Kristen Doyle, CEO of the Cancer Prevention and Research Institute of Texas (CPRIT). Photo courtesy CPRIT.

With its plethora of prestigious health care organizations like the University of Texas MD Anderson Cancer Center, UTHealth Houston, and the Baylor College of Medicine, Houston sits at the heart of cancer research and prevention in Texas.

Of course, it takes piles of cash to support Houston’s status as the state’s hub for cancer research and prevention. Much of that money comes from the Cancer Prevention and Research Institute of Texas (CPRIT).

Data supplied by CPRIT shows organizations in Harris County gained $2.3 billion in institute funding from 2009 through 2025, or nearly $145 million per year. That represents almost 60 percent of the roughly $4 billion that CPRIT has granted to Texas institutions over a 16-year period.

“The life sciences ecosystem that has developed and changed in Houston is phenomenal,” Kristen Doyle, who became the agency’s CEO in July 2024, tells InnovationMap. “In the next decade, we will look back and see a great transformation.”

That ecosystem includes more than 1,100 life sciences and biotech companies, according to the Greater Houston Partnership.

Houston plays critical role in clinical trials

Texas voters approved the creation of CPRIT in 2007. Twelve years later, voters agreed to earmark an extra $3 billion for CPRIT, bringing the state agency’s total investment in cancer research and prevention to $6 billion.

To date, CPRIT money has gone toward recruiting 344 cancer researchers to Texas (mainly to Houston) and has supported cancer prevention services for millions of Texans in the state’s 254 counties. CPRIT funding has also helped establish, expand, or relocate 25 cancer-focused companies. In Houston, MD Anderson ranks as the No. 1 recipient of CPRIT funding.

Regarding cancer research, Doyle says Houston plays a critical role in clinical trials.

“[Clinical trials are] something that CPRIT has focused on more and more. Brilliant discoveries are crucial to this whole equation of solving the cancer problem,” Doyle says. “But if those brilliant ideas stay in the labs, then we’ve all failed.”

Researchers conduct more clinical trials in Houston than anywhere else in the U.S., the Greater Houston Partnership says.

Doyle, a 20-year survivor of leukemia, notes that a minority of eligible patients participate in clinical trials for cancer treatments, “and that’s one of the reasons that it takes so long to get a promising drug to market.”

An estimated 7 percent of cancer patients sign up for clinical trials, according to a study published in 2024 in the Journal of Clinical Oncology.

MD Anderson takes on cancer prevention

Doyle also notes that Houston is leading the charge in cancer prevention.

“We get some national recognition for programs that have been developed in Houston that then can be replicated in other parts of the country,” she says.

Much of the work in Houston focusing on cancer prevention takes place at MD Anderson. The hospital reports that it has received more than $725 million from the CPRIT since 2007, representing approximately 18 percent of CPRIT’s total awards.

“These efforts can have profound impact on the lives of patients and their families, and this funding ensures our exemplary clinicians and scientists can continue working together to drive breakthroughs that advance our mission to end cancer,” Dr. Giulio Draetta, chief scientific officer at MD Anderson, said in a November news release, following the most recent CPRIT award for the hospital totaling more than $29 million.

CPRIT funding for Houston institutions supplements the more than $4.5 billion in federal funding for health and life sciences research and innovations that the Houston area received from 2020 to 2024, according to the Greater Houston Partnership.

“We are curing cancer every single day,” Doyle says of CPRIT. “Every step that we are taking — whether that’s funding great ideas or funding the clinical trials that are bringing promising drugs to Texas and to the world — we are making a difference.”
Eleven medtech startups, hailing from Houston to the Netherlands, have been selected to join TMCi's HealthTech Accelerator. Photo via tmc.edu

TMCi names 11 global startups to latest HealthTech Accelerator cohort

new class

Texas Medical Center Innovation has named 11 medtech startups from around the world to its latest HealthTech Accelerator cohort.

Members of the accelerator's 19th cohort will participate in the six-month program, which kicked off this month. They range from startups developing on-the-go pelvic floor monitoring to 3D-printed craniofacial and orthopedic implants. Each previously participated in TMCi's bootcamp before being selected to join the accelerator. Through the HealthTech Accelerator, founders will work closely with TMC specialists, researchers, top-tier hospital experts and seasoned advisors to help grow their companies and hone their clinical trials, intellectual property, fundraising and more.

