Screening diseases through pharmacogenomics with NalaGenetics' Levana Sani
Episode show notes and transcript
About The Guest
Levana Sani is the co-founder and CEO of NalaGenetics, a startup company based in Singapore that focuses on pharmacogenetics with an emphasis on the Southeast Asia region. Levana graduated from the University of Southern California with a major in biochemistry and later earned an MBA from Harvard Business School. Prior to starting NalaGenetics, Levana worked at the Genomic Institute of Singapore and gained experience in the intersection of business and sciences. Levana is passionate about using genetics to deliver meaningful patient outcomes and is dedicated to expanding access to personalized genetic services.
📄 Summary
Levana Sani is the co-founder and CEO of NalaGenetics. In this episode, Levana shares about her motivation behind spinning off from academia, the value of an MBA during this process, and the resources she tapped into when first starting NalaGenetics. Additionally, she highlights the differences in commercialisation in Singapore and Indonesia, and the current challenges faced with the adoption and application of pharmacogenomics in clinics.
🥡 Key Takeaways
NalaGenetics aims to solve four main problems in the field of genetic testing: the lack of diversity in genetic databases, manual interpretation of genetic information, lack of integration into health systems, and the absence of reimbursement for genetic testing.
The collaboration with the Indonesian government has been instrumental in NalaGenetics' success, as they focus on expanding access to genetic testing in Indonesia.
The Singapore and Indonesian markets have different needs and challenges, requiring NalaGenetics to adapt their product offering and business model accordingly.
Ethical considerations play a significant role in offering personalized genetic services, and NalaGenetics prioritizes patient outcomes and quality in their operations.
NalaGenetics plans to expand to other Southeast Asian markets, the Gulf region, and North Asia, offering a comprehensive range of genetic testing solutions for risk prediction and preventive care.
💬 Quotes
"One of the things was, for example, an insurance company that asked us, you know, whether or not we can help them adjust premium, quote unquote, or include genetic testing as a part of a pre -policy check up. And you know, the answer was obviously not. And, they were saying, we can test a lot of people, et cetera. And that was an opportunity that multiple companies really approached us for and we decided to turn that down."
"After looking at multiple different markets, pharmacogenomics is just one of those things that doesn't have the perfect storm for adoption, and it's a sad story, but with population genomics programs, pharmacogenomics might be catching on a little bit more. But I think especially in preventive healthcare, value-based healthcare. A lot of the stakeholders need to all say yes for something to happen."
"Nala really wants to be the company that utilizes genetics to truly deliver patient outcomes in a meaningful way."
⏱️ Timestamp
01:00 - Introduction
05:09 - Early beginnings of NalaGenetics
12:11 - Product development and market expansion
17:10 - Technology and democratization of genetics
24:15 - Future outlook
🎙️ Transcript
Episode Preview
Levana Sani: After looking at multiple different markets, pharmacogenomics is just one of those things that doesn't have the perfect storm for adoption, and it's a sad story, but with population genomics programs, pharmacogenomics might be catching on a little bit more. But I think especially in preventive healthcare, value-based healthcare, a lot of the stakeholders need to all say yes for something to happen.
Jessie Wong: Hi, thanks for joining us on Nucleate Singapore Pulse, Singapore's premier podcast on the biotech ecosystem. I'm your host, Jessie Wong, a PhD candidate at Duke-NUS Medical School. Whether you're a student thinking about creating your own startup or an industry professional looking for diverse perspectives, this is the podcast for you.
The show notes and transcripts for the episode can be found on nucleatesingapore.substack.com.
Introduction
Jessie Wong: Today, we have Levana Sani from NalaGenetics, who graduated from University of Southern California and subsequently an MBA from Harvard Business School. Levana is also the co-founder and CEO of NalaGenetics, which is a startup company based in Singapore, focusing on pharmacogenetics with an emphasis in Southeast Asia region.
Thank you for joining us, Levi.
Levana Sani: Really happy to be here. Thanks so much for having me.
