From World of Warcraft to raising $44 million: How Marcel Gehrung is transforming endoscopy

Cyted Health is a Cambridge-based diagnostics company founded in 2018 by Prof Rebecca Fitzgerald, Dr Marcel Gehrung, and Dr Maria O’Donovan. Its flagship product, EndoSign, leverages a simple capsule sponge to collect oesophageal cells for molecular diagnostics, enabling rapid, minimally invasive detection of Barrett’s oesophagus and pre-cancer. So far, the company has delivered over 35,000 tests across more than 80 NHS sites and continues to expand its footprint, targeting accelerated growth both in the UK and internationally, having received FDA 510(k) clearance. At the helm as CEO is Marcel, who has a Cambridge PhD in machine learning in healthcare and whose leadership earned him recognition such as Forbes 30 Under 30 and the Prix Galien award.

I sat down with him over a video call on a Tuesday afternoon in August. It was just off the back of a very busy couple of days for Marcel, as he was on the last stretch of closing a series-B funding round of  $44 million from some of the top life sciences investors. I can sense the relief on Marcel’s face and he says “it’s been a bit of a pain fundraising but it’s a really good syndicate’’. I know Marcel through my day job as a venture capital investor in life sciences companies (he provides valuable due diligence on startups in the diagnostics sector as an advisor) so we skip the introductions and jump straight into Marcel’s journey.

Hassan: I wanted to start off with your backstory – you have a PhD in machine learning, specifically within healthcare. I was quite curious because not that many people were interested in AI and healthcare when you were doing your PhD, you were doing something before it was ‘hot’. Did you see a trend or did you always have a passion in that area?

Marcel: Let me go one step before that. I always had an interest in natural science when I grew up. When I was 15, I had a congenital heart defect and had open-heart surgery. I was out of school for nearly a year. So I had nothing better to do besides playing World of Warcraft and teaching myself coding.

This was when I became interested in software development, but from a very practical perspective, not theoretical. When I went to university, I [did an interdisciplinary degree] called nanoscience. It was mostly material sciences with lots of physics and a bit of biology and a bit of chemistry. 

Later on [during my] PhD, I changed tact slightly and did a masters degree in biomedical engineering, at a time when deep learning in radiology and medical imaging was becoming interesting And because I had a fairly broad background, I tried to sell myself to a maths and machine learning group in Cambridge.

They wanted to do a lot more stuff in biomedical imaging, other types of imaging data, and also other types of omics data. I ended up doing a PhD in that space which then became a lot about the applied machine learning, though more so on the clinical side and a lot less on the biological side. 

H: I wondered, because Cyted has someone with your background – looking from the data side and the AI side, how to interpret the biology – that's the reason where Cyted is today? Otherwise it would be an incomplete story because it's just collecting samples initially.

M: Weirdly enough, in many areas of academia and in business, it doesn't really matter whether you know the answer. It only matters whether you know the right question. Finding the answer is achievable, while knowing the right question is not so easy sometimes. In a very convergent world, having different disciplines is probably still the most relevant skill to have. When I started working on some of the data around the technology, that ended up becoming the foundation for Cyted – I just continuously asked questions. 

The capsule sponge test (EndoSign®) made by Cyted.

H: You have mentioned elsewhere how you met your co-founder Prof Rebecca Fitzgerald while working in the lab. What triggered you to take the step from academia? 

M: I actually was looking at postdocs at the same time we started the company because I didn't really know where it was going until we had some material seed funding. It might have been Steve Jobs who said this 10, 15 years ago – it's much better for the world if people lead by necessity rather than by desire. If you're the right team at the right place, then do it.

It became obvious that the team we put together with the data, if it wasn’t us, then probably no one would have done it. Maybe that would have changed in the last few years, who knows? 

In academia, that's particularly relevant because most academics might be scientifically arrogant, but very few of them dare to know anything or want to know anything about the world of business. So you find a lot of people who have all the right abilities and assets and might even make good founders or CEOs to spin out technologies. But they never want to, even though they would probably be the best ones. And I think that's at the core of a lot of issues: why we have so much good IP lying around in universities and not enough people that spin it out. 

H: You mentioned if it was not, you and the team around you, then who else? It feels like a sense of urgency, like ‘we should take it out rather than wait for someone else to do it’.

M: What took me a long time to learn is that you really lean into this. There are two fundamental differences in my world view on this: one is people truly believe in a problem being a problem and whatever they're working on the true solution for it. Or it’s a ‘fake it til you make it’ problem, where timing plays into it. The best technologies and companies happen right at the intersection of this. 

