Developing a Brain-Computer Interface with Nick Opie, CTO of Synchron

(Intro Narrator at 00:00:03) Hello, my friends. Today, Joel is talking to Nick, CTO of Synchron, and they discuss how Synchron is developing a brain-computer interface that can help treat various neurological diseases, the brain.io operating system that powers the interface, and how brain-computer interfaces may change the world. All of this right here, right now, on the Modern CTO podcast.

(Joel Beasley at 00:00:30) Here we go. This is the Modern CTO podcast. I've been watching the videos of this—what do you call it? It's a brain neural interface?

(Nick at 00:00:46) Yeah. Brain-computer interface, the Stentrode.

(Joel Beasley at 00:00:49) What does it do?

(Nick at 00:00:50) Well, it allows people with paralysis to control external equipment, communicate with loved ones, and use computers with their thoughts.

(Joel Beasley at 00:00:59) Do you have to have paralysis?

(Nick at 00:01:01) You don't have to have paralysis, no.

(Joel Beasley at 00:01:03) So that's just the first use case that can move the technology forward through commercialization?

(Nick at 00:01:09) Yeah, that's right. I mean, there's a lot of people out there with paralysis from various reasons—stroke, spinal cord injury, motor neurone diseases, or ALS in the States. And, fortunately, for a lot of them, the brain remains intact and is still functional. So, while they can't use their mind to control their limbs, they are still generating the same sort of signals that they would have before the accident. So with the devices that we're developing, we're bypassing the damaged region and getting the information from the brain and directly using that into a computer to allow them to control it.

(Joel Beasley at 00:01:44) That's pretty cool. You get to geek out at work.

(Nick at 00:01:47) Yeah. Yeah. That's right.

(Joel Beasley at 00:01:48) How did you get involved with this project?

(Nick at 00:01:51) It goes back to about 2011, 2012. Met a colleague of mine, and I think from there—yeah, I was working on bionic eyes previously, so making little devices to help blind people restore vision, and really wanted to get into the brain space. And so, started a company, yeah, maybe a decade ago now to try and solve this problem and try and allow people with initially paralysis to have some restoration of their mobility and freedom and independence.

(Joel Beasley at 00:02:20) Nice. So why did you get into this in the first place? Why this industry? There's so many different things.

(Nick at 00:02:26) Yeah. I don't know. I don't know. Maybe just growing up watching cartoons like Astro Boy and Inspector Gadget. I thought, yeah, that seems pretty cool. Why don't I do that? We live in an amazing time where that's possible now. Right? So I've always just loved medicine and biology, and I've always wanted to figure out how to put them both together and make body parts or make bits for humans.

(Joel Beasley at 00:02:48) That definitely seems like the direction we're headed. If you had to guess over some beers about how far in the future we would be before it's an elective thing for the general public, how many years do you think that would be?

(Nick at 00:03:03) I think it'll start with smaller things, and you can see that there's a lot of elective procedures that are happening—not with the brain, but with other parts of the body. And I'm sure, over time, it'll get there. Just a matter of proving that it's safe and functional, which is certainly something that we're looking at showing.

(Joel Beasley at 00:03:21) So like six months?

(Nick at 00:03:23) Who knows? Who knows?

(Joel Beasley at 00:03:25) That's like an Elon Musk timeline. Right? What's the difference between what you guys do and Neuralink?

(Nick at 00:03:31) Well, listen, there's not a whole lot that's been published about Neuralink, so I'm just going by sort of some of the things I've seen online. But it appears that what they're doing is making a small hole in the skull and then sort of stabbing electrodes all the way through into the brain itself to take recordings. We're doing it in a way where we don't impact the skull or we don't impact the brain and use blood vessels as a way to get to the area of interest in a way that's invisible so we don't have the same sort of infection risks that some other technologies might have.

(Joel Beasley at 00:04:05) Yeah. When I was watching that video, they ran the stent up the jugular, I believe, up into the brain. Is the stent the tube that they put in, or is it the thing that remains behind?

(Nick at 00:04:14) The thing that remains behind. So we put it in through a catheter, and then the Stentrode is what goes through the catheter. When the catheter—the tube—is removed, then the Stentrode self-expands to conform to the vessel.