Jessie Wong: So I noticed that you actually have an MBA in Harvard Business School, around the same time that NalaGenetics was founded.
Did that come about because of NalaGenetics or was it prior to that?
Levana Sani: Prior actually. So I applied to the program concurrently as I was contemplating like a PhD because I really wanted to work in sciences. And during that time it was a senior year of college, and they had a program specifically for college seniors called “2+2” that encourages STEM students to apply for business school and that the program allows you to work for two years and then go to business school for two years afterwards, which is why it's called “2+2”. And during that time of working before going to business school, after getting accepted to the program, I worked in Genome Institute of Singapore where I met my co-founders for NalaGenetics. So I knew that I was already interested in business or the intersections of business and sciences and then I had the idea of NalaGenetics afterwards.
Jessie Wong: So in that case, how did the MBA actually help you in developing NalaGenetics?
Levana Sani: It was really helpful because I majored in biochemistry and I guess I had a minor in entrepreneurship, but it really wasn't much. It was really just a door opener to understanding what I didn't understand. And the MBA degree set my foundation of how business should be run. What exactly is a business? Why do people create businesses? And doing so in a very, I would say a very unique way.
The Harvard business school degree is very much big on a case study method, which means that you imagine yourself to be a protagonist of a case study or a business and in that program, then you would be faced with problems or decision making that you need to do as if you were a CEO or this person was a protagonist. It was very important for me to think through what creating a business looked like and all the way until if I was a CEO of a public company or a Fortune 500 company, what would I do?
And that end to end kind of perspective and projection of oneself really helped me to build confidence and understanding. I guess to a certain degree, the complexity that may be required later down the line, but it's also very humbling in terms of how difficult the process was going to be moving forward.
And also, it gave us a lot of friends and network and access to the best thinkers and practitioners in the field, especially in biotech where Harvard was located, it was in Boston, it was really the mecca for biotech startups and company. So it's really helpful.
And maybe the last part is the access to peers that still is a support network. I guess building businesses is hard and you don't see a lot of people who are maybe creating similar businesses or pursuing a similar career path. And having that network was to me personally, so precious and I still keep in touch with some of them who are interested in this field, interested in the region or interested just to keep in touch and be friends.
So, it's very helpful in that regard.
Early beginnings of NalaGenetics
Jessie Wong: You mentioned that you met your co founder back in A*STAR, right? And so, I was curious, how did the idea of spinning off NalaGenetics come about actually?
Levana Sani: So when I was working at Genome Institute of Singapore before business school, I was working under the human genomics group with Professor Jianjun Liu, and I was assigned to help a particular postdoc who also happens to be Indonesian. Her name is Astrid, who currently is my COO and later became one of the co-founding advisor. One of our collaborators was a translational science expert, who is Sandro or Alexander Lezhava, who currently also is our founding advisor. So we were working on a very particular project for pharmacogenomics in Singapore that was funded by one of Singapore's national program and grants. And the task was to create a panel for screening in Singapore for pharmacogenomics screening. We created an approach, we created a prototype, and then that became the inception of the first product that we licensed. But even before then, we had a side project for commercializing or translating a biomarker specifically for leprosy, which was very important for Indonesian population, which Astrid and I were highly passionate about.
Because of those projects, we really liked the team that we were working with, we seemed to have a pretty good chemistry and, you know, we thought that it would be good to try to create a company together. We didn't really know what we were doing back then. I think the vision has changed a lot, but I think it was really that conception of a bunch of scientists wanting to make impact. And a bunch of scientists that wanted to keep working together that kind of really solidified the idea that maybe a company stemming from these four people would be a good idea.
Jessie Wong: Right. What was some of the problems that you and your co founders aim to solve through NalaGenetics?
Levana Sani: Yeah, it stemmed from this very basic understanding that diverse population genome is not well studied and a lot of human genetics studies are created in Caucasian populations. And there wasn't really a good understanding of how different or how impactful it would be to still have that dataset and how to clinically translate a lot of these findings.
The clinical problem that we eventually settled on is the fact that current germline testing or human genetic testing for either diagnosis and screening of diseases do not fulfill the requirement of developing markets and we narrowed it down to basically four main problems.
