Pioneering research to bring hope to patients with miscarriage risks and autoimmune diseases

9/18/2024 4:00:00 AM | The Straits Times

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Dr Ku Chee Wai (right), inspired by his obstetrics and gynaecology rotations during his studies at Duke-NUS, now focuses on advancing research to improve preconception care for women. PHOTO DUKE-NUS

Duke-NUS Medical School's specialist expertise and resources empower clinician-scientists to drive medical advancements and enhance patient care in Singapore

During his obstetrics and gynaecology clinical rotation as a student at Duke-NUS Medical School, Dr Ku Chee Wai witnessed the distress of expectant mothers at risk of losing their babies in early pregnancy.

Their plight left such a lasting impression that he dedicated his career after medical school to reproductive medicine, determined to help women facing pregnancy-related challenges.

This dedication culminated in 2020, seven years after earning his Doctor of Medicine (MD) degree at Duke-NUS Medical School. Dr Ku, together with his colleagues at KK Women’s and Children’s Hospital (KKH), the largest maternity hospital in Singapore, implemented a simple blood test to help doctors assess the risk of miscarriage among women with early pregnancy bleeding.

The test, which measures progesterone, a hormone crucial for pregnancy, effectively predicted pregnancy outcomes at 16 weeks, enabling clinicians to provide timely interventions to prevent adverse pregnancy outcomes.

“Based on the screening results, clinicians are able to differentiate between women who have low-risk or high-risk pregnancies so that we can better care for the patients through tailored treatment,” the clinician-scientist explains.

Eager to advance his research on reproductive health further, Dr Ku, a recipient of the National Medical Research Council (NMRC) Research Training Fellowship, returned to Duke-NUS to pursue a PhD in Clinical and Translational Sciences. This unique programme at Duke-NUS prepares clinicians and healthcare professionals for translational research to bridge the gap between the bench and the bedside.

It was a “natural choice”, he says, given the medical school’s access to specialist expertise and resources within the SingHealth-Duke-NUS Academic Medical Centre (AMC), a partnership between Duke-NUS and its academic medicine partner SingHealth that integrates research and education with patient care across SingHealth’s network of hospitals, speciality centres, community hospitals and polyclinics.

“Many of my collaborators are within the SingHealth-Duke-NUS AMC research ecosystem,” shares Dr Ku, now a consultant at KKH.

Throughout his PhD journey, Dr Ku worked closely with his mentor, Professor Jerry Chan, a senior consultant at KKH and professor at the SingHealth Duke-NUS Obstetrics and Gynaecology Academic Clinical Programme.

With Prof Chan’s support, Dr Ku developed and piloted a novel lifestyle intervention tool called 6P which breaks nutrition and physical activity into six components — portion, proportion, pleasure, phase, physicality and psychology — to help overweight women improve their health and fertility through better diet and exercise.

“I conducted a mixed-methods validation study that showed participants were satisfied with the tool, felt it was useful in guiding healthy eating, and thought it raised awareness of eating behaviours,” he explains.

The success of 6P led to the development of the HELMS (Healthy Early-Life Moments in Singapore) programme, a mobile health platform that provides educational content to guide women with challenging pregnancies in managing their metabolic and mental health from preconception through their child’s first two years.

“Whatever happens in the womb lasts a lifetime,” says Dr Ku, who completed his PhD in February this year. “This means that if the mother is healthy, the child has a better headstart in life.”

Tackling complex autoimmune rheumatic diseases

Another Duke-NUS graduate from the MD programme, Dr Maria Noviani, also felt that to advance in her research career, a return to medical school would help her fulfil her aspirations. In 2023, she enrolled in the same PhD programme as Dr Ku.

Through her clinical research, she aims to find a more personalised therapeutic approach to managing heterogenous diseases like systemic sclerosis and connective tissue diseases. Systemic sclerosis is a chronic autoimmune rheumatic disease that causes hardening of the skin, lungs and other internal organs. While the disease affects a small number of patients, its impact is life-altering and potentially life-threatening.

“Systemic sclerosis may be relatively rare but it is a disease that affects people at the time of their life when they are starting a family, between the ages of 30 and 50, and more than half of the patients are women,” explains Dr Noviani, who is an associate consultant at the Singapore General Hospital (SGH) Department of Rheumatology and Immunology.

Dr Maria Noviani (centre) is working with Duke-NUS mentors Associate Professor Andrea Low (left) and Professor Salvatore Albani to uncover the underlying cause of systemic sclerosis and develop targeted patient treatments. PHOTO: DUKE-NUS

The cause of systemic sclerosis is not completely understood. Whilst there is currently no cure for the disease, there are emerging treatments over the last decade that are effective in slowing down the progression of the disease in varying degrees in different patients. However, there are no reliable markers to guide the selection and timing of treatments tailored to each individual’s needs.

Dr Noviani hopes her research can help doctors identify the underlying cause of the disease and find potential indicators to guide treatment strategies in patients with systemic sclerosis and other autoimmune rheumatic diseases.

During her PhD studies in the Clinical and Translational Sciences programme, she has benefitted immensely from the guidance of her mentors: Professor Salvatore Albani, an internationally renowned rheumatologist and immunologist who directs the Translational Immunology Institute at the SingHealth Duke-NUS AMC, and Associate Professor Andrea Low, an expert in systemic sclerosis who is also the Director of Early Career Development at the SingHealth Duke-NUS Medicine Academic Clinical Programme and a senior consultant at the SGH Department of Rheumatology and Immunology.

“Working alongside my mentors has enabled me to dive into the immune signatures by integrating clinical evidence and treatment responses, providing great insights to understanding the underlying causes of these diseases. This will pave the way to identify potential therapeutic and prognostic markers to guide medical therapeutic approaches,” said Dr Noviani.

Thanks to the strong commitment to academic medicine at the SingHealth Duke-NUS AMC, Dr Noviani, who is also an NMRC Research Training Fellowship recipient, can fully immerse herself in a nurturing research environment whilst pursuing her passion in clinical research to translate scientific findings into more personalised care of patients with complex autoimmune rheumatic diseases.

Sharpening skills in translational research

For Dr Noviani, the Duke-NUS Clinical and Translational Sciences PhD programme is equipping her with the essential skills to analyse data, design experiments and interpret results – all crucial to her research.

“The programme also provided me with the opportunity to attend the Eureka Monsoon Certificate Course in Translational Medicine, which offered valuable insights into the business, scientific, and regulatory aspects of translating research discoveries into patient applications,” she says.

Meanwhile, Dr Ku appreciates the flexibility of the programme, which has enabled him to balance his clinical practice with his research.

“It is a programme that’s tailored for busy working clinicians,” he says.

“When I returned to Duke-NUS for classes, I could devote my full attention to research and vice versa – I could dedicate myself entirely to patient care on the days when I needed to be back at KKH.”

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Pioneering research to bring hope to patients with miscarriage risks and autoimmune diseases

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