Singapore Opens Stem Cell Centre to Study Asian Heart Disease and Tailor Treatments

A 5ml Blood Sample Offers a New View of Heart Disease

Singapore has opened its first centre dedicated to stem cell research into Asian heart disease, building on a National Heart Centre Singapore (NHCS) library of more than 40 disease models made from patients' cells. The aim is to understand why heart disease affects Asian patients differently and find treatments better suited to their biology.

The Centre for Integrative Human Cell Research and Translation (CIPHER) was launched on October 16 by Senior Minister of State for Health Tan Kiat How at the sixth NHCS Heart to Heart Gala at The Ritz-Carlton Millenia Singapore. Its researchers can start with just 5ml of blood, reprogram cells from that sample into stem cells and then grow beating heart muscle cells for laboratory study.

CIPHER deputy director Chrishan Ramachandra, also a principal investigator at the National Heart Research Institute Singapore (NHRIS) and NHCS, said Asian patients develop heart disease earlier, show different patterns of illness and tend to have worse outcomes than Western patients. Yet much of the research behind treatments has relied on animals and Western biology.

The centre brings together several strands of work: models carrying features of individual patients' diseases, drug testing on human cells and a miniature heart chamber designed to reproduce selected features of a failing heart. Alongside the launch, a separate $2.5 million gift established a professorship to support heart and chest surgery research and future surgical leaders.

Why Study the Biology of Asian Patients?

Singapore's Chinese, Malay and Indian communities give researchers an opportunity to examine cardiovascular disease across different Asian populations. CIPHER director Derek Hausenloy said that diversity allows the centre to study how disease appears in particular ethnic groups, rather than treating Asian patients as a single biological category.

Researchers want to identify the processes that drive those differences. A disease model can help them examine how heart cells behave, how they use energy and how they respond to a medicine. Those observations could point to a treatment target, meaning a biological process that a drug might change.

The need is substantial. Figures cited at the launch put deaths from heart disease and stroke in Singapore at about 23 a day, with cardiovascular disease accounting for one in three deaths in 2025. CIPHER's task is to turn a more detailed understanding of patients' biology into useful choices for their care.

How Blood Cells Become Beating Heart Cells

Researchers use a process called reprogramming to turn specialised cells into induced pluripotent stem cells. These stem cells can then be directed to develop into other cell types, including heart muscle cells. In simple terms, scientists reset a cell's identity before guiding it towards a different job.

A blood sample therefore offers a way to study a patient's heart disease without taking a piece of the heart itself. The resulting cells retain the patient's genetic background and can reproduce features of their condition in the laboratory.

Ramachandra described the value of that approach:

"When we grow a heart muscle cell from a patient's own blood and watch it beat in a dish, carrying that patient's disease, we are looking at something no animal model can replicate," Chrishan said.

The move towards blood samples also makes collection easier for patients. In December 2023, Ramachandra explained that the team had moved away from taking skin samples because the procedure was invasive and could leave a small scar. Blood could instead be collected when patients attended their checks.

More Than 40 Models Form the Starting Library

NHCS has developed more than 40 models derived from patients, forming the foundation of CIPHER's research programme. They cover conditions including heart failure, arrhythmogenic disorders and cardiomyopathy.

Heart failure means the heart cannot supply blood as effectively as the body needs. Cardiomyopathy is disease of the heart muscle, which may become stretched, thickened or stiff. Those changes can make pumping more difficult.

The inherited arrhythmogenic conditions described by the researchers involve heart muscle cells failing to hold together properly and gradually being replaced by scar tissue and fat. Such changes can interfere with the electrical signals that keep the heartbeat coordinated.

A library spanning different conditions gives scientists several ways to investigate disease. They can study what goes wrong in the cells, compare responses to potential treatments and look for biological features associated with a better response.

Testing Medicines Before Patients Take Them

Hausenloy said CIPHER's cell platforms can be used to test drugs and study their effects on heart function and metabolism, the chemical processes through which cells obtain and use energy. The goal is to identify treatments more precisely, including which patients might benefit.

A medicine can help one patient and work poorly for another. Testing it on cells grown from a patient's sample could help researchers investigate that variation before exposing the person to an ineffective medicine or unwanted effects.

Personalised treatment, in this setting, means matching care more closely to the biology of the individual. The same research can also serve a wider purpose: finding a disease mechanism shared by many patients could lead to a treatment useful across a larger group.

The launch announcement gave no timetable for when CIPHER's models would guide routine prescribing or produce a new approved treatment. The immediate work centres on understanding disease and testing potential therapies.

