Episode #80 | Live from San Francisco: Innovation in 3D Printing & Bioprinting - The Lattice (Official 3DHEALS Podcast)

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Hello guys, let's see we have three people logged in.
That's a sign of life.
Good evening everyone.
Thanks for coming in virtually.
We have a room full of veryhappy attendees drinking and
eating.
I just want to report live fromthe conference here, live from

(00:27):
the conference here.
But I want to start things onschedule and this is the first
San Francisco in-person orhybrid event for us, 3d Heels,
and as a company, we have threemissions.
One is to educate people about3D printing healthcare.
You know specifically what kindof applications are really
viable using 3D printing andbioprinting and related 3D
technology as we are expandingthe topic.

(00:49):
Number two mission we have isnetworking.
So in the past several years,hello David, we mostly 100%
virtual, but now that things arenormalizing, we're going to do
more and more in person.
In-person events difficult, alsopretty challenging logistically

(01:13):
to attend, but if you'reentirely trying to reorganize
the event, please join us.
And number three is Pitch3Dprogram.
Pitch3d program, which is avery straightforward program.
We don't charge any money forearly stage startups, which
means pre-seed to Series A.
We help them to connect with 30plus institutional investors

(01:38):
directly and if you'reinterested, please apply.
You can go onto our website,pitch3d, and apply to pitch
through our program.
Okay, so without further ado, Iam going to start to start our
presentation, and let me justcheck the order of the speaker.

(01:58):
One second Not streamlined here.
Yeah, one second Notstreamlined here.

Speaker 2 (02:06):
Yeah.

Speaker 1 (02:08):
Do you mind asking them to come in, please?
Ding ding ding, ding ding ding.
Yes, okay, we're startingpresentation guys, all right.
All right.
Oh, the first speaker is JoshMcCulloch.
Okay, he currently is workingat ArthroVax.

(02:31):
In fact, because we only haveone podium, I will ask speakers
to just introduce yourself.
Okay, so I don't have to comeback in.
Okay, all right, Awesome.

Speaker 3 (02:40):
And stay put?
Or can I wander with themicrophone, or is it best if I
stay here?

Speaker 1 (02:43):
Best to stay here.
And where is the phone?
The phone is here, okay, soyour presentation, okay, this is

(03:05):
yours.
I believe All right, that'syours.

Speaker 3 (03:10):
Thank you, okay, and then advanced slide.
Is there a wand or we can justuse the arrow?

Speaker 1 (03:19):
Yeah, this is not as a One sec.
Let me just do this, there yougo.
Let me just do this, there yougo.
So you should stay here,because it's recording you from
this camera and the voice.

Speaker 3 (03:35):
Okay, and then if I want to change slides, you have
it.

Speaker 1 (03:37):
You can just do this.
No, just click.
Okay, use the finger.

Speaker 3 (03:52):
You can just go right or left.
Okay, here we go.
I try not to put you, puteverybody to sleep.
I'm josh micklelidge.
I work for a company calledevolution.
Evolution surgical.
That is an exclusive agency, uhfor arthrex, a large medical
device company spanning theglobe and currently let me get
through this so everything thatI talk about obviously this has

(04:15):
nothing to do with EvolutionSurgical or Arthrex.
These are sort of ideas andexperiences that I've had in the
past with 3D printing andcurrent ideas that I have around
3D printing in the field ofspine surgery, around 3D
printing in the field of spinesurgery.
All right, so a little walkdown memory lane.
This is our booth at the first3D Heels Conference in San

(04:35):
Francisco back in 2017.
A very fond memory of DeanCarson and I at that conference
and Paul came out from Australiato speak.
Fantastic experience and stillvery much relevant to today.
So I started as a medicaldevice rep and had no idea that

(04:58):
I would fall in love with thefield of all things medical
device.
And at that time 3D printingwas just kind of being applied
to medical devices, both in thetotal joint replacement world as
well as in spine.
I remember these picturesrepresent, on the left here two
basic implants and then on theright these knee jigs were being

(05:21):
introduced by a company calledMedacta and at the same time
these spinal implants are beingintroduced by a company called
4Web.
And I remember going around andtalking to the spine surgeons
and I said, hey, I've got thiscool implant.
And they said, well, we'llnever stop using this peak stuff
because titanium is too hardand bone won't fuse to it.

(05:41):
And I said, well, this is kindof different.
I think you know, maybe give ita shot.
No, no, I'm not changing frompeak.
And I reached out at that timeto Paul Durso, who was running
anatomics in Australia, and Isaid I really think this 3D
printing thing is going to be abig deal.
And I went out and started myown independent distributorship
and started adding products tomy bag and he said Josh, you

(06:05):
know it's ironic, you'rereaching out because I think
it's a very big deal and I'mgoing to be heading to the Bay
Area very soon why don't we meetup?
And he, you know, comes, wemeet up, he puts out all these
different implants and these arethings that I still to this day
have not seen anybody else do,all custom patient specific
stuff.
And I also met Dean Carson, whoended up being his VP, and
Gibran Maher, who was also partof the sales team, and really us

(06:29):
three were bringing thismessage to the US market at that
time.
And I was also running my ownagency and started picking up 3D
printed guide for hip surgeryat Stanford, where we used a
very patient specific method tomake sure the cup was in the

(06:50):
right place to reduce the rateof dislocation.
And then some early 3D printedimplants and then also HAP
coated implants.
And then I became fullyimmersed.
So I'm not an engineer bybackground or you know, and this
stuff is just.
I fell in love with it, becamevery passionate about it and
Paul and I met with SwinburneUniversity.

(07:13):
They offered me the opportunityto start a PhD or start in a
PhD program there and it was allaround localized 3D printing
for surgical tools and implantsand that was basically the
thesis.
And also CSIRO, the federalagency in Australia, co-located
in San Mateo.
So I was working a little bitwith CSIRO through anatomics,

(07:38):
because they print a lot of theanatomics implants over in
Australia, atomics implants overin Australia, and these are two
implants, or sorry, guides, forspine surgery and then a custom
3D printed chest wall implant.
That's actually a compositeimplant of two different things.
It's titanium with a porouspolyethylene structure where you
can suture into it and suturethe musculature to the implant.

(08:00):
I also that picture.
I didn't say I should say thatthat is in Lawrence Livermore
Lab.
I had the opportunity to gotour their additive
manufacturing facility and thatmachine can 3D print a well an
object in, without anystructures, in a vial of fluid.
So it passes a series of lasersthrough mirrors and is able to

(08:23):
polymerize um an object inthree-dimensional space.
It's really unique.
So that was an exciting thingand they let us take a picture
in there.
I also saw a bunch of otherwild things that were really
interesting, so that was areally cool experience.
However, um, I do have a familyand you, I have to pay my bills
.
And COVID hit and I realizedthat I cannot do this PhD

(08:49):
program.
It was just too much.
At that time I couldn't fly toAustralia.
They were completely lockeddown.
One case of COVID and you knowthey shut the whole country down
, so I backed out of that.
But it was a great experience.
Here's some conclusions to theresearch I had.
So number one there is noconsensus for fusion criteria of
a spinal implant and thepreclinical models are really

(09:12):
not consistent.
So there is no systematicreview for preclinical models of
interbody fusion devices and Ithink these research
opportunities also probablyrepresent market opportunities
in there.
I spoke with Bill Walsh andthere are some preclinical
models that are better fortesting spinal implants than

(09:33):
others.
So I think it's probablyinhumane that we're using
beagles and other animals thatdon't closely match the anatomy
of a human and also not testingan implant in the intervertebral
space just really doesn't makesense.
If you're testing an implant inthe distal femur and it's not
going in the distal femur, youmay have varied results there.

(09:55):
I also did not find any alientechnology that fuses faster or
better than those of similarkinds.
So there was no acceleratedtitanium that fused 100% of the
time.
And then, lastly, in the spineand inner body world, there are
some implants that don't have agraft window in them and they
seem to be performing prettywell.
So that feature may or may notbe an important part of future

(10:20):
devices.
Today I'd like to talk aboutthese topics.
So expandable implants,thinking outside titanium this
slide speaks for itself.
Quick facts about interbodydevices.
So they can't create fusion.
You really have to do thecarpentry and also lock down the

(10:42):
segment of the spine in orderfor it to fuse.
You can't put something inthere and it just automatically
does it magically.
And they are more than just aspacer now.
So they're being used tocorrect imbalances and then
they're also being used todistract the space, to free up
the nerve root.

