How Juniper Biomedical are using Neuromodulation for pelvic health conditions

I recently had the chance to chat with David N Constantine , an experienced medtech entrepreneur and the Co-founder and CEO of Juniper Biomedical .

At Juniper, they’re working on innovative neuromodulation technology to tackle pelvic health issues. Their approach uses neuromodulation and focuses on super precise micro-implants that target specific nerves, offering new treatment possibilities for conditions that currently lack good options.

In our chat, David talked about his path, the challenges of bringing groundbreaking technology to life, and his vision for where neurotech is headed.

Let's get into it....

Tell me about your background and the journey that brought you to where you are today? 

“I began my career in medical technology as a biomedical engineer, working with multinational companies like Medtronic and Smith & Nephew across different clinical domains. I later joined a well-funded startup that gave me a comprehensive view of how a company operates. Two things became clear to me: first, if I wanted to work on paradigm-changing solutions with a significant clinical impact, I needed to do so in a smaller or startup company. Large companies tend to focus on incremental changes - small adjustments that don’t really push the boundaries of innovation. 

If you want to pursue something with the potential for a major impact, it usually happens in an entrepreneurial setting. Second, smaller companies allow you to have a more direct influence on the overall direction of the company. In large organizations, it's challenging to "move the needle" because of their size - it's like steering a big ship. These realizations led me to focus on entrepreneurial ventures. Since then, I’ve launched a few companies, mostly in healthcare, including ventures in both medical technology and digital health. I find working in medical technology rewarding because it’s a concrete pursuit. There’s no room for vague ideas; you’re targeting specific clinical problems with cutting-edge technologies, aiming to make a profound impact on patients.” 

What is it about neurotech that drew you to this sector? 

“Neurotech and more specifically, neuromodulation, is one of the main frontiers in medical technology today. The nervous system is a primary control system in the body, and there’s still a lot we don’t fully understand, both in the central and peripheral nervous systems. This creates tremendous opportunities to build on early innovations from companies like Medtronic. These companies initially worked on cardiac rhythm management and later expanded their technologies to different parts of the body, setting a foundation for further advancements. 

For a while, the field plateaued from a commercial perspective, but we’re now seeing a significant resurgence in neuromodulation innovation. I believe the next 20 years or so will bring groundbreaking research and applications that will fundamentally change how we provide care to patients across a wide variety of medical conditions.” 

Tell me about Juniper Biomedical. What product are you developing, and what problem does it solve? 

“We’re developing innovative solutions for pelvic health conditions, an area that has been marginalized when it comes to innovation. Much of the focus in medical technology has been on cardiovascular, neurology, cancer, and orthopedic areas, which makes sense given the scale of those problems. However, this has left gaps in other areas, especially pelvic health for both men and women, but particularly for women. That's where we decided to focus our innovative efforts. 

Our technology revolves around a unique neuromodulation microimplant designed to deliver very precise therapy to specific distal nerve targets. Most neuromodulation in the peripheral nervous system focuses on stimulating large nerve trunks with high power, often affecting surrounding tissues unintentionally.  

In contrast, our approach targets very small, specific distal nerves and employs novel implantation methods. This precision allows us to explore new therapeutic applications for conditions with significant unmet needs. It opens up possibilities for creating new, more effective treatments where none currently exist. That potential for making a real difference drives our team’s commitment to this project.” 

Where are you in the development process, and what are you currently focusing on?

“We’re currently conducting a clinical feasibility study. We’ve done extensive preclinical work, much of it in-house, to deeply understand the anatomy, physiology, and how our technology interacts within those contexts. Our goal isn’t just to gather the minimum data needed for regulatory approval but to come into the clinic with a well-characterized solution supported by robust data. 

We’ve built hundreds of working prototypes and have refined our innovation to a clinical design that’s quite advanced. As a PMA (premarket approval) product and an active implantable device, we have the opportunity to build a lot of clinical evidence before we reach the market, and that's beneficial for everyone. We want to ensure that when we present our solution, it's backed by substantial evidence of safety and efficacy.” 

What has been your approach to investment, and how much have you raised so far? 

“We closed an oversubscribed seed round in April with a $2 million target, preceded by several SAFE notes. A key aspect of our strategy has been to keep operations lean. Our team has done an exceptional job of using capital efficiently to conduct over 25 preclinical studies with hundreds of specimens and cadaver studies, all on a tight budget. This efficiency is a testament to the expertise of our team, where everyone has 20 to 30 years of experience in both large multinationals and startups. This experience has allowed us to stay lean, especially in an environment where seed and A-round investment is not at its peak.” 

I saw you won the SPARC Neuromod Prize from the NIH Common Fund. Can you tell us more about that? 

“Yes, it's a fantastic program. The NIH's SPARC initiative includes the Neuromod Prize, which is designed to foster and accelerate neuromodulation innovation for commercial use. They were looking for modalities that could affect multiple targets and manage off-target effects. Our technology aligns well with this, as it's designed to be precise and multi-targeted. The program has been very supportive, not just financially, but also by providing access to NIH expertise and relationships. The leadership and connections we've gained through this have been exceptional.” 

What has been the biggest challenge you've faced, and how did you overcome it? 

“That’s a great question. For any entrepreneur, the biggest challenge is often the need for persistence and resilience. It’s not about one specific hurdle; it’s about managing a continuous flow of challenges in product development, clinical trials, operations, and fundraising. Our team excels at balancing adaptability with consistency. We don’t jump off course based on every piece of advice, but when we see consistent evidence prompting a significant change, we act on it. 

For example, our first device was wirelessly powered, which made it extremely small - about the size of a freckle. We later switched to a battery-powered device, which, while still very small (half the size of a US dime), was a significant technical shift. This decision came after conversations with patients, doctors, and investors, who indicated that a device requiring daily activation was an unattractive compliance challenge. So, we made the change promptly but carefully. It was a well-informed decision that we’re proud of, and it demonstrates our ability to adapt when necessary.” 

Where do you see the biggest opportunities in neuro over the coming years? 

“There are many opportunities, especially in uncharted areas. While central nervous system interfaces get a lot of attention, there’s also significant potential in the peripheral landscape. For innovators, one key opportunity lies in maintaining focus. Neuromodulation technologies can often be applied as platforms - used on different nerves to treat various conditions. However, this can lead to diverse applications that create systemic effects and side effects. 

By focusing on a specific clinical domain, like pelvic health, we can apply a platform approach while maintaining focus. This allows us to concentrate on similar devices, clinical procedures, and commercial call points, while still cultivating a platform that can address multiple therapeutic needs. I believe this focused approach can be applied to other clinical disciplines or organ systems where neuromodulation or combined therapies could offer substantial benefits.” 

What advice would you give to a first-time founder or someone starting their journey? 

"Resilience and persistence are key because this path is tough. Beyond that, the most important thing is to surround yourself with exceptional people - whether they are part of your core team, advisors, or investors. Be very selective about who you work with. The right people can make or break your experience. I’ve learned this the hard way through multiple ventures, sometimes being the wrong fit myself or having the wrong fit in a teammate. It really comes down to a clear understanding of what’s best for your venture and authentic communication around the table. Don’t just jump at the first opportunity; it’s worth waiting for the right people to come along, even if it takes time.” 

I enjoyed the chat with David and it was interesting to hear how Juniper are utilising neuromodulation for pelvic health conditions. While they’re still in the development phase, their work has the potential to make a significant difference in patient care.

If you’re keen on learning more about advancements in neurotech and staying updated, feel free to like, comment, or share 😀. Stay tuned for more to come