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Medical fish skin pioneer aims to speed mastectomy recovery

Fish skin could be used to improve post-mastectomy breast reconstruction procedures

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Fertram Sigurjonsson, founder and CEO of Kerecis

Iceland’s first billion-dollar ‘unicorn’ – which harnesses fish skin to treat wounds and burns – is now aiming to help women recovering from mastectomies.

Kerecis has disrupted the global market for wound, burn and trauma treatment in the last decade, thanks to a biproduct of one of Iceland’s biggest exports.

It utilises North-Atlantic cod skins to create a natural graft material that enables cellular therapy, tissue regeneration and protection.

Last year it became Iceland’s first unicorn after the Danish healthcare products multinational Coloplast acquired it for US$1.3bn.

To date its focus has been limited to chronic, acute and surgical wounds, burns and trauma. This is supported by growing body of clinical evidence for faster wound healing via its products.

But speaking to Femtech World in Reykjavik, CEO and founder Fertram Sigurjonsson reveals that the company’s research and development team is now working on applying fish skin to improve post-mastectomy breast reconstruction procedures.

“We have three avenues for growth,” he says. “The first is geographical expansion, and we will do that through the [parent] company. The second is to expand within the business we are already in, which is chronic wounds, burns and surgical wounds; so more features and products.

“The third avenue for expansion is new indications, including breast reconstruction.

“When women lose breasts after a mastectomy for cancer, there is a pocket that is put into the chest, stapled into the muscles. You can then put a silicone implant into the pocket. The silicone implant is heavy and so there is a sling that keeps the breast elevated normally. This sling is made of plastic. This means the woman has two foreign bodies, plastic and silicone.

“We are developing the use of fish skin as a sling that will keep the breast elevated over half a year to a year. This skin will eventually be replaced by the woman’s own tissues when they are strong enough to keep the breast elevated.”

Sigurjonsson says being part of a publicly listed company prevents him from sharing when the innovation may be available to women undergoing mastectomies; he also admits that a long road awaits in terms of building evidence and clinical data needed to reach that goal.

With Kerecis spending 10 to 15 per cent of revenue on research and development, including via investigations into hernia and ligament repair solutions, it is clearly committed to broadening the reach of medical fish skin to help more patients globally.

Sigurjonsson says: “We need new research, new trials and new regulatory submissions. Of course, now we are part of a bigger company and we have more money, this becomes more realistic.”

Bringing new medical applications to the fore is a notoriously cost-intensive, long-haul journey that requires patience among investors and shareholders; and an abundance of research funding.

Given the bright business outlook for Kerecis, however, the company seems to have these fundamentals in place as it looks to realise its mastectomy hypothesis and other new applications.

“I’ve raised money from shareholders four times and [each time] I was able to provide them a very good return on their investment,” says Sigurjonsson.

“We have very good market access in the United States, with 600 employees [there] and we are by far the fastest growing wound care company in the US.

“We are continuing to operate the Swiss unit and we are treating thousands of people every day with our products

“Coloplast has operations in 140 countries. I have the ability to work with them and over the next decade, make my invention from my hometown a global product around the world.”

Kerecis was conceived after a journey of discovery for Sigurjonsson as he sought a new and improved approach to wound care.

“I was an employee in several medtech companies and then came back to Iceland and had an opportunity to found Kerecis.

“I’m a specialist in wounds and wound treatment. Wounds are a huge global problem. People get diabetes, then lose the sensation their legs. They get a small wound and sometimes the wounds get bigger and bigger because of bad blood circulation in diabetics. Half a million people [every year] will have an amputation [in their lower extremities because of this].

“There are three generations of wound treatment products. Firstly gauzes, which keep the wound very dry. This is not very good for cells because they need to proliferate and need moisture and humidity. The second generation, emerging in the 50s, was moist wound dressings. Then in the first decade of this century, the third generation emerged, which is biologic material from animals or humans.”

The origins of such products developed to date include pigs and human foetal sacs.

Through fish, Sigurjonsson took this product class into entirely new territory.

“I came back here looking for a new project that inspired me, with a material that Iceland has a lot of. Of course we have fish all around the country, we have small fishing towns everywhere and there is a lot of fish export.

“I started to think about using scales from the fish, but then when I was studying more about the anatomy of fish skin, I found out that it is identical to human skin. You might think that human skin is very different from fish. We used to be fish two million years ago, but actually evolution has focused on the brain, the fingers and the feet. The epidermis, dermis, subcutaneous tissue are identical, except we have developed hairs out of scales.”

Furthermore, because there is no known risk of viral disease transmission, fish skin needs only minimal processing by Kerecis, preserving its structure and components.

“When I discovered these things, the first person I talked to about it, apart from my wife, was a patent attorney.”

Today, the Kerecis product journey starts with fish caught in the North Atlantic, off the township of Isafjordur, on Iceland’s northwest coast. Skins that would otherwise have been thrown away are sent to the company’s processing plant in the same town – where products are made for the rest of Europe, the US and other jurisdictions.

The continued presence of Kerecis in its homeland has helped to draw attention to the country’s growing prowess in health innovation. Sigurjonsson believes its emergence as the country’s first unicorn has also helped to change the mindset of investors.

“Iceland does not have a very developed investor community. Most investments in the past have been in real estate and traditional businesses. Companies on the Icelandic stock exchange have their values based on multiples of EBITDA [earnings before interest, taxes, depreciation, and amortisation].

“There has not been a big history of venture investments in Iceland. But, because people can see others making money now, there is now substantially more investment interest in start-ups.”