(11:02):
So surgeons are asking a lot outof their interbody fusion
devices.
Now, expandable cages are verysimilar to building a ship in a
bottle.
You want to get through thesmallest portal and then get to
the biggest footprint, and sothis is what a surgeon may ask
you.
You know, I want it to fit likethat, but I got to get around
that nerve root through thisport.

(11:23):
And here's an example of astatic cage and an expandable
cage.
That expandable cage is notonly filling that space but it's
also distracting it open enoughfor the foramen to or for the
nerve root to be freed up in theforamen there, and it's
restoring the lordotic angle ofthe spine as well.
So here's some early examples ofexpandable spinal interbody

(11:44):
devices.
And you know this implant here,stax.
It's a series of wafers thatyou feed into the casing of that
implant in order to raise it up.
The blue centered one is a rampsort of method where you expand
the implant up on a ramp, andthen the cylindrical where
you're turning a little washerinside of that and opening it up

(12:06):
that way.
And then now things have kindof evolved into these cam-driven
implants that can expand in twoplanes so you're really able to
fill that space much better inboth planes.
And then also there's balloontechnologies that you can deploy
through a small port and thenfill up with bone graft and
create fusion there.

(12:27):
And I've been thinking a lotabout this.
My good buddy of mine andcolleague, former colleague
Matt's in the back of the roomand whenever we have an extra
moment we grab a beer and weoften talk about, you know, cool
ideas, right, and thinkingoutside of these very locked up
devices IP wise up devices, ipwise.
And one of the things that I'vebeen thinking about is some
kind of foam that's similar tolike what you'd find in a Nike

(12:48):
running shoe, a 3D printed foamthat you could control the
durometer so that when you putit in it's under pressure and
you release it in a capsule orsomething and maybe the front
can expand higher than the backto create the lordotic angle or
a series of hinges, like thattoy that I think it's called a
Buckyball, that toy that you cankind of expand and contract and
maybe drive it with a cam andthen fill it up with bone graft

(13:08):
and just playing around withcool ideas for expandable cages.
But I think at the end of theday, those other devices are
great devices but I thinkthey're very locked up with IP.
So I think you really have tothink outside the box and I
think that you know sometimesthose ideas come from places
outside of a medical device.
So another area of where 3Dprinting can impact spine

(13:31):
surgery is just disposable kitsof instrumentation.
You know, cost is kind of outof control and you know, as a
rep.
Some of the things that we dealwith is lost instrumentation,
missing screws or that specialdriver that the surgeon really
likes, that all of a sudden youget up to surgery it's not in
the tray.
What are you going to do andthis is a very repeatable thing
to deliver to somebody,especially if the quality of the

(13:53):
instruments are adequate.
A lot of businesses or I callit business surgeries are moving
to the ASC and you know, havingsomething that's more ASC
friendly, that can be.
The cost can be controlled.
We're not opening up traysbecause we can't find something
or we want something else.
We can really control the costthere and and have a more
predictable episode of care andand then I think the quality is

(14:17):
really improving on theseinstruments.
I mean, those look great to me.
There's metal there and on mynext slide here you've got a
spine retractor.
So it's not just theinstrumentation and the implants
but the means of getting to theplace that you want to go in.
The spine is important as welland it's kind of standard of
care in a lot of proceduresalready.
If you look at sports medicine,they have kits.

(14:37):
Arthrex sells a sports medicinekit for many different
procedures.
That is currently standard ofcare for many different
procedures.
That is currently standard ofcare.
And then also the total jointreplacement world has seen 3D
printed tools in the conformanceas an example Another one here.
So anatomic simulators havecome a long way.

(15:01):
We use these at our booths atconferences and the tissue
planes are now very realistic.
You can simulate a pathologythat a patient has.
So if you want to create aspondylolisthesis in this thing
it's no longer just a basic.
You know lumbar spine you canreally get creative and create
things, create pathologies withthe 3D printing and also just

(15:22):
the musculature and tissue andstuff is becoming very realistic
.
So I love these things.
The best thing you can use is acadaver when you want to get in
and you know, especially likespinal endoscopy right now, it's
very tricky and there's nothingbeats a cadaver.
However, they're expensive andthere's a lot that goes into

(15:43):
these labs.
That we do so anytime you canuse one of these, especially for
a quick demonstration or abooth, is great and there's a
bunch of companies.
But you know, maybe this ismost of what I found out there.
I think there's still a lot ofopportunity in the simulator
world to use to apply 3Dprinting and bioprinting.

(16:04):
So if you look at the evolutionof spinal implants, it sort of
started with bone.
You know you have femoral ringallografts and then machined
allografts.
Then it went to sort of thesetitanium implants.
But then the titanium implantswere too stiff and bone didn't
grow into them.
So things change over to peak,because peak has a better
modulus of elasticity, it's alsomore radiographically friendly,

(16:26):
but then also bone didn't growinto that.
So you know, the poroustitanium came and now we have
porous Peak.
One of the funny things aboutthis is that the stiffness of
titanium is now kind of we'regetting less and less stiff with
the material.
And I beg the question, or itbegs the question are we just
you know, you end up in latticeland my lattice is better than

(16:46):
this lattice is better than thatlattice and bone grows into my
bedder and all this kind ofstuff Are we just kind of going
back towards bone?
I did a deep dive into all thefusion data out there, the
published articles, and I thinkwhat I found was well, I know
what I found was that most ofthese cages are fusing in the

(17:09):
lower to mid-90s, no matter whatlattice and what kind of
methodology you're using.
So I'm sure that there arenuances to porosity and things
like that, but at the end of theday, if we're driving towards
less and less stiff material,we're going to end up back at
bone.
This is an example of theDimension Inc material that was

(17:30):
FDA cleared recently.
I think that kind of paves thepathway for next-gen implants
there.
And then another example of amagnesium implant that is a very
controlled, not like the pastmagnesium implants At least it
would seem that way and mythoughts on this is that you
could take bone marrow, aspirateand soak the implant and create

(17:53):
a bioactive synthetic bone sortof implant there that may
actually rival any of the 3Dprinted titanium implants
potentially.
So I think this is a promisingfield in spine surgery.
I think it's something that Ithink we'll see more of.
Lastly, I just want to connecteverybody here with a few of my

(18:13):
friends.
I mean, what would be mypresentation without a couple of
shameless plugs?
So these are things that Ithink are pretty cool.
A good buddy of mine, luke, isworking on an implant that has a
charged core that creates apiezoelectric effect in the
implant, so it's generating alittle electro field there and
he's seeing some promisingresults in preclinical studies

(18:36):
and that's a 3D printed titaniumshell around it.
So if you're interested in that, I would put you in touch with
Luke and here's some referencesthat he has on the material.
And then Gibran, in Australia,my former colleague at Anatomics
, has created an entire 3Dprinted spine company.

(18:56):
Well, the company is not 3Dprinted but the products are,
and he's a good buddy of mine aswell, and I would love to put
you in touch if you're lookingto partner with a company that
is 3d printing spinal implants.
So I ran through that prettyquickly, but if you have any
questions, I'm happy to answer.

Speaker 5 (19:14):
Yeah.

Speaker 3 (19:15):
Okay.

Speaker 1 (19:16):
All right Thanks everyone.

Speaker 5 (19:29):
I think I can find my presentation, that'd be great.
Okay, yeah, that's me, oh,shoot oh is.

Speaker 1 (20:29):
Is it sharing?
Yeah, it is One second Sorry.

Speaker 5 (20:35):
I'm also terrible at Mac.

Speaker 1 (20:41):
The question is oh yeah, here we are.
No, we're not sharing, Okay.

Speaker 2 (20:46):
There you go.

Speaker 5 (20:49):
Now we're sharing.
Okay, all right, cool.
Well, good evening everyone.
My name is Bhushan Mahadik andI'm actually with Prelis
Biologics.
That is not too far from herein Berkeley, and we are actually

(21:11):
a drug discovery company, butthat is absolutely not my
background.
I have been in the field oftissue engineering and
regenerative medicine for a longtime and when I was called to
talk about 3D printing andbioprinting, I was thinking well
, that is a pretty broad topicto talk about, because it has

(21:34):
been a field that has beenevolving for a very long time,
and one of my favorite ways toactually picture and think about
how this field has beenevolving is to just look at the
publications.
My background and a lot of thethings that I've done is from
the academic realm, so I've beeninvolved in a lot of different
kinds of research involving 3Dprinting, bioreactors for a

(21:57):
whole lot of differenttissue-based applications, and
obviously, as researchers andacademicians do, they go to
PubMed, and that is what I did.
And what's really fascinatingabout this to me is, if you just
look at the number of researcharticles that have been
published over the last 20 yearswhich doesn't seem like a long
time, but it is there has been aphenomenal rise in just the

(22:20):
number of people that talk about3D printing or bioprinting.
And I'm talking at the momentalmost 6,000 papers that are
published yearly that do 3Dprinting 1,000 a year more than
that just talking aboutbioprinting and that's almost
like a 150% increase year afteryear.
And that tells me the volumeand the speed at which this

(22:42):
field has been growing.
It's exponential and that to meis, you know, very interesting
because there's a lot ofresearch that is being done that
is outside of just the academicrealm and it covers a lot of
different applications.
We just heard from Josh about alot of different interesting
bone applications for 3Dprinting that are being done.

