BioSpectrum Asia November 2020

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[email protected]/ [email protected] ASIA EDITION

www.biopectrumasia.com

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4 BIO EDIT

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Dr Milind Kokje ATTACK BY A DIFFERENT VIRUS

Chief Editor Another attack by a virus but of a different nature. A recent ransomware attack on
Dr. Reddy’s Laboratories, an Indian pharma company, just a week after the Drug
[email protected] Controller General of India (DCGI) permitted the company to perform phase II
clinical trials of Russian COVID-19 vaccine Sputnik V in India. Few weeks ago, a Japanese
pharma firm Shionogi & Company’s Taiwanese subsidiary was hit by a cyberattack.
Shionogi, too, is developing a vaccine against coronavirus.

The attacks on two major pharma firms based at two different locations within just a
span of a few days have raised an important issue - Can the engagement of both the firms in
coronavirus vaccine related work be considered as a mere coincidence?

In July, the US, Britain and Canada had accused hackers connected to Russian
intelligence service of attempting to steal information from researchers in their countries
working on coronavirus vaccine. In the same month, the US justice department indicted
two Chinese nationals accused of working for Chinese government to hack into computer
systems of many companies and organisations in the US to steal COVID-19 related research.
Both Russia and China have denied the respective allegations.

A US information security firm, CrowdStrike, recently repeated the allegation that
Japanese research institutions developing vaccines have been hit by cyberattacks. Without
disclosing the names of the targeted organisations, the security firm has expressed the
possibility of Chinese hackers’ involvement in those cyberattacks. Japanese government’s
National Center of Incident Readiness and Strategy for Cybersecurity has asked the
research organisations to raise cybersecurity alert levels.

In the recent cyberattacks, both Shionogi and Dr. Reddy’s have clarified respectively
that no vaccine information is leaked and the company took immediate required preventive
measures and isolated impacted IT services. Dr. Reddy’s had anticipated that all services
would become operational in 24 hours. However, experts are rightly concerned that in
case of significant downtime of more than 24 hours, it could delay vaccine delivery when
the whole world is anxiously waiting for it. Experts opine that attacking the organisations
engaged in COVID-19 vaccine development could have two motives. One is obviously to
steal the information and another could be to disrupt vaccine research, as the competition
to hit the market first is of utmost importance.

Whatever the motive, the end result could be a possible delay in availability of the vaccine,
which is needed with utmost urgency, given the nature of the pandemic. These cyberattacks
also demonstrate the vulnerability of the healthcare industry to such incidences and this is
the second important issue related to such attacks. Thus, the organisations need to further
strengthen their cyber security systems and keep updating them, given the nature of threat
actors who keep inventing new ways to circumvent the security.

Such a vulnerability to cyberattacks in healthcare is a much more sensitive and serious
issue, since, if the data is compromised, it may lead to topsy turvy outcomes resulting in wrong
line of treatments, having more number of patients, exposure of confidential information
of patients and even endangering patients’ lives. Organisations in the healthcare sector
store incredible amounts of patient data, which is confidential. Exposure of confidential
information may prove costly for a lot of healthcare organisations. No wonder, healthcare
is a lucrative target of hackers for the much sought after data, which is worth a lot of money.

Healthcare organisations have an extensive network of connected medical devices in
large numbers and these devices provide entry points for such attacks. Although they do
not store data, they can still become a launchpad for the attack, exposing the server storing
data. Healthcare information needs to be open and shareable as the concerned staff need
to access data remotely, providing more opportunities for the attacks.

Whatever may be its inherent weaknesses, the healthcare sector must overcome them
as it cannot afford to lose its sensitive data pertaining to research, drug development,
clinical trials and patient information.

BIO MAIL 5

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Acknowledgements pleasure working with BioSpectrum Asia
on this opportunity and we look forward
Cytiva team highly values BioSpectrum to other opportunities with you again!
Asia’s influence as the leading trade
media in Asia-Pacific, and we would love - Clarinda Ng, Singapore
to have more opportunities to talk with
you on the topics cover the pan-APAC BOGE Kompressoren found BioSpectrum
theme. Thank you for the interview Asia to be very responsive and interested
opportunity in the October edition. It in the article we contributed. The article
echoes our global expansion plan with is of no doubt of great interest to BSA
APAC dimension. readers as this is where the future of
healthcare is headed. It was a pleasure
- Iris Zhao, China working with the BioSpectrum team.

Thank you very much for the interview - Tanisha Khanna, Singapore
feature on Takeda Pharmaceuticals. We
have amplified it on LinkedIn. It was a

Vol 15; Issue 11; November 2020 MM Activ Singapore Pte. Ltd. Taiwan
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Reprinted in India for private Circulation

6 BIO CONTENT

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

COVER STORY 20

REFRAME DIABETIC

RETINOPATHY

Diabetic retinopathy (DR), the most common complication of diabetes mellitus, is the leading cause
of new cases of blindness in middle-aged and elderly in the world. It has been estimated that 51 per
cent of all those with blindness due to DR globally and 56 per cent of those with visual impairment
due to DR come from the Asia-Pacific (APAC) region. This is mainly due to the fact that management
and awareness of DR in the APAC region is limited and sub-optimal. This year, as we celebrate Word
Diabetes Day on November 14, we must address the urgent need to improve the screening and
diagnosis of DR within the APAC countries.

ANALYSIS The Dragon OPINION
beckons big pharma
18 27

COVID-19 Managing diabetes
the figital way!
29
Omar Sherief Mohammad,
COVID-19 linked GM, Roche Diabetes Care, India
maladies startling
researchers 33

Betting big on
anti-COVID-19
NASAL SPRAYS

BIO CONTENT 7

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com LAB MANAGEMENT

TECHNOLOGY 42

36 Driving laboratory efficiency
with Data Intelligence
APAC’s 5G
ambitions in Philippe Desjardins,
Healthcare Lab Productivity Scientist,
Agilent Technologies, Wilmington,
Q&A Delaware, United States

39 REGULARS

“Chinese pharmaceutical BioEdit..................................................................... 04
market is growing rapidly Regulatory News.................................................... 08
and is now a key market for Company News....................................................... 10
western companies” Finance News.......................................................... 12
Start-up News......................................................... 13
Stefanos Theoharis, World News............................................................. 15
Chief Business Officer, WHO News.............................................................. 17
Bone Therapeutics, United Kingdom People News........................................................... 44
R&D News................................................................ 46
41 Academic News...................................................... 48
Supplier News......................................................... 49
“We would be seeing more
regulatory approvals for
Guardant360 CDx across Asia”

Simranjit Singh,
CEO, Guardant Health AMEA, Singapore

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Merck, the vibrant M and Millipore are trademarks of Merck KGaA, Darmstadt, Germany The life science business of Merck Preparation, Separation,
or its affiliates. All other trademarks are the property of their respective owners. operates as MilliporeSigma in the Filtration & Monitoring Products
Detailed information on trademarks is available via publicly accessible resources. U.S. and Canada.

© 2020 Merck KGaA, Darmstadt, Germany and/or its affiliates. All Rights Reserved.

8 REGULATORY NEWS

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Australia invests $2.3B in native COVID-19 vaccine

The Australian government is (UQ)-CSL COVID-19 vaccine the COVAX facility, providing
investing a total of $2.3 billion to candidate, including key terms access to a large portfolio of
support home-grown researchers to support clinical and technical COVID-19 vaccine candidates
and manufacturers to develop development activities for and manufacturers across the
and produce a COVID-19 vaccine, the vaccine candidate. The world, with an upfront payment
while engaging in strategic government has also joined of $123.2 million.
international partnerships to
support access for Australia and
its region. Under its COVID-19
Vaccine and Treatment Strategy,
the government is investing
$1.7 billion to pre-order
doses of vaccine with leading
Australian manufacturer CSL
Limited (Seqirus) and UK-based
AstraZeneca. The government has
entered a final supply agreement
with CSL/Seqirus around the
supply of 51 million doses of
the University of Queensland

Korea plans Thailand triggers
to strengthen production of COVID-19
biosuppliers network vaccine for 2021

The Ministry of Trade, Industry, and Thailand Ministry of Public Health, Siam Bioscience, Siam
Energy, South Korea has announced plans Cement Group and British-Swedish biopharmaceutical
to establish a council comprised of leaders company AstraZeneca have signed a Letter of Intent
in bio manufacturing and supply to further (LOI) on the manufacturing and supply of the University
strengthen the K-bio industry through of Oxford’s potential COVID-19 vaccine AZD1222.
Under this LOI,
collaborative efforts. The all parties agree to
Korean government is work together to
set to invest 80 billion prepare large scale
won in five years to manufacturing
support the bio suppliers capacity at Siam
with the capabilities to Bioscience to create
independently develop broad, equitable
the necessary materials, and timely access
technology, and resources. to the potential
This development is vaccine in Southeast Asia. AstraZeneca is providing the
expected to allow bio suppliers to stably meet potential vaccine at no profit during the pandemic and will
the increasing demands of bio manufacturers, work with Siam Bioscience to set up the manufacturing
and further strengthen Korea’s manufacturing facilities through technology transfer. The Ministry of
competitiveness within the industry. The Public Health (MOPH) has endorsed manufacturing
Korean Biotechnology Industry Organization in Thailand and will be receiving AZD1222 doses for
and Korea Evaluation Institute of Industrial distribution along with the highest safety standards,
Technology will also work with the council to with the aim of commencing the vaccination of the Thai
provide the required support for the industry population in the first half of 2021.
growth.

REGULATORY NEWS 9

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

New Zealand changes Singapore
prescribing rules for medicines
commits $2.2B
A change to prescribing rules for special authority approvals.
will make it easier for New However, from October 1, 2020, for MediShield
Zealanders to get the medicines pharmacist prescribers are now
they need, according to both able to apply for special authority Life premiums
the Ministry of Health and the to prescribe specific restricted
Pharmaceutical Management medicines. The Ministry of The MediShield Life Council
Agency (PHARMAC). Some Health and PHARMAC worked has made preliminary
medicines are only funded together to make the change, recommendations for the
under certain conditions to actively responding to calls MediShield Life benefits to be
ensure access to medicines is from pharmacists and other enhanced, and for premiums to
available for those, who would specialists. To allow pharmacist be correspondingly adjusted.
benefit most from treatment. prescribers to apply for a special While the public consultation
To receive these medicines, authority, the ministry updated on the proposed benefit
a special authority approval the complex IT systems used enhancements is ongoing, the
is required. Until now, only to process special authorities, government of Singapore has
medical practitioners, dieticians, and then PHARMAC updated committed about $2.2 billion for
nurse practitioners and the pharmaceutical schedule, premium subsidies and support
optometrists were able to apply effectively changing the rule. over the next three years to help
Singapore residents with their
India issues regulatory MediShield Life premiums,
guidelines for COVID-19 vaccine particularly in view of the impact
of COVID-19 on Singapore
The Ministry of Health and Family recommended storage conditions Residents and the economy.
Welfare, Government of India for the duration of clinical trial With these support measures,
has launched draft regulatory during clinical development the net premium increases for
guidelines for development stage and throughout its shelf life all Singapore citizens will be
of vaccines with special post approval. It will also ensure kept to up to about 10 per cent
consideration for COVID-19 that post marketing surveillance in the first year. MediShield Life
vaccine. This document will including assessment of adverse is a basic health insurance plan,
provide guidance to the vaccine events following immunization administered by the Central
developers to ensure that (AEFI) and adverse events of Provident Fund (CPF) Board,
vaccines are well-characterized special interest (AESI) is carried which helps to pay for large
and manufactured consistently; out to assess vaccine safety in hospital bills and selected costly
vaccines remain stable at the post market scenario. outpatient treatments, such as
dialysis and chemotherapy for
cancer. It is structured so that
patients pay less MediSave/cash
for large hospital bills.

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Merck, the vibrant M and SAFC are trademarks of Merck KGaA, Darmstadt, Germany or
its affiliates. All other trademarks are the property of their respective owners. Detailed
information on trademarks is available via publicly accessible resources.
© 2020 Merck KGaA, Darmstadt, Germany and/or its affiliates. All Rights Reserved.
The life science business of Merck operates as MilliporeSigma in the U.S. and Canada.

10 COMPANY NEWS BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

SOLBIO PPD targets multipurpose
signs deal clinical research lab in China
to distribute
COVID-19 PPD, Inc., a global contract research organization headquartered in the
vaccine in US, is opening a new laboratory in Suzhou, China, to support China-
Malaysia based biotech companies and Western pharmaceutical companies
managing China research studies. The 67,000 square foot facility in the
Malaysia based Solution Suzhou New District, Jiangsu Province, is expected to be fully operational
Biologics Sdn Bhd,
(SOLBIO), a subsidiary of in 2021, offering bioanalytical,
Solution Group Bhd, has biomarker and vaccine services
inked a deal with China to support trials across all phases
based CanSino Biologics of pharmaceutical development.
to distribute Ad5-nCoV The company anticipates adding
vaccine candidate targeting approximately 350 positions as a
COVID-19 in Malaysia. result of the expansion. In Suzhou,
Indonesia is currently the bioanalytical lab offering will
preparing to support include services for small molecules,
commercialization. SOLBIO biologics, and cell and gene therapies.
is ready to pursue the Market The lab will encompass multiple
Authorization Certificate technology platforms across a wide
from Malaysia’s National range of applications, including ligand-binding immunochemistry, liquid
Pharmaceutical Regulatory chromatography tandem mass spectrometry (LC-MS/MS), polymerase
Agency (NPRA) to commence chain reaction (PCR) and flow cytometry. The lab will specialize in
the marketing and the development and validation of fully compliant robust custom
distribution of Ad5-nCoV. assays for pharmacokinetic/pharmacodynamic (PK/PD) analyses and
SOLBIO and CanSino have immunogenicity assessments in both preclinical and clinical studies.
also formed a joint working
committee to ensure smooth Santen, Orbis tackle increasing
project implementation. The burden of eye diseases in Asia
vaccine, Adenovirus Type
5 Vector, will be registered Japanese firm Santen across 200 countries and regions
after completing a phase III Pharmaceutical and Orbis will carry out the following
clinical trial with Malaysia’s International in the US have activities such as to provide
NPRA. The vaccine has to announced a ten-year partnership quality residency training and
pass phase III clinical trial to to tackle the increasing burden of grow ophthalmologists’ expertise
prove to be safe and effective eye diseases in low- and middle- in glaucoma, thereby building
as per US FDA standards. income countries, especially and strengthening skills that are
in Asia. Under this long-term critical to protecting vision and
partnership, Santen and Orbis will providing quality patient care, in
accelerate the growth of quality Vietnam and India. The objective
eye care systems by building the is also to develop digital training
capacity of eye care professionals, programmes, such as artificial
developing digital technology intelligence (AI)-augmented care
and increasing awareness of the and a digital surgical training
importance of eye health. During platform for glaucoma, that enable
the initial three years of the ten- greater access to patient care.
year partnership, Santen and The partners plant to invest in
Orbis, through Orbis’s initiatives research that aims to quantify the
and award-winning telemedicine importance of eye health, including
platform, Cybersight, which how improved care and better
reaches eye care professionals vision can affect quality of life.

COMPANY NEWS 11

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Dr. Reddy’s receives approval
for Sputnik V vaccine trial in India

Dr. Reddy’s Laboratories which will include safety and
in India and Russian Direct immunogenicity study. Earlier
Investment Fund (RDIF), in September 2020, Hyderabad
Russia’s sovereign wealth fund, based Dr. Reddy’s and RDIF
have announced that they have entered into a partnership
received approval from the to conduct clinical trials of
Drug Control General of India Sputnik V vaccine and its
(DCGI) to conduct an adaptive distribution in India. As part
phase II/III human clinical trial of the partnership, RDIF shall
for Sputnik V vaccine in India. supply 100 million doses of the
This will be a multi-center and vaccine to Dr. Reddy’s upon
randomized controlled study, regulatory approval in India.

Taiwan inks COVID-19 Novo Nordisk launches
vaccine agreement innovative treatment for
with BioNTech diabetes in Singapore

Taiwan based TTY Biopharm Company has Novo Nordisk has announced the launch of
announced that it has received authorization for Ryzodeg in Singapore. The new treatment is a
the delivery of coronavirus vaccines developed by combination of two distinct insulin analogues,
Germany’s BioNTech SE, which is under the phase III insulin degludec and insulin aspart in the ratio
clinical trials for safety. Under the agreement, Taiwan of 70 and 30 per cent, that helps maintain stable
can acquire up to 30 million COVID-19 vaccine doses, control of glucose levels.
with 10 million expected to be delivered in the first The new treatment is a
quarter of 2021. The vaccine requires two doses per prescription medicine
person to be effective, meaning 15 million people in available in a prefilled,
Taiwan can be immunized with the number of doses disposable insulin
the company is authorized to sell. TTY Biopharm is pen called FlexTouch,
negotiating with the Taiwanese health authorities on specifically designed for
the precise quantity, delivery time, and price of the accurate and consistent
vaccines. Taiwan is waiting for legal approval from the dose delivery as well
BioNTech SE. BioNTech’s mRNA-based COVID-19 as ease of handling.
vaccine candidate is currently in phase II/III clinical The improvements and
trials in Argentina, Brazil, South Africa, Turkey and innovations in Ryzodeg
the United States. The vaccine is co-developed by US FlexTouch will provide
pharmaceutical giant Pfizer and is one of the leading Singaporeans living
candidates in the race to gain regulatory approval in with diabetes a smarter
the US and Europe. treatment alternative to
increase their confidence
in managing diabetes.
Globally, Ryzodeg has
been approved in more
than 70 countries, including the US in September
2015. In Australia, it has been approved and
listed by the government into the Pharmaceutical
Benefit Scheme, which has enabled universal
access to people with diabetes nationwide.

