With Guest Shawn Singh [TRANSCRIPT]
[Colin Miller]
Hello, I'm Colin Miller, CEO at the Bracken Group, and this is Fractals: Life Science Conversations. Bracken is the professional services firm for life sciences and digital health organizations. Our intelligence ecosystem fulfils consulting, regulatory, marketing and analytics needs with an integrated and strategic approach.
Today's episode will focus on innovation in neuroscience and the development of novel therapies for psychiatric and neurological disorders. To explore this topic, I'm excited to be joined by Shawn Singh, the CEO of Vistagen Therapeutics. Shawn has dedicated over 30 years to advancing biotechnology, pharmaceuticals and medical devices, serving in senior leadership roles across public and private companies, a venture capital firm and a contract research organization.
Since joining Vistagen's board of directors in 2000 and assuming the role of CEO in 2009, he has been instrumental in guiding the company's mission to pioneer neuroscience therapies that target neurocircuitry in the brain. Under Shawn's leadership, Vistagen has built a diverse pipeline of five clinical stage product candidates in a novel class of intranasal drugs called Pherines. These therapies are designed to rapidly activate brain neurocircuitry through the olfactory system, offering therapeutic benefits without systemic absorption, really quite a potential advantage in safety and efficacy.
Vistagen's lead asset, Fasadianol, is currently in phase three development for social anxiety disorder or SAD, representing a promising new approach in neuropsychiatric treatment. With that, welcome to Fractals, Shawn. Thank you so much for joining me today.
[Shawn Singh]
Colin, likewise, it's great to be here. Thank you very much for having me. It's always a pleasure.
[Colin Miller]
That's absolutely delightful. And you've really had quite a fascinating career spanning law, investment banking, biotech leadership. Can you start by sharing your journey and what ultimately brought you to Vistagen?
[Shawn Singh]
What has been just the privilege of the career is being surrounded by incredibly talented, expertised and smart people. And that really has transcended every sector that I've been in. And so starting as a corporate finance lawyer in Silicon Valley, focusing on biotech and high tech, and then finally making the decision to move into an in-house role with a company I helped take public, then graduating up to the C-suite and then moving over to venture capital associated with the Contract Research Group, where we were able to leverage services for equities and promising companies, as well as guide them through development milestones. And then the connection with Vistagen arose first as a director position. And then it was a portfolio company of the fund that I was running.
And over time, at a different stage of the company's history, which was focused on a different set of technologies than we are at now, but moved into an operating role. And since then, I'll tell you the tremendous advantage that we're able to now show in terms of the pipeline. All that credit goes to Dr. Louis Monti, who's our Senior VP of Transformational Medicine. Dr. Monti ought to get, if we're successful with these programs, I think he should be getting a Nobel Prize, because what we're able to check the box on things that are associated with the concerns about neuropsychiatric drugs. We've checked those boxes. So things like sexual side effects, sedation, weight gain, abuse liability, cognitive impairment.
Those are the things that are the clarion calls and Dr. Monti's design. So the drug candidates were advancing really in a way we've never seen anywhere and still don't to this moment. Able to use the nose as a portal to achieve tremendously transformative therapeutic effects.
So hopefully that continues.
[Colin Miller]
Fantastic. So perhaps you could just explain just a little bit about what pherines are, because for most people, I think listening to this, they'll have no idea what they are or how to think about them, other than maybe it's something you put in your nose. So perhaps you could just explain a little bit more.
[Shawn Singh]
Yeah, simple. Even though it's not exactly the same, there's a parallel highway. Think about you come home from school and your mom just opens the oven and it's a wonderful new batch of chocolate chip cookies and how that makes you feel.
Or you're walking down the street and there's across the street and there's sewage. That's also sending you a different message. So there's ways where our nose can actually be the portal to achieve different operations and different neurocircuitry outcomes in the brain.
We're in a mode where the olfactory system is key, as you noted, but our drugs are all odorless and tasteless. So pherines are a new class of drugs that activate neurons that are only in our nose. So all of them are formulated as intranasal or nasal sprays.
