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John E.L. Wong, MBBS, FAMS, FRCP, FACP
Isabel Chan Professor of Medical Sciences
Vice Provost (Academic Medicine), National University of Singapore
Deputy Chief Executive, National University Health System
Director, National University Cancer Institute, Singapore
NUS SoC Faculty Retreat
13 September 2013, 12-1pm, Rasa Shangri La, Sentosa
Research
Clinical Care
Education
Copyright © 2011 National University Health System
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NUHS:
•Introducing new topic
Academic Medicine in Singapore
Copyright © 2011 National University Health System
(Lead)
Governing Board
Chief Executive
Deputy Chief Executive
National University Health System
NUS Yong Loo Lin School of Medicine
NUS Faculty of Dentistry
Saw Swee Hock School of Public Health
Alice Lee Center for Nursing Studies
National University Hospital
National University Health System, Singapore
Copyright © 2011 National University Health System
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•Introducing new topic
NUHS Research Strategy
NUHS Research Strategy
6 diseases interrogated by
8 platforms in a matrix fashion
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•Introducing new topic
Key Disease Research Areas
• Cancer
• Cardiovascular
• Metabolic Medicine
• Infectious Diseases
• Neuroscience
• Eye Diseases
Cancer
National University Cancer Institute,
Singapore
Phillip KOEFFLER
Soo-Chin LEE
Research Directors: Phillip Koeffler, Soo-Chin Lee
Development of Novel Therapeutics and Biomarker-Directed Strategies in
Refractory Solid Tumors and Haematological Malignancies
Research Themes
1. Early Phase Drug Development
2. Developmental Therapeutics in Endemic Cancers
3. Immunotherapy in Cancer
4. Childhood Malignancies
5. Translating Epithelial-Mesenchymal Transition for Cancer
Prognostics and Therapeutics
Cancer
Daniel
TENEN
GOH Boon
Cher
CHNG Wee
Joo
Phillip
KOEFFLER
Cancer Science Institute, Singapore
•Present: 17 PIs and 200 scientific staff
•At steady state: up to 25 PIs and approx 350 staff & students
Basic programs –
experimental models
Cancers Affecting
Singaporeans
Cancer
Stem Cells
Cancer
Biology
Translational programs –
human studies
Genomic
Oncology
Experimental
Therapeutics
Gastric
Lung
Liver
Leukemia
Breast
Nasopharyngeal
IMPACT:
Personalised Medicine for Asian population
Finding Cancers Early to Enable Cure
LEE SooChin
Gastric Cancer
Note: Data for Univ Cambridge retrieved on 3 July 13 (27 May for all others).
Cardiovascular Diseases
TAN
Huay
Cheem
Mark
Roger
RICHARDS FOO
Carolyn
LAM
•
•
To understand the biological processes leading to cardiovascular disease
Target parts of those disease pathways with new treatments in order to prevent or
ameliorate the disease
•
Heart Failure
– new candidate biomarkers for diagnosis and prognosis
– Establishing specific improved therapies for subtypes of heart failure.
•
Cardiac Valve Disease
– Assess value of plasma biomarker measurements in predicting progression of
valve disease
– and in optimising timing of interventions such as valve replacement or repair.
•
Acute Coronary Syndrome
– Exploration of novel candidate peptide biomarker tests for detection of cardiac
ischaemia or heart failure
•
Ventricular Repair
– Pre-clinical studies devoted to the development of bioengineered tissue
constructs seeded with progenitor cells to be used in the repair of postinfarction left ventricular scar.
•
Cardiovascular Epigenomics and Epigenetics
Mark
CHAN
Cardiovascular Diseases
National University Heart Centre Spore (NUHCS)
Cardiovascular Research Institute (CVRI)
TAN
Huay
Cheem
Mark
Roger
RICHARDS FOO
Carolyn
LAM
Singapore Heart Failure Outcomes and Phenotypes (SHOP) study:
•SG Heart Failure (HF) cases average 8 yrs younger than in NZ
•Diabetes in SG HF cases > NZ (55% versus 27%)
•Diabetes may be a more important underlying substrate for HF in SG than in western
populations
IMPACT:
1.Development of new clinical practice guidelines for heart failure and coronary
artery disease in Asian patients
2.Improve the ability to predict the onset of HF, anticipate what kind of HF will
occur and the course of its progression
3.New treatment approaches to HF
Mark
CHAN
Cardiovascular Diseases
Note: Data for Univ Cambridge retrieved on 3 July 13 (27 May for all others).
