B R O U G H T T O YO U B Y :
Faculty members of the National University of Singapore (NUS) Yong Loo Lin School of Medicine are leading key research programmes
to find better therapies and solutions to illnesses affecting Singapore’s population. Here are three such initiatives.
Targeted drug therapy yields higher
survival rates in blood cancer
This method is more effective in the treatment of multiple myeloma and there
are no toxic side effects for the patient, reports Koh Joh Ting
Patients suffering from multiple myeloma
(MM), a cancer of the plasma cells, now
have a better chance of surviving the disease with drug treatments that do not produce side effects like nausea and vomiting.
Their survival rates have gone up to an
average of seven years over the past decade, compared to four years previously.
A targeted drug therapy has proven to be
more effective than the standard treatment of
chemotherapy and bone marrow transplant.
This revolutionary treatment came about
largely from research that maps the genomic structure of the cancer-causing myeloma
cells as well as a better understanding of
the abnormal processes that make these
cells cancerous.
Associate Professor Chng Wee Joo is the
principal investigator of the research.
He is also a senior consultant haematologist at the Department of HaematologyOncology at the National University Cancer
Institute, Singapore and leader of its Haematologic Malignancy Tumour Group.
In Singapore, there are about 100 cases of MM every year. The disease usually
strikes elderly men or women in their 60s.
It is known to be the most incurable form of
cancer of the blood and is associated with
anaemia, repeated infections, bone pain
and unexplained bone fractures.
Drugs for MM act by “switching off” abnormal genes or correcting the abnormal processes in the MM cells to stop their growth.
These drugs are taken orally or by injection
and they do not induce debilitating side effects like hair loss, nausea and vomiting.
“In fact, patients say their friends often
don’t know they have cancer because they
are not losing their hair,” says Assoc Prof
Chng.
Targeted drug therapy treatment is outpatient-based and is more effective than
chemotherapy, which destroys even noncancerous cells.
Some 35 per cent of the patients have
complete remission and 10 per cent of patients also survive beyond the 10th year. Although relapses still occur, the treatments
are effective, says Assoc Prof Chng.
“This has shifted MM from being an incurable disease to a chronic condition that
is manageable,” says Assoc Prof Chng.
This has shifted MM from
being an incurable disease
to a chronic condition
that is manageable.
— Assoc Prof Chng Wee Joo (above),
senior consultant haematologist at the Department
of Haematology-Oncology at the National University
Cancer Institute, Singapore
Genomic studies have mapped out the
critical events and processes that cause
plasma cells to become abnormal, tracking
the step-wise transformation from a normal
cell to a pre-cancerous one and then to a
cancerous cell and eventually, to a cancerous cell that spreads to different organs.
This has greatly contributed to knowledge
of how myeloma develops and progresses.
Mapping out the genetic factors in the
MM cancer cell has also helped researchers
to classify patients into three groups: highrisk, standard-risk and low-risk.
This classification allows doctors to tailor
treatments to the level of severity of MM in
a patient.
“Those in the high-risk group will need
better treatments than what we have now
and should be an area of focus for ongoing
research,” explains Assoc Prof Chng.
“Those in the low-risk group are expected
to respond very well and survive for a long
time. We are conducting research to see if
they can do without a bone marrow transplant or prolonged treatment.”
Mapping the genomic structure of MM
cells could also mean a speedier method of
diagnosing and classifying MM, he explains.
By applying genomic technology to check
for multiple genetic alterations and “weak
points” in a patient’s sample, researchers
can pin-point the severity of MM and potentially match relevant drugs to help the patient in a single test kit.
Assoc Prof Chng is working with a computational team to programme the test kit
to crunch data and generate a simple report
that will help clinicians make treatment decisions. He hopes to have such a test validated by researchers in three years.
“This can be a very powerful tool which
saves time and money for the patient and
the healthcare provider,” he says.
“Right now, a battery of tests for a patient
can cost over $1,000 but one test based on
the genes of the cancer cells may cost much
less and yield more information.”
The next step for Assoc Prof Chng is to
initiate a clinical trial covering China, Hong
Kong, Taiwan, Japan, South Korea and Singapore. This is being done as part of the
recently-formed Asian Myeloma Network,
which aims to improve outcome for myeloma
patients in Asia.
As principal investigator, he hopes to set
up an Asian tissue bank comprising cancerous cells drawn from MM patients in Asia
to study how Asian and Caucasians differ in
their responses to drugs used to treat MM.
He says this trial platform will enhance
the access of Asians to new drugs to combat MM.
