If genomics and AI research are becoming favorite research themes in developed countries, will our scientists follow suit?

In October, the Royal Swedish Academy of Sciences awarded the 2024 Nobel Prizes in the categories of Medicine-Physiology, Chemistry, Physics, Literature, and Peace.

Looking at the Nobel Prize winners in Medicine, Physics, and Chemistry, it appears that there has been rapid progress in genomic research and artificial intelligence (AI) and this is driving technological progress in the medical and health fields.

What can we learn from this Nobel laureate?

New breakthrough

The Nobel Prize in Medicine-Physiology was awarded to Victor Ambros and Gary Ruvkun from the United States (US). Both were considered to have contributed to their discovery that microRNA plays a role in regulating post-transcriptional gene activity. This discovery opens up opportunities to develop new ways to treat various diseases, including cancer and autoimmune diseases.

The jury of this award considers that this breakthrough discovery reveals an entirely new principle about gene regulation, which turns out to be very important for multicellular organisms such as humans.

Genomic research focuses on a structure, namely genes. Genes are the blueprint of genetic information in all living beings, including humans, which are arranged in the form of DNA (deoxyribonucleic acid) molecular strands necessary for the formation of body structures.

Genomic research began decades ago and now brings technological breakthroughs in gene editing, RNA (ribonucleic acid) technology, and stem cell therapy, which open new hopes for the treatment of several human diseases that previously seemed to have no solution.

Genomic research has experienced a spectacular leap since the discovery of the gene editing method, clustered regularly interspaced short palindromic repeats-associated protein 9 (CRISPR-Cas9), which can correct genetic errors or edit DNA strands with precision.

With this method, certain diseases, such as cancer and autoimmune disorders, can be addressed early through prevention, rather than treatment after falling ill.

The Nobel Prize in Physics was awarded to John Hopfield (USA) and Geoffrey Hinton (Canada) who were considered to have used physics concepts to develop methods that became the basis for machine learning and AI technology.

The Nobel Prize in Chemistry was awarded to David Baker, John Jumper, and Demis Hassabis for their success in determining the complex three-dimensional structures of proteins. Baker (a professor at the University of Washington, USA) was recognized for his contributions to "computational protein design." Jumper and Hassabis (working at Google DeepMind, an AI company from the UK) were acknowledged for their work on "protein structure prediction."

According to the Nobel Committee, Baker succeeded in discovering an entirely new type of protein. Jumper and Hassabis managed to develop AI modeling to solve a problem in the field of chemistry that has remained unresolved for 50 years, namely predicting protein structures from their amino acid sequences.

Nobel Prize winners in physics, Hopfield and Hinton, are on the same track, namely AI development research.

Both can be considered as the pioneers of AI. Hopfield has a strong command of basic physics, chemistry, and molecular biology. Meanwhile, Hinton is a computer science expert who began researching neural networks in the early 1970s at the University of Edinburgh.

The network developed by Hinton is similar to the one built by Hopfield, but with a different explanation. Hopfield used the principles of physics, while Hinton with the principles of statistical mechanics, a branch of science that underlies modern physics.

The neural network model research built by these two people was later developed by many digital technology companies. Their important contribution is using the concept of physics for machine learning development research, which is the basis for today's AI technology.

The entire AI technology industry today can thrive thanks to Hopefield and Hinton's research and findings. Technological progress cannot be separated from the mastery of basic sciences such as physics and mathematics. Likewise, the progress of AI technology is apparently built on the principles of physics as shown in Hopfield and Hinton's Nobel-winning research.

Therefore, if we want to spur technological development, basic science research needs to be further strengthened.

Genomic research and AI

From the 2024 Nobel Prize, we can see that genomic and AI research are two favorite research themes in the future. Genomic research, including stem cell research, is now being carried out everywhere.

These stem cells can develop into many different types of cells in the body and have the potential to replace damaged body cells, whether due to disease or age (degenerative).

In recent years, stem cell therapy has been considered a breakthrough in regenerative medicine. This innovative therapy uses stem cells, the body's raw material, to repair damaged tissue, treat various diseases, and improve overall health.

Currently, countries that are advanced in stem cell research include the US, Germany, England, China, Japan, India, South Korea, Singapore, and Israel.