12 FINANCE NEWS

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Samsung Biologics, AstraZeneca
sign supply agreement for $330.8M

South Korean firm Samsung biologics therapeutics,
Biologics and British which could be increased to
multinational pharmaceutical $545.6 million. By leveraging
company AstraZeneca Samsung Biologics’ robust
have announced a long- expertise and capabilities in
term supply agreement, the manufacturing of high-
valued at approximately quality biopharmaceuticals,
$330.8 million. Under this new partnership will
this agreement, Samsung enable AstraZeneca to expand
Biologics will provide its biologics manufacturing
large-scale commercial capabilities into Asia Pacific.
manufacturing for drug According to AstraZeneca,
substance in its plant 3 this collaboration agreement
as well as drug product is also expected to accelerate
to support AstraZeneca’s Korean bio-health innovation.

Takeda inks deal worth Australia delivers
$1.04B with Arrowhead $115.5B in 2020-21
budget for healthcare
Japan based Takeda Pharmaceutical and
Arrowhead Pharmaceuticals in the US have The Australian government is delivering a record $115.5
announced a collaboration and licensing billion in 2020-21 and $467 billion over the forward
agreement to develop ARO-AAT, a phase II estimates to deliver the essential health services
investigational RNA interference (RNAi) therapy Australians need under the long term national health
in development to treat alpha-1 antitrypsin- plan. The 2020-21 budget funds the government’s
associated liver disease (AATLD). ARO-AAT ongoing health response under the Australian Health
is a potential first-in-class therapy designed to Sector Emergency Response Plan, extending initial
key COVID-19 health initiatives. It helps chart the
reduce the production road out, including through unprecedented mental
of mutant alpha-1 health support, and implementation of the COVID-19
antitrypsin protein, vaccine and treatment strategy. The government has
the cause of AATLD committed more than $16 billion to the emergency
progression. Under health response to the pandemic. Aged care is a
the agreement, Takeda particular focus. Since the pandemic began, the
and Arrowhead will government has invested more than $1.6 billion to
co-develop ARO-AAT, protect senior Australians and workers in aged care,
which, if approved, will and support providers. At the same time, this year’s
be co-commercialized budget strengthens the four pillars of long term
in the United States national health plan.
under a 50/50 profit-
sharing structure. Outside the US, Takeda will
lead the global commercialization strategy and
receive an exclusive license to commercialize
ARO-AAT with Arrowhead eligible to receive
tiered royalties of 20-25 per cent on net sales.
Arrowhead will receive an upfront payment of
$300 million and is eligible to receive potential
development, regulatory and commercial
milestones up to $740 million.

START-UP NEWS 13

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

See-Mode Technologies receives
FDA clearance for AI software

See-Mode Technologies, a click and in less than a minute, Kanaph
medtech startup based in AVA can analyze a full vascular Therapeutics
Singapore and Australia that ultrasound scan, minimizing the closes $21M
seeks to empower clinicians to need for manual drawings. By Series B
better predict stroke, has recently significantly reducing the time funding
announced that it has received taken to analyse images and
510(k) clearance from the US Food generate reports, See-Mode’s Kanaph Therapeutics
and Drug Administration (FDA) AVA augments the clinical recently completed its Series
for its debut product, Augmented workflow, resulting in greater B funding of $21 million in
Vascular Analysis (AVA), a world- overall productivity, accuracy South Korea. In this round,
first medical Artificial Intelligence and improved patient outcomes. a large Korean pharma
(AI) software for automated See-Mode is developing novel company, GC Pharma, and
analysis and reporting of vascular solutions to improve the analysis venture capital funds such as
ultrasound scans. AVA uses deep of routinely collected medical Kolon Investment, Timefolio
learning, text recognition, and images. By applying AI and Asset Management and more
signal processing technologies to computational models on these participated in the fund
assist clinicians in interpreting medical images, clinicians are able raising. In addition to the $2
and reporting vascular ultrasound to obtain stroke risk factors that million angel funding and
studies – typically a manual and may not be accessible in current $6 million Series A funding,
error-prone process. With a single clinical practice. Kanaph has raised a total of
$30 million to date. Kanaph’s
Ubiquitome signs NIH RADx front runners are bi-specifics
contract for COVID-19 tests from their TMEkine platform
for immuno-oncology,
New Zealand based startup end of the year. The Liberty16 and a bi-specific Fc-fusion
Ubiquitome is ramping up will be targeted for use by rural inhibiting both alternative
production of its mobile, real- and metropolitan hospitals and complement and angiogenesis
time (RT) PCR technology with mobile labs to test for SARS- pathways for the treatment of
funding from the United States’ CoV-2 - the virus that causes retinal disorders. Their small
National Institutes of Health COVID-19. Ubiquitome’s device molecule pipelines include
(NIH) Rapid Acceleration of can detect virus in 16 samples the development of novel
Diagnostics (RADx) initiative. in 40 minutes or less. It reports small molecules targeting
Ubiquitome is the only NZ positive or negative results via its specific mutational signaling
private company to be accepted proprietary iPhone app. Battery- pathways or removing
into the highly competitive operated, less than the height of immune-suppressive
RADx and to receive federal the latest iPhones and weighing environment created by
funding through the NIH in only 2.5 kg, the Liberty16 is one tumors. Kanaph focuses
recent years. on three small molecule
Ubiquitome of the smallest programmes in this regard,
will scale its open system a fourth generation EGFR
Liberty16 RT-PCR inhibitor targeting C797S,
mobile PCR systems a dual EP2/4 inhibitor and
technology on the an undisclosed target in the
to enable international KRAS pathway, where the
thousands market. first two are entering the
of tests It is being preclinical stage in early 2021.
per day distributed in
by the Asia Pacific by

Swiss giant DKSH.

14 START-UP NEWS

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Eko.ai signs new deals for BE Capital
automating echocardiograms launches
a virtual
Eko.ai, a fast-growing medtech Janssen will focus on automating cross-border
startup based in Singapore using collaboration
machine learning to automate echocardiography analyses platform
the analysis of echocardiograms
(echos), or ultrasound images to facilitate identification of BE Capital, a startup
of the heart, has announced accelerator and venture
several significant milestones, pulmonary hypertension. The capital firm, together
including renaming the company with Taiwan Tech Arena
to Us2.ai. Us2.ai has announced AstraZeneca research collaboration and Startup Island, has
the grant of a US Patent No. launched a virtual cross-
10,702,247 for its automated will refine algorithms for the border collaboration
clinical workflow that recognizes platform, HealthForAll,
and analyzes 2-dimensional and diagnosis of heart failure, as well connecting the
Doppler echo images for cardiac international healthcare
measurements and the diagnosis, as test access to automated echo ecosystem with Taiwan’s
prediction and prognosis of heart dominant industries.
disease. The startup has partnered analysis with point-of-care solutions The platform provides
with AstraZeneca and Actelion a unique opportunity
Pharmaceuticals, a Janssen for people with heart failure. for corporate-startup
Pharmaceutical Company of engagement across the
Johnson & Johnson to automate The company’s decision support areas of medical data,
the fight against cardiovascular research & development,
disease. The collaboration with software is currently undergoing clinical trials,
manufacturing, supply
validation for regulatory review in chain, and information
& communications
multiple regions, and is available technology. This
platform is the first
for research use. step in fostering
closer corporate-
Lucence makes assay kit for startup relations
profiling SARS-CoV-2 sgRNA between Taiwan and
the international
Molecular diagnostics startup Lucence, based in Singapore, has announced healthcare community.
the availability of the world’s first assay kit to directly profile SARS-CoV-2 The corporates have
subgenomic RNA (sgRNA), a marker of active viral replication, from an opportunity to
clinical samples. DeepMARK utilizes provide a reverse
Lucence’s proprietary ultrasensitive pitch for startups to
next-generation sequencing (NGS) better understand how
technology, AmpliMARK, to concurrently they could potentially
detect and analyze the genome and collaborate. The initial
transcriptome of SARS-CoV-2. Using phase of the platform
high-quality genetic fingerprinting, will culminate in a
DeepMARK can enable rapid community virtual meeting with
case tracing by identifying transmission corporates and selected
paths, clusters, and viral contagiousness. startups as they seek
DeepMARK’s increased sensitivity ways to work together.
also allows for asymptomatic and
recovering cases to be more thoroughly
evaluated for contagiousness. SgRNA
as a marker of viral replication is also a
well-recognized efficacy measurement in
SARS-CoV-2 vaccine development. Thus, comprehensive sgRNA profiling
by DeepMARK could facilitate more efficient vaccine discovery.

WORLD NEWS 15

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Oxford researchers offer COVID-19 viral diagnosis in less than 5 min

Scientists from Oxford University’s the need for genome extraction, labeling due to differences in their
Department of Physics have purification or amplification of the surface chemistry, size, and shape.
developed an extremely rapid viruses, the method starts with the The scientists have worked with
diagnostic test that detects and rapid labelling of virus particles in clinical collaborators at the John
identifies viruses in less than the sample with short fluorescent Radcliffe Hospital in Oxford to
five minutes. The method is DNA strands. A microscope is validate the assay on COVID-19
able to differentiate with high then used to collect images of the patient samples, which were
accuracy SARS-CoV-2, the virus sample, with each image containing confirmed by conventional RT-
responsible for COVID-19, from hundreds of fluorescently- PCR methods. The researchers aim
negative clinical samples, as well labelled viruses. Machine-learning to develop an integrated device that
as from other common respiratory software quickly and automatically will eventually be used for testing
pathogens such as influenza and identifies the virus present in the in sites such as businesses, music
seasonal human coronaviruses. sample. This approach exploits the venues, airports etc., to establish
Working directly on throat swabs fact that distinct virus types have and safeguard COVID-19-free
from COVID-19 patients, without differences in their fluorescence spaces.

Genome editing tool
wins Nobel Prize
2020 in Chemistry

The Royal Swedish Academy of Sciences has

awarded Emmanuelle Charpentier from Max

Planck Unit for the Science of Pathogens,

Harvey J. Alter, Michael Houghton, and Charles M. Rice Berlin, Germany and Jennifer A. Doudna from

Hepatitis C virus the University of California, US, the Nobel
discovery gets Nobel
Prize 2020 in Medicine Prize in Chemistry 2020, for the development

The Nobel Assembly at Karolinska Institutet has of a method for genome
awarded the 2020 Nobel Prize in Physiology or
Medicine jointly to Dr Harvey J. Alter (Transfusion editing. In 2012, the two
Medicine Department, NIH Clinical Center,
US), Michael Houghton (Department of Medical scientists reported that
Microbiology & Immunology, University of Alberta,
Canada) and Charles M. Rice (Professor in Virology, the Cas9 endonuclease
Rockefeller University, US) for the discovery of
Hepatitis C virus. This year’s Nobel Prize is awarded to can be programmed
three scientists, who have made a decisive contribution
to the fight against blood-borne hepatitis, a major global with guide RNA
health problem that causes cirrhosis and liver cancer
in people around the world. The three scientists made engineered as a single
seminal discoveries that led to the identification of a
novel virus, Hepatitis C virus. Prior to their work, the transcript to cleave
discovery of the Hepatitis A and B viruses had been
critical steps forward, but the majority of blood-borne any double-stranded
hepatitis cases remained unexplained.
DNA sequence. Their

discovery has led to Jennifer A. Doudna and
widespread applications Emmanuelle Charpentier

of the CRISPR-Cas9

system as a powerful and versatile tool in

genome editing. Coupled with the availability

of genome sequences for a growing number of

organisms, the technology allows researchers

to explore these genomes to find out what

genes do, move mutations that are identified

as associated with disease into systems where

they can be studied and tested for treatment,

or where they can be tested in combinations

with other mutations.

16 WORLD NEWS

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Multisectoral partnership
strengthens healthcare in Africa

Brazil tests A group of public, private genomic sequencing. This
TB vaccine and non-profit organizations, network will not only help
against COVID-19 led by the African Union identify and inform research
Commission through the and public health responses to
Brazil has begun to test the efficacy Africa Centres for Disease COVID-19 and other epidemic
of Bacillus Calmette-Guerin (BCG) Control and Prevention threats, but also for endemic
tuberculosis (TB) vaccine in treating (Africa CDC), has launched diseases such as AIDS,
COVID-19 patients. State-run research the Africa Pathogen Genomics tuberculosis, malaria, cholera,
center the Oswaldo Cruz Foundation Initiative (Africa PGI) in and other infectious diseases.
(Fiocruz) began testing on healthcare a $100 million, four-year Microsoft will contribute
workers after the vaccine proved partnership to expand access technical assistance and
effective in reducing respiratory to next-generation genomic resources to support the
infections. Initially the vaccine will be sequencing tools and expertise design and build of Africa
tested on 2000 volunteers in Campo designed to strengthen public PGI’s digital architecture
Grande, the capital of Mato Grosso do health surveillance and in partnership with African
Sul state, and on 1000 other volunteers laboratory networks across institutions, and offer in-
in Rio de Janeiro. The tests are part Africa. This new initiative will kind access on Azure to high-
of a phase III clinical trial that aims build a continent-wide disease performance computing and
to assess whether BCG vaccination surveillance and laboratory genomics software developed
can reduce the impact of COVID-19 network based on pathogen by its Life Sciences Division.
on healthcare workers, those most
exposed to the virus. In addition to
the 3000 Brazilian volunteers, 7000
volunteers in Australia, Britain, Spain
and the Netherlands will also take part
in the trials. All are to be monitored for
a year.

UNICEF contributes medical supplies in Nigeria

United Nations Children’s Fund to understand the COVID-19 status
(UNICEF) received the delivery of of an individual and link that person
115,800 COVID-19 test kits to support to care, support and treatment while
the fight against the COVID-19 contributing to the protection of
pandemic in Nigeria. These supplies families and communities. IHS Towers
were funded by IHS Nigeria, the has been a strong and continuing
Nigerian subsidiary of IHS Towers. partner of UNICEF. At the onset of the
Testing remains the mainstay of coronavirus in Nigeria in late February,
the response led by the Presidential IHS Nigeria provided funding to
Task Force and Nigeria Centre for UNICEF to urgently procure essential
Disease Control (NCDC) and the supplies and equipment with which
first step towards diagnosing the UNICEF supported the Government
infection. Tests enable health officials of Nigeria in its COVID-19 response.

WHO NEWS 17

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

WHO emphasizes on right investment in digital health

With the right approach and published by WHO and Human past ten years, from institutions,
effective investment, digital Reproduction Programme (HRP) who have been deeply involved
health interventions can be in collaboration with partners with planning and implementing
successful long-term solutions United Nations Children’s Fund digital health technologies with
that help to improve the health (UNICEF), United Nations national governments.
and wellbeing of the people they Population Fund (UNFPA) and
were designed to reach. A new PATH. This guidance will be
guide has been launched by particularly useful for donors and
WHO to help ensure that digital ministries of health, who make
health investments are effective, decisions on digital investments
sustainable, and equitable, and for health, in government, in
that they are implemented in a technical bodies, and in national
coordinated way and appropriate health and/or digital systems.
for the local context. The digital The guide gives a step-by-step
implementation investment approach to planning, costing
guide (DIIG): integrating digital and implementing digital health
interventions into health systems, investments. Users learn from
also known as the DIIG, has been diverse experiences covering the

WHO takes position WHO, UNICEF
on GM mosquitoes
recommit to accelerate
Recognizing the urgent need for new tools to combat
vector-borne diseases (VBDs) such as malaria, dengue, health at all ages
schistosomiasis, leishmaniasis, Chagas disease, yellow
fever and Japanese encephalitis, among others, and The World Health Organization
in the spirit of fostering innovation, the World Health (WHO) and UNICEF have signed a new
Organisation (WHO) supports the investigation of all collaborative framework, which will
potentially beneficial technologies, including genetically accelerate joint public health efforts
modified mosquitoes (GMMs). A new position statement that put the most marginalized and
clarifies WHO’s stance on the evaluation and use of GMMs vulnerable populations first. The new
for the control of vector-borne diseases. According to the strategic collaboration framework builds
WHO statement, computer simulation modelling has on a robust 70-year collaboration between
shown that GMMs could be a valuable new tool in efforts the two organizations, and prioritizes
to eliminate malaria and to control diseases carried by four strategic areas for immediate
Aedes mosquitoes. WHO cautions, however, that the use of attention and action at all levels of the
GMMs raises concerns and questions around ethics, safety, organizations: universal health coverage,
governance, affordability and cost–effectiveness that must through a primary healthcare and health
be addressed. The statement notes that GMM research systems approach; mental health and
should be conducted through a step-wise approach and psychosocial wellbeing and development;
supported by clear governance mechanisms to evaluate public health emergencies. Additionally,
any health, environmental and ecological implications. the two organizations signed a new
joint programme on mental health and
psychosocial well-being and development
of children and adolescents. This 10-year
collaborative effort will promote mental
health and psychosocial well-being and
development, increase access to care for
mental health conditions, reduce suffering
and enhance quality of life among children
and adolescents, and their caregivers.

