Company of the Month: MultiplAI
MultipleAI was set up with the vision for universal access to genomic screening for cardiovascular disease. Having moved the company from their home in Argentina, co-founders Santiago Miriuka (CEO), Charlie Luzzani (CSO) and Mark Ramondt (COO/CFO) are quickly building a new home in London and Cambridge. We spoke to Mark about how they’re using AI in exciting new ways, and why they chose the ‘golden triangle’ for their new home.
Skin in the game
In Mark’s words, he has ‘skin in the game’ when it comes to cardiovascular disease. MultiplAI started as a conversation between Mark and his cardiologist (Santiago). Around 15 years ago Mark developed a heart problem, and Santiago had been his cardiologist for the last 12 years. In 2019, knowing that Mark had a background in finance at Unilever, followed by consultancy with startup businesses, Santiago approached Mark with a business idea. Two short years later, they have patented their technology, completed three clinical trials and relocated across continents with the business.
The technology is based on work that Santiago was doing in a lab he founded in Argentina. Along with their third co-founder, Charlie, he was looking at RNA sequencing to identify opportunities to diagnose complex diseases like cancer and cardiovascular diseases. The process is widely used in cancer diagnosis, but they found that its potential for heart disease wasn’t being recognised:
“Despite all the information that was coming out about sequencing RNA, there wasn’t a good way to analyse it. This has changed more recently as next generation sequencing has matured as a technology, both in efficacy and cost. What we’ve developed is a technology that takes all of the RNA in the blood – the data that we can extract from just one blood sample is equivalent to a 20 Gigabyte data file – and converts it into an image that’s ideal for algorithmic analysis.”
Example of an image produced from RNA sequencing (Image credit: MultiplAI)
Training the algorithm
That algorithmic analysis is what the team have been focused on since relocating to the UK in February this year. In March they joined a 6-month programme for startups run by genomic sequencing specialists, Illumina. The programme gave them access to Illumina’s sequencing tools, which they’ve used to full benefit, running three clinical trials in Argentina, and using the data to train their algorithm, and test their hypothesis.
“From those first trials, we’ve been able to classify samples for their risk in different cardiovascular diseases, with an accuracy of over 90%, and often closer to 98-99% accuracy. It’s hugely promising for the potential for earlier diagnosis of cardiovascular diseases like heart failure and arterial sclerosis.”
Mark says that that accuracy is, in part, down to the detailed analysis they do – running ‘deep’ sequencing of 100 million reads for each blood sample.
Aside from the founders’ personal interests in heart disease, Mark explains why they felt it was an important area to address:
“Cardiovascular disease is the number one cause of mortality globally – it kills about 18 million people a year. It’s also not just a male disease, as people commonly think. In the UK, 7.6 million die from cardiovascular disease every year, around 47% of those being female. In fact, it is 15 times more deadly for women than breast cancer. So, it’s a disease that affects people across the board, and on top of that, the costs of treatment are huge. Around £1 in every £6 spent in healthcare is related to combatting cardiovascular disease.”
Mark sees huge potential for those healthcare costs to be slashed if their technology takes off. The test itself involves a simple blood test – taking 3 millilitres of blood – that can be kept at room temperature for a number of days without degrading. So, the vision for ‘universal’ screening suddenly seems very achievable. The ability to carry out the test at home, or in the middle of the desert for that matter, is something close to the hearts of the founders, as lack of access to healthcare means the general population have a very small chance of being diagnosed with cardiovascular disease early.
As well as the relatively low cost of taking a sample, Mark explains that rapid advancements in technology mean their costs for carrying out the analysis will continue to drop into the future:
“Around 80% of our cost is in the sequencing processes involved in extracting the RNA from the blood and converting that information into a digital format. Five years ago, that cost was between $2000-6000 per blood sample. Today it’s around $300-500 per sample. So, the affordability of sequencing technology is growing all the time, with it’s scale of use.”
Choosing the golden triangle
The speed of developments for the company is impressive – that first conversation between patient and cardiologist in 2019 led to them spending 100% of their time on the project within six months, a company officially formed within a year, and a PCT patent shortly after that. Then, five months after forming the company in September 2020, in February 2021 they took the leap to move to the UK.
Mark says that they considered a few options of where to locate the company, including the Netherlands, New England and San Francisco, but ultimately, the decision to choose the UK was easy from a business perspective:
“The focus on genomics, AI and diagnostics in the UK, as well as the NHS’s focus on cardiovascular health, were all big pulls to the UK. Genomics England, the Wellcome Trust and others help make the UK the global leader for genomic technology. Combine that with the public funding that is available, and the amazing pool of talent in the UK, and you have a clear winner. Soon we hope to be in a position to hire a number of talented data scientists, experts in AI and bioinformaticians. Those people don’t exist in many other places in the world.”
That said, the decision to move cross-continents wasn’t so easy on a personal level. Both Mark and Santiago have families at home in Argentina (who they hope will eventually join them in the UK), and visits have been made all-the-more difficult with the COVID-19 pandemic. Mark notes that Santiago has spent 37 days in quarantine this year, and so, trips home to visit family have to be considered carefully.
The difficulties seem to have been outweighed by the support they’ve received for the move though:
“The support we’ve had from MedCity has been amazing. From endorsing our visas, to putting us in touch with potential partners, to helping us find lab space – it’s been hugely helpful. We’ve also had support from One Nucleus, Innovate UK, and grant funding from South Cambridge District Council. We’ve been really impressed with how hands-on and supportive the whole ecosystem is.”
That funding so far, gave them £500k to complete their first three trials, as well as build a team of 11 (including five in the UK and six in Argentina). They’ve now launched a seed round to raise £2.5 million to support a new set of UK-based trials (to ensure regulatory approval), and to secure lab space in the UK.
The immediate focus is on completing those UK clinical trials and building partnerships to achieve that. They’ve just agreed a partnership with Queen Mary University of London:
“The partnership with Queen Mary will create expanded opportunities for academics, clinicians and industry to work together to develop and test new diagnostics with the local population. Queen Mary have an amazing track record in cardiovascular treatment, so we’re really excited about it. On top of that, we’re also exploring other routes to build engagement with academic institutions, by way of MedCity’s Collaborate to Innovate programme, which is yet another fantastic opportunity available to young companies here in London.”
Beyond this, although Mark agrees the technology and processes they’re developing could be applied to many other diseases, they’re currently laser-focused on cardiovascular health:
“I think, with any startup, you need to be very focused and figure out what market you’re going to develop for, and where you can get investment. For us, the future is more about our geographical spread. We’re focused on the UK at the moment – we’d love to be working with the NHS on a pilot programme – and then Europe and the US.”
And of course, in the longer term, they hope their technology will be able to be widely used for early diagnosis and treatment:
“To be able to identify the risk of a 10, 20 or 30 year-old developing cardiovascular disease later in life, and then be much more precise and certain about the treatment they need. And for that to be possible universally. That’s the vision.”
Find out more: multiplaihealth.com