New manufacturing facility, task force set up as Singapore ups game in cell and gene therapy

A new 2,000 sq m cell therapy facility aims to meet the increasing demand for cell and gene therapy (CGT) in the Republic, and allow patients to receive such treatments faster.

The facility, under the Advanced Cell Therapy and Research Institute, Singapore (Actris), includes 14 clean suites which comply with good manufacturing practice standards, four translational laboratories and a quality control laboratory.

Hospitals, research institutions and biotech startups will be able to use the facility to support their work in areas such as cell selection and genetic modification.

A task force has also been formed to develop and support the growing field of precision medicine.

Convened by the Ministry of Health (MOH), it will be chaired by Director-General of Health Kenneth Mak and include clinicians, researchers and health economists.
 

Cell therapy is a growing field in medicine where living cells are used to treat a variety of diseases and conditions.

It falls under the sphere of precision medicine, where treatments are tailored to meet the specific needs of patients.

Such treatments can be costly. For example, Kymriah Chimeric Antigen Receptor T-cell therapy – where certain blood cells are extracted from a patient, manipulated to target cancer cells and then reinfused into the patient – reportedly costs US$475,000 (S$637,000).

Market research firm Grand View Research said the global cell therapy market is expected to reach US$15.89 billion by 2028, from US$5.46 billion currently.

The new facility was launched on Friday during the first Singapore Cell and Gene Therapy Conference, held at the National Cancer Centre Singapore (NCCS). It is located in NCCS’ 24-storey building on the Singapore General Hospital (SGH) campus.

Actris chairman Chee Yam Cheng described the facility as a game changer in Singapore’s cell therapy ecosystem.

“Being able to manufacture high-quality cell therapies locally will mean that treatments can reach our patients in less time, and they get access to life-saving therapies sooner,” he said.

Including those undergoing clinical trials, Singapore sees about 100 patients each year who require cell and gene therapy treatments, which are usually offered to those who have not responded well to conventional treatments for conditions such as aggressive leukaemia and lymphoma.

The institute’s interim executive director, associate professor Danny Soon, said the facility will help to contribute to ground-breaking work in the advancement of cancer treatment and regenerative medicine, referring to new treatments to heal tissues and organs.
 

“In addition, Actris will facilitate more public-private partnerships in future and help companies looking to develop their CGT products to obtain the required regulatory approvals to bring their cell therapy products into Singapore,” added Prof Soon, who is also chief executive of the Consortium for Clinical Research and Innovation, Singapore (Cris).

The scale of the facility could also result in the cost of such treatments coming down, he told reporters.

Actris chief medical officer Francesca Lim said the institute is currently in advanced discussions with public healthcare clusters and research institutes here on the development and manufacturing of treatments for a wide array of diseases.

These include Car T-cell therapy for blood cancers and solid tumours as well as virus-specific T-cells which are effective in targeting infectious diseases caused by the likes of the Epstein-Barr virus and cytomegalovirus, said Dr Lim, who is also a senior consultant haematologist at SGH.

Actris also announced a joint grant call with the National Health Innovation Centre Singapore to accelerate the adoption of cell therapies in hospitals here.

Eligible projects will receive funding and support for the development of cell therapy products.

Established in 2020 to meet the rising demand for cellular therapeutics to treat life-threatening diseases, Actris comes under Cris, a subsidiary of MOH Holdings.

Minister for Health Ong Ye Kung, who attended the launch on Friday, noted several concerns with precision medicine, such as cost and the ethical question raised by the modification of genes and cells.

While the Republic aims to embrace the technology, it must also ensure that clinical practices are sound and result in good and cost-effective outcomes, he said.
 

Mr Ong identified several key areas which would allow precision medicine to grow while ensuring safeguards. These include establishing a proper clinical governance framework and setting up legislative safeguards, he said, noting genetic data could be misused by employers to make hiring decisions, for example.

There also needs to be a sustainable way to finance precision medicine, whose costs are “considerably higher than traditional treatments”, he added.

An appropriate financing framework is needed to prevent a schism from forming between those who can afford such treatments and those who cannot.

“I don’t think there is a healthcare system in the world which has found such a solution yet. But given the nature of CGT – relatively infrequent in deployment and high cost – the solution will likely lie in strengthening national healthcare insurance,” Mr Ong added.

Cell therapy refers to the harnessing of living cells to treat diseases such as cancer and autoimmune disorders. 

Existing cell therapy treatments have largely targeted blood cancers like leukaemia and lymphoma. Use of the technology has been studied in treating solid cancers – like cancers of the breast, lung and liver – as well as autoimmune and infectious diseases.

While these cells are typically harvested from patients, a two-year trial at the National University Cancer Institute, Singapore is testing the use of white blood cells from healthy donors in treating cancer.

How are the cells obtained?

T-cells are part of the immune system and chimeric antigen receptors (Car) are proteins. In Car T-cell therapy, blood is collected through a process called apheresis.

This involves drawing the blood from the body, passing it through a machine which separates the T-cells and returning the remaining blood to the body.

Car are added to the T-cells and reprogrammed to target cancer cells.
 

How are the cells introduced to the body?

The patient will have a brief course of low-dose chemotherapy, which improves the chances of the body accepting the new Car T-cells. These Car T-cells are infused into the patient in a process similar to a blood transfusion.

The genetically-modified cells are able to recognise and attach to antigens – proteins found on tumour cells – helping the body kill these tumour cells.

The patient may experience some side effects for a month and the immune system may take several months to recover.
 

Who can get cell therapy?

In Singapore, Car T-cell therapy is available to some patients up to the age of 25 who have relapsed or not responded to therapy for acute lymphoblastic leukaemia, as well as some adults with certain types of lymphoma who have relapsed or not responded to initial treatment. Those with other types of cancer may also have Car T-cell therapy as part of a clinical trial.

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