At Alto, New COO Mikael Eliasson Aims to Transform Psychiatry

Alto Neuroscience COO Mikael Eliasson, M.D., Ph.D./Courtesy Alto Neuroscience

“Mental health is one of our most pressing needs,” Mikael Eliasson, M.D., Ph.D., the new COO at Alto Neuroscience, told BioSpace, but large pharmas sometimes lack the entrepreneurial attributes needed to drive leading-edge innovation. Therefore, this former “intrapreneur” became an entrepreneur, leaving giant Genentech (Roche) for the nimbleness of the much smaller Alto.

“I had a great job at Genentech/Roche (as global head of innovation in neuroscience product development). I loved the work, and my boss was great.” What was lacking – and this is true of virtually all large companies – was the ability to scale transformative innovation.

He used Tesla as an analogy for the approach large companies take to scaling innovation. “I commute to Alto in a Tesla. Tesla could have been built by any large automobile company in terms of resources. They all have the resources to do it, but they didn’t.” That decision by big automakers speaks to the difficulty large corporations often have in scaling transformative innovation. Today, Tesla has a market capitalization of nearly $935 billion (even with recent stock downturns). This makes it the sixth-largest corporation globally, significantly larger than Toyota, Volkswagen, Audi AG, GM, Fiat Chrysler and Daimmler combined.

“That’s why I wanted to go out (to a smaller company). You only get so many chances in life to create transformative change, and I really feel Alto has a chance to transform psychiatry or mental health,” Eliasson said.

During the past several years, data generation, data mining and analytics have progressed to the point that it is now possible to bring precision medicine to psychiatry. “We’re getting more data than ever before, with our phones and wearables, etc., so the amount of data to help phenotype individuals or understand what’s going on has massively increased,” he said.

“During that time, however, there have been a lot of late-stage failures of psychiatric drugs. The fundamental hypothesis is that the trials failed not because of the molecule, but because we didn’t know who to give it to.” Depression, for instance, is caused by multiple underlying pathophysiological changes in the brain that cause a similar set of symptoms. “There could be 100 different reasons someone has depression,” but not all respond to the same therapy.

Alto, therefore, is developing tools that allow more precise patient identification based upon physiological changes. It applies machine learning to analyze brain waves from electroencephalograms (EEG) and identify the signal – the biomarker – that tells scientists whether the patient is likely to respond to that particular drug. “We also look at genetics and data from wearables,” Eliasson added.

Basically, Alto identifies patients who responded to a particular drug and then analyzes their baseline EEGs to identify any elements that could predict response. “In machine learning, that’s called supervised learning,” he said.

Readouts from Phase II trials in major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are expected by mid-2023. Such speed is possible because of the maturity of the assets. “These drugs already have been used in humans, so we know they are safe,” he explained. Alto’s pipeline has 11 clinical assets, making it “the largest clinical-stage precision psychiatry portfolio in the industry.” Three molecules are in Phase II, while the others are in Phase I.

Throughout his career at GE, Novartis, Roche and now Alto, Eliasson has always tried to do two things: integrate technology into biotech, and understand how to scale it. “That’s hard to do, but doing it right can have massive benefits, not just in psychiatry, but also in other fields.”

Alto has the benefit of being founded by scientists with expertise in AI as well as psychiatry. “That made it very attractive to me.” Eliasson also knew the company and the space well, which guided his decision.

Small biotechs operate differently from large corporations and for Eliasson, that’s a benefit. “When you’re in a large company, you’re not in the action all the time, and there are so many things moving in all directions, but when you’re in a startup company like Alto, you’re in the middle of everything all the time, which is great. I just love that. Every day I go to work, something meaningful happens in terms of adding value to the company. At Alto, there’s also a common sense of purpose. At a small company, you’re all in the same boat. I like that,” he shared.

Not all small, innovative companies are alike, of course. He advises executives considering the transition to “be mindful of the type of company you go into. I wanted to scale breakthrough, transformative innovation, and that’s where Alto was. But you also have companies that are very early stage, developing proof of concept. Others know what they need to do and are more operational. These are very different beasts.”

He also pointed out the importance of getting along with people. “In a company of 100,000, there are some people you don’t get along with, and that’s okay. But in a small company, you have to get along with everyone. You’re always together, so it’s important to fit in. People don’t necessarily think about that.”

Eliasson initially came to the U.S. from Sweden on a track and field scholarship at Northern Arizona University. “Sports created opportunities for me. I came from the middle of nowhere in Sweden. My parents never went to high school, so you wouldn’t think I would end up where I am now.”

That part of Eliasson’s story began when “A friend (in Arizona) called me in the middle of winter and then handed the phone to the head coach of track and field…who offered me a scholarship.” Once there, Eliasson took a zoology course “and the professor needed good runners for a research study, so he asked me to help.” That professor was associated with Harvard, so Eliasson transferred there.

“But,” he recalled, “I needed a job to be able to afford to attend Harvard. I was interested in genetics, but there was a job opening at a neuroscience lab at the medical school.” That quirk of fate set him on the path toward becoming a neuroscientist. His Harvard B.A. in biochemical sciences was followed by M.D. and Ph.D. degrees from Johns Hopkins University.  

Now, he continues to learn. “I’ve tried to pick up a hobby once every other year to learn new skill sets. Lately, my son and I are doing eSports – FIFA soccer. It’s amazing. Twenty-five million people play it, and it’s interesting to see the business ecosystem that’s built up around it. For example, you can get a coach, get apps to help you trade players or get trading advice. It’s roughly a $3 billion business for Electronic Arts and is growing at double digits. Any pharma company would love to have an asset like that.”

From eSports, Eliasson has learned about customer engagement and innovation in ways that apply to mental health. “It’s not just about the drug,” he said. “It’s also about building solutions in terms of getting care to people and learning to manage the elements around that.”

Eliasson and his son (who, at age eight, wants to become a chef) are also exploring campfire cooking and California’s many hiking trails. His daughter, his wife says, is still too young for that.