Maryam Soomro, "Black Phosphorus Saves Lives"

Bacterial growth in an IV caused a kid to lose his legs. Shocked by the tragedy, young physician Maryam Soomro began researching solutions. Her startup, TuCann, now uses black phosphorus tech from RMIT, Australia's MIT, to fight infection. Heartening!

Highlights:

Transcript of, “Black Phosphorus Saves Lives”

Guest: Maryam Soomro

Sal Daher Introduces Maryam Soomro

Sal Daher: I'm really proud to say that the Angel Invest Boston podcast is sponsored by Purdue University Entrepreneurship and Peter Fasse, patent attorney at Fish & Richardson. Purdue is exceptional in its support of its faculty, faculty for its top five engineering schools, in helping them get their technology from the lab, out to the market, out to industry out to the clinic.

Peter Fasse is also a great support to entrepreneurs. He is a patent attorney specializing in microfluidics and has been tremendously helpful to some of the startups which I'm involved, including a startup came out of Purdue, Savran Technologies. I'm proud to have these two sponsors for my podcast. Welcome to Angel Invest Boston, conversations with Boston's most interesting founders and angels. Today, we are very privileged to have with us Maryam Soomro who is a physician, a young physician from Australia. Say hi to our audience, Maryam.

Maryam Soomro: Hi, everyone.

Sal Daher: Maryam is right now back home in Australia but she has very recently been at TechStars Boston. I'll let Maryam tell us what problem her startup TuCann is solving.

Maryam Soomro: Absolutely. In order to understand to can you really have to understand the problem around peripheral IVs. What happens with peripheral IVs is that generally, we use one for almost 80% of patients that enter the hospital. These peripheral IVs--

Sal Daher: Peripheral IV, please unpack for the 99% of us who are not MDs?

Maryam Soomro: Peripheral IV is basically that little drip that you get in the arm. The needle that goes in with the plastic sheets and then they insert the fluids through that and they use that for antibiotics, medications, even blood transfusions, almost everything needs intravenous access. That's growing in this day and age as well with the newer pharmacology drugs all requiring intravenous as opposed to oral arm administration.

Sal Daher: Excellent. Thank you. Please, continue.

The IV Issue

Maryam Soomro: Absolutely. The thing about peripheral IVs is that they actually are terrible devices in that you get one at the beginning of your patient's day as 80% of patients do and then about half of them fail at day two and a half and the average patient say being about four days. The problem that occurs is that these failures result in first of all patient complications. Things like sepsis, things like great big inflammation, medication leaking out of the vein into the rest of the skin and soft tissue, and causing lots of terrible effects and scarring and so on as a result.

Often, they also on top of that need replacing, which is an extra added cost for hospitals on top of the patient suffering that goes on. What happens interestingly enough is that these IVs, the reason why they cause all of these side effects is because they actually have two great big issues. The first one is that they cause a lot of mechanical trauma. They're basically inside the vein knocking the vein around causing inflammation.

The second thing is that they're essentially a bridge from the outside world for bacteria to crawl right into your vein, which is a sterile space where bacteria should never grow. This is something that not only did I see in my own medical practice seeing the hospital numbers around for peripheral line infections. In America, for instance, Americans spend $1.6 billion on IVs but they spend $6 billion treating the complication of just the sepsis and that is the rarest occasion it has.

Sal Daher: That's staggering. If you doubled or tripled the cost of the IVs, you'd still save money if you solved the problem. You solved one of the problems.

Maryam Soomro: Exactly. That one problem is still tied to that bacterial contamination. That's where seeing this in my own practice and then also seeing our CTO Kenneth is a combat medic from the Singaporean armed forces and he noted as well the risk in the first responder situations where you don't have optimal fields like you do in the hospital. You have compromising conditions. He actually made an excellent use case for this as a military-type dual technology, which has worked really well for us I have to say.

