Dr. Koh Poh Koon, Consultant Surgeon, Novena Colorectal Centre,
Medical Director and Consultant Surgeon, Capstone Colorectal Surgery Centre,
Adjunct Assistant Professor, Duke-NUS Graduate Medical School,
Adjunct Clinician Scientist, Institute of Bioengineering & Nanotechnology, A*STAR,
Visiting Consultant, Department of Colorectal Surgery, Singapore General Hospital,
Visiting Consultant, Department of General Surgery, Changi General Hospital,
Acting Director, Colorectal Cancer Molecular Genetics Research Laboratory, Singapore General Hospital,
Acting Director, Colorectal Cancer Genomic Health Service, Singapore General Hospital

18 February 2012

By Ai San Yip

Edited by Wan Qing Leow Rachel

Photo courtesy of Novena Colorectal Centre

Photo (Left to Right): Dr Koh Poh Koon, Dr Francis Seow-Choen, Dr Ho Kok Sun, Dr Lim Jit Fong

Novena Colorectal Centre (NCC) is a dedicated group practice formed by four prominent Singapore colorectal surgeons – Dr Koh Poh Koon, Dr Francis Seow-Choen, Dr Ho Kok Sun and Dr Lim Jit Fong, in partnership with Fortis Healthcare Singapore offering comprehensive and integrated colorectal care. Some of the services include genetics screening for hereditary colorectal cancer, treatment of functional bowel disorders and advanced minimally invasive surgical (MIS) techniques in colorectal surgery. With an in-house Anorectal Physiology Measurement Laboratory, patients can receive comprehensive diagnostic and investigative services for dis-coordinated bowel movement and bowel incontinence.

1. What is your background?

I received advanced training in surgical treatment of Inflammatory Bowel Diseases in Edinburgh (UK) and Cleveland Clinic U.S through a HMDP Scholarship provided by the Ministry of Health Singapore. In 2010, I was awarded a second HMDP Scholarship to pursue further training on “Clinical Gene Testing and Personalised Medicine in Colorectal Cancer Management” at the Genomic Medicine Institute at Cleveland Clinic, USA.

2. The motivation behind Novena Colorectal Centre is ... ?

Novena Colorectal Centre is set up as a new partnership between four colorectal surgeons with expertises in various aspects of colorectal disease management. We came together because we can synergise and pool our individual in-depth knowledge in specific domains to collectively manage the entire spectrum of colorectal diseases. In this way, the partnership as a whole is greater than just the sum of its parts. Together, we have the bandwidth and the necessary expertise to deliver excellent surgical care, induct cutting edge technologies, perform translational research and support surgical education. As a group, we now have the synergy to bring about a truly one-stop service to all patients with the entire spectrum of colorectal diseases.

For example, apart from general colorectal surgical and laparoscopic procedures, I specialise in the management of hereditary colon cancers such as Lynch Syndrome or Hereditary Non-polyposis Colorectal Cancer (HNPCC). My contribution is in the genetics of colon cancers and the management of patients and their families with hereditary colon diseases especially pertaining to genetic testing, clinical risk management and surgical strategies for cancer risk reduction in these high risk families.

One of my other colleagues, Dr Lim Jit Fong has specialised interest in dys-synergic defaecation. He diagnoses and treats patients with functional bowel problems such as chronic or obstructed constipation as well as faecal incontinence using sacral nerve neuromodulation. This utilises an implanted device capable of electrical stimulation of the sacral nerves to induce colorectal motility. These devices are available in U.S. and Europe but not locally. Why? Use of these devices require specialised skills  and advanced investigation tools to measure and monitor key clinical  parameters such as rectal pressure, anal muscle strength, tolerable volume of rectum etc. Thus we have set up the first and only private-operated Anorectal Physiology Measurement Laboratory in our Centre to provide anorectal physiological measurement in the Singapore in order to support this innovative technology of Sacral Nerve Neuromodulation.

Dr Francis Seow-Choen brings with him years of experience as a master-surgeon. His vast international network allow us to tap into the expertise of other academic centres of excellence to benchmark our level of care. Dr Ho Kok Sun who is also an accomplished laparoscopic surgeon and the current President of the Society of Colorectal Surgeons (Singapore), brings with him a keen business and financial sense that is crucial to us as we endeavour to bring cost effective and value-added services to our patients.

