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Papadopoulos KI, Papadopoulou A, Aw TC. Anexelekto (AXL) no more: microRNA-155 (miR-155) controls the "Uncontrolled" in SARS-CoV-2. Hum Cell 2024; 37:582-592. [PMID: 38472734 DOI: 10.1007/s13577-024-01041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/30/2024] [Indexed: 03/14/2024]
Abstract
AXL is the gene that encodes the Anexelekto (AXL) receptor tyrosine kinase that demonstrates significant roles in various cellular processes, including cell growth, survival, and migration. Anexelekto is a Greek word meaning excessive and uncontrolled, semantically implying the crucial involvement of AXL in cancer and immune biology, and in promoting cancer metastasis. AXL overexpression appears to drive epithelial to mesenchymal transition, tumor angiogenesis, decreased antitumor immune response, and resistance to therapeutic agents. Recently, AXL has been reported to play important roles in several viral infections, including SARS-CoV-2. We have previously outlined the importance of microRNAs (miRNAs, miRs) and especially miR-155 in SARS-CoV-2 pathophysiology through regulation of the Renin-Angiotensin Aldosterone System (RAAS) and influence on several aspects of host innate immunity. MiRNAs are negative regulators of gene expression, decreasing the stability of target RNAs or limiting their translation and, enthrallingly, miR-155 is also involved in AXL homeostasis-both endogenously and pharmaceutically using repurposed drugs (e.g., metformin)-highlighting thrifty evolutionary host innate immunity mechanisms that successfully can thwart viral entry and replication. Cancer, infections, and immune system disturbances will increasingly involve miRNA diagnostics and therapeutics in the future.
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Affiliation(s)
- K I Papadopoulos
- THAI StemLife, 566/3 Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd, Wangthonglang, Bangkok, 10310, Thailand.
| | - A Papadopoulou
- Feelgood Lund, Occupational and Environmental Health Services, Ideon Science Park, Scheelevägen 17, 223 63, Lund, Sweden
| | - T C Aw
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
- Department of Medicine, National University of Singapore, Singapore, 119228, Singapore
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Myrou A, Aslanidis T, Makedou K, Mitsianis A, Thisiadou A, Karalazou P, Chatzopoulos G, Papadopoulos A, Kalis A, Giagkoulis D, Lezgidis F, Savopoulos C. Fibroblast Growth Factor 23 in COVID-19: An Observational Study. Cureus 2023; 15:e42561. [PMID: 37637614 PMCID: PMC10460241 DOI: 10.7759/cureus.42561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Fibroblast growth factor 23 (FGF23) belongs structurally to the endocrine FGF protein family, which also includes FGF19 and FGF21. In the past decade, FGF23 has emerged as a possible diagnostic, prognostic biomarker, and therapeutic target in several conditions. Data about COVID-19 and FGF23 is still limited, yet they suggest interesting interactions. OBJECTIVE In the present study, the levels of FGF23 were investigated in COVID-19 patients. These levels were also correlated with other inflammatory markers. MATERIALS AND METHODS In our prospective observational study, blood samples were collected from 81 patients admitted with COVID-19 (31 males and 50 females). We analyzed the relation of serum FGF23 levels with biochemistry, total blood count, coagulation parameters, and demographic data. RESULTS The distribution of FGF23 serum levels according to sex and age (n28-40=8, n41-60=28, n65-75= 25, n75+=20) was similar. No significant correlation between FGF23 and any other biochemistry, total blood count, and coagulation parameter was revealed in the whole sample. Nevertheless, there was a variation in the results among different age groups. CONCLUSION FGF23 levels seem to vary in symptomatic COVID-19 infection, but well-organized studies with larger numbers of patients in each group are needed to determine any reliable correlation between FGF23 and other laboratory parameters.