Number one is that the database itself or the biobanks are very much skewed toward Caucasian populations. About 80 percent of total studies or biomarkers are found in Caucasian populations.
Number two is that a lot of the interpretation of genetic information is still being done manually, so doctors would go and, compile papers that would help them translate a variant all the way until, say, what drug is recommended for that specific variant, or what disease is associated with that specific variant.
Number three is that it is not integrated into current health systems. Both in terms of protocol, but also in terms of systems, which means that it is very hard for physicians to keep updating themselves about what's the latest in the current technology and the current updates in science. Hundreds of papers are published every quarter, every month.
And the fourth one is that it is not reimbursed. There's no company currently collecting or attempting to collect data to argue that genetic testing should really be a part of standard of care, especially for predicting diagnosis of certain conditions.
So NalaGenetics set out to really solve these four problems, especially across chronic conditions, like cancer, cardiometabolic and your neurodegenerative conditions.
Jessie Wong: It seems like NalaGenetics, your team is really trying to reinvent the process, the entire process of diagnosis to treatment. So going back to how you started out NalaGenetics, I was curious how did your PI come into this equation, were they actually supportive of this decision between you and Astrid?
Levana Sani: The decision actually came through from JJ, I think, who, if I remember this history correctly, but I remember him telling us that, you know, he has life plans and in this next decade, he really wanted to try entrepreneurship and he wanted to find partners to be able to do that. And we were looped in as partners because we have this understanding that Indonesia as a market is a very interesting market. We were both Indonesian and I was interested in business. Astrid wanted to move out from academia and we sort of banded together and saw an opportunity to kind of work together.
Astrid and I really thought about it and, and really liked working with each other and still have a pretty good working relationship until today. So you know, that mentorship from JJ and Sandro together with the working relationship that I have with Astrid today, I would say, it's a pretty good involvement quote unquote, as a principal investigator, but now they're more of an advisor and mentor to us.
Jessie Wong: That's really great to have your PI support you in your decisions to actually create a company from that. So, were there any resources that you guys tapped on when you first started out?
Levana Sani: A lot, yeah. So, a couple of resources in Singapore, in Genome Institute of Singapore, at that time, there was Innovation Fellow Program. I'm not sure if it's still available today, but the idea was that there was a changing landscape in Singapore that wanted to spin off more entrepreneurs from the institute and they were giving out grants. So it's most related to generating commercial value from their IP.
There was that program that Astrid was a part of that I thought was really helpful to not only develop skill sets, but also shift the mindset from a purely academic mindset to do something that is a little bit more product centric or clinical impact centric.
And then afterwards we, we went on to apply for gap funding together, which I think today is still like an excellent kind of thesis of how companies should be, how public sector can help the private sector to start up. From that gap funding, we developed two products, one for leprosy, one for PGx Core®, which is a screening qPCR kit for cardiovascular, psychiatry and pain medication. There's still our bread and butter today.
So I was in business school for two years before joining full time. And one of the resources as I was in business school at the time when we first got in was with the Venture Incubation Program from Harvard which gave me access to people who have built companies around biotech and clinical data before, and it was just really great to have that type of mentorship and access to competitions and a platform where eventually a competition invited a lot of investors and that's how we got our first investment was through joining that competition.
But yeah, so it was a lot of resources that really scraped through in the beginning both from Singapore and I guess at the time in Boston when I was in business school.
Jessie Wong: When startups actually start out, they really have a lot of trouble trying to get funding. And it's really amazing to hear that you guys actually got a lot of traction already from the start.
Product development and market expansion
Jessie Wong: But when we talk about starting out especially for NalaGenetics, it seems as if like you guys started out with multiple products. Was the pharmacogenetics kit the first product that you came up or was it like a slew of problem statements that you guys actually had, which is the four that you mentioned, then you developed the products for it. So I'm just curious about how the entire process came about.
