Checking in with Dr. Koh Poh Koon, Adjunct Clinician Scientist, IBN; Senior Consultant and Director, Colorectal Surgical Oncology & Cancer Genetics Service, Fortis Colorectal Hospital
09 October 2012
By Rachel Leow
Edited by Ai San Yip
Photo courtesy of IBN and Fortis Colorectal Hospital
Photo credits (from left to right): Professor Jackie Y. Ying and Dr. Tan Min-Han of IBN, with Dr. Koh Poh Koon and Dr. Jeremy Lim of Fortis Colorectal Hospital, at the Fortis-IBN TissueBank.
We ran an interview article on Fortis Healthcare Group during March 2012. About six months later, Genewired.com checks-in with Dr. Koh who is recently appointed as the Adjunct Clinician Scientist of Institute of Bioengineering and Nanotechnology (IBN), A*STAR and Director of the Fortis-IBN Tissue Bank (FIT)
1. Just a while ago, we have heard of the news establishment of IBN and Fortis Colorectal Hospital for Colorectal Cancer Research. How is the Fortis-IBN Tissue Bank resource used to accelerate translational research in colorectal cancer?
The Fortis-IBN Tissue Bank (FIT) resource is the result of a partnership between the Institute of Bioengineering and Nanotechnology (IBN), the world’s first bioengineering and nanotechnology research institute, and Fortis Colorectal Hospital (FCH), Southeast Asia’s first hospital dedicated to the full spectrum of colorectal disease management.
Conducting research with cell lines in a culture dish is not quite the same as working with a clinical tumor sample, and animal models do not always replicate the complex cellular environment in vivo. The true value of this tissue bank is in its potential to catapult the research outputs in a more clinically relevant direction.
The tissue bank will serve two important purposes. Firstly, tumor tissues collected with the corresponding clinical data over time allows us to gain better insights into the biology of tumors and discern the cellular mechanisms that may shed light into targets for improved diagnostics and therapeutics Secondly, well-annotated tissue samples of Asian tumors are precious resources that can serve as magnet for pharmaceutical companies to further invest their R&D resources into advancing the care and treatment of Asian diseases. I do believe that there are potential ethnic differences in the disease biology that we do not yet fully understand and further research into ethnic differences in certain tumor genotypes can allow us to personalize the management of these diseases in Asians.
2. How is Fortis-IBN Tissue Bank (FIT) different from SingHealth Tissue Repository?
The Fortis-IBN Tissue Bank was set up with the aim of banking colorectal cancer tissue and blood samples from Fortis Colorectal Hospital. As a hospital dedicated to the management of Colorectal Disease, Colorectal cancer features very prominently on our radar as one of the key diseases that we want to focus on. Colorectal cancer is the most common cancer in Singapore and is among the top 3 causes of cancer-related deaths. In addition, up to 25% of all colorectal cancers have a familial clustering with at least 10% having a fairly strong genetic basis for their causation. Setting up a dedicated Tissue Bank to complement the work of Fortis Colorectal Hospital in the fight against this very challenging and common cancer is therefore a very unique arrangement that I believe will allow us to take the fight to the molecular level. The partnership with IBN will also allow us to leverage on the exciting developments in nanotechnology to find novel and innovative ways to diagnose and treat colorectal cancer. This close integration of a specialized surgical hospital in the private sector, dedicated colorectal tissue bank and premier research institute is what distinguishes us from the Singhealth Tissue Repository (STR) which caters to the diverse research needs of a health cluster.
3. What is the motivation and vision for starting the Tissue Bank?
Fortis-IBN Tissue Bank is the first and only tissue bio-repository in the private sector in Singapore. Our vision is to use the resources vested in Fortis-IBN Tissue Bank to improve our understanding of Asian genetics and bring forth novel technologies that will benefit our patients. I firmly believe that for science and technology to directly benefit the masses, we must be able to commercialize the product. In setting up Fortis-IBN Tissue Bank, we are open to all collaborators who can demonstrate the clinical potential of their technology platforms.
