Nandan Padukone: CEO of IM Therapeutics

Nandan Padukone, CEO of IM Therapeutics, headquartered in Woburn, Massachusetts, shares his thoughts with BioBoss host John Simboli about leadership and how IM Therapeutics is targeting the root cause of autoimmunity with therapeutic design directed at human leukocyte antigens.

Transcript

John Simboli  
Today I'm speaking with Nandan Padukone, CEO of IM Therapeutics, headquartered in Woburn, Massachusetts. Welcome to BioBoss, Nandan.

Nandan Padukone  
Thank you, John; thanks for the opportunity. Great to be here.

John Simboli  
What led you to your role as the CEO at IM Therapeutics?

Nandan Padukone  
So John, you know, I've been in the biotech industry now close to 25 years, almost all of it has been in startups. I like the concept of early-stage innovation, and biotech. That's what has drawn me to this career. So all of those 25 years, probably, have been spread between about six different ventures. And I've taken different roles; I'm not insistent, necessarily, on the title of a CEO. But, more or less, I've stepped in at early stages of a company; I really love team building, bringing the right people, the right skill sets, but also, alongside seeing the development of the concept or the fundamental biological concept and taking it all the way to the clinic, and perhaps, you know, hopefully, helping patients as well. So with that, as a progression, certainly I have been involved in a variety of disease areas; cancer to begin with in the early part of my career, gravitated to diabetes, and certain aspects of diabetes. And that's what led me to IM Therapeutics, which is a company focused on type 1 diabetes. But what is interesting, and that's what led me to this is, it's in some ways, a window to the broader autoimmune spectrum and how we can impact the broader autoimmunity. 

John Simboli  
How did you decide you wanted to lead a biopharma company?

Nandan Padukone  
What has drawn me to the biotech industry, I started my career as a chemical engineer, and a biochemical engineer, and certainly now much more, you know, tilted towards the biology side and the biology side of disease. So I think the fundamental aspect of what causes disease, and if we understand what causes disease, how do we utilize our information, indeed, to stop, prevent, and stop the progression of disease, has been very exciting to me. So I think the ability to step in early, whether it's a university-based idea, whether it is a early-stage venture funded idea, or a mid-stage idea where it needs a certain amount of growth, to be very applicable to patients. That has always drawn me and I think the ability to step in, be able to take charge of the idea, but also put the rest of the package together, whether it's people, whether it's skillsets, whether it's the ecosystem around as well as the ability to bring capital, which was pretty important in the space. I think it was exciting to see over all of the ventures that I've been involved in that the fundamental idea, and it's not just about technology, but how else you can package that with the rest of it, which is people, capital, and the ability to execute. That's been really fun. And I've been fortunate that I've been able to do this now about five or six times, and hopefully I get a chance to do it again, in future ventures,

John Simboli  
How did you find that you were able to get at that particular idea of IM Therapeutics, was it instantly clear once you came across it? Was it something that fit in with something you were already looking at?

Nandan Padukone  
So I came from the cancer world, and as you quite well know, in cancer now, not only are there many different cancers, very well treated, but fundamentally, those treatments are what is now regarded as personalized medicine, which is, you if you can find out what the telltale signs of that particular tumor and that patient is, you are able to, in fact, indeed, identify a corresponding therapy, not only that will go against that tumor, but hopefully, you're selecting patients and that particular patient for that right therapy. That's very exciting for the industry. It's been proven, certainly in oncology, and we're beginning to take some extremely good strides in neurology, cardiology. But what I felt was, as I transitioned to diabetes, the problems of diabetes and type 1 diabetes genetically inherited disease, that this paradigm did not exist, it was an unmet need. And as I began to look at type 1 diabetes, in particular, it so turned out that autoimmune as a whole spectrum, which is also a genetically inherited spectrum, that this sort of a paradigm is not only in dire need but the types of therapies that you would otherwise expect to be developed, didn't exist. And that's what drew me to the space. And IM Therapeutics, in particular. 