Diabetes, Obesity and Metabolism
•
•
•
•
CHONG
Yap Seng
TAI E
Shyong
LEE
Yung Seng
Sue-Anne
TOH
Address the rising incidence of metabolic diseases in Singapore, where
diabetes now affects 11.3% of Singaporeans (nearly 7% rise within 2 decades)
Asian features of the metabolic diseases – Singapore comprises 3 major Ethnic
differences in the prevalence rates and pathogenesis of metabolic diseases
We have:
– built up capacity for epidemiology, physiology and metabolic imaging to
facilitate target identification and validation
– established in-vitro models for all three ethnic groups
1. Pathogenesis
type 2 diabetes
We
have active of
programs:
•Mechanistic basis in genetic variants with unique effects in populations of Asian ancestry
•Ethnic differences in insulin resistance
2. Nutrient metabolism and insulin resistance
•Role of protein intake, amino acid metabolism & fat intake/metabolism in pathogenesis of
insulin resistance
•Role of carbohydrate quality on glycemic control & appetite regulation
•Role of altered nutrient handling in the ability of bariatric surgery to ameliorate diabetes
3. Burden of diabetes mellitus & novel models of health care delivery for chronic
disease
•Unique features of type 2 diabetes in Asia and designing of stratified medicine
•Designing of programs for prevention of type 2 diabetes mellitus
•Efficacy of patient-centered medical home in reducing hospitalization and improving
outcomes
Our Research
Focus
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Implications for Clinical Practice
Initial Findings
Higher incidence of gestational diabetes (GDM) than
previously suspected & higher glucose levels in mothers even in the absence of GDM – can still affect infant
adiposity.
Obesity has a major role to play in the risk of diabetes in
Chinese and Malays. However, Indians are at high risk of
diabetes, but obesity has a smaller impact.
Life Course Cohort:
Human Metabolic Studies:
IMPACT:
Interventions to reduce obesity and diabetes in the population
How to advise public on healthier food choices & lifestyles
Metabolic Disease
Note: Data for Univ Cambridge retrieved on 3 July 13 (27 May for all others).
Infectious Diseases
•
•
•
Paul
MACARY
Naoki
YAMAMOTO
Vincent
CHOW
Dale
Paul
FISHER TAMBYAH
Nick
PATON
Provide innovative solutions to local, regional and global infectious disease
challenges through a world-leading research programme
Extensive collaborations across NUS, A*STAR Research Institutes and Industry
Partners.
We have active programs:
1.
Antibiotic Resistance Surveillance/Infection Control
•
Methicillin-resistant Staphylococcus aureus (MRSA), multi-resistant gramnegative bacilli, hand hygiene and device-associated infections
2.
Influenza
•
Influenza pathogenesis, pandemic influenza preparedness and business
continuity, guidance to health policies, cost-effective prevention strategies,
mathematical modeling of influenza infections, novel prophylactic and
therapeutic approaches
3.
HIV
•
HIV pathogenesis and its metabolic consequences (dyslipidemia, heart
diseases, osteoporosis, diabetes mellitus and other metabolic dysfunctions),
improvement of HIV treatment strategies and patient management
4.
Tuberculosis
•
Pathogenesis, genotyping and phenotyping of the various strains, clinical and
immunological characterization, development of diagnostic tests and assays,
development of cost-effective treatment strategies
5.
Dengue
Infectious Diseases
Neuroscience
SOONG Christopher Carlos
Barry
HALLIWELL Tuck Wah CHEN
IBANEZ
•
Peter
WONG
Current Neuroscience research programmes at YLLSoM focused on ischaemic
stroke, dementia, and neurodegeneration:
1.
Ischaemic stroke focus on intracranial stenosis or intracranial large artery disease,
which is the redominant stroke subtype among Asians
Aim:
to understand better the mechanism of stroke, improve diagnostic and prognostic
methods, improve patient care and treatment, develop new treatment modality
including studying the feasibility of stem cell therapy
2.
Vascular and Neurodegenerative Mechanisms in Dementia
Aim:
to identify biomarkers for vascular and neurodegenerative mechanisms, and obtain
insights into the mechanisms of interaction may lead to potential therapeutic
approaches, through study of clinical and epidemiological cohorts,
neuroimaging, neurochemical and animal studies
3.
Neurodegeneration focusing on role of excitotoxicity & free radicals in aging and
dementia, role of glial cells and vascular factors in promoting neuroinflammation,
role of metal ions and lipids in neurodegeneration, exploring neuroprotection and
promoting resolution of neuronal injury
Aim:
to conduct in-depth analyses of factors which contribute to, or modulate,
degeneration of the nervous system
Neuroscience
SOONG Christopher Carlos
Barry
HALLIWELL Tuck Wah CHEN
IBANEZ
Peter
WONG
Dementia and Age-related Cognitive Impairment
•Singapore ageing population: by 2030, 19% of the population
will be aged 60 & above.
