[00:00:28] Aaron Martin: Hi, this is Aaron Martin. I’m the Chief Digital Officer for Providence, and I’m also a Day Zero advisory council member. Really awesome to be interviewing Nina Tandon, who is an incredible entrepreneur. And one of the, key things I’m super excited about talking to Nina about is that, usually in my line of work, we’re looking kind of two to three years out, and software, and that kind of thing. The work that Nina is doing is a little bit further out, but not super futuristic with kind of flying cars and that kinda thing. So Nina, you and I met at Digital 50. Can you just kind of describe what your company is doing? It’s super exciting and I couldn’t wait to kind of see if I could get you on this podcast.

[00:01:09] Nina Tandon, Ph.D.: Aw, thanks for having me. And it was so great to meet you at that event. So I’m CEO and co-founder of EpiBone. EpiBone is a company that combines digital fabrication, which is technologies like 3D printing, 3D carving, and the like, with stem cells. And so we can take stem cells and we can differentiate them into lots of different shapes and lots of different tissues. So we’re making bone, we’re making cartilage, we’re making combinations of bone and cartilage that can help folks who require skeletal reconstruction, whether that’s for congenital defects, cancer, trauma, and the like.

[00:01:42] Aaron Martin: That’s excellent. That’s really incredible too and we’ll get more into the details in a little bit, to hear you talk about the technology, and how it’s evolved, and that kind of thing. But before we go there, tell me a little bit about your journey to kind of starting a company and kind of your background, and what got you into an entrepreneurial mindset and what got you to kind of take the leap?

[00:02:05] Nina Tandon, Ph.D.: Well, I think the entrepreneurial mindset came from my upbringing. My sisters and I had a little babysitters co-op going in our neighborhood growing up. And so the idea of working for oneself or working in a, starting something like that, it certainly came from my childhood. But I’m an electrical engineer by training. And so I started out doing software programming for enterprise communication software. And I think what really happened for me was that I had hereditary diseases that had run in my family. I was an electrical engineer. And after undergrad, I started taking classes at the local community college in anatomy and physiology. And I think I started to notice something that a lot of people have really also noted as well, which is that the technologies that run in our bodies, the technologies that lead to things like data storage or signal transmission, are a lot like the wires and hard drives of the world that we build with our hands with the technology we associated with civilization. And so I really wanted to explore that further and see if mining that could help address diseases like the ones that run in my family. Like heart disease runs in a lot of people’s family, there is a disease called retinitis pigmentosa that runs in my family. That is a degeneration of the retina. And so I specifically wanted to work on neural prostheses and things like that, basically technologies at the interface between cells and circuits. And so that’s how I found myself doing my Ph.D. and my Ph.D. didn’t focus on the eye entirely It focused on cardiac tissue engineering, how to use electrical signals to get stem cells, to turn into heart tissue. Heart disease kills more people than all cancer combined. And so as the population ages and the world globalizes, it’s a really big problem. But tissue engineering, unfortunately, hasn’t quite progressed enough to help people in the immediate future for those kinds of perfused organs, like liver and heart and so on. And so my co-founder, who’d been working on bone and cartilage while I was working on muscle, he was getting closer to clinic. And it got to a point where we needed a business plan, and by then I’m graduated out of the lab. I’d been working as a management consultant at McKinsey. And I think I became a natural person to ask for help on writing that first business plan. And then I just thought to myself, wow, I really want to be a part of this. And I came back to the lab as a post-doc. We incubated the technology for a couple of years longer while I was getting my MBA at Columbia. And it became this kind of accelerator, almost, for the idea. And we launched the company not too long after my graduation back in 2014. So it’s been seven years now as a company. And what we’ve really done in the meantime is gotten our technology through animal studies now into human studies. So we’re the first company to ever be green-lit by the FDA to use stem cells to make a tissue product. And we’ve now successfully implanted three patients. So it’s a really interesting time, kind of the end of the first chapter of our marathon, but now really beginning another marathon in its own right.

[00:05:16] Aaron Martin: That’s incredible. That’s just an incredible story. So take me into the room, kind of the, if you can remember the day that you’re like, okay, I’m doing this. What was kind of going through your head? I’m always kind of curious about that because I’ve started a couple of startups and I can distinctly remember the day I was like, okay, I’m committing to this. It wasn’t kind of gradual. For me, it was like a switch. I’m like, I’m going to go do this.