In NCC, our tag line is “Pushing Frontiers, Saving Lives”. “Pushing Frontiers” embodies our desire to expand the technological envelope to ensure that no patient is denied the state-of-the-art when it comes to their care. It also articulates our philosophy that we will spare no effort to explore all options for the benefits of our patients. “Saving Lives” clarifies that our focus is always on the patients and their well-being, so that all our endeavours are patient-centric. Advanced surgical techniques such as key-hole (laparoscopic) surgery and robotics-assisted surgeries require a team approach which would be extremely difficult for a single surgeon to champion. Having a strong team like ours with individual competency in advanced laparoscopic and robotic surgical techniques will also allow us to rapidly adopt innovative, new techniques and technologies for the benefit of our patients. With a large collective patient pool, we can more effectively analyse outcome measurements to ensure that our practice is evidence-based even as we push the technological frontier to save lives.

3. We saw you on Straits Times interview several weeks ago. What is Fortis Healthcare Singapore’s (FHS) involvement (strategic role) in the partnership? How can this involvement add value for patients?

Fortis Healthcare Singapore is our facilities provider and management partner. Fortis Healthcare Singapore through the anticipated launch of the Fortis Hospital for Colorectal Diseases (FHCD) at Adam Road this June 2012 is committed to bringing integrated, patient-centric healthcare. Novena Colorectal Centre (NCC), a partnership with the four of us as founding partners, will provide the clinical and surgical expertise. This new hospital, dedicated to the treatment of colorectal diseases, is designed with the needs of the colorectal patient in mind. Sparing no details to make the convalescent period of the patient a soothing and pleasant experience, we believe that both NCC and FHCD are aligned in our vision to be a global leader in the integrated and comprehensive colorectal diseases management healthcare space and to continually push the technological frontiers to save lives while remaining patient-centric at all times.

From this viewpoint, we would expect to fine-tune our engagement model with Fortis Healthcare Singapore as we learn and evolve together. Our model is not the typical employee-employer model, but a partnership model where each of us has an identity, domain interest and collective competence while at the same time, remaining driven by our vision.

We believe that this unique partnership between a group practice and a dedicated healthcare management provider will generate a critical mass to drive the twin arms of clinical research and translational application. We hope to be the first adopter of new technologies (first-to-use and first-to-try). To adopt new technologies or techniques in surgical treatment, a framework that supports exploratory research and teaching pedagogies is crucial.  The close partnership between FHCD and NCC allows for the creation of a governance framework focusing on patient safety and a conducive environment for peer appraisal and group-learning to shorten the learning curve. This is a unique model in the private healthcare space in Singapore.

Editor’s note: The Straits Times article, dated 04 February 2012, revealed that Fortis Healthcare invests SGD 70 Million in two colorectal centres in Singapore.

4. What are some of the challenges you face?

The biggest challenge is finding the right group of surgeons with the correct alignment and vision, yet possessing the necessary complementary skill sets in the realm of colorectal disease management. The next challenge is creating an engagement framework and core values that can align the individualism (yes, most surgeons have big egos!) to create the right team dynamics and propel the group towards the common vision.

Add on a healthcare partner like Fortis Healthcare Singapore (FHS) who is part of a huge global healthcare conglomerate with diverse interests globally, and one begins to see the challenges of integrating NCC with FHS. Fortunately, the four of us have had prior experience working together in Singapore General Hospital so the first challenge is easily surmounted. We are still evolving as we go along in terms of finding the ideal engagement model. With the key principles of engagement nailed down, I believe the minor adjustments that are necessary along the way will not be a show-stopper. Having been engaged with Fortis Healthcare Singapore’s senior management team in the early stages of our mutual development has allowed us to evolve a common set of core values and strategic vision. I am optimistic that with this common set of core values and alignment in our strategic vision, we will be able to navigate the grey areas as we embark on creating a unique game-changing private practice healthcare model in Singapore and beyond.

Moving forward, one of the issues close to my heart when it comes to public engagement and healthcare delivery is in the management of patients and their families diagnosed with hereditary colon cancers. Colorectal cancer is the most common cancer in Singapore and adopting a cancer screening program as a cancer prevention strategy should clearly target high risk groups. These programs are currently focused on the screening of individuals who are older than 50 years old and selected at risk individuals via endoscopy or fecal occult blood testing.