Sal Daher: Just in the interest of helping the transcribers,

Maryam M-A-R-Y-A-M, Soomro S-O-O-M-R-O, and the name of your technical co-founder Kenneth.

Maryam Soomro: K-E-N-N-E-T-H.

Sal Daher: Kenneth Wong-

Maryam Soomro: Wong, W-O-N-G.

Sal Daher: Very good. He saw this problem in the field, it also resonates with him.

Maryam Soomro: Actually we've got three co-founders in total, it's myself, Kenneth, and Santiago yes.

Sal Daher: So, Santiago and his last name?

Maryam Soomro: Diaz.

Sal Daher: Diaz, D-I-A-Z. What does Santiago bring to the equation?

Maryam Soomro: He's a materials engineer and biomedical scientist.

Sal Daher: Ah, okay.

Maryam Soomro: Yes. That will touch on that antimicrobial material that we're talking about, but--

Sal Daher: This for me was a real mind opener, I had not heard of this material before, so please continue your narrative.

Black Phosphorus: How it Works

Maryam Soomro: Kenneth, his background is in mechanical engineering and industrial design, and he's focused very much on that user experience, the mass manufacturing, getting it to the price points, et cetera. Santi's specialty and expertise is that antimicrobial materials and so on. Of course, we've got our own version of MIT, it's called RMIT the Royal Melbourne Institute of Technology.

Our research team is based there as well. As I was talking about before with the IVs, because there's that issue of mechanical trauma and there's that issue of bacterial contamination, these are the two things that we have essentially prevented through our user experience-based design plus antimicrobial materials.

Essentially we are redesigning the cannula so that it doesn't have the complications that it has currently, and so in terms of the antimicrobial material, our antimicrobial material is it's a very incredible piece of technology I have to say as a physician. It's also got a very cool name. It's called black phosphorus which sounds like a great metal band name.

Sal Daher: Oh man. Black phosphorus sounds like something kids would want to get their hands on for next Halloween.

Maryam Soomro: [laughs] Exactly, and so with black phosphorus we've got a lot of know-how really because we're working with one of the maybe two or so universities in the entire world working with this compound. We're perhaps the only ones that I know of that are actually working with it in an antimicrobial perspective. The other guys are all trying to build semiconductors out of it.

With black phosphorus what happens is that this is a really incredible material that is not only bactericidal and fungicidal against antibiotic-resistant strains of bacteria, it's also very, very cost-effective to manufacture. It's an incredible piece of tech, and the aim is that essentially because with IVs what happens is that the entire manufacture line tends to be a part of the efficiency.

It's a part of the reason why IVs are so cheap because we've literally got BD has these incredible warehouses where they don't even have lighting, it's all infrared lighting with robots and so on just to save on those costs. What you need is a material that is not only cost-effective in the raw material sense but able to adapt to that integration, that mass manufacture line with literally zero changes, because every change is a cut on that bottom line. That's what black phosphorus is.

Sal Daher: Cool. Explain to me the antimicrobial action. How is it antimicrobial?

Using Reactive Oxygen Species to Eliminate Bacterial Infection

Maryam Soomro: It's antimicrobial through breakdown into reactive oxygen species. Essentially what it does is that when it releases these oxygen species, the bacteria that come and that are present in the first five layers of skin that are present on the surface, that are also present within the blood, when they come in contact with these species, these species interact with their cell walls and they interact with the innards essentially of the bacteria, and distort them in a way that they're no longer usable by the bacteria, so the bacteria dies.

Sal Daher: Oxygen species, is this some kind of oxygen ion like ozone or something like that, what is it?

Maryam Soomro: Yes. It's a handful of them. It uses essentially multiple different types of reactive oxygen species. Some of them are ionized, some of them are just straight-up ozone-type compounds. For us, I remember one of the biggest things when we were first starting out on the journey was, we were thinking reactive oxygen species, you have to consider the safety efficacy profile within the human.

