Blog 5 min

We Know Precision Medicine: Rakesh Nagarajan

June 27th, 2018

"We Know Precision Medicine" is a series of blog posts and articles about the people of PierianDx and how we know precision medicine through our expertise and personal experiences. In this first article, Rakesh Nagarajan, Founder and Executive Chairman, discusses the origin of PierianDx and why he has devoted his life to make precision medicine a reality.

What is your connection with precision medicine?

Early in my life I was quite preoccupied with the fragility of life, always worrying that I would lose the people who were closest to me. I am a logical person, so I tend to want to confront my fears head on and understand where they come from. My 10th grade biology class gave me the opportunity to do just that and provided me with a fascinating new framework for thinking about life: DNA. My teacher, Mrs. Fulghum, inspired me so greatly and that was when I had my first “aha moment” about what I wanted to do the rest of my life. From that moment on, I knew I wanted to somehow use DNA to help people.  In fact, after my first undergraduate year, I worked in a neurobiology laboratory at the University of Virginia. It was there that I was able to marry my second love: computer programming! At this summer research opportunity and forever thereafter, I would frequently write computer programs to help make meaning of the data we were collecting in the lab.

Can you describe your first coding project?

One of my first projects was helping my grandfather. I developed a word processor to produce some prayer books in Sanskrit. These prayer books ended up being in use for over 20 years. He was so grateful, and I was so proud to have helped him.

Can you describe your educational background?  

Yes, at the University of Virginia, I studied yeast genetics (S. cerevisiae) for several years, and it was there that my mentor recommended I enter an MD-PhD program at Washington University in St. Louis. As a PhD student in molecular neuroscience, I witnessed the constant change and technology advances that are inherent in the life sciences. I studied gene expression by working with Northern blots, but then brought qPCR (real-time polymerase chain reaction) into the lab. Then came microarrays. That was when I asked my principal investigator if I could do some programming to process mRNA annotation data because we needed to look up dozens of annotations on the internet manually and individually for tens of thousands of mRNA probesets!

This trend of me studying medicine but wanting to leverage computational power continued. As a medical school student, I was always trying to bring computers into the mix. In fact, during one summer rotation, my professors discovered that I could program computers and they asked me to write some software to determine target genes of transcription factors. For me, there has always been this natural convergence of biology and engineering.

Can you talk about the origin of PierianDx?

When I finished my MD-PhD program, I attended a keynote talk given by Francis Collins, who led the Human Genome Project and is now the director of the National Institutes of Health (NIH). His talk made me realize that the future of biomedical research and medicine was in the integration of the biological and computational sciences. It was during this talk that I realized my impact would be greatest if I stayed on the computational side of medicine.

Consequently, I started a dry lab in bioinformatics at Washington University. Over time we were involved in virtually all the disciplines of biomedical informatics from bioinformatics to biospecimen and medical informatics. I grew my lab team to 30 in St. Louis and launched the Center for Biomedical Informatics with a large presence in India where we contracted over 100 people there.

In 2011, the departments of Genetics and Pathology at Washington University decided to apply genomics clinically. A CLIA-certified, CAP-accredited laboratory was created to support clinical sequencing and reporting. We were among the first laboratories to validate and report our experience utilizing Next Generation Sequencing clinically.  Between 2011 and 2014, I remember that we had almost 50 labs visit because they wanted to learn how we did things in the lab and on the informatics side. Undoubtedly, each lab wanted to know if there was some solution they could purchase to do what we were doing -- to replicate what we had built to analyze sequencing data and efficiently derive biological and medical insight from them. This was the origin of PierianDx. We took what we did in that lab, expanded it, and have been working with partners and customers to fine-tune it ever since.

And what about the name? Dx stands for “diagnostic.” But where does “Pierian” come from?

In Greek mythology, the Pierian Spring of Macedonia was sacred to the Muses. As the metaphorical  source of knowledge of art and science, it was popularized by a couplet in Alexander Pope's poem titled "An Essay on Criticism": "A little learning is a dang'rous thing; Drink deep, or taste not the Pierian spring."1

How will PierianDx help make precision medicine as routine as a trip to the doctor?

We all know somebody who has gone through cancer and as we discover and give a name to many rare diseases, we are beginning to understand that they aren’t so rare. Whether it’s cancer or some other disease, the impact is great on the patient and family’s life. But our ability to do something with precision medicine is equally great. We are in the right place at the right time. Mass profiling modalities, such as next generation sequencing (NGS), are providing us with valuable insights. And although the genome is the first place to look for variations that cause disease, I believe we will also one day routinely examine and integrate metabolomics, lipidomics, proteomics, and the other omics as part of the precision medicine equation. At PierianDx, we will play our very small but very important part by integrating omics data with what is already known in the world of biomedical research, medicine, and patient clinical data to help provide actionable insights for the precise treatment and clinical management of patients.

What do you do when you aren’t thinking about new approaches to precision medicine?

I enjoy spending time with my wife and two children. My parents also live close by, and I am blessed with the world’s best cook in my mom. I, too, enjoy cooking and realize that I use it not only to making something delicious to eat but to relieve stress.  

In the fall, if I have free time, you might catch me watching football, rooting for the world’s greatest football team, the San Francisco 49ers. I am also a home theater enthusiast and love watching movies.


  1. (2018). Pierian Spring. [online] Available at: [Accessed 26 Jun. 2018].



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