Biomedical sciences' next frontier, here at home

Singapore has expertise in microelectronics, material science and nanotechnology - all relevant in the field of biomedical sciences. This is why the Republic can play a key role in integrating knowledge in this field.

Research in the biomedical sciences no longer just depends on the work of the scientific community but needs the understanding and cooperation of the people.

This is because in the 10 to 15 years, our understanding of biology has progressed to the stage where deep inquiry into human biology can be made through the study of individuals and also large cohorts of the population.

The path to where we are gives a glimpse of the huge advances that have been made in medicine and in prolonging the life span of the human race.

GOLDEN AGE OF BIOCHEMISTRY

In brief, the period from 1900 to 1950 was the golden age of Biochemistry, a new discipline where the underlying chemical substances and processes in living systems were initially discovered.

German scientist Otto Warburg was one of the 20th century's leading biochemists together with his pupil Hans Krebs, who emigrated to England and was Head of the Department of Biochemistry in Oxford from 1954-1967, where I started my independent research career.

The period 1950-2000 saw a revolution in biology and the subject Molecular Biology was born.

The composition, structure and role of many key components of the living cell were determined, including the famous DNA double helix by James Watson and Francis Crick.

During this period, Singapore became independent (in 1965). Biomedical research here however got off to a real start only after 1985 when a new Institute on Molecular and Cell Biology was established.

At the turn of the 21st century, another major event took place. This was the determination of the entire sequence of the human genome, essentially the "blueprint" of human life.

United States President Bill Clinton and British Prime Minister Tony Blair held a transatlantic press conference where PM Blair said: "Ever so often in the history of human endeavour, there comes a breakthrough that takes humankind across a frontier into a new era.... today's announcement is such a breakthrough, a breakthrough that opens the way for massive advancement in the treatment of cancer and hereditary diseases. And that is only the beginning."

He was right. While rapid technical developments have now made it possible to sequence every person's genome in less than a day and for perhaps only US$1,000 (S$1,409), only about 20 per cent of the information that the genome contains has been read and interpreted.

PRECISION MEDICINE

The next 50 years may be necessary to complete the task.

Nevertheless, our knowledge of the genome is sufficient to be "translated" into medical practice, to help us appreciate the extent to which our genomes differ from person to person and the implications of this variation to tailoring drug treatment to the individual.

Undoubtedly, "personalised" or "precision" medicine, as this is now called, is on its way and research in Singapore has an important role in this because of the nature of its population.

This was made possible because Singapore took the bold step in 2000 to invest in a new phase in biomedical sciences and develop Biopolis, the Asian hub for this. This created an unprecedented major opportunity for Singapore to become a powerhouse on the world stage in biomedicine in less than 14 years, anchoring Biomedical Sciences as the fourth pillar of Singapore's economy.

But Biology, especially Human Biology, is much more than just deciphering the genome. While 20th century biology emphasised the analysis of components of living systems, 21st century biology has to concentrate on understanding how component parts collaborate to create complex biological systems, and then promoting the flow of results into practice.

We have to study homo sapiens as a whole and describe its behaviour, its reaction to food and the environment, the way it develops from a tiny infant into an adult that inevitably gets older.

Hundreds of thousands of different biomolecules and small chemicals move around in our body, connecting different organs like the heart and stomach and orchestrated by one of the most complex organs, the Human Brain.

I call the processes that we have to develop to understand all this Integrative Molecular Physiology.

INTEGRATING BIOLOGY, CHEMISTRY AND ENGINEERING

The future is about integration.

Much progress has been made in understanding the role of human genetic variation in disease. Genomic medicine will develop so that each individual's genetic

print will be available to and used by the doctor to make clinical decisions about preventing ill health or treating a person's specific condition.

However, the major challenge will be to understand the molecular mechanisms by which the genetic variations affect complex human diseases. Genes essentially contain the information necessary to produce functional products such as proteins that perform

essential functions in the body, for example as enzymes and hormones. The process by which genetic instructions are used to make gene products is called "gene expression".

