though, was not sort of direct. I initially worked in finance. The area had studied at MIT became very interesting to investors in around 2004 related to nanotechnology.

So I did this for a couple of years. We really loved business and went to business school. I did the two-year MBA and started companies basically after that. So I did two other medical device companies, two diagnostics company, one in the space of glucose monitoring and then another one in the space of RNA expression analysis.

Really great experiences. and then my PhD advisor actually called me back and say, hey, you know how to do this business thing. You should actually come and let's work together. I've got this tech out of my lab. It's ready to go. It wasn't really, but this is how we started the company. And so the idea was,

could we inject patients, in particular patients on chronic medicines, is it a better way to inject them than anil and syringe? And so this is how the idea of portal basically came to be. It's an idea that had actually, pharma backing at MIT. And as a lot of IP getting, the had gotten developed,

and we were able to license that from MIT and then start a company around that. Got it. That's the genesis. Yeah, that's super helpful. And the company that you were working on with respect to kind of glucose sensor monitoring,

that was, is it, how do you pronounce it? Is it art? Artis. Artis, yeah. It was an amazing technology that actually came out of Texas A&M where you,

you use so-called anti-stalked Raman spectroscopy of C-A-R-I-S-Cars. And KAS is a much more sensitive method to do Raman spectroscopy. And I forgot actually what the ratios are, but I think for every thousand photons that you sent in into a sample, you only get one that's Raman shifted. And as such, it really requires a powerful source. With the Korean-Antistrope Raman spectroscopy, you used a laser pulse, a Korean laser pulse.

actually it's two parts together to create almost like a key that would only kind of shake the molecules of interest and not shake the others and you could imagine

that for each analyte there could be a specific key that you could actually develop. It was an amazing technology it was actually very hard on the other hand

to miniaturize it the whole setup was like two optical tables which didn't really phase us because the green lasers those used to be also the size of an optical table before they now became, you know, like the size of the pen. So that was kind of what we did there. It was when backing from FISA, actually, at the time to do that, which was really great.

Got it. And we'll jump into kind of what the cool technology you're working on at Porto here in a bit. But it caught my attention just because that space is so hot, right, right now. And you were working on it, gosh, almost 20 years ago now. It was like 10 years. Yeah, yeah. 20 years ago. Yeah, yeah, 15, 20 years ago.

yeah, so whatever it ended up happening with the technology, was it, was it, you end up selling it? What happened to the company? Yeah, it's kind of sort of quietly, sort of folded in that. We were the diagnostic companion to a therapy that eventually Pfizer actually discontinued, which was the inhalable insulin. And this was that maybe it's in the annals of medical device and drug delivery. It's probably one of the most infamous examples. But we were the. sort of the companion diagnostics. And so very quickly, actually, as they made a decision not to pursue that,

we sort of, you know, quietly sort of also folded it down. But interestingly, the miniaturization part was not impossible. And so I went to business school. Actually, all of this happened when I was in business school, actually, as well as another colleague basically running the company. And in the end, you know, with the financial crisis coming in, in 08, then, you know, it was a bit more difficult to raise money actually at the time. But whenever we're faced really by the miniaturization,

it seemed that it was enough hard work and ingenuity. It would be possible to do that. Yeah, yeah. No, I always like to kind of touch on some of these stories because you have such an impressive background in terms of your education, but also you've worked on just like a lot of really cool technology. Yeah, yeah, that's just sort of the nature of startups, right? Like some work out, some are too early.

some get caught up in a financial crisis. You know, it's just the ebb and flow of kind of pushing a boulder up a hill. But with that said, let's circle back around to portal instruments. So you mentioned this needle-free kind of drug delivery technology and kind of the origin story, but give us a little bit better sense of kind of like what it is. You know, I'm unfamiliar with the space, never really spent a lot of time in it. But yeah, if you can get a summary of it, that would be great. That sounds great.

So needle-free injection and in particular jet injection have been tried for many years. In fact, it has actually interesting history. It was coincidentally started or invented by a French scientist in the mid-1800s. And a principle is very simple, which is that you pressurize a vessel that contains the drug. And then at the end of the vessel, you have a very small orifice. And here, imagine the orifice is much smaller than a needle. And so as you pressurize it, the drug is just going to shoot out of that orifice. And at the same time, it's all the also known that with a water jet cutter, you can cut metal this thick. I mean, this is just not a big deal.

