Ceryx Medical: company uses bioelectronics to coordinate the heart and lungs

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Hello, and welcome to the Physics World Weekly

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podcast.

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Heart failure is a serious condition

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in which a damaged heart

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loses its ability to pump blood around the

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body.

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The damage usually gets progressively

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worse

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so that 5 years after a diagnosis,

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about 50%

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of patients

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with heart failure will be dead.

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The disease affects as many as a 100,000,000

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people

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worldwide.

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And in the UK,

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about 1 to 2 percent of the National

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Health Service budget is spent on managing the

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disease,

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with most of the expenditure

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related to hospitalization.

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So it's not surprising that scientists

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are looking for new ways to improve the

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outlook for people with heart failure

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and perhaps even cure the disease.

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This podcast features the biomedical

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engineer,

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Stuart Plant,

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and the physicist,

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Ashok

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Chowhin,

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who work for Sirix Medical,

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a UK based company that's developed a bioelectronic

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system that helps patients with heart failure.

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Stewart is the company's CEO,

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and Ashok

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is its senior scientist.

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Here they are in conversation

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with Physics World's Margaret Harris.

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As well as chatting about the company's work

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on treating heart failure,

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Ashok and Stewart also talk about other applications

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of bioelectronics

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and the challenges and rewards

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of developing

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medical technologies

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within a small company.

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Okay. So

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first question, Stuart.

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What medical problem is CERiX trying to address

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here?

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Well, the first,

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medical problem we're looking to address, and there

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are actually multiple

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applications

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for our technology. But in the first instance,

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we're looking at a disease called

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called heart failure.

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Now heart failure occurs when you've had,

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you know, heart attack, you've had chronic hypertension.

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Maybe, you know, these days you have to

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think about COVID

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and infections that that can affect the the

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muscle of the of the heart. But basically

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some incident has caused caused damage to the

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heart and the muscle

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has been has been damaged. Some of it

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may have died. Some of it has become

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dysfunctional

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or at least immobile,

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but your heart basically can't work as, as

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well as it, as it once did.

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So it means that it's not supplying as

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much blood to the body

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and your body doesn't like this. So it

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kind of

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activates various compensatory mechanisms. It will push your

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blood pressure up and increase the volume of,

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of, of fluid basically

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in your body. And it will cause your

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heart to beat harder and it will cause

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it to be beat faster.

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Now this is one of the nature's quite

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good at these types of mechanisms. And it

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does, it does provide compensation for that decrease

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in cardiac output from the, from the damaged,

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damaged heart. So it is kind of restoring

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its blood supply. But now you've got a

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heart which is damaged already, which has been

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made to work harder.

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And as with any muscle, if you don't

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rest it, once it's been damaged, the the

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injury just gets worse.

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So heart failure occurs when the body reacts

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to this initial initial injury

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and drives the heart on. And then over

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a period of time, that injury just gets

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worse and worse and worse. And the structure

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of the heart becomes

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more abnormal

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and the function of the heart just becomes

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poorer and poorer. And what this means for

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patients is that eventually they start to experience

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feelings of breathlessness. They can't exercise in the

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way that they once they once did. But

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as the heart gets worse and worse, eventually

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you can't even get out of a chair.

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Making a cup of tea becomes exhausting exhausting.

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And ultimately, these patients, you know, they end

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up on oxygen 24 hours a day. They

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end up in bed.

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They end up in hospice care. And then

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unless they get something extreme like a heart

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transplant or maybe a,

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an LVAD heart pump device,

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ultimately, they'll they'll sadly, they'll die.

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So at the moment, there's about, you know,

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if, I mean, if you Google it, it's

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it says that there's about 30,000,000

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people in the world with with heart failure.

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That's a bit of a European

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US centric

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number, right, I'd say. I mean, on average,

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there's about 2% of the adult population has

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heart failure. So it's probably more like a

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100,000,000 people worldwide

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currently have heart failure.

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And the survival rates for these patients are

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pretty poor. So on average,

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5 years after diagnosis, 50% of the patients

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with heart failure

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will be dead. And in fact, in the

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1st year, 30% will will probably die

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after the initial diagnosis.

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Moment the, you know, medications are directed towards,

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you know, trying to control the symptoms of

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heart failure. So they'll try and, you know,

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give you a better quality of life, improve

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your exercise tolerance. And a lot of them

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are trying to, you know, maybe slow the

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heart down. They give you beta blockers, slow

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the heart down. They'll give you ACE inhibitors,

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dilate your blood vessels. And that's trying to

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relieve the strain on the heart. So trying

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to release the extra strain on the heart

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and try and prolong

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the, the lifespan of the, of the heart

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itself. But they're not really getting to the

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core of the disease itself and trying to,

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trying to treat

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and basically reverse and cure this disease.

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And that's why Ceryx is, is a, is

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a bit different.

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So you've talked a little bit about what

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the existing treatment is in terms of oxygen,

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ultimately a heart transplant or a physical device

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to help the heart continue to beat.

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How is Ceryx's technology different from that? How

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is your solution different from that, I should

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say?

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Well, CERECS came to this problem, I I

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suppose in a bit of a convoluted way,

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really, to be honest. I mean,

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I I I we're 2 academic founders. 1

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was a cardiac physiologist in Bristol, and he

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was studying a phenomenon

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called respiratory sinus arrhythmia.

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Now this is a natural synchronisation between the

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heart and the lungs. Your heart and the

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lungs are linked. So that when we're, when

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their system's healthy, they'll work together to optimise

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the performance of both of those organs. And

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put simply, when we, when we breathe in

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our hearts accelerate, our heart rate goes up

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very slightly. And when we breathe out, our

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heart rate goes down very slightly.

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Now it'd been known for us, you know,

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it's a couple of 100 years since this

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phenomenon was first identified, but no one really

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examined as to why, why the body would

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bother to do this.

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More recently in the, you know, the recent

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decades, people have started to look at why

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this phenomenon occurs and have discovered that it

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actually brings quite a lot of benefits to

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both organs.

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So most obviously, you know, when we breathe

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in our lungs fill with oxygen, so our

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heart accelerates to to to pump as much

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blood as possible around the lungs to aid

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with the gas exchange.

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Also, you know, our lungs are in our

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chest. When we breathe in, we lower the

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pressure in our chest to allow the air

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into our lungs. Of course, our heart is

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in our chest as well. So now the

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heart's in beating the lower pressure environment, so

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it takes less energy for the, for the,

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for the heart to be.

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And now there's a growing body of evidence

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in the literature around, you know, the all

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these little benefits that RSA bring to their

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cardiovascular assist, cardio respiration.

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Now Julian was looking at well, he was

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looking at this phenomenon in itself and he

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was also looking at the

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we have this RSA when we're young and

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healthy and we it's enhanced in athletes. It's

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also present in all vertebrae animals. So even,

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you know, even fish display some RSA type

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mechanism.

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You know, so that when we get diseases

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like heart failure, you lose this, this RSA

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mechanism, the synchronisation between the heart and the

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lungs. So Julian's hypothesis was,

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if you could put RSA back into patients

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with RSA, would it restore the benefits of

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this mechanism and could that potentially be therapeutic?

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And the problem Julian has was that restoring

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this link is actually bit of a more

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of a complicated problem than it than it

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might first appear.

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But fortunately, he

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he kind of received an email from a

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physicist at at Bath University,

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who is looking at synchronization between nonlinear oscillating

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systems.

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Now

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where you get a lot of nonlinearity

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is in is in biology. Biology seems to

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love nonlinearity.

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So although it's not a natural place for

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maybe a physicist to be looking, they they

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tended to look towards biology and looked at

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things like your legs. Your legs to a

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physicist in in in in their field would

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is just, are just a couple of oscillators.

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Not linear oscillator, like, but it's keeping synch,

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allow us to walk and then to run.

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And how is the body able to to

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do that? How are we able to change

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our gait? How are we able to go

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from walking to running, trip on a stick,

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and actually not fall over? And I suppose

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it is is an interesting physics problem.

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So So the physicist in question was Alan

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Nogaret at Bath and he had, you know,

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been studying this for some time and had

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come up with,

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basically,

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a paper, an electronic representation

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of the MEC control systems that the body

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uses to control these nonlinear oscillators.

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And now he had these devices and he

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sent out a blanket email, I think, to

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Bath and Bristol University saying, I've got this

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technology. Does anybody have any ideas of what

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I should do with it? Now, fortunately,

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Julian saw the email, got in touch. And

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that's really how how, Cerrits came about.

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So we spent, you know, that, that was,

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well, I always started from 2016, but I

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think those guys have been working on it

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prior to, to that. But we've spent since

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about 2016, trying to develop Alan's technology into

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something which we could eventually use

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to re,

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reestablish this connection between the heart and lungs,

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restore RSA.

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And at the moment we're trying to identify

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whether,

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whether doing this has a therapeutic effect on

273
00:10:03,565 --> 00:10:04,785
patients with heart failure.

274
00:10:05,804 --> 00:10:07,404
Okay. I wanna bring in the ASH Lock

275
00:10:07,404 --> 00:10:09,085
here. You know, can you tell us a

276
00:10:09,085 --> 00:10:11,245
bit more about the technology and how that

277
00:10:11,245 --> 00:10:12,225
actually works?

278
00:10:12,924 --> 00:10:15,825
So as Stuart just touched on the respiratory

279
00:10:15,965 --> 00:10:16,785
sinus arrhythmia,

280
00:10:17,220 --> 00:10:18,360
how it is beneficial

281
00:10:19,620 --> 00:10:20,759
to the body, and

282
00:10:21,139 --> 00:10:21,639
you

283
00:10:22,100 --> 00:10:23,399
find that in healthy,

284
00:10:23,860 --> 00:10:24,360
humans.

285
00:10:24,740 --> 00:10:27,480
But in heart failure, that respiratory sinus arrhythmia

286
00:10:28,419 --> 00:10:29,240
doesn't exist.