However, the approach of offering genetic testing and genetic screening in individuals or families with significant family history of colorectal cancer that may have hereditary colorectal cancer has not been emphasized enough. Up to 30% of all colorectal cancers have a familial clustering and indeed, our local data suggested that up to 23% of all colorectal cancers occurring under the age of 50 may have a hereditary basis. This means that a significant number of family members of these patients could be at risk of developing colon cancers themselves even before they reach the age of 50. Without a clear management strategy that must include genetic testing, many of these families are “cursed” with the development of multiple cancers that are preventable to a large extent. We need to raise public knowledge and awareness about hereditary colon cancer and the options available to detect and risk stratify them.

To this end, NCC and FHCD offers a one-stop integrated high-risk family consultation clinic with ability for genetic testing and supported by a laboratory for genetic research. We will also be embarking on public outreach programs to engage and educate the public on the management options for those at high risk of hereditary colorectal cancers. 

5. What do you think of the direct-to-consumer (DTC) genetic testing or the next trend in research?

Direct-to-consumer (DTC) genetic testing that allows the consumer access to their genetic make-up through a buccal swab or simple blood sampling done at the local pharmacy is controversial. This is a situation where the science has not caught up with the technology. Today, we can sequence the entire human genome at a fraction of the cost and within a matter of days or weeks compared to the time when the first human genome was sequenced. However, we do not yet know the risks and significance conferred by certain polymorphisms in the genome. Many diseases are also likely to be polygenic in nature and their causation multifactorial, reflecting a complex interplay of genetic factors and environmental influences. Hence, DTC gene testing is largely industry driven without clear clinical benefits or application at the moment. However, the tidal waves of DTC gene testing in U.S. and Europe may hit our shores in Asia, especially the affluent and internet-savvy Singapore sooner than we can imagine. With the internet, many services offered at any part in the world are now readily available. It is not uncommon to have a patient walking into my consultation room with information gathered from the internet and asking about the utility of these DTC testing services. Where there is demand, there will be supply and we may soon face the prospect of having to legislate this segment of the healthcare space ...

In Singapore, we do not currently have legislation pertaining to genetic testing, especially in the realm of germline genetic testing for hereditary disease. While ‘gene testing’ takes place in the prenatal diagnosis such as Down’s Syndrome, much of the gene testing currently pertains to cancer genomics (e.g. KRAS, EGFR testing etc.) that has no clear hereditary basis. However, BRCA (Breast Cancer Susceptibility) gene testing for hereditary breast cancer and APC testing for Familial Adenomatous Polyposis Coli (APC) can have potential knock-on effects pertaining to the insurability of the affected’ s children. Presently, there is no legislation in Singapore that protects the rights of an individual with regard to insurability or employability. This is unlike in the U.S. which has the federal Genetic Information Nondiscrimination Act [GINA 2008] passed by the Congress. This protects against discrimination (for health insurance coverage and employment etc.) based on genetic information. Clinicians, in advising patients the pros and cons of genetic testing, have to help their patients to rationalise the potential downsides to life-saving information needed for their care. Sadly, many patients are deterred by the lack of clarity in the law that safeguards their rights and often chose to forego genetic testing, to both their own and their families’ detriment. Even in the realm of biomedical research, the widespread availability of deep sequencing technologies have allowed a huge amount of genomic data to be easily available. What happens when the equivalent of a “WikilLeak” in genomic research happens? Imagine information about the finding of a “Schizophrenia pre-disposing gene” in a supposedly healthy volunteers being released inadvertently.

In the absence of a law that can protect an individual’s private and confidential genetic information without disadvantaging him from employability and insurability, biomedical research may face a stumbling block when that happens. Who will be the healthy volunteer for your clinical trial that investigates the genetic biomarker for Schizophrenia? Are his personal rights being protected?  Are all these things being spelt out in the Informed Consent? Is that alone a sufficient safeguard?

6. If there is one word of advice you can give to aspiring technopreneur or fellow clinician-scientist who are looking to start their business in the industry, what would that be?

To have a good chance of success, one must understand the market situation and use one’s strengths to the maximum advantage. Stay within your core competencies which are your strength but constantly find innovation and novel applications to create a unique value proposition to your potential customers.

I think it is also important to be driven by a vision. While the strategy may change with the situation, the vision should allow one to remain focused.

