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Journey In Changing Lives With Aorto Medical – Exclusive Interview With Youssef El Azouzi

Youssef El Azouzi is a pioneering entrepreneur in the development of paradigm-shifting medical technology. Through various trials and tribulations, Youssef is leading his team through the challenges of bringing Aorto Medical's invention to save the lives of millions of heart failure patients. Aorto Medical has devised numerous concepts that may change the world in the near future ranging from the treatment of heart failure to the enablement of animal to human organ transplant using innovative medical technology.

image photo of Youssef

Youssef El Azouzi, Chief Executive Officer

Introduce yourself! Please tell us about you and your life, so we can get to know you better.

With a Moroccan father and American mother, I’ve always looked at people and things in life through mixed lenses. Having lived in 4 different continents by the age of 19, I’ve also always felt somewhat foreign. At times, either I didn’t understand people around me fast enough or people didn’t understand me. This may have been why I went through some difficulty in middle school and was at times bullied for being considered “strange”. I remember being enrolled at an international school where half the students were children of diplomats mainly coming from western countries and the other half were Moroccan. Due to their different mindsets, demeanours and outward interests, these two groups seldomly interacted outside the classroom and it felt as though I had to choose one of the groups to belong to although I never fit into either one of them. Growing up in a mixed-culture household and polarized school environment certainly has its challenges and I’m sure I’m not the first person to live through it. It also however helped me appreciate the vast spectrum of human tendencies and behaviours. It particularly helped me adopt a bystander or observer stance as different events took place around me. The circumstances of my upbringing therefore gravitated me towards being less staunch in my approach and rather more ambivalent to different ideas. This is the core of who I am today and is also what pulled me towards the field of innovation and the uncertainty associated with it. Being able to move through unknown landscape requires one to accept and be at ease with what is obscure. Although many can’t tolerate the thought of depending their livelihood and future on something that is undefined, that was not an issue for me and was actually rather intriguing because the unknown always involves novelty and because obscurity was an old friend of mine I had known for years.

I am a very visual person and have particularly always loved looking at maps. As a child and adolescent, I had a road map of the world in my room next to the side of my bed and would at times visit the shared desktop computer room to gaze at a road map linking different cities of the continental United States. The linking of different places and regions through networks of rail and highways always fascinated me and is what I effortlessly dedicated hours on end studying without feeling the weight of time passing by. My father who is a Harvard alumni neurosurgeon and mother who was a registered nurse throughout my childhood however always gave me an inclination towards pursuing a career in medicine. This lead me down the path of going to medical school although I was always interested in pursuing what many perceived to be far-fetched research ideas I believed had an unknown secret that was lying in wait to be revealed. This was especially true when it came to my interest in neuroscience and exploring the evasive bridge that links the brain and the mind. My final year of medical school is when I developed a concept related to the treatment of heart failure associated with chronic kidney disease by modifying the direction blood travels throughout the arterial network of the body, in order for transportation to be more efficient. Contrary to conventional wisdom, I chose to forfeit opportunities of entering specialty training to subsequently generate a stable income job after my final year of medical school because that seemed too mundane and boring to me. I had wanted to take an unlikely chance at doing what more than 1000 specialists couldn’t do, which was to develop a new treatment method, a new medical device, which could save the lives of millions of patients worldwide. There was only one risk though. If I failed, I would “lose” about 5 years of my life, thereby leaving me trailing behind my peers as an “ordinary” general physician while they finish securing their “prestigious” spots as specialists in their respective fields. I gladly took the risk. Could you provide an overview of Aorto Medical's core mission and objectives?

Aorto Medical is not in the business of developing medical technology but rather is in the business of redirecting the trajectory of medicine and human survival. We are primarily an impact-driven team that strives to pioneer profound, minimally-invasive and cost-competitive treatment to some of the most debilitating and difficult-to-treat conditions, affecting just shy of 1 billion people or approximately 1 out of 10 people worldwide.

Our current focus is on developing deep technology that treats chronic kidney disease, whether that is part of the complex disease process seen in heart failure or whether that is due to other causes such as diabetes or autoimmune disease. Similar to how interchanges on a highway network facilitate the flow of traffic by diverting vehicles through alternative paths in order to reach their destinations, Aorto Medical aims to treat chronic kidney disease seen in heart failure by diverting blood flow such that it favours a higher distribution share towards the kidneys while reducing the distribution share in other less critical areas of the body. By increasing the filtration capacity of the kidneys, the objective is for patients to reduce their dependency on toxically high levels of diuretic medication and thereby reducing their risk of mortality and rehospitalization.

Aorto Medical also aims to treat other forms of chronic kidney disease by diverting elements of blood flow in alternate directions in order to enable rejection-free, animal to human organ transplantation. In doing so, we believe our solution may one day free a patient of the need to take routine medication that suppresses the immune system and that it may one day open the gates to effective and widely accessible organ replacement. One of our objectives therefore is to make a major breakthrough in the field of organ transplantation as a whole, so that the millions of people who suffer from advanced-stage organ failure no longer need to wait for the availability of scarce human donor organs.

What sets Aorto Medical apart from competitors in the medical industry?