287
00:10:31,705 --> 00:10:33,144
And another aspect of,

288
00:10:33,705 --> 00:10:36,924
respiratory sinus arrhythmia is that, heart rate variability,

289
00:10:37,144 --> 00:10:40,105
which is a good sign, again, present in

290
00:10:40,105 --> 00:10:41,004
healthy humans.

291
00:10:41,784 --> 00:10:44,105
So that heart rate variability is lost in

292
00:10:44,105 --> 00:10:45,480
heart failure in patients.

293
00:10:46,679 --> 00:10:48,759
So our technology, what it does is it

294
00:10:48,759 --> 00:10:49,259
mimics

295
00:10:49,799 --> 00:10:50,699
neural networks

296
00:10:51,000 --> 00:10:52,459
in the body,

297
00:10:52,839 --> 00:10:54,299
called central pattern generators,

298
00:10:54,839 --> 00:10:57,559
and these neural networks have specific tasks. They

299
00:10:57,559 --> 00:10:58,940
can generate rhythms

300
00:10:59,845 --> 00:11:01,384
without rhythmic inputs.

301
00:11:01,924 --> 00:11:04,424
And so, our electronics basically emulates

302
00:11:04,804 --> 00:11:06,345
those neural networks,

303
00:11:06,884 --> 00:11:08,424
and it generates rhythms,

304
00:11:08,965 --> 00:11:10,585
in coordination with restoration,

305
00:11:11,205 --> 00:11:11,705
and

306
00:11:12,245 --> 00:11:12,745
other,

307
00:11:13,365 --> 00:11:13,865
inputs.

308
00:11:15,000 --> 00:11:16,860
And it does it breath by breath

309
00:11:17,480 --> 00:11:19,580
Okay. To provide those subtle,

310
00:11:20,680 --> 00:11:22,540
respiratory sinus arrhythmia.

311
00:11:23,560 --> 00:11:25,639
And we we re so this way, we

312
00:11:25,639 --> 00:11:26,139
reinstate

313
00:11:26,855 --> 00:11:29,735
the healthy respiratory sinusoid pneumonia in the heart

314
00:11:29,735 --> 00:11:30,554
failure patients.

315
00:11:32,294 --> 00:11:32,794
And

316
00:11:33,414 --> 00:11:33,914
the,

317
00:11:35,334 --> 00:11:35,834
physiological

318
00:11:36,615 --> 00:11:37,115
improvements

319
00:11:37,495 --> 00:11:40,375
found was the increase in cardiac output by

320
00:11:40,375 --> 00:11:41,914
about 18 to 20%

321
00:11:43,009 --> 00:11:44,230
in the heart failure.

322
00:11:45,330 --> 00:11:48,149
Just to give a reference, 3% is considered

323
00:11:48,210 --> 00:11:48,710
significant.

324
00:11:49,170 --> 00:11:50,370
So, yeah, if you if you could put

325
00:11:50,370 --> 00:11:51,649
this in a pill form, it would be

326
00:11:51,649 --> 00:11:54,149
flying off the shelves and selling out. Yeah.

327
00:11:54,704 --> 00:11:56,964
So what does it actually look like in

328
00:11:57,105 --> 00:11:58,704
a patient? I mean, I guess you've you've

329
00:11:58,704 --> 00:12:00,565
done some animal studies so far?

330
00:12:01,584 --> 00:12:04,065
Yes. So the studies have been done in

331
00:12:04,065 --> 00:12:06,480
small animals and large animal models.

332
00:12:07,039 --> 00:12:09,519
And in both cases, we had similar amount

333
00:12:09,519 --> 00:12:10,019
of

334
00:12:10,559 --> 00:12:12,259
increase in the cardiac output.

335
00:12:12,639 --> 00:12:13,139
And,

336
00:12:13,759 --> 00:12:15,860
so in the the initial

337
00:12:16,320 --> 00:12:18,980
prototypes of the technology were just the electronic

338
00:12:19,039 --> 00:12:20,615
circuit on board and

339
00:12:20,995 --> 00:12:21,654
the trialed,

340
00:12:22,514 --> 00:12:24,595
in in the labs. But for the large

341
00:12:24,595 --> 00:12:25,495
animal trials,

342
00:12:26,434 --> 00:12:27,254
these were,

343
00:12:28,514 --> 00:12:30,934
again, in the static conditions in the lab.

344
00:12:31,394 --> 00:12:31,894
So

345
00:12:32,929 --> 00:12:34,769
what we're now trying to do is make

346
00:12:34,769 --> 00:12:35,269
them,

347
00:12:37,410 --> 00:12:38,549
we've got an external,

348
00:12:39,649 --> 00:12:42,850
pacemaker now. So and then the next stage

349
00:12:42,850 --> 00:12:43,910
is to make implantable,

350
00:12:44,769 --> 00:12:46,950
pacemaker out of this. And

351
00:12:47,954 --> 00:12:50,274
the electronics remains the same, but it shrinks,

352
00:12:50,274 --> 00:12:52,355
of course, a bit. Okay? Yeah. So you

353
00:12:52,434 --> 00:12:55,154
you've got potentially something you would wear on

354
00:12:55,154 --> 00:12:57,475
the outside, and then the next step is

355
00:12:57,475 --> 00:12:59,875
to make it so you can actually implant

356
00:12:59,875 --> 00:13:01,815
it. Implant it. Yes. I see. Okay.

357
00:13:02,980 --> 00:13:04,419
And you told me a little bit, Stuart,

358
00:13:04,419 --> 00:13:06,899
about how the company got started. How did

359
00:13:06,899 --> 00:13:08,579
you get involved in it? Because you're you're

360
00:13:08,579 --> 00:13:10,019
not you're not one of the 2 sort

361
00:13:10,019 --> 00:13:11,799
of the physicists and the physiologist,

362
00:13:12,339 --> 00:13:13,559
or clinicians, founders.

363
00:13:14,945 --> 00:13:16,465
I had I had kind of an interesting

364
00:13:16,465 --> 00:13:17,985
job. I mean, I'm a I'm a scientist

365
00:13:17,985 --> 00:13:18,644
by background,

366
00:13:19,345 --> 00:13:21,845
but at the time I was working for

367
00:13:22,065 --> 00:13:24,865
a company, it was essentially a a venture

368
00:13:24,865 --> 00:13:26,325
capital investment company.

369
00:13:26,840 --> 00:13:27,980
Now their USP

370
00:13:28,440 --> 00:13:30,620
at the time was that they had relationships

371
00:13:30,759 --> 00:13:31,740
with universities

372
00:13:32,440 --> 00:13:34,600
and they signed contracts with these universities, which

373
00:13:34,600 --> 00:13:36,200
would allow them to go in and meet

374
00:13:36,200 --> 00:13:36,860
the academics,

375
00:13:37,480 --> 00:13:39,480
look at the, research that they were doing,

376
00:13:39,480 --> 00:13:41,014
look at the IP that they were producing,

377
00:13:41,014 --> 00:13:42,954
and then they'd have kind of first dibs

378
00:13:43,334 --> 00:13:45,195
on potentially investing in that technology

379
00:13:45,575 --> 00:13:47,834
and, and, and, and spinning it out, essentially.

380
00:13:48,615 --> 00:13:50,534
So my role was to, I was the

381
00:13:50,534 --> 00:13:52,554
guy that went into the, into the university.

382
00:13:52,615 --> 00:13:54,690
So part of my patch within the, within

383
00:13:54,690 --> 00:13:55,990
the UK at the time

384
00:13:56,769 --> 00:13:58,690
to the Southwest and some of the London

385
00:13:58,690 --> 00:14:00,610
universities. So I'd go in all these universities,

386
00:14:00,610 --> 00:14:03,269
meet everyone and anything like the look of,

387
00:14:03,409 --> 00:14:05,970
I'd take it back to IP group at

388
00:14:05,970 --> 00:14:07,009
the time and,

389
00:14:07,649 --> 00:14:08,309
you know,

390
00:14:08,985 --> 00:14:10,745
pitched that we should, we should be backing

391
00:14:10,745 --> 00:14:11,404
this technology.

392
00:14:12,105 --> 00:14:13,865
So when I saw, when I saw this

393
00:14:13,865 --> 00:14:16,825
technology in 2016, I, I, it was, I

394
00:14:16,825 --> 00:14:18,264
mean, it was, I mean, I say this

395
00:14:18,264 --> 00:14:19,384
now, but I mean, it was the best

396
00:14:19,384 --> 00:14:21,384
thing I I'd seen with the universities. I

397
00:14:21,384 --> 00:14:22,200
mean, this is

398
00:14:23,720 --> 00:14:24,540
the the RSA,

399
00:14:25,240 --> 00:14:27,559
as a therapy for heart failure in itself

400
00:14:27,559 --> 00:14:29,720
is is massively exciting. You know, this is

401
00:14:29,960 --> 00:14:32,059
it is one of the big healthcare challenges.

402
00:14:32,759 --> 00:14:34,759
The expenditure on it on the heart failure

403
00:14:34,759 --> 00:14:36,919
is is, you know, it's only comparable by

404
00:14:37,080 --> 00:14:39,045
with cancer, to be honest, at the amount

405
00:14:39,045 --> 00:14:41,004
it costs that the health systems at the

406
00:14:41,004 --> 00:14:41,504
moment.

407
00:14:42,524 --> 00:14:42,845
And it's

408
00:14:44,285 --> 00:14:45,884
as with any disease, I suppose, you know,

409
00:14:45,884 --> 00:14:48,225
the world's getting older, the oil's getting fatter,

410
00:14:49,085 --> 00:14:51,160
and the problem's only getting worse. So that

411
00:14:51,160 --> 00:14:52,519
in itself is a is a is a

412
00:14:52,519 --> 00:14:55,799
big target. But the technology underneath is interesting.