And within milliseconds at low microgram level doses, because drug is sprayed directly onto the receptors of neurons that we need to kick into gear, that's the switch we need to flip up, that then causes a stream of neurocircuitry cascades that ultimately go through what are called the olfactory bulb neurons that then project to different regions of the brain, depending upon the synthetic chemical structure of each pherine. So with different targets in mind, each of the unique five assets in the pherine pipeline we're developing, and each of them has achieved at least phase two level success in a study in the human patient populations we're trying to help, to improve on the conditions that they are affected by. So in the case of the lead drug you noted, fasadienol, the target is the amygdala, the fear and anxiety center of the brain.
But to get there in a way that is fundamentally different from any other anti-anxiety drug that we have ever seen, so let's say a benzodiazepine, an oral drug, where it has to go in your mouth, in your gut, through your liver, through your kidney, in your blood, over the blood-brain barrier, into your brain, and then maybe bounce around and go where you want it to, but not where you don't, then the consequences associated with that really are the way then that drug works in the brain. These pherines do not have to make that trip. They're not detectable in plasma.
They do not have to act directly on neurons in the brain. It's all about activating the neurocircuitry in the nose that projects two different regions of the brain to achieve a therapeutic effect. So there's inhibitory neurotransmission that is possible when you activate GABA neurons in the brain, right?
So you can get without adding to a benzodiazepine blood, you're potentiating GABA, you're flooding inhibitory neurons into the brain or inhibitory neurotransmission. Not doing that with pherines, you're not potentiating it, but you are activating what we call GABAergic activity within the amygdala to achieve that anti-anxiety effect, to modulate or regulate down. So that all is done within inches of the entry point and within minutes of the activation of the neurons.
The key is the lock and key relationship between the neurons in the nose and the olfactory bulb neurons at the base of the brain. That's a match set. There's a lot of different subsets, but fundamentally, you gotta have that first one to punch.
And then depends on what you're trying to do. So let's say we're focused on women's health and menopausal hot flashes. Well, for that, we need to get to the body's thermostat, the hypothalamus, the different region of the brain.
And so we're able to assess with very elegant electrophysiological tests that timing. Why do I know it's 30 milliseconds to activate? It's because we have electrogram of nasal receptors, studies like you would see in EKG, but you're looking for a depolarizing effect on those neurons to assess the time to activity.
And same thing with the olfactory bulb neurons. So Dr. Monti has invested decades in assessing which of these chemical structures actually achieve the targeted therapeutic effect, whether it's antidepressant effects, anti-anxiety effects, appetite increase, improvement in reaction time if you're a mentally fatigued patient, a person, shift worker, truck driver, or if you're a late stage cancer patient, for example, and you need to enhance appetite to get through the hypothalamus.
So again, there's a lot of connect the dots for where you wanna get to from where you start to be able to achieve the therapeutic effect that's associated with a certain disorder or condition where the current standard of care either doesn't exist as a standard of care or it's suboptimal because of side effects or safety concerns or lack of efficacy. So those are the gaps we're trying to fill with each of these fairings.
[Colin Miller]
Wow, okay. Thank you. That was a beautifully described process.
Do people have different neuroplasticity that makes them more able to respond positively to the fairings?
[Shawn Singh]
You certainly think that's certainly possible, right? Especially in depression. A lot of it is really related to the disorder and the nature of the stressor.
A lot of the onset for social anxiety disorder, for example, is in adolescence and it's social media driven, team orientation in school and work. These are main drivers. And a lot of times it does depend on where people are in their journey as to whether you get the kind of synaptic activity that's associated with the effect you're trying to generate.
So with depression, for example, it's the opposite we're trying to see. And we see objective biomarkers as well. So what you're looking for in anxiety, is there a reduction in sweating?
Is there a reduction in blood pressure? Is there a reduction in heart rate? For depression, it's the opposite.
Are you seeing an increase in those things? Jumpstarting your car, driving around town, and then the next time you turn it on, you don't need the cables because you've got the synapses acting up again and connecting with each other. So keeping them the way that the disorder manifests is also important, the way we dose.
For social anxiety, what we're focused on is the acute treatment. To be able to have something you take out of your pocket or your purse, backpack, right at the time you're experiencing whatever that stressor is that you need to knock down to be able to engage and not avoid. It's part of the beauty that we see across this pipeline is the ability to tailor to fit the way that the drug candidates could be used ultimately in the context of life of how people are affected by the disorder.