[00:05:41] Nina Tandon, Ph.D.: You know, it’s so funny. People often ask about the aha moment. And I think for us, it was more of a slow burn. There was like an a…ha, if you will. A few things, a few signals, low power signals that, on their own, you might be able to ignore. But my co-founder getting his research published in PNAS and on the front page of the Science Times in the same week. And I thought to myself, wow, this is something, being able to grow bone in any anatomical shape from stem cells is certainly interesting scientifically, but also interesting to the world at large. And I just, I, that was a data point. When I was working at McKinsey, I saw lots of big companies buying littlecompanies, and I thought to myself, wow, we’re at this patent cliff. Everyone’s panicking about where they’re going to get their innovation from. And it seems like all this innovation is coming out of small companies that are spinning out of academia. That was another aha moment for me because I’d left academia thinking I wanted to go to the real world where things happen in industry. And in fact, to kind of realize that coming full circle, if I wanted to be part of the most interesting, innovative ideas that it actually wasn’t quite in industry, nor was it in academia, but it was at that border. I think that was the other aha moment for me. And just realizing that there were dots that needed to be connected in order to make that translational journey successfully made me realize that, wow, you probably need a crossover type person to lead this project. And wow, wouldn’t it be nice to be that person? So it was kind of organic. No single moment in and of itself was the light bulb. But together it was just impossible to ignore. And I’m so honored that my Ph.D. advisor had the foresight to think that I could contribute to the project. She really was the one who asked me to do it. I’ll never forget the phone call. “Hey, Nina, there’s this grant opportunity coming up. They want to see if maybe we can start a company out of this. Would you want to help with that?” And I was like, yeah, I’ll drop whatever I’m doing and be a part of that. And it’s almost like a family business in that respect our origin story.

[00:07:45] Aaron Martin: You said something really interesting there about the edge of academia and the real world. Can you talk a little bit about, what’s it like being kind of on that edge, right. So where you’re kind of, dealing with the academic environment and you’re dealing with kind of commercialization or pre-commercialization, that kind of thing. Can you talk a little about that?

[00:08:03] Nina Tandon, Ph.D.: Well, I think in the life sciences, and I’ve seen this because I also used to work in software. And we see this in biopharma versus devices as well, that the design cycle and the timing around the design cycle and how that relates to the timing of IP protection is one that’s a really interesting ratio to pay attention to. So in software, and even to a certain extent in medical devices that use hardware and software, the design cycles are quite quick. And so patent protection is kind of long in comparison to that. And so you don’t find that patent protection really drives innovation the same way it does in biopharma. In biopharma, it takes a long time to go through clinical trials and patent protection is similarly a quite a long time. And so I think that the transition, being that it’s better matched patents become so important, foundational patents for even starting a company, patents become, in a way, one of the only assets of an early stage company is that patent portfolio. And so what I found was during my postdoc years, while we were incubating still in academia, but with the awareness that there was going to be the right time to transition out, I think there were a few things that had to come together. We needed to make sure we had a good relationship with our tech transfer office because we wanted to set the stage for licensing that IP and licensing it exclusively. I think we also wanted to kind of solve as much, as we could, of that chicken and egg problem of, you need money to get data, to de-risk, to get money, to get data, to de-risk. So where do you jump in? How do you do that? And I think the academic setting can be really helpful because you can start to apply for translational grants that might be appropriate to take into an academic setting. In our case, we got a grant from our city, the New York City Bio Accelerate Program. So it was a grant to allow us to do the experiments that served as the kind of go, no go decision around starting the company. We were able to do that as academics and generate IP that we later licensed. And so getting back to your earlier question of, when did we know that it was the right time to leave? I talked about it being rather slow. But on the other hand, as soon as we got our first funding, we knew that we had to fire ourselves and hire ourselves to the company because, come October 15th of that year, we had money, we were working for the company. So that was a very clear decision. For us grants were really great. And I think that’s similar for a lot of really deep tech companies that are coming out of academia. SBIR grants are a great way to transition because academics are familiar with writing NIH grants and NSF grants. So you write a grant, you get money into the company, and that’s also then a de-risking to go out to friends, family, whatever that first round comes together from, and say, look, I’ve got funding. It’s been de-risked to a certain extent. Do you want to match some of this grant funding so that we can do more than what we’ve said in this proposal? And that’s really how it worked for us.

[00:11:09] Aaron Martin: And it’s de-risking in two different ways. One is, correct me if I’m wrong, but there’s like peer reviews. So you’re getting validation from the IP. And it’s also money,right? So there’s also a kind of funding that goes along with it.

[00:11:21] Nina Tandon, Ph.D.: Yeah. So you can say there’s been peer review, really difficult rigorous peer review, that this has passed through. So that serves as a kind of diligence for the purposes of the investors. And then also they’re not the only money coming. So that was a great way for us to get started. We raised many multiples of capital over the non-diluted funding. In fact, our ratio is about 10% non-dilutive and the rest is private.

