Cyted: From Cambridge start-up to digital pathology front-runner in one year

Economic wreckage lies all about as one of humanity’s most traumatic years comes to a less-than-glorious finale yet, as the smoke clears, it is a fact that in Cambridge science and technology has remained, not just resilient, but capable of kicking on.

Take Cyted as an example. 2020 saw its artificial intelligence-based healthcare offering accelerate both scientifically and business-wise. Where there was a trio of co-founders there is now a team of 25, with more than 10 roles pending.

“This is now growing faster than anyone expected,” admits CEO Marcel Gehrung, who co-founded the digital detection of disease specialist in 2018 with CSO Prof Rebecca Fitzgerald, professor of cancer prevention at the University of Cambridge, and CMO Maria O’Donovan, who is lead pathologist for upper GI cancer and diagnostic cytology at Cambridge University Hospitals.

Cyted was in stealth mode until 2019. Marcel, previously a tech entrepreneur in his native Germany, only finished his PhD in artificial intelligence in healthcare from the University of Cambridge in November.

“Late last year the thoughts crystallised that this could be a start-up,” he says by way of explanation.

2020 started briskly, with a £7.5m funding boost via an investment round led by Morningside Venture Capital, and then a £1.2m industrial challenge strategy fund from Innovate UK.

“We raised the round in January, and announced it in February,” notes Marcel. “We’re getting close to burning through to the 50 per cent mark now. One of the major things was the acquisition of Pathognomics, plus building a team, the software engineering involved, and building our operations.”

Cyted acquired Huntingdon-based Pathognomics in October: the provider of digital pathology and clinical diagnostic laboratory services was already working with Cyted, and the headcount duly rose from 15 to 23 – all Pathognomics employees joined the Cyted group. Pathognomics’ co-founder and laboratory director Christopher Evagora became Cyted’s senior director of laboratory operations, and Alec Hirst, co-founder and project director, became Cyted’s senior director of business technology.

Mr Evagora said: “From our first conversations with Cyted, it was clear that the diagnostic technology and infrastructure being developed by the team will bring significant benefit to patient care. Over the past four years, we have established and optimised our workflow here at Pathognomics.

“I look forward to expanding the scope of our services to the next level.”

Cyted now both develops and service-provides AI technology and digital diagnostic infrastructure which enables earlier detection of disease. The acquisition of Pathognomics has provided an accredited laboratory environment and digital pathology technology: the two companies have already set up and launched diagnostic services enabling the rapid uptake and expansion of the pipeline of novel biomarkers and AI technology for the earlier detection of disease.

“It was a strategic decision,” says Marcel of the purchase. “We started with Pathognomics as a sub-contractor and had been doing work with them for one year already. We wanted to get the development in-house.”

The diagnostic process now is focused on Barrett’s oesophagus, in which the cells of your oesophagus begin to resemble the cells that make up your intestines (often after years of acid reflux).

“Barrett’s oesophagus is a precursor lesion for cancer of the oesophagus – cancer of the food pipe,” says Marcel. “It’s an important service because it offers early detection in the cancer space – cancer of the oesophagus is seen by Cancer Research UK as a ‘cancer of unmet need’.

“The normal service for a patient who has symptoms is to have an endoscope inserted into the oesophagus. So if they want a tissue sample it has to be taken from a specific area, but Cyted can get a tissue sample from the entirety of the oesophagus to pick up disease.”

The test relies on use of the Cytosponge, an ingenious device developed by researchers at the University of Cambridge with Cancer Research UK funding, and commercialised by Medtronic.

It consists of a mesh sphere on a string inside a gelatine capsule.

The capsule is swallowed by the patient and the gelatine capsule dissolves in the stomach, allowing the sponge to expand.

The sponge is then quickly withdrawn from the stomach by a nurse, sampling cells from the surface of the oesophagus.

The cells and biomarkers associated with Barrett’s oesophagus are analysed using the Cyted pathology platform.

It is a simple and well tolerated test.

“With Barrett’s the cells are currently analysed by the pathologists manually, but one of the main things Cyted does is working with the images we have of those cells to spot things the pathologists don’t see,” says Marcel.

It is a massive step forward, and Cyted is already “working closely” with NHS Scotland and NHS England – firstly on the diagnostic testing but also on how to maximise the potential of the data residing in the NHS records system.

Dr O’Donovan said: “We are delighted to be working with UCLH, alongside Medtronic and Pathognomics, to launch the first clinical procedures for the early detection of Barrett’s oesophagus.

“We are excited to bring this technology to patients, which, when paired with our state-of-the-art biomarkers and digital solutions to maximise accuracy and high-throughput delivery, will make a real difference to the earlier detection of oesophageal cancer.”

So is the final analysis done by people or by machine learning?

“It’s a good question,” replies Marcel on the virtual chat room. “It’s not fully-automated tools, it’s semi-automated tools.

“A doctor has to look at a massive sea of cells, and 99.95 per cent will be fine, and 0.05 per cent is interesting, and you just ask the machine ‘Don’t highlight areas which are not relevant, only highlight an area when you’re sure there might be something – you always keep the human in the loop.

“The only thing these tools can do is helping with bottlenecks, and they lessen the risk of missing something important by focusing on the right things at the beginning.”

So Cyted is doing both the cell analysis and the machine learning – will it continue with both tracks?

“We see ourselves as a company developing into the second area – machine learning rather than cell analysis, but with the cells it’s the best first-use case using the technology we are building.

“It’s married up quite a lot and is developing. So far it has been planned – not the scale, but what we have been doing. The technology strategy for the next year is a lot of what I’m doing now.”

Marcel gets input from Martin Frost, the co-founder and former CEO of CMR Surgical, now enjoying new-found freedom as a roving ambassador sage for a variety of companies including Cyted, where he took on the role of non-executive director in November.

Martin’s business style had long since caught Marcel’s eye. One of the reasons Hong Kong-founded Morningside was the prime initial investor was due to a desire to build a different type of company.

“Martin also doesn’t behave within the standard rules of the Cambridge ecosystem,” says Marcel, “and that kick-started us not to be constrained by any common factors which the Cambridge ecosystem imposes on companies, so we’re thinking about the UK and the scope of the market, and going directly for what can move things forward.

“I was interviewed by Martin – I had a chat with him in Espresso Library – and actually we’ve become quite good friends. As well as being a non-executive director for Cyted, he’s also a mentor for myself.”

Martin Frost CBE told the Cambridge Independent: “Cyted is a great company and is moving quickly to fulfil its mission to revolutionise digital pathology.

“I love working alongside, contributing and learning from Marcel; he has a relentless drive and curiosity with a strong clinical and ethical approach – critical ingredients making up an impressive leader.”

So as well as having a handle on the digitisation of medical science, Cyted also has a de novo business strategist – a useful asset for 2021– at its heart.