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Liu B, Su L, Loo SJ, Gao Y, Khin E, Kong X, Dalan R, Su X, Lee KO, Ma J, Ye L. Matrix metallopeptidase 9 contributes to the beginning of plaque and is a potential biomarker for the early identification of atherosclerosis in asymptomatic patients with diabetes. Front Endocrinol (Lausanne) 2024; 15:1369369. [PMID: 38660518 PMCID: PMC11039961 DOI: 10.3389/fendo.2024.1369369] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Aims To determine the roles of matrix metallopeptidase-9 (MMP9) on human coronary artery smooth muscle cells (HCASMCs) in vitro, early beginning of atherosclerosis in vivo in diabetic mice, and drug naïve patients with diabetes. Methods Active human MMP9 (act-hMMP9) was added to HCASMCs and the expressions of MCP-1, ICAM-1, and VCAM-1 were measured. Act-hMMP9 (n=16) or placebo (n=15) was administered to diabetic KK.Cg-Ay/J (KK) mice. Carotid artery inflammation and atherosclerosis measurements were made at 2 and 10 weeks after treatment. An observational study of newly diagnosed drug naïve patients with type 2 diabetes mellitus (T2DM n=234) and healthy matched controls (n=41) was performed and patients had ultrasound of carotid arteries and some had coronary computed tomography angiogram for the assessment of atherosclerosis. Serum MMP9 was measured and its correlation with carotid artery or coronary artery plaques was determined. Results In vitro, act-hMMP9 increased gene and protein expressions of MCP-1, ICAM-1, VCAM-1, and enhanced macrophage adhesion. Exogenous act-hMMP9 increased inflammation and initiated atherosclerosis in KK mice at 2 and 10 weeks: increased vessel wall thickness, lipid accumulation, and Galectin-3+ macrophage infiltration into the carotid arteries. In newly diagnosed T2DM patients, serum MMP9 correlated with carotid artery plaque size with a possible threshold cutoff point. In addition, serum MMP9 correlated with number of mixed plaques and grade of lumen stenosis in coronary arteries of patients with drug naïve T2DM. Conclusion MMP9 may contribute to the initiation of atherosclerosis and may be a potential biomarker for the early identification of atherosclerosis in patients with diabetes. Clinical trial registration https://clinicaltrials.gov, identifier NCT04424706.
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Affiliation(s)
- Bingli Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liping Su
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Sze Jie Loo
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Yu Gao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ester Khin
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Xiaocen Kong
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital Lee Kong Chian School of Medicine Nanyang Technological University Singapore, Singapore, Singapore
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Kok-Onn Lee
- Division of Endocrinology, Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
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2
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Leong SY, Lok WW, Goh KY, Ong HB, Tay HM, Su C, Kong F, Upadya M, Wang W, Radnaa E, Menon R, Dao M, Dalan R, Suresh S, Lim DWT, Hou HW. High-Throughput Microfluidic Extraction of Platelet-free Plasma for MicroRNA and Extracellular Vesicle Analysis. ACS Nano 2024; 18:6623-6637. [PMID: 38348825 DOI: 10.1021/acsnano.3c12862] [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] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Cell-free RNAs and extracellular vesicles (EVs) are valuable biomarkers in liquid biopsies, but they are prone to preanalytical variabilities such as nonstandardized centrifugation or ex vivo blood degradation. Herein, we report a high-throughput and label-free inertial microfluidic device (ExoArc) for isolation of platelet-free plasma from blood for RNA and EV analysis. Unlike conventional inertial microfluidic devices widely used for cell sorting, a submicrometer size cutoff (500 nm) was achieved which completely removed all leukocytes, RBCs, platelets, and cellular debris based on differential lateral migration induced by Dean vortices. The single-step operation also reduced platelet-associated miRNAs (∼2-fold) compared to centrifugation. We clinically validated ExoArc for plasma miRNA profiling (39 samples) and identified a 7-miRNA panel that detects non-small cell lung cancer with ∼90% sensitivity. ExoArc was also coupled with size exclusion chromatography (SEC) to isolate EVs within 50 min with ∼10-fold higher yield than ultracentrifugation. As a proof-of-concept for EV-based transcriptomics analysis, we performed miRNA analysis in healthy and type 2 diabetes mellitus (T2DM) subjects (n = 3 per group) by coupling ExoArc and ExoArc+SEC with quantitative polymerase chain reaction (RT-qPCR) assay. Among 293 miRNAs detected, plasmas and EVs showed distinct differentially expressed miRNAs in T2DM subjects. We further demonstrated automated in-line EV sorting from low volume culture media for continuous EV monitoring. Overall, the developed ExoArc offers a convenient centrifugation-free workflow to automate plasma and EV isolation for point-of-care diagnostics and quality control in EV manufacturing.