[00:11:44] Aaron Martin: That’s really incredible. So, all right, so talk a little bit about the technology now and what are the use cases in the near term, and then where do you see it going?

[00:11:52] Nina Tandon, Ph.D.: Yeah. So, our technology takes stem cells and combines that with digital fabrication. So in order to make bone, let’s say, and you might need a piece of bone. Bone is the most transplanted human material after blood. And the only way to get human bone is to cut it out of a human until now. But so for cancer, trauma, congenital defects, if you needed bone you’d either cut it out of yourself. That’s called autograft. Or you’d get cadaver bone, which is called allograph. Or you’d use synthetic implants made out of metal, plastic, ceramic, and so on. What we do is we take two things from the patient. We first take a scan, a CT scan, so that we can extract three-dimensional data out of that and understand the geometry and the perimeter of the tissue we want to grow. We also take a small sample of adipose tissue from the patient. So we take you know, 10 ML of fat, and we extract the stem cells, they are adult stem cells called mesenchymal stem cells that live inside our fat tissue in bone marrow. We extract those stem cells out, expand them in the lab, and infuse them onto a perfect puzzle piece shaped bio material that we’ve designed using that CT scan. And we cantain the cells, plus that biomaterial inside an advanced cell culture system, which we have IP on, called a bioreactor. That bioreactor allows us to feed the tissue with the exact cytokines, oxygen, nutrients, temperature, and mechanical forces that get those stem cells to attach to the scaffold, proliferate and differentiate. It takes us three weeks to grow bone, takes us four weeks to grow cartilage, and when we’re done with our processes, we have tissues that really recapitulate the tissues that reside in our bodies anatively It’s remarkable that the same signals that drive stem cell differentiation in our bodies can also be used to drive stem cell differentiation in the laboratory and the cells are the ones really doing all the work.

[00:13:52] Aaron Martin: That is amazing. What are some of that kind of the early kind of uses that you’re thinking about right now?

[00:13:57] Nina Tandon, Ph.D.: So we think of our pipeline as being cumulative and interdependent. That is,we have a platform technology. It’s really important for us to choose our use cases wisely. We wanted to choose our first use case to be kind of blue ocean, not a lot of competition, high unmet need, so that we could showcase our technology and potentially even qualify for certain accelerated approval programs through the FDA. So for us, that’s bones in the head and face. That’s where shape really matters. The treatment options are not good. And our first clinical trial, our phase one two, is working with patients who’ve suffered from either, so far, trauma or congenital defects. So patient one had suffered a traumatic injury from a car accident. We provided four pieces of bones to help reconstruct his face, perfectly matched. He’s six months out, doing well. Patients two and three had congenital defects that resulted in facial asymmetry and even severe airway obstruction. So we provided bones to elongate the jaw and relieve those conditions. For our second product, we are layering cartilage on top of the bone. So we’re making a two tissue graft, a biphasic graft, we call it, so bone and cartilage. That has orthopedic applications. So we’re looking at, we did an equine study, a preclinical study, where we were going head to head with fresh osteochondral allografts, meaning donor tissues from cadaver. We studied those animals for a year and we hope to be ready to go into the clinic next year. That is an orthopedic application with a much larger, in terms of patient number, unmet need and involves a different type of surgeon too, orthopedic surgeons versus craniofacial maxillofacial surgeons. So it’s a really interesting journey for us as we kind of migrate out of this niche application towards broader indications in orthopedics and sports medicine.

[00:15:47] Aaron Martin: And orthopedics and sports medicine, I guess there’s a lot of joint replacement with artificial.

[00:15:52] Nina Tandon, Ph.D.: That’s right.

[00:15:53] Aaron Martin: Is this meant to kind of displace that or how, what are the situations in which, this is fascinating to me. And then, why is it superior, what you’re doing versus kind of what already exists in the market?