(23:03):
It goes obviously way beyondthat from a 3D printing or
bioprinting perspective.
We have 3D printingapplications for 3D printing
anatomical models for differentkinds of surgical applications.
My favorite is the developmentof complex in vitro models.
We use that to be able tobetter inform ourselves about

(23:25):
different kinds of disease,models that we can use and test
pre-screen therapeutics for tobetter understand native biology
, because you cannot go in vivoto supplement animal models,
because 3D printing with humansystems is probably a better,
smarter, safer choice.
There's obviously a lot of workdone in 3D printing with human
systems is probably a better,smarter, safer choice.
There's obviously a lot of workdone in 3D printed biomedical

(23:50):
devices, which obviously I don'thave to tell this crowd it is
actually.
Dentistry was actually one ofthe first fields that really
picked up 3D printing, beforeany of the other fields did.
And the way my dental surgeonfriend put it, dentists are okay
with risks that's what he toldme because they are okay with
implanting things in people'smouths and trying to fix their
teeth.
3d printing was one of thefirst early adoptions that they

(24:12):
did for their technology and nowobviously that field has
exploded, even in dentistry aswell.
Pharmaceuticals there has beensome research going on in terms
of 3D printing drugs that can beused for time release or
different kinds of API in a 3Dprinted manner.
There are advantages anddisadvantages of that, obviously

(24:33):
, but that also is being done.
And finally, my other favoriteis implantables.
A lot of 3D printed constructsare used in implantation, not
just for hard tissue, but alsobeing explored for soft tissue
as well.
The simplest one, although it'snot really simple, would be
skin grafts that are used forimplantation, but obviously the

(24:54):
field is moving towards more ofthe soft tissue for
musculoskeletal and otherapplications as well.
So there are a lot of differentapplications and the field is
very interesting, at least to me.
But again, when I come at itfrom a research perspective, the
parameter space in which youcan do 3D printing or

(25:16):
bioprinting is really large.
I'm talking about a lot ofdifferent factors that go into
what you actually 3D print, andit's really an
application-driven decision.
Are you doing bone?
Are you doing you know, carb,muscle?
Are you doing skin?
Are you doing, you know, liver,kidney, heart, whatever it is?
There's a lot of factors thatwe have to consider, like what

(25:39):
are the kinds of biomaterialsyou're using, especially for
bioprinting?
Is it a natural, a synthetic?
Does it degrade, does it changewith time?
What are the biomolecules thatare being incorporated?
What are the impacts of thechemokines, cytokines, and how,
ultimately, they impact thecells?
Because if you're talking aboutbioprinting, well, you're
talking cells and you have tothen take into account how a

(26:01):
cell functions inside of your 3Dprinted construct, how it
interacts, interfaces and thenchanges the construct itself.
So the parameter space, like Isaid, is very large, and so are
the print platforms.
You know we started 3D printingback.
Actually, the first 3D printerplatform would be like in the
1980s with stereolithography.
That was truly the firstprinting that came out, but then

(26:24):
again it has exploded.
From that, you havestereolithography,
extrusion-based printing, fdmprinting, sls, inkjet and hybrid
technologies that are alsobeing developed right now, and
the platform you choose for yourprinting also ultimately
impacts the product that youmake as well.
So, that being said, because theparameter space is so large,

(26:46):
one of my guiding principleswhen I think about 3D printing
or bioprinting is just becauseit's complex doesn't mean it's
better.
Sometimes a simple solution isprobably what you need.
And I say that because,obviously you know, from a
research perspective, I haveworked with collaborations that
have looked at projects whereit's like oh, I want to print

(27:07):
something really cool that isreally complex of
multi-materials, a lot ofbiomolecules, and I want to use
this for a particular.
I want to make a functioningliver.
I want to 3D print afunctioning heart.
Well, that's great, but it'svery complex and that does not
mean it will work.
So that doesn't mean it's notuseful, but it's more
complicated than that, althoughit sounds very fancy.

(27:27):
So we can go on and talk hoursof all the different tissues
that we can do 3D printing withand, like I said, this field has
exploded a lot over the pastfew years.
There are models for liver,bone, cranial implants, joint
tissue my favorite topic,because it's extremely

(27:49):
complicated to 3D print jointtissue, like cartilage, tendon,
bone, and one of the reasons andit's actually primed for 3D
printing or bioprinting becauseit's a lot of complexity in a
very small space.
Joint tissue is heterogeneousin terms of cellular structure,
in terms of matrix composition,in terms of its physical
characteristics.

(28:10):
So to be able to pack all ofthat into a single piece of
cartilage or a tendon, it'scomplicated and 3D printing is
probably the way to do it, butit's also very challenging.
So it's a very interesting areaof research.

(28:40):
Obviously not a lot of or anycommercial products that come
out of it, for very good reason.
Kidney models, large.
Thinking about it and thinkingabout well, what should I really
be talking about?
Like I said, I have shifted myfocus from doing a lot of 3D
printing to drug discovery, andwith that comes immunology.
Immunology and that actuallyalso is a very fascinating topic

(29:03):
, because anytime you thinkabout something that is
implanted, the first questionyou would ask is well, what does
the body do?
Does it reject it?
Does it incorporate with it.
What is the immune response?
And that's something that thefield has realized over time as
they started doing theseimplants and thought well, this
got rejected in the body.
There's fibrotic tissue, thereis just rejection, there is just

(29:23):
macrophage invasion.
Whatever it is, the implant didnot work.
So the immune response ofsomething that is 3D printed,
bioprinted and eventuallyincorporated into the body is
very important.
So for me, when I think of thesefibrinated constructs, there
are two things that come out ofit.
One is that they inform, whichmeans you're developing a model

(29:44):
system to better understandsomething, a particular question
, or you implant.
It can be a repair,regeneration, restoration
applications.
Oh, there you go.
So, speaking of immune response, this is one of the works that
we did at the University ofMaryland in John Fisher's lab

(30:07):
when I was over there, and thisis a very good and interesting
case study of using 3D printingor bioprinting in this case for
a function to a form fit, andthe challenge over here was the
application of using 3D printingfor a nipple areola complex
Breast cancer survivors,patients who have undergone

(30:28):
mastectomy.
There's actually a very seriousclinical need to be able to
restore, if nothing else, anipple areola complex and the
current clinical solutions forit are actually very lacking,
because anything that you do totry to restore this particular
tissue does not sustain overlong term.

(30:48):
So one of the recent questionsthat this particular student
asked was well, can I 3D printthat?
And this is actually a veryinteresting material problem and
an interesting biologicalproblem, because you want
something that can go inside thebody and that can maintain form
for a very long period of timeand I'm talking about
non-degradable tissue, right,but that's still.
It cannot be something hard.

(31:09):
It's soft tissue, but it'sstill non-degradable.
So what she really did wassomething very interesting, was
she 3D printed this constructusing a hybrid material of
something that is non-degradablea PEG-based product, and
something that is degradable,like Gelma gelatin methacrylate,
which is a collagen-derivedcomplex.
So the reason why you createsomething that is a hybrid is

(31:32):
because you want the form thatcomes from your PEG construct
that does not degrade when youimplant, but you want something
that is biologically friendly,and that's why she used gelatin
that allows for cellularinfiltration, that allows for
functionality and, moreimportantly, does not have
severe rejection when it isimplanted.

(31:53):
And it's actually pretty coolbecause you can actually see the
different layers of what sheprinted.
The white was thenon-degradable and the pink was
the degradable material that shedid, and we were able to show
that the cells within thedegradable construct were alive
after 14 days.
So there's a lot of researchthat went into how do you
actually print a hybrid materialwith this particular shape and

(32:16):
still retain that shape afteryou try to digest it, so you can
actually see the post imageover there.
Well, the degradable gelma haskind of gone away and what
you're left with is a skeletalstructure.
The idea behind that would bewell, when you implant it into
your body, eventually anythingdegrades and dies down.
But the hope is that your bodythen starts reconstructing its

(32:38):
own tissue and it needs ascaffold to be able to
reconstruct something around.
And the purpose of thenon-degradable part would that
it would stay, provide thesupport while allowing for
cellular infiltration.
Well, that's great.
You 3D printed, but how does itactually perform?
Because one of the questions,like I just said, is how does
the immune system respond to itwhen you put it in vivo?