413
00:14:55,799 --> 00:14:57,820
I mean, I'm not a physicist by background

414
00:14:57,960 --> 00:14:59,879
and I admit that, you know, I still

415
00:14:59,879 --> 00:15:01,820
struggle with with some of that

416
00:15:02,679 --> 00:15:04,919
with some of the theory behind how our

417
00:15:04,919 --> 00:15:05,419
devices

418
00:15:05,795 --> 00:15:08,115
our devices work, I could comprehend enough to

419
00:15:08,115 --> 00:15:10,274
see that this actually had the potential to

420
00:15:10,274 --> 00:15:10,774
be

421
00:15:11,154 --> 00:15:13,795
really a new approach to medical devices more

422
00:15:13,795 --> 00:15:15,795
more generally. I mean, I think as Ashok

423
00:15:15,795 --> 00:15:17,475
was saying and I was mentioning earlier, I

424
00:15:17,475 --> 00:15:19,335
mean, it it really does look at biology.

425
00:15:19,590 --> 00:15:22,250
How does, how is biology able to control

426
00:15:22,309 --> 00:15:24,950
the complex processes that go on within, within

427
00:15:24,950 --> 00:15:25,529
the system?

428
00:15:26,070 --> 00:15:27,529
Within the, within the body.

429
00:15:29,029 --> 00:15:31,110
And medical devices up to this point, we've

430
00:15:31,110 --> 00:15:33,764
kind of taken you know, electronic technology. So

431
00:15:33,764 --> 00:15:35,445
the same technology in your phones or your

432
00:15:35,445 --> 00:15:35,945
computers.

433
00:15:36,485 --> 00:15:38,325
And we kind of impose that on, on

434
00:15:38,325 --> 00:15:40,904
the body. And the 2 things don't communicate

435
00:15:40,965 --> 00:15:41,945
very well. One's

436
00:15:42,404 --> 00:15:44,665
a basic level. One's a digital system,

437
00:15:45,524 --> 00:15:47,144
communicating ones and zeros.

438
00:15:47,629 --> 00:15:50,429
One is a very complex analog system. So

439
00:15:50,429 --> 00:15:52,769
everything's, everything's 1, no everything

440
00:15:53,230 --> 00:15:53,970
in between.

441
00:15:54,350 --> 00:15:56,590
And the, and the body, that's how the

442
00:15:56,590 --> 00:15:58,830
body functions and trying to control that process

443
00:15:58,830 --> 00:16:01,789
of trying to correct biological processes using digital

444
00:16:01,789 --> 00:16:04,325
system in some ways, doesn't really make sense.

445
00:16:05,024 --> 00:16:07,105
So when you first saw what Alan and

446
00:16:07,105 --> 00:16:09,184
Julian were doing, you go, well, actually that

447
00:16:09,184 --> 00:16:11,745
makes sense. That's a sort of seamless connection

448
00:16:11,745 --> 00:16:13,684
between the human body. You can feed,

449
00:16:14,759 --> 00:16:17,080
biological signals into this technology and it can

450
00:16:17,080 --> 00:16:19,160
process it as part of its natural, natural

451
00:16:19,160 --> 00:16:21,320
functions. Whereas, you know, digital systems, you've got

452
00:16:21,320 --> 00:16:23,480
to take the, take the biological signal, you've

453
00:16:23,480 --> 00:16:25,080
got to filter it, you've got to process

454
00:16:25,080 --> 00:16:27,179
it to enable it to,

455
00:16:27,559 --> 00:16:29,605
to maybe to feed it into the, into

456
00:16:29,605 --> 00:16:31,605
the medical device itself. And what that means

457
00:16:31,605 --> 00:16:33,445
is you get very crude, you get very

458
00:16:33,445 --> 00:16:36,404
crude systems. I mean, most medical devices at

459
00:16:36,404 --> 00:16:38,665
the moment, a bit harsh,

460
00:16:40,325 --> 00:16:40,985
they just

461
00:16:41,860 --> 00:16:42,360
electrocute.

462
00:16:42,820 --> 00:16:44,500
They just electrocute in every of the body.

463
00:16:44,500 --> 00:16:46,580
I mean, the pacemaker today, you just get

464
00:16:46,580 --> 00:16:47,559
60 electrocute

465
00:16:47,940 --> 00:16:49,860
the heart 60 times a second, 60 times

466
00:16:49,860 --> 00:16:52,500
a minute rather to control rate. You know,

467
00:16:52,500 --> 00:16:55,379
Parkinson's disease brain implants, it's mostly just as

468
00:16:55,379 --> 00:16:55,879
simple

469
00:16:56,355 --> 00:16:58,115
stimulation in particular area of the brain. There's

470
00:16:58,115 --> 00:16:59,954
not a lot of complexity there. There's not

471
00:16:59,954 --> 00:17:00,934
a lot of feedback.

472
00:17:01,475 --> 00:17:03,394
So I thought that, you know, this first

473
00:17:03,394 --> 00:17:05,954
application in heart failure is incredibly exciting, but

474
00:17:05,954 --> 00:17:07,394
there's more to it there. I think that,

475
00:17:07,394 --> 00:17:09,015
you know, further down the line,

476
00:17:09,409 --> 00:17:12,470
certainly Ceryx's more biomimetic approach, create

477
00:17:12,929 --> 00:17:15,009
mimic the systems that they're trying to to

478
00:17:15,009 --> 00:17:17,269
control, makes makes a lot of sense.

479
00:17:18,130 --> 00:17:19,970
And that's kind of the premise that that

480
00:17:19,970 --> 00:17:21,984
it came from. So I, yeah, getting back

481
00:17:21,984 --> 00:17:23,825
to your question, I mean, I, I, you

482
00:17:23,825 --> 00:17:25,664
know, I found the technology in 2016. I

483
00:17:25,664 --> 00:17:27,424
continued to work for IP Group. We, we

484
00:17:27,424 --> 00:17:29,825
did some early investments into, into CEREC after

485
00:17:29,825 --> 00:17:31,825
we spun out of, of Bath and Bristol

486
00:17:31,825 --> 00:17:32,325
Universities.

487
00:17:33,345 --> 00:17:34,325
And then in 2019,

488
00:17:36,250 --> 00:17:38,250
say IP group, you decided to take a

489
00:17:38,250 --> 00:17:40,730
different route. It's got moved away from the

490
00:17:40,730 --> 00:17:42,910
university model. They didn't want to, they couldn't,

491
00:17:43,289 --> 00:17:45,609
can we work with the universities in the

492
00:17:45,609 --> 00:17:47,289
same way they had before? So when they

493
00:17:47,289 --> 00:17:49,275
went off in that direction, not I stayed

494
00:17:49,275 --> 00:17:51,275
behind, and I left IP group and and

495
00:17:51,275 --> 00:17:52,975
joined CEREC full time.

496
00:17:54,315 --> 00:17:55,615
Yeah. That's how I came about.

497
00:17:56,555 --> 00:17:58,475
And, Ashlag, you you are a physicist by

498
00:17:58,475 --> 00:18:00,475
background. How did you get interested in this

499
00:18:00,475 --> 00:18:03,355
this technology and and get involved in helping

500
00:18:03,355 --> 00:18:04,680
to make it it work? So

501
00:18:05,299 --> 00:18:08,599
I was a doctoral student of professor Nagar

502
00:18:08,900 --> 00:18:11,380
in University of Bath. And, when I was

503
00:18:11,380 --> 00:18:13,240
finishing my PhD, there was

504
00:18:13,539 --> 00:18:14,920
a this project had,

505
00:18:15,380 --> 00:18:17,605
was going on. And so there

506
00:18:18,585 --> 00:18:19,085
was

507
00:18:20,065 --> 00:18:21,365
a position for postdoctoral

508
00:18:21,664 --> 00:18:23,184
researcher in in that group,

509
00:18:24,065 --> 00:18:25,125
on that project. So

510
00:18:25,664 --> 00:18:27,505
I found it fascinating. So I joined the

511
00:18:27,505 --> 00:18:29,525
project, and I spent few years

512
00:18:30,545 --> 00:18:31,845
developing actually the

513
00:18:32,160 --> 00:18:32,820
hardware and

514
00:18:33,279 --> 00:18:36,160
the technology and working between the labs labs

515
00:18:36,160 --> 00:18:38,259
of professor Norbert and professor Julian.

516
00:18:39,680 --> 00:18:41,680
And what was the most difficult part of

517
00:18:41,680 --> 00:18:43,700
that task instead of developing the technology?

518
00:18:46,894 --> 00:18:49,295
As there are 2 different disciplines involved, there

519
00:18:49,295 --> 00:18:52,595
are challenges from both disciplines. 1st was,

520
00:18:53,055 --> 00:18:54,515
actually making the

521
00:18:54,975 --> 00:18:58,174
hardware designs and studying the dynamics that will

522
00:18:58,174 --> 00:18:58,674
be,

523
00:18:59,559 --> 00:19:01,320
dynamics of the network that will be more

524
00:19:01,320 --> 00:19:03,980
useful in coordinating respiration and heartbeat.

525
00:19:05,720 --> 00:19:06,460
And then

526
00:19:07,080 --> 00:19:11,240
bring bringing it, for physiological application and actually

527
00:19:11,240 --> 00:19:11,740
saying,

528
00:19:12,359 --> 00:19:13,820
for example, tuning the parameters

529
00:19:15,085 --> 00:19:17,184
and the range and the rate of adaptation,

530
00:19:17,404 --> 00:19:18,144
those kind

531
00:19:18,764 --> 00:19:20,924
of technical details that you have to work

532
00:19:20,924 --> 00:19:23,085
out from the scratch in in a different

533
00:19:23,085 --> 00:19:25,904
lab, which is physiology lab. And I wasn't

534
00:19:28,650 --> 00:19:30,809
a a physiologist from background. So it was

535
00:19:30,809 --> 00:19:31,789
a learning process

536
00:19:32,250 --> 00:19:33,630
on 2 different levels,

537
00:19:34,089 --> 00:19:35,789
but, eventually, we got there.

538
00:19:36,410 --> 00:19:37,849
And, Stuart, what will you say in terms

539
00:19:37,849 --> 00:19:39,529
of what was the most difficult challenge you

540
00:19:39,529 --> 00:19:41,690
had from the business side of things to

541
00:19:41,690 --> 00:19:43,205
get this this company to where it where

542
00:19:43,205 --> 00:19:43,945
it is now?