What the Human Heart-in-a-Jar Adds

CIPHER is also working with clinical stage biopharmaceutical company Medera Inc. on Human Heart-in-a-Jar, a bioengineered human ventricular chamber about the size of a fingertip. A ventricle is one of the heart's main pumping chambers. The miniature model is designed to reproduce selected features of heart disease.

Earlier work described in December 2023 involved NHCS and stem cell biotechnology company Novoheart. That project focused on creating miniature models from Asian patients with heart failure, using cells grown from their blood.

The construction process adds a physical structure around the cells. Researchers place them in a gel containing collagen and supporting materials, then shape the mixture around a mould. As the cells form tissue and the mould is removed, a hollow chamber remains that can beat and pump.

That chamber gives researchers measurements beyond the beating of individual cells in a dish. They can examine contraction, relaxation and pressure, features directly relevant to the heart's work of moving blood around the body. At the CIPHER launch, the miniature model was described as a first in Asia.

A Focus on Hearts That Struggle to Fill

The project described in December 2023 targeted heart failure with preserved ejection fraction, a condition said to account for half of heart failure cases. Ejection fraction measures the proportion of blood pushed out of a ventricle with each beat.

In this form of heart failure, that proportion can remain within a normal range while the heart muscle is too stiff to relax and fill properly. A heart can therefore squeeze reasonably well yet still deliver too little blood to meet the body's needs.

A miniature chamber that contracts and relaxes offers a way to study that problem. Researchers hope pressure measurements and other observations will help them reproduce the disease more closely and identify promising medicines.

NHCS received a $5 million Industry Alignment Fund – Industry Collaboration Project award from the Agency for Science, Technology and Research for drug discovery in Asian patients with heart failure. The December 2023 account also put heart failure at 17 per cent of cardiac admissions to public hospitals, underlining the scale of the clinical need.

Research Roots Stretch Back to 2009

CIPHER builds on work that began well before the new centre opened. In its 2011 research announcement, published on September 15, NHCS documented the creation of beating heart muscle cells from patients' skin using a method that did not use viruses to produce induced pluripotent stem cells.

The project had been running since 2009. Its team comprised 15 members, including three clinician scientists and five research scientists, supported by a National Research Foundation grant of close to $9 million over five years. NHCS identified both disease modelling and personalised drug testing as potential uses.

• 2009: The NHCS team began the stem cell project later described in its official announcement.
• September 15, 2011: NHCS announced beating heart cells generated from patients' skin.
• December 4, 2023: The miniature heart project was described with a focus on Asian patients and heart failure with preserved ejection fraction.
• October 16: CIPHER launched with a research foundation of more than 40 models derived from patients.

The 2011 announcement estimated about 5,000 heart failure admissions annually in Singapore, with NHCS treating about 1,000 cases. Those historical figures help explain why researchers pursued ways to study damaged heart muscle and individual responses to drugs.

A $2.5 Million Gift Supports Surgical Research

SingHealth Duke-NUS Academic Medicine Centre also announced the Tong Ming Chuan Professorship in Cardiothoracic Surgery at the launch. Funded by a $2.5 million gift from Tong, it will be awarded by Duke-NUS Medical School under the Cardiovascular Sciences Academic Clinical Programme.

Tong, a cardiothoracic and vascular surgeon in private practice at Mount Elizabeth Medical Centre and a visiting consultant at NHCS, helped pioneer cardiac procedures during his time at Singapore General Hospital from 1981 to 1992. He was involved in Singapore's first heart transplant in 1990 and was part of the team that performed its first lung transplant in 2000.

The professorship aims to support surgical research, clinical excellence and the development of future surgical leaders. NHCS chief executive Yeo Khung Keong described it and CIPHER as complementary commitments: one grounds scientific research in patients' biology, while the other develops surgeons able to bring advances into care.

Tan Kiat How, the Senior Minister of State for Health who launched CIPHER, placed the work within Singapore's greater focus on prevention, earlier intervention and helping people remain healthy and independent. He set out how innovation should be judged:

Innovation can support this shift, but its value is not measured by how sophisticated a technology is. It is measured by what it changes for patients.

Key Points

• CIPHER opened on October 16 to study Asian cardiovascular disease using human stem cell models.
• Researchers can use a 5ml blood sample to generate stem cells and then beating heart muscle cells.
• More than 40 NHCS models derived from patients form the centre's research foundation.
• A miniature heart chamber allows researchers to study pumping, relaxation and pressure while testing potential treatments.
• NHCS documented earlier work producing beating heart cells from skin in September 2011.
• A separate $2.5 million gift established the Tong Ming Chuan Professorship in Cardiothoracic Surgery.