(32:59):
So she did mouse models and theresults were actually quite
promising.
This was a subcutaneous implantthat she did off the nipple
areola into the mouse, and youcan actually just look at this
picture over here.
These are the scaffolds that weprinted.
We had to scale them downbecause this mouse were tiny and

(33:20):
it would be a very largescaffold that we had to implant.
But she did differentcombinations and ratios or
proportions of the PEG to theGELMA and the hybrids that you
see in between and, notsurprisingly, the more
digestible material you have,over a period of four weeks that

(33:41):
gets completely digested anddestroyed.
But if you have something likePEG which is not degradable, you
maintain that structure.
So the answer that you want issomething in between, where you
want something that's not fullydigestible but you want
something that maintains thatstructure.
That's part number one, andpart number two is what kind of
immune response do we get?
Notably, what we did see wasvascularization inside these

(34:02):
constructs.
The cells were able toinfiltrate inside the scaffold
itself, develop vascularization.
We did see infiltration ofmacrophages and a few of these
immune cell types, granulocytes,et cetera, but nothing that
screamed that there's a completeimplant rejection.
A little bit of fibroticcapsule that were formed, but

(34:25):
that's again not surprising foranything that is implanted into
the body.
But overall, what this told mewas that it's a very neat
experiment for how you canincorporate bioprinting into
something that is a real worldapplication of something that is
implantable.
So that to me, really stood outand the main takeaway for me

(34:47):
from this was well, the immuneresponse that you see over here
is quite critical and as we gointo how the field of 3D
printing is being evolving, whatI've noticed as I look at all
of these articles and fields ofresearch is it's being used more
and more for immune modelsthemselves.
The field of drug discovery and, more specifically, antibody

(35:13):
production and discovery, relieson a lot of animal models, a
lot of traditional technologieslike phage display, using
hybridomas, using mouse models,humanizing mouse antibodies so
that they can be put intopatients, and the key word over
there is humanizing them.
They come from something thatis animal derived and we'll get

(35:35):
to why.
That is critical, at least formy work, for what I do right now
.
But you can use 3D printing forsomething like antibody
generation, as this group didover here, where they mixed
murine immune cells, essentially3D printed that into a collagen
matrix and let these cells dowhat they do B cells, producing

(35:58):
antibodies over a period of time, and essentially what they
found out was that they wereable to generate antibodies
against two foreign antigens,sars and Ovalbumin.
That's interesting because theywere able to incorporate the
concept of 3D printing withsomething completely alien.
Like antibody discovery, it'snot something quite common and,

(36:19):
again, if you look into research, that is really not at least as
mainstream as some other 3Dprinting and bioprinting
applications.
But again, the field isevolving so you never know where
this goes forward.
The other thing is using 3Dprinting for model testing.
Like I'd mentioned, you caneither use something to inform

(36:40):
or implant, and I just talkedabout implant.
The inform for me, is veryimportant because you can do
things with 3D printed modelsthat give you the level of
complexity that you want thatyou don't necessarily get from a
mouse model or an in vivo model, because it's a lot more
complex.
Case in point over here was totest the efficacy of a

(37:02):
bispecific antibody that thisparticular group wanted to
investigate for treating kidneycancers.
So this particular model thatthey did was engineering a 3D
kidney organoid and then 3Dprinting a bioreactor within
that to test how theirbispecific antibody responds to

(37:24):
the tumor when incorporated inthe presence of circulating
blood cells, almost like whatyou would do if you were trying
to test this in preclinicalapplications.
When you give a therapeutic toa mouse, you are accounting for
the fact that it's circulatingthrough your bloodstream and
eventually finds its way to atumor that it's then supposed to

(37:45):
treat, which is exactly themodel that they were trying to
replicate over here.
It's a very nice paper.
Bottom line in this is that itactually did work.
They were able to show thatthis therapeutic was able to
target these kidney organoidsinside a perfusible circulating
system, while not targetingother non-specific cell types

(38:06):
that are also in that organoid.
So it means, for at least theirpurposes, their particular
therapeutic was target specific,which is kind of the answer
that you want to get out of acomplex model like this Does
your therapeutic work?
Is it a good model to actuallytest it out?
So to me, that is also a veryuseful application of
bioprinting, and that kind ofgoes to what I do right now.

(38:27):
Like I said, I work at Frellis,which is a drug discovery
company, which normally youwouldn't really associate with
3D printing, but what we have isa platform of an externalized
immune system or the excessplatform I just talked about.
You know the traditional drugdiscovery that people do, which

(38:47):
is you use mouse models,hybridomas, you use face display
, things that the pharmaceuticalcompany has been doing for a
very long time, and there areupsides to it and there are
downsides to it, the biggestdownside being it is a humanized
system, which means it isanimal derived, that you then
make it fit for human purposeand what we are doing right now

(39:07):
is actually sourcing these cellsof interest directly from
humans.
So it's a human to humanantibody development system
system and what we're doing isengineering the organoids to
essentially generate the kind ofimmune response you want, so
that the B cells in questiongenerate the antibodies we want.

(39:28):
So that essentially makes it avery target, agnostic platform
for antibody generation.
That means we can developantibodies or therapeutics for
cancer inflammation, can developantibodies or therapeutics for
cancer, inflammation, obesity,cardiometabolic, depending on
what the target is and what theinterest is.
It is an agnostic platform andthe way we actually do that is

(39:51):
via using 3D models and 3Dorganoid systems.
We are recapitulating essentialelements of the lymph node,
which is where all of theantibody production of your body
happens, and within the lymphnode itself there are these
things called the germinalcenters, which is essentially
where all of the B-cellactivation and interaction of

(40:13):
the T-cells actually occurs.
That gives you very highaffinity, highly specific
antibodies and the reality ofthe system is in our human body.
This system is extremelysophisticated, very complicated,
hard to actually replicateoutside, but that is what we are
trying to do using a 3D printedsystem.
We have what we call theholographic two-photon

(40:35):
lithography printing, which is atwo-photon printing system that
we use to 3D print ourscaffolds that we then use as a
platform for generating ourorganoids.
So we have been doing that andhave been relatively successful.
Like I said, there are elementsof biomolecules, biomaterials,
the form and the cells that areinvolved in actually generating

(40:55):
these organoids that we are thendoing our drug discovery with,
again, a completely offshootapplication of a bioprinter or
3-printer construct, which iscompletely relevant from a
clinical perspective.
I think I'm going very fast,but that's fine.
Yeah, and the last thing Iwanted to say is the use of

(41:18):
bioreactors.
I did talk about perfusionsystems.
To me also, this complementshow a 3D-printed system works.
A static system by itself isuseful, but the human body is
very dynamic.
Bones have pressure, cartilageor tendons, they have tension,
blood has flow.

(41:39):
There's a lot of physicalstimuli that actually occurs
inside your body.
So the role of bioreactors isto then incorporate that into an
in vitro system as well.
So, again, a lot of interestingwork that goes on, and you know
, most of us are familiar withbioreactors.
But from an expansionperspective, we use bioreactors
for, you know, expansion cellsor again, actually for antibody

(42:01):
production.
But a flip side of that is howto actually use that to make
more biologically relevantmodels.
And again, another fascinatingfield of work.
So that's my last slide.
So I am done, and the only lastthought I have for this is it's
a question that I ask anyone whodoes, who is interested in 3D

(42:21):
printing, is do you really needto 3D print?
Because it is complicated?
Um, you know there areadvantages and disadvantages to
it, but if you really do, theseare some of the questions that
you should absolutely consider.
Uh, like, what is yourapplication.
Do you really need it to bethat complex?
Because yes, then that's great,then we can talk about.
You know how we can actually doit.
What is the form that you wantto generate?

(42:43):
You know, if you have 3dprinting on the area complex for
that form, great, that's aparticular purpose.
And, the most important of all,if you're trying to make
something that is commercial, isit reproducible?
Because more often than not, itis actually hard to do on a
commercial scale.
So a lot of different things toconsider, but that, in the gist
, is what I think of 3D printing.
So I will stop because I knowI'm over, but I'm happy to take

(43:06):
questions at the end.
Thanks, guys.
There you go.