(Joel Beasley at 00:04:25) So Stentrode, that's like electronic stent?

(Nick at 00:04:27) Yeah. Pretty much. Yep. So it's got all these sensors on it, so it can pick up the neural signals from the brain in different regions.

(Joel Beasley at 00:04:34) And then I couldn't tell in the animation that I saw. They put this sort of lace tube thing into the blood vessel, and then it seemed as if it expanded. And then does the blood vessel actually—cells grow over it, and then it becomes embedded?

(Nick at 00:04:50) Mhmm. Yep. So it's a process called endothelialization, which is essentially the way that the device gets incorporated into the vessel, which means the blood can obviously still flow and the device is invisible to the inside of the blood vessel, but also the outside, which is good for us because it stabilizes the signals and gets us a little bit closer to what we're trying to measure.

(Joel Beasley at 00:05:13) So it's unremovable. You can't take it out.

(Nick at 00:05:15) Yeah. I think you can. But like with cardiac stents, generally, they don't bother taking them out. If they want another one, they just put another one up underneath it.

(Joel Beasley at 00:05:24) Oh, okay. So there's really not a reason to take them out?

(Nick at 00:05:26) Yeah.

(Joel Beasley at 00:05:27) Yeah. Because I'd imagine that would rip up your blood vessels or be slightly annoying to your blood vessels. Right?

(Nick at 00:05:33) I think it's difficult surgery, but it can be done, but you generally don't bother because once it's in there, then it's safe and it's not going to go anywhere, not going to cause any problems.

(Joel Beasley at 00:05:43) Yeah. I love technology. One of the things I've gotten to talk with others about recently is transhumanism. So people are telling me about what others are embedding in their body voluntarily. They're doing it in sort of an underground scene. They are pushing a whole—they call it a transhumanistic movement. Have you heard about this?

(Nick at 00:06:08) I mean, I think this has been going on for decades. Right? Pacemakers and cochlear implants and all those sorts of medical devices have been used to help people with medical conditions for a long time, and I think it's now just starting to escape from the pure medical world into the more commercial use. Not safely, though. I mean, I think a lot of these people putting the things in their arms aren't clinicians or doctors and perhaps don't have the expertise to know how to do it, but they're doing it anyway. Right?

(Joel Beasley at 00:06:39) Oh, yeah. It's crazy. The one thing I really wanted to know, are there laws against people volunteering that don't have the medical issues? Can an average person volunteer and come up to you and say, hey, Nick. I want to volunteer and be part of your next program. You can put the thing in my head, whatever. Is that a possibility, or is there laws against it?

(Nick at 00:07:02) No. People are allowed to volunteer. The problem is that the ethics committees for the hospitals have strict inclusion and exclusion criteria, so they wouldn't be included in the study, and so the physicians wouldn't implant it. But everyone's allowed to ask. Right? But just at this point in time, that wouldn't be suitable for us.

(Joel Beasley at 00:07:21) Do you have any of these implants actually in people?

(Nick at 00:07:25) Yeah. Yep. It's four Australians who have been implanted, and we're just starting a trial in the US, and we've got a couple of recruits that should be implanted in the next little while. So getting some numbers up. Still a long way to go, but it's been looking really good so far.

(Joel Beasley at 00:07:41) And is it just your CEO that's doing the surgeries, or is he training other surgeons, or is it so common that they can just do it?

(Nick at 00:07:47) There are lots of other surgeons around that are involved in doing it. Yeah. A couple of guys—Peter Mitchell in Australia and Shahram Majidi in the US—are going to be the first practitioners that do the implants. And, obviously, it's a procedure that's done in a hospital suite that's very common. When people have strokes and blood clots, their angio wards are all around our country and your country and the world, and the procedure itself is pretty well understood. We haven't designed any new medical procedures. We're just using what they already do normally to either remove blood clots or to put stents in. So all the clinicians and physicians should be trained in doing this, and we're not really asking them to do anything outside their real level of expertise.