The social anxiety, it's very episodic. It's not all day every day for some unspecified reason. It's very episodic associated with certain social and performance-related stressors.
People have at work, people have at school. And there are days where you don't have those stressors. So why do you need a medicine in your body when you're reading a book in the middle of a park and nothing's bothering you?
We tend to see more often use during the week when people are engaging. We've seen this in prior open-label studies when people have to go to work or have to go to school, they're forced to see people to maintain their livelihood or to advance and less on the weekends. But you do know with certain medications, whether or not you're having a benefit, sometimes you're gonna get the side effects no matter what.
So for old school antidepressants, there are three of them approved for social anxieties or the overall treatment, not the acute treatment. You're really likely not gonna get a benefit in an acute setting. And you probably are taking them because you have comorbid depression, but the probability that you're gonna get the side effects is way up there, no matter what happens.
So we're trying to remove not only the ability to, or remove the side effect and safety concern potential, but also give people agency over the disorder and the way or the condition and the way that they wanna be able to manage that. Fortunately, because of our safety profile, we've seen so far in completed studies, it may be up to six times a day that someone can use fasadienol in the context of their life. It's very rare you'd see six stressors in a day, but you could have something in the morning that's a client, you could have a lunch with a friend or a date, and then you could be going to your in-laws a dinner.
Like there are many things that can trigger you that require different interventions.
[Colin Miller]
I love the, yeah, I can see that. And that is so useful to have it at that immediacy is that you comment on and the ability to take something for the, within a few minutes prior to, or I presume you can almost take it during the course of the stressor, that's causing that effect, so.
[Shawn Singh]
When you think about it too, often engaging is the hardest part. And once you engage, you're actually able to do okay. But if you think about it vocationally in particular, there are so many jobs where you have to deal with people and you have to make presentations and your livelihood is associated with being able to do that.
And so having an alternative to what is really, there aren't any treatment guidelines, established treatment guidelines for social anxiety disorder in an acute setting. And there's no other approved drug ever in the United States for the acute treatment of social anxiety. But to have an alternative to alcohol or a benzodiazepine or a beta blocker or other, they have all significant considerations.
One of the things we hope to achieve, it's not just in the moment benefits. It's, you might be surprised, but perhaps not, that many individuals affected by social anxiety disorder cancel or don't go to appointments, even normal health checks. We would hope to see things like DUIs reduced because people aren't drinking alcohol in order to get through a party and then having to take that risk associated with leaving and going home.
Heart disease could be improved because people get to the doctor. Dental care could be approved because people will take that appointment. So compliance with typical health checks, it's not what we typically think of as a benefit, but it's certainly a collateral potential consequence of being able to engage and being able to sit in a waiting room and wait your turn when there are other people there.
Being able to actually just decide to leave your home to make the trip to go to a doctor or a therapist or even the grocery store. So it's those kinds of, you start to think through it. And all the 30 plus million people in the United States, especially an age group that's growing in the 18 to 22 range, there are a multitude of potential benefits that can be achieved once you're confident and once you're more resilient, that's ultimately what you're trying to get to.
And eventually at some point, people won't be taking this drug if we're able to successfully get it approved and commercialized. If, as their journey advances, they're able to have that cognitive behavioral effect that's associated with successful acute wins. And you also, people have different seasons in their journey.
What you're bothered by as an adolescent or a young collegian or a young professional, they change as time goes through. So being able to adapt and be confident about engaging is, it's just critical, especially today, in today's world, isn't it?
[Colin Miller]
Yeah, I pick up on multiple facets there. You could almost imagine that the dentist will send you out a bottle of this stuff for spraying a week before you're due to go and visit him. And that way you'll always be at your dental appointment, which is always probably one of the biggest stresses for everyone.
[Shawn Singh]
And on the caregiver side or the practitioner side, it's a more enriching experience. If someone's going to get exposure therapy or therapy for PTSD, and they can't get to the appointment because they hear a car backfire as they're getting on the off-ramp, that's going to affect the quality of that service. Or even if it's online, things that people now worry about is being online.
People worry about is, are my freezing? Is my background okay? Is my dog coming into the picture?
So there's a whole new wave from the Zoom boom that we have of especially remote working consultants who can't provide the service that's their livelihood because they're worried about how they're projecting online. So it's, again, there's new alternatives that are needed. There's never one size fits all.