Levana Sani: Yeah, which came first. But I think it's more the product first. You know, JJ had a couple of findings that he wanted to commercialize, but we knew those were the first product and we had our first client for PGx Core®, which was one of the collaborators in pharmacogenomics study. So it was really good for us to have that all set up in the beginning, but I think what was hardest for us was to understand where do we go next? And that's where, you know, solidifying the problems, creating a scope of what NalaGenetics aims to be. And placing ourselves in a very small and competitive market like Singapore to make sure that we don't overlap with other players.
Those are things that we develop much later on as we commercialize our first product. So I would say we kind of understood where we want to go and we have our first product, but really, the biggest challenge for us, I would say, is really determining what what comes after. And that's where the 4 problems that I mentioned before, probably help solidify
Jessie Wong: As you mentioned earlier on, you and Astrid are Indonesians and it seems like NalaGenetics also has collaborations with the Indonesian government. So, I wondered how did that collaboration come about and how did the Indonesian government noticed NalaGenetics?
Levana Sani: I think it was in the beginning where it's just not a lot of indonesians creating biotech companies at the time, and we really thought of indonesia as a market that we've always wanted to focus and work together on. So, we Invested a lot in learning about the players from the get go. We had investors who are based in Indonesia and had a specific hypothesis around it. It was something that from partly our interest to be involved in the Indonesian ecosystem and also Indonesia's interest in a shiny new object like entrepreneurship and that I think kind of like was a good match.
Jessie Wong: Singapore and Indonesia are very different countries with different standards of healthcare and economy. So is there a difference in the markets in Singapore and Indonesia and whether they have different needs?
Levana Sani: Yeah, a lot. The product offering and the business model in Singapore and Indonesia today are vastly different for Nala (NalaGenetics). And we learned that the hard way, for many, many years of trying to commercialize in both markets.
I think Singapore is very strong in fostering public private partnerships, especially for research and IP building. So there's just a lot of support, a lot of technology and talent and keeping in leaders that are very much incentivized to be the forefront in a certain field of science, I would say. And that shows through all the different metrics that you see Singapore really achieving in terms of number of investments, publications, IP filed, et cetera, et cetera.
If you look at Indonesia, it's really growth of GDP, number of people is very much developing market in a lot of the sense, maybe not all, but still a majority of the metrics really show that and especially in terms of awareness of healthcare needs. Let alone genetic testing.
I remember with the first time we pitched QA, this was way before COVID, so maybe a year before COVID, we were pitching through a premier hospital here to a director. And after , you know, going through a couple of slides, the director stopped us and asked what exactly is the DNA ? So it was a, it was, you know, a lot of context we had to bring to the market. And I think COVID really accelerated a lot of the understanding around genetic testing, and we were very, very excited about the opportunities that came along with that, especially with the new population genomics program in Indonesia. So in Singapore now, the way that we operate is really to co-develop solutions and also research, especially translational research. And then in Indonesia, it is like our beachhead where we try to pilot different solutions which is not completely regulatory approved, but it's validated for a single lab. So we have lab partners here that, that work with employers, insurance companies, hospital, clinic, doctors to sell our solutions as a service. And then with enough clinical evidence, we actually go through regulatory approval and export the product in the form of a kit and a software to other markets such as other Southeast Asian countries, the Gulf region and even Taiwan.
So that's kind of how we see the different markets. We work with whatever strength each market has and try to fulfill the needs of the markets themselves.
Technology and democratization of genetics
Jessie Wong: I see, I noticed that your main customers or stakeholders are actually based in Singapore and Indonesia as mentioned. So how is NalaGenetics working to make your kits and products more accessible to people in both of these countries?
Levana Sani: So I guess in Singapore and Indonesia, we give access by working with labs who can run our kit and software .
And we marketed ourselves to hospitals and employers. Mostly so they understand the value of genetic testing. If you look at the barrier of adoption of access, I don't think lab capacity is really the issue. There's a lot of labs, especially after COVID. It's really understanding why people need to get tested for certain things.
