One of the crucial yet oft-ignored human organs is the liver. Responsible for filtering blood, detoxifying harmful substances, producing bile for digestion, storing nutrients, and regulating blood sugar levels, the liver is the silent workhorse and the CEO of your body’s detox system.
Unfortunately, the Indian liver is in peril.
According to a 2022 study, India contributed to 18.3% of the 2 Mn global liver disease-related deaths in 2015. Not to mention, the stats have only worsened with time. At the centre of this crisis is India’s youth, carrying the load of poor nutrition, a sedentary lifestyle, alcohol abuse, obesity, diabetes, and a rising level of bad cholesterol. The situation is worse in metro cities.
As per a recent report, 35% of adults under 45 years of age showed signs of fatty liver in ultrasound scans. What’s even more concerning are studies from AIIMS, which indicate that the prevalence of non-alcoholic fatty liver disease (NAFLD) in India is as high as 65.7% among adults and 12.4% among non-obese children.
While NAFLD is curable with lifestyle changes, liver problems like hepatitis, cirrhosis, and drug-induced liver injury increase the chance of liver cancer. However, what’s more alarming is that most of these chronic liver diseases are silent killers. They continue to prevail in the human body until irreversible damage sets in.
This is where Srikar Raman and K Sreedurgalakshmi decided to contribute by incorporating Tvaster Genkalp in 2021. The founders are obsessed with bringing innovative solutions for the early diagnosis of liver cancer.
While still in its early stages, Tvaster Genkalp is working on early diagnosis and prevention of liver cancer with its non-invasive, highly sensitive liquid biopsy solution.
Simply put: Tvaster Genkalp specialises in detecting critical genetic and epigenetic changes through a simple blood test.
By analysing DNA from blood samples rather than relying on traditional, invasive tissue biopsies, Tvaster Genkalp is working to make cancer diagnostics more accessible, accurate, and affordable.
Its flagship product, Episcreen Liver, is a blood-based screening test designed to detect key genetic and epigenetic changes associated with hepatocellular carcinoma (HCC), the most common type of primary liver cancer, typically occurring in patients with chronic liver diseases such as cirrhosis or hepatitis. HCC is also one of the most aggressive and difficult-to-diagnose cancers, making early detection crucial for improving survival rates.
The Chennai-based startup has served around 1,400 patients so far. It has raised over $1.25 Mn in a Pre-Series A round led by Ideaspring Capital. Existing investors Invigo Software and Prof. Mohamed Rela, a globally renowned liver transplant surgeon, also participated in the round.
How Tvaster’s Pieces Fit Together
Tvaster Genkalp is the brainchild of Raman, who brings over 15 years of experience in biotech, gene therapy, and molecular diagnostics. A first-time founder and scientist, Raman has been associated with cutting-edge oncology research both in India and the US.
He has also served as the president and head of R&D at Levim Biotech, where he led gene therapy programmes using siRNA and CRISPR platforms and advanced several drug candidates to preclinical and clinical trials.
He has also worked as a postdoctoral fellow at the University of Missouri, where he co-developed Near-infrared (NIR) fluorescent agents for cancer detection and filed multiple patents on cancer diagnostics and gene therapies. The University of Illinois, Chicago alumnus has over 15+ patents and research publications to his name.
During his stint at Levim Biotech, he developed five to six biosimilars and one gene therapy technology, two of which are now in the market. This is also where he met his cofounder, Sreedurgalakshmi, who was his first hire in the R&D team. After working together on multiple biosimilars, tech platforms, and even filing patents, the two started thinking about building something of their own.
With Sreedurgalakshmi’s strong background in genetic engineering and his expertise in gene therapy and biomaterials, they decided to explore cancer detection and molecular diagnostics.
Speaking with Inc42, Raman said that the trigger to incorporate Tvaster stems from his passion to build a real-world solution.
After incorporating Tvaster in 2021, the duo spent the next one year engaging with physicians and clinicians to understand what gaps persisted in the diagnostics industry.
“Coming from a middle-class background, we didn’t have enough personal wealth to support our cause. We knew we had to start with something that could be commercialised relatively quickly to ensure the startup’s survival,” said Raman.
Until 2023, the duo handled everything from research to experiments, validation and operations. The turning point came in early 2023 when, during their research, they identified several epigenetic markers that could outperform the current global standard, alpha-fetoprotein (AFP), in detecting liver cancer early.