18 ANALYSIS

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

The Dragon
beckons big pharma

Big pharma continues its fascination with China. The latest big pharma firm to push deeper into
the country is the US based Pfizer, with its $200 million acquisition of CStone, a firm focused on
cancer therapies. Most big pharma firms such as Amgen, USA and AstraZeneca, UK who have
historically focused on mature markets such as the United States, Japan and Europe, are now
eyeing China. Let’s explore this shift and what it means for the Chinese pharma industry.

At a value of around $137 billion at the end $2.7 billion in cash in October 2019 to expand its
of 2018, the pharma market in China has oncology presence in China.
surpassed Japan to become the second largest
market, after the US, according to IQVIA. China’s “Cancer is a leading cause of death in China and
pharmaceutical market will be an increasingly will only become a more pressing public health issue
important source of growth for foreign drug as the Chinese population ages. With its extensive
companies through 2023, according to a report from commercial and clinical capabilities within China and
credit rating agency Moody’s. Though its growth a commitment to global quality standards, BeiGene
rate is likely to slow over the next few years, the is the ideal strategic collaborator as we seek to make
Chinese pharmaceutical market will still be among a meaningful difference in the lives of millions of
the fastest growing markets worldwide, underpinned cancer patients in China and around the world,” said
by domestic regulatory reforms supporting the faster Robert A Bradway, Chairman and CEO, Amgen.
rollout of innovative drugs and continued expansion
of healthcare coverage, as per the report. In November 2019, AstraZeneca announced
three large-scale initiatives in China to advance
“The Chinese pharmaceutical market will be a global medicine research and development. The
pocket of growth for the entire global industry, with announcements include the creation of a new
companies exposed to oncology, vaccines and rare Global R&D Centre and an Artificial Intelligence
diseases standing to benefit in particular,” it said. (AI) Innovation Centre, both in Shanghai, and the
This explains why large pharma firms have made
a number of major structural moves in China. The
world’s most populous country offers an enormous
opportunity for pharma firms. Drug spending in the
country has surpassed $141 billion in 2019, and is on
track to grow five to eight per cent year from 2020 to
2024, as per IQVIA.

Recent regulatory reforms have also made it a bit
easier for firms to get drugs approved in the country.
According to McKinsey, China had approved about
100 new drugs between 2016 and 2018, with many
more to come in the next few years.

Chasing dreams
In recent years, firms like Amgen,
AstraZeneca and Pfizer have made
strategic changes to gain a strong
foothold in China. The biggest
deal till date, perhaps, was made by Amgen when it
bought 20.5 per cent stake in BeiGene, a research-
based, oncology-focused biotechnology company for

ANALYSIS 19

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creation of a first-of-its-kind Healthcare Industrial “In terms of challenges, China
Fund with China International Capital Corporation is a difficult market to be
Limited (CICC).
commercially successful, given
Based in Jing’an district of central Shanghai, the the country’s large scale. You
Global R&D Centre will carry out R&D for potential
new innovative medicines and more than double need to have good relationships
AstraZeneca’s Shanghai R&D headcount to around with local hospitals and players.
1,000. Its primary focus will be on diseases that are
prevalent in China as well as other parts of Asia. It is also a low margin country
for pharmaceuticals, compared
A new AI Innovation Centre, also in Shanghai,
will be established to capitalize on the latest digital to other parts of the world.
technology in R&D, manufacturing, operations and So, skill with a high volume/
commercialization in order to accelerate the delivery low price business model is
of medicines to patients in China and globally. The
agreement with CICC is to create a $1 billion fund to required”.
support domestic companies. - Brad Loncar,

China is already an important market for CEO, Loncar Investments, USA
AstraZeneca, which recorded more sales there in
the third quarter of 2019 than it did in all of Europe, investment in the country with the launch of a China
earning $1.3 billion. These new initiatives suggest the and Emerging Markets Global Business Unit and a
firm’s commitment to win the Chinese market. Research Institute. The country accounted for nine
per cent of its annual drug revenue in 2019.
Expanding with acquisitions
Another firm, which is serious about heading to “Pfizer already has a big presence in China
China, is Pfizer, which in September 2020, acquired but not as much in new medicines. China has
CStone for a sum of $200 million, to expand its traditionally been a generics based market, and Pfizer
oncology presence in the country. Established in 2015, has competed as a branded competitor to generic
CStone is a biopharmaceutical company focused on medicines. However, today, China’s pharmaceutical
developing and commercializing innovative immuno- market is shifting to innovation. This partnership
oncology and precision medicines. helps Pfizer participate in that. It is the company’s
“In many ways, this deal reminds me of when second recent deal with a Chinese biotech. Recall
Amgen bought a 20 per cent stake in BeiGene. that Pfizer also recently agreed to be the distributor
Multinationals see that China has a bright future as of CanSino’s meningitis vaccine,” said Loncar. The
a market for innovative medicines, and that cancer firms’ emerging growth markets sales grew by six per
especially is going to be strong. We are also seeing cent in 2019, led by double-digit growth in China.
western companies buying into Chinese science. This
gives Pfizer a foothold in a company (CStone) that Challenging market
has promised to be an oncology leader”, said Brad “Despite recent progress and favourable
Loncar, CEO, Loncar Investments, Lenexa, USA. conditions, China still remains a bit of a hard nut
In 2019, Pfizer restructured its business into to crack. In terms of challenges, China is a difficult
three units, one of which is Upjohn, an off-patent market to be commercially successful, given the
branded and generic established medicines business country’s large scale. You need to have good
headquartered in China that is bringing 20 of its relationships with local hospitals and players. It
most iconic brands to more than 100 markets around is also a low margin country for pharmaceuticals,
the world. The pharma giant has also upped its compared to other parts of the world. So, skill with
a high volume/low price business model is required.
Chinese companies are excellent at that because it
is what they know from the start, but sometimes it
takes time for western companies to adapt”, revealed
Loncar.

The past decade has been the years of growth
and establishment of a robust pharma industry
in China and the next decade will be all about
the maturity and new innovation in the sector.
The current COVID-19 crisis, its ongoing trade
war with the USA will all play a significant part in
shaping China’s pharma industry.

Ayesha Siddiqui

20 COVER STORY

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REFRAME DIABETIC

RETINOPATHY

Diabetic retinopathy (DR), the most common need to improve the screening and diagnosis of DR
complication of diabetes mellitus, is the within the APAC countries. The prevalence of DM is
leading cause of new cases of blindness in pretty high in countries such as China, Hong Kong,
middle-aged and elderly in the world. It has India, Singapore, Malaysia, South Korea, thereby
been estimated that 51 per cent of all those demanding increased awareness on DR examination.
with blindness due to DR globally and 56 per
cent of those with visual impairment due CHINA
to DR come from the Asia-Pacific (APAC)
region. This is mainly due to the fact that Nearly 80 per cent of those with diabetes live in
management and awareness of DR in the low and middle income countries (LMIC) of which
APAC region is limited and sub-optimal. This China and India share the major proportion. The
year, as we celebrate Word Diabetes Day on total number of adults with DM in China is currently
November 14, we must address the urgent 116 million and it is projected to rise to 366 million
need to improve the screening and diagnosis by 2030, meaning that China will become the
of DR within the APAC countries. country with the largest diabetes population in the

The devastating consequences of diabetes
mellitus (DM) is set to continue as a result
of the predicted increase in prevalence
from 463 million in 2019 to 700 million in 2045
due to population expansion, increased ageing,
urbanisation, reduced physical activity and adverse
dietary changes.

In particular, diabetic retinopathy (DR) is the
most common complication of diabetes mellitus.
It is the leading cause of new cases of blindness in
middle-aged and elderly in the world. It has been
estimated that 51 per cent of all those with blindness
due to DR globally and 56 per cent of those with
visual impairment due to DR come from the Asia-
Pacific (APAC) region.

This is mainly due to the fact that management
and treatment of DR in the APAC region is limited
to traditional laser retinopexy. It is suboptimal
despite new clinical approaches such as use of
intravitreal anti vascular endothelial growth factor
and steroids due to limited resources. There is
also limited awareness of DR screening in these
countries. This year, as we celebrate Word Diabetes
Day on November 14, we must address the urgent

COVER STORY 21

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world. This number accounts for approximately FUTURE DIRECTIONS
11 per cent of the total adult population in China.
Despite mounting concerns about the emergence of DR remains a significant major public health
diabetes as a major public health problem in China, issue in the Asia-Pacific. A major concern is the
epidemiological data on DR in Chinese population more severe problem of Vision-threatening DR
are still rather scarce or inconsistent. (VTDR), which could be a reflection of the lack
of routine DR screening and timely treatment
“Several epidemiological studies have reported in the developing region, resulting in its late
a high prevalence of DR, ranging from 11 to 43.1 per diagnosis only at the symptomatic stage.
cent, and its risk factors among patients with DM  Awareness of DR remains alarmingly low and
in mainland China. Screening for DR is accepted
as an important means of early identification well-organized efforts are needed to educate
of the eyes with mild DR or sight–threatening patients, physicians, and policy makers.
diabetic retinopathy (STDR), which allows prompt  Use of low-cost screening technologies
intervention to prevent DR progression. In China, a such as digital retinal imaging and remote
national screening system for DR has not yet been grading may identify patients requiring
established, and DR screening among diabetes ophthalmologist review.
has not been carried out in most places in China”,  Telemedicine has increased access to
points out Prof. Mingzhi Zhang, Department of screening for diabetics living in remote
Ophthalmology, The Joint Shantou International Eye and hard-to-reach areas and has optimized
Center of Shantou University, China. screenings to be more cost-efficient and
convenient in urban areas.
Banking on the fact that early diagnosis through  Uptake of vascular endothelial growth factor
regular screening is important for preventing (anti-VEGF) therapy for treatment of DR is
and managing this disease, researchers from the sluggish due to cost.
Shenzhen Institutes of Advanced Technology  A more cost-effective treatment strategy for
(SIAT) of the Chinese Academy of Sciences have diabetic macular edema (DME) is urgently
needed for the Asia-Pacific.
 Management of DR in the Asia-Pacific
requires establishing clear, specific
guidelines that would serve as a foundation
for structuring an effective public healthcare
programme.

Source: Asia-Pacific Journal of Ophthalmology

recently proposed a multi-channel-based generative
adversarial network (MGAN) with semi-supervision
to automatically grade DR using machine learning
technology.

“It is of great significance to apply deep-
learning techniques for DR recognition. However,
deep-learning algorithms often depend on large
amounts of labeled data, which is expensive and
time-consuming to obtain in the medical imaging
area. Therefore, it is a big challenge to learn the
distribution of such DR features. We have proposed
model that can grade DR effectively”, says Dr
Shuqiang Wang, Associate Professor, Shenzhen
Institutes of Advanced Technology, China.

Another research group in China has proposed
the development of a simple blood test as an accurate
method for DR detection. The research involves the
use of vanadium core–shell nanorods for metabolic
fingerprinting to probe molecular variation in DR.

22 COVER STORY

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“In China, a national “Early detection and early intervention are
screening system for important but the major screening technology is eye
DR has not yet been imaging, which depends on expensive equipment and
established, and DR the judgment of ophthalmologists. It is important to
screening among diabetes develop a simple, effective and economic technology
has not been carried out in for diabetic retinopathy screening”, says Prof.
most places in China.” Qian Kun, Department of Biomedical Engineering,
Shanghai Jiao Tong University, China.
- Prof. Mingzhi Zhang,
Department of Ophthalmology, Along with the academicians, the industry is also
The Joint Shantou International setting up new initiatives to enhance screening of
Eye Center of Shantou University, China DR across the country. For instance, German firm
Euro Eyes has initiated DR screening in its clinics
“It is of great significance to at Shanghai and Beijing. Equipped with the latest
apply deep-learning techniques optical coherence tomography (OCT) technology and
optical coherence tomography angiography (OCTA)
for DR recognition. However, devices from Zeiss, EuroEyes plans to counter the
deep-learning algorithms often increasing number of Chinese with retinal diseases.

depend on large amounts of INDIA
labeled data, which is expensive
and time-consuming to obtain With around 77 million cases of DM reported in
adults in India in 2020, it is right behind China in
in the medical imaging area.” becoming the diabetes capital of the world. This
- Dr Shuqiang Wang, number accounts for 8.9 per cent of the total adult
Associate Professor, population in India. According to the National
Diabetes and Diabetic Retinopathy survey conducted
Shenzhen Institutes of Advanced Technology, China in 2019, one in 46 diabetic patients in India become
visually impaired due to diabetes, and one in seven
“The VUNO Med-Fundus AI diabetic patients have vision impairment. The survey
device analyzes retinal fundus report clearly indicates that there is a lack of data on
DR in India.
images to detect more than
12 lesions and classifies them “Diabetic retinopathy is a common vision-
for diagnosing a wide range threatening complication, which causes damage to
the retina, the light-sensitive layer at the back of the
of retinal diseases including eye. The risk of developing retinopathy is higher for
diabetic retinopathy, macular patients, who have had uncontrolled diabetes for a
degeneration and glaucoma.” long time. The main problem in diabetes retinopathy
is that patients will not have any visual or ocular
- Yeha Lee, symptoms until the central seeing area of the retina
Co-Founder & CEO, Vuno, South Korea or macula is affected or if there is bleeding in the eye.
The retinal examination must be done once a year
“Early detection and early starting from the time of diagnosis of diabetes for all
intervention are important patients with diabetes”, says Dr V Mohan, President
and Director, Madras Diabetes Research Foundation,
but the major screening India.
technology is eye imaging,
which depends on expensive Over the years, the researchers in India have
equipment and the judgment understood that there is an urgent need of an
accurate and affordable testing method for detecting
of ophthalmologists. It is DR. As a result, scientists at the Indian Institute of
important to develop a simple, Technology, Guwahati in collaboration with Shri
Sankaradeva Nethralaya in Guwahati have developed
effective and economic a point-of-care testing device that can detect DR at
technology for diabetic an early stage, without need for invasive testing.
retinopathy screening.”
“Currently, the first step in the test for diabetic
- Prof. Qian Kun, retinopathy is an invasive eye exam, in which the
Department of Biomedical Engineering,

Shanghai Jiao Tong University, China

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eyes are dilated and the ophthalmologist inspects the DIABETES PREVALENCE
eye. As people, who have had eye examination know, IN APAC COUNTRIES
this is inconvenient, with blurry vision for a long
time after examination. Advanced detection methods Country Adult population Prevalence
such as optical coherence tomography, fluorescein with diabetes (in of diabetes in
angiography, detection of exudates in retina, and China milllion) adults (%)
image analysis are complicated and require skilled India
operators and can show the malady only after it has Indonesia 116.4 10.9
progressed enough to be detected”, mentions Prof. Japan
Dipankar Bandyopadhyay, Department of Chemical Thailand 77 8.9
Engineering and Head of Center for Nanotechnology, South Korea
IIT-Guwahati, India. Malaysia 10.6 6.2
Australia
Besides developing simpler methods for DR Taiwan 7.39 7.9
detection, India is also exploring the use of artificial Hong Kong
intelligence (AI) in this space. For instance, Sankara Singapore 4.2 8.3
Eye Hospital in Bengaluru has collaborated with New Zealand
Singapore based Leben Care to deploy a cloud-based 3.6 9.2
AI software platform called Nethra AI in order to
diagnose retinal conditions in patients. The solution 3.6 16.8
uses cutting edge algorithms, developed in guidance
with some of the leading experts in retina globally, 1.28 7.3
with a four-step deep convolutional neural network
(DCNN). 1.2 6.6

Few other hospitals within India such as Aravind 0.7 12.2
Eye Hospital and Sankara Nethralaya have partnered
with Google in its efforts to apply AI in screening 0.6 14.2
of DR. Google has opened an AI based laboratory
in Bengaluru to solve India’s biggest healthcare 0.2 7.7
challenges, with diabetes being one of them.
Source- idf.org, as on May 2020
Although there is strong clinical evidence that the
control of blood glucose, blood pressure, and lipid GLOBAL DIABETES
level can prevent and slow down the progression of PREVALENCE IN 2019
DR, studies have also shown that genetics may play a
role in the development of DR. The global diabetes prevalence in 2019 is
estimated to be 9.3% (463 million people), rising
Focusing on this aspect, US headquartered to 10.2% (578 million) by 2030 and 10.9% (700
firm MedGenome, with operations in India and million) by 2045. The prevalence is higher in
Singapore, is exploring the use of next-generation urban (10.8%) than rural (7.2%) areas, and in
sequencing (NGS) for detection of DR. “The benefits high-income (10.4%) than low-income countries
of NGS based testing is that it offers targeted panel (4.0%). One in two (50.1%) people living with
testing, clinical exome, whole exome or whole diabetes do not know that they have diabetes.
genome sequencing (WGS). The diagnostic yield The global prevalence of impaired glucose
of the NGS testing in ophthalmological diseases tolerance is estimated to be 7.5% (374 million)
is about 50-70 per cent. With advancement in in 2019 and projected to reach 8.0% (454
technology and innovation in science, the process of million) by 2030 and 8.6% (548 million) by 2045.
NGS has evolved to offer comprehensive, affordable Just under half a billion people are living with
genetic testing with a very short turn-around time diabetes worldwide and the number is projected
of 3-4 weeks”, says Dr N Soumittra, Disease Head, to increase by 25% in 2030 and 51% in 2045.
Ophthalmology, MedGenome, India.
Source: diabetesresearchclinicalpractice.com/
SINGAPORE

