The Road Ahead: A New Year of Possibilities for Brain Tech Startups
Why brain tech, why now?
Over the past few years, we have seen the continued maturation of the brain tech startup ecosystem. Brain tech startups, or
neuro startups, lie at the interface between neuroscience and technology. They are building a future where the diseased brain can be healed and the healthy brain can be optimized, or even augmented. Not long ago, the idea of a “neuro startup” was obscure. Now, investors can track the Neuroscience Startups category on AngelList, which (as of this writing) includes 231 early-stage companies. Data aggregator Crunchbase tracks a total of 367 neuroscience startups. Neuroscience based products are becoming pervasive in popular culture. Lately, as neurotech has blown up in the media (examples here, here, here, and here), there has been an explosion of interest from investors and analysts in a space that was once the exclusive domain of highly specialized academics and enthusiasts.
Here’s where we stand now, and what we can expect in the year ahead. Taking a broad view of the brain tech ecosystem, ranging from brain-computer interfaces to neuropharmacology, we sought the perspectives of those who might know best — founders, mentors, and expert friends from the NeuroLaunch community.
The High-Performing Brain
“2019 will be a defining year for personalized neuroinformatics to become fully pervasive in the workplace. Scaling mobile neurotechnologies together with translational algorithms and artificial intelligence will allow us to improve people’s focus, wellness, productivity and safety at work.”
Improving human function through neurotechnology is an ambition that has excited consumers, institutions, and investors. Product launches in this area have been plentiful. At CES this year, Halo Neuroscience announced its second-generation wearable “neuropriming” device to enhance athletic function. Neurable has announced a major partnership to develop mixed-reality solutions for architecture and transportation, combining AR/VR with EEG signals. On the therapeutic side, we expect more brain tech companies like MindMaze and NeoSensory to tackle neuro-rehabilitation with novel devices. Neuro-gaming is evolving into a multifaceted category of its own, blurring the lines between entertainment, medical applications, and work; for instance, games by Akili Interactive made waves in the medical community after demonstrating efficacy for ADHD in randomized controlled trials, opening up a pipeline for games as prescribed therapies for neurological disorders.
“Voice computing is transforming medicine; from digital biomarkers in psychiatry to helping drive compliance through reminders sent through voice assistants, voice-centered devices will complement EEGs, MRIs, and blood tests as a new medium to diagnose and treat patients.”
A new crop of companies is recognizing, as its foundational principle, that the human voice is a direct window into brain function. This past year, the Voice Health Summit made history as the largest event bringing together voice tech startups around health care applications. Among these were companies like Beyond Verbal, which is developing AI-enabled voice biomarkers of emotion, and NeuroLex Laboratories, which applies machine learning to voice data for detection of mental health conditions. Abundant capital is flowing into voice tech, notably from Amazon’s Alexa Fund, which is investing over $200m to fuel voice tech innovation. AI-enabled technologies to translate brain signals directly into speech are now on the horizon. In the next year, we can expect the increasingly seamless integration of voice tech into daily life, along with success stories for the startups who make it happen.
“Many think mental health will be the last to be digitized, because the clinicians involved need face time and have deep clinical intuition. However, I think it will be one of the first, and driven by the needs of the patient: to get useful care, not just during doctors’ hours, without stigma, privately, in their own homes, and on their own terms!”
Digital products in the arena of mental health are being released at a breakneck pace. Recent examples include a service for matching patients with therapists, psychiatric chatbots, and digital therapy for corporate employees. Transcranial magnetic stimulation as a treatment for depression is burgeoning as a non-drug alternative, thanks to devices from Magstim and Neuronetics. Startups like Brain Power are applying augmented reality to previously hard-to-treat neurodevelopmental disorders such as autism. Headspace, the mobile app for meditation, had a banner year in 2018, posting over $100m in revenue. The US Department of Veteran Affairs has partnered in a pilot with behavioral tracking app NeuroFlow to improve clinical outcomes for “the whole person.” Mindstrong Health, co-led by former NIMH head Dr. Tom Insel and backed by a star-studded coalition of investors that includes Jeff Bezos, promises seamless continuity between mental health services by utilizing an array of mobile technology, telehealth, early detection, and digital biomarkers. In 2019, we are likely to continue seeing a funding frenzy for neuro startups that enable the mass integration of digital technology with mental health services.