WWhereas most medical device companies hereas as most medical device companies focus on marginal improvements and changes in the treatment of niche disease processes, Aorto Medical attempts to think outside the box and is not afraid to pursue what many may perceive to be radically new therapeutic concepts. Many in the industry favor working on marginally-enhanced products because they involve less technical risk although the impact of such endeavors is quite limited and thus the returns on investment are also proportionally low. At Aorto Medical we are different as we are mostly interested in developing breakthrough technologies that have the chance of creating paradigm shifts in medicine. We also prefer to work on projects that may attract a return on investment of at least $1B when produced at scale. These are generally the first two thresholds that we evaluate before potentially taking on a thrilling venture. Anything less in these two categories would probably be too boring for us. To survive across the sometimes unforgiving frontlines of disruptive medicine, we are therefore in need of continuous refinement and mastery of risk management methods in all aspects of our endeavor. Moreover, our successes have given us motivation and cautious optimism that we in fact do have the capabilities and discipline to make the seemingly impossible happen sooner or later. What are Aorto Medical's future plans for growth, innovation, and expansion?

After having achieved promising results in animal studies concerning the treatment of chronic kidney disease-associated heart failure, our team is excited to announce that a potential first-in-human study may soon take place by the first quarter of 2024. Aorto Medical hopes to achieve this feat in collaboration with the CM6 research and innovation institute based in Rabat, Morocco and in collaboration with our accelerator partner at The Garage Plus based in Riyadh, Saudi Arabia, who are supporting our mission to accelerate the advent of a sustainable and more widely accessible therapy of the most intractable form of heart failure. By Aorto Medical’s side in consultation is it’s medical scientific advisory board, which consists of prominent cardiovascular researchers hailing from prestigious hospitals across the US and France.

Aorto Medical is also thrilled to announce that its year-long and hard-fought design process regarding a first of its kind, anti-rejection medical device, adapted for the enablement of safe and effective animal to human organ transplant is finally complete. Aorto Medical is now launching the manufacturing of prototypes in anticipation for a historic and first-ever cross-species kidney transplant operation that would subsequently involve no use of immunosuppressive medication. This potential breakthrough operation is expected to take place in collaboration with a renowned and undisclosed US university research center. We are also pleased to mention that our accelerator partner at The Garage Plus based in Riyadh, Saudi Arabia, will also be supporting us on this breakthrough undertaking. Pursuant with The Garage Plus’s goal to attract deep technology startups globally and supporting them to realize ambitious goals for humanity, The Garage Plus and Aorto Medical’s visions are both aligned to revolutionize the future of healthcare the world is eagerly awaiting.

If you could change one thing about your industry, what would it be and why?

The medical device industry is one of the most litigation-littered sectors on average. My opinion is that this can only be a symptom of one essential cause and that is the lack of innovation in the medical device industry as a whole. Had companies upped their game in terms of novel ideas and concepts, companies in turn would deprioritize spending a significant portion of their budget on lawsuits against other fellow competitors. Similarly, had there been more innovation in the medtech space, companies would not find the need to closely mimic or copy the intellectual property of other fellow medtech companies. The 90’s was an era when the medical device industry was heavily invested in compared to today. This is because investment money has in time shifted towards the rapid growth of the non-health tech sector, especially with modern advancement of artificial intelligence (AI) and the internet of things (IoT). The reason for the migration in investment is understandably due to lower regulatory risk in the tech space compared to medtech or biotech for instance. However, instead of attempting to cannibalize and bankrupt each other through lawsuits, the medical device industry needs to adapt to the financial challenge by employing smarter mechanisms in order to increase the overall success rate and return on investment of different projects. Isolated and closed innovation circles also guarantees a very heterogenous approach to the problem across the entire industry. Companies need to be incentivized, potentially through different forms of government action to open the doors of collaboration between different medtech companies, albeit within reasonable limits, in order to reverse the tide of low investment in the sector. The acquisitions and mergers we have witnessed throughout recent years are also an indication that the minimum threshold of innovation we should be seeing in the medtech division of life sciences is not being attained. Had it been reached, there would a higher volume of companies working on different, promising technologies that would attract a high rate of return. With ballooning healthcare expenditures by the government, it is also in the interest of officials to consider regulating the sector such that the incentives of medtech players are more aligned, an open space of innovation is cultivated through more pooling of common resources and so that ultimately companies are not at each other’s throat all the time.

Tell us about a pivotal moment in your life that brought you to where you are today.

The concept of our implant device for the treatment of heart failure relies on the increase of blood pressure in the biggest artery of the body, known as the aorta. The suggestion of increasing aortic pressure in a heart failure patient goes against conventional wisdom and a significant number of cardiologists opposed our proposal of treating heart failure patients with preserved ejection fraction in this manner. Interestingly, less than one year after many doubted the scientific merit of our concept during a televised international competition in 2019, a pivotal clinical trial that involved the largest number of patients who suffer from heart failure with preserved ejection fraction revealed in 2020 that in fact, aortic blood pressure needs to be higher than expected in order to reduce the likelihood of negative outcomes such as death or rehospitalization. This contradicted conventional wisdom regarding the management of these patients and thus indicates that our medical device solution for this group of patients (which consists of almost half of all heart failure patients) has a significantly higher likelihood of success than previously thought. We now have increased confidence and strong data to support our conviction, thus marking a vital turning point for the Aorto Medical team.

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Whereas most medical device companies



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