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Affiliation(s)
- Athena Myrou
- Department of Internal Medicine, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
| | - Theodoros Aslanidis
- Department of Intensive Care Unit, St. Paul Agios Pavlos General Hospital, Thessaloniki, GRC
| | - Keli Makedou
- Department of Biochemistry, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
| | - Athanasios Mitsianis
- Department of Internal Medicine, Mpodosakeio General Prefecture Hospital, Ptolemaida, GRC
| | - Aikaterini Thisiadou
- Department of Internal Medicine, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
| | - Paraskevi Karalazou
- Department of Internal Medicine, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
| | - Georgios Chatzopoulos
- Department of Internal Medicine, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
| | - Anastasios Papadopoulos
- Department of Internal Medicine, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
| | - Antonios Kalis
- Department of Internal Medicine, Mpodosakeio General Prefecture Hospital, Ptolemaida, GRC
| | - Dimitrios Giagkoulis
- Department of Internal Medicine, Mpodosakeio General Prefecture Hospital, Ptolemaida, GRC
| | - Fotios Lezgidis
- Department of Internal Medicine, Mpodosakeio General Prefecture Hospital, Ptolemaida, GRC
| | - Christos Savopoulos
- Department of Internal Medicine, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
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Papadopoulos KI, Papadopoulou A, Aw TC. Beauty and the beast: host microRNA-155 versus SARS-CoV-2. Hum Cell 2023; 36:908-922. [PMID: 36847920 PMCID: PMC9969954 DOI: 10.1007/s13577-023-00867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/29/2023] [Indexed: 02/28/2023]
Abstract
Severe acute respiratory coronavirus 2 (SARS-CoV-2) infection in the young and healthy usually results in an asymptomatic or mild viral syndrome, possibly through an erythropoietin (EPO)-dependent, protective evolutionary landscape. In the old and in the presence of co-morbidities, however, a potentially lethal coronavirus disease 2019 (COVID-19) cytokine storm, through unrestrained renin-angiotensin aldosterone system (RAAS) hyperactivity, has been described. Multifunctional microRNA-155 (miR-155) elevation in malaria, dengue virus (DENV), the thalassemias, and SARS-CoV-1/2, plays critical antiviral and cardiovascular roles through its targeted translational repression of over 140 genes. In the present review, we propose a plausible miR-155-dependent mechanism whereby the translational repression of AGRT1, Arginase-2 and Ets-1, reshapes RAAS towards Angiotensin II (Ang II) type 2 (AT2R)-mediated balanced, tolerable, and SARS-CoV-2-protective cardiovascular phenotypes. In addition, it enhances EPO secretion and endothelial nitric oxide synthase activation and substrate availability, and negates proinflammatory Ang II effects. Disrupted miR-155 repression of AT1R + 1166C-allele, significantly associated with adverse cardiovascular and COVID-19 outcomes, manifests its decisive role in RAAS modulation. BACH1 and SOCS1 repression creates an anti-inflammatory and cytoprotective milieu, robustly inducing antiviral interferons. MiR-155 dysregulation in the elderly, and in comorbidities, allows unimpeded RAAS hyperactivity to progress towards a particularly aggressive COVID-19 course. Elevated miR-155 in thalassemia plausibly engenders a favorable cardiovascular profile and protection against malaria, DENV, and SARS-CoV-2. MiR-155 modulating pharmaceutical approaches could offer novel therapeutic options in COVID-19.
