An Interview With Dr Matt Kelly, Head Of Innovation At Perspectum Diagnostics

LiverMultiScan is a diagnostic aid for the liver which is now FDA cleared and CE marked. What can you tell us about the bench to bedside journey of this technology?

The idea spun out from the DPhil project of Perspectum Diagnostics’ CEO, Dr Rajarshi Banerjee (Banjo), who at that time was on a cardiology track at the University of Oxford. He thought of deploying one of the tools used to characterize cardiac tissue, MRI T1, to other areas, particularly to the non-invasive assessment of chronic liver disease, in order to address a significant unmet medical need.

The first challenge was that the iron in the liver interfered with the magnetic resonance imaging signal. An algorithm for correcting the T1 for the effects of iron was created, together with MR physicists, and then becoming the core of LiverMultiScan™. Banjo ran a clinical study at the hospital to perform an initial validation of the algorithm and based on the results, decided to create a spin-out company with colleagues from the University to develop the technology he was passionate about. Grant funding from Innovate UK allowed them to develop the algorithm in a professional software environment with all the necessary ISO accreditation needed to build a medical device.

Perspectum Diagnostics has now offices in Singapore and the United States of America. How did the international expansion occur?

The market we’ve had most traction in initially is the pharmaceutical one. We’ve had a lot of success using our technologies, both as a surrogate endpoint to give information on treatment efficacy and to help place patients into trials. The standard procedure for testing drugs for liver diseases requires biopsy which is an invasive procedure, yet only around a third of the participating patients are declared eligible for enrolment into the study. Perspectum Diagnostics uses LiverMultiScan™ to screen patients before a trial to support the decision on whether they go forward for biopsy or not. This leads to a substantial increase in the chances of meeting the criteria, up to 2/3 of participants. The odds are better, it’s easier to recruit patients with fewer unnecessary biopsies, and pharmaceutical companies are using their budgets more efficiently.

This is a big source of revenue that allowed us to grow the company. But these drug companies are international enterprises. Before expanding to Singapore and USA we were running everything from the UK. This was difficult at times because of the time zone differences and overseas meetings at drug companies and clinical sites.

Setting up a US site to coordinate US projects and commercial studies has made the logistics a lot easier and the same happened in Asia. We’re now looking forward to the next phase, which will be clinical adoption. Rather than targeting drug companies we will target clinical service providers (hospitals, private clinics) and to do that we need teams who understand the local markets.

Perspectum Diagnostics technology started at University of Oxford. You are also collaborating with more than 40 expert clinical sites and offer support in clinical trials in a variety of ways. What do you think about the academia-industry-clinical environment dynamic?

The biggest issues that we have when setting up collaborations with key opinion leaders – either from academia or clinical centres – is that the contracting process is very, very slow. That’s a huge problem. When setting-up a study we want to move as quickly as we can and the success of collaborations can be determined by how quick they are to contract. We often go and talk with the clinical or academic experts and they will be enthusiastic, we’ll come up with a great project idea and then we move into contracting and progress can stall, with a lot of time spent chasing. Sometimes these projects don’t proceed because it just takes too long. Typically, these delays aren’t down to disagreements over IP or publishing results, as you might expect, but to limited bandwidth of the sites’ contracting teams.

In terms of partnering with academia, Perspectum Diagnostics co-supervises a PhD student at King’s. This type of collaboration where there’s a shared person or resource is often the most productive. PhD projects are great because they allow us to investigate problems that are further out on our roadmap or slightly tangential to our main business focus. The depth of expertise you can find from academic partners is great in that sense. Innovate UK funded knowledge transfer partnerships are another great way of collaborating with academic partners.

What are the most promising trends in the IGT field at the moment?

One trend at the interface between imaging and clinical practice is the introduction of more objective, quantitative tools and technologies. Radiology as a field has traditionally been quite qualitative in the way data is interpreted and images are read. In an academic/research setting, however, you see a wealth of tools that extract accurate, quantitative information that can guide treatment and help clinicians make better decisions. Then, there are the artificial intelligence tools such as machine learning and deep learning which allow you to amalgamate large diverse data sources to identify novel biomarkers with utility in a particular setting (in our case risk stratifying patients with liver disease or detecting change with treatment at the earliest possible stage).

We’ll see an increasing translation of quantitative imaging to inform decision making, but there’s a lot of work needed to bridge the gap between basic research and a clinical product that can be used globally to change the way patients are managed and treated. Research shouldn’t stop at the publication of clinical studies, but should consider “How do we get this into the clinic?”. In our case, we bridged that gap by spinning out a company, raising funding from investors and Innovate UK. But if you don’t have a pathway to integrate the technology into a medical device, that gap won’t be bridged. Unfortunately, too many technologies are published as a great proof a concept study, but go no further; effectively, it is left on a shelf to gather dust, where it’s lost to society. It’s a huge shame. There are likely many potentially beneficial ideas that never make it to the clinic because that gap isn’t bridged.

What are Perspectum Diagnostics’ main goals and challenges today?

We are in the process of learning how to build on our success in the clinical trials market to target wider clinical adoption. We are testing a few hypotheses, seeing what other companies have done, talking to experts in the field, and trying to understand customers from different markets. This is the biggest challenge at the moment and it requires answers to questions like, “How do we scale a business? How do we address reimbursement in different markets? What’s the most efficient route to get our technology in clinical guidelines and on the radar of clinical customers?”.

It’s a difficult, but highly motivating challenge, and we will address it in our usual style of going quickly and learning fast. If we crack it, it will be a major source of revenue, and positively impact the care of patients across the world. There’s no point in having great technology if no one uses it. The challenge that we have set ourselves is to enable as many people as possible to benefit from our technology and that’s what we’re working to achieve.