Their findings caught the attention of Professor Rela, who decided to invest in their company. This investment came in August 2023. The angel round helped them kick off their venture commercially.
During the discovery phase, the founders worked with 40 patients — 20 with liver cancer (HCC) and 20 with chronic liver diseases.
During this phase, the duo were involved in building the technology, taking samples, and conducting multiple iterations. They used a technique called droplet digital PCR, identifying a “sweet spot” that allowed them to differentiate between chronic liver disease and HCC patients.
Reimagining Cancer Diagnostics
While India has some of the most advanced liver care centres, diagnostics still rely on old-school methods like AFP, PIVKA-II, LFT, imaging scans, and even invasive biopsies.
For years, liver diseases have been detected through a mix of biochemical tests, ultrasound, and serum scores like FIB-4 and APRI, but these tools often miss early-stage cancer.
According to the founders, these markers have poor sensitivity in detecting early stage HCC. “Imaging techniques such as ultrasound, CT scans, and MRI are important, but they often miss smaller or early stage tumours. Invasive biopsies, though accurate, come with risks like pain, bleeding, or infection, and are not always feasible for wide-scale screening,” the founders said.
They added that with their tech, they have been able to detect 92% of HCC cases missed by AFP.
Currently, the brand’s technology is patented as “Sequencing-Independent Compositions for Detecting Carcinomas Using Methylation Markers”.
This invention involves non-sequencing-based methods to detect cancer-specific methylation patterns, enabling early, cost-effective and scalable cancer diagnostics.
Under this method, the startup takes blood from patients with chronic liver disease, extracts cell-free DNA, and then performs methylation profiling on the same. This helps determine early on whether the person has HCC or not.
Tvaster operates on a B2B model and has partnered with Dr Lal PathLabs and Dr Rela Institute & Medical Centre in Chennai to reach clinicians, who prescribe the test.
“We’re not moving to B2C just yet. Our priority is to build clinical trust. If we can get hepatologists and gastroenterologists to adopt this as a first-line screening tool, we can save lives,” said Raman.
The founders added: unlike sequencing-based technologies, which require expensive infrastructure and technical expertise, Tvaster’s approach is non-invasive, affordable, and scalable.
Tvaster’s Road Forward
Although in its early stages, the startup harvested more than INR 60 Lakh (unaudited) in FY25 revenues and claims to have exceeded INR 1 Cr till date. Priced at INR 10,000, the test gives tough competition to advanced genomic testing to identify specific DNA alterations, such as a tumour. For context, standard genomic tests can cost north of INR 30,000.
The startup has also started working on a pilot technology to detect chemoresistance in paediatric patients with hepatoblastoma (the most common type of liver cancer in children younger than three years).
“We are developing Episcreen HBResist to identify chemotherapy resistance in pediatric patients with hepatoblastoma to enable more precise and personalised treatment decisions,” the founders said.
This solution is aimed at minimising unnecessary chemo exposure and improving overall care for young patients.
The startup is also working on a screening solution for bile duct cancer (a rare but aggressive cancer with limited early detection methods).
While the startup has been able to achieve satisfactory results on the accuracy and reliability front, the major challenge that currently stands in front of the founders is building the brand and awareness about its solutions.
“Convincing doctors to shift from legacy diagnostic standards to novel tools requires clinical trust, awareness, and strong marketing muscle, which we are currently building. The idea is to show clinicians and doctors that spending INR 10,000 once or twice a year is a small price to pay for saving lives,” Raman said.
However, despite promising prospects, regulatory hurdles lie ahead. To scale nationwide and gain deeper clinical traction, the brand has initiated the process of obtaining in-vitro diagnostic (IVD) approval from the Central Drugs Standard Control Organisation (CDSCO).
This involves in-house validation, manufacturing test kits, and partnering with an ICMR-certified lab. As per the founder, while all of this is in process, it could take some years to solidify.
The founders are targeting to serve 5K patients in the next few years. However, the bigger question is how patients will know that they need to take this test.
To address this gap, the startup plans to integrate Episcreen Liver into routine health checkups through partnerships with hospitals, diagnostic chains, and corporate wellness programmes. While expansion to major metro cities will likely help the Chennai-based Tvaster in this quest, the real challenge lies in building a recognisable and trusted brand in preventive diagnostics. Can it make the cut?
[Edited By Shishir Parasher]
The post Can This Chennai Startup Solve India’s Silent Liver Cancer Crisis? appeared first on Inc42 Media.