LKCMedicine Guest Lecture

LKCMedicine Guest Lecture
24 June 2015, Wednesday
3.00pm - 5.00pm
Matrix Building, Level 2M, Aspiration Theatrette
30 Biopolis Street, Singapore 138671
Chaired by Prof Philip Ingham, Lee Kong Chian School of Medicine, NTU
No Decision about Me, Without Me
Liberating Power of Co-Design and Crowdsourcing in Healthcare
Dr Lorainne Tudor Car, Clinical Research Fellow, Imperial College London
Singapore’s commitment to provision of world-class healthcare is unique and distinctly demonstrated in
the tripling of its healthcare budget in less than a decade. This has an ultimate triple aim of better, more
person-centred healthcare, improved population health and simultaneous reduction of per capita cost of
care. The pinnacle of the first aim, person-centeredness, is empathic, participatory decision-making (i.e. a
collaborative process in which patients and clinicians make health care decisions together). The principles
underpinning participatory decision-making are as important for shaping an individual patient-doctor
interaction as they are for co-design of health systems. A paramount example of the importance of
engagement and partnership of all healthcare participants is patient safety. This central pillar of highquality healthcare is though very difficult to measure and monitor. Crowdsourcing represents a novel,
evolving, simple and cost-efficient solution to this. Dr Car will present how crowdsourcing was
implemented to identify and prioritise patient safety-related problems and respective solutions in NW
London, and how it could play a role in Singapore. Next, using an example of working population with
diabetes, she will illustrate how crowdsourcing and a user-centred healthcare co-design that bring
together people, healthcare staff, families and communities are central for world-class health system
delivery, its innovation, sustainable transformation and, at individuals’ level, empathic, participatory
decision making.
Ground State Adult Stem Cells: New Potential for Patient-Specific Disease Models,
Regenerative Medicine, and Cancer Therapeutics
Dr Wa Xian, Founder, MultiClonal Therapeutic, Inc., Farmington, Connecticut, USA
The discovery of induced pluripotent stem cells by Yamanaka in 2006 now dominates the stem cell
landscape for prospective regenerative medicine and disease models. In contrast, tissue-specific or adult
stem cells, especially for columnar epithelial organs such as the gastrointestinal tract, liver, pancreas,
and kidney, have been relegated to the backwater due to the lack in methods to clone and propagate
them. Efforts by Dr Xian’s laboratory to mitigate this problem have led to new technologies to capture
stem cells specific for each of the columnar epithelial tissues in their most immature, undifferentiated
states. Now that they have had the opportunity to examine the basic properties of such ground state stem
cells, it is clear that they will play a major role in medicine. In addition to their rapid proliferative
expansion with minimal mutations, these stem cells show remarkably stable programs of commitment to
precisely the epithelial from which they were derived. For the gastrointestinal tract stem cells for
instance, those from the duodenum are poised to differentiate only to duodenum, while those from
the transverse colon only yield transverse colon. Using stem cells derived from standard
endoscopic biopsies, Dr Xian and her team show that they can readily recapitulate the C. difficile
toxin-induced pseudomembranous colitis in vitro as well as provide unique insights into the role of
the gastrointestinal epithelia in the etiology and/or chronic features of Crohn’s disease. Their
work with exogenous lung stem cell transplantation for lung regeneration further
underscores the potential utility of adult stem cells in regenerative medicine, which they
are presently expanding for potential treatments of liver and inflammatory bowel disease.
Finally, Dr Xian will discuss the adaptation of this same technology for generating
libraries of patient-specific cancer stem cells, and how these can be mined for
understanding and treating pre-existing chemotherapy resistance in high-grade
ovarian cancer.