WILL BIOPSIES SOON BE RELEGATED TO HISTORY?

Would you prefer an invasive biopsy or high-tech medical imaging to diagnose your disease? Faced with the choice, who would want the needle?

By Nicky Godding, Editor

Biopsies have been used by doctors for hundreds of years. The term was first coined in 1879 by French dermatologist Ernest Besnier, although the procedure was already centuries old.

A needle is inserted, twisted 180 degrees to extract tissue which is sent to a laboratory for analysis.

It is very invasive and, for some organs such as the heart, there is a risk. The heart won’t repair itself and the patient is left with a permanent scar.

In the 1980s, cardiologists began investigating ways of scanning the heart and Oxford University’s George Radda (now Sir George), pioneered the use of nuclear magnetic resonance (NMR) in ‘live’ biological imaging, paving the way for the worldwide use of MRI scanning in human disease diagnosis.

As a result, biopsies are now rarely carried out on hearts. But what about the rest of our bodies?

Oxford-based Perspectum is pioneering new medical imaging to improve diagnoses including for liver disease and cancer. In March the company completed its latest $55 million funding round.

Perspectum’s software enhances the capabilities of a standard magnetic resonance imaging (MRI) machine and uses artificial intelligence to measure organ inflammation with much greater precision.

From PhD student to med-tech founder

Dr Rajarshi Banerjee, 45, known to pretty much everyone as Banjo, originated Perspectum’s patented technologies.

“I was an Oxford PhD student researching whether obese people are more prone to a specific kind of heart disease – fat deposited in the heart which could affect the way it pumps.

“I learned to scan the heart to measure fat content, inflammation, fibrosis and iron with great precision. I also showed that it wasn’t very useful in the non-symptomatic obese.

“But just upstairs in the John Radcliffe Hospital, where I was doing my research, people were having biopsies every day, and for those undergoing liver biopsies, the labs were looking for the same: fat, fibrosis inflammation and iron. I could scan them all to a second decimal place, so I wondered why not scan livers using my technology which is more accurate than a biopsy?”

Surely someone had thought of this before? “Experts could scan any one of these four indicators, but not all of them together like we could,” said Banjo.

Forget the parking tickets, focus on the tech

Opportunity knocked when he was called to the office of Regius Professor of Medicine at the University of Oxford, Sir John Bell.

If a student gets called to the Regius Professor’s office it’s often because something really bad has happened, so Banjo went in trepidation. “All I could think of was that I was a PhD student with unpaid parking tickets.”

But it was Sir John with the problem. The UK Biobank, which held genetic and health information from half a million UK participants, and which he helped set up in 2007, had a lot of heart and brain information, but it didn’t have a liver test. He’d looked at all the UK biobank’s liver tests, but none of them were that good.

This was in 2012, when an edict had come down from the Chief Medical Officer, Sally Davies, that liver disease and obesity were now government priorities.

“Sir John had heard from the Dean of the Medical Schools, Dr Ken Fleming, about this PhD student who had come up with a scan for liver disease which was predicting biopsies and had secured patents on the technology. Sir John said he wanted to include my test in the UK Biobank, but it needed to be quality assured which meant forming a spin-out company.

“The meeting wasn’t about parking tickets, but about putting my research to practical use.”

With the help of Sir John Michael Brady, Emeritus Professor of Oncological Imaging at the University of Oxford, Banjo set up Perspectum the following year and secured seed funding from Sir Martin and Lady Audrey Wood. In 1959 they had founded Oxford Instruments, the university’s first spin-out company. And as Banjo had carried his research out while in the employment of the NHS, he also made sure that it had a legal stake in the business, alongside the university.

Enjoying the highs means navigating the lows

Perspectum has since gone on to raise a total of more than $120 million, including its latest round of $55 million.

“We are investing the funds in applied sciences and commercialisation. Liver disease is so prevalent that if we get this right, we will make a lot of people better and will be a multi-billion-dollar business,” said Banjo. “The sustainable win is the ethical win.”

But growing a med-tech is tough and you only enjoy the highs after overcoming the lows. Perspectum has the technology, but its patents are only the start. “You have to commercialise and raise awareness, get the right people in, including legal and financial advisers as well as scientists, make the right medical and industry connections, get scanners preloaded with our software (which we are doing now), and many other things,” said Banjo.

“Even knowing that, it would take a long time to establish the business and has taken longer than I expected.”

There is an added benefit, according to Banjo, who alongside his CEO role at Perspectum, continues to work as a consultant physician with the Oxford University Hospitals NHS Foundation Trust, where he also researches liver disease in adults and children. “Using AI in diagnosis is not only quicker and more accurate, it also frees up time for medical professionals to spend more time with their patients.

“Some medical consultants see themselves as scientists. Perhaps they have come from a molecular biology background and really prefer to be involved in trials and papers, not engaging with patients. But most of us will see a medical consultant at exactly the time of life when where we are most vulnerable.

“AI can help your diagnosis, and the doctors and consultants have more time to actually spend time with you, their patient. Surely this is better for the patient?”

Perspectum has now completed around 80,000 scans. “To achieve profitability, we need to achieve 4,000 scans a month. We are expanding first in the USA because that’s the highest paying and also has the

Artificial Intelligence frees up time for patient contact

Another challenge has been changing ingrained working practices within the medical profession. Consultants have long used biopsies as a tried and tested method of aiding diagnosis, and many must be persuaded to embrace new technology.

“Our technology is better for patients and for consultants. The pharmaceutical companies we are working with have mandated our scan, encouraging a greater uptake of our service,” said Banjo.

highest prevalence of patients with liver disease who have insurance cover for our scans. That’s how we get to our 4,000 scans per month.”

Perspectum employs 280 people, about half are based in Oxford. Banjo is keen to ensure that the company’s successes are enjoyed by all staff. “Everyone has share options. On the day that we win, we will all be able to celebrate. It makes for a better culture.

And what is a win for Perspectum?

“We want every patient to be able to access our software, wherever they are in the world.”