“This cohort of startups is tackling some of today’s most pressing clinical challenges, from surgery and respiratory care to diagnostics and women’s health," Tom Luby, chief innovation officer at Texas Medical Center, said in a news release. "At TMC, we bring together the minds behind innovation—entrepreneurs, technology leaders, and strategic partners—to help emerging companies validate, scale, and deliver solutions that make a real difference for patients here and around the world. We look forward to seeing their progress and global impact through the HealthTech Accelerator and the support of our broader ecosystem.”

The 2025 HealthTech Accelerator cohort includes:

  • Houston-based Respiree, which has created an all-in-one cardiopulmonary platform with wearable sensors for respiratory monitoring that uses AI to track breathing patterns and detect early signs of distress
  • College Station-based SageSpectra, which designs an innovative patch system for real-time, remote monitoring of temperature and StO2 for assessing vascular occlusion, infection, and other surgical flap complications
  • Austin-based Dynamic Light, which has developed a non-invasive imaging technology that enables surgeons to visualize blood flow in real-time without the need for traditional dyes
  • Bangkok, Thailand-based OsseoLabs, which develops AI-assisted, 3D-printed patient-specific implants for craniofacial and orthopedic surgeries
  • Sydney, Australia-based Roam Technologies, which has developed a portable oxygen therapy system (JUNO) that provides real-time oxygen delivery optimization for patients with chronic conditions
  • OptiLung, which develops 3D-printed extracorporeal blood oxygenation devices designed to optimize blood flow and reduce complications
  • Bengaluru, India-based Dozee, which has created a smart remote patient monitor platform that uses under-the-mattress bed sensors to capture vital signs through continuous monitoring
  • Montclair, New Jersey-based Endomedix, which has developed a biosurgical fast-acting absorbable hemostat designed to eliminate the risk of paralysis and reoperation due to device swelling
  • Williston, Vermont-based Xander Medical, which has designed a biomechanical innovation that addresses the complications and cost burdens associated with the current methods of removing stripped and broken surgical screws
  • Salt Lake City, Utah-based Freyya, which has developed an on-the-go pelvic floor monitoring and feedback device for people with pelvic floor dysfunction
  • The Netherlands-based Scinvivo, which has developed optical imaging catheters for bladder cancer diagnostics
Tatiana Fofanova and Dr. Desh Mohan, founders of Koda Health. Photo courtesy Koda Health.

6 Houston health tech startups making major advancements right now

meet the finalists

Home to leading hospitals, universities and health-focused incubators, Houston is a breeding ground for innovative medical technology and breakthroughs that can improve outcomes and lead to a better quality of life for patients.

The Health Tech Business category in our 2025 Houston Innovation Awards will honor an innovative startup within the health and medical technology sectors.

Six forward-thinking businesses have been named finalists for the 2025 award. They range from an end-of-life care company to others developing devices and systems for heart monitoring, sleep apnea, hearing loss and more.

Read more about these businesses, their innovative founders, and how they're shaping the future of health care below. Then join us at the Houston Innovation Awards on Nov. 13 at Greentown Labs, when the winner will be unveiled at our live awards ceremony.

Tickets are now on sale for this exclusive event celebrating all things Houston Innovation.

Bairitone Health

Bairitone Health is bringing anatomy imaging for sleep apnea to the home environment. The company's platform maps users' anatomy during natural sleep using a facial patch to determine the root cause of airway obstruction. It then offers effective therapies for each patient. The system is currently in the research and development phase and is being used in clinical trials and studies.

The company was founded in 2022 in the Texas Medical Center's Biodesign program by CEO Meagan Pitcher, CTO Onur Kilic and chief medical officer Britt Cross. It was a member of Activate Houston's inaugural cohort and has participated in numerous accelerators and incubators. It raised a pre-seed round last year of $435,000.

Corveus Medical

Corveus Medical has developed a novel catheter device that allows cardiologists to perform a splanchnic nerve ablation, restoring the pressure balance in patients with moderate heart failure. Its pre-FDA-approved, minimally invasive solution deactivates a nerve that has been demonstrated to be a root cause behind heart failure progression, which allows physicians to treat patients who have traditionally had few options.