Nandan Padukone  
There was about a decade worth of research in type 1 diabetes as a landmark program, that, fundamentally, the genetic factors that lead to the disease could indeed be opportunities in the way therapies could address those genetic factors. And based on that underlying research that was done and the applicability of that research to developing small molecule-based therapies, that truly attracted me. It came up on the radar, I was talking to a number of venture partners as I was looking for new ventures, the JDRF T1D fund, which was relatively young in its cycle, had picked it up as a possible idea. And my relationship with another venture firm called Morningside Ventures, in the Boston area. It just seemed like both of them liked the idea. They liked the package, they liked the underlying biology. And with that early-stage financing that both those teams put together, it seemed like it was a good time to step in, take charge and build a company around that fundamental concept.

John Simboli  
Did you at any time think, Oh, I'll take this interesting idea and I'll go to an established large pharma company and I'll see if I can build it within since the infrastructure will be built. 

Nandan Padukone  
You know, some ideas are best incubated within a larger infrastructure, some ideas are best done independently within a, perhaps a more nimble, a more agile infrastructure. It just so happened in my case that several other ventures that I've been involved with, with some exceptions, but some of the ventures that I've been involved in, have been independently venture-funded ideas, and IM Therapeutics is one of those. But I've also been fortunate enough when I was head of innovation and ventures at the Joslin Diabetes Center, which is part of the Harvard Medical School, I spent six years there, and several different innovative ideas that, whether it was incubated within the center itself, whether it was done in partnership with a larger pharma to accelerate it, or you spin it out as an independent company that could be venture funded. I think depending on the idea, depending on the modality, depending on the context, I think different mechanisms could serve each idea differently. It just so happened that with IM Therapeutics, the amount of research that had been done, prior to the time that I stepped in, was just a good catalyst that we could create an independent company get it funded and move it forward. 

John Simboli  
What were you hoping to achieve at IM Therapeutics that really could not be done anyplace else?

Nandan Padukone  
What we understand the autoimmune spectrum to be is, unfortunately, while a body, you know, is in fact, allowed to fight as a normal immune response, pathogenic attacks, unfortunately, erroneously, part of our body starts attacking itself. And there are genetic factors, genetic switches that seem to come on, that unfortunately, lets that body think that what is self is actually foreign and parts of a body which are self is actually foreign. And if you can, indeed identify these genetic switches, be able to turn them off, one way or another, then that the ability for your body to think that something is foreign, when it is not foreign, should not happen. And you're arresting the disease in its early stages, if you will, by turning that genetic switch off. And this was an idea in type 1 diabetes, these are called HLA proteins. HLA proteins, in fact, are involved in our normal immune response, they fight viral infections, bacterial infections are probably active as we fight COVID, as we speak. But unfortunately, certain parts of HLA, or certain variations of HLA, are erroneous. And those are the ones that, in fact, allow the body to present certain self-peptides or parts of our native proteins, natural proteins that seem to be suddenly recognized as foreign, which is why the body attacks itself. So the approach that we are taking, and that's what gravitated me to this concept is you could go after this erroneous function of HLAs and very selectively just turn off that function, that erroneous function, with a small molecule. And if you're able to turn that erroneous function off, the rest of the HLA continues to have its intact function to fight your pathogenic attacks. But just that erroneous function can be turned off. That was very exciting. If we can prove that with type 1 diabetes, not only is that an important impact on an unmet need, but it opens up the window to the larger autoimmune spectrum. And we can do this repeatedly for other genetic switches and turn them off and hopefully be able to turn off the autoimmune spectrum.

John Simboli  
You know how at a family gathering sometimes or in a non-professional setting, people will say, Well, what do you do for a living? And in my experiences with founders and CEOs in biopharma that can be a complex answer. I'm curious how you handle it, when you're talking to someone who's intelligent, but outside the field and they say, Nandan, what do you do for a living? What do you say?

Nandan Padukone  
One of the key features of being a CEO is to be a facilitator You cannot be an expert at everything. And certainly, I am not and most people aren't. And I think, in some ways, the best way to describe a CEO is understanding key pieces of the puzzle on what needs to be solved at what point in time, and making sure you have the right people around the table who can solve that puzzle. And create an environment where that puzzle can be solved. Essentially be a facilitator and a person who can empower other people. And where there are bottlenecks, identify those bottlenecks, but be facilitative enough to be in that situation where that problem, that bottleneck. can be removed and move things forward.