[Colin Miller]
Just my personal background is in the imaging field, particularly in interceptive imaging and clinical trials. Because it's, and so there's a lot of work going on in neuropsychiatry with fMRI and imaging. Does this show up on fMRI scans or is it because it's changing the neuroplasticity?
You're really not seeing an effect on an imaging, but you're actually seeing it, as you said earlier on, a more physiological output.
[Shawn Singh]
Oh, it's both. We think you can see an effect on imaging and fMRI. Yeah.
Some of the early work was associated with that on the lead drug. Oh, was it? Okay.
Yep. Fascinating. But you look to, you've got to marry that up, as you know, with other things.
So what are the objective biomarkers? Are you seeing, in this particular case, reduction in the physical symptoms, right? Yes.
The sweating. Are you seeing a reduction in heart rate, blood pressure? Things that give you additional confidence, especially if you have a drug candidate, this will be aligned, I think, with a lot of your experience.
What do you do if you can't detect a drug in plasma? Yeah. You've got to take that PK chapter out of your textbook and put it aside because it's just not, there's nothing you can do with that one.
You do have to do a bit of a patchwork quilt up front. You will have to harvest nasal epithelia in order to put them in a dish to assess whether there's calcium flux. You then do the studies we talk about where we have volunteers come in and we'll set a baseline nasal spray and then insert electrodes in their nose and at the bridge, and then we'll put an active to see if there's that depolarizing effect.
I mentioned the EGNR studies or the EGOB studies, we call them the electrogrammable factory bulb. And then you look obviously downstream, are you seeing a clinical effect with standard endpoints that are associated with the particular disorders, whether it's hot flashes or SAD. And you put that all together and you can't argue with the clinical outcomes, but it's just not always a conventional unpacking of a mechanism that is an old friend way of thinking for every other neuropsychiatric drug that's ever been developed.
You're putting something in the nose, how's it not addictive? So the other, obviously you do binding affinity studies with opiate, nicotine, dopamine, the kinds of abuse liability receptors to show no affinity there. And it is a bit of a patchwork quote, but it's pretty good looking when you take a look at the whole picture.
Yeah, yeah.
[Colin Miller]
But quite impressive, the way that you can get to the amygdala through the olfactory process, really just a very impressive, the way you've obviously thought that one through. And as you say, Dr. Lewis-Monti as well, being part of that.
[Shawn Singh]
A lot of trial and error up front. That's for sure. Early on, it was very challenging because there are not animal efficacy models.
These are human species specific neurons and receptors for the neurons. And so you get to, there was a point early on where they were very frustrated. They weren't seeing any benefit in these models.
And then all of a sudden, the texts that were pipetting started to say, feel a little bit calmer, not euphoric, but just calmer. And that then caused a whole different lane of exploration that really was the right lane to get on and get to the point today where we are after a lot of his early work. Wow.
So it was truly just lab or bench work. Initially, yeah. The thought early on was general anxiety disorder.
And then when, and this is where Dr. Leibowitz, Dr. Michael Leibowitz is the, he's the godfather or the Babe Ruth or whoever you want to assign to it. I call him the Babe Ruth of social anxiety disorder and evolved in creating what's called the Leibowitz social anxiety scale that's associated with the overall treatment. The endpoint we use in the studies is more like a selfie or a Polaroid.
It's in the short acute moment. Whereas the Leibowitz scale assesses activity over time, severity and whether you're engaging more or less. And he suggested early on to Dr. Monti that the way this drug candidate then called PH 94B was working was a really significant and better fit for social anxiety as an episodic and as needed type of a therapeutic intervention than the all day, every day associated with an unpredictable but persistent feeling that drives general anxiety disorder. So it was his knowledge about how social anxiety disorder was manifesting back in those days and having been involved in the registrational trials for the antidepressants, he was able to, with Dr. Monti, talk through really the substantial difference between what was being studied at the time, not only for GAD, but also for overall treatment of SAD. And that's the pocket in addition to the fact that there still hasn't been for 20 something years in acute treatment approved and controlled studies in the FDA. Yep.
[Colin Miller]
Wow. Great to hear how that history all came together. Fascinating that Vistagen really got a unique focus on neuroscience and mental health.