The company, formerly known as Caridian Medical, was founded in 2021 by CEO Tyler Melton and CMO Ishan Kamat. It has participated in incubators such as TMC Biodesign, Y Combinator, MedTech Innovator and Fogarty Innovation and was named one of the 10 most promising life science companies at Texas Life Science Forum in 2022. The company says it will move toward validation and verification testing for its device in Q4 of this year.

FibroBiologics

Regenerative medicine company FibroBioligics uses fibroblasts, the body’s most common type of cell, rather than stem cells, to help grow new cells to repair tissue and modulate the immune system. The cell therapies offer treatments for chronic conditions such as degenerative disc disease, multiple sclerosis and non-healing wounds.

The publicly traded company was founded in 2021 by CEO Pete O'Heeron. It opened a new 10,000-square-foot Houston lab earlier this year to scale up research efforts and pave the way for in-house manufacturing. The company says it plans to launch its first clinical trial for diabetic foot ulcers soon, representing the transition of its fibroblast technology to the clinic setting.

Koda Health

Koda Health has developed an advance care planning platform (ACP) that allows users to document and share their care preferences, goals and advance directives for health systems. The web-based platform guides patients through values-based decisions with interactive tools and generates state-specific, legally compliant documents that integrate seamlessly with electronic health record systems. The company also added kidney action planning to its suite of services for patients with serious illnesses last year.

Koda Health was founded out of the TMC's Biodesign Fellowship in 2020 by CEO Tatiana Fofanova, chief medical officer Dr. Desh Mohan, and chief technology officer Katelin Cherry. The company raised a $7 million series A earlier this year, and also announced major partnerships and integrations with Epic, Guidehealth, Medical Home Network, Privia Health and others.

NanoEar

NanoEar has miniaturized hearing aid technology so that it can be implanted across the eardrum, allowing adults with age-related hearing loss to enjoy better sound quality than they would with behind-the-ear hearing aids.

Dr. Ron Moses, an ENT specialist and surgeon at Houston Methodist, developed the technology, and the company was founded in 2016 with CFO Willem Vermaat and COO Michael Moore. The company participated in the TMC Innovation Institute in 2016. It has issued nine U.S. patents and performed successful human cadaver and animal proof-of-concept experiments. Its next step is developing a prototype.

Wellysis USA

Wellysis USA Inc. works to detect heart rhythm disorders with its continuous ECG/EKG monitor with AI reporting. Its S-Patch cardiac monitor is designed for extended testing periods of up to 14 days on a single battery charge. The device weighs only 9 grams, is waterproof and designed to be comfortable to wear, and is considered to have a high detection rate for arrhythmias. It is ideally suited for patient-centric clinical trials to help physicians make diagnoses faster, cheaper and more conveniently.

It was established in Houston in 2023 and participated in the JLABS SFF Program the same year. It closed a $12 million series B last year. It was founded by CEO Young Juhn, CTO Rick Kim, CFO JungSoo Kim and chief strategy officer JoongWoo Kim.

---

The Houston Innovation Awards program is sponsored by Houston City College Northwest, Houston Powder Coaters, FLIGHT by Yuengling, and more to be announced soon. For sponsorship opportunities, please contact sales@innovationmap.com.

Recent funding from CPRIT will help launch the new Accelerator for Cancer Medical Devices. Photo via TMC

TMC lands $3M grant to launch cancer device accelerator

cancer funding

A new business accelerator at Houston’s Texas Medical Center has received a nearly $3 million grant from the Cancer Prevention and Research Institute of Texas.

The CPRIT grant, awarded to the Texas Medical Center Foundation, will help launch the Accelerator for Cancer Medical Devices. The accelerator will support emerging innovators in developing prototypes for cancer-related medical devices and advancing them from prototype to clinical trials.

“The translation of new cancer-focused precision medical devices, often the width of a human hair, creates the opportunity to develop novel treatments for cancer patients,” the accelerator posted on the CPRIT website.

Scientist, consultant, and entrepreneur Jason Sakamoto, associate director of the TMC Center for Device Innovation, will oversee the accelerator. TMC officials say the accelerator builds on the success of TMC Innovation’s Accelerator for Cancer Therapeutics.

Each participant in the Accelerator for Cancer Medical Devices program will graduate with a device prototype, a business plan, and a “solid foundation” in preclinical and clinical strategies, TMC says. Participants will benefit from “robust support” provided by the TMC ecosystem, according to the medical center, and “will foster innovation into impactful and life-changing cancer patient solutions in Texas and beyond.”

