Translational Immunology

This year, the Nobel Prize in Physiology or Medicine was given to James P. Allison and Tasuku Honjo- “for their discovery of cancer therapy by inhibition of negative immune regulation”. The era of cancer immunotherapy has come, offering a beacon of hope in our long, ongoing fight against this serious disease. Increased knowledge of the human immune system has been translated into exciting clinical solutions not only in cancer, but other disease areas as well. The objective of this interactive session on Translational Immunology is to provide a comprehensive overview of the immunotherapy landscape and to highlight successful immune modulation approaches in various diseases areas, such as cancer, autoimmune diseases and infectious diseases.

The event started with a talk given by Prof. Toh Han Chong (NCCS, Duke-NUS, Tessa Therapeutics). He shared with us the important discoveries in the history of immunology dating back from the 90s until now. To him, the recent breakthroughs in immunology were made by standing on the shoulders of giants, building on the discoveries of brilliant scientists likeSir Gregory Winter andAlexander Fleming.Prof. Toh gave an interesting analogy that the fetus, which is foreign from the mother’s perspective, does not provoke an immune reaction from the mother, in a very similar way that cancer avoids the immune system. Thus, a better understanding of the immune mechanisms during pregnancy can improve our understanding of cancer immunology. An in-depth understanding of cancer immunology and cancer mutations with the advancements in genomics will help bring in the new dawn for cancer therapy.

Prof. Toh sharing stories about key milestones in immunology research history.

Following Prof. Toh’s talk, a panel discussion with distinguished panelists consisting of Prof. Toh, Prof. Salvatore Albani (Eureka Instititue of Translational Medicine, Translational Immunology Institute), Dr Piers Ingram (Hummingbird Bioscience), and Prof. Ooi Eng Eong (Duke-NUS, Tychan) was then convened with the floor open to questions from audience members. The Q&A generated a vibrant discussion on the upcoming exciting developments and challenges we can expect in this new era of immunotherapy.

Here are some highlights from the Q&A session:

It is an exciting era in Singapore for immunology. Besides the limited funding available, what is missing in Singapore for translational immunotherapy?

Dr. Albani: The tendency to be reactive rather than proactive may be the biggest hurdle for translational immunotherapy in Singapore. Though the ability to react quickly in Singapore may allow us to compete in this field, we might not be able to lead, especially in areas where innovation is crucial, if we are unwilling to take risks. The willingness to take risks is paramount to be the innovative leader in this field.

Dr. Ingram: Only the accumulation of experience from multiple cycles of trials and failures will allow us to achieve success. We need the patience and willingness to build an ecosystem because there is no quick way to do it.

Dr. Ooi: The appetite for risk in Singapore is still lower than that in Boston and Silicon Valley. It is hard to convince people who are risk averse and impatient to invest in translational immunology, where the fruits of labor will only be apparent after a significant number of years. In Singapore, there is a greater focus on Medtech rather than biotech because it is faster for Medtech startups to achieve commercial success. We might really need to tough it out in order to win big.

Prof. Toh: One advantage of Singapore is that it can connect the important dots and gather all strength together. But in certain areas Singapore might need to do more. For instance, to encourage biotechnology innovation and build a more sustainable ecosystem, Singapore needs to work hard to catch up with regions like Boston and Cambridge.

What are the considerations of a big (biotech) company for coming to Singapore or leaving Singapore?

Dr. Albani: Singapore is doing so much as compared to some much larger countries in various aspects to build its ecosystem and lead the way. So if you do want to make a difference in improving patient health, that is a reason to stay in Singapore and there are plenty of opportunities here.

Prof. Toh: Singapore has been great in some ways but compared to Massachusetts, Singapore is not yet an epicenter. Compared to places like Silicon Valley, the tolerance of failure in Singapore is not high enough. We will need to accept failure to achieve more success.

Dr. Ooi: Certain diseases have mutations that are prevalent in Asia. The fact that Singapore is in Asia gives us certain advantages to tackle prevalent diseases in the region. For example, Singapore has significant influence in regional organizations such as Association of Southeast Asian Nations (ASEAN) and this could improve the capability of Singapore in accessing this regional market. Another example is that if the drug needs to go through clinical trials in major Asian populations, such as Chinese, Indians or Malaysians in order to get its approval, Singapore then possesses the right data to access those markets as a result of its own population composition.

Dr. Ingram: One advantage Singapore has in creating an ecosystem is the presence of big pharma companies here.

Dr. Ooi addressing questions raised by the audience during the panel discussion

What might be the next “big” instructive technology in the next 5 years in immune oncology?

Dr. Albani: (1) The biggest challenge now is to think out of the box and look at immunology systematically. The next big technologies are those that can explore both upstream, and downstream in research innovation. They should not be just mere tools, but technologies that enable understanding and manipulating at the interfaces of immune system and tissues. (2) The utilization of precision medicine, to target a small proportion of patients based on their genomic or molecular profiles is our current “low-hanging fruit”. In this area, we see many opportunities.

Dr. Ooi: One fundamental problem of the current healthcare situation is how to make medicine more accessible and affordable. Research that can reform the regulatory system may be what the society truly needs.

Prof. Toh: People making breakthroughs did not search for trendy topics to work on. In the end, we still need to go back to ask fundamental questions for research, which I believe will contribute to the next “big” technology. However, I do believe in the diverse pool of available technologies and innovations, predictive public health would be worth exploring. It will play an important role in the future healthcare system, where the identification of population to intervene is crucial in catching high risk patients even before they develop the disease.

Dr. Ingram: It is crucial to consider questions regarding “when to use the right drugs at the right time”. Technologies that can help close this gap will be very promising.

The event ended with an active networking session among speakers and participants. The BCS team would like to thank all speakers and participants for making it a successful interactive event!