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Affiliation(s)
- K. I. Papadopoulos
- THAI StemLife, 566/3 Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd., Wangthonglang, Bangkok, 10310 Thailand
| | - A. Papadopoulou
- Occupational and Environmental Health Services, Feelgood Lund, Ideon Science Park, Scheelevägen 17, 223 63 Lund, Sweden
| | - T. C. Aw
- grid.413815.a0000 0004 0469 9373Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
- grid.4280.e0000 0001 2180 6431Department of Medicine, National University of Singapore, Singapore, 119228 Singapore
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Lansiaux E, Drouin E, Bolm C. Beta-Thalassemia Minor and SARS-CoV-2: Physiopathology, Prevalence, Severity, Morbidity, and Mortality. Thalassemia Reports 2023; 13:21-32. [DOI: 10.3390/thalassrep13010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Since the first year of the COVID-19 global pandemic, a hypothesis concerning the possible protection/immunity of beta-thalassemia carriers has remained in abeyance. Methods: Three databases (Pubmed Central, Scopus, and Google Scholar) were screened and checked in order to extract all studies about the incidence of confirmed COVID-19 cases, mortality rate, severity assessment, or ICU admission among patients with beta-thalassemia minor, were included in this analysis. The language was limited to English. Studies such as case reports, review studies, and studies that did not have complete data for calculating incidences were excluded. Results and discussion: a total of 3 studies out of 2265 were selected. According to our systematic-review meta-analysis, beta-thalassemia carriers could be less affected by COVID-19 than the general population [IRR = 0.9250 (0.5752; 1.4877)], affected by COVID-19 with a worst severity [OR = 1.5933 (0.4884; 5.1981)], less admissible into the ICU [IRR = 0.3620 (0.0025; 51.6821)], and more susceptible to die from COVID-19 or one of its consequences [IRR = 1.8542 (0.7819; 4.3970)]. However, all of those results remain insignificant with a bad p-value (respectively 0.7479, 0.4400, 0.6881, and 0.1610). Other large case-control or registry studies are needed to confirm these trends.
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Papadopoulos KI, Papadopoulou A, Aw TC. A protective erythropoietin evolutionary landscape, NLRP3 inflammasome regulation, and multisystem inflammatory syndrome in children. Hum Cell 2023; 36:26-40. [PMID: 36310304 PMCID: PMC9618415 DOI: 10.1007/s13577-022-00819-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/24/2022] [Indexed: 11/04/2022]
Abstract
The low incidence of pediatric severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and the associated multisystem inflammatory syndrome (MIS-C) lack a unifying pathophysiological explanation, impeding effective prevention and therapy. Activation of the NACHT, LRR, and PYD domains-containing protein (NLRP) 3 inflammasome in SARS-CoV-2 with perturbed regulation in MIS-C, has been reported. We posit that, early age physiological states and genetic determinants, such as certain polymorphisms of renin-angiotensin aldosterone system (RAAS) molecules, promote a controlled RAAS hyperactive state, and form an evolutionary landscape involving an age-dependent erythropoietin (EPO) elevation, mediating ancestral innate immune defenses that, through appropriate NLRP3 regulation, mitigate tissue injury and pathogen invasion. SARS-CoV-2-induced downregulation of angiotensin-converting enzyme (ACE)2 expression in endothelial cells (EC), impairment of endothelial nitric oxide (NO) synthase (eNOS) activity and downstream NO bioavailability, may promote a hyperactive RAAS with elevated angiotensin II and aldosterone that, can trigger, and accelerate NLRP3 inflammasome activation, while EPO-eNOS/NO abrogate it. Young age and a protective EPO evolutionary landscape may successfully inhibit SARS-CoV-2 and contain NLRP3 inflammasome activation. By contrast, increasing age and falling EPO levels, in genetically susceptible children with adverse genetic variants and co-morbidities, may lead to unopposed RAAS hyperactivity, NLRP3 inflammasome dysregulation, severe endotheliitis with pyroptotic cytokine storm, and development of autoantibodies, as already described in MIS-C. Our haplotype estimates, predicted from allele frequencies in population databases, are in concordance with MIS-C incidence reports in Europeans but indicate lower risks for Asians and African Americans. Targeted Mendelian approaches dissecting the influence of relevant genetic variants are needed.
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Affiliation(s)
- Konstantinos I Papadopoulos
- Department of Research and Development, THAI StemLife Co., Ltd., 566/3 THAI StemLife Bldg., Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd., Wangthonglang, 10310, Bangkok, Thailand.
