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PierianDx: Dr. Rakesh Nagarajan’s Insights into Startup Success

kokou adzo



Rakesh Nagarajan PierianDx

First of all, how are you and your family doing in these COVID-19 times? 

Rakesh Nagarajan: We are taking all the necessary precautions of wearing a mask, socially distancing, and following the CDC guidelinesSo, thankfully, my family and I are healthy and well. As for my PierianDx family, their well-being is of the utmost importance. That is why we have instituted a work from home policy until we are certain it is safe to return to an office environment.

Tell us about you, your career, how you founded PierianDx?

Rakesh Nagarajan: PierianDx was founded in May 2014. It was a technology transfer out of Washington University in St. Louis, where the very first version of our solution was conceived of and developed in a collaboration between the Departments of Pathology & Immunology and Genetics.

Washington University was among the first to validate and report its experience using next-generation sequencing clinically. This was in the very early days, so many other laboratories–about 50–visited to find out how we were addressing the challenges inherent in a clinical next-generation sequencing environment. A key challenge every laboratory reported was an inability to reproduce the comprehensive workflow and Knowledgebase we had developed, thus resulting in spinning out PierianDx. 

Our mission is to improve patient lives and advance the field of medicine by democratizing clinical next-generation sequencing. We want precision medicine to operate at scale by becoming routine in healthcare, such that patients can receive better diagnoses and treatments for cancer and other complex diseases.

How does PierianDx innovate? 

Rakesh Nagarajan: Our mission is to democratize NGS clinically for somatic and germline indications and provide supportive services to enable molecular diagnostic laboratories and health systems to practice precision medicine. As precision medicine matures and accelerates, our unique network sharing and knowledge update capabilities ensure that the latest advances and consensus-based, best medical practices are applied to patient management using information derived from clinical genomic testing. Indeed, we expect that the PierianDx Knowledgebase will inform clinical genomic testing that is expected to influence virtually every patient encounter as the practice of precision medicine operates at scale in the field of medicine globally. 

As we typically do when we are faced with difficult challenges that need solving, we look to our team members and their passion. At PierianDx, we have a big focus on diversity and inclusion. We recognize that when people get to be themselves, they feel free to speak up and share their ideas and feedback. 

This leads to remarkable results. 

How does the coronavirus pandemic affect your business, and how are you coping?

Rakesh Nagarajan: Patients and physicians can’t wait on critical reports. And unfortunately, cancer doesn’t have a pause button. In response, PierianDx is fully staffed and providing needed support to our customers who have had to pivot many of their resources to address coronavirus testing demand. 

Did you have to make difficult choices, and what are the lessons learned?

Rakesh Nagarajan: Working in one of the most advanced areas of medicine offers great opportunities that can only be realized by overcoming significant obstacles. The field of precision medicine, catalyzed by clinical genomic tests, offers great promise to how all patients will be managed during the course of their medical journey. As a nascent field, multiple stakeholders, including payors, pharmaceutical companies, and healthcare provider organizations, need to be aligned on when clinical genomic testing will be conducted, how it will be reimbursed, and what clinical utility it has. Clinical genomic interpretation is complex and requires more advanced and integrative thinking. And given our leadership position in the industry, we feel a strong sense of obligation to help educate the community and develop solutions that enable better patient care.

We’re always faced with difficult choices, and since we’ve built such a strong company culture, we all look to our core values to make these hard decisions. 

How do you deal with stress and anxiety? How do you project yourself and PierianDx in the future?

Rakesh Nagarajan: PierianDx recently celebrated its inaugural “Good Deed Day,” and it made me stretch myself, go outside my comfort zone, and look beyond myself and family to give back to the community. I have found that volunteering and giving back inspires me and brings out the better person in me, which puts any anxiety or stress in perspective.

As we know, this pandemic has changed everything. We are all working from home. And as you quickly realize, it’s actually quite easy to spend more time working when you are doing it from home. In addition, many of our employees have young children or other family members they must care for. We have encouraged employees to practice that mindfulness around taking the time they need to stay mentally and physically well. Because our solutions touch patients, we need the people who work here to do their best work. Period. This can only be accomplished when they have balance. 

Who are your competitors? And how do you plan to stay in the game?

Rakesh Nagarajan: Indeed, we work in a very competitive space. It’s easy to get caught up in what each of our competitors does, but we prefer to focus all of our energy on continuing to build the best solution available for the interpretation and reporting of variants in somatic cancer and hereditary germline disease. 

We’ll continue to innovate and lead the space by focusing on customers and the patients they treat, relying on our deep experience and clinical provenance, and by leveraging the incredible talent and experience we have on our team. 

Your final thoughts?

Rakesh Nagarajan: At PierianDx, we’re an inquisitive bunch, but recently, we’ve had an added opportunity to stop, look around, and question the status quo. COVID-19 and many of the other events in 2020 are unspeakably tragic. These tragedies only serve to strengthen our resolve. We want to play our part to make the world a better place, and we plan to do this by driving the adoption of genomics in clinical care to accelerate the fight against cancer and germline hereditary diseases. 

Your website?  

Kokou Adzo is the editor and author of He is passionate about business and tech, and brings you the latest Startup news and information. He graduated from university of Siena (Italy) and Rennes (France) in Communications and Political Science with a Master's Degree. He manages the editorial operations at

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