(Joel Beasley at 00:08:35) Dude, this is so cool from the outside. I know you're in it, and I've watched videos from you all the way back 2016, and then you told me all the way as far back as 2011. So you've been in it for over a decade. But for me, looking at this and watching how quickly—I check in on technologies from time to time every couple years, I'll check in, oh, you know, how far have we gotten with humanoid-type robots? How far have we gotten with general intelligence AI? And I've checked the Neuralink-type stuff because when I was a kid, one of the earliest memories of my dad—and I thought it was funny that you said this—was he was working on technology to help blind people see. It was some sort of implant and it played tones at them so they wouldn't run into things. So watching him work on that type of stuff was really cool. He didn't work on it long. He was a freelancer, so he had a year-long project where he worked on something like that.

(Nick at 00:09:25) Lot of cool stuff coming out in there.

(Joel Beasley at 00:09:27) Yeah. So you're a CTO. What do you do? What is your day like?

(Nick at 00:09:32) When you're a small company, as we have been, the role is really to do everything. Right? So all the way through from designing the device, prototyping it and testing it, obviously then trying to ramp up and run the clinical trial and collect the data from the trial is sort of the engineering side of things. But, obviously, with all companies, you gotta do all the other stuff as well. Right? All the admin and hire the people and do the finances and budgeting and all the stuff that is perhaps less exciting, but just as important. But really, I mean, we've been focused on developing this technology and doing a huge amount of tests that need to be government-regulated—FDA-regulated tests—to prove that it's safe and functional, while we're doing that in the background, making whatever comes next. So it's a good job. It's a lot of fun.

(Joel Beasley at 00:10:21) What is the brain.io?

(Nick at 00:10:23) It's sort of the intelligence behind it, I suppose. So the Stentrode itself is passive. It doesn't do anything. Once it's implanted in there, it can pick up the brain signals, transmit these to the telemetry unit that's implanted under the skin in the chest, and these signals are wirelessly transmitted out to what we call this brain.io, which is really what decodes and interprets the brain signals and then translates these into commands that can be used to control a computer or other external devices.

(Joel Beasley at 00:10:53) So the connection happens from—I saw you put some device in the person's chest, and then a magnet can connect to it to transmit data. Yep. Can it only work with the operating system that you guys have developed, or can it work with others?

(Nick at 00:11:10) In the first case, it was intentionally designed only to work with our device. You know, there are obviously initial safety and efficacy issues and things like that that you need to demonstrate, which is one of the reasons the first generation has—you have to have the external unit connected for it to work. So if you take it off, it doesn't work. That was done by design. And now that we've shown that things are starting to go well, we're starting to reevaluate that design.

(Joel Beasley at 00:11:37) Okay. So it might be an option that I don't have to have that.

(Nick at 00:11:39) Yeah. There's a lot of things I think that the future products won't need to have, but are in at the moment for initial safeguards.

(Joel Beasley at 00:11:46) All right. Is it just like a full-blown operating system? I mean, I saw a little bit of it on your website, and I think the thing that was unique about it when I was reading was that it's completely designed, obviously, for no touch. Right? But that requires reworking how you do things. Obviously, recently audio, with the Alexas over the past five, six years, there's been new design patterns on how to build interfaces through these voices. But now you're building these no-touch, no-voice interfaces. Right? It's just through their brain activity that you're controlling the device.

(Nick at 00:12:25) Yeah. So there's two parts. There's one part which is sort of a clinical programmer, if you will. So it allows the doctors or researchers or carers to help the patient out. But yeah, the part you're talking about, that's how we get the signals, what's the best way of decoding them and interpreting them, how do we really know what the person's trying to do, and how can we then make that really safe and reliable for them to use a keyboard, for example, or a digital keyboard on a screen or some other application. The patients we've got at the moment, they're amazing in helping us figure out what is valuable to them, and then we can start working with them to do that. So one of the great examples was, you know, our first patient—motor neurone disease or ALS—what happens is you become more and more paralyzed, and you just can't walk, you can't use your hands, then you start losing the ability to talk. And his wife, who was his carer, had to be near him so that if he needed to go to the bathroom or needed a drink or whatever, she was able to be there to know that. And so one of the things that seemed to be very valuable and useful was, well, why don't we just connect him to a phone? Right? Why can't we connect him to a messaging application that he can control through his computer or through a phone, which allowed her to leave his side and go into the garden and do some gardening or go down to the shops and have some independence for her own life. So I thought that was pretty amazing that some of the technology we're building, while it helps the person that's been implanted, there also seems to be bigger effects that help the loved ones and the community around them by providing them with the freedom and independence as well.