So awareness is still the biggest issue. So in terms of access, I think that our biggest contribution to the Indonesian market and to a certain degree the Singapore market is educating physicians how genetic testing or germline testing can be beneficial for their practice. And how preventive care and personalized care can boost the patient outcomes.
I think to a certain degree that was helpful in the first phase where a lot of the tests are still paid out of pocket. But then the second phase where Nala plays a lot of role in right now is.arguably for reimbursement. If you look at the willingness to pay, maybe not in Singapore, most majority of people can pay, but in a country like Indonesia not a lot of people can pay $200, $300 for a test.
So what we do is we work with insurance companies to give more access to people who may need the test. And to that end, we've worked with ten employers, three insurance companies and really ramping up the number of testing because of those reimbursement collaborations that we were able to get.
Jessie Wong: So pharmacogenetics has been around for a while. Is there a reason why the uptake of pharmacogenetics in Asia is slower compared to the rest of the world?
Levana Sani: Honestly, it's slow everywhere. After looking at multiple different markets, pharmacogenomics is just one of those things that doesn't have the perfect storm for adoption, and it's a sad story, but with population genomics programs, pharmacogenomics might be catching on a little bit more. But I think especially in preventive healthcare, value-based healthcare. A lot of the stakeholders need to all say yes for something to happen. And these include pharma insurance companies, physician, patient, hospital, and they all need to say, yes, we need the solution because it benefits their own incentives to be able to move forward for a solution to be adopted in a meaningful way.
I think with pharmacogenomics, it was just harder because in two ways. Number one is the way that drugs currently are incentivized is that pharmaceutical companies would invest more in drugs that are newer, but then by default, a lot of pharmacogenomics biomarkers take a while to find and generally, it's found for drugs that are a little bit older traditionally, right? These days, I think pharmacogenomics are moving up front where they're already included in the trial phase. And so it is commercialized together with the drugs. It is a game changing trend. But traditionally, that's why I think pharmacogenomics has been really hard to adopt.
I think this is also why NalaGenetics have been looking at pharmacogenomics as a initial starting phase, but we know for a while that it will never be the only thing that we do. We need to expand to other types of indications or risk prediction of other diseases or conditions pretty quickly.
And so that's why we expanded to risk prediction of cancer, cardiovascular conditions and also personalized nutrition and wellness solutions just to ensure that we have ways of sustaining the company beyond pharmacogenomics.
Jessie Wong: I guess this is why NalaGenetics really try to take a multi pronged approach to kind of integrate pharmacogenetics into the system to in an attempt to increase the uptake of pharmacogenetic testing, right?
Levana Sani: Exactly. Yeah, I would say so.
Jessie Wong: NalaGenetics actually secured a $12.6 million in Series A funding two years ago in 2022. So how different were the processes for securing pre-seed, seed and Series A funding? Were the asks by the investors different in each stage?
Levana Sani: Huge. Yeah, it's super different. Looking back it was easy, but at the time it was ridiculously difficult. Okay, the same thing that spans across , all stages is how difficult it is. Fundraising is a very difficult process. But it's difficult in very different ways in the beginning because the process was pretty I guess opaque at the time for us because we didn't have a lot of experience. We were all first time entrepreneurs.
And at the time, a lot of people were making bets on founders specifically , their conviction and founder market fit. For Seed, the story was whether or not NalaGenetics can be a serious player in a very big market that it's set out to achieve.
And then in series A is whether or not there are proof points of that thesis. And then it looks like in series B is whether or not the numbers back up that initial proof point and whether or not that initial success is a fluke or something that is repeatable. Like we can actually turn out systems that not only create a single product, but can create multiple successful products.
So, yeah, so I think the progression was very steep or the learning curve was very steep, but it was something that we, we learned along the way for sure that it's very, very different from one stage to another.
Jessie Wong: When you offer pharmacogenetics testing, are there any ethical considerations involved in offering personalized genetic services and how does Nala actually approach these issues?
Levana Sani: There were a lot of ethical considerations that we have to address, for example, there are a lot of diseases that you can predict, but really cannot intervene because we just don't know how to intervene them yet so the question is whether or not we want to report those.