[00:16:05] Nina Tandon, Ph.D.: Yeah. And I would love to see a world in which there’s no such thing as a synthetic joint replacement. I would love to see that a company or a cluster of companies like EpiBone that obviate the need for replacing parts of our bodies, a whole joint, because of just a couple of millimeters of damaged cartilage, it just seems like an approach that is, while effective, inelegant at best. And the younger you are when you get a joint replaced, the less time they last. So if you’re 85 getting a knee replaced and they have a 15 year lifetime, does it really, that’s not the equation we’re looking to solve, but people are 40, 50 getting these replaced and the equation there is, the more you exercise that joint, the more it will exacerbate that mechanical mismatch at the site of implantation that degrades over time and leads to failure. And if you look at the math, people always ask, well, if we can’t afford non generalized medicine, how are we going to afford personalized medicine? But I think that’s the wrong question. We should think about the inefficiencies in the way we’re doing medicine right now. If you’re going to get a joint replaced at 40 and you know you’re going to need three or four of them over a lifetime, and that a revision surgery costs more in terms of time and money to that patient than doing a one and done solution, I think a one and done solution in which we can say, look, you need some new cartilage. Let’s give you some new cartilage. That, to me, is where science fiction has been pointing us. Whether you are watching Marvel movies about Wakanda or Star Wars or whatever your favorite science fiction, is there is always some sort of form of tissue regeneration that exists in these in pop culture. So I think people understand intuitively that replacing a couple of millimeters of cartilage with an entire joint made out of metal and plastic is just not the way to go. I would love to be an extra in that movie that makes that future possible. Whether it’s cancer, trauma, or congenital defects, I would love to see a kind of one-stop body shop that allows us to repair ourselves with truly bioactive solutions that are just like what we were born with. Nature is so beautiful and gives us such. We often take our bodies for granted. But when they start to fail, we realize how beautiful they are. We’d like to leverage that beauty of nature and biology and help us just extend the high performance period of time that we spend in our bodies by taking the cells that grow our bodies every day and just using them to do a little bit more.

[00:18:46] Aaron Martin: Yeah. Speaking as a 52 year old, please go fast because it feels like things are starting to break. You know, I also think too that, because of longevity and people hopefully will be more active. I would say even the folks kind of hitting 80 in the future are going to be, this is going to be an issue for them as well because of the extension of lifetimes because I think what you’re saying is that the reason why the artificial joints later in life are probably okay. Is because they don’t move a lot, right? But I think that’s going to probably change over time.

[00:19:18] Nina Tandon, Ph.D.: I think that’s a very good point. You know, if we’re getting injured at 15 and living until 115, we need our implants to last as long as we do.

[00:19:25] Aaron Martin: What’s the three or four things that you would tell yourself, the secrets, if you will, like, oh, hey don’t do this, or do this, or definitely do this. Don’t have any kind of doubt about that. You know, your kind of seven years ago, if you will.

[00:19:41] Nina Tandon, Ph.D.: Coming from an academic upbringing, I think we’d always been taughty you know, you need to find your mentors. You need to find the guru of XYZ and apprentice yourself and learn. And I think one of our strengths as a company is that my co-founder and I do come from that background and recruit mentors of all shapes and forms so that we can learn the things we don’t know. But I think something surprising for us is that, when it comes time to make a difficult call, like, at a crossroads, do we make a certain choice, A or B, that we’re wiser than we thought, if that makes sense like, because past performance is not always the predictor of future performance. So if people have learned lessons from a past, that is no longer applicable. In a way we are more positioned than we thought at being able to make difficult decisions. And so I think I transitioned from, in my early days, trying to be everyone’s student, okay, like I’m your student, I’m doing my homework. I’m going to learn from you and apply the lessons you’ve learned. I think I’ve transitioned more into almost like a, oh no, I don’t know what this is going to sound like, a ringmaster in a circus or something where the way that we kind of power through difficult decisions now is we try and recruit people with very different points of view and try and facilitate and mediate a conversation between them to try and understand what we don’t understand and then try and figure out, well, then what’s the best way forward. So I think if I could go back to my younger self, I would say this has never been done before and there are people that are going to help guide you along your way. But, you, Nina and Ik, my co-founder, do have the discernment and the knowledge that you need in order to move this forward. I would like to give her a little bit more confidence, my seven years ago, self.

[00:21:48] Aaron Martin: I think you’re exactly right. It’s like we’re advisors. We’re not in there day to day as board members. I think that’s really sage advice for founders, kind of trust yourself, I think is what you’re saying.

[00:21:57] Nina Tandon, Ph.D.: Yeah.

[00:21:58] Aaron Martin: Trust, your engagement into the details. And that

[00:22:02] Nina Tandon, Ph.D.: Yeah.

[00:22:02] Aaron Martin: Really

[00:22:02] Nina Tandon, Ph.D.: matters, right?