Control of gene expression is key to produce the desired gene products when needed. We can expect significant advances in the next decade as scientists learn how all these work in the human body.

They will follow the biological and chemical processes in cells and organs and study how they determine development and ageing of the individual and how they respond to the environment. All these require new techniques for detection of dynamic processes in living organisms.

Expertise in Singapore in microelectronics, material science and nanotechnology could play a key role in designing and developing new human molecular sensors for detecting important biomolecules.

One of the processes we need to understand and observe is the elaborate defence mechanism used by humans to combat infections, foreign invaders and to preserve our normal, healthy functions.

Advances in immunology are also providing new types of therapies, including those in cancer, or by suppressing the immune response in arthritis, diabetes and multiple sclerosis.

The challenges are daunting but exciting and the possibilities endless. Major unexpected and unforeseen breakthroughs will be made by a few, but steady and often rapid progress will more often than not, be made by teams bringing together expertise and ideas from different disciplines. Biology needs the concepts and tools of chemists and physicists and the ability of engineers to solve a major problem.

PUBLIC HEALTH

The excitement, progress and practical and economic outcomes of molecular medicine and genomic medicine sometimes overshadow an equally important part of the biomedical sciences: the study of public health, sociological and environmental issues affecting human health.

New methodologies are needed to address such problems as we often have to call on large population based studies and advanced information technology to deal with the large sets of data collected.

Ultimately the integration of health records, population studies (epidemiology) and genetic, molecular and imaging information will give us the complete picture for human health and the well-being we need to achieve. Such an approach has many ethical and social constraints and will require not only political but also public support.

In the United Kingdom, where there has been a longstanding tradition in large scale population studies, I had a direct role in setting up one of the largest programmes involving half a million healthy volunteers who gave blood and other samples for genomic studies, detailed life-style history and will be followed for 14 to 20 years.

The UK Biobank is aimed at understanding the effect of the genome, environment and life-style on the development of major diseases in the population. While Singapore can learn from such experiences, it has been my view, consistently, that Singapore's impact on the biomedical sciences and its economic and health values has to be tackled in a novel and different way from some of the other major research efforts elsewhere.

Some of the issues Singapore can manoeuvre in its own unique way will involve dismantling the tradition of dividing Science into basic and applied as it had already done in the Physical Sciences and Engineering, as well as to take a keen focus on local problems that have major relevance to global issues. Choosing the right problems to focus on, and having the self-confidence that they can be solved not by copying others but by doing it the Singapore way, is the path to success.

Research in the biomedical sciences undoubtedly already resulted in economic outcomes and health benefits - but much more is to come if emphasis on applications and clinical benefits is carefully built into the research agenda.

Singapore is in a strong position to have a national research strategy that gives a balanced portfolio of knowledge generation and applications of such knowledge for economic and medical value creation.

In 50 years, Singapore has been transformed from a small city with a port into a major metropolis. During this time, advances in the Biomedical Sciences have changed the world of medicine and bioindustry.

Singapore is ready to remain a force in the future of biomedical sciences. It may even lead a new revolution in science and its applications by focusing its efforts in convergence of different disciplines to solve major problems relevant to Singapore with global implications.

• Hungarian-born Professor Sir George Karoly Radda was educated at Oxford University, and in Berkeley, California. He went on to assume teaching and research positions at Oxford for many years. He has a decade-long involvement with Singapore, as Scientific Director and Chairman of the Singapore Bioimaging Consortium (2005- Dec 2010) and Scientific Advisor to the Dean, National University of Singapore Medical School (2005-2011). He has been Chairman, Biomedical Research Council of A*Star, Singapore since 2008.

This article is also available in The Straits Times on August 31, 2015, with the headline 'Biomedical sciences' next frontier, here at home'.