In Singapore, the prevalence of diabetes follows
the same trend as China and India with an average
of 14 per cent. At present, Singapore is estimated
to have 0.6 million adult cases with diabetes and

24 COVER STORY

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“Advanced detection methods it is expected to increase to one million by 2050.
such as optical coherence Unfortunately, Singapore has ranked first in the
tomography, fluorescein incidence of type 2 diabetes (T2D) related end-
angiography, detection of stage renal disease and amputations worldwide.
Consequent to the alarming rate of T2D and its
exudates in retina, and image complications in Singapore, the Health Ministry had
analysis are complicated & declared a war against type 2 diabetes in 2016.

require skilled operators & can Telemedicine based DR screening has now been
show the malady only after it successfully integrated into the National Diabetes
has progressed enough to be Programme in Singapore. This method has resulted
in cost savings when compared with a physician
detected.” assessed model. According to a recent study, adding
- Prof. Dipankar Bandyopadhyay, AI technology using deep learning systems in a semi-
Department of Chemical Engineering and Head of automated model to the process has been shown to
Center for Nanotechnology, IIT Guwahati, India be equally effective as the assessment performed by
trained human graders for detecting DR.
“The diagnostic yield of the NGS
testing in ophthalmological “From the health system perspective, a semi-
automated screening model is the least expensive
diseases is about 50-70 per cent. costing around $62 per patient per year. The fully
With advancement in technology automated model is $66 per patient per year, and
the human assessment model costs $77 per patient
and innovation in science, the per year. The savings to the Singapore health
process of NGS has evolved to system associated with switching to the semi-
offer comprehensive, affordable automated model are estimated to be $489,000,
genetic testing with a very short which is roughly 20 per cent of the current annual
turn-around time of 3-4 weeks.” screening cost. By 2050, Singapore is projected
to have one million people with diabetes; at this
- Dr N Soumittra, time, the estimated annual savings would be $15
Disease Head, Ophthalmology, MedGenome, India million”, explains Prof. Tien Wong, Medical Director,
Singapore National Eye Center, Singapore.
“With the intelligent deep
learning system by SELENA+, it A perfect example of this comes in the form of a
can perform automated image breakthrough machine learning technology called
analysis of retinal images with SELENA+, jointly developed by a research team from
results in mere seconds, much the Singapore National Eye Centre’s Singapore Eye
Research Institute and the National University of
faster than the best trained Singapore’s School of Computing.
human graders. Moreover, there
EyRIS has bagged a five-year contract from
is always a chance of human Singapore’s Integrated Health Information Systems
error, which can be prevented (IHiS) for the deployment of this technology.
Expected to be a part of Singapore’s national
with SELENA+.” screening programme from November 2020,
- Lai Teik Kin, SELENA+ will initially be deployed to screen
120,000 patients annually.
Chief Executive Officer, EyRIS, Singapore
“With this intelligent deep learning system by
“The savings to the Singapore SELENA+, it can perform automated image analysis
health system associated of retinal images with results in mere seconds,
much faster than the best trained human graders.
with switching to the semi- Moreover, there is always a chance of human error,
automated model are which can be prevented with SELENA+”, says Lai
Teik Kin, Chief Executive Officer, EyRIS, Singapore.
estimated to be $489000,
which is roughly 20 per cent of Though performance of AI in DR screening is
highly promising, its application within low-resource
the current annual screening settings needs more careful and comprehensive
cost.” design and planning for best outcomes.
- Prof. Tien Wong,
Medical Director,

Singapore National Eye Center, Singapore

COVER STORY 25

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

SOUTH KOREA “The main problem in diabetes
retinopathy is that patients will
Despite a rapid increase in the prevalence of diabetes
in the South Korean population in the past decade, not have any visual or ocular
the prevalence of diabetic retinopathy is somewhat symptoms until the central
stable in the country. With the current status of 3.6 seeing area of the retina or
million cases of DM in adults, South Korea is seeking macula is affected or if there is
an improvement in the continuity of DR screening bleeding in the eye. The retinal
among patients with diabetes to reduce the risk of examination must be done
visual impairment as a result of DR. once a year starting from the
time of diagnosis of diabetes for
The most recent innovation in the DR screening all patients with diabetes.”
space has been added by a startup Vuno in the
form of an AI based medical device. The VUNO - Dr V Mohan,
Med-Fundus AI device has also gained the honour President and Director,
of being the first ever innovative medical device Madras Diabetes Research Foundation, India
in South Korea by the Ministry of Food and Drug
Safety (MFDS) in recognition of its high level of “We have developed a smart
technological innovation. LED contact lens that can

“The device analyzes retinal fundus images to diagnose diabetes and treat
detect more than 12 lesions and classifies them for diabetic retinopathy with
diagnosis. The 12 findings detected by the device
are an all–encompassing set of medical information light for the first time in the
that is crucial to diagnosing a wide range of retinal world. We are planning to
diseases including diabetic retinopathy, macular
degeneration and glaucoma”, shares Yeha Lee, commercialize the products
Co-Founder & Chief Executive Officer, Vuno, South with Stanford Medicine.”
Korea. - Prof. Sei Kwang Hahn,
Department of Materials Science &
Moving a step further in terms of innovation, Engineering, POSTECH, South Korea
researchers at the Pohang University of Science
and Technology (POSTECH) have developed a “In terms of clinical benefits,
technology that allows diagnosis of diabetes and AI-assisted diagnosis software
treatment of diabetic retinopathy just by wearing
smart light-emitting diode (LED) contact lens. by Acer can effectively assist
After putting the new smart LED contact lenses physicians in identifying potential
on rabbit eyes with diabetic retinopathy disease
and irradiated light repeatedly for a month, the diabetic retinopathy patients,
researchers confirmed that there was significant early detection & referral,
reduction of angiogenesis in retina and verified & avoiding patients’ vision
clinical feasibility of the smart LED contact lens for
the DR therapy. deterioration or even blindness
due to delayed treatment.”
The team has also developed a smart wearable - Dr Yi-Ting Hsieh,
medical device that can do highly sensitive analysis Department of Ophthalmology,
on the glucose concentration in sweat. “We have National Taiwan University Hospital, Taiwan
developed a smart LED contact lens that can
diagnose diabetes and treat diabetic retinopathy with
light for the first time in the world. We are planning
to commercialize the products with Stanford
Medicine”, says Prof. Sei Kwang Hahn, Department
of Materials Science & Engineering, POSTECH,
South Korea.

TAIWAN

According to a survey conducted on diabetic
patients in Taiwan in 2019, most of them indicated
that their physician suggested the need for eye

26 COVER STORY

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KEY FACTS ABOUT DIABETES care but a substantial percentage of patients with
diabetes were not aware of the need for a regular
 The number of people with diabetes rose screening of DR. Taiwan, at present, reports around
from 108 million in 1980 to 422 million in 1.2 million cases of DM in adults with no substantial
2014. research examining the factors associated with the
acceptance of DR screening among patients with
 The global prevalence of diabetes among diabetes.
adults over 18 years of age rose from 4.7 per
cent in 1980 to 8.5 per cent in 2014. Addressing this concern, multinational
technology company Acer has recently announced an
 Between 2000 and 2016, there was a 5 per AI-assisted diagnosis software for DR examination,
cent increase in premature mortality from in collaboration with National Taiwan University
diabetes. Hospital (NTUH). Novartis Taiwan has provided its
rich clinical trials and medical evidence collection
 Diabetes prevalence has been rising more experience for this project.
rapidly in low- and middle-income countries
than in high-income countries. “According to the results of clinical trials
conducted at National Taiwan University Hospital,
 Diabetes is a major cause of blindness, the accuracy is over 95 per cent, which is close to
kidney failure, heart attacks, stroke and lower the accuracy of interpretation by retinologists. It
limb amputation. has been certified by the Taiwan Food and Drug
Administration (TFDA) of the Ministry of Health
 In 2016, an estimated 1.6 million deaths and Welfare as a second-level medical device
were directly caused by diabetes. Another software. The rights and interests of users such as
2.2 million deaths were attributable to high physicians and patients are fully protected. In terms
blood glucose in 2012. of clinical benefits, AI-assisted diagnosis software
can effectively assist physicians in identifying
 Almost half of all deaths attributable to high potential diabetic retinopathy patients, early
blood glucose occur before the age of 70 detection and referral, and avoiding patients’ vision
years. WHO estimates that diabetes was the deterioration or even blindness due to delayed
seventh leading cause of death in 2016. treatment”, points out Dr Yi-Ting Hsieh, Department
of Ophthalmology, National Taiwan University
 A healthy diet, regular physical activity, Hospital, Taiwan.
maintaining a normal body weight and
avoiding tobacco use are ways to prevent or LOOKING FORWARD
delay the onset of type 2 diabetes.
To combat the increasing burden of DR and
 Diabetes can be treated and its reverse the trend of blindness from DR, a collective
consequences avoided or delayed with diet, approach integrating diabetes and eye care should
physical activity, medication and regular be developed within the APAC countries. This could
screening and treatment for complications. include integration of eye care into routine diabetes
care, training primary care physicians and diabetes
Source: WHO as on June 8, 2020 care professionals to raise the awareness of DR
among patients, provision of eye heath examinations
or screening services as part of routine diabetes
care, advising patients on appropriate management
strategies etc.

We need to reframe DR not only as a specific
condition that can be managed by ophthalmologists
but fundamentally as a preventable condition. To
win this war against DR, on the whole, a major
focus on primary and secondary prevention is most
important. In addition, it also requires a strong
public health system and effective public health
policies across the APAC region.

Dr Manbeena Chawla
[email protected]

OPINION 27

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Managing diabetes the figital way!

The COVID-19 pandemic has posed several new «
challenges and an opportunity to transform diabetes
care with digital innovation. Looking ahead, Omar Sherief
technology will play a greater role in diabetes Mohammad,
treatment and management once lockdowns ease. GM, Roche
Diabetes Care, India
The outbreak of COVID-19 has posed several
new challenges to diabetes care and has also practice GlucoVigilance, which is to keep a regular
provided an opportunity for transforming the watch on their sugar levels: eat a balanced diet,
treatment of diabetic patients. Lockdowns caused by exercise regularly, take medicines properly and
the coronavirus disease have up-turned the lives of monitor sugar regularly with a glucometer. A high
people everywhere. Yet, for those living with diabetes, degree of alertness with frequent self-monitoring of
the movement restrictions have raised a whole series blood glucose levels is certainly advisable in known
of extra questions: how can they seek advice; how can diabetic patients, particularly insulin users, to reduce
their health be monitored; and how can they continue the risk of being affected with COVID-19 infection
to manage their condition? and avoid any undesirable consequence should they
get infected.
Because of the containment and mitigation
measures, people with diabetes found themselves At the level of healthcare providers, it is important
without essential services. This has been disrupting to detect fresh cases of diabetes early—something
the practices for preventing diabetes-related which is very difficult at a time when the medical
complications. However, Government bodies and fraternity is struggling to manage the COVID-19
Healthcare professionals and those who support pandemic. Just as it is important that people
people with diabetes have rallied really well during with diabetes make every effort to achieve good
the lockdown to find innovative ways to help. glycemic control during these COVID times, it is
equally important that healthcare provider identify
People with diabetes most vulnerable during diabetes co-morbidities and complications early and
COVID-19 effectively manage them.

Some of the issues and challenges that have A huge challenge
emerged include the reported high incidence of
COVID-19 infections among persons with diabetes Diabetes management is challenging for the patient
resulting in a higher number of ICU admissions and as well the healthcare provider. It is not always
higher mortality reported in them. The increased easy to keep up with exercise schedules, diabetes
predisposition of patients with diabetes to COVID-19 meal plans, blood sugar check, medications, and
infections is believed to be related to a compromised much more. Diabetes care demands a lot of self-
innate immunity that accompanies uncontrolled management on a day-to-day basis. This is where the
diabetes. The situation would be worse if there are real challenge begins for a person with diabetes.
other co-morbidities such as hypertension, chronic
kidney disease, or coronary artery disease which On the other side, doctors too have a tedious task
often co-exist with diabetes and are also associated of analysing blood sugar fluctuations, medication
with more aggressive COVID-19 infections. adherence and other factors that influence the
outcome of diabetes care. Thinking through the
Furthermore, because people with diabetes present operational challenges, restrictions imposed
represent a fragile population that is at an increased by the lockdown and changing attitudes and
risk of mortality from COVID-19, it is recommended behaviours, it appears that technology has been
to avoid unnecessary diabetes-related hospital provided with an opportunity to prove its worth and
admissions to reduce the risk of COVID-19 exposure can play an important role more than ever before in
in the hospital. times of COVID-19.

People with diabetes need to be GlucoVigilant

In current times, people with diabetes have to be
even more vigilant about their health. They should

28 OPINION

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In India, management of diabetes and its mentioned telehealth among essential services
complications is a big challenge due to problems such in strengthening the health systems response to
as lack of awareness, scarcity of healthcare specialists COVID-19 policy. According to this new policy, within
and lack of data that helps in therapeutic decision- the optimising service delivery action, Telehealth
making. could be one of the alternative models for clinical
services and clinical decision support.
Going digital could be the answer
Future of diabetes management will be
In the modern world today, technology governs FIGITAL (F2F and Digital)
almost every aspect of our lives and healthcare
is no exception. With development of advanced As the pandemic forces healthcare systems across
technologies such as health apps, pedometers, the globe to respond rapidly to the crisis, many are
food trackers and glucometers, data tracking has adopting digital solutions such as digital medicine
become manageable. Social media is another evolved products, telehealth, and remote monitoring. A new
technology that many patients with diabetes use to report, published by IQVIA, has now highlighted how
educate themselves and drive motivation to bring the COVID-19 pandemic is also an opportunity to
lifestyle change. transform diabetes care with digital innovation.

With the emergence of health apps, smartphones Looking ahead, technology will play a greater
may be used to address many aspects of healthcare. role in diabetes treatment and management once
Most diabetes apps take care of diabetes self- lockdowns ease, particularly through advances in
management part as they allow manual entry for medical apps and devices linked to smartphone and
blood glucose, food intake, exercise time and insulin tablet computer cameras. A lot of what happens can
intake. be delivered through technology-enabled approaches,
whether that’s through uploading symptoms, weight,
During this global pandemic, remote patient blood pressure, or blood sugar meter readings from
monitoring (RPM) is emerging as an effective and home so that healthcare professionals can review
sustainable solution for precaution, prevention, and them and give feedback remotely. There are many
treatment to stem the spread of COVID-19 known ways technology can keep people on track whilst we
as telemedicine. It has been on the rise during the limit face-to-face (F2F) contact.
pandemic which refers to remote consultation where
a doctor and patient can exchange health information Managing diabetes has been made easier by recent
through electronic communication such as video developments in digital medicine products and smart
calls or SMS. Telehealth can provide several benefits diabetes management. One such diabetes treatment
particularly related to chronic illnesses such as is a wearable insulin patch pump that can monitor
diabetes. A patient can get treated from a specialist insulin levels, however, managing the condition can be
of choice without having to travel. Telehealth has difficult when face-to-face care is restricted.
suddenly reached the widespread adoption many of
us wouldn’t have even thought about. Home care could be practiced in future. Home-
based medical care could be the F2F management
Recognising the necessity of telehealth ensuring less risk and high level of treatment
considering the current crisis. Authorities have also satisfaction for wide ranges of acute and chronic
relaxed certain restrictions regarding its use across conditions including Diabetes Management.
clinical specialties. Moreover, the WHO recently
In summary, in future we will see a new wave of
innovations in the area of digital health, smart data,
telemedicine and home care delivery models. These
innovations will for sure transform the current model
of care and will facilitate triaging those who need to
come to hospitals, supporting care at home, and even
creating mobile clinics to support care for patients.

Last but not the least, during these times of
lockdown and even post lockdown, all caregivers
will have to deliver diabetes care more innovatively
and increasingly use telemedicine and other novel
approaches to be in touch with the diabetic patient
while keeping face-to-face consultations to a
minimum. This will ensure maximum benefit with
minimum risk.

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COVID-19 linked
maladies startling researchers

Although millions of people have recovered from the coronavirus worldwide, beating the initial sickness
appears to be the first of many battles for those who have survived. The list of gnawing maladies
associated with COVID-19, such as heart diseases, liver injuries, brain damage, anosmia etc., is surely
of a huge concern for the world.