John Simboli  
What have you learned works best for you in terms of how you work with people who report to you in your company?

Nandan Padukone  
My style is always catch them early and empower them, where they feel they are in charge of their own space, they realize their strengths, they realize the limitations, they realize this is about teamwork. And if they can work in an early-stage venture where the unit works in the best way possible, where the skills are complementary, that works extremely well. I would say the second thing is to be thinking outside the box, I think, be able to let people know, it's not just being about in their cubby hole, following you know, the letter of the law and how their role is defined and that's what they do every day. But if they can come in every day, get their work done, but also think about, what else should I be doing? How do I take this frontier forward and think outside the box, then people can really be motivated every day to do something different beyond what they've done before? And I often say, a young company in an early-stage venture or small company like ours, and a growth company like ours, that, in fact, the advantage, beyond a competitive package, and the compensation and having the right title, one of the attractive features is you're able to challenge yourself and you're able to learn something new every day. You're able to interact with people who, perhaps, in a larger company, you might know of them, but you never interacted with them. But here you almost have conversations every day with them, you sit in a team meeting with them, they are your friends, and you almost co-teach each other. So, I think most of the employees I've dealt with, they find that as a very attractive feature to be joining. And they continue to find that energizing enough that they can grow upon themselves and keep challenging themselves. And a couple of years down the road, it's several new feathers in the cap, if you will. And I found that attracting those kinds of people to the company, it's a terrific asset to any venture.

John Simboli  
Can you remember back when you were eight or nine or 10 what it is that you wanted to be or most likely what your parents wanted you to be? And does that relate in any way to what you were doing?

Nandan Padukone  
You know, I grew up in a culture, I grew up in India. And perhaps, to some extent, it is the same way today. If you were at least reasonably smart in school, academically, you were encouraged to be either a doctor or an engineer. And perhaps, as I was growing up, I always liked biology, I liked medicine. And I thought I would be a doctor. I did the very opposite. One of the exams I took, which I excelled in, I went into an engineering school and became a chemical engineer. But it's funny how, after a number of years, you know, your passion never goes away. It comes full circle and I came to graduate school to the US, did a master's in chemical engineering, but just a casual conversation which happened to be in the hallway, somebody talked about a biochemical engineering course and biotechnology, which was still pretty young back then. This was the late 80s, early 90s. I felt I should try that. I mean that's one way to get back, complete that circle and get back to medicine and biology. So I got a Ph.D. in a combination of Biochemical Engineering and biotechnology and genetic engineering. 

Nandan Padukone  
And then I've spent the rest of my career actually at the interface of what engineering is and what medicine and biology is. So, in a way, that's all come full circle but I do have the fun part that I've been able to combine my academic learning in engineering and then have a chance to come back to medicine and biology and be able to practice that in my career. It's not the outcome that matters. It's having a passion to get somewhere. I often say, and you will believe in this as well, never lose your passion. Ultimately, you're going to come back to that in one way or another, whether it's part of your career, one of your hobbies. And I've been always passionate about biology and medicine. And even though I came about it in a roundabout way, through engineering, but back into the practice of medicine and biology, it's a fun place to now see in today's context, how these different disciplines of biochemical engineering, biomedical engineering, prosthetics, treatments, medicine, biology, are all coming together. And you can come at it from different angles. But you can also complement it, whether it's academically through your career experience, and through, obviously, professional relationships. And I've been in a fun place now, certainly over the last several decades, to be in the biotech industry that celebrates this confluence of these disciplines.

John Simboli  
I bet it also must occasionally feel like prescience, as in, I didn't know where this was going, but I ended up being at a place where it was going anyway. I ended up being ahead of something or at the front of something. If that's the case, that must be exhilarating when that happens.