And so in the early days of industrialization, when people had high-pressurized line, like hydraulic lines, they also realized that if there would be a leak and you try to patch it with your thumb, you'd end up basically with oil, you know, embedded in your finger. And so fast forward to after the war, people thought, well, you know, with vaccination coming online and the need to inoculate a very large population, the idea to use jet injection actually really became very important. And in fact, many, many people were actually vaccinated in that particular way in the early days, and including the U.S. military actually use those types of devices.

There was a minor detail that kind of was overlooked, which is that as you do so across patients, there is a little bit of splashback that happens. It's not as dramatic as inserting an needle into someone and inserting it into someone else afterwards. But nonetheless, you can be unlucky in that some of the contaminant may actually get transmitted from patient to patient. And so that was issue number one. Issue number two, as you try to increase the volumes of injectate,

it became more difficult because you really needed to control the jet to do that. And finally, the third thing is that, controlling actually the shape of the jet, making sure that it was always culminated, is also something that people didn't really understand actually that well. And so fast forward to the origin story, I guess, of portal at MIT, our scientific founder Ian Hunter, was a professor there at MIT in mechanical engineering. His realization was that you could actually use a powerful linear actuator to do the pressurization. You didn't need to use actually what people were using at the time,

which is some form of explosive energy release form, like a big spring, a compressed gas, or in fact, the crazy way to do it is literally to use an explosion. So think about airbag technology, for example. So he realized that with a linear, electrically powered actway you could actually achieve the same energy release. And the moment you introduce electricity, you can actually computer control it.

And as such, it would not only allow you to actually do a smooth injection. you could also control the injection during the injection process. And so fast forward to today, we have an injection that's a large volume. So this is mostly for chronic disease, and I can talk about the business side of things. It's a volume that is comparable to doing three vaccines back to back. So it's quite a lot. That injection, if you do it by hand using a syringe with a fluid that's not viscous, it would still take you a few seconds to do that.

If it's viscous, it could take you minutes, actually, to literally crank it in. And as you do so, the needle wiggles in, it's very uncomfortable for the patient. In our case, that injection takes place in about a third of a second. So it's just very, very, very rapid, actually. And during that injection, we do measurements to make sure that the output corresponds to what the device is actually programmed to do.

So we have a volume over time curve that leads, to a specific injection depth. And the job of the control is to make sure that it matches that. And it uses a combination of real-time control plus modeling of the device, plus the fluid, plus the cartridge, including the compliance of the cartridge, actually, to make sure it always does the same thing.

So that's the major innovation that was provided here. And then the next thing is, how do you miniaturize it to make it something else about this shape? And how do you create a business model that also makes sense? because this is just so expensive compared to a nil and syringe, right? You're talking like many orders of magnitude in terms of cost. And so I would spend a lot of time to really making sure we can actually crank in that power and in a form factor that's actually usable.

Yeah, that's super helpful overview. And for those listening, you know, we're recording this on video. But Patrick just held up, you know, the device itself. And so you can learn a little bit more about kind of the form factor, the technology in general at the on their website portal instruments.com just as it sounds portal p-o-r-r-t-l-traments.com we'll link to it in the full write-up on medsider as well as patrick's linked in profile but really really cool technology and i want to i want to carve out carv out enough time to kind of sort of step inside the time machine and learn a little bit more about how you got

here over the past you know decade or so but give us a give us a high-level sense Patrick of kind of where the company's at today in terms of development, Reg Klin, eventualization. So the business model is to actually do partnerships with pharma. So at the end of the day, you know, the common adage is that you should always follow the money. So who's got the money? Well, it's not the patient, right?

Because they typically, even if they have it, they just don't want to pay for anything related to health. This is what insurance should help. On the other hand, pharma companies actually has, money. In addition to that, they actually also have drugs that need to be injected. So all the, I would guess, all the modern drugs, all the so-called biologics, those have to be injected. People, of course, are trying to make pills out of biologics. And even when they do, which is actually very, very hard, the drug efficacy or the loading, the amount of

loading you need to do to get the therapeutic dose, it's just so high that you're not getting the therapeutic effects that you actually really want. So in the end, injections are not going anywhere, at least for quite some time. And as such, it causes a problem for my companies in that they have to basically get the patients to do the injection themselves.