543
00:19:46,404 --> 00:19:47,605
I'm not sure. I put I should put

544
00:19:47,605 --> 00:19:49,045
this out in a in a podcast, but,

545
00:19:49,045 --> 00:19:50,884
I mean, the the biggest problem for any

546
00:19:50,884 --> 00:19:52,664
any start up is always funding.

547
00:19:53,525 --> 00:19:54,105
It's so

548
00:19:55,380 --> 00:19:58,420
so much effort is put into just, just

549
00:19:58,420 --> 00:19:58,920
feeding

550
00:19:59,539 --> 00:20:00,359
cash into,

551
00:20:01,059 --> 00:20:03,480
into, into the business. I mean, we're, we

552
00:20:04,980 --> 00:20:06,440
Ceryx has been quite,

553
00:20:06,894 --> 00:20:08,414
efficient, I think in the way that he's

554
00:20:08,414 --> 00:20:09,855
done things. You know, we've got a very,

555
00:20:09,855 --> 00:20:11,555
we've got a small but highly

556
00:20:12,255 --> 00:20:12,755
experienced

557
00:20:13,134 --> 00:20:13,634
team.

558
00:20:14,255 --> 00:20:15,775
We've also been quite smart in how we've

559
00:20:15,775 --> 00:20:18,335
been using sort of external subcontractors just to

560
00:20:18,335 --> 00:20:21,130
kind of keep sort of overheads overheads down

561
00:20:21,130 --> 00:20:23,950
and proceed as, as efficiently as possible.

562
00:20:24,330 --> 00:20:26,330
So our cash requirements have been kept to

563
00:20:26,330 --> 00:20:28,090
a minimum, but it's but it's just been

564
00:20:28,090 --> 00:20:30,250
so difficult to to raise the to raise

565
00:20:30,250 --> 00:20:32,085
the money. I mean, one of the things

566
00:20:32,085 --> 00:20:33,464
that you want to do

567
00:20:34,164 --> 00:20:34,825
with any

568
00:20:35,365 --> 00:20:38,085
development program is is to keep momentum. You've

569
00:20:38,085 --> 00:20:39,545
got to keep pace up.

570
00:20:42,005 --> 00:20:42,744
And sometimes

571
00:20:43,605 --> 00:20:44,585
doing that alongside

572
00:20:45,390 --> 00:20:46,369
funding timescales

573
00:20:46,670 --> 00:20:48,509
is just really, really hard. I mean, on

574
00:20:48,509 --> 00:20:50,130
the one hand you have, you have grants.

575
00:20:50,670 --> 00:20:52,289
Sometimes they have like ludicrous

576
00:20:53,710 --> 00:20:55,869
process which can take, you know, 12 months

577
00:20:55,869 --> 00:20:56,529
or so.

578
00:20:57,549 --> 00:20:59,394
And, you know, that just doesn't fit with

579
00:20:59,394 --> 00:21:00,295
a fast moving,

580
00:21:00,994 --> 00:21:03,715
startup. You know, we've, we've 12 months' time,

581
00:21:03,715 --> 00:21:04,775
we'll have we're

582
00:21:05,715 --> 00:21:07,075
in a completely different place than where we

583
00:21:07,075 --> 00:21:08,994
were 12 months ago. Trying to plan that

584
00:21:08,994 --> 00:21:10,215
ahead is quite difficult.

585
00:21:11,130 --> 00:21:11,630
Investment

586
00:21:11,930 --> 00:21:13,130
in the account I mean, I think that

587
00:21:13,130 --> 00:21:15,210
we, you know, we were unlucky, I think,

588
00:21:15,210 --> 00:21:17,049
in that, you know, when we really started

589
00:21:17,049 --> 00:21:19,369
to move around sort of 2018, 2019, we

590
00:21:19,369 --> 00:21:21,369
started getting into the sort of pandemic type

591
00:21:21,369 --> 00:21:21,869
period

592
00:21:22,170 --> 00:21:24,589
and then everything became a lot more difficult.

593
00:21:25,204 --> 00:21:27,285
Funding became a lot more difficult. I mean,

594
00:21:27,285 --> 00:21:28,025
even now,

595
00:21:28,484 --> 00:21:30,164
you know, investors tell me that they're having

596
00:21:30,164 --> 00:21:32,404
difficulty raising money. So us raising money from

597
00:21:32,404 --> 00:21:34,265
then, everything was quite difficult.

598
00:21:34,805 --> 00:21:35,865
I mean, we were

599
00:21:36,244 --> 00:21:38,644
we did well. We wrote we closed a

600
00:21:38,644 --> 00:21:39,704
pretty large round,

601
00:21:40,200 --> 00:21:42,279
nearly nearly 3 years ago now where we

602
00:21:42,279 --> 00:21:43,419
we wrote oversubscribed.

603
00:21:46,039 --> 00:21:47,559
But even then, it was, you know, it

604
00:21:47,559 --> 00:21:49,400
was it was a 14 month process, I

605
00:21:49,400 --> 00:21:51,099
think, to to to.

606
00:21:53,494 --> 00:21:55,734
I do think as well that, you know,

607
00:21:55,734 --> 00:21:57,914
working in the space where, that we are,

608
00:21:58,134 --> 00:22:00,214
I mean, investors have a, to be fair,

609
00:22:00,214 --> 00:22:01,494
I mean, I've been one, so I know

610
00:22:01,494 --> 00:22:02,934
that investors have a hard time with it.

611
00:22:02,934 --> 00:22:04,714
They, they look at a lot of technologies,

612
00:22:04,855 --> 00:22:06,535
a lot of companies, there's a lot of

613
00:22:06,535 --> 00:22:08,990
information that they take in. And very often,

614
00:22:08,990 --> 00:22:10,669
you know, they, they they're dealing with the

615
00:22:10,669 --> 00:22:12,529
business side and they come from a financial

616
00:22:12,669 --> 00:22:13,169
background.

617
00:22:14,029 --> 00:22:15,309
And I'll sit them down in front of

618
00:22:15,309 --> 00:22:17,230
a physicist and just go, come on, why

619
00:22:17,230 --> 00:22:19,309
don't you appreciate how brilliant this is? And

620
00:22:19,309 --> 00:22:20,829
it's really hard for them to do that.

621
00:22:20,829 --> 00:22:22,269
But I mean, it is particularly hard, I

622
00:22:22,269 --> 00:22:24,345
think for CEREX because we, as Ashok said,

623
00:22:24,345 --> 00:22:27,065
we encompass so many different aspects. We've got,

624
00:22:27,065 --> 00:22:28,845
you know, cardiovascular physiology,

625
00:22:29,865 --> 00:22:32,585
we've got electronics, we've got physics, we've got

626
00:22:32,585 --> 00:22:33,085
mathematics.

627
00:22:34,025 --> 00:22:34,525
And

628
00:22:35,144 --> 00:22:36,505
part of the beauty of what we do

629
00:22:36,505 --> 00:22:37,404
is in the complexity

630
00:22:37,944 --> 00:22:38,684
of the technology.

631
00:22:39,049 --> 00:22:40,890
It's why, you know, it's why we've been

632
00:22:40,890 --> 00:22:41,710
able to achieve

633
00:22:42,009 --> 00:22:44,009
what we have with RSA with other other

634
00:22:44,009 --> 00:22:45,769
people may not have been able to because

635
00:22:45,769 --> 00:22:47,929
it is, it is quite complex and that's

636
00:22:47,929 --> 00:22:50,730
what's great about it. But trying to communicate

637
00:22:50,730 --> 00:22:52,409
that message in a way that people just

638
00:22:52,409 --> 00:22:52,909
don't

639
00:22:53,325 --> 00:22:55,005
investors in particular, don't just turn off and

640
00:22:55,005 --> 00:22:57,565
just go, no, actually this one's too hard.

641
00:22:57,565 --> 00:22:58,765
I'll look at the next, I'll look at

642
00:22:58,765 --> 00:23:00,924
the next technology. At least I slightly understand

643
00:23:00,924 --> 00:23:01,424
it

644
00:23:01,724 --> 00:23:04,144
is, is a difficult problem. I mean, and

645
00:23:04,444 --> 00:23:05,265
yeah, so

646
00:23:06,500 --> 00:23:08,100
that's my long winded answer to say, yeah,

647
00:23:08,100 --> 00:23:10,420
just, just, just cash. But I think any,

648
00:23:10,420 --> 00:23:12,259
any startup probably in the world will say

649
00:23:12,259 --> 00:23:15,299
exactly the same thing. Just, just sourcing funding

650
00:23:15,299 --> 00:23:17,539
for, for even, it doesn't matter how brilliant

651
00:23:17,539 --> 00:23:18,494
your idea is.

652
00:23:19,535 --> 00:23:21,535
Getting getting cash to fund it is always

653
00:23:21,535 --> 00:23:22,194
the challenge.

654
00:23:23,375 --> 00:23:25,394
And I understand you're you're about to enter,

655
00:23:25,694 --> 00:23:28,015
a new and and differently challenging phase for

656
00:23:28,015 --> 00:23:29,775
the company. You're you're starting your first in

657
00:23:29,775 --> 00:23:32,015
human trials. What sort of challenges does that

658
00:23:32,015 --> 00:23:34,380
bring? Maybe, Ashlag, you wanna go first?

659
00:23:35,819 --> 00:23:36,319
So

660
00:23:36,619 --> 00:23:38,079
some of that are the regulatory

661
00:23:38,940 --> 00:23:41,359
approval we need. It takes a very long

662
00:23:41,579 --> 00:23:42,960
time and longer

663
00:23:43,259 --> 00:23:44,240
document preparation.

664
00:23:45,099 --> 00:23:45,599
And

665
00:23:45,980 --> 00:23:47,819
even before that is the preparation for the

666
00:23:47,819 --> 00:23:48,319
technology

667
00:23:49,105 --> 00:23:50,325
that will be evaluated

668
00:23:50,625 --> 00:23:51,125
for

669
00:23:51,585 --> 00:23:52,804
regulatory approval.

