Mid-sized M&A, collaborations, creative financing, and biotech consolidation will feature in 2023. IPOs and follow-ons play bit-parts.

Private Company Edition: While Coya Therapeutics raised $15.25m in the final initial public offering in the US last year, Apnimed stayed private raising $80m in a series C extension and Metagenomi extended its series B by $100m to total $275m.

Despite industry-wide contraction last year after Medtronic's SYMPLICITY, some believe a hypertension device is just around the corner. With a market estimated in the billions or even tens of billions of dollars, both Medtronic and Boston Scientific are launching redesigned studies, and a determined handful of medtech start-ups continue to pursue a device-based solution for treating hypertension with invasive and noninvasive approaches, including renal sympathetic denervation through radiofrequency, ultrasound, or drugs; neuromodulation in the forearm; and cold therapy to specialized cells in the neck.

Despite industry-wide contraction last year after Medtronic's SYMPLICITY, many agree the trial was flawed, and some believe a hypertension device is just around the corner. A determined handful of medtech start-ups continue to pursue a device-based approach, most by reducing “fight-or-flight” outflow from the sympathetic nervous system.