Athanasiou: For academics, taking the entrepreneurial path is about more than money

Kyriacos A. Athanasiou is a formidable figure in biomedical engineering, whose work has bridged the chasm between innovative research and life-saving products through several spinoffs.

He currently holds the position of Distinguished Professor at the University of California, Irvine, and here he speaks to GOLD about his entrepreneurial adventures, shedding light on past and present bottlenecks in research translation and the importance of aiming for higher goals in the relentless pursuit of innovation:

“We are all going to die someday. So, the question is what are you leaving behind – what is your legacy?” muses Kyriacos A. Athanasiou. Behind his desk, a series of family photographs mingle with awards from his illustrious career, which has seen him translate academic research into life-saving medical products in the field of biomedical engineering. He nonchalantly sheds his jacket, placing it outside the frame of our Zoom call – Athanasiou currently works out of the University of California, Irvine, where he is a Distinguished Professor – and proceeds to unravel the motivation that drove him beyond the cosy confines of academia and into the tumultuous seas of entrepreneurship. He says, “Am I going to be remembered through a trail of papers and books? That’s all good; but am I going to save or improve the quality of someone’s life? That, to me, remains the fundamental question.”

In 1980, despite gaining admittance into Greek-speaking universities in both Cyprus and Greece, having finished top of his class in high school, Athanasiou’s insatiable thirst for adventure overcame any fear of the unknown and he ventured across the Atlantic to the United States. The Larnaca-born son of a blue-collar family, he hustled tirelessly in New York’s Greek diners to make ends meet while studying mechanical engineering at the New York Institute of Technology. Armed with relentless determination and a huge amount of intelligence, he once again topped his class, which paved the way to a full scholarship at Columbia University. In the late ‘80s, the dawn of biomedical engineering brought a thrilling wave of research and ideas aimed at tackling the most intricate challenges in medicine and biology. Athanasiou sensed an opportunity to make a meaningful impact and plunged head-first into this burgeoning field.

He finished his doctoral degree in just three and a half years and, rather than embarking on the usual postdoctoral fellowship route, he leapt into academia right away, joining the University of Texas in 1989. He relished the experience and, by 1993, he had defied norms once again, securing an associate professorship with tenure – a path that typically takes seven long years. In that same year, amidst these professional accomplishments, he tied the marital knot. Everything appeared idyllic at first glance. However, his rapid ascent through the academic ranks had taken its toll, leaving him burned out. It was at this juncture that Athanasiou grappled with the most profound existential question that life can summon and the subconscious urge to overcome death evidently ignited an entrepreneurial spark within him.

At the time, Athanasiou’s laboratory work at the University of Texas centred on the intricate task of mending small cartilage lesions. With a medical product to treat the condition sorely absent from the market, he decided to translate his research. It’s worth noting that back then, terms such as “translation” (in this sense) and “commercialisation” were absent from both the academic and business lexicon. Even so, Athanasiou doggedly pursued the idea, adeptly wearing a multitude of hats – from inventor and professor to business owner – with the invaluable support of the University’s Vice President.

On the frontiers of commercialisation, the uninitiated often find themselves bewildered by the whirlwind of developments. Athanasiou humorously recalls how “people were getting whiplashed” as they tried to wrap their heads around the complexities of licensing the rights of his research from the University to the company that he had founded. The endeavour also came with its own set of lessons for himself, one of which emphasised the substantial cost and equity relinquishment when engaging early-stage investors. As the famous saying goes, they were fixing the plane in mid-flight. The resulting spinoff, Osteobiologics, Inc., would ultimately introduce a range of products to the market, including the first FDA-approved solution for treating minor knee cartilage defects. Following an arduous journey, in 2006, the venture was acquired for US$78 million by the renowned British multinational, Smith & Nephew. In the meantime, Athanasiou was incubating another paradigm-shifting concept.

It was a mundane Monday morning in early 1994. As the clock struck 7am, Kyriacos Athanasiou was attending the Orthopaedic Grand Rounds lecture hosted at the University of Texas Health Science Centre. Sitting at the back of the dimly lit auditorium, he struggled to keep his eyes open. Addressing an assembly of – mostly – physicians, the lecturer recounted a case involving the 25-year-old victim of a motorcycle accident, whose potentially treatable fractures had led to his tragic demise. On hearing the story, Athanasiou was jolted awake from his mornng slumber and he raised his hand above a sea of nodding heads. “Why couldn’t they treat the injuries?” he asked. Given the perceived simplicity of the inquiry, the lecturer, perhaps somewhat condescendingly, proceeded to explain that when peripheral blood supplies were rendered shut, it was impossible to administer drugs to a patient – a recurring and distressing scenario, as it transpired. As a non-physician, Athanasiou continued with a volley of questions – to the lecturer’s growing dissatisfaction. “Listen to a problem that you’ve never heard of before, and I can guarantee you, you’re going to have a very fresh way of looking at it,” Athanasiou says, echoing the tried-and-true paradigm that an outsider’s gaze offers new perspectives often eluding those deeply entwined with the issue at hand. As the lecturer moved on to new topics, Athanasiou took out one of his favourite green pens and, on a napkin, sketched an idea for delivering drugs into the human system via a different avenue. The notion that bone marrow, the body’s blood-making facility, could be used as an alternative route to administer IV fluids and drugs in emergencies had already been theorised but no reliable technology had been developed to put the idea into practice.