(Joel Beasley at 00:14:07) Do you know about how many people there are that are paralyzed in the world or in a specific country?

(Nick at 00:14:16) One of the studies that came out a few years ago said that by 2025, there'll be over fifty million people in advanced economies alone that will have paralysis or will benefit from brain-computer interfaces. So it's a big number. And, yeah, there's a huge number of reasons why someone can be paralyzed. But one of the interesting things that we're doing is, unlike a lot of other medical technologies where you have to have a disease and then something to fix the disease, we're coming at it and saying, well, we don't care what the disease is. If it's stroke or spinal cord injury or motor neurone disease or anything else that causes the paralysis, that's sort of irrelevant.

(Nick at 00:14:54) We just want to fix the problem of the output. And so we've been working closely with the FDA to provide us the ability to solve the problem rather than the medical condition, which is something that hasn't been done before, but obviously makes perfect sense in this sort of field.

(Joel Beasley at 00:15:09) 50 million people. That's a lot of people, man.

(Nick at 00:15:11) Yeah, there's a few. There's a few here.

(Joel Beasley at 00:15:13) Oh, I love what you're doing. Hello World on Twitter? Like, you did a Hello World on Twitter through the interface? Tell me about that.

(Nick at 00:15:19) Yeah.

(Joel Beasley at 00:15:19) Interface? Tell me about that.

(Nick at 00:15:21) Yeah. Yeah. Yeah. I mean, that was pretty amazing. The patient, a fantastic gentleman, a beautiful person, and really wanted to get his story out and encourage other people and provide them with a little bit of hope that what they're going through is horrible, but there are things that are coming out that'll make their lives easier. So he wanted to do that and was pretty excited about being the first person to tweet just using his mind. You know, obviously, Hello World seemed like the most appropriate thing to say, and yeah, he's been loving it.

(Joel Beasley at 00:15:51) Help me understand as a layman. Like, I saw the video where they can actually, you know, he could pick the letters Hello. And I understand for me, it's really easy to understand the muscle movement thing. Right? Like, if I think my arm will go there because it's happening partially autonomously, right, anyways, in the background. But like, how do you call out specific letters?

(Nick at 00:16:14) Yeah. So there are a couple of ways it can be done. Essentially, your brain is split up into, there are parts of your brain, the motor cortex, and that's split up into all of your different limbs and fingers. So there's a spot here for your left leg and, you know, your right arm and, you know, your left finger and all that sort of stuff. And so if you put sensors over those different parts, then you know when the person is thinking about doing an intentional movement to move that. So if I do a squeeze of the hand, then a part of my brain will become more active. If I move my leg, then a different part of the brain will be active. And so by using those signals, then the person can start controlling a switch. And once they can start controlling a switch, then it's like playing a game, right? Different games use the same button. There might be accelerate or jump or punch or whatever it is depending on the game. It's the same button, just a different game. And so we can get them to control a whole lot of different things by learning how to use the button and then providing them with different games to do it on.

(Joel Beasley at 00:17:17) I love that explanation. Can you boil it down a little bit more? Like, I get what you're saying as far as you can map muscle movements to letters. Is that correct?

(Nick at 00:17:27) Yeah, you can. But what we're doing is we're mapping muscle moves to, call it switches, and then using those switches to control, for example, a letter or the click of a mouse to select the letter.

(Joel Beasley at 00:17:40) Oh, so you can track their eyes and then, well, they can, right? Is that—

(Nick at 00:17:44) So then one way you can do it is you can use eye tracking to track the eyes. Other ways you can do it is you can use different switches, if you will, to decide which direction to go and then have another switch for clicks. So it's like a brain mouse, I suppose, where they can, you know, there are some switches that go up, some that go left, right, down, and then there's a click one, and you can use the whole mouse just by thinking about moving it in different directions.

(Joel Beasley at 00:18:08) That is so cool. And so when I'm doing that, pretend I'm a user, I'm doing that. How do you train these people? Like, how do you teach them this stuff?

