Business Talk Magazine

Skin is a critical barrier, shielding us against invading microbes and pathogens. However, the skin is also susceptible to many chronic conditions, including inflammatory ones. One of the most common and increasing incidences is Atopic Dermatitis, also known as Eczema. This condition has always been challenging to treat and stressful to live with. Researchers have been exploring therapeutic avenues to find a simple and safe remedy to treat this condition. Although there are numerous treatments available, they come with significant issues ranging from safety, speed of impact, limits on who can use them, cost and breadth of efficacy. In the quest to find a safe and effective treatment, Todd Krueger, President and CEO of AOBiome Therapeutics, is breaking new ground.

Our magazine recently spoke with Todd to understand his mission, vision, and the novel cure his company is working on. The discussion is summarized below.

SOWING THE SEEDS

Todd is a healthcare evangelist, having spent over 20 years as an entrepreneur in the life science industry. He graduated Phi Beta Kappa from Northwestern University and earned his MBA from Kellogg. He began his career at Bain and Company and, working his way up the corporate ladder, now serves on the boards of three early-stage biotech companies, where he works closely with first-time CEOs. As part of his life science path, he realized that society is no longer synergic with nature, and this separation has coincided with the rise of modern diseases. “We have mistakenly declared war on the microbiome because bacteria have been viewed negatively,” he says.

As a result of this imbalance, a spate of maladies that aren’t evolutionarily appropriate, such as eczema, acne, and rosacea, have arisen since the arrival of modern hygiene. These conditions didn’t exist a few hundred years ago. Current drugs often don’t work well against such conditions, can be very expensive, have unwanted side effects, and can’t be used in vulnerable populations. There is little to no recognition that 99% of those bacteria on our skin are benign and, in some cases, critical to our health. AOBiome is focused on restoring a specific lost bacterium, Ammonia-Oxidizing Bacteria (AOBs), to human skin. AOBs are a critical part of the nitrogen cycle, seminal for the balance of living things in our world. AOBiome believes restoring this lost bacterium to humans will also be able to treat many inflammatory skin diseases.

Todd and his team set out to develop a topical biologic formulated from this bacterium that breaks down ammonia and produces the vital nutrients for good health—nitric oxide and nitrite. The idea laid the groundwork for a late-stage clinical company that targets real-life-interfering issues, and thus AOBiome Therapeutics was born. Over the past 7 years, it has carved a niche developing novel treatments for inflammatory disorders like Atopic Dermatitis, Acne and Rosacea.

A REDEFINING BREAKTHROUGH

What separates AOBiome’s biotherapeutic drug from others? It regulates down IL-4, 5, 13, and 31, which, among other diseases, are hallmarks of atopic dermatitis. Most importantly, the bacteria down-regulates the itch pathways, thus treating both the underlying condition and its related side effects. Being up all-night scratching is far more concerning than the red, flaky skin. “We are working hard to position our products as a treatment for not only the appearance of AD but for the primary complaint atopic dermatitis patients have—which is itch,” Todd explains. By focusing on both sides, the drug will hopefully become a first-line therapy before patients move on to more expensive, intrusive, or risky therapies.

As promising as the drug’s background looks, making people aware of it hasn’t been so easy. Striving to become a pioneer in drug development is challenging, given most pharma companies are reticent about early stages of breakthroughs. Despite these hurdles, Todd and his team knew a large population of underserved patients were actively looking for a safe, natural, and effective solution. Keeping that in mind and recognizing the unique safety profile of AOB, they launched their product as a cosmetic spray without any clinical claims whatsoever. “Our intent was to get real-world customer feedback in order to better inform our drug development programs,” says the CEO. This approach of “testing” on humans provided real input from subjects who, unlike mice, have opposable thumbs to provide feedback on their experience with the bacteria. This learning helped optimize the product delivery, revamp the packaging, and target specific indications.

GOING BEYOND THE INNOVATION CHASM

While having a targeted objective, AOBiome is also challenging 100 years of traditional dermatology treatment. The existing treatments often have serious limitations. Steroids weaken the skin barrier and are not suitable for kids or elderly patients. JAK inhibitors come with black box warnings, and even the current leading product, Dupixent, takes a long time to treat itch, if at all. AOBiome’s innovative drug has the safety profile of salt water and has been shown in clinical trials to treat moderate-to-severe itching while addressing the underlying disorder of Atopic Dermatitis. The company seeks to be at the forefront of discussion on the benefits of healthy bacteria. But the discussion has met resistance as it shakes the foundations of the entrenched, traditional, conservative view of Big Pharma. 

As such, getting this innovation through the chasm required finding the right opinion leaders and commercial partners intending to break out of the status quo. They also developed unique ways of manufacturing a mono-sterile product—a live bacterial product—with only one bacterium without using preservatives. This called for creating various cutting-edge techniques, demonstrating AOBiome’s innovation.

TODD KRUEGER – LEADING WITH CONVICTION AND AN UNORTHODOX APPROACH 

Given the obstacles AOBiome had to overcome in order to gain recognition, it says a lot about Todd’s leadership. As Todd is not a trained scientist, he felt comfortable pushing conventional thinking. However, a lack of a credible route to market, distrust from existing players, and decisions that were frequently not fully informed by historical facts tested Todd’s capacity to be decisive in the face of uncertainty. This challenge required leading from the front. Todd took up thought-leadership and onboarded a mission-critical team. They follow a top-down approach, pushing the issues from top management to every employee’s desk. “We try to be explicit about what the company’s goals are, so every team member knows exactly how their role supports this vision.” “When you are pioneering, it really helps to make sure people see the end, even if the path to get there is not cut yet,” says Todd. 

The cascade of goals and strategies alleviates many ambiguities that come from working in an environment that has no existing roadmap. This was especially rewarding during COVID, as everyone and everything was disconnected. Not only did the team work on all kinds of issues, but Todd also discussed core business issues that normally don’t get pushed below the board level. This gave the team an opportunity for better buy-in, better answers, perspective and growth that will allow them to be better leaders in the future. They have assumed more responsibility because of this exposure. Under Todd’s stewardship, AOBiome has seen a quantum leap in the accuracy and decisiveness of its team over the past 3 years. This is definitely a critical feather in Todd’s cap and an achievement the company needs to preserve.

ON A MISSION TO ACCOMPLISH

At a high level, AOBiome is creating a new paradigm to treat inflammatory skin conditions. At the same time, it also aims to reconnect people with nature and lessen their reliance on chemistry, which is often harmful to their health. As the leader of this mission, Todd is constantly strategizing the company’s approach to achieving this. He is not a scientist by trade; instead, he is trained in strategic leadership. He suffered from a rare heart condition in his 20s, which led him to study life sciences. Given his 25 years of experience dealing with scientists, he can meld a room of researchers with a vision statement. He inspires communication to maintain coherence and engages everyone to contribute to success, not individually, but as a group. “We’ve seen this happen frequently, where people from disparate areas of the company have helped to fix issues in another. “That makes me proud to have done my duty as a leader,” says the CEO with pride.

The symbiotic ecosystem has made the AOBiome the torchbearer having successfully completed a Phase 2b study targeting skin conditions using a live biotherapeutic. Their core mission is yet to be achieved, but the progress clearly demonstrates a shining future ahead.

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