Their government strongly supports stem cell research, allocating sufficient funds for the development of medical and biotechnology research infrastructure, developing professional human resources, and integrating them with the medical and health industry.

Likewise with the development of AI. Many technology and digital companies are involved in developing and taking advantage of AI.

Genomics and AI research in Indonesia

If genomics and AI research become favorite research themes in developed countries, do our scientists also follow suit? Of course, although with intensity and government support that is not as good as in developed countries.

In the genomics research sector, we are actually not too far behind, although we are not yet on par with developed countries. We have the Eijkman Institute for Molecular Biology, which was established during the Dutch East Indies, which unfortunately has now been closed and merged into BRIN.

From this institution, many works have been produced. For example, a few years ago, a research was launched on mapping the Indonesian human gene with respondents from various races and tribes from Aceh to Papua. The results of this mapping, it is known that all tribes and sub-tribes in Indonesia do not have a single DNA.

All tribes mix with each other with varying degrees of mixture. By social scientists, this is then called Bhinneka Tunggal Ika in a genetic context.

During the Covid-19 pandemic, the Eijkman Institute was also able to develop its own vaccine, on par with vaccine producers in other countries.

This is because the Eijkman Institute has decades of experience producing vaccines. For the genomic research sector, we already have a good foundation. Hopefully, budget support, infrastructure, and research ecosystems can be developed in universities and other research institutions.

For stem cells, not many of our scientists have studied this promising sector. It needs support and encouragement of policies, regulations, and budget allocation from the government so that stem cell research can develop faster.

The issue of regulation is important because now many practices are emerging that claim to be "stem cell therapy" by clinics or private doctors, but do not yet comply with medical standards.

There are doctors who apply this therapy practice to a limited number of patients, not for commercial purposes, and explain that their therapy practice is part of their research process. However, there are also those who have practiced commercially, charge high rates, and sell well because they are publicized by influencers, even though they do not meet medical standards.

Commercial practices with claims of “stem cell therapy” but still far from medical standards do not only exist in Indonesia, but also in developed countries. In an article entitled Putting Stemcell-Based Therapies in Context, Karen M Wai et al highlighted the proliferation of “fake” stem cell clinics in the United States (stemcell.nih.gov, 11/16/2022).

Citing this article, a 2021 study estimated that there are more than 2,500 clinics in the US selling medically unproven stem cell treatments. Patients are led to believe that these treatments are registered, approved by the US Food and Drug Administration (FDA), or are assured that FDA approval is not needed.

As a result, there are many cases of malpractice that harm patients. This article gives an example of a clinic in Stanford treating a patient whose vision was damaged after receiving stem cell injections in the back of his eyes. There is also a clinic in Florida that made a patient blind after giving stem cells in his eyes.

This unregulated and non-medical stem cell treatment carries risks and side effects that can be dangerous. For example, the injected cells can multiply into inappropriate cell types or even become dangerous tumors.

Still according to the article, the Pew Charitable Trusts collected 360 reports of side effects resulting from stem cell therapies that were not or have not been approved by the FDA, including 20 cases that resulted in death. These are the cases that were reported and it is believed that there are many more cases that are not reported.

In fact, stem cell-based therapies that do not meet medical standards are usually expensive, while the risks can be dangerous. Fortunately, in 2017, the FDA released guidance under the 21st Century Cures Act that clarified which stem cell-based therapies fall under FDA regulation.

Since May 2021, the FDA has been enforcing a crackdown on stem cell clinics that continue to market treatments that do not meet medical standards.

In the AI sector, we are not yet at the level of developed countries. In the realm of digital technology that is the umbrella of AI, we are still just consumers.

Reflecting on one of the world's figures from the Netherlands who once worked and researched in Indonesia, Christiaan Eijkman, who was a Nobel laureate in 1929 thanks to his discovery of beriberi, we must believe and be confident that in the future there will be Nobel laureates born from Indonesia.

The Nobel Prize continues to take place every year, the winners rotate from many countries, but Indonesian scientists are only spectators. Hopefully this can spur our scientists to seriously explore research in the upstream sector and sectors that are trending in future research.

Djoko Santoso
Professor of the Faculty of Medicine Airlangga University
Head of the Health Agency of the MUI of East Java Province