Researchers establish BRIDGES program to synergize diagnostic efforts, patient outcome management

For over 20 years, the Genetics Service at the KK Women's and Children's Hospital (KKH) has been providing clinical care to patients with genetic disorders. In 2014, BRIDGES (Bringing Research Innovations for the Diagnosis of GEnetic diseases in Singapore) was set up, in collaboration with genomic research institutes at SingHealth, Agency for Science, Technology and Research (A*STAR) and Duke-NUS to synergize the diagnostic efforts and patient outcome management.

After six years, the KKH has met the goals set out in its BRIDGES program, achieving 39 per cent in diagnostic yield through identifying more patients with genetic mutations. This result is on par with similar research programmes globally which have a diagnostic yield of 25 to 40 per cent.

BRIDGES has helped 160 children with rare and undiagnosed conditions to receive proper diagnoses, and enabled doctors to provide better care to them and their families. In addition, six of these children were diagnosed with a new disease that had never been reported before, with two of these discoveries being led by the team of KKH clinicians and A*STAR scientists in Singapore:

1. PKB Syndrome - the first human report of mutation in the EIF6 gene in a six-year-old Chinese boy who had features like those for Shwachman-Diamond syndrome (SDS), a rare disorder characterized by pancreatic insufficiency and bone marrow failure. The clinical symptoms had not previously been associated with the EIF6 gene and the PKB Syndrome was named after the doctor who first identified the unique cluster of symptoms, Professor Phua Kong Boo, Senior Consultant, Gastroenterology, Hepatology & Nutrition Service, Department of Pediatrics at KKH. The findings were published on 13 July 20201; and

2. Jamuar Syndrome -- the world's first known case of a genetic syndrome in two Indian sisters with a unique clinical profile that presented epileptic seizures and developmental delays. Jamuar Syndrome was named after Dr Saumya Jamuar, Senior Consultant, Genetics Services, Department of Pediatrics at KKH, who first recognized the clinical features as a new disorder. The findings were published on 30 January 2020.2

Genetics is a useful tool to gain insight into the underlying causes of childhood disorders, and explore possible treatment strategies. The BRIDGES programme illustrates the potential of multi-institutional collaboration working closely to solve problems of medical importance."

Patrick Tan, Professor, Executive Director, Genome Institute, Singapore

Professor Roger Foo, Senior Group Leader of the Laboratory of Molecular Epigenomics and Chromatin Organization, Principal Investigator of the Biomedical Research Council (BMRC)- funded Singapore Rare Disease programme (SUREKids), said, "This is a great advance for patients in our clinics. The powerful technology and science of Next Generation Sequencing can radically change the way we treat our patients. We are now seeing the evident proof of this today."

Bridging the unknown to a diagnosis, and making timely discoveries

For the majority of patients and their families, living with rare, undiagnosed disorders is a long and trying journey. Even knowledge of the underlying cause to the disorder offers relief and a positive step toward finding targeted options for treatment and symptom management.

In cases of critically-ill children and especially those with suspected genetic disorders, timely yet definitive diagnoses are often essential. Under BRIDGES, the Rapid Genomic Sequencing test (RapidSeq) was developed for cases in the neonatal and pediatric intensive care units.

Compared to the typical turnaround from two to three months for standard sequencing results, RapidSeq has been able to expedite that to 10 working days. This is crucial to help families make decisions about the care options available to their children.

Taking precision medicine mainstream Since 2014, BRIDGES has completed analysis for 412 families and made a diagnosis in 160 families (39 per cent), leading to tailored clinical management and improved health outcomes in at least one of three families. To hasten and foster access to full spectrum of risk assessment, testing and genetic counselling, the SingHealth Duke-NUS Genomic Medicine Center (SDGMC) was set up in 2019 to set up specialty genetics clinics at all hospitals and institutions under SingHealth.

Dr Saumya Jamuar, Senior Consultant at KKH and Head of SDGMC said, "The success of the BRIDGES programme has helped us to diagnose many more patients with rare childhood disorders as compared to the past. Moving forward, with improved understanding of the causes to these genetic disorders, we are exploring collaborations to identify therapeutic targets and develop treatments for these children."