In all, CPRIT recently awarded $27 million in grants for cancer research. That includes $18 million to attract top cancer researchers to Texas. Houston institutions received $4 million for recruitment:

  • $2 million to the University of Texas MD Anderson Cancer Center to recruit Rodrigo Romero from Memorial Sloan Kettering Cancer Center in New York City
  • $2 million to MD Anderson to recruit Eric Gardner from Weill Cornell Medicine in New York City

A $1 million grant also went to Baylor College of Medicine researcher Dr. Akiva Diamond. He is an assistant professor at the medical college and is affiliated with Baylor’s Dan L. Duncan Comprehensive Cancer Center.

MD Anderson is teaming up with TOPPAN Holdings on cutting-edge organoid tech to help match cancer patients with the most effective treatments. Photo via Getty Images.

MD Anderson launches $10M collaboration to advance personalized cancer treatment tech

fighting cancer

The University of Texas MD Anderson Cancer Center and Japan’s TOPPAN Holdings Inc. have announced a strategic collaboration to co-develop TOPPAN Holdings’ 3D cell culture, or organoid, technology known as invivoid.

The technology will be used as a tool for personalized cancer treatments and drug screening efforts, according to a release from MD Anderson. TOPPAN has committed $10 million over five years to advance the joint research activities.

“The strategic alliance with MD Anderson paves a promising path toward personalized cancer medicine," Hiroshi Asada, head of the Business Innovation Center at TOPPAN Holdings, said in a news release.

Invivoid is capable of establishing organoid models directly from patient biopsies or other tissues in a way that is faster and more efficient. Researchers may be able to test a variety of potential treatments in the laboratory to understand which approach may work best for the patient, if validated clinically.

“Organoids allow us to model the three-dimensional complexity of human cancers in the lab, thus allowing us to engineer a powerful translational engine—one that could not only predict how patients will respond to therapy before treatment begins but also could help to reimagine how we discover and validate next-generation therapies," Dr. Donna Hansel, division head of pathology and laboratory medicine at MD Anderson, added in the news release. “Through this collaboration, we hope to make meaningful progress in modeling cancer biology for therapeutic innovation.”

The collaboration will build upon preclinical research previously conducted by MD Anderson and TOPPAN. The organizations will work collaboratively to obtain College of American Pathologists (CAP) and Clinical Laboratory Improvement Amendments (CLIA) certifications for the technology, which demonstrate a commitment to high-quality patient care. Once the certifications are obtained, they plan to conduct observational clinical studies and then prospective clinical studies.

“We believe our proprietary invivoid 3D cell culture technology, by enabling the rapid establishment of organoid models directly from patient biopsies, has strong potential to help identify more effective treatment options and reduce the likelihood of unnecessary therapies,” Asada added in the release. “Through collaboration on CAP/CLIA certification and clinical validation, we aim to bring this innovation closer to real-world patient care and contribute meaningfully to the advancement of cancer medicine."

A new cancer-fighting drug will move to clinical trials after being tested on Axiom's Ax-2 and Ax-3 missions. Photo courtesy Axiom Space.

Axiom Space-tested cancer drug advances to clinical trials

mission critical

A cancer-fighting drug tested aboard several Axiom Space missions is moving forward to clinical trials.

Rebecsinib, which targets a cancer cloning and immune evasion gene, ADAR1, has received FDA approval to enter clinical trials under active Investigational New Drug (IND) status, according to a news release. The drug was tested aboard Axiom Mission 2 (Ax-2) and Axiom Mission 3 (Ax-3). It was developed by Aspera Biomedicine, led by Dr. Catriona Jamieson, director of the UC San Diego Sanford Stem Cell Institute (SSCI).

The San Diego-based Aspera team and Houston-based Axiom partnered to allow Rebecsinib to be tested in microgravity. Tumors have been shown to grow more rapidly in microgravity and even mimic how aggressive cancers can develop in patients.

“In terms of tumor growth, we see a doubling in growth of these little mini-tumors in just 10 days,” Jamieson explained in the release.

Rebecsinib took part in the patient-derived tumor organoid testing aboard the International Space Station. Similar testing is planned to continue on Axiom Station, the company's commercial space station that's currently under development.