Speaker 1 (43:24):
Start sharing this Spirit.
Okay, let's see, let's see how.

(43:58):
Let's see, let's share this.

Speaker 4 (44:15):
You just up and down, change side.
Next is up.

Speaker 1 (44:17):
Just use your finger.
Next is up, just use yourfinger.

Speaker 4 (44:22):
Okay.

Speaker 1 (44:23):
And you can introduce yourself too.
Awesome.

Speaker 4 (44:27):
This is the camera Fantastic, so stand right here.
Yeah, awesome.
Thank you, jenny.
Thank you for having me andpleasure to meet you all.
I have known Jenny for quite afew years now.
This is the first time I'mactually helping her out by
attending one of these meetingsand presenting, so thank you.
My background I'm a medicaldevice developer.

(44:48):
I've been doing this for quitea few decades now.
I also have an incubator and aninvestor arm, so I do a lot of
different things.
Today I'm going to be talkingabout additive manufacturing in
oncology.

Speaker 1 (45:14):
Focusing just this doesn't look right.
One second, make this bigger.
Okay, I just don't know ifpeople are, but the audience was

(45:44):
remote.
Can you tell me if you'reseeing the slide?
I'm not really sure, actually.

Speaker 4 (46:08):
Thank you, Did I break the system?

Speaker 1 (46:14):
No, I think it's just .
The PDF version is tricky, butI think people can see it here
and try to stand closer to thisso we can hear you.

Speaker 4 (46:22):
Okay, awesome, so let's just dive into it.
So, additive manufacturing Ihave been using it for quite a
few years now, basically from aprototyping perspective.
So I saw some greatpresentations about how deep you
can go into 3D printing.
My application is very simple.

(46:43):
I like what you said keep itsimple and we have come up with
something which is a simplesolution to a complex problem,
and I'm not the founder of this.
We got this licensingtechnology from MD Anderson
Cancer Center.
They basically developed thisover a decade in trying to solve
the problem of minimizing sideeffects as a result of cancer

(47:08):
therapy, and they then wanted tocommercialize it.
And, to your point earlier,it's not easy to commercialize
3D printing technology for themedical device application, and
I'm not just talking about thescalability version, but also
cost regulatory compliancereimbursement.
So what I'm going to give youis an example of how we have

(47:29):
taken additive manufacturingtechnology and launched a
product in the oncology space.
So most of you probably knowthis.
You know cancer used to be anacute condition.
You got diagnosed with cancerand you died.
What has happened with theadvancement in technology is

(47:51):
that it's become more of achronic disease Early diagnosis,
a lot of different treatments,a lot of very complicated drug
treatments have started keepingthe patients alive for a much
longer time.
Now the bad news about that isthat they also live with side
effects and, like this graphsays you know, 18 million are

(48:12):
survivors, with 4 million goingthrough oral mucositis.
Now you have seen peoplewithout hair who have gone
through cancer therapy.
What you probably haven't seenis this, which is oral mucositis
.
It's literally imagine sunburning the inside of your mouth
.
So when a patient goes throughradiation or chemo treatment, it

(48:34):
destroys the inside of themouth to a point where they
cannot eat.
They have to be fed using atube, they don't speak and more
than 30% of patients die becauseof the side effects.
The toll is huge, bothfinancial as well as on humans,
for the chemotherapy patient,which is a large population of

(48:58):
cancer treatments that gothrough chemo.
More than 40% of patients haveside effects of oral mucositis
Radiation therapy, especiallyfor head and neck cancer.
More than 90% of patients haveoral mucositis and the worst
part is you know 20% of patientsthey get hospitalized with a
cost of $40,000 per patient.

(49:19):
So the impact is huge.
The solution is a simple one,which was developed, like I said
, at MD Anderson over 12 yearsago and a lot of clinical
studies have been presented.
The most compelling is thatmore than 75% of patients' oral

(49:42):
mucositis could be prevented ifyou have a patient-specific
solution for that cancer patientand I will dive into what that
means and then these otherstatistics, also shown through
clinical evidence, are justanother advantage of this
technology.
So, talking about simplesolution, you know the simplest

(50:04):
thing that you can do if you aregoing through radiation
technology is separate thehealthy tissue away from the
tumor.
So what they do like it isshown in the CT scan of a head
and a cancer patient goingthrough radiation treatment is
that you remove the tongue ordisplace the tongue away from
the tumor which is in this redzone, and as a result of that,

(50:27):
if you notice in the graph, thetongue is protected from the
radiation.
So, essentially, if you cancreate a part which can go
inside the mouth duringradiation, push the healthy
tissue away from the tumor, nomatter where the location is,
and then do the radiationtreatment, you're essentially
protecting the organs.
Very clever idea, very simplesolution, and what we did is we

(50:52):
have commercialized that.
Basically, md Anderson gave usthe research formula of what is
needed.
How do you come up with adevice which essentially keeps
the mouth open, pushes thehealthy tissue away and then
allows the patient to becomfortably treated during
radiation treatment.
And the patient specificity isextremely important here,

(51:16):
because no two patients arealike and each part has to be
made custom.
This was not possible a fewyears ago and 3D printing or
additive manufacturing is aresult that we're able to do
this.
We are able to get precisemeasurements of the mouth using
optical scan of a cancer patientand create a stent which allows

(51:38):
them to be treated without sideeffects.
This probably is the mostappropriate additive
manufacturing slide, jenny.
The other two presenters werevery technical.
Mine is more towards startups,investment, medical device

(51:58):
development, et cetera.
But this to me, is what isexciting from an additive
manufacturing perspective.
The first image here shows thatno matter what the patient type
is whether they're edentulous,which is no teeth, or partially
edentulous, like Sean, or haveall the teeth and any other
deformities in their mouth, wecan optically scan it Once we

(52:22):
take the STL file from there.
Now we have our automatedsoftware which converts that
optical image of the patientinto the stent that is needed
for creating the radiotherapytreatment device.
Unlike dentists who have adoptedthis technology.
There's a couple of differences.
You know this is still beingused in the mouth, but it is a

(52:45):
510k clear product.
Class 2 dentist devices are notclass 2 devices.
They can go from design tomanufacturing and probably get
away with murder.
We had to create we.
We had to actually go through alot of heavy lifting to
commercialize it.

(53:05):
And then the second thingthat's more important for us in
oncology is the time.
So I remember going to mydentist and I said hey, do you
have a scanner?
And it's like no, I don't havea scanner, but I know somebody
who's got a scanner, so we goget the scanner.
They create a part like, okay,let's look at the part.
Oh, I don't have a scanner, butI know somebody who's got a
scanner, so we go get thescanner.
They create a part Like, okay,let's look at the part, oh, this
doesn't look right, go back.
And this went on for a fewweeks before I actually got the

(53:28):
part.
And then I finally gave up.
I said can we just go to theold school way of, you know,
putting a wax putty and creatinga mold?
And this was allowed indentistry.
In oncology you have three days.
So our biggest challenge inadditive manufacturing was to
create something which wouldallow us to go from an optical

(53:49):
scan to a stent as fast aspossible.
Theoretically, we can do it inone day, but we're trying to be
more optimistic and practical,because our biggest issue here
is shipping and receiving inhospitals.

(54:09):
So now it's getting into non-3Dprinted.
So I'm gonna go a little bitfaster, jenny, if it's okay,
slow me down, guys, if you need.
But our product isdifferentiated really well.
Mainly, the biggest thing ispatient specificity.
These other competitors are not, and so they would use the
product, but it would not allowyou to move the healthy tissue
away as needed.

(54:30):
Our technology is based on aplatform for addressing oral
mucositis, and before, duringand after is our focus.
The first product the bottomleft image is the one that is
already launched.
We have FDA cleared the product.
It's being sold.
The top right is the one thatwe're working on now, submitting

(54:54):
FDA for clearance this year,and that's a cryotherapy device
where we're going to have thesame approach of taking an
optical scan and providingcooling channels inside the
stent so that the inside of themouth can be cooled.
And then the bottom right is adrug delivery device.
And, as I was listening to Josh.
You know we have another ideawhere we also want to do some

(55:17):
nerve stimulation inside themouth, for which we may need,
you know, some electricalcircuitry inside.
A lot of different applicationare possible with this.
This is our team, the foundingteam at the top row, like I said
, you know, our incubator comesup with a lot of different ideas
.
This is one of the companiesthat we have spun out and we're

(55:40):
working on on developing a fewothers, and the bottom row is
from our strategic partners atMD Anderson and Ricoh who's
doing our manufacturing anddistribution.
Clinical advisors are veryimportant from a investment
perspective to get the KOLs tosort of endorse your technology.