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Affiliation(s)
- Sheng Yuan Leong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798
| | - Wan Wei Lok
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798
| | - Kah Yee Goh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 168583
| | - Hong Boon Ong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798
| | - Hui Min Tay
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798
| | - Chengxun Su
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798
| | - Fang Kong
- School of Biological Sciences, Nanyang Technological University, Singapore 637551
| | - Megha Upadya
- School of Biological Sciences, Nanyang Technological University, Singapore 637551
| | - Wei Wang
- Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology and Research (A*STAR), Singapore 138634
| | - Enkhtuya Radnaa
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas 77555-1062, United States
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas 77555-1062, United States
| | - Ming Dao
- School of Biological Sciences, Nanyang Technological University, Singapore 637551
- Department of Material Science and Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Rinkoo Dalan
- Endocrine and Diabetes, Tan Tock Seng Hospital, Singapore 308433
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232
| | - Subra Suresh
- Department of Material Science and Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- School of Material Science and Engineering, Nanyang Technological University, Singapore 639798
| | - Darren Wan-Teck Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 168583
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore 138673
- Duke-NUS Medical School, Singapore 169857
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232
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3
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Batagov A, Dalan R, Wu A, Lai W, Tan CS, Eisenhaber F. Generalized metabolic flux analysis framework provides mechanism-based predictions of ophthalmic complications in type 2 diabetes patients. Health Inf Sci Syst 2023; 11:18. [PMID: 37008895 PMCID: PMC10060506 DOI: 10.1007/s13755-023-00218-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 02/19/2023] [Indexed: 03/31/2023] Open
Abstract
Chronic metabolic diseases arise from changes in metabolic fluxes through biomolecular pathways and gene networks accumulated over the lifetime of an individual. While clinical and biochemical profiles present just real-time snapshots of the patients' health, efficient computation models of the pathological disturbance of biomolecular processes are required to achieve individualized mechanistic insights into disease progression. Here, we describe the Generalized metabolic flux analysis (GMFA) for addressing this gap. Suitably grouping individual metabolites/fluxes into pools simplifies the analysis of the resulting more coarse-grain network. We also map non-metabolic clinical modalities onto the network with additional edges. Instead of using the time coordinate, the system status (metabolite concentrations and fluxes) is quantified as function of a generalized extent variable (a coordinate in the space of generalized metabolites) that represents the system's coordinate along its evolution path and evaluates the degree of change between any two states on that path. We applied GMFA to analyze Type 2 Diabetes Mellitus (T2DM) patients from two cohorts: EVAS (289 patients from Singapore) and NHANES (517) from the USA. Personalized systems biology models (digital twins) were constructed. We deduced disease dynamics from the individually parameterized metabolic network and predicted the evolution path of the metabolic health state. For each patient, we obtained an individual description of disease dynamics and predict an evolution path of the metabolic health state. Our predictive models achieve an ROC-AUC in the range 0.79-0.95 (sensitivity 80-92%, specificity 62-94%) in identifying phenotypes at the baseline and predicting future development of diabetic retinopathy and cataract progression among T2DM patients within 3 years from the baseline. The GMFA method is a step towards realizing the ultimate goal to develop practical predictive computational models for diagnostics based on systems biology. This tool has potential use in chronic disease management in medical practice. Supplementary Information The online version contains supplementary material available at 10.1007/s13755-023-00218-x.