Oh, one of the things was, for example, an insurance company that asked us, you know, whether or not we can help them adjust premium, quote unquote, or include genetic testing as a part of a pre -policy check up. And you know, the answer was obviously not. And, they were saying, we can test a lot of people, et cetera. And that was an opportunity that multiple companies really approached us for and we decided to turn that down. And then there was a lot of things related to processes that we had to not cut corners on. So during COVID, we pivoted to building labs for hospitals because we were really good at churning out labs and we knew how to do that pretty well. And a lot of hospitals wanted it to be fast. You know, a lot of hospitals wanted it to be cheap and cut corners on a lot of kind of quality, and we see that a lot still today when we look for lab partners. So we are very, very careful about who we partner with in different markets and really try to make sure that the data is good quality when we partner for entering a certain market. So there was a lot of ethical considerations that hopefully, we've made good decisions on, I think the fact that a lot of partners still believe in us really is a testament to my co founder as well. She's been tirelessly making sure that our SOP and operations are really top notch. So you know, kudos to her and the rest of the team for sure.
Future outlook
Jessie Wong: NalaGenetics really stayed true to the core, which is to really help patients and integrate pharmacogenetics in this sense. So, are there plans for you guys to actually expand beyond these two markets and how are you planning to do so?
Levana Sani: Yeah, we plan to expand to other Southeast Asian markets, the Gulf region and North Asia, mostly. And we do so by selling our kits and software through a regulatory approved product.
Honestly, it has been more than pharmacogenomics that people are interested in. We also have a risk prediction for breast cancer that in terms of positive predictive values, performs nine times better than BRCA1 and 2 testing, especially for a diverse population. So, I think these improvements or IP that we have generated allow us to carve our own niche in the market that is quite busy today and still are able to get partnerships in mature markets like Taiwan, for example. So excited to kind of explore that market a little bit more, especially a little bit of last year and this year.
Jessie Wong: So following on that, I'm just curious about how can technology be leveraged to further democratize access to personalized genetics and empower individuals to actually take control of their health.
Levana Sani: Well, I think in many multiple ways. Number one is the way that the algorithms themselves are built so very upstream where you are trying to understand the biomarkers or which ones to test and how a lot of machine learning applications there, a lot of the way that the data is organized through the federated access of different data sets in different countries. So that's one aspect of being able to combine different data sets in such a way that generates different insights, more insights that we know today.
Second part is really on how technology brings more data in terms of genetics, right? So more and more sequencers are paving the path of what else can we read on the human genome. We thought that we can read whole genome sequencing, but there are still dark regions. There's still structural variations that currently are not being addressed by current technologies.
And then finally, on the patient side a lot of applications about how do we report and derive insights that is meaningful for patients. So how do we maybe create a chat bot or something like that, that allows patients to interact with the report much more intuitively. How do we integrate these insights into electronic health record system? These are where quote unquote technology is really helpful for patients and physicians at the very downstream level. So yeah, I would say those are kind of the three types of technology that we're pretty excited about and are working on to a grand degree today, and hopefully benefits the whole field.
Jessie Wong: What is the future outlook for NalaGenetics and what can people expect from NalaGenetics in the next five to 10 years?
Levana Sani: Yeah. We introduced genetic testing for risk prediction. I think people know risk prediction through direct to consumer testing, like 23andMe and maybe Circle DNA, where actionability is just a big issue. People see this as entertainment value and people see risk of cancer as something they treat as seriously as whether or not you like cilantro . And I think Nala really wants to be the company that utilizes genetics to truly deliver patient outcomes in a meaningful way.
I think what people can expect from Nala is a comprehensive offering that can deliver preventive outcomes using genetic testing.
Jessie Wong: Thank you so much, Levi. Thank you so much for joining us on this podcast.
Levana Sani: Thank you so much for having me. Thanks so much for all the insightful questions.
Jessie Wong: Stay tuned for monthly podcasts with key stakeholders of the biotech ecosystem, including founders, investors, and policy makers.
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📚 Further readings
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