Sal Daher: Oh my, yes.

Maryam Soomro: Yes and it was a very incredible thing that we noted that now human blood testing that the reactive oxygen species, as well as in our fibroblast testing it's quite safe to use because humans are very very well equipped to deal with reactive oxygen species, their bacteria are not.

Sal Daher: Right, we have antioxidants in our body dealing with oxygen all the time, and so we have a system designed for that, but it creates a local environment which is not friendly to bacteria because it has been oxidized so that oxidized environment is unfriendly for bacteria, but for humans, it's just like a little bit of dry skin or something like sloughing off some cells and so forth which we're used to doing.

Maryam Soomro: Exactly.

Sal Daher: Just enough to prevent the entry of bacteria. This is fascinating. What kind of tests have been conducted to bear out this design, this idea of using black phosphorus as an antibacterial agent in these peripheral IVs, the drips?

Maryam Soomro: We've tested on a variety of human cells; skin, GI, et cetera, as well as human blood. We've tested on actually different surfaces as well because you're looking at the whole broader commercialization picture, so in medicine the devices that are commonly used are largely made of either plastic derivatives like polyurethane PET, Titanium for those hip joints, and so on, and so we tested on all of them to show that antimicrobial efficacy and that commercial industrial application. We've also tested particularly that generalized safety profile.

We're actually heading in and preparing for that ultimate Q sub meeting with the FDA because we want to negotiate what the animal trials would look like ultimately. I think that's a very powerful way of getting through an antimicrobial, Gendine for instance is a fascinating antimicrobial coating that came out a few years ago from Cook Medical. Gendine actually essentially argued that their animal trials, because they were done so well, they would not likely need extension into humans for safety. Efficacy they can improve on their own and that's a hospital sales dynamic but safety they would not.

Sal Daher: Your thought here is that your FDA approval route that you'll be able to go into efficacy trials in humans just with animal safety trials showing that it's safe in animals.

Maryam Soomro: Yes. I think for us, we are a slightly different use case to Gendine. The thing about Gendine is that they're not quite hyper-focused on the market whereas we are very hyper-focused on the peripheral IV market. The way we see it is that no matter what if we're heading into a clinical trial why not have those safety endpoints and the efficacy endpoints anyway, because the more data we build, that's friendlier, that relationship, our intention is to expand into a suite of products. The more data we build the better for us in the long run.

Creating a Startup: Where to Begin

Sal Daher: Basically your thought is to have animal trials and then to proceed to some kind of efficacy trials without having to do human safety trials because it's been accepted before in the case of Gendine. You've just finished at Techstars, so tell us about your experience of Techstar. What did Techstar do for you? Techstar Boston.

Maryam Soomro: Yes. Techstars Boston. It was an incredible experience. I think from now on whenever I see a startup, the first thing I want to say is in my space, "Have you applied to Techstars Boston?" It's been really incredible I think. It's been eye-opening because here in Australia, there's almost a lot of startups are sadly used-- It's kind of like the grocery shopping or supermarket of the American acquisition world, in that they come in, buy products, and then it's taken away to America and never seen again.

That's accepted and practiced model here in Australia, but as I went to Techstars Boston I realized that that's not the only model that exists. We've got a lot of options in terms of acquisitions because this is a very hot space with antimicrobial resistance being bred and hospitals currently.

Sal Daher: Sure sure.

Maryam Soomro: If you look at it the greater good lies within setting up a company hyper-focused on preventing sepsis because sepsis is such a huge issue. One in three deaths in American hospitals, and this is the CDC stats, one in three deaths are from sepsis itself. That's the ultimate fight here. That's what we really want to do. That's the problem we want to fix.

Where Will TuCann be Based?

Sal Daher: Very interesting. Are you planning to be based in Australia, to be based in the US? What are the plans? Given that your research is being done in Melbourne, in that at least one of your co-founders has connections in Singapore and so forth, the physical location, what do you expect that to be?