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Affiliation(s)
- Arsen Batagov
- Mesh Bio Pte. Ltd., 10 Anson Rd, #22-02, 079903 Singapore, Singapore
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andrew Wu
- Mesh Bio Pte. Ltd., 10 Anson Rd, #22-02, 079903 Singapore, Singapore
| | - Wenbin Lai
- Mesh Bio Pte. Ltd., 10 Anson Rd, #22-02, 079903 Singapore, Singapore
| | - Colin S. Tan
- Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore, Singapore
- Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Frank Eisenhaber
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- School of Biological Science (SBS), Nanyang Technological University, Singapore, Singapore
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4
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Kong F, Upadya M, Wong ASW, Dalan R, Dao M. Isolating Small Extracellular Vesicles from Small Volumes of Blood Plasma using size exclusion chromatography and density gradient ultracentrifugation: A Comparative Study. bioRxiv 2023:2023.10.30.564707. [PMID: 37961562 PMCID: PMC10634961 DOI: 10.1101/2023.10.30.564707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Small extracellular vesicles (sEVs) are heterogeneous biological vesicles released by cells under both physiological and pathological conditions. Due to their potential as valuable diagnostic and prognostic biomarkers in human blood, there is a pressing need to develop effective methods for isolating high-purity sEVs from the complex milieu of blood plasma, which contains abundant plasma proteins and lipoproteins. Size exclusion chromatography (SEC) and density gradient ultracentrifugation (DGUC) are two commonly employed isolation techniques that have shown promise in addressing this challenge. In this study, we aimed to determine the optimal combination and sequence of SEC and DGUC for isolating sEVs from small plasma volumes, in order to enhance both the efficiency and purity of the resulting isolates. To achieve this, we compared sEV isolation using two combinations: SEC-DGUC and DGUC-SEC, from unit volumes of 500 μl plasma. Both protocols successfully isolated high-purity sEVs; however, the SEC-DGUC combination yielded higher sEV protein and RNA content. We further characterized the isolated sEVs obtained from the SEC-DGUC protocol using flow cytometry and mass spectrometry to assess their quality and purity. In conclusion, the optimized SEC-DGUC protocol is efficient, highly reproducible, and well-suited for isolating high-purity sEVs from small blood volumes.
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Affiliation(s)
- Fang Kong
- School of Biological Sciences, Nanyang Technological University, SINGAPORE
| | - Megha Upadya
- School of Biological Sciences, Nanyang Technological University, SINGAPORE
| | - Andrew See Weng Wong
- Facility for Analysis, Characterisation, Testing and Simulation, Nanyang Technological University, SINGAPORE
| | - Rinkoo Dalan
- Lee Kong Chian School of Medicine, Nanyang Technological University, SINGAPORE
| | - Ming Dao
- School of Biological Sciences, Nanyang Technological University, SINGAPORE
- Department of Material Science and Engineering, Massachusetts Institute of Technology, USA
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5
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Fan BE, Mucheli SS, Tang YL, Yong E, Dalan R, Cheung C, Young BE, Lye DCB, Wang L, Tan CW, Lim KHT, Sum CLL, Gallardo CA, Christopher D, Leung BP, Lim XR, Wong SW, Chia YW, Chong VCL. Post COVID-19 Large Vessel Vasculopathy in a Previously Healthy Young Male. Semin Thromb Hemost 2023. [PMID: 37748516 DOI: 10.1055/s-0043-1774793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Bingwen Eugene Fan
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shravan Sadasiv Mucheli
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Yee Lin Tang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Enming Yong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rinkoo Dalan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Christine Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - Barnaby Edward Young
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
| | - David Chien Boon Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Linfa Wang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
- Singhealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - Chee Wah Tan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Kiat Hon Tony Lim
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | | | - Christian Aledia Gallardo
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Dheepa Christopher
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bernard PuiLam Leung
- Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Xin Rong Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shiun Woei Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yew Woon Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vanessa Cui Lian Chong
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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6
