With hundreds of thousands on organ waiting lists, science fiction is ready to become science fact
When I left TechCrunch at the end of 2021, one of my last features was a deep dive into the U.S. organ procurement market. It focused on how UNOS, the government-contracted (and often heavily criticized) network for organ procurement, was using new technology to deliver organs faster to transplant centers with the hope of offering the gift of life to one fortunate patient. America’s waiting lists remain gargantuan: roughly 100,000 people are waiting for a kidney and the freedom it offers from regular dialysis visits.
Three years later, I’ve come full circle. I’m so excited to write about Lux’s investment in eGenesis, where we led a $191 million Series D round to commercialize the best option we have for procuring more organs: xenotransplantation. This is our biggest initial check in Lux’s 20-year-plus history, and it’s exactly the kind of intrepid bet that we need more of in the venture capital industry.
The first organ transplantations began a couple of decades ago, and today, they are a mainstay at many large hospital systems. These awe-inspiring feats of medical science have only been slowed by a dearth of organs, which must be procured from a human donor within a very tight timeline (known as ischemic time). Organ donations are rarely planned, and so the entire system is designed to operate in crisis to respond to a sudden availability and deliver that organ into a patient within the strict time limits imposed by biology.
Up until now, solving this shortage involved science fiction. Scientists have approached the problem from two ways: xenotransplantation (procuring organs from mammals, often porcine donors) or lab-grown organs (using modern tissue engineering to construct an organ de novo). Both routes are fraught. With xenotransplantation, the human body’s immune system actively works to reject the new organ, sensing a foreign object that must be fought. Lab-grown organs have struggled to both meet the functionality of natural organs, and also to scale without biocontamination.
The invention of CRISPR-Cas9 a decade ago paved the way for xenotransplantation to make the transition from science fiction to science fact and take the lead in this technological race. With precise gene editing, organs can be tailored for compatibility with the human immune system while limiting the growth of possible infection vectors. Scientists had made a breakthrough, but it’s one thing to evaluate an organ in the lab, and another to transplant it into a person who relies on their organs for life.
Earlier this year, eGenesis’s technology was used to transplant a kidney from a porcine donor into a 62-year-old patient at Massachusetts General Hospital, a landmark milestone in the pursuit of xenotransplantation. That xenotransplantation was the first through an Expanded Access pathway study authorized by the Food and Drug Administration, which offers a route for experimental therapies to be offered to patients who would otherwise suffer life-threatening conditions with no recourse to alternative therapies.
Early experimental results have been promising, and now, the goal with this Series D funding is to scale eGenesis’s study further in the pursuit of a permanent solution to America’s kidney organ shortage. As with any new clinical therapy, the company will be assiduously collecting data to ensure robust safety and efficacy for all patients involved.
From a Riskgaming perspective, xenotransplantation brings up a whole panoply of interesting questions over the next decade, some that mirror the recent debates around GLP-1 drugs like Ozempic. How much can the cost of transplantations be reduced with a more reliable source of organs? If we don’t have to operate in a crisis mode with shifts of transplant surgeons on call in the event that an organ suddenly arrives, could we make the transplantation system vastly more efficient? The typical kidney transplantation in the United States costs $442,500 — an extraordinary sum.
Without a shortage to be worried about, can we preventatively transplant organs into healthier patients so that they are more likely to have better long-term outcomes? In order to get prioritized on an organ waiting list today, a patient must be evaluated as the most critically in need, which generally means in the worst health. How much could we improve outcomes if patients didn’t have to wait to be on the cusp of death to get the treatment they need?
Finally, how do we bring such therapies to everyone who needs them globally? Transplantation surgeries are among the most complex in medicine, and also involve extensive pre-op and post-op evaluations. The vast majority of the planet can’t offer these treatments, but with a more reliable source of organs, do we have the ability to bridge this inequality?
Those are questions I get to intellectualize in the years ahead. Right now though, a team of brilliant scientists are arduously working to bring this important technology to a wider population. I can’t wait for them to succeed, and prove once again that science fiction can and will become science fact.
In addition to Lux, eGenesis’s Series D had participation from existing investors ARCH Ventures, Khosla Ventures, Farallon Capital Management, Alta Partners, Fresenius Medical Care Ventures, and Leaps by Bayer as well as new investors DaVita, Eisai Innovation, NATCO Pharmaceuticals, and Parkwood Corporation.
Japan’s Sakana AI raises nine-figure Series A
While we are talking about massive fundraises, I have previously covered Tokyo-based Sakana AI, which is increasingly becoming a national AI champion for Japan, in “Sakana, Subways, and Share Buybacks” as well as a podcast. Lux led the $30 million founding seed round for the company, and now, it’s raised more than $100 million from NEA, and Khosla with participation from Nvidia. Nikkei had a front cover story on the round.