Lastly, to succeed, one must not be afraid to take some calculated risks!

To contact the reporter on this story: Ai San Yip at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Dr. Carl Firth, Chief Executive Officer, ASLAN Pharmaceuticals Pte Ltd

17 January 2012

By Ai San Yip and Horrace Owino 

Photo creative by Larry Lim, Macro Studios

 
From Left to Right: Carl Firth, Kiran Asarpota and Angie Lee, Sean Wong, Victoria Lovatt and Kingsley Leung.

ASLAN Pharmaceuticals is an “Asia-enabled”pharmaceutical company headquartered in Singapore that develops novel medicines for global markets. The company licenses preclinical and early clinical compounds from global pharmaceutical companies, focusing on oncology, respiratory and inflammatory diseases, and uses the high quality and efficient development resources available across Asia to progress the drugs through clinical development.

1. Share with us your story and the motivation behind ASLAN Pharmaceuticals.

I started my career in science and that was my passion. I was educated at University of Cambridge with a PhD in Molecular Biology focusing on modelling and simulation of cell signalling pathways. That was at the time when bioinformatics and human genome sequencing were heralded as the next big breakthrough.

After graduation, I joined AstraZeneca as a lead bio-informatician, worked in that role for a few years then developed an interest to get a broader perspective of the pharmaceutical and healthcare industries. I took on positions in the commercial side of the company including business development, acquisitions, licensing and competitive intelligence in the UK. I then got the opportunity to do an Executive MBA in London Business School, as well as a chance to work for AstraZeneca in China for a few months. After my MBA, I was invited back to China for a placement where I ended up looking after our new product portfolio and worked with R&D teams to figure out the studies that were required to bring our products to the Chinese market.

I did that for two and half years then I moved to Singapore and spent a year with responsibility for business development and strategic planning in Asia Pacific. Shortly afterwards I had the opportunity to move into the finance industry, but still related to healthcare, at Bank of America Merrill Lynch as Head of the Asia Healthcare investment banking team.

I gained a deeper understanding of how the public and private markets approached the various industries by working on compelling stories for investors. I experienced firsthand how companies evolved – from raising capital to seeking exits and trade sales to other industry players. In addition, my background gave me a certain advantage in this new role. In banking you do not necessarily need to be an expert in a particular sector. You need to know how the finance industry works; how investors think and how to raise capital. Since I came from a background where I knew the healthcare industry also, I found that clients respected us because we understood their business. We were able to go in and show our clients that we understood what made strategic sense for them. I was able to put together transactions and negotiate better deals.

My time at Bank of America Merrill Lynch reignited my passion to build something. I was inspired by other people (entrepreneurs / founders) who lived their passion and built a business around it. So, at the beginning of 2010, I stepped down and joined some of my former colleagues from AstraZeneca to devise a plan to see how we could use some of the emerging clinical capabilities in Asia to develop drugs more effectively and more efficiently. 

Historically, drug development actually has not been very successful due to increasing time to market, tougher regulatory hurdles and the increasing R&D costs of developing a new drug. At the same time, there are a few visible trends occurring in Asia. Pharma companies have been outsourcing manufacturing, drug chemistry and drug toxicity studies to Asia for quite a while to the large number of high-quality and reputable CROs and CMOs based around the Asia region. Pharma companies have also progressively conducted an increasing number of large clinical trials (Phase III and Phase IV) in Asia. But with the emergence of high quality early phase clinical centres, we asked “What can we do to leverage on these capabilities in global drug development?” With that in mind, we started ASLAN Pharma in late 2010.

Our business model is relatively straightforward. We will license compounds from biotechnology and pharmaceutical companies. Typically, we are mainly interested in compounds that have been chosen for clinical trial Phase I so they have just finished animal testing, or compounds already in Phase I. We will then design innovative programs and creative studies to take these compounds through Phase I and Phase II and demonstrate these compounds are effective in human subjects. Once we can demonstrate a robust proof-of-concept in these studies, we then look to partner with multinational pharmaceutical companies for global Phase III developments and commercialisation, while retaining rights to certain Asian markets.

So, what is unique about our model? We will be conducting all of the work in Asia. And the data which we deliver at end of Phase II should enable a global Phase III trial that can lead to global registration and launch. We are not just doing it “in Asia for Asia”. We are using Asia as a platform to conduct and make more efficient the global drug development process – “in Asia for Global”.

