Driving the engine of discovery @ HELIOS

Precision medicine offers an effective means of translating research into more efficient healthcare delivery systems and better health outcomes for Singaporeans. To realise the benefits of precision medicine, Singapore has established the National Precision Medicine (NPM) programme, which is a three-phase roadmap to establish Southeast Asia’s most deeply phenotyped cohort to support the understanding of multi-ethnic Asian health; implement data-driven healthcare systems to identify groups at higher risk of disease and progression; and catalyse Singapore’s precision medicine industry by uplifting local companies and attracting multi-national companies.

This effort will place Singapore in a competitive position globally for precision medicine research and enable the development of better interventions, strategies and platforms for health management for Asians.  

Phase I of Singapore’s National Precision Medicine (NPM) programme set the stage by establishing a Singaporean reference database containing 10,000 genomes, and partnering with industry as co-investors in the NPM programme. Phase II is currently underway to scale this database. In December 2022, PRECISE-SG100K was launched – a landmark population study of 100,000 consented Singaporeans to identify the social, environmental, lifestyle and genetic factors associated with diseases prevalent in Singapore. It is a comprehensive, long-term study focusing on the health and well-being of the Singapore population.

The study comprises four cohorts: Health for Life in Singapore (HELIOS; Lee Kong Chian School of Medicine, Nanyang Technological University), Singapore Population Health Study (SPHS; Saw Swee Hock School of Public Health, National University of Singapore), Singapore Epidemiology of Eye Diseases (SEED; Singapore Eye Research Institute) and SingHeart (National Heart Centre, Singapore).

A year on, the PRECISE-SG100K study has achieved a remarkable recruitment milestone of 80,000 participants ranging from 30 to 84 years old from all walks of life in Singapore. 

Led by Professor John Chambers, Chief Scientific Officer of PRECISE in his capacity as Lead Investigator for the PRECISE-SG100K study and Principal Investigator for HELIOS, the HELIOS team plays a pivotal role in contributing to this rich database of 100,000 individuals.

The HELIOS team implements several functions, such as: Recruitment & Outreach, Registration & Discharge, and Operations (which comprise Data Collection, Biobanking, IT Support, and Reporting). Members of the team work synergistically, supporting each other, each contributing to the wider national precision medicine effort.

Here’s a closer look at what the HELIOS team does on a daily basis!

The Recruitment & Outreach Team: Carrying the PRECISE-SG100K flag with pride and recruiting with enthusiasm!

Meet (L-R) Erny Marlina Ithnin Daynas Teow, Nor Aslindah Tahrim, Nurfaiezah Kamat and Bala Saravanan.

They form the intrepid Recruitment & Outreach team which play a crucial role in finding and recruiting participants to meet daily recruitment targets to keep the study on track. In the event that participants withdraw at short notice – which happens from time to time – they are determined to find replacements promptly.

The team is also responsible for orchestrating events and roadshows to reach out to the public and disseminate study-related information, as well as connect with individuals interested in participating in the study.

During these roadshows, the entire HELIOS team, including Professor Chambers, come together to speak to potential participants and help with on-the-spot recruitment. In addition to distributing flyers and posters, the team shared that providing simple health measurements (for example, a bioimpedance machine which measures body composition) at these roadshows help tremendously to garner interest and attract potential study participants.

The team also leverages various channels to connect with corporate and community organisations to promote the study, thereby expanding recruitment avenues. On Instagram at @heliossg100k and on Facebook, they also share fun facts about the study and participant experiences to generate public interest on the study. For example, did you know that excess visceral fat affects one’s cognitive function?

When asked how the team managed to interest a steady stream of participants and achieve the 80,000-recruitment milestone just one year after the launch of the study, the team shared that it is thanks to the power of word of mouth. The entire HELIOS team come together to ensure that study participants feel at ease and come away with a positive experience – often, the participants become ambassadors themselves and recommend their family and friends to take part in the study too.

The Registration Team: Gateway guardians ensuring participant eligibility and confidentiality

Every PRECISE-SG100K participant’s adventure begins at registration, where they are greeted with warm smiles from the Registration team – Ann Wong, Adabelle Ang, Isabel Pik and Deborah Michael, before they are formally enrolled in the study. They receive a lanyard with a unique participant ID which safeguards their identity during the study. Following this, the participants delve into an informative video about the study and give their informed consent to participate. This sets the stage for the next step of their journey.

Overview of the participant journey with the various stations and tests as part of the research study

The Operations Team: Precision in action

The Operations Team coordinates the collection of a series of biological samples and phenotypic data on-site. With a focus on accuracy and participant well-being, they meticulously manage a series of stations ranging from sample collection to specialised health assessments like clockwork.

The first stop for participants is a visit to the restroom where urine and stool samples are collected. In the event that participants are unable to provide stool samples during their visit, they are provided with a take-home stool sample collection kit and can mail them in later.

Next, they are ushered to the Phlebotomy station where trained phlebotomists and nurses collect microbiome skin tapes, blood samples together with their blood pressure, height and weight measurements, as well as handgrip strength assessment which are indicators of overall strength and health.