So what excites you most about where the company is heading in the next few years?
[Shawn Singh]
Well, I think it's a day to day passion that drives our whole team about the ability to change lives and to be able to really imagine even a thousand, let alone a hundred thousand or millions that are not affected by this disorder that they built their life around. That they get to now have agency over decision-making about relationships and careers and academic advancement. That's a once in a generation, mind-blowing career opportunity for anybody to see that kind of an outcome and have some part in it, small as it might be or large as it might be.
That's a day-to-day benefit because I've seen it. I've seen it over and over, whether I'm coaching girls softball or I'm traveling through Wall Street or I'm on a college campus. You see the effects of this disorder across so many different types of lives and social journeys that people are on and vocational journeys people are on.
It's hard. And that's the case with mental health beyond the social anxiety disorder, whether it's depression, we see increasing suicidal ideation. Unfortunately, there's often a match set.
Social anxiety early on set to depression, to suicidal ideation, and then the tragic suicide. It's just got to change. And I think that's what drives us up and down this pipeline, but it's exciting to have the potential to change and improve lives.
I think fundamentally doing that also puts us in a position to generate hopefully remarkable value for the stakeholders in the company who have invested and have been loyal to what we're trying to accomplish. It's not easy. It's a complex business.
Getting a drug to affect what happens through the brain, it's a pretty tough putt. And doing it with safety and the ability to have the flexibility of tailoring to fit the use to a life that in a broad range of lives, terrific.
[Colin Miller]
Yeah, I concur and really appreciate you and the team in what you're doing in these areas because it is a real key medical need. I guess the other piece to it is also as well, we always have to make sure that we affect the regulatory authorities in a positive light as well and get their alignments. And so I presume that's also part of the puzzle in the process here because you've got such a novel approach going on that you must have had a lot of regulatory connections going on to keep this moving.
[Shawn Singh]
Yeah, and often you just, you have to anticipate what the analog is that the agency is going to want to lean into. And then sometimes really the effort is to try to differentiate with clarity why you're not a benzo, why it's not a fixed dose antidepressant, why it isn't things that have been associated with a potential treatment paradigm on or off label. And especially when you have a new mechanism, there's definitely a need and an art, not just advocacy, but education about why it makes sense to be able to move forward and why a certain study design and a certain end point is appropriate for what you're studying.
A legacy registrational pathway may not be appropriate for a new technology or a new mechanism. And that's an important relationship as all along, I think here, at least with this mechanism and this approach, there's a lot of confidence that goes into believing that we can imbalance that and make the benefit much better than the cost.
[Colin Miller]
I'd like to change gears just a little and focus not just on the Pherines, but a little bit about you and your career. And you've led companies through multiple phases of growth. What lessons have been most valuable in steering Vistagen's development strategy and how you think about being a CEO of a company coming from the board down to a CEO or down, but shifting gears and changing?
Fascinating to hear your insights.
[Shawn Singh]
There's many pages of lessons learned and best practices, no question. But fundamentally, communication is critical and cross-functional teamwork, especially in a drug development context is from your own career. It's impossible to move forward if there's a siloing of information and effort.
And each group's work stream is, there are others dependent upon that work stream to do what it is that they have to do, right? It's CMC to clinical, to regulatory, to there's just got to be interactivity and circulating people around a mission that is not just illusory, that's realistic, that you can become passionate about, that you can feel a participation in. And that's always challenging as you go through different growth stages.
We're in another growth mode, so growth management's always important to ensure that you've got that kind of leadership by example as well. I can't say to people in a mental health company, make sure you take time off and refresh when they know I'm not. So I have to be visible in those ways, at the same time, trying to provide the opportunities for people to grow where they are.
And that's key to all of what we do. I think fundamentally though, it's the mission and the passion. And we have a lot of folks that have come from big pharmaceutical companies who have a different voice in an entrepreneurial setting similar to where we are and have a lot of experience to be able to see and say why what we're doing is so different than anything they've ever been associated with.
And that also drives even the younger generation of workers that we have because we have multiple demographics as anybody does these days, especially with a remote workforce. That's been challenging initially because you always worry that productivity would wane. This is a big lesson to a lot of us as CEOs during the pandemic.