2. Who funds all these business activities, projects and trial expenditures? Are you tapping on any government funding? Technology assistance grant? Venture Capital?

When we started ASLAN, we seeded the company with money primarily from management, friends and family.

During 2011, we conducted our Series A funding, at the end of which we had USD 12 Million, in a round led by Bioveda Capital, a Singapore-based VC fund, and Sagamore Bioventures, a West coast fund, along with a number of private investors who provide us with good connections and support. As we are in our early rounds of financing, it is important that we know our investors well. They would have to be committed to our vision and extend our reach in terms of relationships and on-going access to capital, novel compounds for our pipeline and capabilities.

Generally, there has been a reduction in the availability of funding from VC firms for the drug development industry. This is particularly true in the United States but interestingly, China is able to access ‘hot’ money which can be a dilemma as there may be too much money chasing after too few good deals. I believe that the rise of Asia is somewhere in-between the U.S. and China systems. And often, we may be able to access newer sources of capital in Asia.

As drug development is a much more specialised industry, you need investors who are knowledgeable in biotech and drug development. Such investors are difficult to come by in Singapore and this is a real challenge. I think there have been great programmes developed by the government to help build up these resources and capabilities in Singapore, but these sources of funding are only good for getting companies started for the first few years. The growth and potential of these companies will be significantly hindered if they are unable to access suitable capital markets.

Fortunately, ASLAN is well-positioned to move past these challenges. We are looking to raise more capital early this year.

Firth says ASLAN Pharma is not the only company (notably, there are some companies in United States that pursue this unique risk-sharing development model as a virtual organisation). ASLAN is one of the first with such a model, working with different CROs and CMOs based in Asia.

Editor’s notes: we were amazed to find out that ASLAN is a virtual company, with a team of just 12, operating from a two-storey shop house at 10A Bukit Pasoh Road, Singapore.

3. How do you secure capital and venture funding?

You need, of course, a great business, a great team and a great portfolio of drugs. Relationships are also important - you will need to build constructive working relationships with the right people, thus, having worked in the finance industry can be very useful! The fact is that having made the right connections with VC firms, private equity groups, you can use these connections and reach out to more people and build good networks of potential investors who will answer your emails and calls because they know you. Clearly, having a great business model is also critical. You will also have to build collaborative teams and have some experienced players on your team - the track records of the team are also going to make the difference.

When you start to talk to investors, you might not have too much to show other than a business plan and team profiles (these people in your team might not have joined you as yet). Thus, at the first round, it helps if the entrepreneurs / founders can bring some money to the table. For instance, you will need to have some capital (either from founders, friends or family) that can support the business and at least about twelve months of financial runway to cover your start-up expenses. This action will also demonstrate to potential investors that you are truly committed – much more so than a small government grant.

In our case, we had not licensed in our first compounds when we were in Series A financing. But we had a good sense of what our portfolio / pipeline would look like. We went to our investors with a good business plan and term sheets, and they invested in the team and in the model.

4. Tell us about your business plan and the processes you went through.

Many big pharma are facing unprecedented patent expiries; there is less money to fund R&D from operations and earnings. Companies are still developing some good compounds (targets and lead candidates) out of the lab. But it has becoming tough to have enough internal capabilities and resources to take all the compounds through Phase I and Phase II. However, once the compounds have completed Phase IIb (and generated good datasets and clinical outcomes), big pharma will be happy to invest and conduct Phase III because the drug is now only three or four years away from the market.

In Phase I, when the compound is still seven to eight years away from launch, you are still looking at a lot of risks and uncertainties plus a heavy sum of investment. It is an increasing challenge for big pharma to move all the compounds through this part of the development process. With Phase I compounds, most of the pharma companies do not want to in-license too early because they face the exact same high risk and capital to move these compounds into the market. Therefore, biotech and pharma companies often want to share risk on early clinical compounds. At ASLAN, we have our own preferred disease areas we want to work on. When we talk to companies which have strong pre-clinical or Phase I compounds within these disease areas, we like to see evidence that these compounds have the potential to be either “best-in-class” or “first-in-class”. We will then design an innovative clinical strategy to develop these compounds in Asia.