And those drugs historically were administered as IV, but of course no one wants to do that. And so the whole market shifted from IV to secure subcutaneous injections in the past 10 years. And so the realization that we did was that, well, first of all, farmers the money, so we can actually structure a deal with royalties, with upfront payments, milestone payments, $100 and so on, things that they're doing anyways for formulations actually today. And in addition to that, the summary realization was that, well, if what we inject is of high value,

then there's an opportunity for us to actually capture some of that value back. So in other words, the contrary, if what we inject, is a commodity, then well, and it's just difficult to actually capture any value because the whole therapy, which is the only thing that matters, already is quite cheap and as such as very little margin to sort of go around.

So I think there was a big, big shift. And I'm sure yourself or your listeners have been faced with a challenge, which is that you've got a platform technology, you could do anything. How do you select actually the right application? And it's not that we actually woke up one day and realize that it took us a long time,

because of course, you know, the attraction is to say, well, we're going to do everything, you know, but of course that's not practical as well. And so here may be my lesson is that, you know, follow the money, who's able to pay you and make sure you're part of an ecosystem of value where you contribute to that value as well. And if that value is a lot, then you can actually capture some of it back. And so, sorry, it's a very long-witted answer to your question. Where are we today? Okay. So there's a positive, there's a negative. The positive is that Farmer is great. They pay a lot. We love it. On the other hand, farmer is very, very slow. And if you're someone who's running a franchise where that franchise, that particular drug

brand, is bringing billions per year, you're going to be very, very risk adverse. And kind of understanding that, you know, it really took us actually some time. And so we have several programs in development with pharmaceutical companies, we've got four programs in development. but to this day, we still haven't launched actually a product because again, we're sort of the, we're kind of part of the drugs, so to say, right? We're part of the drug process actually as well. On the other hand, where's the device at?

So here's a device here. It's a clinical grade. We're manufacturing it on a GMP condition. It has a disposable single-use cartridge has also made actually on the GMP conditions. It's actually made by Gersheimer, one of our partners. And so we're able to enable clinical stuff. studies for our former partners.

We've also been in a clinic ourselves, where we've injected human subjects with saline to make sure that, you know, when inject themselves, not only can they actually do it themselves, but also how does it feel? And what we've been able to show, and we've published actually many studies on that, is that the injection sensation is much smaller

than what you get with a typical knee-lan syndrome when the patient is actually doing it themselves. So that's kind of where we are. So still, working, you know, slugging our way, I guess, through commercialization. But invariably, I think if you'd ask anyone on the team, it's a, it's a great mission. It's really an opportunity for us to transform kind of this high-end part of the market and then later on to transform every other injection, including, you know, common vaccination, like the full vaccination, and so on.

Got it. Yeah, that's a super helpful overview. And I want to touch on real quick your answer around kind of this topic of business model, right? because, you know, and a lot of people that are listening, a lot of founders and CEOs and just other startups in general that listen to the program, oftentimes there's a very straightforward path, right, to commercialization. But, you know, I would say maybe equally as much, it's a little bit unknown, right? And the path to the path to market is a little bit more ambiguous. And so when you think about the past 10 years, it sounds like that's very much kind of evolved, right? Like where you're at now with this kind of partnering with pharma companies it wasn't that wasn't overly clear up it was not obvious yeah and in fact my experience i'm sure it's probably the same for you i mean it takes

us typically two years to figure out what the business model is uh so so that was the case was i mean synapti x the the prior company in between the two uh that one it took us two years to realize that we were looking at it in the wrong direction we had to look at the other way and here this was a diagnostic company and we were focused on sensitivity specificity as you always are, what we didn't realize really the value of the, this was done actually for autism diagnostics. And so the value of the diagnostics was to realize that by the age of five, you had, I forgot actually what the numbers were, let's say, there were 80% of force negative actually. And that's the thing that we were changing. And it's amazing. It's like,

well, you could have focused on the false positive or just on the positive themselves and so on. But actually, no, it's really kind of forming the essence of the value prop. And that, in my experience, takes a lot of time. Until you're in the market or talking to customers, talking to partners, you just have no idea. It's almost made up in your own mind.

And I think, again, the advice easier said than done because I don't think it's particularly for us engineer, it's always hard to talk to people. yeah, just go talk to as many people as you can. The sooner you can do this, which of course presuppose that you actually have something to show too. This is why this is very iterative actually at the end of the day. But as soon as you can do those conversations, the better.