(56:04):
These guys are some famousnames in the space.
Current activities like I said,we already are launching
Stentra in the marketplace.
Some of the names out on theright are the ones we're working
with.
We're looking at a few newapplications for the product and
then clinical studies todevelop our pipeline product.

(56:28):
And then this is marketing.
I'm gonna skip through this.
This is basically the problemstatement.
You know there are millions ofcancer patients that go through
this side effect and it's a hugeopportunity from an investment
as well as a potential solutionperspective, and 3D printing has

(56:52):
allowed us to do that.
I'm going to skip through thefunding slide.
This is for investment summary.
I'm going to skip through thatand this is my last slide.
This is for investment summary.
I'm going to skip through thatand this is my last slide.
But I think this when I gotinvolved in 3D printing, I was
fortunate because we wereliterally placed right next to

(57:14):
the first machine that was builtin Southern California.
I was at Minimed, which was astartup at that time, and that
was 89.
Some of you probably were notborn and I thought this was
ridiculous.
This is like how is thispossible?
Because I was used to machinedparts.
How can you make these partsand how are they going to
function?

(57:35):
And you fast forward now to 3Dprinting and you don't even
think about doing any kind ofmathematical analysis if the
part is going to work or not.
You just 3D print it, test itand it goes off into production.
I love that, and oncology isone of our main focus right now,

(57:55):
mainly because of MD Anderson.
We're starting here.
Our next product is for livercancer.
Md Anderson, we're startinghere.
Our next product is for livercancer and also we're going to
be looking at some of thebioprinting solutions that were
very early in the stage.
So please stop by or email meif you have any questions, and
thank you for entertaining.

Speaker 5 (58:26):
Thank you so.

Speaker 1 (58:54):
Okay, let me.
You probably want to share thispresentation mode here.

Speaker 6 (59:11):
It's okay, it's still full screen mode.

Speaker 1 (59:15):
Okay, you have 71.

Speaker 6 (59:17):
Oh no, it's very quick, don't worry.
So, yeah, hi everyone.
Oh, I really enjoyed theprevious presentations and it's
really a pleasure to be here.
So today I'm going to talkabout evidence-based innovation.
I'm also a pedic surgeon bytraining and I'm joining a

(59:42):
venture now to go into theinvestor side.
3d printing is a really great,wonderful journey during my
residence training and alsosolving clinical challenges
during the clinical works stageof my life.
Is it moving?

(01:00:04):
Okay?
Oh, yeah, so I'm currently themedical advisor in AMAD Ventures
.
Yesterday, we just launched ourportfolio company, spira
Medical.
We're a co-investor with.
It raised 120 million and forme, the reason why I was hired
into this group is we'reexpanding our indication into

(01:00:26):
the field of orthopedics.
We look into orthopedic surgery, especially in minimally
invasive intervention, and alsowe create a CDMO platform for
new startups trying tocollaborate with us to do a
co-development.
So a little bit about mybackground.
I'm also a hip and knee surgeonby training and then also I did

(01:00:49):
because of my interest indesign.
I did my master's degree at UCBerkeley and UCSF, so that's
actually the fun time.
When I started, I met Jenny.
So this is a 2018 3D Heels SanFrancisco.
It's my first 3D Heelsexperience and I totally feel

(01:01:10):
the passion from Jenny and got alot of inspiration and that's a
really true foundation of how Ipivot and actually leaning
towards my career.
So after this meeting, aftergraduation I came back to Taipei
and then during the meeting Italked to Jenny and saying that,

(01:01:31):
hey, why not we have a aftergoing back to Taipei, why not
have a 3D Hills Taipei chapter?
So that was my first year inresidency Really tough, 100
hours per week.
And then we made it happen.
So that was in our clinicalinnovation center at Taipei

(01:01:53):
Veteran General Hospital.
Even though it's called VeteranGeneral Hospital, it's the
largest public hospital inTaiwan, so the president and all
the government leaders andindustry leaders are treated in
this hospital.
So there were 150 attendees andJenny was there and I truly
value that experience.

(01:02:14):
And then later on the storycontinues.
So besides being a clinician,I'm more like a designer.
I initiated myself as adesigner Before going to med
school.
I really loved separatingelectronics and all mechanical
devices.
I thought about going tomechanical engineering in my

(01:02:37):
career, but a lot of my familiesare actually physicians in the
area of medicine, so it makeslike a default to go into
medicine.
But I didn't give up in tryingto design, build some stuff for
us, for the patient, because, uh, as all you know, a great
product that helps a patient, amillion patient at a time.

(01:02:58):
So this is a just a quickexample of how I utilize,
utilize 3D printing in terms ofpatient care.
So a little bit about background.
So this is a device for ulnarshortening procedure.
Ulnar impaction is a conditionthat happens usually after a
radius fracture.

(01:03:18):
It's a very common osteoporoticfracture and when the bone got
shortened your ulna got impactedwith the couple bones.
So there are already existingseveral different systems in
large manufacturers like OccuMedthat have good systems in
shortening the ulna to reducethe infection.

(01:03:39):
However, in Taiwan, where Itrain from, we have national
health insurance, so it's auniversal care, but those
specific systems are actuallynot covered by insurance.
So, however, those patients areusually underserved because
poorly managed fracture.

(01:04:00):
Those patient segments arereally poor.
So in order to make the samequality of treatment, I designed
, used 3D additive manufacturingin Colabora's E-Tree, a
thousand ISO certified additivemanufacturing facility in Taiwan
, to build a device that workswell with the already reimbursed

(01:04:24):
implants.
So that's enhanced the qualityof those procedures.
So that's just a short glimpseabout, in addition to clinicians
what I do during my training.
So I did a lot of designs andso many projects so many hours
after 1 am, which I sometimesafter the busy scheduled days.

(01:04:47):
So some of my projectscollaborate with my professors.
He started a company treatingcomplex tumor conditions without
osteotomy and the preliminaryprototypes of this device all
did all made possible by 3Dprinting and also cryo-surgical

(01:05:07):
devices with making cryogels forintrabone lesions, tumor
lesions.
This is actually published inCOR and actually got in the OKU
textbook, which is a commontextbook that all orthopedic

(01:05:28):
surgeons around the world studybefore their board exam.
So for orthopedics it's areally exciting time for
orthopedic surgeons to step into3D printing.
So in addition to surgicalguides and jigs, this is
actually already commercializedby Stryker for total and
co-guidance.
As a tumor joint reconstructionsurgeon myself, of course,

(01:05:51):
large defect reconstruction is awell-known area of application
with patient-specific design andprint out the metal, big metal
part for reconstruction.
However, currently the companyis going to be overvalued
because actually the cases thatrequire this kind of treatment
is really limited.

(01:06:12):
And also from several teamsfrom Italy, from Hong Kong, some
producers team doing this kindof procedure, all of them has
consensus that infection per setof joint infection is still a
challenge.
Some additional coatings anddifferent management of the

(01:06:33):
surface of the implant iswarranted to make this a more
reliable product.
But look on the bright side,this is already making a huge
fortune and transform theorthopedic industry a lot.
So it's enhanced.
Also OCS integration by 3Dprinting.
So those are acetabular cupsfor total hip replacement.

(01:06:57):
So before 3D printing well, Imean commercialized in
orthopedic implants those arelike sandblasting and HA coating
the bone ingrowns, ungrowns.
It's just not as good ascurrently used 3D printed
trabecular metal.
So it gives surgeons a hugeconfidence on having a good

(01:07:22):
osseous integration.
Huge confidence on having agood osseous integration because
before this technology appearssubsurgence will be worried
about loosening afterwards andespecially for complex bone
geometry like developmental hipdysplasia, where the contact
area is very limited.
But with those trabecular metal3D printed trabecular metal the

(01:07:43):
contact area doesn't have to beso big.
So it gives a lot of confidencefor surgeons.
And also going to total knees.
So hip and knee consists ofabout 1.6 or 1.7 million
procedure every year only the US, so very huge market, us, so

(01:08:08):
very huge market.
And so this kind of surfaceallows good bone healing in the
Poloni procedure, whichtraditionally be done by
cemented technique.
And also, just very recentlyFDA cleared the Osseous fit
stemless shoulder system, alsotargeting using 3d printed
structure as a osus integration.
So, uh, a little bit myexperience.