So why Asia? Increasingly, Asia has some of the highest quality clinical centres in the world, particularly in centres like Singapore, Korea, Australia and Taiwan, with experienced clinical investigators. Many regulators in the Asia region are relatively open to innovative approaches and have a balanced view of risk / benefit in clinical programs, particularly in diseases where there are high levels of unmet need. Compare this to the increasingly conservative regulatory environment in the West. This allows us to have a more open dialogue with the regulators, and often work with shorter regulatory timelines. In terms of recruitment rates, you typically see rates between two and five times faster in Asia due to the structure of the healthcare system – large medical centres serving large populations. Costs can also be lower, though this is not really out primary driver. Indeed, the costs of smaller clinical studies may not be much lower, but certainly for much larger studies, and importantly for manufacturing and preclinical animal studies, the costs can be a lot less than the same study in US or EU.

We really like to sit down with our potential partners, with our proposed development strategy and say: “This is how we can develop your compounds in Asia”. Then, we will discuss a fair split of the value based on what each party brings to the table, and put together a transaction to license the compound so it’s fair and equitable to both parties. Typically, we in-license global rights across all indications and geographies, and - in some scenarios - the pharma partners might have a right to buy the compound back at the end of the Phase II.

Currently, there are an increasing number of quality early-stage compounds available for partnering in the pharma industry. I think there will be more and more companies like ASLAN that bridge this gap in drug development. So far, we are excited to be the world’s first pan-Asian company. I believe our vision is to build a robust portfolio of innovative compounds in our clinical pipeline. So far we have licensed two compounds and will be looking to announce our third deal (licensed compound) in the next 3 months. Towards the end of this year, we hope to have the strongest portfolio of innovative compounds in Asia (ex-Japan).

We want to stay lean – we are a team of 12 people at the moment - and efficient so we can make quick decisions, move quickly in delivering studies and have minimal overhead. Our team provides the ability and expertise to screen and identify the right compounds, evaluate these compounds, structure deals, and design innovative development strategies, but we then outsource the operations to experienced clinical / preclinical CROs and CMOs. We are responsible for  designing the studies, reaching out to experienced principal investigators, and forging partnerships with CROs and CMOs, who will execute these plans.

5. What are the licensing deals with Bristol-Myers Squibb and Array BioPharma?

During July 2011, we licensed ARRY-543 from Array BioPharma of Boulder, Colorado. ASLAN001, as we named this compound, is a pan-HER inhibitor that has completed a number of Phase I studies already (studied in over 200 patients) for solid tumours in United States. We are putting together the development plan of ASLAN001 to focus on gastric cancer,  hepatobiliary cancer and other cancer diseases in which there have been few changes in therapies over the last 20 years and where the prognosis is often poor. Gastric cancer is one of the biggest killers in oncology in Asia, so a significant unmet need exists. Our first Phase II gastric cancer study has started now in Korea, but we will expand to other countries, including Singapore, after this first study completes.

Our second in-licensing deal was with Bristol-Myers Squibb on BMS-777607 (ASLAN002) is a cMET inhibitor, a receptor tyrosine inhibitor for gastric cancer. We also plan to run studies in other tumour types in the future. We licensed this in November 2011 and plan to start a Phase I study shortly.

When we evaluate these pre-clinical compounds, we want to be “first-in-class” or have the potential to be “best-in-class”. We are continuing our licensing efforts over the course of 2012 and hope to make another announcement very soon.

6. If there is one word of advice you can give to aspiring technopreneurs who are looking to start their business in the biomedical industry, what would that be?

There is no easy way to set up a company in this space. The challenge is that one individual (scientist) who comes up with an idea will not likely have a full set of skills to execute and build the company. I do not have this. That is why you start building a team of people who complement one another to bring the requisite skills to the table, for example, through your team, partners, investors and advisors.

One of the critical success factors is bringing together that right group of people. And you can easily pull people in, as long as you have a compelling idea and are prepared to recognize the value that these individuals can bring to the business and not get too concerned with what you have to give away at an early stage. I would rather own a little bit of an incredibly success company than a big piece of an unsuccessful one. It is all about the people that surround you and what you may do to bring them onboard.

To contact the reporter on this story: Ai San Yip at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Dr. Miles Gilman, Managing Director, A2 Bioscience Pte Ltd

06 January 2012

By Ai San Yip and Erwin Chan 
 

Dr. Miles Gilman, Managing Director, A2 Bioscience and Mentor-in-Residence, Institute for Innovation and Entrepreneurship (IIE), Singapore Management University.