Additionally, the drug will be tested aboard Ax-4 under its active IND status, which was targeted to launch June 25.

“We anticipate that this monumental mission will inform the expanded development of the first ADAR1 inhibitory cancer stem cell targeting drug for a broad array of cancers," Jamieson added.

According to Axiom, the milestone represents the potential for commercial space collaborations.

“We’re proud to work with Aspera Biomedicines and the UC San Diego Sanford Stem Cell Institute, as together we have achieved a historic milestone, and we’re even more excited for what’s to come,” Tejpaul Bhatia, the new CEO of Axiom Space, said in the release. “This is how we crack the code of the space economy – uniting public and private partners to turn microgravity into a launchpad for breakthroughs.”

Ad Placement 300x100
Ad Placement 300x600

CultureMap Emails are Awesome

Intuitive Machines lands $148M as part of NASA Moon Base funding

to the moon

Houston-based Intuitive Machines has been awarded $148.3 million to deliver its Nova-C lander to the moon by 2028. The funding is part of $600 million that NASA recently awarded to three companies as part of the agency’s Moon Base Program.

The contracts aim to support sustained human presence and commercial operations on the Moon. Austin-based Firefly Aerospace was awarded $144.2 million by NASA for one mission and Pittsburgh-based Astrobotic netted $297.9 million for two lunar landings. Intuitive Machine's award is the company's sixth task order under NASA's Commercial Lunar Payload Services (CLPS) program.

“We’re building a proving ground for Moon Base operations,” Ryan Stephan, NASA’s Moon Base acting director of cargo landers, said in a news release. “Accelerating our Moon mission ordering cadence and launch opportunities enable us to move quickly to learn, iterate, and improve.”

Under the latest task order, Intuitie Machines will deliver three scientific and operational payloads to the moon, which include a:

  • Linear Energy Transfer Spectrometer (LETS) radiation monitor to gather critical environmental safety data
  • Advanced stereo cameras to analyze surface-plume interactions (SCALPSS)
  • Laser retroreflector array (LRA) for precise cislunar positioning

The funding breakdown includes a $68.6 million base contract and a $79.7 million performance incentive for Intuitive Machines.

The company says the funding will allow it to create a standardized and repeatable "lunar utility pipeline" for delivering cargo to the moon.

"We are shifting the paradigm from custom aerospace engineering to commercial mass production of lunar infrastructure," Steve Altemus, CEO of Intuitive Machines, said in a separate news release. "Our flight-proven Nova-C platform allows us to build, test, and deploy multiple landers in parallel using Industry 4.0-powered manufacturing. This contract directly advances our core mission to provide persistent, reliable, and commercial baseline of transport, connectivity, and operations that allows our customers to stay longer and achieve more on the Moon."

NASA also shared that it is exploring plans to send PROMISE, a rover based on the Mars Perseverance and Curiosity rovers, to the moon and it plans to seek proposals for additional lunar lander missions, technology demonstrations, a communications and navigation satellite network, and new science payloads to support its lunar outpost. NASA is developing its Moon Base near the lunar South Pole. The agency expects it to come to fruition sometime after 2032.

Intuitive Machines had received its last CLPS award for $180.4 million in March 2026. It will be the first mission to utilize the company's larger cargo lunar lander, Nova-D. The company was also recently awarded a $1 million grant from Maryland Gov. Wes Moore to expand its robotics operations in the state.

UT team develops wearable technology for atmospheric water harvesting

In The Air

Engineers at the University of Texas at Austin have developed a prototype jacket that harvests clean drinking water directly from the atmosphere, and it works even in the driest desert conditions.

The research, published in Science Advances, marks the latest milestone in nearly a decade of work by materials scientist and chair professor Guihua Yu and his team at the Cockrell School of Engineering's Walker Department of Mechanical Engineering and Texas Materials Institute. The wearable technology marks a significant leap: instead of a bulky, stationary machine, this jacket does the work.

Photo courtesy of UT Austin

"We have been working on atmospheric water harvesting technology for a number of years," Yu says. "This current version is even more wearable. We're transitioning from conventional, more stationary water harvesting to something truly portable and personal."

Yu's lab first published work on hydrogel-based water harvesting around 2019, and the jacket is the latest evolution of that platform, now called AirGel. Last year, the broader AirGel invention won the top prize in the graduate category of the National Collegiate Inventors Competition.