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Abstract
Neutrophils are the most abundant circulating white blood cells and one of their critical functions to eliminate pathogenic threats includes the release of extracellular DNA, also known as neutrophil extracellular traps (NETs), which is dysregulated in many diseases including cancer, type 2 diabetes mellitus and infectious diseases. Currently, conventional methods to quantify the NET formation (NETosis) rely on fluorescence antibody-based NET labelling or circulating NET-associated protein detection by ELISA, which are expensive, laborious, and time-consuming. In this work, we employed a novel "virtual staining" using deep convolutional neural networks (CNNs) to facilitate label-free quantification of NETs trapped in a micropillar array in a microfluidic device. Virtual staining is constructed to establish relations between morphological features in phase contrast images and fluorescence features in Sytox-green (DNA dye) images. We first investigated the effect of different learning rates on model training and optimized the learning rate to achieve the best model which can provide outputs close to Sytox green staining based on various reconstruction metrics (e.g., structural similarity (SSIM) and pixel-wise error (MAE, MSE)). The virtual staining of different NET concentrations was investigated which showed a linear correlation with fluorescent staining. As a proof of concept for clinical testing, the model was used to characterize purified neutrophils treated with NETosis inducers, including lipopolysaccharide (LPS), phorbol 12-myristate 13-acetate (PMA), and calcium ionophore (CaI), and successfully detected different NET profiles for different treatments. Collectively, these results demonstrated the potential of using deep learning for enhanced label-free image analysis of NETs for clinical research, drug discovery and point-of-care testing of diseases.
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Affiliation(s)
- Chayakorn Petchakup
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Siong Onn Wong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
| | - Rinkoo Dalan
- Endocrinology Department, Tan Tock Seng Hospital, Singapore
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Blk N3, Level 2, Room 86 (N3-02c-86), 639798, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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7
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Jie Chee Y, Dalan R. Repurposing exercise training and pharmacological therapies to address the post-acute sequelae of COVID-19 (PASC) in diabetes mellitus. Diabetes Res Clin Pract 2023; 199:110651. [PMID: 37015258 PMCID: PMC10073874 DOI: 10.1016/j.diabres.2023.110651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Ying Jie Chee
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore.
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University Singapore.
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Mina T, Yew YW, Ng HK, Sadhu N, Wansaicheong G, Dalan R, Low DYW, Lam BCC, Riboli E, Lee ES, Ngeow J, Elliott P, Griva K, Loh M, Lee J, Chambers J. Adiposity impacts cognitive function in Asian populations: an epidemiological and Mendelian Randomization study. Lancet Reg Health West Pac 2023; 33:100710. [PMID: 36851942 PMCID: PMC9957736 DOI: 10.1016/j.lanwpc.2023.100710] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
Background Obesity and related metabolic disturbances including diabetes, hypertension and hyperlipidemia predict future cognitive decline. Asia has a high prevalence of both obesity and metabolic disease, potentially amplifying the future burden of dementia in the region. We aimed to investigate the impact of adiposity and metabolic risk on cognitive function in Asian populations, using an epidemiological analysis and a two-sample Mendelian Randomization (MR) study. Methods The Health for Life in Singapore (HELIOS) Study is a population-based cohort of South-East-Asian men and women in Singapore, aged 30-84 years. We analyzed 8769 participants with metabolic and cognitive data collected between 2018 and 2021. Whole-body fat mass was quantified with Dual X-Ray Absorptiometry (DEXA). Cognition was assessed using a computerized cognitive battery. An index of general cognition ' g ' was derived through factor analysis. We tested the relationship of fat mass indices and metabolic measures with ' g ' using regression approaches. We then performed inverse-variance-weighted MR of adiposity and metabolic risk factors on ' g ', using summary statistics for genome-wide association studies of BMI, visceral adipose tissue (VAT), waist-hip-ratio (WHR), blood pressure, HDL cholesterol, triglycerides, fasting glucose, HbA1c, and general cognition. Findings Participants were 58.9% female, and aged 51.4 (11.3) years. In univariate analysis, all 29 adiposity and metabolic measures assessed were associated with ' g ' at P < 0.05. In multivariable analyses, reduced ' g ' was consistently associated with increased visceral fat mass index and lower HDL cholesterol (P < 0.001), but not with blood pressure, triglycerides, or glycemic indices. The reduction in ' g ' associated with 1SD higher visceral fat, or 1SD lower HDL cholesterol, was equivalent to a 0.7 and 0.9-year increase in chronological age respectively (P < 0.001). Inverse variance MR analyses showed that reduced ' g ' is associated with genetically determined elevation of VAT, BMI and WHR (all P < 0.001). In contrast, MR did not support a causal role for blood pressure, lipid, or glycemic indices on cognition. Interpretation We show an independent relationship between adiposity and cognition in a multi-ethnic Asian population. MR analyses suggest that both visceral adiposity and raised BMI are likely to be causally linked to cognition. Our findings have important implications for preservation of cognitive health, including further motivation for action to reverse the rising burden of obesity in the Asia-Pacific region. Funding The Nanyang Technological University-the Lee Kong Chian School of Medicine, National Healthcare Group, National Medical Research Council, Ministry of Education, Singapore.
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Affiliation(s)
- Theresia Mina
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Yik Weng Yew
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,National Skin Centre, Research Division, 1 Mandalay Rd, 308205, Singapore
| | - Hong Kiat Ng
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Nilanjana Sadhu
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Gervais Wansaicheong
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,Department of Diagnostic Radiology, Tan Tock Seng Hospital (TTSH), 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Rinkoo Dalan
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,Department of Endocrinology, TTSH, Singapore
| | - Dorrain Yan Wen Low
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Benjamin Chih Chiang Lam
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,Khoo Teck Puat Hospital, Integrated Care for Obesity & Diabetes, 90 Yishun Central, 768828, Singapore
| | - Elio Riboli
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 152 Medical School, St Mary's Campus, London, W2 1NY, United Kingdom
| | - Eng Sing Lee
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,Clinical Research Unit, National Healthcare Group Polyclinic, 3 Fusionopolis Link, Nexus@one-north, #05-10, 138543, Singapore
| | - Joanne Ngeow
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,Division of Medical Oncology, National Cancer Centre, 11 Hospital Drive, 169610, Singapore
| | - Paul Elliott
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 152 Medical School, St Mary's Campus, London, W2 1NY, United Kingdom
| | - Konstadina Griva
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Marie Loh
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,National Skin Centre, Research Division, 1 Mandalay Rd, 308205, Singapore
| | - Jimmy Lee
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,Research Division, Institute of Mental Health, 539747, Singapore
| | - John Chambers
- Nanyang Technological University Lee Kong Chian School of Medicine, Level 18 Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 152 Medical School, St Mary's Campus, London, W2 1NY, United Kingdom
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9
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Vadassery SJ, Seneviratna A, Ho EW, Dalan R. Polyuria after spinal cord injury. Singapore Med J 2023:370787. [PMID: 36926738 DOI: 10.4103/singaporemedj.smj-2020-532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
| | - Aruni Seneviratna
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, we, Singapore
| | - Ernest Weisheng Ho
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Department of Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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10
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Wang SSY, Chee K, Wong SW, Tan GB, Ang H, Leung BP, Tan CW, Ramanathan K, Dalan R, Cheung C, Lye DC, Young BE, Yap ES, Chia YW, Fan BE. Increased Platelet Activation demonstrated by Elevated CD36 and P-Selectin Expression in 1-Year Post-Recovered COVID-19 Patients. Semin Thromb Hemost 2023. [PMID: 36781153 DOI: 10.1055/s-0043-1762578] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
| | | | - Shiun Woei Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Guat Bee Tan
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hong Ang
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bernard PuiLam Leung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore.,Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chuen Wen Tan
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Rinkoo Dalan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Christine Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - David Chien Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore
| | - Barnaby Edward Young
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore
| | - Eng Soo Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Haematology-Oncology, National University Health System, Singapore, Singapore
| | - Yew Woon Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bingwen Eugene Fan
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore.,Becton Dickinson, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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11
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Chee YJ, Fan BE, Young BE, Dalan R, Lye DC. Clinical trials on the pharmacological treatment of long COVID: A systematic review. J Med Virol 2023; 95:e28289. [PMID: 36349400 PMCID: PMC9878018 DOI: 10.1002/jmv.28289] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 08/15/2022] [Revised: 10/20/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022]
Abstract
The postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), also known as post-acute coronavirus disease 19 (COVID-19) or the long COVID syndrome (long COVID) is an emerging public health concern. A substantial proportion of individuals may remain symptomatic months after initial recovery. An updated review of published and ongoing trials focusing on managing long COVID will help identify gaps and address the unmet needs of patients suffering from this potentially debilitating syndrome. A comprehensive literature search was conducted on the international databases and clinical trial registries from inception to 31 July 2022. This review included 6 published trials and 54 trial registration records. There is significant heterogeneity in the characterization of long COVID and ascertainment of primary outcomes. Most of the trials are focused on individual symptoms of long COVID or isolated organ dysfunction, classified according to cardiovascular, respiratory and functional capacity, neurological and psychological, fatigue, and olfactory dysfunction. Most of the interventions are related to the mechanisms causing the individual symptoms. Although the six published trials showed significant improvement in the symptoms or organ dysfunction studied, these initial studies lack internal and external validity limiting the generalizability. This review provides an update of the pharmacological agents that could be used to treat long COVID. Further standardization of the diagnostic criteria, inclusion of participants with concomitant chronic cardiometabolic diseases and standardization of outcomes will be essential in future clinical trials.
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Affiliation(s)
- Ying Jie Chee
- Department of EndocrinologyTan Tock Seng HospitalSingaporeSingapore
| | | | - Barnaby Edward Young
- National Centre for Infectious DiseasesSingaporeSingapore,Department of Infectious DiseasesTan Tock Seng HospitalSingaporeSingapore,Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Rinkoo Dalan
- Department of EndocrinologyTan Tock Seng HospitalSingaporeSingapore,Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - David C. Lye
- National Centre for Infectious DiseasesSingaporeSingapore,Department of Infectious DiseasesTan Tock Seng HospitalSingaporeSingapore,Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore,Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
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12
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Zhang Z, Dalan R, Hu Z, Wang JW, Chew NW, Poh KK, Tan RS, Soong TW, Dai Y, Ye L, Chen X. Reactive Oxygen Species Scavenging Nanomedicine for the Treatment of Ischemic Heart Disease. Adv Mater 2022; 34:e2202169. [PMID: 35470476 DOI: 10.1002/adma.202202169] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/08/2022] [Indexed: 06/14/2023]
Abstract
Ischemic heart disease (IHD) is the leading cause of disability and mortality worldwide. Reactive oxygen species (ROS) have been shown to play key roles in the progression of diabetes, hypertension, and hypercholesterolemia, which are independent risk factors that lead to atherosclerosis and the development of IHD. Engineered biomaterial-based nanomedicines are under extensive investigation and exploration, serving as smart and multifunctional nanocarriers for synergistic therapeutic effect. Capitalizing on cell/molecule-targeting drug delivery, nanomedicines present enhanced specificity and safety with favorable pharmacokinetics and pharmacodynamics. Herein, the roles of ROS in both IHD and its risk factors are discussed, highlighting cardiovascular medications that have antioxidant properties, and summarizing the advantages, properties, and recent achievements of nanomedicines that have ROS scavenging capacity for the treatment of diabetes, hypertension, hypercholesterolemia, atherosclerosis, ischemia/reperfusion, and myocardial infarction. Finally, the current challenges of nanomedicines for ROS-scavenging treatment of IHD and possible future directions are discussed from a clinical perspective.