A2 Bioscience develops, designs, licenses, and markets therapies in the areas of neuroscience, anti-infectives and cosmeceutical over-the-counter products. The company is interested in merging new proprietary drug delivery systems with natural compounds with improved efficacy and safety profiles.

A2 Bioscience was established in 2008 as a Singapore start-up.

1. Share with us your story and the motivation behind A2 Bioscience.

When I began my career in the medical field, I have always been interested in how technologies can be used in healthcare and pharmaceutical industries. Although I obtained my doctorate degree in clinical pharmacy and cardiovascular drug research, I moved on to focus on clinical drug research and eventually transitioned into healthcare business including pharmaceutical care, drug research, fund management, healthcare services and biotechnology. My career had evolved from developing concepts to viable businesses.

A2 Bioscience was formed in 2008 as the nineteenth company that I have started. Building and selling companies over the past 25 years has been both rewarding and challenging. The smallest company grew and attracted external equity investment with a size of 280 employees in four years whilst the largest grew to 4,500 employees in four years.

When this particular business (A2 Bioscience) opportunity came up, we did a tremendous amount of research and due diligence in six (emerging) Asia countries. Our guiding questions were; “Where is the best place to commercialise natural medicines? Where is the best place to launch OTC products, create positive growth for our business and best chance of being successful?” That was in the mid-2008. We travelled to these six countries and utilised a “traffic light system” to evaluate the feasibility. In this particular case, Singapore got all ‘green lights’ which was rather rare.

We found that Singapore had a robust healthcare system as well as a growing economy. Singapore was also an easier market to study due to its density and the relatively smaller population. It would therefore be easier to generate consumer data and marketing research studies to find problems and identity improvements before we launch our products in other regions. Most of our products are manufactured in the United States, shipped to a local warehouse, received and quality-verified in Singapore before exporting out to other areas. In the future, we hope we can set up a manufacturing base here.

2. Tell us more about A2 Bioscience flagship product, GABAnite. What are other exciting products?

GABAnite has a key active ingredient called Gamma Amino Butyric Acid (GABA) in a nano-encapsulated form that enhances relaxation. GABA and melatonin are naturally produced in the body and are responsible for a good night’s sleep. The idea is that if you are sleep derived or stressed, your body should be using more naturally occurring GABA in the brain. GABAnite provides the body with bioavailable GABA, so if the brain needs GABA, the brain should take it up in equilibration.

 
 
GABAnite is marketed as an “all natural drink to calm and relax” at a retail price of SGD 3.50 per bottle. The product is available at most pharmacies including Watsons, Guardian, Unity and Nishino stores island-wide.

We have been designing products for three and half years. A2 Bioscience has 23 products in our pipeline now. We have launched three products in Singapore to date, ie; GABAnite, Lumisys and Eyelash Growth Factor.

The fourth is MEDIslim (a soon-to-launch supplement product in 2012). It is a bio-absorbable thin film strip impregnated with 5-Hydroxytryptophan (5-HTP). 5-HTP is also known as oxitriptan, a naturally occurring amino acid and chemical precursor, that is involved in the biosynthesis of the neurotransmitter serotonin.

In terms of the technology deployed, we use a proprietary dissolvable oral thin film strip (TFS) for the drug delivery system so that we can load soluble small molecules and compounds. Only certain small molecule compounds are capable of absorption into the bloodstream and suitable for use with this drug delivery system.

MEDIslim is formulated to dissolve quickly and normally in less than one minute when one places it in the mouth or under the tongue. Using the combination of 5HTP’s molecular structure and the technology of TFS, we can get the active pharmaceutical ingredient (API) into the bloodstream due to the unique membrane structure of the oral mucosa. Our technology provides absorption typically in one’s bloodstream in about 15 to 30 minutes.

MEDIslim is designed to be a convenient and stable product to enhance consumer compliance. Therefore, MEDIslim is packaged in single use foil sealed sachets for each strip so the consumer can easily carry the product with them, day and night. Compliance and consistency in eating habits are some of the most important factors with programs like MEDIslim in order to provide long-term weight reduction.

Editor’s Note: TFS technology, one can even tailor compounds to meet specific API-loading needs and dissolution rates.