Photo: Singapore eye research institute
Eye scan to detect
major diseases
The eyes can be an early marker as they provide a way to
study the blood vessels of the body in a non-invasive way
By Douglas Chew
The eye is more than just a window to one’s
soul. Peering deep into the eye to examine
its blood vessels can also help doctors detect major diseases early.
The research by Professor Wong Tien Yin
(above), head of ophthalmology at the National University of Singapore (NUS) Yong
Loo Lin School of Medicine, has provided
insights into major sicknesses and causes
of death in Singapore, such as diabetes, hypertension and cardiovascular diseases.
“The eyes can be an early marker of
these diseases, providing a way to study
blood vessels of the body in a non-invasive
way,” says Prof Wong.
Certain changes in these blood vessels
give early indication that something is wrong,
with different diseases affecting these blood
vessels differently. The current methods for
predicting a patient’s chance of developing such diseases are based on identifying
risk factors in the patient. A family history
of such a disease, obesity and smoking are
among some of the risk factors used to categorise patients into low or high-risk groups.
This method, however, misses a sizeable
number of people who do get these diseases
but do not fall into the high-risk group.
In some studies, up to 10 per cent of
healthy adults have abnormal eye scans. Prof
Wong’s research shows that narrowed arteries in people who presently do not have hypertension predict a higher risk of developing
this condition in future. While it is well established that narrowed arteries lead to higher
blood pressure, there was previously no easy
way to observe these arteries without “invasive” techniques. But with Prof Wong’s method, the retinal blood vessels can be observed
by using a digital camera to scan the eye.
Working with the NUS School of Computing,
Prof Wong and his colleagues have developed
software that use computational techniques to
analyse the eye scans when looking for changes in blood vessels at the back of the eye.
Prof Wong also draws on the expertise
of specialists in diabetes, cardiology, stroke
and dementia at the medical school to make
the connections between blood vessels in
the eye to these ailments.
He is currently conducting a pilot study in
medical clinics and working with general practitioners to determine what type of patients
would benefit from such an eye scan and how
much these scans should cost. He notes
that the the commercial viability of such eye
scans is a crucial step in bringing this work
out of the laboratory into the clinics.
While he does not envision such eye scans
to replace all the clinical screening tools for
these major diseases, Prof Wong says: “I
think there are specific clinical needs for
these eye scans where the traditional tools
are not precise enough. Whether it is going to
be used to screen for diseases for the general population, I think it needs to be proven
to be cost-effective from a population basis,
just like any other screening procedure.”
Research on stroke victims unveils new insights
Study shows a 10-minute test can help doctors to predict which stroke survivors
will have moderate to severe cognitive impairment later
After suffering a stroke, a person’s ability
to think and remember may be compromised
because of damage to the brain. In a study
by Singapore researchers, screening for
cognitive impairment as early as two weeks
after a stroke with a simple 10-minute test
can help to identify those who are more likely
to remain significantly impaired three to six
months after a stroke.
Patients who stand to benefit from this
are those who are non-delirious and who appear lucid after a stroke, according to the research findings of Ms Yanhong Dong and a
team from the Memory Ageing Cognition Centre at the Department of Pharmacology, National University of Singapore (NUS) Yong Loo
1905
The Straits Settlement and Federated Malay States Government Medical School is born at Sepoy Lines, offering a full-time five-year course to train doctors in medicine, surgery and midwifery.
Lin School of Medicine. Their research paper
was published in the well regarded Journal of
Neurology, Neurosurgery and Psychiatry.
A total of 300 people in Singapore who
were diagnosed with stroke were recruited for
this study and assessed for cognitive impairment up to 14 days after the stroke. Of these,
239 were followed up three to six months later.
On the crucial 14-day screening time
frame, Ms Dong says that there is a gap
in knowledge about how to detect Vascular
Cognitive Impairment (VCI) early. Most VCI
studies focus on cognitive impairment three
to six months after a stroke, when the opportunity to intervene earlier with advice on
management and treatment for patients with
1910
The pioneering class –– consisting of seven young men –– graduates from the Medical School with a Licentiate in Medicine and Surgery (LMS). 1911
The Tan Teck Guan Building, housing a lecture theatre, a library and a museum, opens. 1912
Professorial chairs begin to be established; the first is the chair of physiology. 1913
The School changes its name to King Edward VII Medical School, in recognition of an endowment by the King Edward VII Memorial Foundation.
The Medical School is renamed 1921
King Edward VII College of Medicine to reflect more accurately its status as an institution that provides tertiary-level education. 1923
The medical course is extended by a year to become a six-year programme. 1926
The three-storey College Building opens.