COVID-19 has taken a significant toll on people of Indian researchers suggest that older people and
all across the world. It has not only upended people with chronic health conditions, including
lives in huge proportions but has also left cardiovascular disease (CVD), are at higher risk
deadly after-effects among patients. According for mortality and morbidity related to COVID-19
to scientists, COVID-19 can have long-term than the average population. While the clinical
consequences on the human body, which can be very manifestations of COVID-19 are dominated by
dangerous. respiratory symptoms, cardiovascular involvement
can occur through several other mechanisms. Acute
The problems seen in recovered patients have cardiac injury is the most frequently reported
alarmed many scientists, doctors and researchers as cardiovascular abnormality in COVID-19, and it
it could lead to severe brain, heart, kidney or liver occurs in approximately 8-12 per cent of all patients.
disorders. Other than affecting the main parts of the The presence of underlying CVD or development of
body, the list of lingering maladies from COVID-19 acute cardiac injury might confer an increased risk of
also involves problems like fatigue, racing heartbeat, death.
shortness of breath, achy joints, foggy thinking,
persistent loss of sense of smell, and mental Another study in China has shown that pre-
illness. existing cardiovascular disease seems to be
linked with worse outcomes and increased risk
Researchers from all over Asia, in of death in patients with COVID-19, whereas
Singapore, China, Hong Kong, India, COVID-19 itself can also induce myocardial
Japan and Taiwan have come up with injury, arrhythmia, acute coronary
many studies showing severe effects of syndrome and venous thromboembolism.
COVID-19 on the heart, liver, kidney and Potential drug–disease interactions affecting
brain in recovered patients. patients with COVID-19 and comorbid
cardiovascular diseases are also becoming a
Impact on heart serious concern.
“A high prevalence of pre-existing
Studies have shown that COVID-19 CVD has been observed among patients
recovered patients in Singapore have died with COVID-19, and these comorbidities
from ischaemic heart disease. It has been are associated with increased mortality.
confirmed and proven by many scientists Furthermore, COVID-19 seems to promote
now that COVID-19 can impact the heart the development of cardiovascular disorders,
health in more ways than one. In many such as myocardial injury, arrhythmias,
ways, the acute inflammatory response acute coronary syndrome (ACS) and
fueled by the virus can also complicate venous thromboembolism. Children with
matters. Acute inflammation could obstruct COVID-19 have also been reported to
arteries, cause blood clots, which develop hyperinflammatory shock
contribute to reduced heart function. It with features akin to Kawasaki
can also so happen that people with disease, including cardiac
rapid heartbeats could observe dysfunction and coronary
heart muscle weakening, vessel abnormalities.
which can cause damage Together, these
to the heart. data indicate

A recent study
done by a team

30 COVID -19

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“A high prevalence of pre-
existing CVD has been observed
among patients with COVID-19,

and these comorbidities are
associated with increased
mortality. Furthermore,

COVID-19 seems to promote the
development of cardiovascular
disorders, such as myocardial
injury, arrhythmias, acute
coronary syndrome (ACS) and
venous thromboembolism.”
- Dr Dao Wen Wang,
Dean of Department of Cardiology,
Tongji Hospital, China

“In patients with COVID-19, the presence of a bidirectional interaction between
the presence of liver diseases, COVID-19 and the cardiovascular system, but
the mechanisms underlying this interaction
including non-alcoholic remain elusive”, says Dr Dao Wen Wang, Dean of
steatohepatitis and liver Department of Cardiology, Tongji Hospital, China.
cirrhosis, could increase the
severity of COVID-19 disease. Targeting kidneys
Additionally, patients with
chronic liver disease may Apart from the post recovery heart and lung
require frequent admission for problems, coronavirus has even targeted the
treatment and gastrointestinal kidneys. Kidney involvement has appeared to be
endoscopy to survey esophageal frequent in people, who have tested positive and
varices, increasing the risk of developed symptoms. A latest study performed by a
COVID-19 transmission through group of researchers from Taiwan, China and India
have revealed that COVID-19 patients have been
aerosolization.” found to have developed massive albuminuria and
- Dr Goki Suda, proteinuria.

Medical Doctor, Department of Gastroenterology “Computed tomography scan of the kidneys
and Hepatology, Hokkaido University, Japan showed reduced density, suggestive of inflammation
and edema. Kidney involvement seems to be frequent
“The estimated risk of COVID-19 in this infection, and acute kidney injury (AKI) is an
patients with liver injury independent predictor of mortality. The impact of
this infection in those with chronic kidney disease
experiencing adverse clinical has not been studied. Management of patients on
outcomes such as intensive dialysis, who have been suspected to have been
in contact with COVID-19 should be carried out
care unit (ICU) admission, use of according to strict protocols to minimize risk to
invasive mechanical ventilation other patients and healthcare personnel taking care
or death was almost eight times of these patients”, points out Dr Chih-Wei Yang,
of other patients. It is suggested Dean of College of Medicine, Chang Gung University,
Taiwan.
that liver function monitoring
is important regarding its

association with adverse clinical
outcomes in COVID-19 patients.”

- Prof. Vincent WS Wong,
Deputy Director, Center for Liver Health,

CU Medicine, Hong Kong

COVID-19 31

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Effect on liver not be ignored and needs to be carefully investigated.
A recent study has also reported that the liver injury
Abnormal liver function, or liver derangement, observed in COVID-19 patients might be caused by
either in the form of hepatitis, cholestasis, or both, lopinavir/litonavir, which is used as antivirals for the
can also be observed in patients with COVID-19. treatment of SARS-CoV-2 infection.
Researchers from the Faculty of Medicine at the
Chinese University of Hong Kong (CU Medicine) have On the other hand, a study in Japan has revealed
recently conducted a study to investigate the impact that concomitant liver disease could increase the
of liver injury on clinical outcomes in COVID-19 severity of COVID-19 disease, and chronic liver
patients. Data from over 1,000 COVID-19 patients in disease patients sometimes require frequent
Hong Kong was analysed and liver injury was found admission and gastrointestinal endoscopy. Thus,
in around 20 per cent of the patients. clarifying the prevalence of asymptomatic COVID-19
in outpatients with liver disease is essential for
“The estimated risk of COVID-19 patients with preventing hospital acquired infections.
liver injury experiencing adverse clinical outcomes
such as intensive care unit (ICU) admission, use of On this note, Dr Goki Suda, Medical Doctor,
invasive mechanical ventilation or death was almost Department of Gastroenterology and Hepatology,
eight times of other patients. It is suggested that Hokkaido University, Japan says, “In patients with
liver function monitoring is important regarding COVID-19, the presence of liver diseases, including
its association with adverse clinical outcomes in non-alcoholic steatohepatitis and liver cirrhosis,
COVID-19 patients. Liver injury, in the form of could increase the severity of COVID-19 disease.
hepatitis, cholestasis or both, can be observed in Additionally, patients with chronic liver disease
patients infected by different coronaviruses”, says may require frequent admission for treatment and
Prof. Vincent WS Wong, Deputy Director, Center for gastrointestinal endoscopy to survey esophageal
Liver Health, CU Medicine, Hong Kong. varices, increasing the risk of COVID-19 transmission
through aerosolization. We have been working on the
Another related study in China has shown that time-dependent changes in COVID-19 seroprevalence
patients with liver damage are advised to be treated in liver disease outpatients, who were asymptomatic
with drugs that could both protect liver functions and for COVID-19.”
inhibit inflammatory responses, such as ammonium
glycyrrhizinate, which may, in turn, accelerate the Linked with brain damage
process of disease recovery. Drug-induced liver injury
during the treatment of coronavirus infection should From the fear of dying, pain, sleep deprivation, lack
of mobility or proper communication, social isolation
or delirium, all of these factors could make a person’s
fight with COVID-19 much harder. Researchers at
the National Brain Research Centre (NBRC) in India
have reassessed the role of the virus as much more
than just a respiratory virus.

“The Middle East Respiratory Syndrome (MERS)
and Severe Acute Respiratory Syndrome (SARS)
virus have earlier been reported to invade the brain’s
nervous tissue through the blood-brain barrier. A
similar invasion route is possible for SARS-CoV-2.
Autopsy studies of COVID-19 have revealed a loss of
taste and smell senses, headache, nausea, dizziness
and incoherence in COVID-19 patients can be
strongly correlated to the brain function”, mentions
Prof. Pankaj Seth, Scientist, National Brain Research
Centre, India.

In another similar study performed in China,
a three-month follow-up of 60 patients, who had
recovered from COVID-19 was done. After studying
the micro-structural changes in their brains through
magnetic resonance imaging (MRI) scans, the
researchers found that during the SARS-CoV-2
infection, 41 of these patients displayed neurological

32 COVID -19

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MAJOR DYSFUNCTIONS symptoms such as loss of a sense of taste or smell,
ASSOCIATED WITH COVID-19 numbness in the limbs and memory deficits. The MRI
scans also revealed enlarged volumes of the olfactory
● Heart failure cortex, hippocampus, insula and the cingulate
● Liver injury cortex. Together, these areas of the brain regulate
● Brain damage the sense of smell, memory formation and emotional
● Loss of sense of smell and taste processing.
● Kidney dysfunction
● Hypertension Studies have also revealed that SARS-CoV-2
● Shortness of breath could cause damage to the central nervous system
● Joint pain indirectly. Viruses do not have to enter the brain to
cause damage, they can activate an immune response
“Computed tomography that triggers subsequent damage within neuronal
scan of the kidneys showed tissue. SARS-CoV-2 has been reported to cause a
reduced density, suggestive of massive release of cytokines, a syndrome known as
inflammation and edema. Kidney cytokine storm, downstream effects of this immune
involvement seems to be frequent response include endothelial damage, disseminated
in this infection, and acute kidney intravascular coagulation, and disrupted cerebral
injury (AKI) is an independent auto-regulation.

predictor of mortality.” More dysfunctions in store
- Dr Chih-Wei Yang,
An increasing number of case series and reports on
Dean of College of Medicine, patients infected with COVID-19 presenting with
Chang Gung University, Taiwan acute olfactory dysfunction as the sole symptom, or
together with other symptoms, have been published.
“Autopsy studies of COVID-19 In a survey conducted by the Global Consortium
have revealed a loss of taste for Chemosensory Research (GCCR), COVID-19 is
and smell senses, headache, associated with severe impairment of smell, taste and
nausea, dizziness and chemesthesis.
incoherence in COVID-19
patients can be strongly As a result, in Singapore, anosmia or the complete
correlated to the brain loss of sense of smell is included in the Ministry of
function.” Health website’s list of COVID-19 symptoms and in
circulars to doctors. Recently, New Zealand has also
- Prof. Pankaj Seth, updated its case definition of COVID-19 to include
Scientist, National Brain Research Centre, India anosmia as a symptom. After the World Health
Organisation (WHO) and the United States, European
“Over 90 per cent of COVID-19 Centre for Disease Prevention and Control has also
patients with loss of smell included anosmia as a symptom of COVID-19.
may recover that sense
within the first month, and “Olfactory training is the only current evidence-
based therapeutic option for post-viral olfactory loss.
olfactory training is strongly Over 90 per cent of COVID-19 patients with loss of
recommended if smell has not smell may recover that sense within the first month,
and olfactory training is strongly recommended if
recovered after that period of smell has not recovered after that period of time
time but can be started earlier.” but can be started earlier”, says Prof. Wang De Yun,
Director of Research, Department of Otolaryngology,
- Prof. Wang De Yun, National University of Singapore, Singapore.
Director of Research, Department of Otolaryngology,
Although millions of people have recovered
National University of Singapore, Singapore from the coronavirus worldwide, beating the initial
sickness appears to be the first of many battles
for those who have survived. The list of gnawing
maladies associated with COVID-19 is surely of a
huge concern for the world.

Pooja Yadav
[email protected]

COVID-19 33

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Betting big on anti-COVID-19

NASAL SPRAYS
With the coronavirus cases continuing unabated worldwide, new approaches are being explored, either
as a therapeutic or as a potential vaccine against COVID-19. Researchers are now focusing on nasal
sprays to target the coronavirus in the nose. Let us delve into the pros and cons of this new approach.

Since the coronavirus outbreak started in include China based Beijing Wantai Biological
China in December 2019, firms have been Pharmacy Enterprise with researchers from
scrambling to find a treatment for this Xiamen University and Hong Kong University;
disease. Vaccines, antibodies, plasma therapy, India based Bharat Biotech in collaboration
repurposing old drugs, every possible method, with Washington University School of Medicine,
which would halt the virus is being tried. The latest St Louis, Missouri, USA; Codagenix, USA in
approach now happens to be nasal spray. collaboration with the Serum Institute of India;
University of Waterloo, Canada and Altimmune,
Why this approach? Nasal sprays are liquid USA. In addition to vaccines, five organisations-
medicines delivered through the nose, which two companies each from Australia -Star Pharma
is far less invasive for the recipient than the and Ena Respiratory; and Austria - CEBINA GmbH
intramuscular injection alternative. The drug can and Marinomed and the UK based biotechs -
be rapidly absorbed through the nasal mucosa SporeGen and Destiny Pharma have been working
since it is supplied by many blood vessels. It on therapeutic sprays.
is also expected to be easier to mass-produce
and distribute because it will utilize the same China, front runner in the vaccine race, has
production technology as the influenza vaccine. granted the first ever approval to begin phase I
clinical trial of a nasal spray vaccine for COVID-19,
Sharing views about the advantages of nasal in September 2020. The intranasal spray is
vaccines, Michael Breen, Director of Infectious being co-developed by Beijing Wantai Biological
Diseases, GlobalData, USA said “They have an
easier route of administration, as simply inhaling “The nasal spray works
something is considered easier than injecting. prophylactically and
Further, it also circumvents issues with needle-
phobia, and could help increase willingness to therapeutically and targets
receive a vaccine, particularly in this group”. a broad variety of respiratory
viruses including Coronaviruses,
Apart from being an easy mode of
administration, the nasal spray vaccines present Rhinoviruses, Influenza A
a few obvious advantages. They don’t require viruses and many more.
needles, may not need to be stored or shipped at Therefore, it is much broader
low temperatures and can be self-administered. in its activity and works
immediately as soon as
Front runners used. Vaccines usually target
particular viruses and need
Nasal sprays are of two kinds, one is a vaccine, some time to work. Additionally,
which is administered through an intranasal route, the nasal spray has a very good
and the other is nasal therapeutic spray, which safety profile with less than
is a preventive treatment and complementary one reported adverse event /
to vaccines and drugs. There are currently five
intranasal vaccines under development and the 100.000 units sold.”
same number of therapeutic sprays at various - Dr Eva Prieschl-Grassauer,
stages of development around the world.
Chief Scientific Officer, Marinomed Biotech, Austria
The organisations that are working on vaccines

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“Advantages of nasal vaccines immunity that occurs primarily in the cells that line
are that they have an easier the nose and throat. Most other vaccine candidates
route of administration, as currently under development can’t do that.”
simply inhaling something
is considered easier than Precision Virologics, which develops
injecting. Further, it also adenovirus-based vaccines in St. Louis, and India
based Bharat Biotech, a vaccine manufacturing
circumvents issues with needle- giant, jointly obtained rights from Washington
phobia, and could help increase University School of Medicine in St. Louis for a
willingness to receive a vaccine, novel chimp-adenovirus vaccine for COVID-19.
Precision Virologics has optioned rights for USA,
particularly in this group.” Europe, and Japan. Bharat Biotech has obtained a
- Michael Breen, license for all other markets.