What’s new? The coolest demonstration has been something the Sakana team has dubbed “AI Scientist,” which was profiled by Nature. The idea is to use a large-language model to automate all aspects of conducting science, including reading and interpreting the existing scientific literature, identifying potential experiments, executing those experiments and then interpreting the results and writing up a final paper. It’s early but inspiring days for the potential of AI to radically improve the productivity of science.
Podcast: Silicon Valley’s secret industrial spy war
Silicon Valley couldn’t be farther from the confines of Langley or Fort Meade, let alone Beijing or Moscow. Yet, the verdant foothills of suburban sprawl that encompass the Bay Area have played host to some of the most technically sophisticated espionage missions the world has ever seen. As the home of pivotal technologies from semiconductors to databases, artificial intelligence and more, no place has a greater grip on the technological edge than California — and every nation and their intelligence services want access.
It just so happens that almost no national security reporter sits on this beat. Nearly all cover the sector from Washington, or in rare cases New York. All except one that is: Zach Dorfman. Zach has been driving the coverage of the technical side of espionage operations for years, and his pathbreaking scoops about China’s unraveling of the CIA’s network of operatives in the early 2010s were widely read in DC officialdom. Now, he’s published two blockbuster features, one in Politico Magazine on the FBI’s attempts to intercede in the chip trade between the U.S. and the U.S.S.R. at the height of the Cold War in the 1980s, and the other in Rolling Stone on a deep-cover agent and the very human consequences of state-to-state skullduggery.
Zach and I talk about Silicon Valley’s history in industrial espionage, the tricky mechanics of intercepting and disabling chip shipments to the Soviet Union, why the U.S.S.R. was so keen on learning the market dynamics of computing in America, the risks for today’s companies around insider threats, Wirecard and Jan Marsalek and finally, some thoughts on Xi Jinping and how China’s rollup of the CIA’s mainland intelligence network affected his leadership of America’s current greatest adversary.
🔊 Listen to “Silicon Valley’s secret industrial spy war”
The Orthogonal Bet: Bio Trajectories and the Importance of Long-Term Thinking
In this episode, Lux’s scientist-in-residence Sam Arbesman speaks with Adrian Tchaikovsky, the celebrated novelist of numerous science fiction and fantasy books, including his Children of Time series, Final Architects series and The Doors of Eden. Among many other topics, Adrian’s novels often explore evolutionary history, combining “what-if” questions with an expansive view of the possible directions biology can take, with implications for both Earth and alien life. This is particularly evident in The Doors of Eden, which examines alternate potential paths for evolution and intelligence on Earth.
Sam was interested in speaking with Adrian to learn how he thinks about evolution, how he builds the worlds in his stories, and how he envisions the far future of human civilization. They discussed a wide range of topics, including short-term versus long-term thinking, terraforming planets versus altering human biology for space, the Fermi Paradox and SETI, the logic of evolution, world-building, and even how advances in AI relate to science fiction depictions of artificial intelligence.
🔊 Listen to “Exploring Alternate Biological Trajectories: The Importance of Long-Term Thinking”
Lux Recommends
- In shameless self-promotion, I chatted with Jason Scharf of the Austin Next podcast on a Texas-scaled sequence of topics, including media economics, xenotransplantation, Riskgaming and the future of venture capital. Be sure to check it out on Spotify and Apple.
- Sam enjoyed Lev Grossman’s brand-new novel The Bright Sword: A Novel of King Arthur, in what’s being dubbed “The first major Arthurian epic of the new millennium.” Kiersten White at The New York Times enjoyed it, writing “Story lines veer from mundane to absurdly fantastical in the blink of an eye. Supernatural contests against devils and the Green Knight contrast with desperate, messy knife fights with humans. Climactic battles happen far before the end of the book, leaving the reader wondering what could be left. (Turns out, quite a bit.)”
- I really enjoyed this preprint paper on Arxiv from Jieyu Zheng and Markus Meister on “The Unbearable Slowness of Being.” “Human behaviors, including motor function, perception, and cognition, operate at a speed limit of 10 bit/s. At the same time, single neurons can transmit information at that same rate or faster. Furthermore, some portions of our brain, such as the peripheral sensory regions, clearly process information at least a million-fold faster. Some obvious questions arise: What sets the speed limit on human behavior? And what can that teach us about the neural mechanisms of cognition?”
- Sam enjoyed Erik Hoel’s new essay in The Intrinsic Perspective on “Curious George and the case of the unconscious culture.” “But it seems to me the more fundamental shift is that, at every economic and social scale, the workings of our conscious minds play less of a role. The growing high strangeness I sense is that culture is draining of human consciousness, and therefore of sense itself.”
- Finally, I enjoyed Ted Chiang’s essay in The New Yorker on “Why A.I. Isn’t Going to Make Art.” “We are entering an era where someone might use a large language model to generate a document out of a bulleted list, and send it to a person who will use a large language model to condense that document into a bulleted list. Can anyone seriously argue that this is an improvement?”
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