1929
The Department of Dentistry admits seven students for its four-year course.
1939
The McLean Commission on Higher Education proposes the amalgamation of the Medical College and the Raffles College of Arts and Sciences into a university college. 1942
significant VCI might have been missed.
Patients who were at obvious risk of cognitive impairment — such as confusion,
delirium and significant physical disabilities
— were excluded from the study. This was
because the researchers wanted to focus on
patients whose clinical symptoms are less
obvious and hence may be missed.
“Those who could speak clearly, draw,
and follow instructions were recruited to see
if there were obvious signs of cognitive impairment that our tests can pick out,” says
Ms Dong. “Cognitively-impaired patients may
escape clinical attention as they may appear
well, and this is not ideal.”
The researchers put the participants through
The College of Medicine stops operating as a medical school as the Japanese begin their three and half years of Occupation in Singapore. 1946
The Medical College reopens and some 200 pre-war students return to continue their medical education. two sets of cognitive tests, a newer test called
the Montreal Cognitive Assessment (MoCA) and
a more established test called the Mini-Mental
State Examination (MMSE).
One in four patients assessed was found
to have moderate to severe VCI three to
six months after the stroke. This is higher
than the prevalence of significant cognitive
impairment in the community, which is approximately 10 per cent. Patients at higher
risk of cognitive impairment were older (over
65 years of age), female and of non-Chinese
ethnicity. They also had lower education levels, more severe neurological impairment
and took longer to stabilise after a stroke.
The study showed that both the MoCA
and MMSE allow convenient, fast and accurate prediction of a patient’s risk for cognitive impairment after a stroke. Patients who
scored below the established test cut-off
points on either test are recommended to
Milestones
Singapore’s
oldest
1948
The Carr-Saunders Commission proposes the formation of a university rather than a university college. 1949
The University of Malaya is formed through the amalgamation of the King Edward VII College of Medicine and Raffles College, and the College of Medicine assumes the identity of a university faculty –– the Faculty of Medicine.
1962
IN
medical school
1950
The University of Malaya confers its first Degrees of Bachelor of Medicine and Bachelor of Surgery on 17 graduands.
1952
The construction of a two-storey building behind the Tan Teck Guan Building gives room for more classrooms and laboratories. 1957
1959
The University of Malaya begins to function as two autonomous divisions, with one located in Singapore and the other in Kuala Lumpur. The Faculty of Medicine operates as the Faculty of Medicine of the University of Malaya in Singapore. The Department of Pharmacy at the University of Malaya in Singapore offers its first three-year degree course. 1953
have their cognitive function monitored.
Results from early cognitive testing can
help health-care professionals and family support such patients better as they are likely to
be more forgetful and less able to cooperate
with rehabilitation after stroke. This, in turn, can
decrease dependency, death or risk of dementia developing after stroke, the researchers say.
“We advise relatives that they should
closely monitor their loved ones’ compliance
with stroke prevention treatment and adherence to healthy lifestyle changes,” says Associate Professor Christopher Chen of the
university’s department of pharmacology,
who is Ms Dong’s mentor.
“Rehabilitation therapists are also better
able to provide customised instructions and
interventions that meet the needs of patients
with cognitive impairment. The early period of
stroke recovery is where appropriate intervention may be most helpful.” — Koh Joh Ting
The pre-registration or housemanship year is introduced. The Singapore Division becomes a fully-fledged university as the University of Singapore. The Kuala Lumpur Division, now also a national university, keeps the name of University of Malaya.
1969
1973
The School of Postgraduate Medical Studies is formed. A Medical Faculty Planning Unit is tasked to oversee the construction of the Medical Faculty and its teaching hospital at Kent Ridge.
1980
1983
The Faculty of Medicine begins its move from Sepoy Lines to Kent Ridge. The entire Faculty of Medicine finds a home in the new campus by 1987. 2002
In line with developments in the life sciences, the Faculty of Medicine broadens its entry criteria so that more students will be eligible to study medicine. 1991
The University of Singapore merges with the Nanyang University to form the National University of Singapore at Kent Ridge. The Medical Faculty undertakes a much-needed review of its curriculum, leading to the setting up of new departments and the reorganisation of the five-year medical course into three distinct blocks.
2005
The School of Medicine celebrates its centenary.
1997
A further revision of the medical curriculum takes place, with problem-based learning introduced in 1999. 2008 The Yong Loo Lin School of Medicine joins the National University Hospital and the Faculty of Dentistry under the common governance of the National University Health System.