Emerging strong

The Emerging Infectious Diseases (EID) Programme, one of five Signature Research Programmes at Duke-NUS, has become a regional infectious disease centre for reference and research in the Asia Pacific.

Prof Wang Linfa

“No doubt about it – EID punches above its weight.”

- Prof Wang Linfa

To work with an unpredictable enemy, the EID Programme has to engage in ‘warfare’ during ‘peace time’. EID Programme Director Professor Wang Linfa explained, “For other diseases, the progression is somewhat predictable. But in the case of infectious diseases, that isn’t so. During ‘peace time’, when a disease isn’t presently a problem, it’s important to try and build up expertise, and research better diagnostic and response strategies so that we can be better prepared to fight the unknown, emerging disease.”

Set up in 2007, the programme conducts research in different aspects of EID. This includes discovering pathogens, improving diagnostics, understanding risk factors that trigger disease outbreaks, identifying mechanisms of pathogenesis, conducting clinical trials and developing novel vaccines and therapeutics. The EID Programme also studies the animal and human interface where infectious diseases occur, particularly in common hosts such as mosquitoes, birds and bats. These hosts carry viruses from virus families like Flaviviridae (dengue and hepatitis C), Orthomyxoviridae (influenza), Paramyxoviridae (Nipah) and Coronaviridae (SARS and MERS).

Building capabilities and collaboration

To develop the next generation of infectious disease experts, Dr Wang and his faculty members have been actively recruiting experienced infectious disease researchers and other ‘rising stars’. This effort in the last three years has grown the EID Programme by 30 per cent. Training conducted by EID researchers has also extended beyond Singapore’s shores. Over the years, Dr Wang said, EID has trained more than 20 PhD students and over 60 research fellows – with many already carving their own careers as future leaders in infectious diseases.

Leveraging on the Academic Medicine platform, three EID principal investigators: Dr Wang, Professor Antonio Bertoletti and Assistant Professor October Sessions, have set up a new home in Academia. Academia is a building in the Singapore General Hospital campus, which houses research laboratories, education and training facilities, designed to improve the output of clinically impactful projects. This is a move that Dr Wang said will bolster a “stronger partnership with SingHealth” and a place where research and application can converge. Dr Wang is convinced that the BSL3 facility will spur the translational process. This year also saw the opening of the ABSL3 facility which can house non-human primates, the only one of its kind in Singapore. This will not only improve the programme, but also Singapore’s research capabilities in infectious diseases.

To better foster collaborations with researchers at Duke in Durham, a Duke/Duke-NUS travel grant was approved this year with an initial 10 travel scholarships offered to post-doctorate and advanced PhD students. “This is a breakthrough”, said Dr Wang, “that will strengthen learning between the two campuses, and those working in emerging infectious diseases”. The scholarships were proposed and then approved after strong relationships were built at the March 2015 Joint Duke/Duke-NUS Infectious Diseases Symposium – From Molecules to Man.

Growing strong

The EID Programme faculty has gone from strength to strength, and many members now hold various grants. This includes the Translational and Clinical Research Flagship Programme Grants, the Singapore Translational Research Investigator Awards, the National Research Foundation (NRF) Competitive Research Programme Funding Schemes and the NRF Investigatorship Grant.

In 2015 thus far, EID Programme faculty members have published more than 50 papers, including two major breakthroughs in dengue research in Science. One of these, led by Associate Professor Shee-mei Lok, is the discovery of an antibody to counter the notoriously resilient dengue serotype 2 virus. Another study from the group of the Deputy Director of the EID Programme, Associate Professor Ooi Eng Eong, explains a deeper understanding of the structure of the virus. These discoveries could help with future therapeutics and better predict outbreaks of the disease respectively.

The EID Programme has also spawned several clinical trials on novel therapeutic and vaccine strategies in fighting dengue and other infectious diseases. Professor Subhash Vasudevan led the research behind Celgosivir, a clinical trial – now in Phase II – to test a new dengue treatment which reported results in 2015. Assistant Professor Ashley St John, meanwhile, is co-leading KETODEN, a clinical trial to test a very novel treatment of dengue which uses an asthma drug. Duke-NUS’ collaboration with Visterra Singapore International, a spin-off of a US-based biotechnology company, aims to take the development of a dengue therapeutic through clinical trials and then to commercialisation. Dr Ooi, who plays a key advisory role in the collaboration, hopes that the trial will chart a course in Singapore to ease future clinical development of therapeutics.

During the relatively young life of the EID Programme, there have also been two biotech companies founded by the programme faculty members:

  • Singapore Advanced Biologics Pte Ltd (SABio) was formed in 2010 to meet the research needs in Singapore for on-time biologics. Founders, co-directors and scientific advisors, Professor Mariano Garcia-Blanco and Dr Vasudevan lead SABio, the company that now offers RNA oglios and services, ready-made antibodies, antibody production services and synthetic peptides.
  • Dr Bertoletti founded Lion TCR Pte Ltd (Lion) earlier this year, a biopharmaceutical company focused on the development of novel cancer and virus immunotherapies. Lion aims to use patients’ T-cells against cancer or virus-infected cells.

What’s next

“No doubt about it – EID punches above its weight,” said Dr Wang, pointing to 2015 in particular as a year of growth and opportunity for the programme. He continues to have conversations with Duke University and different infectious disease stakeholders in Singapore so that fruitful collaborations will continue. Dr Wang is one of only two Asia-based scientists invited to a NIH strategic workshop in Washington DC to identify gaps in the area of fighting infectious diseases. He hopes to personally further research in animal reservoir hosts. “If researchers understand hosts such as bats, and why they are resilient to pathogens, researchers can try and mimic this response or resilience in humans in an effort to prevent or treat diseases,” he explained.

Training the trainers

Last year, scientists from the EID Programme were approached by the Cooperative Biological Engagement Program – a programme under the United States Defence Threat Reduction Agency – to train scientists and veterinarians in surveillance methods, approaches and pedagogy. The aim of these trainings is to develop the capabilities of scientists in the region and around the world.

Dr Ian Mendenhall and participants of a bat surveillance workshop
Dr Ian Mendenhall (front right) and participants of a bat surveillance workshop

With this aim in mind, the EID Programme teaches researchers how to use animal surveillance to understand disease ecology. From studying viruses in their environment and observing how they evolve in nature, this knowledge will build the foundational understanding that could help researchers and scientists come up with ways that may potentially counter infectious diseases.

Senior Research Fellow Ian Mendenhall, based in Associate Professor Gavin Smith’s lab, led a bat-borne virus surveillance training in Singapore in 2014 and two similar trainings in Kazakhstan in 2015. The trainings in Kazakhstan were focused on MERS, at the request of collaborating scientists and institutes, due to the country’s abundance of camels and proximity to MERS-endemic countries. The training sessions imparted knowledge to the attendees which was then shared with key personnel from universities, hospitals and other agencies, which would help to increase capabilities in the region to deal with future threats.

“Though we work in a Signature Research Programme, I’m interested in developing educational and training programmes that serve regional and global partners. These platforms are useful in building capacity and standardising methodologies,” said Dr Mendenhall.