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Company of the Month: Motilent

Motilent is on a mission to change the way we see the gut. Spanning around 9 metres, the intestinal tract forms a crucial part of our digestive system, as well as having a direct link to the cognitive and emotional centres of our brains. But it’s not necessarily seen as the most ‘attractive’ area of the body to focus on. Motilent’s Founder and Chief Executive Officer, Alex Menys, however, has a long-held fascination with the gut.

From PhD to business

With masters degrees in Biochemistry and Medical Physics already under his belt, Alex completed his PhD in magnetic resonance imaging (MRI) image analysis, focusing specifically on the gut. A business in processing MRI images grew organically out of this work, as Alex found himself being asked to provide consultancy on a growing number of clinical research projects looking into areas such as Crohn’s disease. Motilent was formed in 2013 in response to this demand, but a turning point came in 2017, when Alex, along with collaborators at UCL, secured a product development grant from the National Institute for Health Research (NIHR). This allowed the company to hire a small team, focusing on developing their first product – GIQuant.

Enabling precision medicine

The AI-powered software works alongside standard MRI scans to measure and track movement of the intestine. This measure of intestinal movement, known as ‘motility’, is often affected by gastrointestinal (GI) disease activity. GIQuant produces an objective score of motility in patients with Crohn’s disease, allowing doctors to tell with greater accuracy how individual patients are responding to treatment.

As Alex explains, the advent of biologics (a sophisticated type of immunotherapy) led to a revolution in Crohn’s treatment, but they can cost between £5k and £20k per year, and have as much as a 50% failure rate.

“Because they’re a biological class of drugs, the human immune system can build up a response that stops the drug working. This means there’s a really fixed time period where treatment will be effective, so it’s crucial to spot a flare up early and move the patient into remission as quickly as possible. What you don’t want is a patient taking a drug that is no longer working for an extended period of time. Not only can this lead to fibrotic, irreversible disease that needs surgery, but it also increases risk of cancer. Our technology has been developed to help the clinical team tell sooner if that’s the case, so that other treatment options can be explored,” explains Alex.

Sights set on the US

Motilent has around 50 projects running globally, using their technology across inflammatory bowel diseases like Crohn’s, as well as in other areas, including Parkinson’s Disease. Across the UK, it’s being put to use in a number of hospitals, including Great Ormond Street.

But, the most exciting recent development for the company is that, in late November, they secured FDA clearance for their technology. Alex sees this as an opportunity to deliver value to patients and providers in a high-spend area of healthcare:

“In the US alone, roughly $20B is spent on this disease area. Nearly every pharma company has an asset in inflammatory bowel disease, so there are a lot of treatments. But the trouble when there are lots of treatments available, is that there can also be lots of waste. The value we’re able to bring is precision treatment that allows a patient to complete their treatment quicker and with less time on drugs destined to fail. This is the first of, hopefully, many innovations we’re going to bring into this space.”

The company is collaborating with AI patient care software provider Nuance – whose solutions are already used by 80% of US radiologists – to get their technology in the hands of practitioners across the US. The aim of this strategy is to fuel word-of-mouth and personal recommendations of the solution while a critical mass of – increasingly real-world – peer-reviewed literature is developed.

A level-headed approach to funding and spending

This organic approach to growth and pragmatic approach to finances is echoed time and again speaking to Alex. He is understandably proud that the company has achieved its success to date, with no large Series A, or even seed investment. Instead, they have relied on grant funding (following the initial NIHR grant they received £1.6m from Innovate UK, and a further £1.1m from NIHR), some smaller 6-figure private investments, and good, old-fashioned revenue-generation to fund their development so far.

“The approach has been to keep the overheads low and build a company that is set up to endure. I didn’t feel raising huge amounts of money quickly would achieve that, given the nature of the field that we’re in, and the time things take. The path to clinical adoption is absolutely a marathon not a sprint. You need to build trust and confidence in the clinical user base, and that takes time. Of course, when you get a positive signal from the market, you’re going to need money, but it should not be the very first thing you think about.”

To further build that trust and confidence, Motilent have stayed true to their original foundations in Alex’s PhD research, and continue to focus heavily on research, not just to validate their technology, but also to develop deep trust with the clinical user base:

“We will never, ever stop doing research. It is the cornerstone of the entire business, and it fulfils many roles. One of them is simply marketing, because nothing sells a product better than a Lancet paper. But in general, there are just so many questions to answer about both efficiency and efficacy. As a product gains traction and moves to a more significant position in the care pathway, yet more research must be done to define thresholds and build confidence – this is a dynamic process that, as a company, we must stay on top of and drive where we can.”

Motilent currently has a large NIHR-funded multi-centre trial running across 16 hospitals in the UK with 140 recruits, led by Prof Stuart Taylor and Dr Andrew Plump at UCL. The trial will test whether, using MRI scans at month 3 and month 6 after a patient starts therapy, GIQuant can predict what their status will be after 1 year.

London base

This dedication to research has been supported by their London location. Although the company is predicting their future sales growth will come from the US, they continue to see the UK as their research base:

“The UK does incredibly well at high level research. We have this funding infrastructure, through Innovate UK and the NIHR, that allows us to massively outperform per capita on research and clinical work, and of course large numbers of engaged patients who’ve contributed their data via UK Biobank and other NHS initiatives. On top of this, organisations like MedCity provide that connective layer, joining up the research and the entrepreneurs. Some of the MedCity workshops we were able to attend on building evidence strategies were really important to informing our thinking on this. If you’re building an evidence base for your tech, hands down, the UK is the best place to do it. There’s no finer place in the world.”

Alex also found being part of the London life sciences community to be crucial, even if he has missed the opportunities for face-to-face meetings during Covid-19 restrictions:

“The community in London – that MedCity is very much a part of helping to develop – is key to companies like us. It presents opportunities to take part in interdisciplinary meetings and conversations with diverse, interesting and talented people. Those are so valuable to helping work through the occasional sticking points in starting a new company.”

Future plans

Aside from US expansion plans, the company has three more products in the pipeline. One of these will integrate ultrasound scan data alongside the MRI data of GIQuant, to further enhance the care pathway of people with Crohn’s. Alex is taking a typically careful and methodical approach to new product plans though, and has this advice for other innovators in the field:

“What I would ask is ‘If you made your product today, how would you sell it tomorrow?’ There are, of course, opportunities in this space to introduce highly disruptive technologies, but innovators need to be crystal clear on what their next steps are, that there is a ‘home’ for their product, and ensure their business is set up accordingly. If the established care pathway needs to change to make your innovation work, you need to know what that means for your business. If more evidence is needed, then invest in the research. Ultimately, innovators need to be clear that practitioners will be able to put their product to use, that patients will be benefited, and that they know how it’ll be paid for, (but let’s not get into that part!)”

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