The reality is it improves. Productivity improves, but you still have to find a way to make sure people from an HR perspective realize they're part of a team. So I think fundamentally, cross-functional teamwork is essential, but that all has to be behind a collective embrace of the mission with passion.
[Colin Miller]
So taking that to the next step, can you perhaps share a low light and then a highlight from your career?
[Shawn Singh]
I think that the low lights are always when I don't know if it's necessarily career oriented, but it's been exposure to how mental illness has really affected a lot of people that I come across all the time and keep coming across. So you get setbacks in clinical development that set you up for comebacks, and that's what you're hopefully trying to be able to do and manage. There are many cases where it's not so much the drug as the study, as to then you could go back to it and you get another shot at it with lessons learned, integrated, or even environmental macro world changes affecting clinical execution at the trial level.
And but I think that's a challenge. That's really it. It's the days are hard when you are, if you're capital constrained, there's a lot of stress associated with that.
If you have a setback in a clinical trial, we had one that was challenging, but challenges you to be resilient and persevere. And that's critical in our business here because the odds aren't very much in your favor. You do whatever you can do to limit and try to control variability, especially when you're scaling up.
And but humans are humans. And while there's a lot of tradecraft that can be integrated into execution at the end of the day, when studies are double blind and randomized, they are what they are at the end of the day. So that's probably a longer winded answer than you wanted.
But when you get to points where you're on fumes in the career, there were moments in this company where I'm using my credit card to pay the energy bill. So there are those times where you just really have to saddle up and see a future that may be asymmetric to the moment. And it usually is radically asymmetric to the moment because of the value you think is embedded in what you know and your team knows has the potential that you've all collectively been driving around.
And those are the moments that you got to get through.
[Colin Miller]
Yeah. No, I concur and the appreciation of when you're in the driver's seat as a CEO and or in the entrepreneurial position and having to make those judgment calls, as you say, putting your credit card on the line for the power is key critical. So getting to the end game.
[Shawn Singh]
And that's why the binary outcomes are so much so satisfying. Right. So if you ask me the opposite of that, what's the peak?
I think the history we're able to make with the study we call Palisade 2 to have the very first successful acute treatment for social anxiety disorder using our study design and our endpoint. That's a peak to the moment. Hopefully we'll have more peaks and we keep climbing a higher and higher mountain.
But that was a good day.
[Colin Miller]
Yeah. Yeah. Believe it.
And that was where we're heading. So to wrap our time up and in the last few minutes, if you could speak to yourself at the age of 25, what or thereabouts, what advice would you give yourself now?
[Shawn Singh]
Oh, wow. That's a great question. I guess I'd say listen to myself.
I think we have four wonderful adult children. My wife and I, we've been married for 38 years. And I'd say to them the same thing, which is find your superpower and early on and then try to build on it.
And but do that with. Do that with the surround sound you get from building great relationships, interact with people, all kinds of people. Often I say if I'm the smartest guy in the room, I'm in the wrong room.
And that's been, again, so fantastic for a corporate securities lawyer to be able to surround himself in this industry is only because of the MDs and the PhDs and the regulatory experts and the lawyers and the others that have been so much part of the ecosystem. And I just it's really incredible to and important to make relationships and not quit and not expect something to happen in a minute. Those are multiple aspects to the same point, but it's really.
You know, a lot of people think they got to do a lot of things to find their thing, but if they know their thing, go and build on that thing and do it as fast as you can and as passionately as you can and don't quit. That's Churchill coming at you. Right.
[Colin Miller]
Never give up. Yeah. Keep calm and carry on.
Indeed. Shawn, this has been an unbelievable opportunity to have a conversation with you. I've really enjoyed it.
I feel as though I've only just scratched the surface at so many different topics and areas. And thank you for the rich tapestry of just the parts that you've sown. For me, it's been absolutely fascinating.
[Shawn Singh]
It's been a terrific pleasure. I thank you for the opportunity and I'm happy to speak to you at any time. It's been it's been very enjoyable.
Thank you.
[Colin Miller]
Fractals is brought to you by Bracken, the professional services firm for life science and digital health organisations. Subscribe to Fractals via your preferred podcast platform. Visit us at thebrackengroup.com or reach out directly on LinkedIn. We'll be delighted to speak with you. I'm Colin Miller, wishing you sound business and good health. Thanks for listening.
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