Clockwise from top left: Kan Swee Yong conducting handgrip strength assessment, Thanapackiam collecting blood samples, Muhammad Firman Bin Dollah conducting a handgrip strength assessment, Siti Nabilah Binte Hamidon doing a visual acuity assessment.

Unbeknownst to the participants, working hard behind the scenes in the sample processing lab at HELIOS are a team of biobankers who check every biological sample collected and report any deviations and/or anomalies. The checks include sample volume, integrity, and correctly coded labels (de-identified to safeguard participant personal information) on all sample tubes. These lab experts ensure the efficient processing and storage of biological samples at regulated temperatures. Their attention to detail is what transforms a collection of biological samples into a valuable resource for scientific research.

Clockwise from top left: The biobanking warriors Shahidah Nur Shifa’ Bte Amran, Low Guo Liang, Tay Jia Xian, Kenna Hoe and Kerk Swat Kim (team lead), who treat samples as mission critical.

The HELIOS team highlighted that participants are required to fast for eight hours before their blood draw and would have skipped breakfast. As participants would need to spend approximately three to five hours at the study site (depending on the pace at which they conclude their tests and sample collection), the team ensures that food and snacks are readily available for participants to keep their energy levels up. The team even solicits feedback from participants regarding the food options provided and refines them based on the input received!

After participants have replenished their energies, they undergo a bone densitometry scan which measures bone mineral density and assesses bone strength, as well as a carotid ultrasound test on the major blood vessels in the neck which may reveal the presence of plaque or other abnormalities in the carotid arteries that indicate stroke risk.

Clockwise from top left: Choo Wee Lin (team lead) conducting a bone densitometry scan, Nur Ardini Bte Mohd Khafidz preparing participant before a bone densitometry scan, Lu Mei Ling performing a carotid ultrasound test and Dalily Bte Kosnan doing a visual acuity assessment.

Participants then proceed to the Clinical Assessment Room (CAR) to undergo eye assessments which include fundus imaging, which looks at the interior surface of the eye and visual acuity assessment, testing vision sharpness at a distance. An electrocardiogram (ECG) recording is also performed to help identify any underlying heart conditions, and arterial compliance is measured. Additionally, there is waist and hip measurement and skin physiology tests, which includes skin trans-epidermal water loss, skin moisture and skin pH measurements.

Other stations include a spirometry test to determine lung function, as well as a treadmill walking test and a specialised ophthalmology station where optical coherence tomography angiography imaging is performed to study the microvasculature of the retina. Finally, participants also answer questionnaires to provide their health information, lifestyle and dietary habits. The Operations Team members guide participants up and down the HELIOS corridor multiple times a day, inadvertently clocking their own daily exercise!

Clockwise from top left: Hanis Bte Harris in the carotid ultrasound room, Agnes Khoo working with a participant on her medication list, Lim Li Ming performing a resting ECG and Maneshpal Singh Dhillon performing a lens refractometry and intraocular pressure assessment.

After participants have completed all stations, the Discharge team, Annastazia, Ann, Belle, Isabel, Daynas and Amanda run through the necessary checkout instructions. Before they leave, each participant is provided with a wearable device to track their daily-life mobility over the next seven days before mailing it back to HELIOS for data collection. They also receive a token of appreciation for completing the study.

Integral to the Operations Team is the IT support team, who ensures that all IT systems, hardware and software function optimally so that participant data and health measurements can be collected smoothly without disruptions.

Given the complexity and number of the myriad health assessments which participants undergo, it is no easy feat that the Operations Team manages to ensure the integrity of the data collected while maintaining the highest standards of care. Precision is indeed their middle name as they bring order to the daily research chaos, while ensuring that the study participants move from station to station efficiently and enjoy a smooth and meaningful experience!

Two months after their visit, participants will receive a personalised research report comprising clinically interpretable data based on their health assessments. If participants have any concerns regarding test results, they can schedule a discussion with their doctors. For participants who may not have a regular doctor, the HELIOS team also provides a list of doctors whom they have partnered with for participants to seek further medical advice.

These reports are prepared by the Reporting Team comprising Amanda Bates, Deborah Michael, Adabelle Ang, who also work closely with Professor Chambers to address any feedback which participants may have. This dedicated team instils a culture of continuous improvement at HELIOS by addressing issues promptly, learning from feedback and working towards implementing corrective actions to prevent recurring issues.

Together, the teams collaborate seamlessly like a finely tuned orchestra where each member contributes to the harmonious symphony while paying attention to and adapting to each team’s needs, improving their processes and workflows along the way. The HELIOS team members are truly each other’s support system in helping to make the PRECISE-SG100K study a success thus far.

Through their unwavering commitment, the HELIOS team contributes to the PRECISE-SG100K study by not only advancing scientific knowledge but also paving the way for a healthier, more informed Singaporean population. The collective efforts underscore the transformative power of precision medicine, bringing us one step closer to a future of enhanced healthcare outcomes and improved well-being for all.

If you are interested to participate in the study, please visit the HELIOS website at https://healthforlife.sg or email HELIOS@ntu.edu.sg.