670
00:23:53,265 --> 00:23:54,005
So we

671
00:23:54,944 --> 00:23:56,484
again, then we have to coordinate,

672
00:23:56,944 --> 00:23:59,125
as Sushu said, electronics, physics,

673
00:23:59,825 --> 00:24:01,444
and mathematics, and everything.

674
00:24:01,970 --> 00:24:03,589
And we have to commit to a design

675
00:24:03,650 --> 00:24:04,630
of the technology.

676
00:24:05,089 --> 00:24:07,329
There can be other versions, improved versions later

677
00:24:07,329 --> 00:24:09,170
on, but we have to then commit to

678
00:24:09,170 --> 00:24:10,869
a certain design before

679
00:24:11,170 --> 00:24:13,269
we file for the regulatory approval. So

680
00:24:13,904 --> 00:24:16,065
that was a challenging part from my side,

681
00:24:16,065 --> 00:24:18,085
and I think Stew can add further.

682
00:24:19,984 --> 00:24:21,744
So from from the clinical side, I mean,

683
00:24:21,744 --> 00:24:23,265
we as I said, we've we've been pretty

684
00:24:23,265 --> 00:24:25,184
efficient, I think, in the development. We went

685
00:24:25,184 --> 00:24:26,865
from a we went pretty much from a

686
00:24:26,865 --> 00:24:28,085
standing start to

687
00:24:28,920 --> 00:24:29,420
a,

688
00:24:30,200 --> 00:24:32,600
an MHRA approved class c medical device in

689
00:24:32,600 --> 00:24:35,180
about 2 years, which is pretty good going.

690
00:24:35,720 --> 00:24:37,160
And then we thought, right, we just gotta

691
00:24:37,160 --> 00:24:38,920
just gotta put it on a patient now.

692
00:24:38,920 --> 00:24:39,980
It's all been approved.

693
00:24:41,000 --> 00:24:44,664
And, it actually is been incredibly incredibly challenging.

694
00:24:44,664 --> 00:24:46,664
I mean, obviously, you know, the patients we're

695
00:24:46,664 --> 00:24:48,784
dealing with are really quite really quite sick.

696
00:24:48,784 --> 00:24:50,684
I mean, heart failure is a serious condition.

697
00:24:50,984 --> 00:24:53,224
For this clinical study, we're taking patients who

698
00:24:53,224 --> 00:24:55,304
have got heart failure, who are going in

699
00:24:55,304 --> 00:24:57,085
for a coronary artery bypass

700
00:24:57,390 --> 00:24:59,230
graft operation. Now why we were interested in

701
00:24:59,230 --> 00:25:00,609
these patients is because

702
00:25:01,470 --> 00:25:03,950
these patients as part of standard clinical care

703
00:25:03,950 --> 00:25:06,670
are fitted with an external pacing device. So

704
00:25:06,670 --> 00:25:07,710
when they go in, they go in for

705
00:25:07,710 --> 00:25:09,630
the procedure and just when the surgeons finish,

706
00:25:09,630 --> 00:25:11,150
you'll put a couple of pacing wires, 1

707
00:25:11,150 --> 00:25:13,009
in the atrium, 1 in the ventricle.

708
00:25:13,365 --> 00:25:15,125
And these wires then just come out through

709
00:25:15,125 --> 00:25:16,505
a through a hole in the chest

710
00:25:17,125 --> 00:25:18,724
and a patient is stitched up. And when

711
00:25:18,724 --> 00:25:20,805
they get taken down to the ICU, they'll

712
00:25:20,805 --> 00:25:23,444
they'll have a an external pacing box. And

713
00:25:23,444 --> 00:25:25,950
that just controls their heart rhythm as a

714
00:25:26,109 --> 00:25:28,029
surgeon who recovered from the anesthesia. They can

715
00:25:28,029 --> 00:25:29,569
be at sort of high risk for arrhythmias

716
00:25:29,630 --> 00:25:31,569
there, so that prevents that from happening.

717
00:25:31,869 --> 00:25:33,309
But generally what will happen the next day

718
00:25:33,309 --> 00:25:35,649
is the cardiologist's surgeon will come round.

719
00:25:35,950 --> 00:25:37,869
They'll turn down the pacing on this device.

720
00:25:37,869 --> 00:25:39,710
And if that patient's got a normal sinus

721
00:25:39,710 --> 00:25:40,210
rhythm,

722
00:25:40,589 --> 00:25:42,965
they'll turn that pacing box off. Generally, the

723
00:25:42,965 --> 00:25:44,565
wires stay in for a couple more days

724
00:25:44,565 --> 00:25:46,805
just in case the pacing's needed. But eventually,

725
00:25:46,805 --> 00:25:48,244
the nurses will just come around and they'll

726
00:25:48,244 --> 00:25:49,924
just basically just tug on the wires and

727
00:25:49,924 --> 00:25:51,445
it they come off the outside of the

728
00:25:51,445 --> 00:25:52,884
heart and they'll stitch them up and away

729
00:25:52,884 --> 00:25:55,125
they go. So we were interested there because

730
00:25:55,125 --> 00:25:57,065
that's an opportunity for us to

731
00:25:57,759 --> 00:26:00,160
where pacing is huge without having to implant

732
00:26:00,160 --> 00:26:02,240
the device into the patients. What we've done

733
00:26:02,240 --> 00:26:04,099
for this first study is taken our technology

734
00:26:04,720 --> 00:26:07,279
and integrated it with an existing external pacing

735
00:26:07,279 --> 00:26:09,119
device. So they can be fitted with that

736
00:26:09,119 --> 00:26:10,740
pacemaker when they come out surgery

737
00:26:11,044 --> 00:26:12,724
and just give a normal pacing. And then

738
00:26:12,724 --> 00:26:14,265
when they're ready to come off that pacemaker,

739
00:26:14,325 --> 00:26:15,765
we switch it over and then it gives

740
00:26:15,765 --> 00:26:16,244
them their

741
00:26:16,964 --> 00:26:19,525
delivers RSA pacing. And we'll just leave that

742
00:26:19,525 --> 00:26:21,605
on for the duration that patient remains in

743
00:26:21,605 --> 00:26:23,605
hospital, which is, you know, typically about sort

744
00:26:23,605 --> 00:26:25,580
of 5 days or so. So I'll give

745
00:26:25,580 --> 00:26:28,140
this first indication of the kind of safety

746
00:26:28,140 --> 00:26:30,460
and feasibility of RSA patient in patients. But

747
00:26:30,460 --> 00:26:32,539
maybe also we'll get some early indications of

748
00:26:32,539 --> 00:26:33,039
efficacy.

749
00:26:33,340 --> 00:26:35,599
You know, we're that's what we're hoping. But

750
00:26:35,900 --> 00:26:37,424
lot there's a lot going on there. I

751
00:26:37,505 --> 00:26:38,945
mean, these patients, as I say, these patients

752
00:26:38,945 --> 00:26:40,505
got heart failure. They were going in for

753
00:26:40,505 --> 00:26:42,705
a coronary artery bypass. There are risks to

754
00:26:42,705 --> 00:26:44,404
that, to that, to that operation.

755
00:26:45,184 --> 00:26:47,424
So, you know, getting that ulcer approval as

756
00:26:47,424 --> 00:26:49,505
Assoc Sheikin said is quite challenging, but then

757
00:26:49,505 --> 00:26:51,345
also getting the patients into the study are

758
00:26:51,345 --> 00:26:52,085
quite difficult.

759
00:26:52,990 --> 00:26:55,230
One problem that we didn't expect that we've

760
00:26:55,230 --> 00:26:57,069
found in these early weeks of the study

761
00:26:57,069 --> 00:26:57,730
is that

762
00:26:58,509 --> 00:26:59,009
often

763
00:26:59,630 --> 00:27:01,950
these patients are being admitted to hospital several

764
00:27:01,950 --> 00:27:03,650
weeks before they have their surgery.

765
00:27:04,029 --> 00:27:06,125
Now sometimes they've kind of got themselves in

766
00:27:06,125 --> 00:27:07,884
a bad way because maybe they haven't been

767
00:27:07,884 --> 00:27:10,044
able to manage their diseases as well as

768
00:27:10,044 --> 00:27:11,585
they, as well as they might.

769
00:27:12,444 --> 00:27:14,924
One of our first candidates had quite severe

770
00:27:14,924 --> 00:27:15,424
diabetes

771
00:27:15,804 --> 00:27:17,644
and hadn't been very good at managing that

772
00:27:17,644 --> 00:27:19,325
diabetes. So of course, when they came into

773
00:27:19,325 --> 00:27:19,984
the hospital,

774
00:27:20,349 --> 00:27:22,190
the nurses were all over them. They they

775
00:27:22,190 --> 00:27:24,829
optimized their their their therapy. They monitored their

776
00:27:24,829 --> 00:27:26,990
diabetes properly. And what we found was that

777
00:27:26,990 --> 00:27:28,429
this patient was quite unwell when they came

778
00:27:28,429 --> 00:27:30,029
into hospital. By the time they came out

779
00:27:30,029 --> 00:27:31,789
and had the surgery, they were actually too

780
00:27:31,789 --> 00:27:34,095
healthy to be included in our study. So

781
00:27:34,095 --> 00:27:36,115
it's great for them, but, yeah.

782
00:27:36,494 --> 00:27:38,414
And actually that's happened quite a few times

783
00:27:38,414 --> 00:27:40,375
now. So it was this problem of the

784
00:27:40,575 --> 00:27:42,095
it was basically the hospital was doing the

785
00:27:42,095 --> 00:27:43,934
job too well. They were we're, like, making

786
00:27:43,934 --> 00:27:45,075
these patients well

787
00:27:45,375 --> 00:27:46,034
for us.

788
00:27:46,494 --> 00:27:48,434
And then, you know, occasionally you get complications

789
00:27:48,575 --> 00:27:50,069
from the surgery, you know,

790
00:27:50,630 --> 00:27:52,069
one guy unfortunately got a bit of a

791
00:27:52,069 --> 00:27:54,009
bleed after the surgery, had to be readmitted.