| | - Alexandra Papadopoulou
- Occupational and Environmental Health Services, Feelgood Lund, Ideon Science Park, Scheelevägen 17, 223 63, Lund, Sweden
| | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore, 529889, Singapore
- Department of Medicine, National University of Singapore, Singapore, 119228, Singapore
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Papadopoulos KI, Hallengren B. Autoimmunity in sarcoidosis: the tip of the Iceberg. Clin Exp Med 2022:10.1007/s10238-022-00875-4. [PMID: 35976515 PMCID: PMC9382596 DOI: 10.1007/s10238-022-00875-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/08/2022] [Indexed: 02/08/2023]
Abstract
Sarcoidosis is a mysterious condition with an etiology that has to date eluded explanation. Innumerable clinical and serological organ- and non-organ-specific autoimmune associations have been reported. Many of the associated conditions are life-threatening but easily manageable if diagnosed early. Due to the long latency that precedes the clinical onset of autoimmune diseases, it is prudent to ensure a long follow-up and a broad viewing perspective while maintaining a high index of suspicion when viewing the autoimmunity iceberg in sarcoidosis.
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Affiliation(s)
- Konstantinos I. Papadopoulos
- THAI StemLife, 566/3 Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd., Wangthonglang, Bangkok, 10310 Thailand
| | - Bengt Hallengren
- grid.411843.b0000 0004 0623 9987Department of Endocrinology, Skåne University Hospital, 20502 Malmö, Sweden
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Lund, Sweden
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Gupta A, Jayakumar MN, Saleh MA, Kannan M, Halwani R, Qaisar R, Ahmad F. SARS-CoV-2 infection- induced growth factors play differential roles in COVID-19 pathogenesis. Life Sci 2022; 304:120703. [PMID: 35700841 DOI: 10.1016/j.lfs.2022.120703] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 12/12/2022]
Abstract
Aims Biologically active molecules cytokines and growth factors (GFs) are critical regulators of tissue injury/repair and emerge as key players in COVID-19 pathophysiology. However, specific disease stage of GFs dysregulation and, whether these GFs have associations with thromboembolism and tissue injury/repair in COVID-19 remain vague. Main methods GF profiling in hospitalized moderate (non-ICU) and critically ill (ICU) COVID-19 patients was performed through legendPlex assay. Key findings Investigation revealed profound elevation of VEGF, PDGFs, EGF, TGF-α, FGF-basic, and erythropoietin (EPO) in moderate cases and decline or trend of decline with disease advancement. We found strong positive correlations of plasma VEGF, PDGFs, and EPO with endothelial dysfunction markers P-selectin and sCD40L. Interestingly, the HGF and G-CSF were upregulated at the moderate stage and remained elevated at the severe stage of COVID-19. Moreover, strong negative correlations of PDGFs (r2 = 0.238, P = 0.006), EPO (r2 = 0.18, P = 0.01) and EGF (r2 = 0.172, P = 0.02) and positive correlation of angiopoietin-2 (r2 = 0.267, P = 0.003) with D-dimer, a marker of thromboembolism, was observed. Further, plasma PDGFs (r2 = 0.199, P = 0.01), EPO (r2 = 0.115, P = 0.02), and EGF (r2 = 0.108, P = 0.07) exhibited negative correlations with tissue injury marker, myoglobin. Significance Taken together, unlike cytokines, most of the assessed GFs were upregulated at the moderate stage of COVID-19. The induction of GFs likely occurs due to endothelial dysfunction and may counter the adverse effects of cytokine storms which is reflected by inverse correlations of PDGFs, EPO, and EGF with thromboembolism and tissue injury markers. The findings suggest that the assessed GFs play differential roles in the pathogenesis of COVID-19.
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Abstract
Several mechanisms may explain how exercise training mechanistically confers protection against coronavirus disease 2019 (COVID-19). Here we propose two new perspectives through which cardiorespiratory fitness may protect against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Physical exercise-activated adenosine monophosphate (AMP)-activated protein kinase (AMPK) signaling induces endothelial nitric oxide (NO) synthase (eNOS), increases NO bio-availability, and inhibits palmitoylation, leading to specific and immediate SARS-CoV-2 protection. AMPK signaling also induces angiotensin 1-7 release and enhances eNOS activation thus further mediating cardio- and reno-protection. Irisin, a myokine released from skeletal muscles during aerobic exercise, also participates in the AMPK/Akt-eNOS/NO pathway, protects mitochondrial functions in endothelial cells, and antagonizes renin angiotensin system proinflammatory action leading to reductions in genes associated with severe COVID-19 outcomes. Collectively, all the above findings point to the fact that increased AMPK and irisin activity through exercise training greatly benefits molecular processes that mediate specific, immediate, and delayed SARS-CoV-2 protection. Maintaining regular physical activity levels is a safe and affordable lifestyle strategy against the current and future pandemics and may also mitigate against obesity and cardiometabolic disease syndemics. Move more because a moving target is harder to kill.