Maryam Soomro: Yes. What we are planning on doing is that we are finishing off our seed round raise quite soon, actually. As we're setting up those offices in America, I'm going to be settling into those offices because my aim is just going to be that business sales, getting as many pre-agreements on board as possible, by the time we're ready to enter the market.

The reason why we are keeping R&D in Australia is actually, it's a very interesting time in Australia right now. What's happening is that the government for starters gives you the R&D tax incentive which is 43 cents for every dollar cashback in bank that you spend on R&D. It's really great.

Sal Daher: To begin with your dollar for research goes farther in Australia than it does in the US in general.

Maryam Soomro: Exactly.

Sal Daher: I think it still holds. I know that data point from pre-COVID, that was certainly the case. Several of my startups were doing clinical trials in Australia rather than the US.

Maryam Soomro: Yes, exactly. There's also now a lot of grants being opened up where-- The breakthrough Victoria fund, in particular, is about a billion dollars worth of funding invested in just the state of Victoria where Melbourne is. It's a really ripe opportunity with quite a high success rate. You're looking at-- There are some grants here that have success rates of 20%. If you were to have a one million seed raise, for instance, you could easily double that with non-diluted funding and on top of that, get that R&D tax incentive to make it two and a half million.

Sal Daher: That is very attractive.

Maryam Soomro: Exactly. That's why we're going to be split up between the two countries.

Sal Daher: Excellent. Let's just get back to the conversation about the Techstar. You highly encourage people to apply to Techstar, what are the aha thing that you got during your Techstars experience?

Maryam Soomro: The aha thing, the Techstars network cannot be underestimated. It is incredible how much access I have now to the entirety of America just from spending a few months in Boston. With a network, I'm one of those people that says, even if you start out in one point of the network, you can definitely get to the other as long as how to play the game. That was a great big one. The aha moment really was I think--

I really do have to thank, Greg Simon and Jen, because they focus on each startup's individual pain points ultimately. I saw one startup who's incredibly doubled their sales just by switching from a B2C to a B2B model. That was their aha moment. For us, our aha moment was that you don't have to get acquired the moment you build this product. That is a choice amongst many choices.

Sal Daher: That was the discovery for you. Okay. I can see that because this is something which has the potential for growing tremendously. If you can somehow be building your technology, be building the product, and get the funding to stay alive, doing that, the value of the company will grow. If eventually you'll get acquired or you go to an IPO, you will do that in a much more mature form and therefore realize much greater value for yourselves, for your investor, or you, you may just decide to stay a private company and be independent and so on.

These things can happen too. Believe me, it may seem like an aha moment now, but that could all change in six months the way things go with startups. You could have another aha moment that says, "Geez, there's this opportunity with this big partner that really needs us." Now tell me a little bit about the intellectual property portfolio that you have, that supports the possible creation of value in the future.

Maryam Soomro: Yes. Patent portfolio extends from the antimicrobial material, its multiple use cases, to the UX design components of the IV itself as well. The broader implication of that is that, this is a material that can be extrapolated to almost every single device because every single medical device can and often does cause sepsis.

Sal Daher: Okay. You have a license from-- Who's the inventor of the material?

Getting a License for Use of Materials

Maryam Soomro: We're working with the Royal Melbourne Institute of Technology, [unintelligible 00:20:12] who's-- And as well as a [unintelligible 00:20:15]. We've got a whole team of researchers and we are working alongside them. I suppose in Australia there's a lot more-- The culture is very very collaborative in the respect that we are quite bouncing back and forth.

We'll do things like, heck I think about a few weeks ago, Kenneth, my CTO was driving a whole bunch of cannulas out to RMIT for their sake as well. It was just a-- It's a very collaborative process with our research team.

Sal Daher: Is your license from RMIT an exclusive license for this use?

Maryam Soomro: Yes, that's correct.

