Biotech companies I wish existed

While one off companies may exist, I am surprised there is not more biotech activity in these areas

May 20, 2025

The biopharma ecosystem is set up for a limited number of "indication" or disease areas to be worked on. Part of this is industry structure (many biotech firms are incubated by VC firms to flip into biopharma company roadmaps for M&A), part is intellectual snobbery (“cosmetics of aging - yuck! I want to do Alzheimers”) and part of this is regulatory. A lot of important and commercially viable pre-existing biology that can be translated into real world applications is thus ignored. Here are some things I wish there were more startups working on[1,2,3].

Fertility

Given how important fertility is, it is shocking how few companies are working in the area. Two main thrusts of fertility that are interesting:

Allowing any adult to have children with anyone else. There is strong scientific results out of Japan in mice, in which many cell types can be converted into stem cells, and then differentiated into either sperm or egg cells. The human version of this means (roughly) anyone could have kids with anyone else. Gay couples could have kids with each other (one person would have their cells expanded into sperm, the others eggs), as long as they had a surrogate (see for example this paper from Hayashi’s group in Japan about mice produced via this technique using two fathers). Women of any age could have children. It is a huge unlock societally. Some reviews. Popular version. See also.
Expanding usable egg populations in women. Girls are born with 1 to 2 million oocytes (egg cells) and by puberty end up with ~300,000. Only a small number of these ever mature into the eggs that can be harvested for IVF or used for natural pregnancies. Methods to expand and mature egg cells seem dramatically under developed. See for example.

Anti-aging / longevity

There is clear data that aging is a genetically manipulatable and drugable phenotype. Given the size and important of the prize (e.g. adding 100+ years of productive health life to each person) it is a surprisingly empty field with at most a half dozen or so legitimate companies working on it (including eg BioAge and NewLimit - I am an investor in both).

Neurosensory aging. As you age you lose aspects of hearing and site. For example, the muscle holding the lens of the eye weakens in part leading to blurrier vision and the need for reading glasses for people in their 40s. This seems drugable. Ditto loss of hearing in aging adults. This example of reversing aging in mouse age dependent glaucoma models is intruiging (much simpler approaches then this seem like to work).

Cosmetic aging. Cosmetic use of Botox is roughly at $1.6 billion per year. People are literally injecting a bacterial toxin into their skin. Imagine anti-aging drugs that actually rejuvenate aspects of aging? Examples:

Skin aging and wrinkles. There is enormous demand for things that will reverse or stop skin aging, as seen via botox, face lifts, face fillers, and basic cosmetics.
Balding. Hair loss is age dependent. Some treatments like Minoxidal or Propecia can halt or partially reverse it. Why aren’t there drugs that restore hair completely?
Grey hair. As you age you lose melanin cell production in/around hair follicles. This leads to greying hair. A lot of the biology has been worked out. Why are there not more active efforts to reverse this?

Dental

Tooth regrowth. Many species like sharks can regrow teeth indefinitely, while humans naturally produce a second set of teeth during childhood. Why cant we just regrow a tooth with a bad cavity versus do extensive dental work? Genes like USAG-1 may allow for tooth regrowth in certain animal models, and other approaches and factors exist.

Biomarkers

Often the best way to run a clinical trial or discover drugs rapidly is to have an easily interrogatable biomarker that is a proxy for a biological effect. For example, we measure lipid levels as a proxy for certain types of heart health (and people are trying to develop new biomarkers for cardiac health). For most diseases, we do not have any form of biomarker from blood, saliva, or anywhere else that would be easy to track and use to expedite drug discovery. Given all the data we could theoretically generate per person, and all the ML/AI algorithms and approaches, it is a bit shocking that biomarkers are in such a primitive state.

Novel biomarkers. Develop novel biomarkers for disease states as a way to expedite drug development and study disease course. This may not be great as a stand alone company, unless some of the biomarkers are good replacements for less comfortable procedures. For example, Exact Biosciences is a $10 billion market cap company, as its product lets you do a biomarker test of your poop for colon cancer risk versus the less comfortable colonoscopy. One could imagine many more of these sorts of tests.

Smell / volatile molecules. Dogs can smell if people have certain types of cancer. This means some biomarker(s) of cancer is emitted into the air and detectable by a dog nose. Why don’t we have similar sensors built? One example in this direction to screen lung cancer.

Other health areas.

There are a wide variety of other things that may impact human health that go ignored - for example air pollution levels and cognitive function - that may have broader societal value. Those may be subject of a future post.

NOTES

[1] There are one off companies in each area. In some cases good ones, in other cases the translational biotech market seems to not have any legitimate players.

[2] References included are not the canonical or key papers in many cases - rather just wanted to show evidence these things are possible. Full scientific citing would take a lot of time and I am a bit overloaded.

[3] I am generally not investing in much biotech for the last few years. However, if there was an incredibly compelling team taking a smart approach in this area I would be interested.

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