Director of Infectious Diseases, Another Indian firm working on the nasal
GlobalData, Massachusetts, USA vaccine is Serum Institute of India (SII), which
has partnered with New York based Codagenix to
Pharmacy Enterprise with researchers from develop CDX-005. It is Codagenix’s intranasal,
Xiamen University and Hong Kong University. live-attenuated vaccine candidate for COVID-19.
Preclinical animal studies have been successfully
The trials are currently underway. The completed, and Codagenix expects to initiate a
intranasal spray contains weakened flu virus that phase I first-in-human clinical trial in the UK by
carries the genetic segments of the coronavirus’s the end of 2020.
spike protein. Administered through the nasal
tract, it mimics the natural infection of respiratory US based, Altimmune is also working
viruses to stimulate the body’s immune response on AdCOVID Intranasal vaccine, which has
against the pathogen that causes COVID-19, shown positive results in preclinical studies.
according to Science and Technology Daily, a paper AdCOVID uniquely stimulates three key immune
affiliated with China’s Ministry of Science and components: serum neutralizing antibody, T
Technology. Preclinical studies have shown that the cell responses, and mucosal immunity in the
nasal vaccine can significantly reduce lung damage respiratory tract.
among mice and hamsters when challenged with
the coronavirus, the paper further said. Besides teams from India, China and USA,
researchers at University of Waterloo, Canada
A team led by viral immunologist Dr Michael are developing a DNA-based vaccine that can be
Diamond from Washington University in St Louis, delivered through a nasal spray. The vaccine will
USA has found that mice given a single dose of work by using engineered bacteriophage, a process
the intranasal vaccine were fully protected from that will allow the vaccine to stimulate an immune
SARS-CoV-2, with virtually no sign of the virus in response in the nasal cavity and target tissues in
their upper or lower airways. Mice that received an the lower respiratory tract.
injection of the same vaccine were only partially
protected, echoing animal data from some leading “Nasal sprays as therapeutics are not for
candidates. This was because the intranasal immunization”, according to Dr Lon Jones, D O,
vaccine summoned potent ‘mucosal’ immune one of the world’s leading experts on respiratory
responses that can block the virus at the site of health and natural remedies. He said, “Nasal sprays
infection in the upper airways, as per the team of for COVID-19 are to optimize our nasal defense
immunologists. so that destroying the virus is not necessary.
Paul Ewald, in his book, ‘Evolution of Infectious
Dr David T Curiel, Director, Biologic Disease,’ points out that microbes adapt toward
Therapeutics Center, and professor of radiation increased virulence when they can more easily
oncology at Washington University School of move from host to host, and that attacking them
Medicine in St Louis, USA and Precision Virologics’ promotes mutations in the same direction, while
interim chief executive officer (CEO) said in a making it harder for them to get around promotes
statement, “The ability to accomplish effective commensal adaptations.”
immunization with a single nasal dose is a major
advantage, offering broader reach and easier “The nasal spray works prophylactically and
administration. An effective nasal dose not only therapeutically and targets a broad variety of
protects against COVID-19, but it also prevents the respiratory viruses including Coronaviruses,
spread of the disease by offering another kind of Rhinoviruses, Influenza A viruses and many more.
Therefore, it is much broader in its activity and

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works immediately as soon as used. Vaccines “Nasal sprays as
usually target particular viruses and need some therapeutics are not for
time to work. Additionally, the nasal spray has a
very good safety profile with less than one reported immunization. These
adverse event / 100.000 units sold,” said Dr sprays for COVID-19
Eva Prieschl-Grassauer, Chief Scientific Officer, are to optimize our
Marinomed Biotech, Austria.
nasal defense so that
Marinomed Biotech AG is also working on a destroying the virus is
nasal spray therapeutic for COVID-19. In July
2020, the firm announced the positive pre-clinical not necessary.”
studies for decongestant Carragelose nasal spray - Dr Lon Jones D O,
against COVID-19. The firm applied for approval
in September 2020, in Europe. The nasal spray America’s most famous country doctor and practitioner
contains Carragelose and the decongestant of commonsense medicine from Texas in the US
xylometazoline. Carragelose forms a moisturizing
protective film on the nasal mucosa and thus slows for a number of important markets including
down the spread and multiplication of viruses. Europe. This antiviral is patented by Starpharma in
In addition, Carragelose supports the active major markets and a specific patent application has
ingredient xylometazoline in reducing the duration been filed for the COVID-19 nasal spray.
and intensity of symptoms in the event of a viral
infection of the respiratory tract. Marinomed A nasal treatment developed by Australia’s Ena
expects the product to be launched in important Respiratory to boost the natural human immune
EU markets in the 2021/22 season. system to fight common colds and flu, has proved
remarkably successful in reducing COVID-19 viral
Another Austrian biotech company CEBINA replication test. The INNA-051 compound works
GmbH, has announced positive results of its by stimulating the innate immune system, the first
COVID-19 drug repurposing project with the line of defence against the invasion of pathogens
identification of commonly used approved drugs into the body. Ena Respiratory has raised $8.3
with activity against SARS-CoV-2 infection in in million from Australian investors and, subject to
vitro assays. One of these drugs, Azelastine, an successful toxicity studies and regulatory approval,
antihistamine, is currently available as a nasal the company could be ready to test INNA-051 in
spray. It has been identified as a potential topical human trials before February 2021.
preventive or post-exposure anti-COVID-19
approach. CEBINA has applied for patent Insufficient data
protection for its findings and will publish the
scientific data shortly. There is insufficient data available to support
that the immunity generated from nasal spray
Destiny Pharma and SporeGen in the vaccinations lasts longer than that from injected
United Kingdom are working on Bacillus and its vaccines. Talking on the same lines Dr Eva
applications, to co-develop SporeGen’s SPOR-COV Prieschl-Grassauer “The mode of action of the
product. It differs from vaccines as it utilizes the nasal spray is different to vaccines as it neutralizes
innate immune system with the aim of developing viruses similarly as neutralizing antibodies, which
COVID-19 protection a few days after dosing. are the result of a vaccine. For protection you need
As an ‘easy to use’ first line of defense, it has the to use it in a prolonged way”.
potential to reduce COVID-19 infection rates and
transmission significantly. “For COVID-19, we are currently in a state
where we have no idea how well any vaccine for
However, Australia’s Starpharma is now any technology might last. Presently, we don’t even
working on regulatory and manufacturing activities know if any of the vaccines in trials protect against
associated with a nasal spray for protection against the disease. What we do know is that they are
COVID-19 based on its proprietary antiviral immunogenic. Data on how long they last is years
dendrimer, SPL7013. The firm has completed away, but there is nothing that we know about
antiviral testing of SPL7013 confirming potent nasal vaccines in development for COVID-19 to
antiviral activity against SARS-CoV-2 and providing suggest that they might have a different duration
supporting data on mechanism of action indicating than injected ones,” Breen added.
that it acts early in the viral replication cycle. An
expedited regulatory pathway has been confirmed It is important that we try different approaches,
because most likely we’ll need more than one
vaccine to protect all people around the globe.

Ayesha Siddiqui

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APAC’s 5G
ambitions in Healthcare

The surge in virtual healthcare has prompted physicians globally to engage in co-sharing their medical
space and expertise. And Internet-of-Things (IoT) is driving next-generation smart healthcare. Boosted
by advances in robotics, IoT and Artificial Intelligence, healthcare organisations across the globe have
started using 5G network that promises to provide essential levels of connectivity to enable a new
health ecosystem, which will align with a relatively recent idea known as 4P medicine—that is, it will be
predictive, preventative, personalised and participatory, as noted by PwC.

At present, most countries’ healthcare with a total of 4.6 million 5G connections by 2026.
system widely uses the existing 4G (fourth Further, 5G technologies are expected to contribute
generation of broadband cellular network almost $900 billion to the region’s economy over the
technology) network and other communication next 15 years. Currently, medical world is excited to
technologies for smart healthcare applications. The explore some of the notable 5G applications.
existing communication technologies are unable to
fulfil the complex and dynamic needs of the diverse Revealing the advantages of using 5G network,
smart healthcare applications, such as remote Dr Harish Pilla, CEO, Aster DM Healthcare, India
surgeries which imperatively require an ultra- says “5G networks would help in vastly improving
reliable network. the digital networking capabilities. Many of the
digital healthcare initiatives being adopted would
4G latency (lag time between input and output) be very well complemented with such a high-speed
is around 50 milliseconds, a delay long enough to data service. High speed connectivity amongst
prove devastating in an operating room. 5G (fifth hospitals would help in bringing efficiencies
generation mobile network) primarily aims to reduce amongst niche specialties thereby promoting
latency to an almost instantaneous 2 milliseconds quality and cost-effective care. The adoption of
between devices. Hence a 5G network is essential IoT within the healthcare space would also be
to support smart healthcare infrastructure, through greatly enhanced. There will also be a quantum
its ultra-low latency, high bandwidth, ultra-high improvement in the utilization of cloud-based
reliability, high density and energy efficiency. infrastructure and high-end processing for
applications such as AR, VR and 3D Printing. This
The ultra-reliable low-latency communications will happen because the existing computing speeds
(URLLC) is advantageous for remote monitoring
of pharma and medical devices, remote robotic
surgeries, smart ambulance (logistics), and real-
time augmented reality (AR)/ virtual reality (VR)
applications. To list, 5G wireless technology, the
Internet-of-Medical-Things (IoMT), artificial
intelligence (AI), VR/AR tools and blockchain
system are the five interconnected keys influencing
digital healthcare. In summary, 5G transform
current tedious manual processes into smartly
automated workflows and provides integrated,
enhanced patient care.

Currently, South Korea, China, Japan, Thailand,
Australia are leading 5G countries in APAC and
Singapore is a recent addition to the list. In a few
years, 24 countries in the Asia-Pacific are expected
to launch 5G services. Global tech market advisory
firms’ forecasts that by 2026, 5G will generate
$399.8 million in revenues in the healthcare domain

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will be matched by network speeds.” HEALTHCARE ORGANISATIONS
Sharing his views Sumir Bhatia, President, USING 5G IN APAC

Lenovo Data Center Group (DCG), APAC, Singapore China’s ZTE Corporation, in association
says, “New care-delivery models such as remote with China Telecom, East China Hospital and
patient monitoring, virtual care, robotics, and the Sichuan University Clinical Public Health
telepresence rose in prominence due to social Center developed China’s first 5G remote
distancing. According to a study by Market Data COVID-19 diagnosis infrastructure. Sichuan
Forecast, the telemedicine market in APAC is hospital became the central hub, and the
expected to grow from $8.51 billion in 2020 to $ first batch to access 27 other hospitals with
22.45 billion in 2025, with a compound annual COVID-19 patients. The remote system can
growth rate of 21.4 per cent over the next five diagnose COVID-19 infection in three levels:
years. Though it is a small part of the healthcare the province, city and county of Sichuan, in
department at present, it is one of the fastest order to provide a ‘single network’ for remote
growing sectors in the overall healthcare market. diagnosis to all hospitals.
In this Smart Normal and beyond, telemedicine
could become as natural as getting food delivered KT Corporation (Korea’s largest telecom
to us via apps, which could spark a mindset change company) and Samsung Medical Center (SMC)
- especially in fast adoption APAC markets, such as, are jointly developing 5G-powered medical
Singapore where underlying infrastructure (tech service to establish a 5G smart hospital. These
literacy, internet connectivity etc.) made the switch 5G medical services include smart patient
to telemedicine seamless.” care, digital diagnostic pathology, access to
proton therapy information, AR/VR surgery
“Telemedicine requires a network that is education, robotic assistance to surgeons and
able to support real-time high quality video - more. SMC’s 5G-powered technology is the
and 5G will be a critical technology to improve world-first digital pathological innovation for
collaboration and communication. However, with on-site medical procedure.
the increase in the handling of confidential patient
data in a virtual environment, health institutes KT has also deployed a ‘Smart AI Care
require secure solutions to process and store Giver’, an autonomous robot to assist in
patient data with capacity, flexibility and security an operating room and in-patients care. It
as key needs,” adds Bhatia. provides AI services on KT’s GiGAGenie engine,
enabling patients to control their hospital room
Dr Pilla further says “By fast-tracking adoption with a voice command. Hence the medical
of digital healthcare services, the new age patient staff can respond quickly and more efficiently
has been able to acknowledge the effectiveness of to patient emergencies, ensuring better
services like tele-medicine (complemented with medical services and immersive personalized
homecare), thereby effectively eliminating the need experiences for patients.
to visit a traditional brick-and-mortar facility. Not
only this is beneficial to the patient, but also to the In June 2020, Singapore announced
healthcare provider, as this would free up resources its efforts in switching to 5G network
within the facility to treat patients requiring communication to accommodate and enhance
advanced levels of care. Furthermore, the bandwidth the robotic and AI operations in healthcare and
brought in by 5G would also reduce the strain on the other industries to emerge in the post-COVID
hospital networks and help to integrate many of the world. Japan based BitOne Group and a Hong
healthcare devices, bringing about reliable remote Kong-based IBO Telecom are also on the
monitoring services. A potential challenge is to keep similar venture path.
a hawk’s-eye on speed reliability to ensure seamless
service and to build in cost-effective redundancies”. In September, Thailand’s Ministry of
Digital Economy and Society (MDES), Digital
Concerns and debates Economy Promotion Agency (depa) in
association with one of China’s telecom giant
Though, 5G acts as a building block for smarter launched ‘Thailand 5G Ecosystem Innovation
and more efficient healthcare systems, there Center (5G EIC)’. By paving “Thailand
are alleged health risks to the population due 4.0.” ecosystem, Thailand government
to 5G’s higher radio frequencies (RF) and high is integrating 5G, AI, big data and cloud
bandwidth-intensity. However, Food and Drug computing digital technologies.

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“Telemedicine requires “5G networks would help in
a network that is able to vastly improving the digital
networking capabilities. Many
support real-time high
quality video - and 5G will of the digital healthcare
be a critical technology to initiatives being adopted would
improve collaboration and
be very well complemented
communication.” with such a high-speed data
- Sumir Bhatia,
service.”
President, Lenovo Data Center Group (DCG), - Dr Harish Pilla,
APAC, Singapore
CEO, Aster DM Healthcare, India

5G & HEALTHCARE Source: AT&T Business eventually boost medical economy.
Yet, a greater usage of virtualization and
● Quickly transmitting large imaging files
● Expanding telemedicine the cloud might mean a broader, more varied
● Improving AR, VR and spatial computing cyberattack chances. Security analysts are already
● Reliable, real-time remote monitoring recognizing the inherent increases in data security
● Artificial intelligence risk at data storage and exchange, including greater
IoT device usage, medical identity theft, breaching
EMBRACING 5G TO health privacy policy, and mismanagement of
FIGHT THE PANDEMIC medical data. It is essential to leverage the benefits
of 5G in healthcare industry by scrutinizing these
COVID-19 outbreak has accelerated 5G network security issues.
deployment in hospitals. During the pandemic
5G has illustrated tangible benefits to healthcare Elaborating on this, Bhatia says, “Many
and public safety services. 5G can provide new healthcare institutions utilize on-premise data
use cases such as remote temperature checking, centers for security - however these are not as
constant communication for first responders, flexible as cloud solutions. Moreover, there is a
patient transfer, out-patient clinics and temporary significant barrier to entry given the stringent
hospitals, and repurposing networks. software and standards requirement. For greater
flexibility that can still manage sensitive patient data
Broader investment on 5G infrastructure and securely, hybrid cloud will be a key solution. Lenovo
development of AI and big data analytics have DCG recently worked with the National University
propelled healthcare infrastructure. In China, Health System (NUHS) in Singapore and helped
5G-powered telemedicine, remote ultrasound them rapidly migrate their workloads to a hybrid
and CT scanning have been utilized to tackle the cloud, which has been ideal in effectively protecting
shortage of medical personnel during pandemic. the privacy of patients. It also allowed data analysts
access to critical information for research efforts
Market research analysts’ forecasts Asia- using AI in the medical field and streamlined
Pacific’s 5G digital revenue to be worth $60 billion processes within the healthcare spectrum, elevating
in 2030 in the Post-COVID-19 era. APAC region the quality of healthcare administered to patients.
operators have increased Capital Expenditure Innovations in APAC healthcare will be driven by
(CapEx) for 5G rollouts in the year 2020. technologies such as 5G, HPC and AI propelling
According to reports, China alone is investing MedTech sector.”
a total of $ 173.3 billion on their 5G network by
2025. Currently, South Korea has the highest Furthermore, innovation never stops, and 6G
number of cities with 5G availability, followed by (sixth generation of wireless communications
China, the US, and the UK. technologies supporting cellular data networks) is
on the forefront to surpass 5G with more efficacy.
Administration (FDA) has not confirmed the Research on 6G has already begun, with countries
harmful side effects of this medical marvel. Many like the China, Japan, South Korea and the United
APAC governments are reviewing the 5G spectrum States. According to NTT DoCoMo’s recent white
pros and cons to make changes in regulation paper on 6G, it posits that it’s reasonable to expect
and to encourage network sharing which will 6G in 2030.