My interest is in hereditary colorectal cancers. Setting up this Tissue Bank allows me to use this precious resource to profile different groups of colon cancers, especially young people afflicted with colorectal cancers. This will allow us to build up the knowledge-base of Asian colorectal cancers to move towards clinical genetic testing. This is because the knowledge of Asian cancer genetics is still fairly incomplete. At this moment, clinical management of hereditary colorectal cancers in Asia is still based largely on studies that are conducted on Caucasian populations. However, we know that in genetic syndromes, there are often modifiers, genetic differences and ethnic differences across different population groups. So, the same syndrome may have slightly different phenotypic expressions compared to the patients in the west. While a deeper understanding of this inter-ethnic variation has no immediate commercialization benefit, this has far reaching implications in clinical disease management. Some of this knowledge can be practice changing, impacting millions of people in Asia by changing clinical practice, diagnostic and therapeutic algorithm.
For example, Lynch Syndrome, often called Hereditary Nonpolyposis Colorectal Cancer (HNPCC), is a type of inherited cancer of the digestive tract, affecting particularly the colon but which also increases one’s risk of endometrial, ovarian, gastric and pancreatic cancers. Studies of Caucasians with Lynch Syndrome suggests that the colon cancers in Lynch Syndrome tends to affect the right-colon and poses a high risk of second cancer developing in the remaining colon of up to 25%. As such, the clinical recommendation is to perform a Total Colectomy (removing the entire colon and leaving behind only the rectum) However, our observation in Asia suggests that the colorectal cancers affecting Asians with Lynch Syndrome seems to predominantly affect the left-colon, with a significant number of tumors in the sigmoid colon and rectum. This would suggest that a Total Colectomy sparing the rectum as practiced in the West as a risk-reduction strategy may potentially compromise the bowel function of our Asian patients while still leaving behind the organ that is most at-risk (i.e. the rectum) in our Asian patients. So, by understanding the genotypic and phenotypic differences between the West and Asia, we can immediately influence the way we practice by a change in clinical guidelines without even a commercialisable product!
Editor’s note: In a broader context, we can define this as knowledge transfer which somewhat encompasses a bigger role than just IP or technology transfer. It may not have patentable substance but as you said, it is socially impactful …
4. What other research areas besides genetics and profiling? Is there something more direct and straightforward?
The tissue bank with a comprehensive matching clinical database is a research ‘goldmine’. The point is, when you have the tissue bank, you can do many kinds of research. Be it genomics, transcriptomics, proteomics or metabonomics. In clinical medicine, we rely on randomized trials and observation studies of large numbers of patient over time to determine if an intervention is more likely to produce a desired response. However, such population statistics cannot allow us to personalize our treatment algorithm or risk assessment for the specific patient. Individual profiling can translate to more personalized medicine in which treatment and clinical management is tailored to an individual’s biological profile and genetic makeup. I would surmise that as the cost of whole genome sequencing comes down significantly and our ability to interpret these massive amounts of information improves, we may be able to produce a personalized tumor genome that will allow for personalized treatment based on one’s own tumor profile. This could enhance treatment efficacy while minimizing unwanted side-effects of treatment.
5. Do you not think that this concept [personalized treatment] would most likely take place in the private healthcare space because it will most likely be expensive?
You are quite right. The cost for any new technology/test tends to be a bit higher. And, until it finds clinical value, government bodies are unlikely to subsidize it to make it affordable and accessible to the general masses. I see my advantage doing it in the private sector where patients are more willing and able to afford cutting-edge medical treatment. However, for translational research to take-off, it has to be a national enterprise. We are still lacking in laws to protect the individual’s genetic information and its disclosure. Without a robust legal framework that safeguards the individual’s genetic information and his individual rights, it may become difficult to recruit patients or healthy volunteers for genetic research for fear of future implications. For example, I can imagine it would be difficult to move on with research on predictive gene profiling for Psychiatric conditions or hereditary traits if such information can discriminate the patients or the ‘healthy’ volunteers. Some of these things, I think we need to urgently catch-up. Now that we’ve built a world-class research infrastructure in Biopolis, we need to put in place the legal framework for some of these research works to go unhampered.