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Affiliation(s)
- Zhan Zhang
- Cancer Centre and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, 999078, China
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 408433, Singapore
| | - Zhenyu Hu
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Jiong-Wei Wang
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Department of Diagnostic Radiology and Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Nicholas Ws Chew
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, 119074, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, 119074, Singapore
| | - Ru-San Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, 119609, Singapore
| | - Tuck Wah Soong
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Yunlu Dai
- Cancer Centre and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, 999078, China
- MoE Frontiers Science Center for Precision Oncology, University of Macao, Taipa, Macau SAR, 999078, China
| | - Lei Ye
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Xiaoyuan Chen
- Department of Diagnostic Radiology and Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Department of Chemical and Biomolecular Engineering and Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, 117597, Singapore
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
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13
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Dalan R. Racial differences in oxidative stress index in diabetes enriched multiethnic population of Singapore. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Chee Y, Dalan R. Systolic blood pressure, mediated by arterial stiffness, is associated with carotid intima-media thickness in women but not men with type 2 diabetes mellitus. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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15
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Chee Y, Dalan R. Sex differences in subclinical atherosclerosis. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Fan BE, Wong SW, Sum CLL, Lim GH, Leung BP, Tan CW, Ramanathan K, Dalan R, Cheung C, Lim XR, Sadasiv MS, Lye DC, Young BE, Yap ES, Chia YW. Hypercoagulability, endotheliopathy, and inflammation approximating 1 year after recovery: Assessing the long-term outcomes in COVID-19 patients. Am J Hematol 2022; 97:915-923. [PMID: 35477923 PMCID: PMC9073976 DOI: 10.1002/ajh.26575] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 12/23/2022]
Abstract
Sustained hypercoagulability and endotheliopathy are present in convalescent COVID‐19 patients for up to 4 months from recovery. The hemostatic, endothelial, and inflammatory profiles of 39 recovered COVID‐19 patients were evaluated up to 16 months after recovery from COVID‐19. These values were compared with a control group of healthy volunteers (n = 124). 39 patients (71.8% males, median age 43 years) were reviewed at a mean of 12.7 ± 3.6 months following recovery. One patient without cardiovascular risk factors had post COVID‐19 acute ischaemic limb. Elevated D‐dimer and Factor VIII levels above normal ranges were noted in 17.9% (7/39) and 48.7% (19/39) of patients respectively, with a higher median D‐dimer 0.34 FEU μg/mL (IQR 0.28, 0.46) (p < .001) and Factor VIII 150% (IQR 171, 203) (p = .004), versus controls. Thrombin generation (Thromboscreen) showed a higher median endogenous thrombin potential (ETP) of 1352 nM*min (IQR 1152, 1490) (p = .002) and a higher median peak height of 221.4 nM (IQR 170.2, 280.4) (p = 0.01) and delayed lag time 2.4 min (1.42–2.97) (p = 0.0002) versus controls. Raised vWF:Ag and ICAM‐1 levels were observed in 17.9% (7/39) and 7.7% (3/39) of patients respectively, with a higher median VWF:Ag 117% (IQR 86, 154) (p = 0.02) and ICAM‐1 54.1 ng/mL (IQR 43.8, 64.1) (p = .004) than controls. IL‐6 was noted to be raised in 35.9% (14/39) of patients, with a higher median IL‐6 of 1.5 pg/mL (IQR 0.6, 3.0) (p = 0.004) versus controls. Subgroup analysis stratifying patients by COVID‐19 severity and COVID‐19 vaccination preceding SARS‐CoV‐2 infection did not show statistically significant differences. Hypercoagulability, endothelial dysfunction, and inflammation are still detectable in some patients approximately 1 year after recovery from COVID‐19.