792
00:27:54,069 --> 00:27:55,750
I mean, he was fine after the surgeons

793
00:27:55,750 --> 00:27:58,149
had another go, but, but, you know, it

794
00:27:58,149 --> 00:28:00,169
excluded him from the study. So it's

795
00:28:00,710 --> 00:28:03,369
it's it's a it's an interesting but frustrating

796
00:28:03,509 --> 00:28:05,744
period. You know, as scientists, we used to

797
00:28:05,744 --> 00:28:07,264
set up our experiment and then we do

798
00:28:07,264 --> 00:28:09,825
the experiment. Here we've got, you know, health

799
00:28:09,825 --> 00:28:11,044
systems and patients

800
00:28:11,585 --> 00:28:13,424
and medicine getting in the way and it's,

801
00:28:13,424 --> 00:28:14,404
it's, it's,

802
00:28:14,944 --> 00:28:15,845
yeah. It's

803
00:28:16,599 --> 00:28:17,799
making me call my hair out at the

804
00:28:17,799 --> 00:28:19,179
moment, but we're getting there.

805
00:28:19,720 --> 00:28:21,799
How long has this clinical trial's meant to

806
00:28:21,799 --> 00:28:23,500
last, and then what happens after that?

807
00:28:24,039 --> 00:28:25,720
So we're gonna we're gonna look for a

808
00:28:25,720 --> 00:28:27,159
sort of a we're looking sort of 12,

809
00:28:27,159 --> 00:28:30,359
18 month recruitment period. We've we've actually gone

810
00:28:30,359 --> 00:28:32,535
quite large with, with this study.

811
00:28:33,474 --> 00:28:34,914
So normally as a sort of first in

812
00:28:34,914 --> 00:28:36,994
human evaluation, we go for about sort of

813
00:28:36,994 --> 00:28:37,815
15 patients.

814
00:28:38,355 --> 00:28:39,955
Based on the data we saw from the

815
00:28:39,955 --> 00:28:42,195
preclinical work, we've kind of pushed it to

816
00:28:42,195 --> 00:28:43,095
30 patients

817
00:28:43,474 --> 00:28:44,615
because we sort of

818
00:28:45,079 --> 00:28:47,240
based on the human animal data, maybe if

819
00:28:47,240 --> 00:28:49,160
we recruited that many patients, we might start

820
00:28:49,160 --> 00:28:50,619
to see some, some significant

821
00:28:50,920 --> 00:28:53,339
indications of efficacy in these, in these patients.

822
00:28:54,440 --> 00:28:56,440
Now there's 2 ways that this could go

823
00:28:56,440 --> 00:28:57,825
after, after this study.

824
00:28:58,384 --> 00:28:59,825
We've, we've sort of, you know, this is

825
00:28:59,825 --> 00:29:01,184
a first in humans, so we just want

826
00:29:01,184 --> 00:29:03,264
to show that RSA pacing is safe and

827
00:29:03,264 --> 00:29:05,105
that provides us as a gateway to then

828
00:29:05,105 --> 00:29:07,444
take the next step, miniaturize our technology

829
00:29:07,744 --> 00:29:10,244
and implant it with patients with more straightforward

830
00:29:10,384 --> 00:29:11,125
heart failure,

831
00:29:11,440 --> 00:29:13,039
and then pace them over a longer period

832
00:29:13,039 --> 00:29:14,640
of time. That gives us a much that

833
00:29:14,640 --> 00:29:17,359
gives us, you know, months of therapy rather

834
00:29:17,359 --> 00:29:19,039
than the days of therapy that we're getting

835
00:29:19,039 --> 00:29:19,779
this study.

836
00:29:20,080 --> 00:29:21,680
And then we should get an indication of

837
00:29:21,680 --> 00:29:23,940
the full effect of of RSA therapy.

838
00:29:25,005 --> 00:29:25,505
However,

839
00:29:26,125 --> 00:29:28,525
there is the possibility. I mean, all patients

840
00:29:28,525 --> 00:29:30,845
that go in for, for, for heart surgery

841
00:29:30,845 --> 00:29:33,244
generally have depressed cardiac function when they come

842
00:29:33,244 --> 00:29:34,845
out. The heart's been, you know, your chest

843
00:29:34,845 --> 00:29:36,365
has been open. The heart's been messed around

844
00:29:36,365 --> 00:29:38,240
with its, you know, it doesn't like. It.

845
00:29:38,299 --> 00:29:39,980
So your cardiac output probably is going to

846
00:29:39,980 --> 00:29:41,660
be down for a few days to, you

847
00:29:41,660 --> 00:29:43,579
know, few days to a few weeks post

848
00:29:43,579 --> 00:29:44,079
surgery.

849
00:29:44,539 --> 00:29:46,859
Now with most patients, it slowly recovers and

850
00:29:46,859 --> 00:29:48,380
the patients will feel better as that, as

851
00:29:48,380 --> 00:29:49,359
that comes around.

852
00:29:49,835 --> 00:29:52,075
But there are patients about 15% of patients

853
00:29:52,075 --> 00:29:54,234
where that, that recovery never really happens. And

854
00:29:54,234 --> 00:29:56,595
there'll have to be additional interventions to try

855
00:29:56,595 --> 00:29:57,035
and,

856
00:29:57,515 --> 00:30:00,095
make up for this, this deficit in cardiac

857
00:30:00,154 --> 00:30:00,654
function.

858
00:30:01,035 --> 00:30:03,035
So if we had a device whereby, you

859
00:30:03,035 --> 00:30:05,230
know, these patients are getting pacemakers anyway, if

860
00:30:05,230 --> 00:30:07,230
you fitted them with an RSA pacemaker, we'd

861
00:30:07,230 --> 00:30:09,169
not only protect them against those arrhythmias,

862
00:30:09,630 --> 00:30:11,970
but would also improve their cardiac function.

863
00:30:12,349 --> 00:30:14,509
Would that mean that those 15% of patients

864
00:30:14,509 --> 00:30:16,849
never, you know, get that prolonged depressed,

865
00:30:17,515 --> 00:30:21,035
cardiac function. And also all patients, the quicker

866
00:30:21,035 --> 00:30:23,115
you can improve their cardiac function, the quicker

867
00:30:23,115 --> 00:30:24,394
they're going to recover and the better they're

868
00:30:24,394 --> 00:30:26,075
going to feel. So maybe it would be

869
00:30:26,075 --> 00:30:28,795
a solution for all patients having, having reduced

870
00:30:28,795 --> 00:30:29,295
cardiac,

871
00:30:29,674 --> 00:30:30,974
having cardiac surgery.

872
00:30:31,640 --> 00:30:33,240
So there is there is kind of 2

873
00:30:33,240 --> 00:30:35,400
possibilities for this study. 1, you know, it's

874
00:30:35,400 --> 00:30:37,240
just the, you know, the first stepping stone

875
00:30:37,240 --> 00:30:39,080
in our development for long term therapy for

876
00:30:39,080 --> 00:30:41,320
heart failure, but also potentially it's a new

877
00:30:41,320 --> 00:30:43,559
therapy for all patients going in for cardiac

878
00:30:43,559 --> 00:30:44,059
surgery.

879
00:30:44,680 --> 00:30:45,799
And we'll just have to,

880
00:30:46,444 --> 00:30:50,444
just wait and see. Now I understand that

881
00:30:50,444 --> 00:30:52,045
that, you know, this is you're looking at

882
00:30:52,045 --> 00:30:52,785
at cardiac

883
00:30:53,164 --> 00:30:55,244
applications of this sort of,

884
00:30:55,964 --> 00:30:56,545
you know,

885
00:30:57,085 --> 00:30:59,549
your the core technology in the first place.

886
00:30:59,950 --> 00:31:02,830
Are there any other areas where this, you

887
00:31:02,830 --> 00:31:04,350
know, sort of I guess you could see

888
00:31:04,350 --> 00:31:07,309
appreciation of of the nonlinear nature of the

889
00:31:07,309 --> 00:31:11,390
body signals could and and coupling an external

890
00:31:11,390 --> 00:31:12,130
or implanted

891
00:31:12,535 --> 00:31:15,174
electrical device to that. Are there other applications

892
00:31:15,174 --> 00:31:16,234
where that could also

893
00:31:16,535 --> 00:31:17,835
be effective clinically?

894
00:31:19,414 --> 00:31:21,095
Yeah. So, I mean, if if you know,

895
00:31:21,095 --> 00:31:22,855
just to throw a few examples out there.

896
00:31:22,855 --> 00:31:24,630
I mean, you know, you said, you know,

897
00:31:24,630 --> 00:31:25,849
the body's full of nonlinearity,

898
00:31:26,230 --> 00:31:28,230
and we think our technology will be ideally

899
00:31:28,230 --> 00:31:28,730
suited

900
00:31:29,029 --> 00:31:31,609
to a more physiological control to these mechanisms.

901
00:31:32,230 --> 00:31:34,390
So one area that Ashford's been looking at

902
00:31:34,390 --> 00:31:34,789
is,

903
00:31:35,589 --> 00:31:36,809
a condition called dysphagia,

904
00:31:37,535 --> 00:31:40,015
which where you ability to swallow. And this

905
00:31:40,015 --> 00:31:42,575
most commonly occurs after people have had a

906
00:31:42,575 --> 00:31:43,474
had a stroke.

907
00:31:43,775 --> 00:31:46,174
Now swallowing is is a coordination of about

908
00:31:46,174 --> 00:31:48,595
a dozen muscles within the within the throat,

909
00:31:48,990 --> 00:31:50,509
And they all have to have, they all

910
00:31:50,509 --> 00:31:52,750
have a rhythmical contraction, which needs to be

911
00:31:52,750 --> 00:31:53,250
coordinated.