So I personally had enough faith in what we were working on in the early days, but I was also sceptical about what the real world would think about it.

H: That's a crucial mindset to have, isn't it? A lot of founders get so married to the idea and they're very hesitant to take any feedback. So it's interesting that you were quite sceptical as well. 

M: I have not met a single CEO that is not always going through phases of waking up and wondering why they're doing this. It's not a very rewarding job. It's very isolating [and has its] ups and downs. Every day, the emotional roller coaster.

H: Yeah, based on my experience as a founder, the highs are higher and the lows are lower.

M: I actually said something to myself the other day which is if I would give my five-years-younger me some advice now, then it's don't do it because it's not worth the journey. Whereas today, after having gone through it feeling like I'm in for the ride now, I would do it again, because I've gone through it for the last five years. But to my five-years-younger me, I would say I'm not entirely sure whether the lows and the highs are worth the balance there.

H: When you transitioned to CEO and a commercial role from academia, what was harder than you expected? 

M: I realized that the skill set of academia and being a CEO is like a Venn diagram that doesn't really overlap most of the time. 

But it does depend on how the company is being set up. I had two clinical scientific co-founders, but they were never involved in the business side. I never had an experienced CFO or even an experienced FD or anything like that. 

You learn the hard way. The very first time we fired someone, I remember how much it dragged me down for like days and weeks – I didn't know what was right or wrong. No one has the generic manual. I resorted to talking to people and having some mentors over time that were mentors for a couple of years.

But then you've learned what you can learn from them and then there's new people out there and that's how I personally got by.

H: As a CEO in an early stage company, each decision is so crucial, right? Sometimes academics can be risk averse and like a data-driven decision. So I'm curious to get your view, having to make a decision all the time without much information?

M: I think that's a very good question because that's one of the things where, only now after five years, I can go back to certain key decision moments and I know how important they were. But certainly at the time, it felt like a single decision that was isolated. It wasn't as obvious that there was a series and sequence of decisions that led from A to B. 

If I look at something today, I have a much better gut feeling of ‘is it a very important or relevant decision or will it be very relevant in the future?’ That is one of the key CEO skills which you can actually address from different angles. 

Cyted’s EndoSign® is a minimally-invasive capsule sponge device that enables safe and accessible cell collection with full esophageal sampling.

H: What is the impact that you hope to achieve in the next 10 years?

M: The short version is non-endoscopic technologies for GI diseases – I'm 99% sure that will be the gold standard. The way we look at endoscopy and who we do endoscopy on will radically change, and we will look at tools like ours first before someone is subjected to an endoscopy. We are seeing this now already. Clinical guidelines are getting behind that.  

H: One of the things I struggle with early stage diagnostic companies based in the UK is that they're very focused on the UK market because that's what they know the most – it’s low hanging fruit. You have already explored the US market quite a bit. What would be your advice for UK-based diagnostic companies trying to navigate the US market and the FDA?

M: “If it's not made in America’’ is probably the best way of putting this. Operating in the US requires a US mindset, which requires a US team, which requires quite a lot of cultural alignment. This is true for any health tech company. The main thing is to figure out whether your lessons translate from the UK to the US, because people aren't particularly forgiving if you don't look like you understand their system.

It's a country that doesn't care whether you have a British accent or a German accent or anything like that. But they do care if you don't know what you're talking about, even if it's the basic stuff. So that's what I meant “if it's not made in America’’. You can do so many things from here in the UK, and some of these companies can be successful. But if you want to commercially build a business in the US then you have to think primarily like a US company. Because at the end of the day, the US is a much bigger target market than any of the European countries or Europe combined.

So the answer is be as American as you can tolerate.

H: Did you have any mentors or supporters early on who gave you very valuable advice?

M: My favorite one is that the quality of the average CEO is pretty shit so don't worry about your imposter syndrome too much. The other one, which is a bit more important, is that every company is completely broken at least once in its life cycle. And the important emphasis is ‘at least once’. I’d say one is probably the outlier – most companies are broken entirely more than once in their life cycle. And that's not great, but it's part of the journey.

H: If a PhD student or postdoc is thinking of taking their science into the world as well, what advice would you give them?

M: The biggest issue most scientists face in business is that they don't trust their intuition because they feel like there are rules out there which they're not aware of and they are anticipating how they're going to work around these rules. But intuition usually wins. 

Doing the right thing versus playing the game is a very delicate balance to be struck. Usually the right thing should win in the long term. It doesn't mean that it wins in the short term, but it's not a very good reason to compromise on doing the right thing and following your intuition just because it might look like it's the wrong thing.

You can learn more about Cyted Health here: https://www.cytedhealth.com/