(01:08:29):
I uh, in tvg's 3d printingcenter I tried, I established a
different capability to realizesurgeons and physicians idea to
reality.
So we put together metal metaldata manufacturing facility and
cnc machining and also plasticinjection molding so a clinician

(01:08:53):
inside the hospital can buildand realize their ideas in-house
.
Yeah, yeah, so, uh, that's alittle bit background of why, uh
, I still have a I don't have alot of gray hair to be a medical
recruited as a medical advisorin the Venture Group.
This is one of the portfoliocompany that we have the product

(01:09:13):
for vertebral compressionfracture we use percutaneously
like a JEC system to restore theanatomical structure of a
collapsed vertebral body.
And there is predicate, onereally famous predicate, but
with this 3D geometry it createsa higher stability of the

(01:09:37):
structure.
So a little bit glimpse ofwhat's happening in oesophatic
surgery.
So, a little bit glimpse ofwhat's happening in oesophatic
surgery.
So, as Josh and all of youmentioned, so the hospital cost
is driving higher and higher andthe percentage of costs,
according to data, is 60% islabor.

(01:09:59):
But to reduce costs it's verydifficult just to cut people's
salary.
It's almost impossible to dothat.
So there's coming a differentapproach.
So first of all, in osteopedicsurgery, in total hip
osteoplasty, the length of stayreduces significantly over the

(01:10:24):
past few years.
So in the early 2000s aftertotal hit you can stay as much
as one week, even like 30 yearsago, maybe two weeks and some
different services even longer.
But to estimation, 3000 USdollars per day is very heavy

(01:10:44):
burden for the insurancecompanies.
So with this in mind, it's alltrending towards ambulator, real
surgical centers in a differentsetting.
So the system is not cuttingcosts by eliminating staff, it's
like recreating a differentsetting of treatment.
So this is a data from AJRI.

(01:11:07):
The procedure done in ASCs growexponentially and also divided
by specialty type.
Orthopedic and pain is the toptwo specialty to utilize this
facility and ophthalmology forsure already be a long utilizer.

(01:11:31):
But for if it's multi, so itmeans orthopedics procedure are
often done in multi-specialtyASCs.
So this actually creates a hugeburden as a what's judged as a
inventory management.
So the question goes to uh, soasc?
So who, who like what is thepatient segment that can go be

(01:11:53):
treated in ascs?
So uh, current uh research andalso practice is focusing on
identifying optimal patientsegment.
Also do risk stratificationsand we also try to think of
strategic priorities.
So mis technique, any solutionsthat make the procedure more

(01:12:15):
minimally invasive, recoveryfaster, that creates an
opportunity.
And also, if there's a solutionbecause probably because MIS or
that can reduce the grade ofanesthesia from general
anesthesia to hopefully nerveblock, local anesthesia, that
will create a huge opportunity.

(01:12:35):
And also methods to acceleratepost procedural recovery.
And other things is likebecause ASC sometimes
collaborate with universityhospitals or different centers.
How to streamline the operationis one area that can look into.
So, for example, this yearZimmer acquired Paragon28.

(01:12:57):
Paragon28 is a big company inthe food and cold industry, so
they're already in the ASC fieldfor a long time.
So this is viewed as a strategyto expedite their ASC
penetration.
And also Arthrex, as Joshmentioned.
I'm really excited to be ableto meet you today.

(01:13:20):
It's really advanced indeveloping endoscopic spine
surgery.
So traditionally you have tomake a big wound to do
decompressions and likedifferent procedures, but now I
think Arthrex is the mostadvanced company in the US to
proceed to do the revolution inendoscopic spine surgery.

(01:13:45):
It's really promising so thatit enhances recovery.
So also a trend that we see is,from manual to automation, a
lot of robotic assistedsolutions, not necessarily just
the navigation itself, becausethe precision of the robotic
arms creates a huge load ofopportunities.

(01:14:05):
That gives you data, even softtissue tension in the field of
osseoplasty, and it can beapplied to different scenarios
Under the setting of robotics.
Some different technologies arepopping out to try to replace
the traditional light-basedregistration system to reduce

(01:14:29):
the line-of-sight block.
So, for example, chira ismaking a radar-based solution
for registration and their costis a lot lower than a current
solution, also in terms ofdiagnosis.
So to us periprasetic jointinfection is like the Nobel

(01:14:50):
Prize level of topic to work onin osteopathic surgery.
The incidence is around 1% inprimary hip or knee
osteoporosity but, as I said,the volume is so huge now.
So just one percent means ahuge economic burden and also,
most most importantly, inpatient level, there's intense

(01:15:12):
comorbidities even doing thetreatment itself for two stage
standardized care you remove theimplant, you put a temporary
spacer and the patient canbarely move for several weeks
and then you re-implant it andthe level of SESED is
unpredictable.
So there's no revolutionarysolutions over the past 30 years

(01:15:34):
.
So this is the standard of careright now Just resected it, put
a temporary spacer and thenrevision it and hopefully it
will be be successful but notnecessary.
So osteotherapeutics is tryingto make a solution that from

(01:15:56):
weeks to seven days, but theyare still under the trial right
now and I think the trend ismoving forwards from pure
mechanical to also biologics,like different cellular-based
treatment.
However, the AOS and also AJSMhas noticed that evidence-based
is still very important.
So evidence-based innovationsolutions may initially lack

(01:16:19):
supporting evidence, but makesure the problem you're solving
should be clearly supported bythe evidence.
Yeah, so this is something ithelped me a lot to share, so I
want to share to everyone.
I always think is this real andvalidated clinical problem and
is it an isolated issue or partof a broader set of contributing

(01:16:39):
factors?
And how large is the affectedmarket or patient segment?
And can you clearly define yourpatient persona?
And is this problemtransferable to other markets or
settings?
Those are the questions Igenerate.
I ask all myself during myreview of the different side
decks and startups and I alwaystell myself don't jump into a
solution too quickly.
And I always tell myself don'tjump into a solution too quickly

(01:17:02):
.
So this is an example.
Currently, this is often youcan very commonly see the
problem statement 80% ofpatients are satisfied with
their knee after totaling it,only 80%.
So the rest 20% not satisfied.
So people are actuallydeveloping different solutions
toward this.
However we think about, is itreally because the current

(01:17:26):
implant technology being notadequate, or is it because the
poor implanting technique ortechnology?
Or is it actually because ofpreoperative care and the
rehabilitation protocol is notsufficient enough?
Or actually it's a 20% patientis not suitable, suitable for
total knee, but they are deadfor some reason.

(01:17:47):
So we have to, uh, make a stepback to think about it before we
make a a conclusion.
So this is my framework of tohelp inventors as I came from,
and investors think so find thecontradiction of your design and
understand what are theuncompromisable factors.

(01:18:07):
So this is an engineer fromRussia, a Russian engineer that
promoted the trees method.
It helped me a lot.
So he coined this, as we wantsomething, but not at the
expense of something.
So I'll do a quick explanation.
So everybody knows this.
Right, this is putting in thebreathing tube.

(01:18:29):
So traditionally it's done likethis you see a vocal cord, a
little black hole, and you putthe tube in.
So you will say, oh, it's sodifficult to see it this way, so
why not put a camera on it?
And two months later, theengineer was brainstorming.
And then it comes with a full4K camera, expandable stand,

(01:18:51):
ergonomic handle and hours ofimage storage and Wi-Fi
connectivity.
And then you've got more than24 hours battery life, super
light, and you can upload yourintubation process.
However, when you open it, it'swaiting for 40 seconds to turn
on.
And you can upload yourintubation process.
However, when you open it, it'swaiting for 40 seconds to turn
on.
Yeah, so that's something thatyou, the development process,

(01:19:11):
might missed.
So achieve better visibility,but not at expense of the speed
of use, is very important.
So there's already a lot ofcommercialized product like this
, and so currently the most uhwidely adopted solution is the
glide scope.
That looks like a little bitdifferent than traditional

(01:19:33):
learning uh learning scope.
So some companies actuallybring this forward.
Instead of bringing bettervisibility, they try to go
easier insertion.
So they built uh the stylet andthe scope together as just a,
as a, to advance the solution.
So I really want to thank jennyso much for uh the foundation

(01:19:59):
that you gave me and theguidance and then really helping
, landed a great career that Ihave right now and then.
Thank you all for yourattention.
Feel free to contact me.
Yeah, thank you.

