Born in Zimbabwe, Elizabeth's father did a degree in avionics and aviation and landed up becoming a pilot, while her mother went for a career in finance, tax and customs. Attending school in Harare, Elizabeth remembers her teachers always encouraged her to do a range of subjects so that she would keep her options open when she went to university. When deciding which A Levels to take she considered the saying 'if you aim for the moon you will land on the stars' and decided that her ambition was probably higher than that so instead saw herself aiming for the sun, because, as she says, that way she would end up on the moon.

In the end Elizabeth chose to take a degree in engineering at university. She made this decision after getting inspired by watching a warrior robot called Bumblebee in a science fiction film series based on toy Transformers. Inspired by Bumblebee's energy and determination to do the right thing, Elizabeth decided a degree in engineering would equip her with the necessary skills to make her own robot.

Elizabeth did her undergraduate degree in South Africa which she completed in 2013 after four years of study. When she set off from Harare her parents thought she would fail in the first year because the course is notoriously difficult. And at times she says it did prove very tough. Significantly she was the only black girl in her class who managed to graduate.

After finishing her degree, Elizabeth did a graduate internship at Schlumberger (now known as SLB), an oil and gas company. After less than a month with the company she got to see an oil rig for the first time, a platform used to extract and process petroleum and natural gases found in rock below the seabed. Disliking the fact that people needed to go down mines, she began to think about the possibility of designing a robot that could do the same job. Part of this stemmed from her desire to develop technology that could help people. But in the end she did not continue with the internship because she was put off by the inefficiencies and losses she witnessed in the industry.

Disheartened by what she experienced during her internship Elizabeth went home to rethink what she really wanted to do. With some of her family already in Surrey, England, her parents encouraged her to consider doing a master's degree in biomedical engineering at the University of Surrey. They pointed out to her that doing the course abroad would give her a fresh start and new horizons to consider.

Entering the biomedical engineering field

Elizabeth really enjoyed her year-long master's course. During the course Elizabeth took the opportunity to study autonomous electric vehicles, dental implants, robotic prosthetics and medical devices. For her master's project she helped develop a platform that made it possible for a camera pill to harvest electromagnetic energy from any external source so that it could recharge itself while taking pictures as it travelled inside the body (Shumbayaonda). After Elizabeth finished her master's she was offered a position at Smith and Nephew, a multinational medical technology company, to join a team working on a medical device.

Instead of taking the job with Smith and Nephew, Elizabeth opted to do a PhD in biomedical engineering in the School of Mechanical Engineering science at the University of Surrey. Elizabeth points out that it would have been tough for her to do the doctorate in biomedical engineering had she not studied biology for A level. Taking the A level had not been straightforward because at her high school, GCSE chemistry was a prerequisite to be allowed into the A level biology class, something which she had not done. But fortunately by some stroke of luck, she says, her biology teacher somehow overlooked this fact and let her into the class.

For her doctoral research Elizabeth investigated the use of advanced signal processing techniques to study the effects of age on the brain. This included looking at the effects of cognitive decline in the early stages of Alzheimer's Disease. She found that age, sex and cognitive decline had profound effects on brain activity. One of the techniques she used for her research was magnetoencephalography, a non-invasive analysis technique which makes it possible to record the magnetic fields generated by electrical activity in the human brain. In order to analyse the data, Elizabeth had to learn a lot of computer coding which she was glad she learnt during her undergraduate degree and really enjoyed.

Elizabeth had a very supportive supervisor for her doctorate who encouraged her to apply for lots of different research grants. One of those she managed to get was from Santander which gave her funding to go to Spain for four months in the middle of her PhD to collaborate with researchers based at the University of Madrid. This gave her the chance to work with some neuroscientists and neuro physicians using cutting-edge techniques to map the brain of epileptic patients to help guide surgery. It also introduced her to the use of magnetic resonance imaging (MRI) in real-time for the first time. Elizabeth came runner up for the Dennis Hill Award 2016 Healthcare Technologies Student and Early Career Awards held by the Institution of Engineering and Technology for best masters research study (IET). In addition to this, Elizabeth also came second place for the DePuy Prize for Best Medical Engineering PhD Project UK at the awards held in 2021 (IME).

