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Examining the Gut Microbiome of the Asian Population
Southeast Asia’s first stool bank, Asian Microbiome Library, founded by Associate Professor Jeremy Lim, aims to boost microbiome research in the Asian population to address the unmet needs and research gaps in healthcare and understanding of the Asian gut microbiome.

Microorganisms outnumber the human cells in our body by 10 to one. With trillions of these microbes calling our bodies “home”, its relation to health, metabolism, and disease is becoming more recognised. More specifically, the gut microbiome is known to interact with drug metabolism, nutrient metabolism and also provides an antimicrobial barrier through the mucosal surface of the gut.

Research has found that the gut microbiome plays a role in certain diseases such as gastrointestinal disorders and cardiovascular disorders. In order to be able to examine the associations between the gut microbiome and disease, and human health specific to the Asian population, data collection for delineating its components has to be done as the initial step. The Asian Microbiome Library (AMILI) was founded on the basis developing a gut microbiome repository specifically for the Asian population to achieve this aim and widen the understanding of microbiome research. To share more on the AMILI journey and its process of sample collection to data generation is its founder, Associate Professor Jeremy Lim.

1. What are the main goals of starting the Asian Microbiome Library

The Asian Microbiome Library (AMILI) was born out of the need to ensure that the exciting developments in gut microbiome science benefit us in Asia. As clinicians, we were of course very excited about the potential of the gut microbiome in transforming human health, and the science emerging in the last decade has been nothing short of amazing. But we were concerned that the majority of the research was based in the West focused on populations that are genetically very different from us in Asia and with very different diets. We thus started AMILI to focus on the Asian microbiome and contribute to the discovery of insights and applications for Asian populations.

2. What implications does the development of an Asian Microbiome Library have on identifying associations between the human microbiome and human health or disease?

In the last decade, our understanding of the gut microbiome has just exploded. Whilst we are still only scratching the surface, we now know the gut microbiome has been implicated in many diseases outside of the gut including autism, obesity, dementia and even cancer. At AMILI, we believe that establishing a library of Asian gut microbiome will allow us to study and gain insights into diseases that are more prevalent in Asia such as liver cancer, and also understand how the Asian microbiome influences the emergence and progression of diseases such as Inflammatory Bowel Disease (IBD) that were very uncommon in Asia until we adopted ‘Western’ diets.

3. Why is it important to form a Microbiome Library that is specific to the Asian population?

The current repositories of microbiome data are largely European and American and understandably do not account for Asian ethnic diversity. Evidence also shows that diet plays a major role in microbiome diversity, and hence we must know what is ‘normal’ for us in Asia given different genetics, different diets and different environments we live in compared to our counterparts in the West.

4. What is the process like from donor selection to generating data from the sample?

We have been very fortunate that the public have stepped up to support this important mission of characterizing the Asian microbiome. Donors complete an online questionnaire of their health, diet and activities and after that, collect a very small sample of their stool using a special container we send to them and return the sample to us in the mail. It’s all very convenient; there is no need to come into our lab and everything is done remotely. When we receive the sample, we extract the microbiome and sequence it to characterize what the dominant strains are, proportions of the different types of bacteria and so on.

5. What plans are there for data storage? Who will have access to the data and how will it be used for future research on human disease?

Donor confidentiality is of utmost importance to us. We are grateful to those who want to contribute to science and trust us with their data. Our processes are very stringent and all identifiable information is stripped out and kept separately. Only authorised staff who deal directly with the donors will have access to the identifiable information; our researchers work with anonymized data and we extend access to the anonymized data on a case-by-case basis to advance science. For example, we are beginning work with a university hospital in the region to compare the gut microbiome of Asian patients with IBD with their healthy counterparts and this work may help us to identify useful biomarkers that down the line could be used in diagnostics or therapeutics.

6. What are the challenges faced in the process of collecting samples and generating data for the library?

Awareness is the major challenge. It’s amazing how something as simple as donating your poop can play a part in saving someone’s life. Hence we work hard to engage the public that ‘poop saves lives’ (https://poopsaveslives.com/) as our public education campaign emphasizes.

Gut microbiome research is also expensive. A single microbiome is about 1 TB and hence we need massive computing power to conduct our research. The cost of secure storage is also high and we are constantly working out new ways to be more cost-efficient so that more of our funds can be used directly for research.

7. How will sample collected for microbiome data also be used for faecal microbiota transplant?

Faecal microbiota transplants (FMT) are increasingly recognized as important therapeutic options for patients with more and more diseases. However, the science of FMT is still in its infancy and we as a scientific community do need to learn more about matching the donor and the recipient better. It’s a little like blood donation- in the early days, we only knew of the ABO blood types and matched transfusions for these. Later, we learnt about other antigens that were important to match and so blood transfusion gets more and more efficient with fewer side effects. We see a similar future for FMT where we progressively learn more about which factors in the microbiome should be matched for better effect. One day, we think host and donor microbiome will be routinely sequenced and matched for the optimal therapeutic outcome.

This interview was held in conjunction with EmTech Asia 2020 to be held virtually from 4 to 6 August 2020. Associate Professor Jeremy Lim will be speaking on the Future of Healthcare during the virtual conference on 6 August 2020.

About the Interviewee

Associate Professor Jeremy Lim is the founder of AMiLi (Asian Microbiome Library), the first gut microbiome bank in Singapore and Southeast Asia. AMiLi’s mission is to advance human health through microbiome science and we work with clinicians, researchers and patient groups to make accessible the microbiome for patient care and research.

Prior to AMiLi, Jeremy founded global consultancy Oliver Wyman’s healthcare consulting practice in Asia in 2012. He has held senior executive roles in both the public and private sectors in Asian healthcare including as director of research in Singapore’s largest healthcare system and as Singapore CEO of a pan-Asian private healthcare group. He continues to serve in the National University of Singapore as co-director of the global health program in the School of Public Health.


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