Femtech World was speaking to Kerecis CEO and founder Fertram Sigurjonsson at an event organised by Business Iceland on behalf of Reykjavik Science City.

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‘Groundbreaking’ endometriosis study identifies patient priorities

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A “groundbreaking” study into endometriosis has identified three areas for future research that can help improve the outcomes for women with the condition.

The study, commissioned by Endometriosis New Zealand, attracted 1,262 participants, including 1,024 people with confirmed endometriosis, making it the largest ever study involving endometriosis patients and supporters in New Zealand.

Study participants identified the management and treatment of endometriosis, the need for a better understanding of its cause and improvements to diagnostic capability as the three main priorities for further research.

While these findings provide a clear pathway for future work, Endometriosis New Zealand chief executive, Tanya Cooke, said endometriosis research had historically been underfunded.

“With an estimated 120,000 New Zealanders living with endometriosis, much more needs to be invested into finding solutions,” Cooke explained.

“The reality is the outcomes for many endometriosis patients are pretty poor, with diagnosis often taking many years and treatment patchy across the country.”

Estimates based on Australian data suggest that endometriosis is likely to be costing New Zealand somewhere in the range of $1.3-1.5bn annually through increased healthcare costs and lost workforce productivity.

Cooke said: “The good news is that our findings align closely with those in Australia and provide three clear priorities for future research – improved treatment options, causation and better diagnostic capability.

“What New Zealand now requires is proper funding for a future research programme that can investigate these priorities more closely and improve the outcomes for individuals living with endometriosis.”

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Virtual care platform secures US$46m to address US maternal health crisis

Pomelo Care will use the funding to scale its care model and improve maternal and infant outcomes

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Marta Bralic Kerns, founder and CEO of Pomelo Care

The US virtual maternity care platform Pomelo Care has secured US$46m in funding to address the US maternal health crisis.

One in 10 babies born in the US today start their life in a neonatal intensive care unit.

Healthcare access continues to worsen, with one in eight births occurring in US counties with limited-to-no access to maternal care. Due to significant gaps in postpartum care, about half of pregnancy-related deaths in the US occur after hospital discharge.

The evidence exists for how to identify people at highest risk for complications and which interventions are most effective, but existing data gaps and provider capacity challenges make it difficult to apply these interventions at scale.

Pomelo has developed a care model that aims to address these challenges by analysing claims and health record data to identify individual risk factors and providing virtual pregnancy, postpartum, and infant care to patients to reduce those risks.

“We’ve long known what works to reduce maternal and infant complications,” said Marta Bralic Kerns, founder and CEO of Pomelo Care.

“The questions have always been: can you identify the patients who are at highest risk, can you deeply engage them in care to drive uptake of the prevention strategies we know work, and can you do it in the highest risk populations with the most limited access to care?”

“This data demonstrates that we absolutely can. And with this additional funding, we’ll have the opportunity to scale our care model to more pregnant people across the country.”

The funding, led by existing investors First Round Capital and Andreessen Horowitz (a16z) Bio + Health, is hoped to help Pomelo accelerate its partnerships with payors across the US and increase access to “evidence-based” care.

Josh Kopelman, partner at First Round Capital and Pomelo board member, said: “It’s rare to come across an opportunity where the incentives between patient, provider and payor are all aligned.

“Marta and the Pomelo team have found an incredible opportunity to dramatically improve outcomes for the highest risk populations, while helping payors reduce their avoidable costs.”

Vineeta Agarwala, general partner at a16z Bio + Health and Pomelo board member, added: “Pomelo is one among a small set of health tech companies that have earned true scale.

“This scale is evident in our partnerships with major Medicaid and commercial plans covering over three million lives, which create the opportunity to collaborate with OB providers, labour and delivery wards, and NICUs nationwide, while serving hundreds of thousands of expecting mothers and newborns with high quality, technology-enabled care.”

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One in three UK fertility patients seek treatment abroad due to high costs

Expensive fertility treatments prompt UK patients to seek help abroad

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One in three fertility patients in the UK seek treatment abroad due to high costs, a new survey has shown.

Fertility Family has gathered insights from 429 UK participants who have experienced difficulties with infertility.

The Infertility Awareness Report found that the high cost of fertility treatment in the UK has driven over one in four people to spend over £10,000 on both treatments and investigative procedures.

The research showed around 35 per cent of people struggling with infertility have considered seeking fertility treatment abroad due to the prospect of lower costs.

Of those seeking fertility treatment in a foreign country, however, only 14 per cent believed that clinics abroad have a higher success rate.

Of those actively trying to conceive almost one in five have used their life savings in the pursuit of having a child, whilst 25 per cent have paid for their fertility treatments using a credit card.

Dr Gill Lockwood, consultant at Fertility Family, said: “While we tend to cast our gaze on women when it comes to infertility, case studies have shown that infertility can impact both women and men in similar ways. However, women have been observed to seek help more than men.

“Although the psychological struggles of infertility can be overwhelming, many patients ultimately reach some type of resolution. Some of the alternatives include becoming parents to a relative’s children, adopting children, or deciding to adopt a child-free lifestyle.

“Needless to say, this resolution is usually psychologically demanding, and patients may feel forever impacted by the experience of infertility.”

A combination of fertility struggles and accessible healthcare have impacted people across the UK significantly, with one in two admitting to feeling “ashamed” due to their difficulties trying to conceive.

A further 31 per cent reported feeling that other people think “less” of them due to their fertility struggles, showcasing the need for better mental health support.

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