Mike Carusi

From equipment sales to the Forbes Midas List

The arc from selling industrial equipment to being named on the Forbes Midas List is not one that maps neatly onto a standard venture capital career playbook. Mike Carusi's path was less a ladder than a series of deliberate pivots, each building a different kind of literacy that would eventually make him unusually effective in life sciences investing.

He studied mechanical engineering at Lehigh University, graduating in 1987 with the kind of technical grounding that most MBAs lack. A few years in industrial sales followed - not glamorous, but instructive. When he arrived at Dartmouth's Tuck School of Business in 1991, he said, "I had never thought about consulting or venture capital and, frankly, didn't really know what those things were." The Tuck MBA expanded his mental map dramatically. "It became clear right away that there were more options in front of me than I ever realized, and that maybe I needed to think bigger."

Healthcare consulting at The Wilkerson Group came first, with Carusi helping to open offices in London and San Francisco. The international exposure - understanding how different health systems evaluate innovation, reimbursement, and value - proved durably useful when he later had to help portfolio companies think about global markets. From there, a move to Inhale Therapeutic Systems (later Nektar Therapeutics), which was pioneering pulmonary drug delivery. He managed pharmaceutical and biotech partnerships across three continents. The company went public in 1994. Carusi watched, from the inside, how a venture-backed company navigates the IPO process.

The first bet, and what it taught him

Joining Advanced Technology Ventures brought Carusi into the deal-making seat for the first time. His first notable investment was Plexxikon, a small molecule drug discovery company based in Berkeley. By his own account, the company was "a tremendous team and a piece of paper" when he committed. He was new to VC. He fought to get into the deal. He ended up as the largest investor.

Plexxikon's science ultimately produced vemurafenib (Zelboraf), a breakthrough cancer treatment targeting the BRAF V600E mutation in melanoma - one of the first examples of precision oncology at scale. The company was acquired by Daiichi Sankyo for approximately $1 billion in 2011. That same year, another ATV portfolio company, Ardian (a renal denervation device company), was acquired by Medtronic for roughly $800 million. Two landmark exits in twelve months established Carusi as one of the sharper early-stage life sciences investors on the West Coast.

The lesson was not simply that big bets can pay off. It was about how to identify them - a team with deep domain expertise, a scientific insight that represents a step-change rather than an incremental improvement, and a market problem large enough to justify the risk. "There have been too many incremental ideas that got funded, and as a result, there are things that nobody cares about," Carusi has said. The Plexxikon bet codified his investment philosophy.

Building Lightstone: three funds, one thesis

Lightstone Ventures was founded in 2014 as a deliberate effort to build a firm around a focused, long-term life sciences investment thesis, free from the pressures of a larger platform fund. The inaugural $172 million fund was followed by a $250 million second fund in 2017, and the $375 million oversubscribed third fund in September 2021 - the firm's largest raise, and confirmation that the LP community had significant conviction in the Lightstone approach.

The firm operates from offices in Portola Valley, Boston, and Dublin, giving it genuine international presence across the three most important life sciences hubs. The Dublin office reflects the firm's ambitions beyond the U.S. market - both for sourcing deals and for understanding the European regulatory and reimbursement landscape that affects the commercialization of many portfolio companies.

Lightstone's portfolio has produced exits across nearly every modality: oncology drugs, medical devices, diagnostics, gene therapies, and digital health platforms. The common thread is not a therapeutic area but a stage philosophy. Lightstone commits early - often when clinical data is thin or absent - and stays engaged through the full company-building arc. "Our belief is actually that as the capital in the industry shrinks, the demand for our companies will go up because the major players will continue to have a need for innovation," Carusi explained. The majors need to replenish their pipelines. Lightstone positions itself as one of the most reliable sources of the kind of innovation worth acquiring.

Teaching the next generation

One of the less obvious dimensions of Carusi's career is how much of it he has devoted to education. He teaches a five-week healthcare venture capital course at Dartmouth Tuck - his alma mater - where he has been doing so for more than four years. He is a faculty member of the Stanford Biodesign Emerging Entrepreneurs Forum. He sits on the advisory board of the UCSF/Berkeley Venture Innovation Program. He serves on the Board of Directors of the National Venture Capital Association.

This is not resume decoration. Carusi appears to genuinely believe that improving the pipeline of well-prepared healthcare entrepreneurs and investors is part of what makes the ecosystem function. The students coming through these programs become the founders pitching to him, the operators building in his portfolio companies, and eventually the investors writing their first term sheets. The loop is deliberate.

His teaching at Tuck is particularly notable given his own candid admission that he arrived at Tuck not knowing what venture capital was. There is a certain satisfaction in now being the person who explains it to the next generation - and in being able to tell them, with firsthand evidence, that the path from ignorance to expertise is shorter than it looks if you pick the right problems.

What he looks for now

Carusi's current investment focus sits at the intersection of several fast-moving fields: oncology and immuno-oncology, gene therapy, cell therapies, neurotechnology, precision medicine, and medical devices with novel mechanisms of action. The common requirement across all of these: the company must be attempting something that cannot be done by iterating on the current standard of care.

On the medtech side, he has been particularly articulate about reimbursement dynamics - a subject many device investors treat as an afterthought until it becomes a company-killing problem. His view is that the best device investments are the ones where the reimbursement argument is actually strengthened by the clinical data, not ones where companies hope to build a clinical data package and then figure out payer strategy later. "I think our job is to generate that kind of data and do it right."

He is also clear-eyed about the acquisition dynamics that govern most life sciences exits. The era of bankers showing up with 60-day ultimatums is, in his view, over. Strategic acquirers have become more sophisticated. They want to see genuine data, genuine patient impact, and genuine platform potential before they commit. Building that case - over years, through careful clinical development - is what Lightstone's company-building model is designed to do.