Joining a biotechnology venture to combat disease

Really inspired by what she learnt in Madrid, once Elizabeth finished her PhD she began scouting for biotechnology companies that could offer her scope to continue working with non-invasive medical imaging technologies. In April 2019 she joined Perspectum, a spin-out company from Oxford University. It was founded in 2012 by Dr Rajarshi Banerjee who, while doing his doctorate on MRI imaging of cardiovascular disease, hit upon a new way to measure the amount of fat, iron, inflammation and scar tissue (fibrosis) in a person's liver using noncontrast MRI. This was important because people with abnormal livers, usually caused by too much fat, are twice as likely to die of heart disease (Henry; Roca-Fernandez). Banerjee realised his new MRI method could be used to replace biopsies required to diagnose patients suspected to have liver disease thereby reducing the harmful side-effects of the procedure.

One of the problems with biopsies is the procedure is painful, expensive and very time-consuming. A biopsy, and the resulting follow-up care, can take at least eight hours if not more. This includes the patient coming into hospital to be prepared for the procedure before getting punctured. They then have to be observed in the hospital to make sure they are all right before being released to go home. In some cases patients have to stay overnight for observation. All of this adds to the time patients might have to take off from work or school and also occupies hospital beds and staff time that could be used for other purposes. In addition to hospitalisation, there is also the additional risk the procedure carries in terms of bleeding, pain and, in rare cases, death. Elizabeth points out that complications from liver biopsies are especially common in children and can have far more severe consequences. This is a serious problem because children diagnosed with liver disease are expected to have serial monitoring biopsies.

An MRI scan has the advantage that it is non-invasive. It also makes it possible to look at the whole liver and detect patchy disease which a biopsy cannot do as it samples only a tiny fraction of the liver. Having such a non-invasive diagnostic tool is particularly important for addressing the growing public health threat of liver disease which often goes undiagnosed. In 2006 as many as one in ten adults in the UK were estimated to have some form of liver disease and it was the fifth most common cause of death for both men and women (Tunnicliffe). Despite 63% of adults being classified as obese and overweight in the UK, and 1 in 4 estimated to have early-stage NAFLD, only about 83.5 thousand (less than 1%) patients are diagnosed (Morgan; British Liver Trust).

Elizabeth sits in the translational science department and leads the company's research using two of their technologies for supporting the diagnosis, management and clinical decision making in various chronic liver diseases. This includes nonalcoholic fatty liver disease (NAFLD) which is estimated to affect one billion people worldwide and is forecast to rise rapidly in the future due to increased obesity and type 2 diabetes. There are about 14 million adults with NAFLD in the UK. Approximately 20% of the NAFLD population (nearly 2.2 million) have the more aggressive subtype, nonalcoholic steatohepatitis (NASH) (Le; Morgan).

Other chronic liver diseases Elizabeth and her team are working on are autoimmune liver diseases (autoimmune hepatitis [AIH], primary sclerosing cholangitis [PSC] and primary biliary cholangitis [PBC]). These are rare progressive disorders caused by the patient's own immune system beginning to attack healthy liver cells by mistake, which leads to chronic inflammation of the liver. They are of particular concern to healthcare systems as they account for ~41% of all liver transplants (Younossi).

One of the major challenges with NAFLD is that it is a largely silent disease and causes few specific symptoms until the liver is seriously damaged. This increases the patients' risk of liver failure and cancer which is often fatal. NAFLD currently has no cure and depends on getting early diagnosis to try and identify those who are at the most severe risk of cirrhosis and liver cancer so that they can receive appropriate intervention to try to slow down the progression of their disease. In the case of AIH, although there are treatments, due to the complexity of the disease and its diagnosis and management, up to 50% of patients can develop cirrhosis despite therapeutic intervention (Gleeson).

In the case of NAFLD, which is commonly associated with obesity and diabetes, patients are recommended to make lifestyle changes like weight loss and eating a healthy diet to try and slow down progression of the disease. By contrast AIH requires long-term treatment with corticosteroids and immunosuppressants to reduce inflammation in the liver. But such treatment can be highly challenging due to the nature of AIH which can alternate between flare-ups and temporary remission. Disease relapse is very common and affects up to 85% of patients after immunosuppression treatment withdrawal within the first 12-36 months (50% within the first 3 months). The effects of relapse include clinical deterioration (3%), increase in fibrosis (10%), liver death/transplant (20%) and even death (Mack). This means patients need continual monitoring, usually done with blood assessments and liver biopsies, to make sure they are getting the right dose of treatment. Patients need to have these assessments done every 4-8 weeks for the rest of their lives. The MRI method developed by Perspectum provides a much less invasive method for such monitoring.

Elizabeth highlights that one of the advantages with the company's diagnostic tool is it can provide a direct readout of the results in a matter of minutes which is immediately understandable to a clinician without having to wait for interpretation by a radiologist. It also provides a picture which enables patients to see the condition of their liver, including how much fat, inflammation and scarring there might be. This makes it easier for clinicians to explain to patients what is going on.

