By Dr Evelyn Ho

Let us use cancer as an example. Imagine going for a test for genetic profiling, possibly predicting disease even before it arises and then undergoing an early detection test because of your profile. The diagnostic test involving imaging together with the armamentarium of information amassed will give the probability that an abnormality is a cancer. Intervention with minimally invasive techniques removes the tumour and the tumour is also profiled so that the exact treatment that it responds to will be administered. The treatment is thus personalized! No need for unnecessary drugs or radiation or mutilating surgery – treatment administered will be targeted with the confidence of appropriate response and it would have been administered early in the disease. It does not end here, monitoring or tracking continues. Impossible you say? Well, this era is knocking on our door... read on.

The world is moving or perhaps has already moved, into the era of molecular medicine but exactly what is molecular medicine? How does it impact the way doctors diagnose, treat and prevent diseases and contribute to better health? Why can’t we live forever? What is the genome? How is imaging a key component in the world of molecular and personalized medicine? Eminent experts delved into many related areas giving the basics, facts and unraveled mysteries of molecular biology, imaging, biomedical research, genetics and nanotechnology.

The first day’s session started at 7.50am with a brief introduction to the symposium followed by an elegant and compact delivery of the Basics of Molecular Biology by Prof Maude E. Phipps, PhD.

Prof Dr Looi Lai Meng made a complex subject simple to understand in her paper on the Genetic Basics of Cancer. Very simply, cell growth was controlled by oncogenes (the “growth genes”) and tumour suppressor genes which have caretaker and gatekeeper functions. The analogy was a car with an accelerator and brakes.

Prof Onn Hj Hashim, PhD introduced the subject of Proteomics. From Sunil D. Pandit PhD, the audience learnt that the genome was the whole complement of genetic material of an organism. The impact of knowledge of the genome to biology, to health and finally to society was highlighted. Medicine in the future would include finding the predisposition to a disease, focused screening and early detection with individualised treatment and therapeutic monitoring. In other words, personalized medicine would be the norm in the future. This was envisioned for the year 2010 – a mere 5 years away.

The audience was also exposed to the world of research using animals with enough shared to appreciate the role and ethical use of animal models. Animals have assisted in many great discoveries and development of various treatment including surgical techniques (eg kidney transplant) over the last century.

The engineering aspects were not left out as equipment also had to be developed especially for the small animal models as well as for application in disease detection, disease evolution and monitoring of treatment. Basically, how does fundamental or scientific research translate into clinical practice – from the bench top to the bedside? PET-CT appears to be the latest buzz in clinical imaging, but MR-PET is already being developed as currently no single modality of imaging adequately satisfies the various needs in research and clinical practice.

Yet, research is not just a one way traffic – from bench to bedside. Sometimes, it was from bedside to bench top! Dr Charles Keller, a paediatric haematologist and oncologist had gone back to basic sciences (the laboratory) in the quest to find out how to treat some childhood cancers better. He shared his experience and findings and how he used tumour mouse models in the understanding of human cancer and in imaging tumour vessels.

Dr King CP Li from the National Institutes of Health Clinical Center, USA

King CP Li gave a visionary and passionate journey into Molecular Imaging, possibly blurring the borders currently existing in the practice of the different fields of medicine. To stay relevant today, radiologists practising the “traditional” way had to rethink their roles to ensure that the clinical value of a diagnostic test would continue to provide useful information that would affect treatment decisions. (How To Become a Molecular Imager).

As therapeutic medicine was in the realm of molecular medicine or genomic medicine translating into personalized medicine, it would be logical for radiologists to start learning about molecular biology again. Herceptin, approved in 1998 was an example of where targeted therapy was given only to those patients with metastatic breast cancer (cancer that had spread) that expressed HER-2 neu. The greatest role of biomedical imaging would be the ability to study molecular biology in an intact cell within a living organism. This would be where radiologists could play a crucial role.

The above highlights some of the information shared with the audience. There was naturally much more and the 2 day session ended with the topic of Pharmacogenetics and Pharmacogenomics: Ushering an Era of Personalised Medicine!

The key message in molecular imaging and research was the integration of the various disciplines, collaboration, dialogue amongst the scientists (eg geneticists, molecular biologists, engineers) as well as the healthcare practitioners. Cross modality, breaking down barriers and doing away with the defeatist “turf wars” would be the way to go – for the advancement of medicine and better patient care.

The highly inspiring symposium was a tremendous success and the organisers of the symposium deserve the credit for having the foresight to bring to Malaysia via the excellent speakers - this exciting new era of molecular medicine.

The faculty of eminent speakers in their respective fields was led by Dr King Li, MD, from the National Institute of Health, Bethesda, USA. Other eminent speakers include Dr Sunil Pandit, PhD, from the Heart, Lung and Blood Institute, Bethesda, USA.; Professor Dr Rodney Hicks who is the Director at Centre for Molecular Imaging, Peter MacCallum Cancer Institute, Melbourne; Dr Charles Keller, MD, from the Small Animal Imaging Core Facility at the Children's Cancer Research Institute, The University of Texas Health Science Center, San Antonio, Texas USA; Dr. Arne Hengerer PhD, Director of Molecular Imaging Business Development, Siemens Medical Solutions, Germany and Dr. Patricia A Bresnahan, PhD, who is with GE Healthcare Biosciences (formerly Amersham Biosciences), Hong Kong as the Regional Applications Manager, Discovery Systems. From the Faculty of Medicine, University of Malaya, Kuala Lumpur were Professor Dr Looi Lai Meng from the Department of Pathology, Assoc Professor Maude Phipps PhD and Professor Onn Haji Hashim PhD from Department of Molecular Medicine and Dr Haji Azizuddin b Haji Kamaruddin from the animal research laboratory.

The event was the 2nd International University of Malaya Research Imaging Symposium themed “Fundamentals of Molecular Imaging for Tomorrow’s Practice” at Saujana Resort, Selangor Darul Ehsan. The meeting was organized by the Radiology Department of the University Malaya Medical Centre with the support of the College of Radiology, GE Healthcare, Schering, Siemens, Philips and Fujifilm. A varied audience of biochemists, biomedical engineers, medical physicists, oncologists, pathologists, radiologists, nuclear medicine specialists and other healthcare practitioners benefited from this first ever regional meeting designed to facilitate understanding of the fundamentals of molecular imaging.

From L to R: Assoc Prof Dr SI Bux (Acting Head, Radiology Dept, UMMC) Prof Dr Mohd Affandi Muhd (Deputy Dean, Faculty of Medicine), Prof Dr Alias Daud (Deputy Vice Chancellor – Research & Innovation) and Assoc Prof Dr Basri Johan Jeet Abdullah (Organising Chairman, and President of the College of Radiology)

This 2nd symposium was the sequel of a very successful inaugural International “Research Imaging Symposium” held on the 18th and 19th of February 2004; which identified and explored opportunities in imaging research including biomedical imaging and engineering related to diagnosis and therapy and laid the groundwork for the establishment of the University Malaya Research Centre.