Hithaishi C Bhaskar
[email protected]

Q&A 39

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

“Chinese pharmaceutical market

is growing rapidly and is now a key

market for western companies”

Belgium based Bone Therapeutics recently «
announced its entry in China through
partnership with Link Health and Pregene Stefanos Theoharis,
for ALLOB, its off-the-shelf, Allogeneic Osteoblastic Chief Business Officer,
Cell Therapy platform. In an email interaction with Bone Therapeutics,
BioSpectrum, Stefanos Theoharis, Chief Business United Kingdom
Officer (CBO), Bone Therapeutics, United Kingdom
tells us more about the company, their strategy for
China and the impact of COVID-19 on their firm.
Edited excerpts;

Could you give us an overview of Bone companies in the field, by developing products
Therapeutics? tailored to the specific features of each indication we
treat.
At Bone Therapeutics we develop highly innovative
products for patients with high unmet medical needs ALLOB has two distinct advantages compared
in the areas of orthopedics and inflammation. with older stem cell products. Firstly, it is completely
off-the-shelf, as it is made from donor-derived
Our lead product, JTA-004 is a novel and cells that have been expanded to large amounts of
highly differentiated product, currently in Phase doses using our proprietary manufacturing process.
III clinical trials for knee osteoarthritis. This is an Secondly, the cells have been ‘educated’ during
indication where patients are clearly underserved by manufacturing to prepare them for the task of
current treatments. We have so far seen extremely regenerating bone in patients, who have suffered
encouraging results in previous trials and as a result critical fractures that are unlikely to fully recover.
we feel confident that JTA-004 can make a real We achieve this by giving them the right molecular
difference to those patients. signals, added to their culture medium. We have so
far generated excellent clinical and preclinical proof
Our allogeneic (donor-derived), off-the-shelf, of concept and therefore believe ALLOB represents
stem cell platform is our major focus and a significant the next step in stem cell therapies.
value driver for the company. The first product from
this platform is ALLOB, which is about to commence Currently, the standard of care for these patients
a Phase 2b clinical trial. We are continuing to is surgical fixation of the fracture and a subsequent
build on this innovative platform to develop new ‘wait and see’ procedure. This is grossly inadequate
differentiated products for more indications where for critical fractures. As a result of this, many patients
patients have limited options available to them, such will end up with a long-term disability. For that
as inflammation, always with a focus on efficacy and reason, various products or procedures are being
safety. tried, with sub-optimal and variable results. This
includes bone grafts, requiring an additional and
We are building partnerships with companies that painful surgery, or biologic products that induce bone
can help us accelerate our route to market and are formation, but in an uncontrolled way that may often
always on the look for new technologies that can help form bone in other organs and tissues.
us remain at the cutting edge of innovation.
ALLOB is the most advanced approach in
How is ALLOB different from existing the field, and has demonstrated increased bone
therapies? formation in patients and is extremely safe. Bone
Therapeutics has recently announced very positive
Stem cell therapies and the field of regenerative outcomes from a trial on spinal fusion, adding even
medicine have been exponentially growing in
recent years. Our mission is to be one of the leading

40 Q&A

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

more validation to its position as a great new product China and building one would not be straightforward.
for all bone defects. We believe in the power of partnerships as the

Tell us about your partnership with Link best way to grow and expand. The dual partnership
Health and Pregene. with Link Health and Pregene is, for us, the best way
to expand into China and Southeast Asia, navigate
Link Health and Pregene are two companies of very the local regulatory environments and utilize their
similar culture and mentality to Bone Therapeutics. existing network of clinicians and key opinion leaders
We all embrace innovation to develop better products in order to perform clinical trials and, eventually,
for patients in need and have built a significant level commercialization.
of expertise to achieve this ambition. Both Link
Health and Pregene have an extensive pipeline of Clearly every new venture comes with
products and a successful track record in performing opportunities and challenges and Bone Therapeutics’
clinical trials in China and, in the case of Link Health, strategy to tackle those in China and Southeast Asia is
reaching commercialization. In addition, Pregene to work with the local experts.
has a leading position in the cell therapy space in
China and has the knowhow and infrastructure that What has been the impact of COVID-19? Will
is required to build high-quality cell-based products. there be any long-term changes because of it?
The partnership is therefore based on a number of
synergies that will ensure clinical development in The COVID-19 crisis has affected us all, both
China and Southeast Asia is rapid and effective. The professionally and personally. Like everyone else
three companies will work together to achieve our in the world, we have had to learn how to work as
shared ambition to lead the field. a team from different locations. We have realized
that we can be very good at that. Technology has
What is your strategy pertaining to the solved many of these challenges, and it helps that
opportunities and challenges in China? our business is to be innovative! However, we are all
aware that our health systems have been put under
China is clearly focused on innovation to fuel its great strain to cope with the pandemic and clinical
continuing economic growth. We see Chinese trials worldwide have inevitably been delayed. Bone
pharmaceutical and biotech companies develop Therapeutics has been able to minimize these delays
differentiated products on a global scale, and also by being flexible. For example, we were able to
develop partnerships with companies around the commence recruitment on the JTA-004 with only
world, based on innovation. In parallel, the Chinese short delays, by starting with the sites in Hong Kong,
pharmaceutical market is growing rapidly and is now where the pandemic was dealt with very efficiently,
a key market for Western companies, including, of and commencing in European sites as restrictions
course, Bone Therapeutics. But we have not had our were eased.
own infrastructure, network or specific specialism in
Geographic distances between both colleagues
and partner companies matter less now, as we have
all learned how to work better remotely and one
might argue that distances internationally are now
less of a challenge.

What are your long term goals for the future?

As I have mentioned before, Bone Therapeutics’
mission is to develop better and differentiated
products. We see the enormous potential of cell
therapies and regenerative medicine and have built
a considerable amount of expertise and knowhow
in the field and a broad patent estate. Our goal is to
become the preeminent company in the space by
continuing to innovate and we will not stop. We are
keen to continue building partnerships and capitalize
on synergies with large and small companies that can
help us get there faster, and look forward to hearing
from future partners that share our vision and wish
to join us in that journey.

Ayesha Siddiqui

Q&A 41

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

“We would be seeing more regulatory
approvals for Guardant360 CDx across Asia”

Guardant Health, a US based leading precision «
oncology company has launched liquid biopsy-
based Guardant360 and GuardantOMNI tests Simranjit Singh,
for advanced stage cancer patients. On August 7, it CEO,
announced that the US Food and Drug Administration Guardant Health AMEA,
has approved Guardant360 CDx for tumor mutation Singapore
profiling, in patients with any solid malignant
neoplasm (cancerous tumor). BioSpectrum Asia
spoke with Simranjit Singh, CEO, Guardant Health
AMEA, Singapore on advantageous of liquid biopsy
and market opportunities. Edited excerpts;

Can you share more insights into the novel has 90 per cent agreement with tissue for targetable
liquid biopsy for early cancer detection? alterations, making this a feasible alternative to pick
up actionable tumour mutations that are missed during
While we are looking at the whole continuum of cancer tissue biopsies. Secondly, tissue biopsies are invasive
from early detection to recurrence monitoring, our and this can be risky for some advanced cancer patients.
primary focus at Guardant Health AMEA is targeted at Liquid biopsies, on the other hand, are safe and non-
guiding treatment decisions for advanced stage cancer invasive. Thirdly, tissue biopsy procedures are time-
patients with solid tumours. The liquid biopsy assay consuming while liquid biopsies can be done in a matter
that we offer in Asia, Middle East and Africa (AMEA) of minutes either in a clinic or in the comfort of patients’
is the Guardant360 test. Since its launch in 2014, the homes, thanks to the mobile phlebotomy services that
Guardant360 test has been ordered over 150,000 we offer in Guardant Health AMEA. Additionally,
times by more than 7,000 oncologists worldwide. tissue biopsy test results can take up to 2-3 weeks
whereas Guardant360 test results are received within
With a simple blood draw from the cancer patient, seven days upon sample receipt in the laboratory. For
the Guardant360 test provides fast, accurate and advanced cancer patients, time to treatment is crucial
comprehensive genomic results. This is done in a and liquid biopsies make quick treatment decisions a
quick turnaround time of seven days upon sample reality. Lastly, the quantity of tissue from the biopsy
receipt in the laboratory. This liquid biopsy test is may not be sufficient for genetic testing and the patient
done using circulating tumour DNA (ctDNA), which might need to go for a repeat tissue biopsy. In a liquid
is produced when tumours shed small pieces of their biopsy, repeat procedures like this can be avoided as all
genetic material into the bloodstream. Traces of this that is required is a single blood draw for the treating
ctDNA can be detected in the blood using our digital oncologist to see the comprehensive genomic profiling
sequencing technology. of the patient’s cancer.

The comprehensive genomic profiling information How do you foresee liquid biopsy market?
that is received from this liquid biopsy test allows
oncologists to recommend treatment accurately without We anticipate that there would be a significant
the complications and delays of invasive tissue biopsies. paradigm shift in using liquid biopsies for genomic
Tumour mutation profiling can detect specific genomic profiling ahead of invasive tissue biopsies. Liquid
mutation for precision cancer therapy. Guardant360 biopsies are a significant game changer in precision
test detects all four classes of genomic variations and oncology and allows selection of accurate treatment
microsatellite instability-high in 74 genes most relevant for advanced cancer patients. Guardant360 CDx
to solid tumours. Genomic profiling assists physician to has received the first Food and Drug Administration
make a therapy selection decision. approval for comprehensive tumour mutation
profiling across all solid cancer and we would be seeing
How advantageous is liquid biopsy to more regulatory approvals across Asia.
overcome the challenges at tissue biopsies?
Hithaishi C Bhaskar
Compared to tissue biopsies, liquid biopsies have [email protected]
several advantages. Firstly, the Guardant360 test

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BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Driving laboratory efficiency
with Data Intelligence

« laboratory leaders as the requirement for
higher sample throughput continues to increase
Philippe Desjardins, dramatically
Lab Productivity
Scientist, Agilent  Furthermore, 83 per cent believe their
Technologies, workflows need optimization, and 65 per cent
Wilmington, Delaware, globally would welcome new innovations to increase
United States efficiency

The intense focus on healthcare solutions in Asia McKinsey Global Institute estimates that
Pacific, with a building of supply chain and R&D applying big-data strategies to better inform
resilience, will fuel additional demands from the decisions could generate up to $100 billion in
pharmaceutical industry, propelling a greater need value annually across the US healthcare system by
for laboratory efficiency to address the need for optimizing innovation, improving the efficiency of
speed and reliability. research and clinical trials. New tools for physicians,
consumers, insurers and regulators will be needed
Pharmaceutical companies are poised for to meet the promise of more individualized
significant growth within the Asia Pacific approaches.
region, with projections estimated as high
as 42 per cent (2018-2022). The Asian healthcare Laboratories in the Asia Pacific region will
market is expected to grow by almost $200 billion experience the same benefits by using data in a
between 2016 and 2020, to $2,660 billion. Key similar manner to improve lab productivity and
factors include an ageing population, a growing efficiency. Increasing laboratory efficiency can be
middle class and increasing rates of chronic diseases broken down into two broad categories: sample
in the region. To address the need for speed and analysis throughput and laboratory operations.
reliability for this growth, there is a greater need for
laboratory efficiency in the region. Advanced laboratory monitoring

Improving laboratory operations As laboratory complexity continues to grow with an
extensive array of instrumentation and methods, the
Laboratories in the Asia Pacific are looking to ability to comprehensively monitor all assets and
streamline processes and improve efficiencies to resources has become of paramount importance.
meet growing demands in the region. For example, Advanced lab-wide monitoring and management
in 2018, the government in Vietnam announced its capabilities can fill this need by bringing clarity
vision to modernise clinical laboratory practices to and control to laboratory operations, providing
specifically improve quality standards and workflows insight into inventory control, fleet right-sizing, and
in order to optimize turnaround times (TATs). many other aspects needed to optimize laboratory
operations.
Which is why many scientific organizations
are now turning to data-intelligence systems to Lab visualization dashboards display, which
provide visibility into the operations of labs to help laboratory assets are being used with profound
drive decision-making. The importance laboratory clarity by tracking various aspects of laboratory
leaders place on increasing speed, optimization, operations.
and efficiency was recently highlighted in a
Pharmaceutical Laboratory Leaders Survey: For example, a visualization dashboard displays
an instrumentation heat map that provides a
 Speed was the #1 concern of pharmaceutical snapshot of the entire fleet based on the individual
instrument usage. This comprehensive view of
instrument utilization forms the basis for data-
driven decisions. In addition, these programmes can
also identify workflow bottlenecks, capacity issues,
and other inefficiencies.

The information is relatively easy to access
and use. By applying appropriate filters, the

LAB MANAGEMENT 43

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

visualization program can determine precise Association of Singapore.
frequency and usage patterns, allowing lab managers With advanced monitoring tools, laboratories
insight into individual instruments as well as a lab-
wide view of all instrumentation in concert. can now look at the total energy output and identify
ways to optimize processes and reduce energy cost
By ‘turning on the lights’ in this manner, through data analysis. By having visibility across
utilization programmes provide an excellent view all equipment used in the laboratory, managers can
into what is actually happening in the lab in real now easily see the entirety of their operations in a
time. Users immediately see bottlenecks and other lab-wide manner, identifying which instruments
inefficiencies and can now proactively address them are used frequently, and where there is room
before serious issues arise. for optimization. Ageing equipment can then be
scheduled for early replacement with more efficient
High-growth market regions, such as Vietnam, instrumentation, limiting interruptions and helping
can greatly benefit from such data-driven the laboratory become more environmentally
technologies, where there is a lack of homogeneity friendly.
among facilities with differing capabilities amongst
staff, equipment and quality management. Laboratory intelligence systems

Change management expertise As the complexity and interconnectivity of
scientific systems continues to rapidly change the
In today’s fast-paced world, change management laboratory environment, there is an ever-increasing
can be a burden. Agility and flexibility are essential. demand for higher efficiency. Simultaneously,
Laboratories need to adapt rapidly to changing there are pressures on laboratories to minimize
business conditions and market demands to avoid cost, particularly by keeping the manpower to a
falling behind competitors in an increasingly minimum. The diminishing bandwidth to increase
competitive industry. To prevent this, it is laboratory efficiency often results in too much time
imperative to use a combination of data intelligence being spent on operational issues rather than value-
and expert guidance to ensure positive change and added research.
increase efficiency.
The demand for operational excellence is growing
Industry expertise can shed light on how best to rapidly, even to the level of machine learning, where
optimize the size of an instrument fleet and ‘balance’ artificial intelligence (AI) is currently being explored
instrument utilization, making the laboratory nimble to expand lab-wide visibility and efficiency with
and able to address new demands by using data tools unprecedented refinement.
to control all laboratory assets more effectively.
Machine learning is particularly beneficial in
Advancing lab operations can be viewed as three the laboratory environment, as today’s labs are
distinct phases: simplification, optimization, and comprised of an extensive array of instrumentation
transformation. To begin the process, simplification from various manufacturers with numerous
requires an assessment of all laboratory assets models and configurations, each having different
to know the status quo. As we have seen, data- methods and applications. The exponential
intelligence tools help to visualize the entire fleet growth in laboratory complexity requires a better
and allow for better control over all instruments. understanding of how each instrument behaves
Optimization combines the utilization of data with within a complex matrix of interactions.
other instrument attributes, such as service history,
age of equipment, and end-of-service terms; a risk The ability to monitor all laboratory operations
score can be developed to measure the ‘health’ and and continually learn from these various interactions
viability of each instrument. The final step would be is the core reasoning behind introducing AI into the
the transformation of all lab operations to a lab- laboratory environment. The adoption of such a
wide, data-intelligence management system ensures powerful ability will become a necessary component
that all instrument utilization and expenditures of scientific productivity. Business models for
achieve maximum efficiency. scientific advancement will demand efficiency levels
that are only now truly beginning to be understood.
Major scientific organizations must also balance A centralized artificial intelligence system can
productivity while ensuring sustainability goals. establish relationships between instruments and
The level of energy consumption for a typical productivity, driving more efficient and accurate
laboratory is surprisingly high. For example, a results. AI is the inevitable next step in the creation
laboratory in Singapore can consume 5-10 times of lab management systems that are so efficient, only
more energy per unit area compared to their office machine learning will be able to produce them.
space counterparts, as noted by Sustainable Energy

44 PEOPLE NEWS

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

CDISC names Dr Shin as
Chair of Korea committee

Clinical Data Interchange addition to being active on the Brent
Standards Consortium (CDISC) CDISC Advisory Council (CAC) and Denning
has announced Dr Maria Im Hee Asia Pacific CDISC Coordinating heads SE
Shin of Daegu Catholic University Committee (AP3C), Dr Shin is Asia biz at
Medical Center in South Korea has a Professor and the Chair of the Docquity
been named Chair of the Korea Department of Medical Statistics,
CDISC Coordinating Committee School of Medicine, Daegu Catholic Docquity, headquartered in
(K3C). Dr Shin received a BS/ University, where she joined the Singapore, has announced
MS in Statistics and a PhD in faculty in 1997. She has served as Brent Denning as its
Applied Statistics from Kyungpook the Director of Medical Statistics new Regional Head for
National University, Daegu, South & Informatics R&D Institute the South East (SE)
Korea. Special fields of interest within Daegu Catholic University Asia business. Denning
include clinical trial, survival Medical Center (DCUMC) since its has over two decades of
analysis and genetic analysis. In establishment in 2012. experience working within
the life sciences industry
Chris Hourigan steps in as Company and has held several
Group Chairman for Janssen APAC senior management and
country management
The Janssen Pharmaceutical on the value of pharmaceutical roles, leading teams across
Companies of Johnson & Johnson innovation and led an industry Australia, Japan and
have announced that Chris taskforce on new government the Philippines. He will
Hourigan has been promoted to health technology assessment leverage his experience to
lead their operations across eight (HTA) policy. Hourigan has more guide Docquity through
markets in Asia Pacific (APAC). than 25 years of experience in its next phase of growth,
After five years as President of the pharmaceutical industry. as it continues in its
Janssen Japan, Hourigan will Since joining Janssen Australia journey to become the
now report to the Worldwide in 2005, he has worked across professional network of
Chairman for Pharmaceuticals in five countries in positions choice for doctors globally,
overseeing Janssen operations in of increasing responsibility. empowering doctors to
Asia Pacific. Hourigan is a highly Before moving to Japan, this collaborate, share, learn
respected member of the Japanese included successful roles as and drive better outcomes
pharmaceutical industry, well country manager for Australia for the patient. Denning
recognised for his work to & New Zealand, Vietnam, and will be a part of Docquity’s
increase access to innovative New Zealand. He also worked core management team
medicines. As Chair of and will be starting out in
Pharmaceutical Research in the United States as Manilla, the Philippines
and Manufacturers of Global Marketing Lead for before moving into
America (PhRMA) the Janssen Psychiatry Singapore, when the
Japan and previous business unit. Hourigan restrictions of the pandemic
board member of succeeds Ai Hua Ong as eases out.
European Federation of Company Group Chairman,
Pharmaceutical Industries Pharmaceuticals, Asia
and Associations Pacific. She has been
(EFPIA) Japan, appointed Head
Hourigan of Government
engaged with Affairs & Policy
the Japanese for Johnson &
government Johnson in Asia
Pacific.

