[axg11]

I agree it was an odd decision at the time. Grail is very much built on Illumina’s platform and I don’t see them building anything otherwise. If Galleri is successful, Grail will become Illumina’s biggest customer and the two could become completely interdependent.

In the medium term, I think there’s an opportunity for a company to build ctDNA screening on a different sequencing platform. That could present unique advantages against Grail which is very much tied to using Illumina.

[MontyCarloHall]

> Grail is very much built on Illumina’s platform

I’m not sure this is true. GRAIL’s technology is (a) a protocol for efficient bisulfite conversion of cfDNA to infer cytosine methylation, and (b) proprietary algorithms for using that methylation information to infer presence of cancer. Both (a) and (b) are agnostic to the actual sequencing machine (e.g. Illumina): the end product of (a), namely cfDNA fragments with non-methyl C’s bisulfite converted to uracils, could be sequenced on any machine[*] capable of reading short DNA fragments, not just Illumina’s machines. (b) just requires methylation information, which again, is sequencer agnostic.

[*] companies making such machines will likely become abundant once Illumina’s patents expire in a few years

[axg11]

Grail will have to end-to-end validate any changes to Galleri, especially any change of sequencer. Given that any Illumina competitors based on the same IP wouldn't hit the market until 2024 (extremely optimistic) I'd be surprised if Grail were able to launch a non-illumina Galleri before 2026. A company that is locked into the Illumina platform for the next 5 years is very much dependent on Illumina in my eyes.