3. The OTC / TFS product-market are not just consumer marketing and advertising and pricing competition; how much of the scientific evidence can one validate in valuing the product-market feasibilities?

We have devised a set of concepts (resonated as “four filters”) that remain strongly associated with the Company’s objectives.

The first filter is that the active ingredients should be safe, non-toxic and all natural (high safety index).

Secondly, these active ingredients should be proven as ‘therapeutically effective’ with previously known data and research.

Thirdly, these active ingredients should be able to be re-designed and formulated with a unique proprietary method that could further increase the desired therapeutic effects of actives. For example, 5-HTP has a published clinical data as an intranasal spray. We then re-designed 5-HTP using TFS technology which then makes it more convenient to administer as well as create therapeutic its bio-availability in the bloodstream.

The fourth filter is that the consumers must be able to tell that the product works. For example, GABAnite makes you feel relaxed and sleep well at night. As for MEDIslim, the consumer should be able to notice a difference in their appetite and weight reduction when combined with a sensible diet and consistent use.

 
We were astonished when Dr. Miles Gilman showed us the next-in-line product MEDIslim.

4. You have been involved in the start-up scene for a while now, are there any gaps in the Singapore ecosystem?

I have been acquiring more knowledge about the Singapore biomedical and start-up systems over the last few years. Although there are many positive aspects to the start-up scene in Singapore, there are also many areas of the industry which need development to accelerate the commercialization process. Funding sources, beyond the government grants, need to become more abundant. Mentoring and entrepreneur interfacing with business concepts could also be more plentiful.

Singapore has many great technologies and ideas. It is just a matter of putting all the necessary ingredients together to help increase the commercialization process. Once enough success stories and exit strategies are documented, I believe other private equity participants will locate to Singapore and hence establish a permanent eco-system. Singapore also has great resources such as the country’s infrastructure, human talent pool and local expertise. The transparency of the Singapore government and regulatory guidance from Health Science Authority are all big positives for medical and pharmaceutical start-ups.

5. We saw you on Straits Times interview several months ago. You said that A2 Bioscience has a group of investors who poured SGD 3.5 Million in the company. How did you manage to raise the primary investment sum?

Most of them are strategic angels; pharmaceutical CEOs, biotechnology professionals and investment bankers in biotechnology who invested in our company. We have sought to raise strategic angel money from people who are capable of providing business counsel and advice in additional to capital.

A2 Bioscience has raised about SGD 2.5 million (Series A) from strategic angels. The other SGD 1.0 million came from SPRING SEEDS funding.

In other recent start-ups, we raised between USD 15 million to USD 25 million in the first round of investment which came from financial institutions and private equity partners. Over the years, I have met quite a few of people in the financial and healthcare markets (private and institutional healthcare funds) who were excellent value added partners. We cannot guarantee what is going to happen to A2 Bioscience in terms of payback, return-of-investment or liquidity but, historically, the investments that came together in these start-ups have done well over time.

Editor’s note: The Straits Times article, dated as 12 October 2011, revealed that Mr. Richard Eu, Chief Executive of Eu Yan Sang International was one of the local investors.

6. If there is one word of advice you can give to aspiring technopreneurs who are looking to start their business in the biomedical industry, what would that be?

There is great opportunity because the pharmaceutical industry is in dire need of ideas. However, the ideas have to turn into reality before someone or, large multinational corporations (MNCs) will be interested in them. That tricky path from an idea to cashing out after years of investment or, licensing to MNCs is the difficult part.

So, I would have to say “build an experienced and strategic business team” around your idea to seek global partners and attracting these partners to Singapore. The team has to know how to deploy smart money to drive not only innovation but gain calculated traction and quantifiable milestone achievements.  Smart money should be from people who have done start-ups; people who know how to commercialise products, people who have access to insights and analytics and of course; access to capital. Technoprenuers can achieve great outcomes by filing the right variables, lots of hard work and a bit of luck.  As Thomas Edison once quoted: “Genius is one percent inspiration and ninety-nine percent perspiration”. Accordingly, a ‘genius’ is often merely a talented person who has done all of his or her homework”.

To contact the reporters on this story: Ai San Yip at This e-mail address is being protected from spambots. You need JavaScript enabled to view it and Erwin Chan at This e-mail address is being protected from spambots. You need JavaScript enabled to view it