The Centre for Precision Health (CPH), formerly the Centre for Personalised and Precision Health (CPPH) was set up in late 2014, as the core for research in Personalised and Precision health in NUHS. The CPH believes that the future of medicine lies in an individualised healthcare approach for patients based on their health conditions, needs, or the biology of the disease, followed by the delivery of the care that maximises health and cost-effectiveness while limiting toxicity and other adverse effects.
The CPH brings together omics analysis, bioinformatics, health services research, patient data analytics and clinical trials to exploit characteristics unique to Asian phenotypes for targeted diagnosis and treatment. Through this approach, the CPH targets to develop new methods of disease management and evaluation of effectiveness against the Ministry of Health's five strategic areas of diseases, namely cancers; cardiovascular diseases; diabetes mellitus and other metabolic/endocrine conditions; infectious diseases; and neurological and sense disorders.
The CPH is responsible for developing the strategy for precision medicine in NUHS and serves as the contact point for precision medicine efforts at the national level and with other industry players. The core objectives of CPH are to strengthen strategic alliances with industry partners to implement precision medicine in NUHS and to provide advice for project management and administrative support for pilots leading to clinical implementation in specific disease areas where precision medicine may have an impact in the short-term.
Prof Tai E-Shyong
Director, Centre for Precision Health, NUHS
Professor Tai E Shyong is a Professor in the Department of Medicine at the NUS Yong Loo Lin School of Medicine, NUS Saw Swee Hock School of Public Health and the Duke-NUS Graduate Medical School. He is also the Chief Medical Officer of Precision Health Research, Singapore (PRECISE) under the Consortium for Clinical Research and Innovation Singapore (CRIS), a subsidiary of Ministry of Health Holdings. He is a Fellow of the Royal College of Physicians in the United Kingdom and a Fellow of the Academy of Medicine in Singapore (Endocrinology).
Prof Tai has a longstanding interest in the development of novel treatments for diabetes mellitus that leverages human genetics for the identification of novel drug targets. More recently, he has begun working on better ways to implement existing treatments into clinical practice to optimise cost-effectiveness. One approach involves the stratification of patients based on the level of risk of adverse outcomes or responsiveness to specific therapies. Another involves the implementation of novel models of care for chronic disease including (but not limited to) primary care enhancement by implementing the principles of the patient-centred medical home. Prof Tai has published over 200 articles in peer reviewed journals.
Email: [email protected]
Dr Sim Xueling
Co-Director, Centre for Precision Health, NUHS
Dr Sim Xueling is an Assistant Professor at the NUS Saw Swee Hock School of Public Health. She is a molecular epidemiologist whose research focus is centred around the following areas - discovering genetic variants that affect cardio-metabolic disease risk, particularly in Asians; evaluating the role of omics biomarkers, including epigenetics and metabolomics, in prediction and stratification of individuals at high-risk of developing diseases; and using human genetics to inform population-level disease diagnostics and clinical practices in Asian populations.
Email: [email protected]
As opposed to a "one size fits all" approach, Precision Medicine uses relevant biological, medical, behavioural and environmental information about a person to tailor their healthcare.
Having these different types of information help doctors to better predict disease risk, make more accurate diagnoses, and select therapy that is more individualised. Researchers can also harness this wealth of information to develop new and more effective therapeutics, treatment as well as disease management strategies.
Doctors already use information about patients when deciding how to treat each patient. Currently, this information consists of characteristics such as age, sex, body weight, ethnic group, as well as simple measurements such as blood sugar, cholesterol, and blood pressure.
One of the big advantages of Precision Medicine is that it considers genetic factors, which explain up to 30 per cent of your health, such as your life span and which diseases may affect you. Now, technology has advanced to the point where genetic sequencing of people is much more affordable, allowing us to study and understand the genetic contribution to disease better than ever before.
Genes contain basic information needed to code for the proteins, cells and tissues that make up all living things. They play a role in determining our physical characteristics. More importantly, genes determine how individual organs and cells work in our body.
Our genes are coded as sequences of four letters, C, G, A and T. Differences in one or more of these letters are called genetic variants. Genetic variants are part of what make us unique. They affect how vulnerable we are to certain diseases and how we respond to foods, medications, exercise and toxins. Genetic variants can be passed down from parents to children.
From the name, Precision Health, some people may think of keyhole or laser surgery. However, in this case, we are referring to the use of genomics to better understand human health. Up to 30% of the pathogenesis of human disease has a genetic origin. Modern technology has allowed us to interrogate the genome at a level of detail, and at a scale that has not been possible before. This data (often referred to as genomic data), when combined with clinical and disease characteristics, offers the promise of more precise diagnosis, better risk prediction and tailoring of treatments, to maximise health and cost-effectiveness while limiting toxicity and other adverse effects. In some instances, a better understanding of the causes of disease will allow us to develop new therapies when existing therapies are in adequate.
Precision Health is also known by other names, such as Precision Medicine and personalised health/ medicine. Click here for more information if you will like to learn more about this rapidly developing field.
Even as the collection and sharing of healthcare data is growing exponentially, we know that databases containing genetic and clinical information about Asian patients are still relatively scarce. This means that doctors and scientists have to rely on databases of Western individuals to find novel diagnoses and select treatment for their Asian patients. But some diseases do not manifest the same way, or have different underlying mechanisms in Asian versus European populations. For these diseases, using databases containing predominantly European individuals to guide treatment in Asian patients is, at best, a gross approximation.
To address this need, the NUHS Centre for Precision Health (CPH) is actively establishing a bio-banking resource (Phen-Gen). By combining genetic and other omics data with clinical data from patient electronic health records (EHRs), Phen-Gen will serve as a valuable tool to advance a diverse range of research projects.
Another initiative by the CPH, Pre-emptive Pharmacogenomics (PPGX), will build and implement clinical workflows for the incorporation of pre-emptive pharmacogenomics (PGx) into clinical practice at NUHS. PGx makes use of a patient's genetic information to determine the optimal treatment and dose for that particular patient. "Pre-emptive" refers to the fact that individuals undergo testing for a panel of genes that affect commonly used medications, before they need these medications. When they do need one of these medications, the genetic information is already there for the doctor to consult before deciding which medication to use and at what dose.
Yet another aspect of precision health involves using genetic testing to identify people with diseases that may not produce physical signs. The CPH is actively involved in helping people affected by Familial Hypercholesterolemia (FH), a common disease that is often "silent" until a heart attack happens. Through facilitating genetic testing and cascade screening of FH patients and their families, as well as launching an educational program to raise FH awareness, we hope to prolong the lives of people with this condition.
Prof Tai E-Shyong
Director, Centre for Precision Health, NUHS
The Phen-Gen resource represents the first repository of bio-specimens at NUHS that is collected specifically for genomic analysis and linked to curated phenotypic data in patient Electronic Health Records (EHRs) in a secure computing environment.
The PPGX project aims to examine the key issues surrounding the implementation of pre-emptive pharmacogenomics (PGx) in clinical practice in Singapore, including demonstrating its efficacy in improving outcomes and identifying barriers that prevent adoption by clinicians.
Familial Hypercholesterolemia (FH) is a genetic condition in which high cholesterol levels are passed down in families, increasing the risk of premature heart disease significantly in these individuals. CPH is actively involved in helping people affected by this disease through genetic testing and cascade screening.