(Nick at 00:18:17) We found the best way to teach them was to get them to teach themselves, actually. The first patient we had, we had these, you know, it's like, let's do this first and this first and this first and try and teach them how to do it. And for him, it didn't work very well. And it was only when we sort of stepped back and said, okay, you sort it out, that he was really able to just make it work on his own. So I think we're still trying to figure out the best way to help patients use it, but it seems sometimes the best help is just giving it to them and saying, off you go. Like, we'll be here to help, but you figure out how to make it click. You figure out how to get it to work. Because no one knows their brains better than they do, right? And that just seemed to be a really good way of getting them to start using it and getting the feedback. But there's obviously more to it than that, but in the basic sense, I think a lot of people are different, and we've got to just make sure that they learn in a way that's best suited for them.

(Joel Beasley at 00:19:09) So let's say we have four people using this technology. Are the switches the same for all four? Are the mappings the same for all four, or does it learn the user and they could be different for different people?

(Nick at 00:19:20) So in the first four that we implanted, we did a functional MRI. So we mapped the brain based on the different movements. They couldn't do the movements, obviously, but we would ask them, you know, move your left hand, move your right hand, and then we'll be able to see where these brain areas are and where they're mapped to. Generally, people have the same sort of brain, and the mapping's pretty much the same. The difference is how well you can control these different parts of your brain. People who are, you know, really good at typing or playing the piano might be very good with their fingers. People who play soccer might be really good at controlling parts of their brain for their feet. And so people are different in that degree in regards to how well they can control different bits. It's all pretty much the same. And so we can put the sensors, and we've obviously got lots of sensors around, you know, the outside of the stent that goes through these different regions. And so we can just pick and choose and say, okay, well, they're really good at this one. We're getting a great signal from, you know, near the leg area, so let's use that as a way to control the switch or the click they're trying to make.

(Joel Beasley at 00:20:28) Okay. So it's really complicated.

(Nick at 00:20:31) Yeah. I guess the way I said it might sound really complicated, but the end goal is, of course, you know, they'd use it just straight out of the box. They'd have it implanted. You know, they'd leave the theater that day. You know, I mean, it's not an invasive procedure, so you don't have to stay overnight like some of the other, you know, if you're removing skull or putting things in a brain, then you have to be kept in hospital for a while, whereas this you sort of do it and leave the same day as is the case with blood clots, and then you open the box and off you go, you can use it straight away. And I think there's certainly the potential to be able to do that.

(Joel Beasley at 00:21:03) That's amazing, by the way. Like, I mean, so I'm 34 for context, right? When we were kids, technology was at a certain level. But now I believe we're feeling like that exponential curve up. I mean, in the past month, I've talked to a person who can, you know, change the antigens of blood cells to make blood types universal. I've talked to people who can cut frog legs off and send bioelectrical signals to them to get the frog leg to regrow, and frogs don't do that usually. A molecular beverage printer, you could put your cup under there, press a button, and it makes like any beverage in the world. This stuff is insane, and it's happening, and it's like here right now.

(Nick at 00:21:45) Yeah. Yeah. The world is, it's an amazing time to be alive, right? There's so much going on, and that's fascinating. Every sort of rock you look under, there's some new invention or some new group coming up with something that's really going to make a difference on how we live our lives. It's very exciting.

(Joel Beasley at 00:22:03) Yes, it is. What about misconceptions? What do people get wrong a lot about this technology?

(Nick at 00:22:10) The thing people get wrong the most often is sort of mind control and thinking that you can go in and completely change someone else's mind with one of these devices and control them. And it doesn't work like that, right? Like, that's sort of Hollywood science fiction. So what happens is the brain comes up with a signal, and the signal is sent out to allow them to control something with their mind. You can't put things in and get people to do stuff. Like, that's not where we're at. And so I think there's a lot of fear from seeing, you know, Hollywood films that, you know, these devices might one day be able to control someone, but, yeah, I don't see that as a problem at all.

(Joel Beasley at 00:22:50) The signaling, is it one way? It's like only out?

(Nick at 00:22:53) The signal is just coming out. One way signal. Exactly.

(Joel Beasley at 00:22:56) Oh, because in your video, you guys said that you would control the exoskeleton with it.

(Nick at 00:23:01) That's right. So you can control things. But the exoskeleton's not going to control you, right? So it's only information out. Like you're saying, that's a good way to put it.