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Affiliation(s)
| | | | - Tar-Choon Aw
- Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore, Singapore
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Papadopoulos KI, Sutheesophon W, Aw TC. Too hard to die: Exercise training mediates specific and immediate SARS-CoV-2 protection. World J Virol 2022; 11:98-103. [PMID: 35433336 PMCID: PMC8966590 DOI: 10.5501/wjv.v11.i2.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/19/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Several mechanisms may explain how exercise training mechanistically confers protection against coronavirus disease 2019 (COVID-19). Here we propose two new perspectives through which cardiorespiratory fitness may protect against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Physical exercise-activated adenosine monophosphate (AMP)-activated protein kinase (AMPK) signaling induces endothelial nitric oxide (NO) synthase (eNOS), increases NO bio-availability, and inhibits palmitoylation, leading to specific and immediate SARS-CoV-2 protection. AMPK signaling also induces angiotensin 1-7 release and enhances eNOS activation thus further mediating cardio- and reno-protection. Irisin, a myokine released from skeletal muscles during aerobic exercise, also participates in the AMPK/Akt-eNOS/NO pathway, protects mitochondrial functions in endothelial cells, and antagonizes renin angiotensin system proinflammatory action leading to reductions in genes associated with severe COVID-19 outcomes. Collectively, all the above findings point to the fact that increased AMPK and irisin activity through exercise training greatly benefits molecular processes that mediate specific, immediate, and delayed SARS-CoV-2 protection. Maintaining regular physical activity levels is a safe and affordable lifestyle strategy against the current and future pandemics and may also mitigate against obesity and cardiometabolic disease syndemics. Move more because a moving target is harder to kill.
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Affiliation(s)
| | | | - Tar-Choon Aw
- Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore 119228, Singapore, Singapore
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Papadopoulos KI, Sutheesophon W, Aw TC. Genetic polymorphisms affecting nitric oxide and β-cytokine pathways may contribute to increased COVID-19 mortality in schizophrenia. Asian J Psychiatr 2022; 69:102981. [PMID: 34973636 PMCID: PMC8709722 DOI: 10.1016/j.ajp.2021.102981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/22/2021] [Indexed: 02/05/2023]
Affiliation(s)
| | | | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore; Department of Medicine, National University of Singapore, Singapore 119228, Singapore
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Papadopoulos KI, Sutheesophon W, Aw TC. The influence of renin angiotensin aldosterone system (RAAS), endothelial nitric oxide synthase (eNOS) and erythropoietin (EPO) on COVID-19 complications. Chem Biol Interact 2022; 354:109834. [PMID: 35092718 PMCID: PMC8789551 DOI: 10.1016/j.cbi.2022.109834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 02/05/2023]
Abstract
Certain aspects of the renin-angiotensin-aldosterone system (RAAS) have eluded deserved attention such as the role of erythropoietin (EPO) and nitric oxide (NO) both of which appear to significantly modulate COVID-19 disease course. Furthermore, renin-angiotensin-aldosterone system (RAAS) and endothelial NO synthase (eNOS) genetic polymorphisms additionally impact on EPO and NO homeostasis and have extensive implications on pharmacological disease management.
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Affiliation(s)
- Konstantinos I Papadopoulos
- THAI StemLife, 566/3 Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd., Wangthonglang, Wangthonglang, Bangkok, 10310, Thailand.
| | - Warachaya Sutheesophon
- THAI StemLife, 566/3 Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd., Wangthonglang, Wangthonglang, Bangkok, 10310, Thailand.
| | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889.
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