Neurosurgery and Neuromodulation
“In the field of neuroimaging and neurosurgery, connecting clinicians with state of the art quantitative tools will allow for better understanding of the human brain, with more accurate diagnostics and treatment for patients with brain diseases. We will see an era marked by the availability of ‘Google Maps’ for the brain.”
— Dr. Vesna Prchkovska, Co-Founder/COO, QMENTA
Directly manipulating the brain to treat disease goes back at least as far as the ancient Egyptians, but it could be argued that humanity is just now entering the golden age of brain surgery. Anatomical structures can now be targeted with extreme precision, with neuronavigation products from startups like Synaptive joining updated releases from incumbents Medtronic and BrainLab. Specialized robots for neurosurgical applications (see ROSA and Mazor) are accelerating in their adoption, with the next generation of university spinout neuro-robotics startups, such as Israel-based Tamar Robotics, yipping at their heels. Deep brain stimulation will continue to modernize, with steerable electrodes and closed-loop programming improving efficacy and opening up new indications in the realm of brain disorders, from Parkinson disease to depression. Advanced brain imaging (see QMENTA) and minimally invasive surgery will witness some of the most exciting advances. In recent decades, neuro-endovascular techniques have emerged to enable access to strokes and brain lesions via the blood vessels, but the wild horizon of endovascular brain-computer interfaces has only just dawned. Computational methods will play an increasingly important role in pre-surgical planning and surgeon training, with surgical VR products such as Surgical Theater and Osso VR finally hitting the mainstream.
In the near future, surgeon-machine collaboration is coming to an OR near you — in one form or another, digital algorithms and humans shall soon be working together as co-surgeons, each of them indispensable to the best clinical outcome.
“Neuroadaptive technology is set to deliver on its longtime promise — whether game changing active BCI like CTRL-Labs, or new insights into lifelong brain health and disease from very large scale wearable consumer neurotech. We’re entering a new stage of mass adoption in 2019.”
The prospect of market-ready, reliable, useful brain-computer interfaces (BCI) has perhaps generated more attention in the public eye than any other domain of neurotech over the past couple years, and that trend is likely to continue into 2019. Following a spate of BCI-related announcements by Elon Musk’s Neuralink, Facebook, Kernel, Openwater, and other promising but less-hyped market entrants, the past year saw both invasive and non-invasive BCI remaining omnipresent in the news. Notable projects included neuromuscular BCI using facial signals to transcribe words and Internet-mediated brain-to-brain social networks. In the U.S. especially, startups are benefiting from the fruits of publicly funded research; for example, Paradromics raised $7m for bidirectional BCI as a therapy for patients with defects in brain connectivity, based on technology funded by DARPA’s Neural Engineering System Design program. On the noninvasive BCI side, consumer neurotechnology leaders such as EMOTIV and Muse (Interaxon) have been relentlessly improving their offerings with an emphasis on user experience and deep insights from brain data. Based on recent press, one imagines that ubiquitously EEG-enabled Formula 1 racecars and Harley-Davidson motorcycles may not be far off. Insiders are hopeful that we will soon see a fulfillment of the promises that have surrounded BCI since the groundbreaking early results of research programs like BrainGate captured our imagination at the turn of the millennium. In 2019, we can expect more meaningful product launches, funding events, and technical advances. The optimists (analysis here, or here) see a vast market for BCI opening up over the next few years, encompassing both the regulated (i.e., medical devices) and non-regulated (i.e., consumer technology) markets for these technologies.
“[The neuromodulation community] is now developing technologies to exploit our understanding of the mechanisms of neural plasticity and development to achieve a higher level of repair and modulation.”
Neuromodulation is the process of precisely fine-tuning the brain’s function by electrical, biochemical, or other means. And as a fly on the wall at Las Vegas’s annual North American Neuromodulation Society (NANS) convention would tell you, neuromodulation startups are hot. Over the past year, product announcements in neuromodulation have come in rapid-fire succession. For example, Silicon Valley-based NeuroPace released a next-generation responsive stimulator for epilepsy. Groundbreaking results demonstrating efficacy of spinal cord neuromodulation in restoring function to paralyzed patients is a hint of neuro startups to come. Industry giants have kept their proverbial fingers on the pulse through programs like GSK’s bioelectronics initiative, which has invested in a cohort of remarkable companies like SetPoint Medical, a startup aiming to modulate immunity by targeting the vagus nerve.
