Reduction of treatment costs and improved risk-stratification for diabetes patients in primary care: multi-organ MRI technology powered by artificial intelligence.

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"There has been a surge in incidence of the metabolic syndrome, a cluster of conditions including obesity, increased blood pressure and Type 2 diabetes (T2D), which increase the risk of fatty liver disease, steatohepatitis, heart disease and stroke. Multiple interacting organs are involved, primarily the pancreas, liver, spleen, kidneys and heart. Though T2D occurs when the pancreas doesn't work properly, concentrating on a single organ (e.g. pancreas) to diagnose T2D, or to assess the risk of it developing, is insufficient because all of the organs interact as a complex system, and so not only do each contribute to the diagnosis, but so does their combination.Most diabetes cases are detected using circulating (blood, urine) biomarkers (e.g. creatinine, aspartate transaminase, HbA1c). However, these are not sufficiently organ-specific and would benefit from complementary imaging, in particular MRI with its excellent soft-tissue contrast.Once detected and diagnosed, T2D is typically treated with the drug Metformin. This has transformed diabetes care; but it has limitations. New drugs overcome many of these limitations, including the glucagon-like peptide (GLP-1) receptor agonist and immunotherapies. Unfortunately, these cost at least ten times more than Metformin, so prescribing to everyone with diabetes poses a major problem for the NHS. This proposal aims to develop a method to stratify those patients for whom Metformin is expected to be inadequate and who should be prescribed more advanced, more expensive therapies. The technique will be based on Perspectum's Liver_Multiscan_.Perspectum has developed a quantitative MRI method to detect and stage early liver disease. As well, it has pilot data demonstrating its utility in other organs, for example: its technology can be used to estimate portal hypertension from the spleen; that it can detect and measure pancreatitis and fatty pancreas; and can characterise the tissue of the kidneys. Furthermore, Perspectum's founders worked originally in heart MRI imaging.This proposal will extend Liver_Multiscan_ to the other organs and vessels -- pancreas, kidney, spleen, aorta -- involved in the metabolic syndrome. The technical developments by Perspectum will be complemented by the accumulation and analysis of clinical data, both circulating biomarkers, genotyping and imaging, at three diverse endocrinology centres (Liverpool, Oxford, London). There will be strong patient and clinician involvement. The enhanced multi-organ product will be commercialised by Perspectum. The data produced by the project will be made available to researchers throughout the UK who are working to advance our understanding of T2D and the metabolic syndrome."