Sal Daher: Okay, so you're the only ones that are going to have a cannula coated with black phosphorus?

Maryam Soomro: The way things are looking now, we're going to be the world's first antimicrobial IV

Sal Daher: First antimicrobial IV and certainly the only one using black phosphorus.

Maryam Soomro: Yes, that's correct.

How TuCann Came About

Sal Daher: Very good. In your startup right now, so you have the medical, you have the product design customer experience side of it with Kenneth providing that the material science side. I guess the context that you made at Techstars in Boston, really helping you in the business development side, the strategy side. Very good.

Let's step back a little bit here and get a little bit more fuzzy and just talk about the founding story. How did this startup come about? I want to get into your motivation to become a founder, instead of being a physician. What's the founding story? How did this startup come about?

Maryam Soomro: Startups, I think are born in the mind a little bit. There are little moments where you think, huh, that spiral into great big snowball of, "Oh my goodness, this needs to happen." For me, those little moments, I can remember two of them, in particular. The first one was when I first learned how to put in an IV, I remember thinking, "Why on earth are there so many steps?

Why am I almost surgically prepping this patient on this trolley when the patient is literally hemorrhaging in front of me?" It's just such a-- why is it a 10-minute process when seconds matter in the outcome of this patient's life? That was one of the first moments, and then the second moment was actually I remember this patient in the emergency ward. I generally work in emergency and he had come in and he was very young.

He was about 18 and we'd inserted an IV and it was-- It's a run-of-the-mill procedure. You don't think twice when you put it in and wrapped him up, he was all stable. Everything was fine. It was for something so very minor as well. We'd just given him a bag of fluids. I like to track all of the patients leaving the department and how they go because it's a good learning opportunity for the cohorts that you're dealing with.

Four days later, I searched his name in the computer system and he had developed septic shock from essentially the IV. He had ended up in the ICU and lost his legs. It was shocking to see. When someone asks you, "Should I put an IV." Most physicians don't think twice, but after that moment, I thought, "Why am I fixating so much on this decision, and nobody in the healthcare system should have to make this choice about something that we consider essentially so mundane?"

That's where my motivation began. It's a love letter to my patients and to my colleagues in that patients deserve to be safe and healthcare workers deserve to know that whatever they're doing is going to be safe for their patients because ultimately we're all driven by making that change for the patient.

Sal Daher: Yes, this brings to mind, someone that was recently on the podcast, Jeremy Weigel, he's a medical doctor in the United States, a urologist, and his particular beef is that his wife when she gave birth, first child had a problem with the pelvic floor. He is a specialist in this and she had trouble getting the appropriate care because it's not just a physician. There are other caregivers that are necessary, their devices, and all this stuff and he was saying, "Oh my gosh, the wife of urologist specialized in this area has problems accessing adequate care. I imagine what it must be like for someone who doesn't have all these things going for them." He was almost indignant. The point is that if you combine all of the therapies and the right provider and the right monitoring and so on, these things can be solved very often, very frequently, but it's very easy just for lack of coordination. It's the reason for failure is a silly reason,

it's a stupid reason and he had this sense of outrage that it shouldn't be like this.

Here, I mean, this is something even more shocking, that something as mundane as putting in an IV could result in an 18-year-old losing his legs, that is just stunning, and it should not happen. I understand your motivation. Did you have any models for entrepreneurship before? Because someone might easily go in the direction of research because something like this says, "Oh, I'm going to research and figure out the problem from the research side." Why instantiate the solution in a company, instead of publishing research papers?

From Research to Entrepreneurship

Maryam Soomro: The research pathway did call to me actually, initially. I started writing up my proposals as any good doctor would. It took a meeting with a man by the name of Buzz Palmer, who is a he's an ex orthopedic surgeon, who has made it big in the entrepreneurship world.

Sal Daher: Ah, okay.