Nandan Padukone  
Biotech is about, in some ways, being ahead of the curve. And it's often said sometimes your idea is too early for its time, right? You've probably heard that. And one of the ventures I have been involved in, which was a spin-out of MD Anderson and cancer and personalized medicine, this was in the late 90s, early 2000s, where the confluence of genomics, bioinformatics, understanding of genetic risk factors and disease, I would say was still pretty early. And one of the companies along with MD Anderson that we launched,  called Nuvera Biosciences, was one of those examples where people were still toying with the idea of what personalized medicine actually meant. I mean, could you literally have a therapy for each person? Is that what personalized medicine is? But what we found, with the nature of the company, the growth of the company, how the field has evolved, at the end of the day what we call personalized medicine is actually stratified medicine. You are taking tiers, different layers of medicine, and if you can stratify what individual disease areas are, within a disease, what the different layers of the telltale signs are, you are able to put different patients in strata. And it feels like it's personalized, you are picked for, if you have a certain disease, you're picked for therapy, because you have the highest chance of response, because your disease has a telltale sign that physicians or other analysts have been able to say that this is how your disease behaves. But here's a therapy that's going right after the underlying cause of that disease, which is what you are facing. So I think being able to, the following decade, now in 2010 and in 2020 and onwards, to be able to see that come to fruition is very exciting.

John Simboli  
Nandan, what is new at IM Therapeutics?

Nandan Padukone  
IM Therapeutics is a company that develops therapies that get to the heart of what causes autoimmunity. There are several genetic factors that put a person or people at risk of autoimmune disease. We have found that HLAs and certain mutations of variants of HLAs are these genetic factors that are some of the earliest steps in triggering an autoimmune response. Any disease is a cascade of events, and you can stop the disease anywhere in that cascade by putting a stop, and hopefully, when you put a stop somewhere in that cascade, you've taken off a critical path or a critical step in that cascade so that it doesn't proceed. What we have decided, and that's what is new at IM Therapeutics, is we are knocking out the very first step of the disease. So these HLA factors, these genetic factors, which fundamentally are responsible for telling the body that what is self could be foreign, and therefore, you can go ahead and attack self. If we can take that genetic switch off, there is no cascade. There's nothing to start because you switched off that genetic switch. I think that is what is exciting about what we are doing not just in type 1 diabetes, but if we can replicate this paradigm across the autoimmune spectrum, take each of those HLA-based genetic switches, be able to turn it off. Then each of those diseases, even if they have been detected, they've started, they are progressing, you should be able to stop it. Because if you can turn the faucet off, you're not going to have a flood. That's the first rule of the game. To stop a flood, make sure your faucet is off. And we are turning the faucet off of disease.

John Simboli  
It sounds as if you could potentially not only make an incipient disease a lot less bad, you could conceivably make it so the person would never suffer from the disease.

Nandan Padukone  
We are at a stage where if a person is at an early stage of disease, and you can detect it, and it hasn't progressed to a level where you can catch it early. Certainly, the types of therapies that we are developing, will intervene in those early stages because they have been detected. But if you do intervene there, you should be able to stop the progression of the disease. But once you prove that, your clinical trials or clinical studies, your ability to identify patients based on those same genetic risk factors at earliest stages where the symptoms don't exist, but the genetic factors exist. So could you be able to develop safe therapies, oral therapies, where, as a prophylactic, as a preventive, have at least some section of those patients who seem to be at highest risk, be able to take that—whether it's once daily or some manageable modality of therapy, you should be, in fact, be able to prevent disease altogether.

John Simboli  
So that's a bold enough idea that I imagine, sometimes when you're presenting to potential investors and others, they say, how could a company that is relatively new and relatively in development, as opposed to a gigantic company, how could they manage this? How could they pull this off? How do you like to answer something like that?

Nandan Padukone  
The answer is pragmatism, I think you have to start clearly at a stage that you think you can not only make an impact but show an impact in a reasonable amount of time. And that is where we're starting, we chose type 1 diabetes, because number one, it is a disease that impacts many, many patients, half of them are pediatric patients. Once detected, it's a lifelong dependence on insulin, a lot of burden on certainly healthcare as a society, a lot of burden on the family as caregivers, and this is a lifelong commitment to giving care to that patient. And no therapy, as of yet, since 100 years of insulin discovery, there has been no other therapy that has come to market. And so we believe that it's an important disease to go after. But if this is also a disease that points us to this broader issue of how autoimmunity works, and therefore, if we can prove that type one diabetes, we can take it to other diseases as well. And celiac disease happens to be our second program. But a number of rare diseases, a number of other autoimmune diseases where, similarly, patients could be detected earlier, no therapies as of yet, and we could make a significant dent. So we do believe, to your question, that if you take one of these diseases, intervene at a stage where it is an early stage of the disease, they take this therapy and we can show that in a reasonable period of time, whether it's 12 to 18 months, that indeed there is no progression of disease by the right set of biomarkers, then we could, then, whether it is with agencies, regulatory agencies, or with partners who feel they have the right capital, they have the bandwidth, they have the logistics, to take several steps earlier, identify patients and be able to hopefully take preventive strategies ahead as well. That's a strong possibility for the company in our growth strategy. But clearly where we are today is very pragmatically, practically, intervene at a stage where the disease is at an earlier stage. And if we can intervene at that stage with oral once-daily therapy, easy to take, whether it's pediatric or adults, we should be able to show, we hope, with our clinical studies, that there is no progression of the disease.