A few months later, in the grounds of the Pedagogical Academy in Nicosia during a conference convened by the Cyprus Association of Medical Physics and Biomedical Engineering, Athanasiou meticulously crafted a spectrum of applications for intraosseous access, from delivering drugs and stem cells to intracranial pressure management. Back in Texas, despite a pushback from the department chair, he continued his research undeterred and eventually discovered that the area under the knee was a great entry point to reach the bone marrow. And the pharmacokinetics – how a drug interacts with a body – proved the same whether delivered through a vein or via the bone marrow. In 2001, this research would become his third spinoff, called Vidacare Corporation, with the resulting device aptly named EZ IO. A retired General of the US Armed Services who sat on Vidacare’s board saw the pressing need to deploy EZ IO to the US forces in Iraq and Afghanistan. “It worked well and saved so many lives that it went through the FDA very quickly,” Athanasiou says. The product is now widely used all over the world; it is in every ambulance and emergency room. Vidacare, which also developed a few more products, was acquired for US$285 million by US medical device company Teleflex Medical in 2013.

Over the years, the frameworks and processes of translating academic research into products have undergone refinement. However, substantial challenges persist, casting a shadow on the evolution of the field. Athanasiou points out that conventional expectations placed upon faculty members continue to revolve around the triumvirate of research, teaching and service, leaving translation/commercialisation outside the sphere of factors that gauge academic accomplishment. Indeed, over the past half-century, promotions and pay rises for research scientists have increasingly hinged on the quality of citations received, pushing research into a more conservative, risk-averse direction. Athanasiou explains that the h-index – the count of authored publications against the citations they have garnered – remains one of the most important yardsticks inside academia. Indicatively, Athanasiou’s h-index stands at 106 (anything over 60 is considered truly exceptional). “Nowhere is there any mention of the number of companies you have created, how many patents you have developed, or how many technologies have found their way to clinical practice,” he says, his tone tinged with frustration. “Despite all the talk by high-level administrators or universities and even governments, translation hasn’t really reached the level that it could.”

In Cyprus, the situation is even worse where public universities are involved, since intellectual property emerging from translation remains within the jurisdiction of the university; a sadness falls on Athanasiou’s face upon hearing this. He contends that, despite the desire for change, academics become giddy as soon as they see dollar signs in front of them. “They believe that you are polluting academia,” he explains.

“I promise you, though, if you are an academic, you are not walking the entrepreneurial path for money. Don’t get me wrong, we’re all capitalistic and there’s nothing wrong with that. But you don’t do it for the money.” There is also a compelling argument that research devoid of practical applications amounts to squandering valuable time and resources. After all, why should universities solely endorse research that has no tangible impact on society? Nonetheless, Athanasiou warns that translation can be a sinkhole. “I don’t want for one second to convey to you or anybody that it is an easy path to follow. I have omitted 90% of the description of the work, which is tedious. So, I’d advise research scientists to satisfy what is necessary for their academic career, and if they have the bandwidth, then go into entrepreneurship,” he says.

2023 has been a year of recognition for Athanasiou. The US Biomedical Engineering Society, the field’s professional body, has named an award after him: the “Athanasiou Medal” will be awarded annually to individuals who have made outstanding contributions to the field of biomedical engineering with a particular focus on translation. On top of that, he was recognised as a Great Immigrant by the Carnegie Corporation in the 2023 cohort. And December beckons with an invitation from the Cyprus Government, which wishes to offer a laurel in recognition of his immense contributions. “I do not necessarily love to talk about awards and all that. It gets a little embarrassing, I guess,” he says, casting a downward glance. To him, these honours symbolise the remarkable journey of a kid raised in a blue-collar household – his father a painter, his mother a homemaker – where abundance on the dinner table was not always a given. They stand as a testament to the fact that even someone from humble beginnings can ascend to the grandest stages.

“On a lighter note,” I inquire, “the EZ IO device has gained recognition in pop culture, with appearances in shows like Grey’s Anatomy. Where does that rank in your list of accomplishments?”

He smiles. “It doesn’t really rank, to be honest but I have used a few clips from these shows in my talks, so I shouldn’t be so dismissive since they have helped bring these innovations into the non-scientific vernacular!” he says.

Despite the accolades and involvement in six spinoff ventures, Athanasiou shows no signs of slowing down. His latest venture, Cartilage Inc., is investigating ways to fabricate various types of cartilage that can be applied anywhere in the body – temporomandibular joint, knees, hips, shoulders…the list goes on. In a moment of introspection, he reaches behind him and grabs one of the photographs. “You know, in my perhaps futile attempt to understand and define my legacy, it is more than the technologies and achievements I’ve shared with you. More importantly, it is my beautiful wife and my two sons – that is my true legacy,” he says.

This interview first appeared in the November edition of GOLD magazine. Click here to view it.