The a16z Show Novartis CEO Vasant Narasimhan on Transforming a 250-Year-Old Company
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Feb 16, 2026 
Vasant Narasimhan, physician-scientist and CEO who refocused Novartis into a pure-play medicines company, discusses platform bets in cell and gene therapy, RNA medicines, and radioligand therapies. He talks AI’s role across discovery and trials. He also covers global shifts in biotech, China’s rise, and what technical milestones and manufacturing work matter when partnering with startups.
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siRNA Is A Mature, De-Risked Modality
- RNA therapeutics, especially siRNA, are now a de-risked, mature modality for liver-directed targets.
- Advances in delivery aim to expand RNA drugs beyond the liver into muscle, brain, heart, and kidney.
Design Delivery Around A Clear Cellular Address
- Invest in delivery 'addressing'—find receptors or conjugates that target the desired cell type with high specificity.
- Avoid off-target trafficking because low-level hits to other tissues produce unwanted side effects.
Radioligands Are Platformized By Isotope
- Radioligand therapy pairs targeting molecules with radioactive payloads to kill nearby cancer cells.
- Within a given isotope (e.g., lutetium) the approach is platformizable, but switching isotopes requires different supply chains.