John Simboli  
When people hear that description of what you're after, what do they tend to get wrong, if they get it wrong? How do you get them back on track? Is there a pattern there?

Nandan Padukone  
What they do get right is the understanding of the need, the understanding of the need to, at minimum, intervene when it is detected early so that not only patients are still in reasonably good health, but, hopefully, with the right identification of the patient and the right therapy, there is no further progression of the disease. It's also what they get right as the understanding of the need, that this is indeed needed in autoimmunity. There are several autoimmune diseases, the 80-odd diseases that comprise the autoimmune spectrum, there are barely four or five today that have known established therapies, although it's at 120 billion dollars a year market, which means 75 plus diseases are yet to be tapped for new therapies and targeted therapies. So they understand the need. 

Nandan Padukone  
I think, to your point, what can we do better is where do we start? Which, which are those other diseases that we could tap into? And if those are tapped into, do we make a sufficient enough impact on the patient community so that it's a measurable impact? And if so, is it extensible as a paradigm to take to other diseases, as well. And I think if we can lay out that paradigm to say, we are going after an unmet medical need, type 1, diabetes and celiac are important, unmet medical needs, where we can make a significant impact on the market. If we prove it there, indeed it is extensible to other autoimmune diseases as well. And not only is it extensible to other autoimmune diseases in their early stages of detection, but hopefully, as the field of medicine evolves, as the field of regulatory policy evolves, and as the field of how clinical trials are designed and executed evolves, that we are able to, alongside, take a step back as well, and hopefully at least begin to explore how preventive strategies could be blended in, in those treatment strategies. 

Nandan Padukone  
The fun part of a biotech company is you take a well-defined idea, you run with it, you prove your point. And hopefully, it's extensible. And the flip side tends to be that you're cubby holed, like you just said, because by its very nature, it's a tightrope walk between what they say vision and focus, you want the vision of being able to conquer a large enough space, because ultimately, that is about innovation. And that is what you want your innovation to do. But the flip side is you want your focus, with limited resources, limited period of time, and limited people, you can only do so much. So therein lies where do you start. And how do you extend from there? And where you start, in some ways, can be your cubby hole. People tend to bracket you as well, you're a diabetes company, or you're just a celiac company. We do believe, and that's a fair amount of education we do to the market, is we are an autoimmune company, first. We're going after fundamentally changing the way, how we treat immune diseases. And within that we've chosen, consciously and pragmatically, type 1 diabetes and celiac as our lead programs. Those will certainly make an impact in those respective markets. But we continue to believe that we are an autoimmune company, first.

John Simboli  
What makes IM Therapeutics different from other companies in the autoimmune space. Autoimmune space is a gigantic thing, and as you were just saying, you have to work on the difference between focus and extensibility. Is it possible to talk about it in something that vast, how you differentiate it?

Nandan Padukone  
Yes, I would say several points of differentiation, one goes back to this analogy of a cascade. Even though the autoimmune spectrum is a vast space, in some ways, as with any disease, and certainly with autoimmune as a spectrum, the cascades in some ways are similar in that there are genetic risk factors. There are triggers of those genetic risk factors. There's an early stimulation of our immune cells that makes those cells fight the body itself. When they fight the body itself, there are several downstream effects that happen, that cause inflammation, those cause cytokines, and it's called a cytokine storm that begins to go and damage tissue. So within this whole cascade, what we've seen in this vast space is people trying different things, you can start from the bottom end up, you can look at anti-inflammatories and stop the inflammation. You can go after those cytokines and reduce their levels. You can be somewhere in the middle to say, you know what, these specific immune cells that are fighting the body, maybe I can reduce their population. You could use stem cells to figure out how you retrain your body. 