The jacket is woven with specially engineered hydrogel fibers; ultra-porous materials that attract and absorb moisture from the surrounding air much like a household desiccant. Unlike a desiccant, the material doesn't require intense heat to release that water. The hydrogel is thermally responsive, meaning a modest rise in temperature — even from mild solar heating — is enough to release the water it has captured.

Condenser test in AustinSo, somebody would be wearing the jacket, or perhaps carrying this gel-like textile as a blanket, as it passively absorbs moisture from the air. Then they would detach the textile panels and place them into a small, portable collector unit; essentially a compact heater. The water evaporates out of the textile, condenses inside the collector, and drips out as clean, drinkable water.

"It immediately becomes drinkable because it already goes through the distillation process," Yu explains.

In trials, the jacket produced between 400 and 900 milliliters of water per day depending on humidity, or roughly 14-30 ounces, nearly a quart, depending on the air's humidity. With one kilogram of the textile, the researchers found they could generate approximately 3.7-4 liters of water in arid conditions, and potentially double that in humid ones. So far, the team has tried the jacket out in very dry, semi-dry, and humid areas, and the jacket was able to pull water from each climate.

Lead researcher Chuxin Lei, a postdoctoral researcher on Yu's team and co-author on the paper, says the goal was to rethink who this technology could serve.

Portable bag contents

"Many current [atmospheric water harvesting] systems are still built as rigid or stationary platforms, making them less suitable for people who are moving, working outdoors, or operating in some remote environment. This lead us to ask whether we could build a water harvesting system that could become more like clothing — light, wearable, flexible, and naturally suited for personal use," Lei says.

The potential applications are wide-ranging. Yu's team has previously worked with the Department of Defense on water solutions for soldiers, where water logistics can be dangerous and costly. The technology could also serve hikers, emergency responders, disaster relief workers, and agricultural and field workers. Anyone who needs clean water on the go and far from infrastructure.

The team also sees a potential future where the technology complements large-scale centralized water systems rather than replacing them.

"Our solution cannot be a universal solution for all," Yu acknowledges. "But I think it's an extremely important alternative."

For now, the jacket is still a laboratory prototype, but Yu and Lei are optimistic. With the right industry partnerships, they say, the technology could realistically reach commercial scale within three to five years.

---

This article originally appeared on CultureMap.com, written by Natalie Grigson.

Houston ranks among world’s top 30 emerging startup ecosystems

Startup Status

Long known as the Energy Capital of the World, Houston also ranks among the world’s top 30 emerging startup ecosystems, according to a new report.

The report from Startup Genome, a research and advisory organization, doesn’t assign a specific numeric ranking to Houston’s startup ecosystem. Rather, it puts Houston in the ranking range of 21 to 30 for emerging ecosystems. Startup Genome weighed factors such as early-stage funding, performance and talent to identify the top emerging ecosystems.

Houston also gained notice for being one of the world’s 20 emerging ecosystems with at least four unicorn startups in the past 10 years. Houston and nine other ecosystems each had four unicorns.

According to StartupBlink, a startup research platform, Houston’s startup ecosystem grew 24 percent in 2025, with over 1,300 startups and total startup funding exceeding $808 million. StartupBlink places Houston at No. 46 among the world’s top 100 startup ecosystems.

In a recent post on LinkedIn, David Horsup, executive in residence at the Rice Alliance Clean Energy Accelerator, wrote that Houston “has all the ingredients to be wildly successful if it stays true to its differentiated pillars that drive the economy — energy, medical, and aerospace.”

Mumbai topped Startup Genome’s list of emerging ecosystems, followed by Istanbul, Madrid, Salt Lake City-Provo and Barcelona. After Salt Lake City-Provo, the top U.S. ecosystems were Phoenix, Detroit, Minneapolis and Las Vegas.

Silicon Valley led Startup Genome’s ranking of the world’s top established ecosystems, followed by New York City, London, Tel Aviv and Boston. Austin landed at No. 18 in this category and Dallas at No. 27.

“For much of the past decade, this report has chronicled the welcome dispersion of opportunity beyond the traditional hubs,” Startup Genome writes. “That trend has not died — but it has been complicated. Capital and scale are consolidating once more, particularly in the United States, and the gap between leading and emerging ecosystems is widening.”