912
00:31:54,349 --> 00:31:56,990
There are medical device therapies out there for

913
00:31:56,990 --> 00:31:57,490
dysphasia,

914
00:31:57,950 --> 00:31:59,309
but they tend to be, you know, a

915
00:31:59,309 --> 00:32:01,410
single point, electrical stimulation

916
00:32:01,789 --> 00:32:04,285
of the throat or they are special foods

917
00:32:04,285 --> 00:32:06,045
that makes it easier for the for the

918
00:32:06,045 --> 00:32:07,424
patient to to swallow.

919
00:32:08,285 --> 00:32:10,845
Whereas our technology, we're really good at taking

920
00:32:10,845 --> 00:32:13,245
input from those 12 muscles, which were currently

921
00:32:13,245 --> 00:32:14,705
dysfunctional and then coordinate

922
00:32:15,085 --> 00:32:18,409
their contraction into the appropriate rhythm to to

923
00:32:18,409 --> 00:32:19,629
enable swallowing.

924
00:32:22,250 --> 00:32:23,069
There obviously

925
00:32:23,690 --> 00:32:24,429
are the

926
00:32:24,970 --> 00:32:27,450
your di rest of your digestive tract also

927
00:32:27,450 --> 00:32:29,849
is coordinate is a coordination of multiple muscle,

928
00:32:29,849 --> 00:32:32,515
give that peristaltic motion. And there are certainly

929
00:32:32,515 --> 00:32:34,515
plenty of patients out there that have,

930
00:32:35,075 --> 00:32:35,575
problems

931
00:32:35,954 --> 00:32:38,454
with the, lower digestive tract.

932
00:32:39,075 --> 00:32:39,575
The

933
00:32:39,875 --> 00:32:42,275
example that I started with of your legs

934
00:32:42,275 --> 00:32:44,355
is, I suppose, is the most obvious one.

935
00:32:44,355 --> 00:32:46,519
And that's really the kind of

936
00:32:47,299 --> 00:32:47,799
ultimate

937
00:32:48,099 --> 00:32:49,559
application for our technology.

938
00:32:49,859 --> 00:32:50,440
I mean,

939
00:32:51,779 --> 00:32:54,359
Ashok talked about central pattern. Right? Is those

940
00:32:54,579 --> 00:32:57,139
those networks of of neurons in your in

941
00:32:57,139 --> 00:32:59,240
your spine are are amongst the most complicated

942
00:32:59,299 --> 00:33:01,234
ones that we thought we might we might

943
00:33:01,694 --> 00:33:02,515
tackle. But,

944
00:33:03,414 --> 00:33:06,015
I'm a little cat story. I had, people

945
00:33:06,015 --> 00:33:07,295
have told me to stop telling the cat

946
00:33:07,295 --> 00:33:09,375
story, but it's a bit off tangent. But

947
00:33:09,375 --> 00:33:11,055
basically if you go, if you go on

948
00:33:11,055 --> 00:33:12,974
YouTube, there is, and you can find it,

949
00:33:12,974 --> 00:33:15,390
there's a black, grainy black and white image,

950
00:33:15,789 --> 00:33:16,769
video really.

951
00:33:17,470 --> 00:33:19,109
And I imagine it's black and white because

952
00:33:19,109 --> 00:33:21,650
you probably can't do these experiments anymore, but

953
00:33:22,109 --> 00:33:23,630
what they've done to it, they've taken it

954
00:33:23,630 --> 00:33:25,789
out and they've decerebralized the cat. So basically

955
00:33:25,789 --> 00:33:28,029
severed the connection between the cat's brain and

956
00:33:28,029 --> 00:33:30,075
the cat's legs. So you would assume this

957
00:33:30,075 --> 00:33:31,835
cat to be paralyzed, but what they do

958
00:33:31,835 --> 00:33:32,875
is they take the cat and they put

959
00:33:32,875 --> 00:33:34,795
it onto a treadmill. And as soon as

960
00:33:34,795 --> 00:33:37,115
the cat's feet touch the treadmill, it starts

961
00:33:37,115 --> 00:33:39,355
to start to walk and they'll turn the

962
00:33:39,355 --> 00:33:40,875
treadmill up and the cat will start to

963
00:33:40,875 --> 00:33:42,234
run. And they, for some reason, they put

964
00:33:42,234 --> 00:33:43,595
a little trolley on the back of it

965
00:33:43,595 --> 00:33:45,419
and they pull the car. I don't know

966
00:33:45,419 --> 00:33:47,500
the necessity of doing that, but it just

967
00:33:47,500 --> 00:33:49,900
shows that it can change the gait, I

968
00:33:49,900 --> 00:33:52,059
suppose, of, of the animal, even though there's

969
00:33:52,059 --> 00:33:53,819
no connection there between the brain and the,

970
00:33:53,819 --> 00:33:55,259
and the, and the legs. Now I'd always

971
00:33:55,259 --> 00:33:56,940
assume that your brain had something to do

972
00:33:56,940 --> 00:33:58,974
with your ability to walk, but it seems

973
00:33:58,974 --> 00:34:00,575
that you just like where you want to

974
00:34:00,575 --> 00:34:02,034
go and then your legs kind

975
00:34:02,654 --> 00:34:04,815
of control themselves. And the way they do

976
00:34:04,815 --> 00:34:06,974
that is they send sensory inputs up to

977
00:34:06,974 --> 00:34:09,775
the spine, the central pattern generators process that

978
00:34:09,775 --> 00:34:11,474
information, then send the,

979
00:34:11,775 --> 00:34:14,489
the stimulator impulses down to your legs. And

980
00:34:14,489 --> 00:34:17,130
that provides the coordination of the muscles, which

981
00:34:17,130 --> 00:34:19,050
allows us, which allows us to walk. And

982
00:34:19,050 --> 00:34:22,190
that experiment that they performed, which is demonstrating

983
00:34:22,409 --> 00:34:23,210
that the

984
00:34:23,929 --> 00:34:26,030
legs is mediated by

985
00:34:26,489 --> 00:34:28,795
the nerves within the spine, rather than also

986
00:34:28,795 --> 00:34:30,315
the brain. So for us, that means that

987
00:34:30,315 --> 00:34:31,454
someone who's had a,

988
00:34:31,835 --> 00:34:33,994
a spinal cord injury, maybe it's even severed

989
00:34:33,994 --> 00:34:35,675
to the spinal cord, we could set we

990
00:34:35,675 --> 00:34:36,335
could rep

991
00:34:37,035 --> 00:34:38,954
those central pattern generators in the spine and

992
00:34:38,954 --> 00:34:41,135
restore the ability to to walk.

993
00:34:41,889 --> 00:34:42,949
Like Stuart explained,

994
00:34:43,250 --> 00:34:45,409
so these are central pattern generators that control

995
00:34:45,409 --> 00:34:47,969
the rhythms and then stimulate the muscles, and

996
00:34:47,969 --> 00:34:51,010
that generates different gait for the legs. And

997
00:34:51,010 --> 00:34:52,469
if there's somebody's amputated,

998
00:34:53,489 --> 00:34:53,989
and

999
00:34:54,369 --> 00:34:57,170
they can be used to control those artificial

1000
00:34:57,170 --> 00:34:57,670
legs.

1001
00:34:58,425 --> 00:35:00,664
But the control of arms is even more

1002
00:35:00,664 --> 00:35:01,965
complex where you have

1003
00:35:02,265 --> 00:35:02,765
different,

1004
00:35:03,224 --> 00:35:04,285
fingers and

1005
00:35:04,905 --> 00:35:07,485
different grip sizes. So this nonlinear

1006
00:35:08,265 --> 00:35:10,364
dynamics of the central pattern generators

1007
00:35:10,985 --> 00:35:12,445
can then be used to

1008
00:35:12,960 --> 00:35:14,420
control the movement of arms

1009
00:35:15,199 --> 00:35:17,280
with different crypt levels. If you imagine the

1010
00:35:17,280 --> 00:35:20,179
complexity of the network, it can be extended

1011
00:35:20,400 --> 00:35:22,260
by adding more neurons to it.

1012
00:35:22,559 --> 00:35:24,400
And this would presumably require quite a lot

1013
00:35:24,400 --> 00:35:26,019
of computational power as well.

1014
00:35:26,719 --> 00:35:28,545
It would. And if it's to be done

1015
00:35:28,545 --> 00:35:29,045
digitally,

1016
00:35:29,984 --> 00:35:31,525
but in analog systems,

1017
00:35:32,065 --> 00:35:33,764
it can be done much more efficiently,

1018
00:35:35,105 --> 00:35:36,644
because it'll be real time,

1019
00:35:37,425 --> 00:35:39,925
as it's a nonlinear and continuous time

1020
00:35:41,289 --> 00:35:42,349
signals generation.

1021
00:35:42,730 --> 00:35:43,369
So the

1022
00:35:45,049 --> 00:35:46,829
and lots of parameters are already

1023
00:35:47,289 --> 00:35:47,789
defined

1024
00:35:48,489 --> 00:35:50,889
so that you, ma'am, you'd you won't have

1025
00:35:50,889 --> 00:35:51,949
to look for the

1026
00:35:52,824 --> 00:35:55,485
certain level of inputs and then make decisions.

1027
00:35:55,625 --> 00:35:57,804
It will be much more dynamic than that.

1028
00:35:58,184 --> 00:36:00,445
So that's where the true power of the

1029
00:36:00,585 --> 00:36:01,724
continuous systems,

1030
00:36:02,824 --> 00:36:04,925
will be in nonlinear systems, will it?

1031
00:36:05,704 --> 00:36:05,945
Well

1032
00:36:06,905 --> 00:36:07,405
and

1033
00:36:07,980 --> 00:36:09,420
so final question for for both of you,

1034
00:36:09,420 --> 00:36:10,400
actually. You know,

1035
00:36:10,699 --> 00:36:12,079
what do you know now

1036
00:36:12,460 --> 00:36:14,380
that you wish you knew when you started

1037
00:36:14,380 --> 00:36:17,019
this journey back in 2016, in your case,

1038
00:36:17,019 --> 00:36:19,420
Stuart, and when you're starting on your your

1039
00:36:19,420 --> 00:36:20,639
postdoc Ashok?