Nandan Padukone  
How we differentiate ourselves is a number of factors. Number one, as I said, we take the first step in that cascade. If we understand that genetic switch, and how it might be triggered on, with a small molecule therapy, we can go after that switch. And if that switch is locked in, it can never turn on, you don't have a cascade, to begin with. So that's one point of differential differentiation is where in that pathway are therapies acting. The second important one, I would say, is not only are we a small molecule therapy company, we are an oral small molecule therapy. So older drugs within this spectrum, there are many anti-inflammatories, there are certainly many immunosuppressants that are oral. But several of the disease-modifying therapies that have come in autoimmune are antibodies, which means they're injectables. Now they have their place and we need those, they could even complement what we do. But certainly when it's rare diseases, when it's type 1 diabetes, when it's pediatric patients or even elderly patients, if you have an oral therapy it makes it easy to deliver. It's a very significant benefit to the industry. 

Nandan Padukone  
So I think all of those factors on where we intervene, what stage we intervene, how we intervene, and that's with an oral therapy, I think the combination of those factors, certainly complement everything else that's going on, but it differentiates us because we take a piece of the equation that is, as yet, neglected. When we have identified HLAs, which are human leukocyte antigen factors, you open an immunology textbook, one of the first things you're going to read about is HLAs. So they've been known for a long time. But people have not targeted these as possible drug targets. So we often get asked, why is that, and did someone try it and fail? So what we often say is, as with any genetic switches, there are underlying factors, whether they are possible to be converted as drug targets is often a question. And the best drug target is one where you can selectively switch off the erroneous function but keep the normal function intact. And I think with HLAs, that has often been the question is, can you intervene with the HLAs in a way where just the ability to recognize self-peptides and trigger an autoimmune response, can that just be selectively turned off? Because if you don't, you do have the risk of immuno-compromising that patient. I think, in some early studies where people looked at antibodies, they looked at peptide therapies. There were such strong potential drugs because people often in the drug world go for high potency, there were such strong drugs that would not only turn off the self-peptide function of presentation, they would practically turn the entire HLA off, which is a big risk. So there was almost an apprehension, that I should not be touching these genetic factors because it might disrupt your normal immunity. But we have seen that almost as a no-man's territory that we can step in and be very different in that we've shown with small molecule therapies, and the way we design with our computational platform, we can do 1000s, millions, and 10s of millions of experiments in silico, where we can take these molecules in the computer, dock them into the HLA, and find out whether they can be selective enough into a region. But just that self-peptide portion of its function can be turned off, but you retain the conformation of the protein in a way where its normal function can stay intact. And we're continuing to prove that. And if we are able to prove that, we strongly believe that not only is it a first for the industry, but we're going to attract probably a lot more attention, on whether it is HLAs or similar complementary genetic switches that could be worked on by the autoimmune industry,

John Simboli  
Who makes a good partner for IM Therapeutics. 

Nandan Padukone  
A good partner is someone who complements the work we do. And I would say, in all the ventures I've been involved in, we've certainly leveraged partnerships or taken advantage of partnerships. And in our current ecosystem, you have to depend on partnerships, in a way, to be a success. And I would say the easiest way to think about partnerships is the two ends of the spectrum. So if we are a biotech company, we've somewhat proved a concept. We're continuing to plow ahead with our technology, we're expanding it and that's what we're doing at IM Therapeutics in autoimmune.. But the two ends of the spectrum, one being the earlier part of the biology, the more fundamental aspects of are there more mechanisms, would this complement? What are the right reagents? What are the right models? What are the right assays? How do we measure certain kinds of things, whether it's disease progression or the way our drug might work? And how do we screen our drugs? Those more fundamental aspects, while we'll do some things in-house, partnering with either younger companies, or academic partners to look at the more fundamental aspects, becomes quite important, and our starting partnership as a spin-out has been with the University of Colorado, with the Barbara Davis Center. So that's been extremely fruitful and profitable and productive. 