Speaker 2 (01:20:23):
Okay, all right.
Well, yeah, excellent talks.
Everyone Really justinspirational.
A lot of great things.
So I'm Dr Jesse Cordier.
I'm a pediatric radiologist bytraining.
I wear a few different hats.
I'm also founder of SierraMedical and Augmented Reality,
startup and Pre-CerticalPlanning, training and Education
and, most recently, I'm amanaging partner of a new
Ventures, dt Ventures, which isa venture studio that we're

(01:20:45):
building in the healthcareplatform.
So a few different things.
But I was asked to talk a littlebit about some trends in AR and
VR and 3D printing in general,and also a little bit about the
investment landscape.
And so you know, really it's alot of exciting times, a lot of
things that are being built inthe space of AR and VR for a
number of different things andreally things like medical
training simulation this is abig area where we're seeing more

(01:21:07):
traction adoption, surgicalplanning we'll talk a little bit
more about this the AR overlap,the integration
intraoperatively some of thechallenges that would
potentially can be seen thereand more use of applications in
pain management and therapy.
So, again, a lot of reallyexciting things that are being
done both with augmented andvirtual reality, and I think

(01:21:30):
these are very complementary tothe 3D printing as well.
You know, some of the work thatwe're doing specifically at
Serum Medical is using AR and VRfor, and specifically,
augmented reality for printingand planning customized
presurgical planning models thatcan be used to use for training
, education and planning.
This is an example of a heatmap here, where we've taken the

(01:21:53):
thickness and shown the thinnestareas in red, the darkest,
thickest areas in green for apatient with an acetabular
fracture, and we found, inparticular, one of our most
recent customers at UC Davis isusing this to help better train
and educate orthopedic surgeryresidents.
We found that using AR, thatthe surgeons can better, the

(01:22:13):
trainees can better classify thefractures properly and get this
classified more early on intheir training and get it
classified correctly, and weknow that the classification
really drives the management.
Is this conservatively managed?
Is this managed with one typeof operation or another, and so,
particularly for complexfractures in the S-tablet, we
found that this has been reallyuseful for trainees and this is

(01:22:36):
again very complementary to, Ithink, 3d printing, in the sense
it can be used for rapidprototyping, this can be used
for visualization, so a lot ofthings that I think are very
good complements to thistechnology and, as we're seeing
in both the sides of AR, vr and3D printing, improving precision
and outcome.
So, again, some of the earlystudies that we've done looked

(01:22:56):
at using this to better helpsurgeons to preoperatively game
plan how long will my surgery be, what type of equipment will I
need?
Rather than doing things on thefly, intraoperatively, they're
able to think through this caseand go in walking in with lower
cognitive load, meaning there'sfewer things buzzing around in
their mind when they go into thesurgery.
They know what tools they'regoing to use, about how long the

(01:23:17):
case is.
All the other people know theyhave the right equipment there.
So we found a much better,smoother case.
It really allows forpersonalized treatment and
planning.
So, again, patient-specificdesigned implants these can all
be really helpful for advancingthe case.
And patient education is reallyanother interesting idea that

(01:23:38):
we've been using this for andbetter helping the patients
themselves to understand theirprocess.
So we did a study up at OHSUlooking at this for spinal
fractures and spinal trauma andhelping this to better explain
to the patient.
You know what's going on, whattreatment will we use, what is
the problem?
We found that that showsdecreasing anxiety for the

(01:24:01):
patient and that means also thatthere's better adherence to the
treatment plan.
So the better you can conveywhat's going on as a surgeon, as
a physician, the better thepatient will do.
So what is the future outlook?
We see continued investment inresearch, both at the corporate
level, for large companies,technology companies investing

(01:24:24):
into different types of hardware, expanding some of these things
.
We'll probably see areas ofincreased adoption of
patient-specific applicationsand treatment and integration of
AI, both for model creation,generation and processing.
This is just kind of aninteresting example here.
I just played around a littlebit with this new model by give

(01:24:45):
credit to below C2.
This combines Claude withBlender and it's a connection.
You can take the two so you canliterally take text and turn it
into a 3D model from text.
You can use it to refine themodel I asked it to.
Here's some sample pictures tomake a femur.
That's not so great.
Let's see.
Can we add it, make it a littlebit different, maybe make it a

(01:25:08):
different color?
It's getting there.
I don't think it's quite thereyet, but I would say that you
know, at some point within a fewyears I think it is very
possible to take a radiologyreport and then use that to
generate a high-quality modelthat will be the Salter-Harris 2
fracture or the Toulot fractureand give example models that
can be used for patienteducation, teaching and training

(01:25:28):
.
So again, you know this iswhere it is at now, but I think
it really is a lot ofopportunity for further growth,
because these are really justgenerated from basic pictures or
general model databases thatthey have that are generic, that
it does much better if you askit to make a chair or make some
other things like that.
But you know, I think, reallygood work in progress.

(01:25:48):
All right, a little bit aboutthe investment landscape and the
sort of an unnecessarilyobnoxious AI generated image.
Here we have this one about ARand VR.
But, yeah, some interestingfunding trends.
I mean we've seen over the pastdecade about $980 million
invested in this area and,interestingly, the other thing
we'll talk a little bit aboutthis it would be good for
discussion is that really thispeaked at around 2021, 2022 for

(01:26:13):
the investment of about $252million into this area, with US
leading in investment of AR andVR, followed by Israel and then
by France, with the early stagebeing sort of dominant in that
particular area.
And so you know it'sinteresting to think of what are
the trends?
Is the technology matchingReally a lot of these trends we

(01:26:33):
look for is the ecosystem beingbuilt, the infrastructure being
built, the hardware that beingstandardized before sort of some
of the adoptions, because therereally is a good projection
among the use cases foraugmented and virtual reality
here with continued expectedgrowth and market growth both
across a number of verticals inhealthcare and construction,

(01:26:54):
military applications, robotics,manufacturing, those all type
of things where complementary toany kind of 3D imaging or
printing, these type of toolscan be useful as well.
So again, pretty large expectedgrowth of the market overall and
the market expected to continueto grow.
So I think it's very excitingwith the advancements in

(01:27:16):
digitization and artificialintelligence, utilization of
that and support from otherfunding organizations.
So again, some key applicationsthat we've seen is again,
medical education, training,surgical planning and navigation
and rehab.
So again, a lot of these areas.
And then just touching onthings like we talked about,
like patient education andhelping patients better

(01:27:37):
understand their plan and someof the notable developments
we've noted increases in FDAclearance.
So, for instance, ourapplication has recently gotten
FDA 510K clearance.
So that process it will beinteresting to see with some
changes in governmentalorganizations, will this become
faster or will this become moredelayed.
So it'll be interesting to seeand follow these trends further.

(01:28:00):
We'll probably see more AIintegration for creation of
models, more rapid turnaroundand generation of that, and
overall broader applications forAI.
So again, questions.
So regulatory impact,intra-procedural use Some of the
challenges of using overlayingdirectly AR onto a human being

(01:28:21):
is something called focalrivalry, where your eye is
competing with a real object anda holographic object.
So really perfecting that typeof registration is going to be
still a challenge that isneeding to be met and you know
it's just an interestingquestion that we wonder.
You know, why is that?
Why has funding sort of changed?
Is it because companies aremoving towards supporting

(01:28:43):
robotic performance over theperformance of a human?
Those are things to think aboutand, again, just an interesting
question to pose.
Like you know, because of theintegration of robotics and a
number of things, is there atrend to use it?
I think personally that youknow humans augmented by these
types of tools augmented realityand artificial intelligence

(01:29:03):
they're going to continue to bevery useful.
And they say even for myself asa radiologist, where they're
always questioning are you goingto be replaced by AI or
something like that I think theysay that a person using AI is
going to replace somebody notusing AI, but not necessarily a
human.
So I think there's a lot ofgreat things for trends here and
so, yes, yes, I think it isoverall revolutionizing uh

(01:29:24):
growth and there's significantrapid uh impact for for this
technology.
Yeah, thank you very much thankyou, jesse.

Speaker 1 (01:29:34):
Thank you for listening to our presentation
and thank you everyone whostayed online despite that we
had multiple technical problems,and thank you for the audience
here, but we're gonna stopbroadcasting here and we're
gonna do in-person live QA, sohopefully next time you can join
us in person.
See you next time.
Bye.

All Episodes

Episode #80 | Live from San Francisco: Innovation in 3D Printing & Bioprinting

Episode Transcript

Popular Podcasts

Stuff You Should Know

The Joe Rogan Experience

24/7 News: The Latest

.css-15opob5{left:0;position:absolute;top:0.8rem;} All Episodes

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Episode #80 | Live from San Francisco: Innovation in 3D Printing & Bioprinting