Eye scan to detect major diseasesThe eyes can be an early marker as they provide a way to study the blood vessels of the body in a non-invasive way

Targeted drug therapy yields higher survival rates in blood cancer

Patients suffering from multiple myeloma (MM), a cancer of the plasma cells, now have a better chance of surviving the dis-ease with drug treatments that do not pro-duce side effects like nausea and vomiting.

their survival rates have gone up to an average of seven years over the past dec-ade, 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 genom-ic 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 haema-tologist at the Department of Haematology-Oncology at the national University Cancer institute, singapore and leader of its Hae-matologic Malignancy tumour Group.

in singapore, there are about 100 cas-es 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” abnor-mal genes or correcting the abnormal proc-esses in the MM cells to stop their growth. these drugs are taken orally or by injection and they do not induce debilitating side ef-fects 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 out-patient-based and is more effective than chemotherapy, which destroys even non-cancerous cells.

some 35 per cent of the patients have complete remission and 10 per cent of pa-tients also survive beyond the 10th year. al-though relapses still occur, the treatments are effective, says assoc Prof Chng.

“this has shifted MM from being an in-curable disease to a chronic condition that is manageable,” says assoc Prof Chng.

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 de-tect major diseases early.

the research by Professor Wong tien Yin (above), head of ophthalmology at the na-tional 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, hy-pertension 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 develop-ing 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 cat-egorise 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 arter-ies in people who presently do not have hy-pertension predict a higher risk of developing

this condition in future. While it is well estab-lished that narrowed arteries lead to higher blood pressure, there was previously no easy way to observe these arteries without “inva-sive” techniques. But with Prof Wong’s meth-od, 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 chang-es 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 prac-titioners 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 gen-eral population, i think it needs to be proven to be cost-effective from a population basis, just like any other screening procedure.”

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 cancer-ous 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: high-risk, 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 trans-plant 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 poten-tially match relevant drugs to help the pa-tient in a single test kit.

assoc Prof Chng is working with a com-putational team to programme the test kit to crunch data and generate a simple report that will help clinicians make treatment de-cisions. He hopes to have such a test vali-dated 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 sin-gapore. 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 cancer-ous 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 com-bat MM.

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

Research on stroke victims unveils new insightsStudy 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 ap-pear lucid after a stroke, according to the re-search findings of Ms Yanhong Dong and a team from the Memory ageing Cognition Cen-tre at the Department of Pharmacology, na-tional University of singapore (nUs) Yong Loo

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 impair-ment 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 op-portunity to intervene earlier with advice on management and treatment for patients with

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

B R O U G H t t O YO U B Y :

PhoTo: SingaPore eye reSearch inSTiTuTe

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.

significant VCi might have been missed.Patients who were at obvious risk of cog-

nitive 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 im-pairment 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

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 ap-proximately 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 lev-els, 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 accu-rate prediction of a patient’s risk for cogni-tive impairment after a stroke. Patients who scored below the established test cut-off points on either test are recommended to

have their cognitive function monitored.Results from early cognitive testing can

help health-care professionals and family sup-port 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 demen-tia developing after stroke, the researchers say.

“We advise relatives that they should closely monitor their loved ones’ compliance with stroke prevention treatment and adher-ence to healthy lifestyle changes,” says as-sociate 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 interven-tion may be most helpful.” — Koh Joh Ting

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.

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19972005

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.

The pioneering class –– consisting of seven young men –– graduates from the Medical School with a Licentiate in Medicine and 

Surgery (LMS). 

The Tan Teck Guan Building, housing a lecture theatre, a library and a museum, opens. 

Professorial chairs begin to be established; the first is the chair of physiology. 

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 course is extended by a year 

to become a six-year programme. 

The three-storey College Building opens.

The Medical School is renamed King Edward VII College of Medicine to reflect 

more accurately its status as an institution that provides tertiary-level education. 

The Department of Dentistry admits seven students for its four-year course.

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. 

The Medical School is renamed King Edward VII College of Medicine to reflect 

1921

The College of Medicine stops operating as a medical school as the Japanese begin their three and half years of Occupation in Singapore. 

The Medical College reopens and some 200 pre-war students return to continue their medical education. 

The Carr-Saunders Commission proposes the formation of a university rather than a university 

college. 

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.

1926 1929 1948

Lines, offering a full-time five-year course to train doctors in medicine, surgery and midwifery.

Surgery (LMS). Professorial chairs begin to be established; the first is the chair of physiology. 

King Edward VII Medical School, in recognition of an endowment by the 

King Edward VII Memorial Foundation.

King Edward VII College of Medicine to reflect more accurately its status as an institution that 

provides tertiary-level education. 

The Department of Dentistry The Department of Dentistry 

King Edward VII College of Medicine to reflect 1921

1905

Settlement and Federated Malay 

States Government Medical School is born at Sepoy 

Lines, offering a full-time five-year course to 

1949

reopens and some 200 

university rather than a university college. 

The University of Malaya is formed The University of Malaya is formed through the amalgamation of the King 

The construction of a two-storey building behind the Tan Teck Guan Building gives room for more classrooms and laboratories.  The pre-registration or house-

manship year is introduced. 

The University of Malaya confers its first Degrees of Bachelor of Medicine and Bachelor of Surgery on 17 graduands.

The Department of Pharmacy at the University of Malaya in Singapore offers its first three-year degree course. 

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 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.

1959

1962The Singapore Division becomes a fully-fledged 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.university, keeps the name of University of Malaya.

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.

The University of Singapore merges with the Nanyang 

University to form the National University of 

Singapore at Kent Ridge. 

university, keeps the name of University of Malaya.university, keeps the name of University of Malaya.

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. 

university, keeps the name of University of Malaya. Faculty and its teaching hospital at Kent Ridge.

The University of Singapore 

A further revision of the medical curriculum takes place, 

with problem-based learning introduced in 1999. 

The Faculty of Medicine begins its move The Faculty of Medicine begins its move 1983

The Medical Faculty undertakes a much-needed review 1991

2002

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.

The Yong Loo Lin School of Medicine joins the National University Hospital 2008

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. 

The School of Medicine celebrates its centenary.

as the Faculty of Medicine of the University of Malaya in 

2002In line with 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. 

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Source: Straits Times © Singapore Press Holdings Limited. Reproduced with permission