Maryam Soomro: He came up to me, and he said, "How much are you willing to do to make that difference in your lifetime?" I remember reflecting on that question a lot. At the time, I was quite young, I was about 25. I thought, "Well, quite a lot, actually, I'm willing to stop my specialization, focus on this for the next 5 to 10 years, ensure it's built, and push it through. I'm willing to do a lot for my patients, for all patients everywhere, really."

Having that impact and having that role model there, opened my eyes to the entrepreneurship world. Then Buzz said, "Look, it's a bit of a no brainer, you're obviously gearing for this. We'll all mentor you and the Medtech actuator will mentor you through it." At first, I was very hesitant, I did resist the pull to entrepreneurship, in that I think there's a lot to do with, am I really doing this? Am I really making the right choice here? Then you realize, actually, commercialization is one of the most effective ways of getting that change out in the world, because you have so many interested parties pushing through the next standard of care because that's ultimately what we're gearing for.

Sal Daher: Yes. Okay. That's excellent. Very, very good. At this point, is there anything else that you want to bring to the audience, this audience of Angel investors, of founders, of startups, thoughts that you have, that might help other people? It could also be a call for help, the collaborators or support that you might need. Anything come to mind?

Maryam Soomro: For us, in particular, though we have a lot of advisors on the business aspect and though over the next few years, we're actually doing the full R&D, FDA reimbursement, one of the things that we're also fixating on is actually military assets in particular.

Sal Daher: Oh, interesting. Your co-founder, Kenneth, will have an in for the armed forces in Singapore.

Maryam Soomro: Yes.

Sal Daher: Here's a call to all military-connected people who think this could be extremely valuable. It can imagine this having use of the battlefield, give Maryam a shout-out, and connect with her and TuCann because you could save a lot of lives by doing that.

Maryam Soomro: Exactly. It's a very good market in the understanding where the need lies. It lies a lot in the first responder in the emergency and in the immune-compromised spaces. The great thing about the military is that they buy in bulk, which helps with hitting the mass manufacture level numbers that we're looking at.

Sal Daher: Right, and they're willing to be early adopters if it is something that's of great value in saving lives. Most people are not in a situation like in a battlefield when they have to have an IV put in. They're usually in a controlled environment in the hospital. It makes sense for the military to have this technology available to them. That makes a lot of sense to get access to the armed forces and to start conversations with them. Connections with armed forces, calling out our listeners who have connections in the armed forces, do help, Maryam. This is could be a great boon to humanity.

Maryam Soomro: Much appreciated. Thanks so much, Sal.

Sal Daher: Excellent. Any other thoughts that you want to have to close out the interview?

Maryam Soomro: It's interesting seeing I suppose-- I mean, at the stage of growth that we're at because we are all coming from that intense research, production engineering background that when you step into the commercial world, it's an incredible space to really realize the effects of your research very soon. I think for me, I guess the big takeaway or the thing that I would really push out is that commercialization of any medical devices, medical products whatsoever is really ultimately just the fast-tracking of adoption of research.

Going into that startup space, pushing that through, and putting the new standard of care, it allows for patient change at a scale that is really not seen in any other field, I don't think. For me, the exciting thing is that, because we are in that interesting space between clinical research and commercialization, we've got a lot of things that we can work with because we've got access to things like the government standards of good care, working with all of these larger parties at play. I think I'm quite grateful to the Boston space for really showing us that or being with us for that.

Sal Daher: Excellent. Maryam Soomro, physician, founder of Toucan, it's creating sepsis minimizing cannula for IV for intravenous insertion. Thanks for being on the Angel Invest Boston podcast.

Maryam Soomro: Well, thank you so much for having me, Sal.

Sal Daher: Awesome. This is Angel Invest Boston. Thanks for listening. I'm Sal Daher.

[music]

Sal Daher: I'm glad you were able to join us. Our engineer is Raul Rosa, our theme was composed by John McKusick, our graphic design is by Katherine Woodman-Maynard, and our host is coached by Grace Daher.