A star Stanford professor leaves his lab for a startup out to remake psychiatry
About five years ago, Amit Etkin had a breakthrough.
The Stanford neurologist, a soft-spoken demi-prodigy who became a professor while still a resident, had been obsessed for a decade with how to better define psychiatric disorders. Drugs for depression or bipolar disorder didn’t work for many patients with the conditions, and he suspected the reason was how traditional diagnoses didn’t actually get at the heart of what was going on in a patient’s brain.
He had shown in 2006 that some patients with different diagnoses — PTSD vs. depression, for example — looked remarkably similar under brain imaging, suggesting clinicians drew distinctions in the wrong places. And in 2014, he showed that one could define patients by looking at individual discrete behaviors, such as attention or sleep.
But the big advance came in 2017, when his team demonstrated it could predict PTSD patients’ response to therapy by just looking at their brainwaves. Similar predictions, aided with a bit of AI, followed for other disorders.
“So those are the tools that really got us excited,” Etkin told Endpoints News. “And then of course, the main question that you can’t answer in the lab is, how do you develop new therapeutics around this?”
So Etkin left the lab, turning his back on a burgeoning academic career to found and a run a startup around his predictive technology. The company, known as Alto Neuroscience, announced a $32 million Series A Thursday, with plans to launch three Phase IIa trials for treatment-resistant depression and PTSD within the next year and have its first data by 2023.
With the launch, Alto joins a growing boom in neuroscience R&D, a field that much of big pharma abandoned over the last decade.
This resurgence has been predicated in part on new technologies, including the ability to better divide and classify patients by their biology. Last week, ARCH, Amgen and a long list of other investors threw $500 million behind Neumora, a biotech that promises to use a host of different metrics and datasets to come up with so-called “precision phenotypes” — populations most likely to respond to a given molecule.
Alto will try to do something similar with Etkin’s technology. The professor-turned-CEO and his team have spent more than a year going through 200-plus molecules that have been approved or put in clinical development for psychiatric disorders.
They did deep diligence on 21 of them, looking for those that had gone through Phase I for safety and shown the right kind of biological activity. They in-licensed 11 and plan to eventually push each into a psychiatric sub-population that, either because of a given behavior or EEG pattern or other biomarker, they think will respond.
Etkin views the hundreds of failed psychiatry drugs from the last few decade as simply “tools that manipulate the brain in some useful way.” His goal is to find the best place to use them.
“We have all of these tools sitting around that we don’t quite know how to use, and we have all this biology that we’ve been fleshing out over these years,” he said. “This is really how we structured Alto in terms of the strategy: to take all that knowledge from the past 30 years in pharma and biotech, and put it to work in a targeted and meaningful way.”
Etkin found his main backer in a protagonist of the new neuro boom: Christian Angermayer, the German billionaire who founded and largely funded ATAI, the now-$2 billion company trying to develop psychedelics for a panoply of psychiatric disorders. His firm Apeiron led the Series A.
“Alto is well-positioned to revolutionize the treatment of psychiatric disorders by aligning the right patient with the right drug,” he said. “At Apeiron, we have seen recent advancements attempting to expand the toolkit for mental well-being but continue to recognize the dire need to improve the way drugs are developed in this space.”
The company is keeping its 11 molecules under wraps for now, including the three it plans to soon put into Phase IIa trials. Those studies, Etkin said, will hopefully let Alto prove they can develop biomarkers to predict the best patients to respond, allowing them to design pivotal trials just around that group.
It’s the beginning of what Etkin hopes will be a sea change across the field, toward something that looks a lot closer to where oncology is today.
“In five years, in our mind, we’ve completely changed psychiatry, we’ve changed into a much more precise practice,” he said. “And the frustration of trial and error for both patients and clinicians is — if not gone — is certainly on the way to getting there.”