And as soon as you can actually figure out really what the true value prop is. It's not obvious, actually, in my experience, never is. Yeah, yeah. And you mentioned a couple things to kind of keep in mind. I think that are very helpful, right? Follow the money. Figure out where you can truly add value into the equation. right? Because if there's a lot of friction in terms of your product, your device, your solution,

adding value, that ultimately is not going to probably lead to a lot of a strong business model. And but I guess maybe the, you know, hearing you kind of explain kind of how you got here, you know, I'm just, I'm a big, I'm personally a big believer in just momentum is so crucial in startups, right, in early stage companies. And talking to customers, end users, various stakeholders, that's so crucial to kind of keeping this momentum and ultimately kind of figuring out kind of where your product, your solution fits. And, you know, it's just, that's, that, I think it's a key point to keep in mind, you know, in order to eventually kind of get to the end in goal.

You just, you know, you get, that momentum is crucial. And a lot of times momentum is a part of that equation is talking to a lot of people, right? And I think internally as well, I mean, the momentum is what keeps the teams going. And this is what we tell the team all the time. I mean, everything is stacked against us, right? So unproven technology, unproven market. oftentimes unproven team as well. And on top of that, you've got competitors that are entrenched in the markets

and are much more well funded, actually, than you are. So the only thing you really have is time, right? If you can use time effectively, and in particular use it to create experiments from which you can earn actually very, very fast. And so here, I mean, the MIT ethos, but I'm sure it's actually been replicated in many, many other ways. is this idea that in order really to know if your design is working, you need to build it and then you need to test it.

And then from the testing, you can actually go back into the next building phase and so on. And so we've actually structured the whole company in that particular way, because what you want to do is to make sure that those iterative cycles that they are condensed as much as possible. And by the way, this applies not only to engineering, but also to any other area.

It can be marketing, it can be business, business model and so on. But for the engineering side, we've made the decision and have invested heavily in that very, very early on, to equip the engineers with state-of-the-art tools. Such that, not only they can actually express their amazing creativity,

but also that they can build, actually, literally the same day or the next day, they can build prototypes, learn from them through testing and then go back in. And so we've basically invested in a full machine shop, with machining capabilities, 3D printing, laser cutting,

and so on, because even the act of sending your parts to someone else, even though like a protolide, like a super fast, you know, shop,

it might still take you a week, right? So imagine you're an engineer designing that part. If you know, it's going to take you a week to get your part about, well,

you're going to be a bit more conservative, a bit more less risk-taking than if you know, you can actually make it the afternoon and then test it at night. And so that to us

is very, very, important and we certainly have over-invested actually in that. And so, yeah, so time is of the essence always. And it's the only thing you've got. Everything is not good. Yeah, no, that's a really good point. In fact, one of our key development partners at Fastwave has a lot of those sort of key abilities internally, right?

And part of how that development partner got there was this, the same issue, right, that you're talking about. Oh, like I've got these laser cut components that I need to have made. I've got to send them out to a shop. The turnaround time is whatever, two, three, four weeks. I'm solely dependent upon that, and I need to move faster. And so they built out sort of this dysfunction internally. But Patrick, your comment around like this idea of iterating quickly, right, condensing

that timeline. It's easy to kind of apply that to product development. But your point, it can be applied to other functions of the business, right? Like marketing commercialization is a great example. I listen to this podcast that's. that was founded by an engineer by background, but he spends most of his time in marketing. And he calls kind of this, like their approach,

revenue R&D. And it's this concept of like thinking about, thinking about your commercialization or how you're going to drive revenue, but thinking about it like an R&D project, right? You're going to, you're an experiment, you know, build out your funnel, in essence, right? Experiment test and then go back to the drawing board and make tweaks.

And so I love the fact that you brought that up. And on that note, Patrick, when you think about, especially with your engineering background, when you think about how to move quickly with, you know, pretty limited capital, right, which is the case with most early stage companies, is there anything else that I guess that you feel would be helpful to kind of touch on, you know, either based on, you know, mistakes that you've made in the past or just other other startups that you've been around, you know, that would be valuable, right, for other founders, other CEOs that are listening in and kind of at those earliest stages when they don't have a lot of capital in the bank, but they still need to kind of, you know, move, move. move reasonably quickly. Hey there, it's Scott, and thanks for listening in so far. The rest of this conversation is only available via our private podcast for MedSider Premium members. If you're not a premium member yet, you should definitely consider signing up. You'll get full access to the entire library of interviews dating back to 2010.

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