1040
00:36:21,179 --> 00:36:22,755
I mean, it's certainly the I mean, there

1041
00:36:22,755 --> 00:36:24,114
are some of the boring ones and you

1042
00:36:24,114 --> 00:36:25,474
can fill them out. So, I mean, I

1043
00:36:25,474 --> 00:36:26,914
think the I think the clinic I think

1044
00:36:26,914 --> 00:36:28,114
the clinical side of things has been a

1045
00:36:28,114 --> 00:36:29,474
bit little bit of surprise. I mean, I

1046
00:36:29,474 --> 00:36:30,994
think that when we when we when we

1047
00:36:30,994 --> 00:36:32,994
can we thought the message the biggest challenge

1048
00:36:32,994 --> 00:36:34,755
was gonna be the regulatory approval for the

1049
00:36:34,755 --> 00:36:36,054
device, but we were actually

1050
00:36:38,460 --> 00:36:40,539
pretty pleased with the way with the speed

1051
00:36:40,539 --> 00:36:43,119
with which, you know, the the authorities processed,

1052
00:36:44,140 --> 00:36:46,460
and evaluated our technology. And that was really

1053
00:36:46,460 --> 00:36:46,960
straightforward.

1054
00:36:48,394 --> 00:36:50,315
Getting into the clinic, I was warned, I

1055
00:36:50,315 --> 00:36:52,074
think, that it would take 6 months from

1056
00:36:52,074 --> 00:36:54,155
that point to, to getting the first patient

1057
00:36:54,155 --> 00:36:55,614
in, and I didn't believe them.

1058
00:36:56,315 --> 00:36:58,234
And they were right. And they were right.

1059
00:36:58,234 --> 00:36:58,554
And,

1060
00:36:59,034 --> 00:37:01,230
yeah. And I, I didn't appreciate that the

1061
00:37:01,389 --> 00:37:03,630
just what is involved with what seemed to

1062
00:37:03,630 --> 00:37:04,849
be a relatively straightforward

1063
00:37:05,630 --> 00:37:06,130
straight.

1064
00:37:07,550 --> 00:37:09,889
In terms of starting out the

1065
00:37:11,230 --> 00:37:12,829
I think that it took us a little

1066
00:37:12,829 --> 00:37:13,650
bit of time.

1067
00:37:14,110 --> 00:37:15,889
I mean, the the thing about our technology

1068
00:37:16,110 --> 00:37:16,844
is that the

1069
00:37:17,405 --> 00:37:19,244
the clever bit is the is the, you

1070
00:37:19,244 --> 00:37:20,304
know, this this

1071
00:37:20,605 --> 00:37:21,344
this this core

1072
00:37:21,965 --> 00:37:23,824
technology, I say, that's actually

1073
00:37:24,125 --> 00:37:26,045
the the tech. The rest of the device,

1074
00:37:26,045 --> 00:37:27,565
you know, we talked about this the the

1075
00:37:27,565 --> 00:37:30,445
clinical study being involving an external pacing system

1076
00:37:30,445 --> 00:37:32,065
that we've modified with our technology.

1077
00:37:32,719 --> 00:37:33,539
So 99%

1078
00:37:33,920 --> 00:37:35,839
of the device is is just a standard

1079
00:37:35,839 --> 00:37:38,000
pacemaker and the implantable will be exactly the

1080
00:37:38,000 --> 00:37:39,920
same. It's just a pacemaker with our with

1081
00:37:39,920 --> 00:37:40,659
our chip

1082
00:37:40,960 --> 00:37:42,960
in place. So I think we started with

1083
00:37:42,960 --> 00:37:45,199
the premise that, you know, let's let's go

1084
00:37:45,199 --> 00:37:47,039
and talk to Medtronic or one of the

1085
00:37:47,039 --> 00:37:47,940
other big corporates.

1086
00:37:48,344 --> 00:37:50,184
They'll give us their pacemaker. We'll put our

1087
00:37:50,184 --> 00:37:51,758
chip in it. And there we go. That's,

1088
00:37:51,758 --> 00:37:54,105
that's, that's, that's kind of done. And there

1089
00:37:54,105 --> 00:37:55,704
were 2 things that we've learned over the

1090
00:37:55,704 --> 00:37:57,965
years. 1, they're not prepared to do that.

1091
00:37:58,344 --> 00:38:00,264
And 2, we don't need them to do

1092
00:38:00,264 --> 00:38:03,430
that actually because because this technology has been

1093
00:38:03,430 --> 00:38:04,809
around since the fifties,

1094
00:38:05,269 --> 00:38:06,890
most of the most of what's

1095
00:38:07,269 --> 00:38:08,489
required is there

1096
00:38:09,349 --> 00:38:12,630
is available from particular support. The technology and

1097
00:38:12,630 --> 00:38:14,710
the challenge of putting them together is not,

1098
00:38:14,710 --> 00:38:16,574
is not that great. So I think we're

1099
00:38:16,574 --> 00:38:19,074
much more self sufficient now than we were,

1100
00:38:19,535 --> 00:38:21,235
you know, 3 or 4 years ago.

1101
00:38:22,014 --> 00:38:22,335
When we

1102
00:38:23,135 --> 00:38:25,315
in terms of the route that we're choosing

1103
00:38:25,375 --> 00:38:27,869
to develop this technology, it's like, you know,

1104
00:38:27,950 --> 00:38:29,470
no one's gonna help you do this. You

1105
00:38:29,470 --> 00:38:31,470
just gotta do it yourself, but actually, doing

1106
00:38:31,470 --> 00:38:33,070
it yourself is probably the most efficient way

1107
00:38:33,070 --> 00:38:34,110
to do it anyway. So

1108
00:38:35,070 --> 00:38:36,269
Ashok, do you have anything to add to

1109
00:38:36,269 --> 00:38:36,769
that?

1110
00:38:37,710 --> 00:38:39,789
I I would add from my point of

1111
00:38:39,789 --> 00:38:40,769
view, I think

1112
00:38:41,414 --> 00:38:43,355
transition from academia to industry

1113
00:38:44,135 --> 00:38:45,855
has been a big learning,

1114
00:38:46,295 --> 00:38:48,155
although you hear lots of

1115
00:38:50,054 --> 00:38:50,554
suggestions,

1116
00:38:50,934 --> 00:38:53,755
they're all valid, but experiencing them and

1117
00:38:55,660 --> 00:38:58,140
actually, dealing with them is a slightly different

1118
00:38:58,140 --> 00:38:59,039
story. But,

1119
00:38:59,980 --> 00:39:02,219
especially with the start ups, things are very

1120
00:39:02,219 --> 00:39:02,719
dynamic.

1121
00:39:03,500 --> 00:39:06,619
And the key difference between academia and industry

1122
00:39:06,619 --> 00:39:08,699
is the pace at which you can do

1123
00:39:08,699 --> 00:39:11,284
the things. Of course, a lot of academic

1124
00:39:11,284 --> 00:39:12,744
work has been done. And when

1125
00:39:13,125 --> 00:39:15,704
you're making a product, even if it is

1126
00:39:15,924 --> 00:39:18,904
that level of complexity going into human body,

1127
00:39:21,125 --> 00:39:23,704
you can do things much faster than

1128
00:39:24,849 --> 00:39:26,070
in academia. And

1129
00:39:26,530 --> 00:39:27,989
so you need to be

1130
00:39:28,369 --> 00:39:31,590
mentally prepared for that dynamism in the startups.

1131
00:39:31,809 --> 00:39:32,309
And,

1132
00:39:33,969 --> 00:39:35,269
the other is the communication.

1133
00:39:36,609 --> 00:39:37,109
So

1134
00:39:38,784 --> 00:39:40,304
especially in our case, because there have been

1135
00:39:40,304 --> 00:39:41,765
multiple disciplines involved.

1136
00:39:42,224 --> 00:39:42,724
And

1137
00:39:43,265 --> 00:39:46,065
as Stuart mentioned, investors who are not from

1138
00:39:46,065 --> 00:39:49,125
science background or physics background, to convince them.

1139
00:39:49,184 --> 00:39:50,244
So you need to

1140
00:39:50,550 --> 00:39:52,010
speak at multiple levels,

1141
00:39:52,550 --> 00:39:53,289
of complexity

1142
00:39:54,309 --> 00:39:54,809
and

1143
00:39:55,670 --> 00:39:57,849
the details. Oh, and

1144
00:39:58,309 --> 00:40:01,110
it's a learning process. I'm still learning, and

1145
00:40:01,110 --> 00:40:02,949
then but I think I've come a long

1146
00:40:02,949 --> 00:40:03,449
way.

1147
00:40:03,829 --> 00:40:05,610
There's a long way to go as well.

1148
00:40:06,364 --> 00:40:08,444
Well, thank you both for for, coming and

1149
00:40:08,444 --> 00:40:09,964
and and talking to me today. I really

1150
00:40:09,964 --> 00:40:11,885
appreciate it. Stuart Naschach, thank you very much

1151
00:40:11,885 --> 00:40:13,664
for joining us in the Physicworld podcast.

1152
00:40:14,364 --> 00:40:16,144
Brilliant. Thank you very much.

1153
00:40:23,610 --> 00:40:25,369
I'm afraid that's all the time we have

1154
00:40:25,369 --> 00:40:26,750
for this week's podcast.

1155
00:40:27,130 --> 00:40:28,829
Thanks to CRX Medical's

1156
00:40:29,289 --> 00:40:30,269
Stuart Plant

1157
00:40:30,570 --> 00:40:32,030
and Ashok Chowan

1158
00:40:32,410 --> 00:40:34,110
for a fascinating discussion,

1159
00:40:34,464 --> 00:40:37,664
And also thanks to Margaret Harris for asking

1160
00:40:37,664 --> 00:40:38,405
the questions,

1161
00:40:38,784 --> 00:40:42,164
and to Fred Iles for producing the audio

1162
00:40:42,224 --> 00:40:43,284
in this podcast.

1163
00:40:43,824 --> 00:40:45,684
We'll be back again next week.