Pain Management and Addiction
“The addiction crisis is the HIV epidemic of our generation. Unlike the 80s and 90s, we’re fortunate that technology innovation is an order of magnitude faster. I’m hopeful that brain tech will enable us to address our generation’s public health crisis an order of magnitude faster.”
Increasingly, the world looks to neuroscience to solve the interrelated problems of pain and addiction. In this era, neuro startups will lead the fight against the opioid crisis, spurred onward by public and private institutions. Last year, in the United States, a bipartisan bill provided hope for increased access to treatment for opioid addiction and resources for ventures that fight addiction using neuroscience principles. The National Institutes of Health announced the HEAL Initiative, a trans-agency effort to speed scientific solutions to stem the national opioid public health crisis. The FDA joined in with its own Innovation Challenge focusing on medical devices for pain. Finally, Yale University’s new Innovation to Impact program seeks to mobilize entrepreneurship as a tool against substance disorders.
Concurrently with efforts to combat the opioid epidemic, a growing community of brain tech startups is developing safer and more effective methods of treating pain. Neuros Medical is commercializing intellectual property around blockading pain conduction through nerve fibers. Karuna uses VR to manage the behavioral outcomes of chronic pain. Neurometrix has developed a wearable device that quells pain signals in the brain by stimulating peripheral nerves. With the societal problems of chronic pain and opioid use co-existing as dichotomous epidemics, we expect neuro startups offering effective solutions to these problems to gain traction — and scale — quickly.
“For single gene neuro diseases, neuropharma startups will increasingly pursue therapies focused on genetic insertion, silencing, and modification — bringing hope for a cure to patients with rare and catastrophic genetic conditions. For complex spectrum disorders such as autism, neuropharma startups will increasingly conduct clinical trials of drug combinations — to target multiple therapeutic actions when multiple biochemical pathways are involved.”
— Jeffrey S. Aronin, Chairman and CEO, Paragon Biosciences
Although the neuropharma drug pipeline has notoriously been regarded as sluggish over the past decade, a new generation of startups is sparking hope in the battle against CNS disorders. Many of these companies seek to disrupt the process of CNS drug discovery. System 1 Biosciences raised $25m in its effort to use cerebral organoids to reinvent the discovery process. Verge Genomics applies AI to biological model data to aid in finding promising compounds. Well-funded companies with experienced teams have emerged to conquer less-charted territories such as neuroprotection (Magnolia Neurosciences) and the gut-brain axis (Kallyope, which closed an $87M Series B round led by Bill Gates). The neuropharma space will soon see the fruits of partnerships between strange bedfellows. Industry giants Pfizer and Bain Capital announced the development of Cerevel Therapeutics, for which Pfizer is contributing its library of preclinical CNS compounds. Denali Therapeutics made waves by partnering with Sirion Biotech to develop adeno-associated virus vector (AAV) therapies for delivering gene therapies to the nervous system. In 2019, we hope to see the CNS pipeline reinvigorated by new approaches to drug discovery, testing, and delivery.
“New ways of thinking about and intervening in brain processes are among the most promising gateways to human flourishing, but careful thinking about risks and downstream consequences are the only way to assure the realization of these transformative technologies.”
In 2018, we saw discourse around neuroethics — the discipline in which philosophical and societal dimensions of neuroscience are taken to inform policy and behavior — reach international prominence, particularly as it applies to the brain tech industry. The OECD convened academics, policymakers, and neuro-entrepreneurs in Shanghai for the Workshop on Minding Neurotechnology: Delivering Responsible Innovation for Health and Well-Being. The Global Neuroethics Summit, held in Daegu City in 2017 and Seoul in 2018, led to the launch of the International Brain Initiative as a collaboration among the 7 existing national brain initiatives (see the resulting white paper published in Neuron). Neuro-ethical considerations have now descended from the ivory tower into the world of venture-backed startups, with recent situations such as MIT’s repudiation of Nectome and ongoing neuro-privacy concerns showing that every neuro-startup needs an ethics strategy. Grassroots entrepreneurial groups such as BrainMind, NeuroLaunch, and NeuroTechX have continued to grow organically, demonstrating the existence of a coherent brain tech startup ecosystem that can now wrestle with business and policy matters alike. Scholarly groups such as the International Neuroethics Society, journals, and blogs are being cited as resources for companies working at the interface of ethics, society, and neurotechnology.
As our embodied brains forge ahead into 2019, the road is brightly illuminated. Here’s to our neuro future! 🧠🚀
— Jordan Amadio and Ankita Moss