ProKidney's CEO observes that over a 10-year period, the only significant change he saw in dialysis clinics was the addition of flat-screen TVs. This starkly illustrates the profound lack of clinical and technological innovation in a massive, life-sustaining industry, highlighting a huge opportunity for disruption.

A third of small-to-mid-cap biotech firms are becoming profitable, with cash reserves projected to soar from $15B in 2025 to over $130B by 2030. This financial strength, combined with large-cap patent expirations, positions them not just as acquisition targets but as potential players in the M&A landscape themselves.

Launching an autologous cell therapy is complex, involving a nephrologist, a biopsy doctor, and an interventional radiologist. ProKidney's CEO notes success requires standardizing this process to ensure a seamless, best-in-class experience for both the patient and all involved providers, which may mean a slower, more deliberate initial rollout.

Founders can become fixated on achieving a good burn multiple, which is a theoretical measure of fundability. However, they sometimes forget the practical reality: a great burn multiple is useless if the company runs out of cash. Cash in the bank is a material construct, not a theoretical one.

ProKidney's significant funding from co-founder Pablo Legorreta and investor Carlos Slim was driven by their direct family experiences with kidney disease. This shows that for high-risk, long-term biotech ventures, a deep personal connection to the mission can be a more powerful motivator for investors than purely financial interest.

To avoid emotional spending that kills runway, analyze every major decision through three financial scenarios. A 'bear' case (e.g., revenue drops 10%), 'base' case (plan holds), and 'bull' case (revenue grows 10%). This sobering framework forces you to quantify risk and compare alternatives objectively before committing capital.

To save money, Rhythm's leadership considered canceling a clinical study because the prevailing scientific logic suggested their drug wouldn't work. The study's unexpected, resounding success became the company's pivotal turning point, highlighting the value of pursuing scientifically contrarian ideas.

In a capital-constrained market, positive clinical data can trigger a stock drop for biotechs with insufficient cash. The scientific success highlights an immediate need for a highly dilutive capital raise, which investors price in instantly. Having over two years of cash is now critical to realizing value.

When SpeedSize had less than two months of runway, the co-founders immediately stopped their own salaries. This created a personal sense of urgency, forcing them to solve the cash problem before it impacted the entire team, whose salaries were still months from being at risk.