Perspectum now has a range of diagnostic products. This includes one able to evaluate the health of the biliary system which helps to drain waste products from the liver and break down fats during digestion. Another one can be used to aid surgical decision-making in liver cancer care. This tool assesses the overall health of the liver and supports identifying the healthy part of the liver that can rejuvenate itself once the tumour is cut out. Unlike most organs, in the absence of complications, the liver is able to grow back to its near normal size three months after surgery, even if up to 75% is removed. One of the company's products also provides the ability to simultaneously scan the heart, liver, lungs, kidneys, pancreas and spleen which enables assessment of multiple-organ health without the need for multiple tests. Since January 2021 this diagnostic has been undergoing clinical tests in the UK to help in the diagnosis, treatment and rehabilitation of long COVID.

Every day is different

What Elizabeth really likes about her job at Perspectum is that no day is the same. It ranges from gathering and analysing data to regularly discussing it with key opinion leaders and clinicians. Her day may also involve talking to health economists to ensure the company can make a persuasive argument about the value of its technology. She may also be called upon to help design clinical trials so that they generate the right data. Some of her time is also spent assisting with presentations and marketing material for the business and sales teams and talking to clinicians to make sure they are aware of the company's technology and what it can do. In addition she is often asked for data to support applications for regulatory approval of products.

Elizabeth says that one of the most enjoyable parts of her job is writing, which previously she never knew she liked doing. She particularly loves pulling together complex data to tell a compelling story that is easily accessible to everyone, including those without a scientific background. Another rewarding part of her work, she stresses, is the chance it gives her to talk to and work with patients. This has helped her understand the challenges patients face and the impact their disease has on both their lives and their families. Knowing that she is making a contribution to helping improve their lives through a quicker and non-invasive diagnostic test is what helps her get up in the morning and work long hours.

Be prepared to go against the odds

In terms of tips to others considering a career in the biomedical sector, Elizabeth underlines how important it is not to be intimidated to start something new outside their comfort zone. She also emphasises how important it is to not be disheartened by failure and to continue trusting in oneself, however hard the situation. As she says, 'nothing is going to be handed to you on a silver platter.'

The key thing Elizabeth says is to 'close your eyes against the odds'. As she points out, she would never have discovered her path forward had she not been willing to take the risk of moving to other countries to study and start afresh when her first job did not work out as expected. She also stresses the need to have the self-confidence to speak up in situations when others can be initially dismissive. In her case she has found it helpful to remind herself that she has every right to sit at the table of influence and the reason she is there is because her opinion is valuable.

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This article was written by Dr Lara Marks based on an interview with Dr Elizabeth Shumbayawonda on 21st August 2023.

It also draws on the following sources:

British Liver Trust: 'Non-alcohol related fatty liver disease', March 2022. Back

Gleeson D, Heneghan M (2011)'British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis'.Back

Henry, M (17 April 2014) 'Perspectum Diagnosis', Oxford Mail.Back

IET 'The 2016 Healthcare Technologies Student and Early Career'.Back

IME (2021) 'Healthcare Technologies Student and Early Career Awards 2021 results'.Back

Le, MH, Yeo, YH, Li, X, et al (Dec 2022) '2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis', Clinical Gastroenterology Hepatology, 20/12. 2809-17.Back

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Mack C, Adams D, Assis DN, et al (21 Dec 2019) 'Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American Association for the study of liver diseases', Hepatology, 10.1002/hep.31065:1-119.Back

Morgan, A, Hartmanis, S, Tsocghatzis, E, et al (June 2021) 'Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis (NASH) in the United Kingdom (UK) in 2018', European Journal Health Economics, 22/4, 505-18.Back

Roca-Fernandez, A, Banerjee, R, Thomaides-Brears H, et al (20 June 2023) 'Liver disease is a significant risk factor for cardiovascular outcomes – A UK Biobank study', Journal of Hepatology.Back

Shumbayawonda, E, Salifu, AA, Lekakou, Cosmas, JP (June 2018) 'Numerical and Experimental Simulations of the Wireless Energy Transmission and Harvesting by a Camera Pill', Journal of Medical Devices, 12/2, 021002-11.Back

Tunnicliffe, E, Robson, M, Banerjee, R (2014) 'Medical Imaging', international patent WO2014140635A1.Back

Younossi, ZM, Stepanova, M, Ong, J, et al (March 2021) 'Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in the United States', Clinical Gastroenterology Hepatology, 19, 580-89.e5. Back