PEOPLE NEWS 45

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com CrystalGenomics
brings Dr Gavin
Innovent appoints Choy on board
Dr Liu as Group President
South Korea based
Innovent Biologics, with operations in the US and China, has CrystalGenomics, Inc. has
announced the appointment of Dr Yong Jun Liu, a renowned world announced the appointment
class scientist and successful leader in biopharmaceutical industry, of Gavin Choy, as President
of CG Pharmaceuticals,
as the president of the group. Reporting Inc., CrystalGenomics’
to Dr Michael Yu, founder, chairman and subsidiary focused on the
CEO of the group, Dr Liu will be mainly clinical development of novel
responsible for group’s global R&D, therapeutics. Dr Choy most
portfolio strategy, business development recently served as Chief
as well as international operation. Dr Operating Officer at Apollomics,
Liu has over 30 years’ experiences in Inc. Dr Choy brings to
both academic institutions and top CrystalGenomics a proven track
global pharmaceutical companies. record in drug development and
Before joining Innovent, Dr Liu served global development operations.
as the global Head of Research at Sanofi He has led cross functional teams
from 2016 to 2020. In 2011, Dr Liu was in areas of clinical research,
recruited by the Baylor Research Institute as the Chief Scientific development operations,
Officer and the Director of the Baylor Immunology Research biometrics, pharmacovigilance,
Institute. After more than 10 years at the academia, he was recruited project and alliance management,
by Medimmune, a biopharmaceutical subsidiary of AstraZeneca, as medical writing, field liaisons,
Chief Scientific Officer and global Head of Research in 2014. clinical pharmacology, legal, and
public relations in therapeutic
Dr Shravan Subramanyam joins areas of infectious disease,
Wipro GE Healthcare as MD hematology and oncology,
immuno-oncology, and vaccines.
Wipro GE Healthcare has announced the appointment of Dr Shravan Through design and leading the
Subramanyam as President and Chief Executive Officer (CEO), formation of high-performing
GE Healthcare India & South Asia and Managing Director (MD), teams, Dr Choy has built
Wipro GE Healthcare, effective October 1, 2020. Dr Subramanyam successful global organizations
joins Wipro from Roche Diagnostics where he was their Managing leading to the advancement
Director, India and Neighbouring Markets, responsible for of pipeline assets and
commercial operations, market access, commercialized drug products.
customer experience and digital
transformation efforts. He succeeds
Nalinikanth (Nal) Gollagunta, who will
be taking up a new role as the Global
Chief Operating Officer (COO) of the
GE Healthcare Digital organization
post transition. Dr Subramanyam will
be responsible for building on Wipro
GE’s expansion plans, delivering on
commercial outcomes, strategic growth
objectives, and driving partnerships in
the region. He will continue to advance the company’s agenda of
innovating disruptive technology and business solutions to enhance
access to high-quality, affordable healthcare solutions. He has over
15 years of senior management and leadership experience in global
and regional leadership roles at Roche, Novartis, Dade Behring and
Ehrlich Laboratories.

46 R&D NEWS

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Australia invents Japan develops tool
app for analysing to alter gene activity
coronavirus genome in stem cells

A new mobile app has made it possible to Researchers from Kyoto University’s Institute for
analyse the genome of the SARS-CoV-2 virus Integrated Cell-Material Sciences (iCeMS) and Tokai
on a smartphone in less than half an hour. The University in Japan reported a new study on terahertz
app Genopo, developed by the Australia based light pulses change gene expression in stem cells. The
Garvan Institute of Medical Research, in findings were discovered using the new tool, with
collaboration with the University of Peradeniya implications for stem cell research and regenerative
in Sri Lanka, makes genomics more accessible therapy development. The team has developed a better
to remote or under-resourced regions, as well tool for investigating
as the hospital bedside. The researchers tested what happens when
Genopo on the raw sequencing data of virus terahertz pulses are
samples isolated from nine Sydney patients shone on human cells.
infected with SARS-CoV-2, which involved The apparatus overcomes
extracting and amplifying the virus RNA from issues with previous
a swab sample, sequencing the amplified DNA techniques by placing
with a MinION device and analysing the data cells in tiny microwells
on a smartphone. The researchers tested their that have the same area
app on different Android devices, including as the terahertz light. The team used the apparatus to
models from Nokia, Huawei, LG and Sony. explore the effects of terahertz radiation on induced
The Genopo app took an average 27 minutes pluripotent stem cells (iPSCs). These are cells that have
to determine the complete SARS-CoV-2 been taken from skin or blood and changed into stem
genome sequence from the raw data, which cells. Scientists are seeking to turn them into other types
the researchers say opens the possibility to do of cells and tissues to help treat diseases like muscular
genomic analysis at the point of care, in real dystrophy. The scientists believe the terahertz pulses
time. The researchers also showed that Genopo generate an electric field that causes zinc ions to move
can be used to profile DNA methylation, a inside cells, impacting the function of transcription
modification which changes gene activity, in factors, which in turn activate or deactivate the genes
a sample of the human genome. they are responsible for.

Singapore, Australia devise algorithm for cell culturing

Researchers at Duke-NUS maintain healthy nerve cells, that trigger stem cells to turn into
Medical School in Singapore and called astrocytes, and heart astrocytes and cardiomyocytes.
Monash University in Australia cells, called cardiomyocytes. The team compared cultures
have devised an algorithm that They also used their model to using protein molecules predicted
can predict what molecules are successfully predict molecules by EpiMogrify to a type of
needed to keep cells healthy commonly used cell culture
in laboratory cultures. They that uses a large amount of
developed a computational unknown or undefined complex
approach called EpiMogrify, that molecules and chemicals. They
can predict the molecules needed found the EpiMogrify-predicted
to signal stem cells to change cultures worked as well or even
into specific tissue cells, which surpassed their effectiveness. The
can help accelerate treatments researchers have filed for a patent
that require growing patient on their computational approach
cells in the lab. EpiMogrify can and the cell culture factors it
successfully identify molecules predicted for maintaining and
to add to cell culture media to controlling cell fate.

R&D NEWS 47

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

Taiwan discovers new molecule for treating liver cancer

China Medical University which provided an important
(CMU) in Taiwan along with the
collaborative teams from MD reference for clinical treatment
Anderson Cancer Center and
Fudan University Zhongshan strategies. Hepatocellular
Hospital, have discovered key
role of the orphan receptor ROS1 carcinoma (HCC) is the most
protein RNase7 in the treatment of
liver cancer, which provided a new common type of primary hepatic
strategy for the target therapy of
liver cancer that can help patients carcinoma and has the second
extend their life span. This
research discovered the ligand highest death rate among cancers.
of the orphan receptor ROS1 and
revealed the function of tumor cell Although a variety of small
growth of ROS1 activation driven
molecule kinase inhibitors have

been approved by the US Food and

Drug Administration for treating

HCC, they can only prolong the

by RNase7. In addition, RNase7 survival period of patients by a few
has great potential to function as
a biomarker to stratify liver cancer months. Therefore, it is urgent to
patients for anti-ROS1 treatment,
find an effective biomarkers and

new alternative therapies.

India makes nano- Korea designs
thermoresponsive
coated Mg alloys nanotopography cell
culture platform
to fix bone fractures
A research team led by Pohang University of Science
Indian Institute of Technology, Madras (IIT-M) and Technology (POSTECH) in South Korea has
researchers have developed nano-coated recently succeeded in drastically reducing the harvest
magnesium (Mg) alloys that can repair bone period of stem cell sheets. A joint research team
defects in rabbits. Encouraged by these results, comprised of POSTECH’s Department of Mechanical
the research team, which is partnering with Engineering and the Department of Orthopedic
several other institutions, is planning to study Surgery at Pohang
medical applications of nano-coated magnesium Semyung Christianity
alloys in other animals and repairing human Hospital has
bones. Alloys of magnesium are being considered significantly reduced
as a good option for orthopaedic applications the total harvest
as magnesium is biocompatible, biodegradable period of a stem cell
and has other important mechanical properties. sheet to two days.
Magnesium is the fourth abundant metal in the The research team
body and is known to accelerate the healing of focused on poly(N-
bones. For this study, the researchers deployed isopropylacrylamide)
AZ31 alloy of magnesium and used it for (PNIPAAm), a
developing magnesium mesh cage implants. polymer that either combines with water or averts it
Further, they coated these implants with depending on the temperature. In previous studies,
polycaprolactone and nano-hydroxyapatite by PNIPAAm has been introduced as a coating material
dipping and electrospinning. This nano-coated for cell culture platform to harvest cell sheets, but the
magnesium mesh was then used to heal the range of utilization had been hampered due to the
bone defect in femur of rabbits. The team is limited types of cells that can be made into sheets. The
exploring funding opportunities to further test study conducted focused on making stem cells, that are
this newly-developed nano-coated magnesium effective in tissue regeneration- into sheets in a short
alloy in repairing bone defects in large animals time in order to increase their direct utility.
such as goat or sheep to demonstrate the efficacy
of the product and show clinical significance of
this research.

48 ACADEMIC S NEWS BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

NUS PolyU launches master
introduces new programme in medical physics
translational
medicine Medical physicists, specialise in radiation treatment technology, with
programme their expertise spanning from diagnostic imaging to radiotherapy, are
strong backers of the cancer treatment team. However, a higher degree
National University of Singapore programme in medical physics was previously not available in Hong
(NUS) Yong Loo Lin School of Kong or in nearby regions. To meet the future demand for medical
Medicine has launched a new physicists, the Hong Kong Polytechnic University (PolyU) has, this
programme called Kickstart academic year, launched the first Master of Science in Medical Physics
Initiative that helps in bringing (MScMP) programme in Hong Kong. The curriculum is designed
promising biomedical research to cover various aspects including health technology, physics and
projects to market. It provides a engineering, offering interdisciplinary training for professionals, who
supportive biomedical eco-system are keen to pursue a career in the field of medical physics. In 2018, the
for knowledge exchange between Department of Health Technology and Informatics of PolyU received
entrepreneurs, academia, and positive responses from the industry regarding the introduction of an
other stakeholders. Kickstart MScMP programme in Hong Kong. After two years’ preparation, the
is a venture creation initiative inaugural 2020-21 cohort of 26 students has enrolled, among which
supporting innovative research 70 per cent have a physics or engineering-related degree while 20 per
ideas along the commercialisation cent are graduates in radiotherapy. The majority are working adults,
path to market. Under and one-fifth of them are in the healthcare or medical field.
the programme, Principal
Investigators (PIs) of shortlisted Eisai collaborates with UoT
research projects will work closely to enhance drug discovery
with a commercial partner that
acts as a collaborator and help The University of Tokyo (UoT) within the Graduate School
drive the path towards bringing and Eisai Co., Ltd., a Japanese of Pharmaceutical Sciences.
the innovation to market. In the pharmaceutical company This research will combine
second stage, a new company with headquartered in Tokyo have the world’s most advanced
both the PI and the commercial announced a collaboration ubiquitin-proteasome research
partner will invest minimally a aiming for the development as conducted in the graduate
matching amount and jointly act and drug discovery of targeted school with drug discovery
as the co-founder to accelerate protein degradation technology. knowledge fostered by Eisai,
the commercialisation journey. The collaboration has been for the development of new
The programme will focus on created, with the establishment protein degradation technology
translating innovations in the of a social cooperation towards proteins targeted by
fastest growing areas such as programme- Protein drugs and the promotion of
therapeutics, diagnostics, medical Degradation Drug Discovery. drug discovery research based
technology and devices, surgical The research time span will on this technology.
robotics, as well as digital health. last five years from October
1, 2020 to September 30,
2025. The social cooperation
programme was established
and operated based on funds of
private organizations dedicated
to conducting research in
collaboration with the UoT
regarding shared issues of high
common concern. The Protein
Degradation Drug Discovery
course is to be established

SUPPLIER NEWS 49

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

HMD sends first shipment of 56 M syringes to COVAX facility

Hindustan Syringes & Medical COVAX facility working for global procurement mechanism for
Devices (HMD), based in India, equitable access to COVID-19 new COVID-19 vaccines, through
scaling up production to a billion vaccines, which is a pooled which COVAX will ensure fair and
in the first half of 2021 as India equitable access to vaccines for
gets ready for COVID-19 vaccine, each participating economy has
has sent its first shipment of 56 ordered 140 million KOJAK AD
million pieces of KOJAK auto syringes from HMD to be supplied
disable syringes to COVAX facility between August and December
as the race for a safe and effective 2020. While HMD is all geared
vaccine against coronavirus up to meet the syringe demands,
infection is on the horizon. Gavi they are still waiting on the Indian
is co-leading COVAX, the vaccines government to start creating a
pillar of the Access to COVID-19 stockpile of syringes as being done
Tools (ACT) Accelerator. The by other countries.

Mevion Medical Systems Waters Corporation
expands biz in Asia
introduces Acquity
Mevion Medical Systems, planning to customer
based in the US, has support. The MEVION Premier columns
signed a partnership S250i Proton Therapy
agreement with Hermes System equipped with Waters Corporation has introduced
Advanced Therapy Systems HYPERSCAN pen-tip Acquity Premier columns, a new family
(HATS) in Taiwan and scanning uses an adaptive of premium sub-2-micron columns
Southeast Asia including multi-leaf collimator to featuring MaxPeak High Performance
Malaysia, Thailand and sharpen the radiation Surface (HPS) technology. The columns
Singapore distributing beam, so that the dose to are for use with any brand of ultra-high-
MEVION S250i Proton the tumor is more accurate performance liquid chromatography
Therapy System. Since and conformal than before, (UHPLC) system and can measurably
1977, Hermes-Epitek has thereby improving the improve data quality by mitigating the
been a trusted provider of effectiveness of proton loss of sample analytes due to analyte-
high-tech equipment and therapy. The advanced to-surface interactions. Designed for
services. Its subsidiary clinical capabilities the analytical laboratory seeking to
HATS will make full use and compact size of the exercise greater control over their
of resources and provide system have changed chromatographic separations, the
Mevion with assistance in the landscape of proton columns improve sample throughput,
all aspects from project therapy. assay-to-assay reproducibility and
overall confidence in analytical results.
The columns feature MaxPeak HPS
technology, a hybrid organic or inorganic
surface technology that forms a barrier
surface layer between the sample and
the stainless steel column.

50 SUPPLIER NEWS

BIOSPECTRUM | NOVEMBER 2020 | www.biospectrumasia.com

OriCiro Mindray brings new offering to
launches high-end anesthesia system market
cell-free
circular DNA Mindray Medical International Limited, based in China, has introduced
amplification brand new A9 and A8 anesthesia systems, which is now available in
technology Europe and other selected regions. This marks Mindray’s entry as a
key player in the high-end anesthesia machine market. Mindray’s new
Japanese firm OriCiro
Genomics has launched the anesthesia systems empower
OriCiro Cell-Free Cloning anesthesiologists to ensure
System, the world’s first comprehensive patient safety
technology enabling cell-free throughout the perioperative
amplification of large circular period, from induction to recovery.
DNA, eliminating the reliance Using High Flow Nasal Cannula
on E. coli cloning. Currently, oxygen (HFNC), Mindray’s new
researchers in life sciences systems extend safe apnoeic time
use cell-based methods to from 8 to up to 30 minutes to help
clone large DNA molecules. clinicians intubate more easily.
Although these approaches The machines also integrate
remain the gold standard, they Automatic Controlled Anesthesia
are infamous for being time- (ACA), a pioneering assistive
consuming, inefficient, and technology that automatically
unable to deal with cell-toxic adjusts fresh gas and vaporizer output to quickly achieve preset target
DNA sequences. The OriCiro end-tidal agent and inspiratory oxygen concentration. The technology
Cell-Free Cloning System also helps cut down on workload for clinicians while reducing cost by
solves all these problems. minimizing the consumption of gas and agents used throughout the case.
The system comprises the
OriCiro Assembly Kit and Thermo Fisher plans new
OriCiro Amp Kit. A simple sterile filling lines in Singapore
two-step in vitro process
enables cell-free assembly and Thermo Fisher Scientific Inc. has announced plans to develop two new
amplification of circular DNA sterile filling lines in Singapore to extend capacity to the Asia Pacific
molecules without the need region for the development and manufacture of therapies and vaccines.
for E. coli transformation Established with the support of the Singapore Economic Development
and culture. It removes the Board (EDB), the $130 million facility will be operated by Thermo
bottlenecks of conventional E. Fisher and have the
coli cloning and unleashes the capability to manufacture
potential of synthetic biology pharmaceutical products
enabling efficient engineering to meet demand in the
of biological functions of region and respond
microbes. effectively to future
health emergencies. The
new facility will initially
include a high-speed
sterile line approved for
live virus filling, the first
such large scale capability
in Singapore, followed
by an additional line for standard fill or finish. The facility will also have
cleanroom capacity, labs, warehousing and offices to support production.
Once operational in 2022, the facility could manufacture up to 30 million
sterile doses per month and employ more than 300 people.