[ Feature ]

APBN chats with

Dr Susan Lim, who

is widely known in Asia and Singapore for being the first surgeon to have performed a successful liver transplant

Why did you choose to study medicine and become a doctor? Why did you choose to specialize in surgery?

come from a background of doctors in my extended family. At the age of 7, I knew I wanted to become a doctor. I focused on studying hard and got good grades. I was a model Singaporean kid. At the age of 10, I knew I wanted to do surgery. I was attracted to surgery as it seemed to embrace technology and as a specialty, delivered immediate results to clinical problems, and this suited my personality.

How do you feel about being the first surgeon to have performed a successful liver transplant in 1990?

I was ecstatic for my patient, myself, as well as the team at the National University Hospital. It was an achievement against all odds, a first for Singapore, and a first for Asia. The stressful part of the project was not the actual surgery but the preparation leading up to it, including raising funds for the operation and rehearsing the team. I am grateful to Dr Goh Keng Swee, the Singapore Turf Club and close friends who generously donated to this project. We managed to raise over half a million dollars, enough to get us started.
Volume 12 > Number 10 > 2008
37

www.asiabiotech.com

[ Feature ]
Since that first transplant, Singapore has now gone on to develop a small but successful liver transplant program. I am truly grateful to the surgical training I received in Cambridge under Sir Roy Calne, which gave me the experience required to pioneer the transplant program for Singapore. In addition, the PhD that I obtained in Transplantation Immunology from the University of Cambridge empowered me with the skills to deal with immunological issues and rejection in transplant patients. It also provided the building blocks which launched my career in biotechnology and the life sciences.

You founded Stem Cell Technologies. Tell us more about this company.

By the age of 36, I had done the landmark first liver transplant operation and became an associate professor in surgery. But I wanted to pioneer in the field of biotechnology and in particular, in cell transplantation, so I started my own company, Stem Cell Technologies i. I felt that an alternative to harvesting organs was required to treat end stage and chronic diseases. At that time I was interested in curing diabetes. I secured a traveling scholarship and went to Minneapolis to learn more about pancreas transplantation. In the early days, most pancreatic transplants failed from a combination of technical and rejection issues. Most of the technical problems were related to the digestive enzymes produced by whole organ pancreases. At this time, a group of clinician scientists came up with the idea that if we can transplant whole organs, why not try to transplant cells? While in Minneapolis, I worked with a pilot group of researchers, led by Professor David Sutherland and Dr Camillo Ricordi in islet cell transplantation. Islet cell transplantation is the transplantation of only the insulin-secreting cells (islet cells) without the exocrine pancreas (the part which produces digestive enzymes). Islet cell transplantation programs soon commenced in the United States and Canada with the lead program in London, Ontario, Canada. But the islet cell transplantation program still relied on harvesting cells from cadavers, and three cadaver pancreases were required to cure one diabetic person. The success rate was only 10% after 5 years and immuno-suppresion was needed as the cells used were allografts (tissue obtained from another individual, non-identical). In 2002, Singapore began looking into stem cells and I started my company, Stem Cell Technologies i (SCTi). I started collaboration with the National University of Singapore (NUS) to pioneer research into adult stem cells derived from fat. NUS provided laboratories and infrastructure for doing the research. I did my part to raise funds and provide manpower for this collaboration through Stem Cell Technologies i. Regenerative medicine is a whole new area of life sciences. In order to realize the clinical needs of patients, the supply of cells must be in abundance, thus we looked to fat cells as one possible source of cells. The idea is to harvest fat from donors and to engineer the fat derived stem cells which can then be differentiated into various other tissue types such as cartilage to produce sheets of cartilage for the re-surfacing of damaged joints. Currently, the research is still at a developmental stage. We are now progressing into animal studies, prior to clinical trials.

38 Volume 12 > Number 10 > 2008

www.asiabiotech.com

[ Feature ]
What are some of the companys collaborations? Stem Cell Technologies i is a biotech start-up, based in Singapore. It has an international panel of scientific advisors and global collaborations in the field of adult stem cell research. These include: 1. The National University of Singapore where Professor Lee Eng Hin (chairman of Singapore Stem Cell Consortium) is co-principal investigator in a research project on diabetes. 2. The Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), Seville, Spain where Professor Bernat Soria, professor of Physiology and director of the Institute of Bioengineering, heads the Diabetes division (he has recently been appointed as the Minister of Health for Spain) and has since relinquished his appointment at CABIMER. 3. Barts and The London, Queen Marys School of Medicine, where Professor Malcolm Alison, professor of Stem Cell Biology, Institute of Cell and Molecular Science, heads his stem cell research program for diabetes and metabolic medicine. 4. Sir Roy Calne, Emeritus Professor of Cambridge University, UK, and pioneer of clinical transplantation in the UK (for which he was knighted). 5. Monash Immunology Stem Cell Laboratories where Professor Alan Trounson, director of the Monash Immunology and Stem Cell Laboratories (MISCL), has recently been appointed to head the US$3 billion California Institute for Regenerative Medicine (CIRMS)

Tell us more about the use of the Da Vinci robot in general surgery

The DaVinci system came to Singapore in 2004 from Sunnyvale, California. We pioneered the first gallbladder surgery successfully with th Da Vinci system. Since then, our Group has had a few more firsts, including the use of system to perform the first robotic myomectomy, hysterectomy and axillary dissection for breast cancer The robotic system provides a superior 3D visualization with 10x magnification. The robotic arms have seven degrees of freedom of movement, and there is tremor filtration. Robotic technology has made such great strides that surgeons may one day be replaced by technicians trained to operate robots for surgery.

www.asiabiotech.com

Volume 12 > Number 10 > 2008

39

[ Feature ]
You have many hats to wear? How do you cope work with family life? I try to balance work with family. My husband is in the banking business. Though we are in different fields, we cross pollinate our ideas. In fact, managing wealth and managing health are almost parallel. My husband and I have jointly established the Indiapore Trust to raise money to fund e-learning and childrens education in the field of information technology. Our children are very much involved in our activities. We share a love for sports and we enjoy taking short breaks to go skiing together.. Skiing is an activity very close to my heart.

Do you think Singapore is doing well in its biomedical and healthcare industry? What are the trends in medicine now?

Singapore has done a great job. Its infrastructure is terrific. The only thing is that the critical mass of talent is not quite there yet and as such, Singapore still needs a lot of global input. However, as foreign talent comes and goes, Singapore should also invest and believe in its people. It should also place more bets on biotech entrepreneurs rather than just focus on established talent. Singapore should invest more in its people. Now is indeed a great time in Singapore to pursue a career in research.

What dramatic changes in the field of medicine do you expect to see in the next 5 to 10 years?

I would like to see stem cell research reaching the clinics to provide medical breakthroughs for patients with chronic and debilitating diseases. I also hope to see clinicians and scientists working more closely together to bring science to the bedside. And not forgetting robots to carry out operations over a long distance, telerobotics. n

About the author

Dr Susan Lim is also widely known as the Spirit of the Century, an award conferred upon her by the Singapore public in a national contest held to identify the role model for the 21st century. She is in active general surgery practice and founder of the several clinical practices.

40 Volume 12 > Number 10 > 2008

www.asiabiotech.com