Nandan Padukone  
I would say the other end of the spectrum, which is more intuitive is, as we grow, it's quite natural that we can't do everything ourselves. As we go into later stages of clinical development, as we expand our pipeline, there can be several layers of partnership with bigger companies and with other biopharma, and that is manage the logistics. When you are in phase 2, phase 3, somebody is better at a certain disease, somebody is better at those larger diseases, recruiting patients, bringing capital in and accelerating, having discussions with regulatory agencies, that this is a global problem, taking your therapeutic, you know, at a global scale. So I think that part of the equation on growth, partnering so that you can accelerate it towards approval, and certainly post-approval, you know, for marketing purposes. But I would also say, with our paradigm when it comes to extensibility, there are only so many diseases. This has applicability across the autoimmune spectrum. There are only so many diseases one company can handle. So we will be looking for partners where even if we cannot do something ourselves, but somebody else could pick up an established disease, identify patients there who have the genetic factor, take it forward. Or it could be a rare disease that we may not handle ourselves, but they feel like they could take it forward. I think the modality of partnerships, whether it is licensing, core development, strategic alliances, I think both ends of the spectrum, having that together, allows us to utilize our in-house skill sets, but complement that with external skillsets in the best way possible.

John Simboli  
This puzzle that you're working on sounds really stimulated and profound because it's such a basic level of understanding of science. Given that, do you find yourself still occasionally thinking, you know, if this works the way I think it would, hope it would, I would actually change the lives of these patients someday? It may be far away, someday, maybe next month, I don't know. Do you allow yourself to think in those terms? Or is this puzzle so deep that one doesn't think in those terms?

Nandan Padukone  
Interacting with patients, interacting with physicians, interacting with advocacy groups, is quite important. Not just because you want your trial to be successful, but you want to stay connected with our patient community. So we do think, as you enter the clinic, as you do take your lead drug into planning your clinical trials, it's almost essential. And I've seen that very important in my career growth and certainly working with the Joslin being part of the Harvard Medical School, you do interact with physicians and patients a lot. But in clinical trials, I think being in touch with who those patients are. What is their motivation to be recruited in the trial? How do they participate in a trial? And if this trial, and therefore the drug, eventually, through its successive stages, indeed is going to be successful, how are they going to respond to that? How are they going to take it every day? How is their modality every day going to change? I think you begin to see that as part of a trial. So a trial is not just an experiment. But I think it's a way to interact with the patient community in a way that allows you to get that forward-looking window on, if this was successful, how would they internalize this? How would it change their life? How would the quality of life be different? I think, you know, having that touch with that community, whether it's through advocacy groups, whether it's the patients themselves, or physicians, or nurses who treat those patients, I think is important for any company and we certainly do that through our clinical team.

John Simboli  
As you think about your particular interests in the future of biopharma and the contribution you can make in the things that you're fastened to right now, what are the areas that you're especially interested in?

Nandan Padukone  
What fascinates me, John, is the huge strides we are making every decade and how fast we're making them in understanding disease. You know, what physiologically changes? What changes genetically leads to disease? What changes beyond our genetics? Is it environmental factors? Is it nurturing factors beyond just genetics? I think beyond just the understanding of those underlying factors, I think the rapidity with which we've been able to apply that to modalities of treatment is just fascinating. It's just truly fascinating. Can we not just understand what the factors are that lead to disease, but can we very quickly take steps in how the therapeutic modalities can evolve? To get at that very quickly? I think that is just fascinating to be in. And I think, following that, but also following how we're treating the disease, whether it is with potentially gene editing, whether it's with reprogramming stem cells, certainly antibody therapies have been out there, you know, could be repurposing oral small molecule therapies. But the whole compendium of these tools that we otherwise have to understand how disease happens, you could actually take the same toolset, and now be able to take it to the clinic, and very fundamentally take one disease at a time and be able to treat that in a very specialized way. I think just being involved in the evolution of how that is happening, is truly fascinating. And I'm just fortunate to be part of it.

John Simboli  
Nandan, thanks for taking the time to speak with me on BioBoss today.

Nandan Padukone  
John, thank you for this opportunity. It's been a fun conversation and I truly appreciate the opportunity.