(Joel Beasley at 00:23:09) Okay. But eventually, I'd probably be able to build like an API and like a third-party product and connect it to yours and put electrodes in my muscles and then do something like that. Do you imagine the ecosystem's going to get huge like that?

(Nick at 00:23:21) I think there's a lot of things that people will be able to start controlling and doing. Certainly, as it goes beyond medical purposes. I mean, you've probably already seen exoskeletons used by people who work in the docks or down by the piers, you know, putting on these robots to help them lift really heavy things. Yeah. Yeah. That's just sort of the start of how, you know, these sort of assistive technologies are starting to be used in commonplace, and that's not a medical application. It's just a really important, you know, way to get more strength for these workers. So I mean, there's a lot of stuff that's going to be very exciting, and I'm glad to be here to see it.

(Joel Beasley at 00:24:02) I think from this whole experience, one of the things that I just kept gravitating towards was that operating system because that's something that other companies could build on top of, right, pretty easily. Right? Like, any physical device that's trying to do the exact same thing is obviously a competitor. But typically, as these things emerge, some of these really hard to solve problems, I mean, it was really hard to make that, right? Like, reimagining an operating system with all of this, I mean, that must have been a super difficult project, or was there like already something out there?

(Nick at 00:24:33) Bits and pieces. We try and take advice and guidance from the things that have come before us and spend our time and energy on the things that don't exist, right? So whatever we can use that's already there, makes perfect sense to do that. But if it doesn't suit the purpose, then yeah, we have to make our own. I think that goes for all the different components, whether it's software or hardware or whatever applications come next. You know, certainly for us, for example, we're not, we don't want to build the prosthetic, bionic arms at this stage. Their companies are doing that, and they're doing an amazing job. So let them do it. Let them make it really good, and then we just want to tap into it when we're ready.

(Joel Beasley at 00:25:10) I've actually got a bionic arm guy.

(Nick at 00:25:13) Do you?

(Joel Beasley at 00:25:15) Never thought I'd say that. Dude, this is amazing. This is amazing. Well, the only question that I didn't ask yet, what do you look for in young entrepreneurs? Are you hiring young entrepreneurs?

(Nick at 00:25:26) Well, always searching. Sure. I mean, we have different positions, right? We're after a hardware engineer or a mechanical engineer or clinician or whatever it is. But really, we want, as just a general rule, someone who's enthusiastic about what's going on, someone who's really driven to make the world a better place, and someone who, you know, likes to have a bit of a laugh. And so I think skills are one thing. You can train people up to do things, but, you know, it's the attitude, really. And if you want it, you're excited about it, you're passionate about it, and are really striving to help others, then that seems to fit in with what we're about.

(Joel Beasley at 00:25:59) Can they find out, do you have careers or jobs posted on your website?

(Nick at 00:26:02) Yeah. Yeah. There are a bunch of posts on the website. There are lots more that haven't been posted, but yeah, that's the best place to start for sure.

(Joel Beasley at 00:26:09) And what's the website?

(Nick at 00:26:10) Synchron.com.

(Joel Beasley at 00:26:12) Perfect. And then for the last question, what is like the one big goal that you and the CEO and everybody is driving towards right now at your company?

(Nick at 00:26:23) The one big one at the moment is to get market approval for the endovascular brain-computer interface. We're well on the way. You know, what that requires is doing a pivotal trial in the US and potentially globally and just getting enough patients that we can have evidence that it's safe and that it's functional. And, you know, the first four patients we've implanted have certainly shown that. There've been no serious adverse events over the number of years that they've had it in. You know, they've all been able to use it to control computers, you know, to do shopping and banking and emailing and texting and so forth. So we just need to show that that happens with more people and that these first four weren't all flukes, and then we should be able to have a device that's in the market and available for the people that really need it.

(Joel Beasley at 00:27:13) I love it. On behalf of all humans, thank you for your time this way.

(Nick at 00:27:16) You're welcome. It's a lot of fun.

(Joel Beasley at 00:27:21) Thank you so much for listening. And if you found this episode useful, please share it with a friend or colleague who you think would get value from it. And if you have topics that you'd like to hear discussed on the podcast, either add me on LinkedIn or send me an email, [email protected]. Every time I get an email or LinkedIn message, it absolutely makes my day and inspires me to keep going.