•Dementia is a disease most common in the elderly
•Singapore and Asia face an epidemic of dementia and cognitive
impairment in the next few decades
Association of ICS with cognitive impairment
Impact of Intracranial Stenosis
Prevalence of intracranial stenosis (ICS)
•
40-50% in Chinese stroke patients
•
8-10% in Caucasian Stroke patients
AIM :
Development of new screening and treatment
strategies for dementia and cognitive impairment
NCI- Non cognitive impairment
CIND- Cognitive Impairment, No Dementia
Eye Disease
Donald
TAN
AUNG
Tin
SAW
Seang Mei
WONG
Tien Yin
Singapore Eye Research Institute
Glaucoma Research
Retina Research
Oculoplastics Research
Cataract Research
Cornea Research
Neuro-Opthalmology Research
There is an epidemic of myopia in Singapore
Singapore* published the most papers
per capita (*95% of papers SERI/NUS)
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Core
Facilitiesnew topic
•Introducing
Copyright © 2011 National University Health System
Core Facilities
Clinical Imaging Research Centre
Investigational Medicine Unit
Clinical Nutrition
Research Centre
Center for Translational Research
& Diagnostics
Medical Engineering
Research &
Commercialization
Initiative
Investigational Medicine Unit (IMU)
•
•
Services:
1. Providing clinical research support
2. Providing administrative support
3. Training in clinical trial management
4. Storage of trial drugs and biological samples
Facilities:
– Clinical Biostatistics and Pharmacometric Unit
– Cardiovascular Imaging Core Laboratory
– Pharmacokinetic/Pharmacodynamic Analytical
Laboratory
– Genomics Core Laboratory
– Clinical Pharmacology Group
Website: http://www.imu.com.sg/
GOH Boon Cher
Clinical Imaging Research Centre (CIRC)
• Partnership between NUS and A*STAR dedicated to
advanced imaging in humans
developing
• Facilities: 3T MRI, the combined positron emission tomography and
magnetic resonance imaging (PET-MR) system and
a PET/CT,
complemented by a radiochemistry suite and cyclotron that will
enable in-house production of a range of clinically relevant PET
tracers.
David TOWNSEND
Website: http://www.circ.nus.edu.sg/
Imaging Facilities at CIRC
Siemens TIM TRIO 3T MR scanner
Siemens mCT PET/CT scanner
Siemens mMR PET/MR scanner
Siemens PRISMA 3T MR scanner
2013
Centre for Translational Research and
Diagnostics (CTRAD)
Richie SOONG
Accredited molecular pathology capabilities
Disease
Clinician
Programs Scientists
Stratified
Medicine
Research
Cores
Clinical
Trials
NUH
DMOC
Biospecimen Repository
Translational Research
•>800,000 biospecimens
>$5M high-end technology
•Logistics infrastructure
>150 publications
•Clinical Data, Cohort Samples >$5M in industry grants
Website: http://www.csi.nus.edu.sg/
Industry
MDC
Molecular Diagnostics
CAP accreditation
>100 assays
>19,000 reports/year
Medical Engineering Research and
Commercialization Initiative (M.E.R.C.I.)
Aims to spearhead the development of medical devices by
leveraging the strengths of NUHS and NUS faculty in the
engineering and physical sciences.
Rachel
HONG
Melvin
LOH
4 themes:
•Microsensors
•Diabetes
•Cardiovascular
•Minimally Invasive Surgery
Website: http://medicine.nus.edu.sg/medsur/contactUs_staffDirectory.html
Overview of projects
MICROSENSORS
CARDIOVASCULAR
•Biosensors for vascular graft
•Tactile steerable catheter
•Ultrasonic needle
•End organ perfusion sensor (PPG)
•AAA Stent
•Preferential covered stent for
embolic prevention
•Percutaneous Mitral valve
•Biodegradable caval valve
MINIMALLY INVASIVE
Two Spin-offs
•Navigation tool for Colonoscopy
•Vascular access monitoring using
Bioimpedence
•Magnetic field based NG tube tracking
•Gastroduodenal chute
•Endoscopic raman spectrometry
OPHTHAMOLOGY
•Glaucoma drainage device
•Multi focal Contact lens
TELEMEDICINE
Next Projects:
Healthcare
Automation
SPECIAL PROJECTS
•Wireless body area networks
(Fujitsu)
•Sub $300 Ultrasound
•Graphene for Med Dev
30
Clinical Nutrition Research Centre (CNRC)
•
Joint initiative between the Singapore Institute for Clinical
Sciences, A*STAR and the National University Health System.
•
First to commission the first whole body calorimeter in Asia,
aiming to conduct nutrition research with sophisticated
instruments.
•
Specializes in basic and translational human nutrition research
involving studies across the life cycle.
Website: http://www.nutritionresearch.edu.sg/
Jeyakumar HENRY
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Some
of the challenges
•Introducing
new topicwe need
help in
Copyright © 2011 National University Health System
Wish List - Hospital
• How to predict patients at high risk of complications / early
relapse / recurrent admissions
• How to run hospitals more “e-fficiently” (E-Health)
• How to improve the co-ordination of patient care between the
specialties
• How to look for potential drug side effects (Pharmacovigilance)
Wish List - Schools
• Identifying actionable genetic mutations; how to store and curate
genetic information we currently do not understand (Genomic
Medicine)
• How to improve imaging (Medical Imaging and Analysis)
• How to model and simulate epidemics
NUHS: Shaping Medicine
for the Future