You’re there doing that job every day. You’re living that life. You can take advice from people and take it very seriously, really contemplate it. And recruit people who have very different perspectives. That diversity. When you’re an inexperienced CEO,as, I think, if you’re in deep tech doing something no one’s ever done before, everyone would be in that category. So how do you make decisions in the darkness of lack of information? Well, I love, I think I had an accounting professor who said, recruit people with diverse and, ideally, opposing views because that’s the best way to figure out where the tensions lie, where the truth really is. And yeah, don’t discount your own experience from being the day-to-day person who is with that. It’s similar advice that my doula gave me when I was about to become a mom. You know, she said there’s nothing like having a small baby, whether that baby is your company or a human baby. Everybody gives you free advice, but actually you’re the kid’s mom. So you do know and I think you know, with my human babies, as well as with my entrepreneurial baby, yeah, I would like to hope that, I would love to go back in time and just whisper in her ear, you’ve got this, you do know what you’re doing.

[00:23:16] Aaron Martin: That is an incredibly apt analogy because I remember, our first child, we had a diversity of opinions about everything, right? And you have to kind of do the synthesis and you have to kind of figure out, like, that fits, that doesn’t, that seems really dangerous. You know, I’m not going to do that, you know? So, that is a really apt analogy. What advice specifically to people thinking about getting into the healthcare space would you give?

[00:23:47] Nina Tandon, Ph.D.: So I talked a lot just earlier about having confidence. I’m not going to backpedal that, but I’m going to say entrepreneurship is like the Olympics and we are in the middle of the Olympics now. I don’t think there’s a single Olympian out there who doesn’t have a coach. So I would say some of the advice that I got that was maybe most useful to me, and I’ve really taken it seriously with the company, is coaching. You know, I do leadership coaching one-on-one. I do leadership coaching in pairs with my chief of staff and with my co-founder. Call it couples therapy. And so the idea is that, if you’re in entrepreneurship, your job description changes every six months. You know, you need a coach to help you figure out which toolkit you need to sharpen or which, help you stay present. And also to help you pre-process the stress of the job so that you’re not transmitting it inappropriately to other people on the team. And the other benefit that I get about implementing coaching with my team at large is that I also get a chance, through this person who does, we are a small enough team that we work with the same coach, really, for all of us, is that I get information bubbled up to me, obviously not confidential information, but if she starts to see patterns with people on the team, she can flag those to me so that I can stay ahead of it. So I think coaching is a secret weapon for any CEO’s toolkit. And then your question was about healthcare. And healthcare is a highly regulated industry with disintermediated decision makers and payers and users. Okay, so, I would say one of our company values that I really hold dear is the high road is the fast road. You know, and for us, what that means is being proactive, working with regulators, treating them with the respect we’d like them to treat us with as colleagues, as fellow scientists who want to make the world a better place and don’t want to hurt people along the way. And don’t cut corners and those will bite you. The high road is the fast road. So those would be my two pieces of advice. If you’re going to enter the startup Olympics, get a coach and make sure your Olympic event, you’re not alone training for it. And don’t try and cut corners. Being penny wise and pound foolish is just not the right way to think in this industry. It’s a longterm field, very collegial. It’s a karma business. The reputation, cultivation, and community cultivation that I think comes from taking that value to heart, I think is another one of our secret weapons.

[00:26:20] Aaron Martin: It’s amazing how many people you bump into. It’s not even six degrees of separation.

[00:26:27] Nina Tandon, Ph.D.: And then people get new jobs, they’re doing something different. Next thing you know, you’re helping someone who you were pitching to years ago and it’s karma, and good people lead you to good people. And this industry is really well populated with good people who want to make the world a better place. And so they might say no to your ask this year. But in two years, maybe you’ll be the one green-lighting their ask. It’s just how it works. Starting to see that now, being 20 years in, seeing that start to pay off is one of the really joyous things about being in this industry, just seeing how people are, all my classmates, what are they doing? You know, things like that.

[00:27:06] Aaron Martin: When I first met you, I was blown away by the technology. Then we got the opportunity to kind of dive deep into it and really blown away by just the applications and what kind of good it could create in terms of for patients and that kind of thing. And now after spending a few minutes with you, I’m blown away with your leadership. So this has been incredible and I’m really looking forward to your products hitting the market. For anybody who gets an opportunity to speak to you and to hear and actually see, I think I’ve seen, I can’t remember if it was on the website or in the presentation or whatever, it is a little bit like looking at Wakanda technology It’s so kind of cool. It’s kind of cool. I have to tell you, I like totally nerd out whenever I talk about this stuff you guys doing. So, Nina, thank you so much for taking the time to speak with me. It’s been a true honor and best of luck to you and the team I’m really looking forward to this hitting the market.

[00:28:05] Nina Tandon, Ph.D.: Thanks for having me and thank you for doing all of the tireless work you do to make the world a better place.