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Affiliation(s)
- Bingwen Eugene Fan
- Department of Haematology Tan Tock Seng Hospital Singapore
- Department of Laboratory Medicine Khoo Teck Puat Hospital Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Shiun Woei Wong
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Cardiology Tan Tock Seng Hospital Singapore
| | | | - Gek Hsiang Lim
- Clinical Research and Innovation Office Tan Tock Seng Hospital Singapore
| | - Bernard PuiLam Leung
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Health and Social Sciences Singapore Institute of Technology Singapore
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore
| | - Chuen Wen Tan
- Department of Haematology Singapore General Hospital Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Cardiothoracic and Vascular Surgery National University Heart Centre Singapore
| | - Rinkoo Dalan
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Endocrinology Tan Tock Seng Hospital Singapore
| | - Christine Cheung
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Institute of Molecular and Cell Biology, A*STAR Singapore
| | - Xin Rong Lim
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore
| | - Mucheli Shravan Sadasiv
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Infectious Diseases Tan Tock Seng Hospital Singapore
- National Centre for Infectious Diseases Singapore
| | - David Chien Lye
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Infectious Diseases Tan Tock Seng Hospital Singapore
- National Centre for Infectious Diseases Singapore
| | - Barnaby Edward Young
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Infectious Diseases Tan Tock Seng Hospital Singapore
- National Centre for Infectious Diseases Singapore
| | - Eng Soo Yap
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Haematology‐Oncology National University Health System Singapore
| | - Yew Woon Chia
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Department of Cardiology Tan Tock Seng Hospital Singapore
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17
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Demashkieh M, Dalan R, Burns SF. Cardiorespiratory fitness and fat oxidation during exercise in Chinese, Indian, Malay men with elevated body mass index. Appl Physiol Nutr Metab 2022; 47:888-892. [PMID: 35679614 DOI: 10.1139/apnm-2022-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A cross-sectional pilot investigation in Chinese, Indian and Malay men (15 each) with elevated BMI to compare: (i) cardiorespiratory fitness (CRF); and (ii) fat oxidation at rest and maximal fat oxidation during exercise. Predicted CRF (Chinese: 37.0 (5.1) mL/kg/min; Indian: 34.8 (5.6) mL/kg/min; Malay: 33.0 (7.1) mL/kg/min; P = 0.208) and resting fat oxidation were similar among groups. Maximal fat oxidation during exercise was lower in Indian (3.81 (1.02) mg/kg/min, P = 0.004) and Malay (Malay: 3.36 (0.95) mg/kg/min, P < 0.001) than Chinese (5.17 (1.23) mg/kg/min) men. Fat oxidation during exercise may contribute toward obesity risk in Asian populations. ClinicalTrials.gov Identifier: NCT05337111.
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Affiliation(s)
- Mayada Demashkieh
- Nanyang Technological University National Institute of Education, 63238, Singapore, Singapore, Singapore;
| | - Rinkoo Dalan
- Nanyang Technological University, 54761, Singapore, Singapore, Singapore.,Tan Tock Seng Hospital, 63703, Department of Endocrinology, Singapore, Singapore;
| | - Stephen Francis Burns
- Nanyang Technological University National Institute of Education, 63238, Singapore, Singapore, Singapore;
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18
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Chee YJ, Liew H, Hoi WH, Lee Y, Lim B, Chin HX, Lai RTR, Koh Y, Tham M, Seow CJ, Quek ZH, Chen AW, Lim Quek TP, Tan AWK, Dalan R. SARS-CoV-2 mRNA Vaccination and Graves' Disease: A Report of 12 Cases and Review of the Literature. J Clin Endocrinol Metab 2022; 107:e2324-e2330. [PMID: 35235663 PMCID: PMC8903505 DOI: 10.1210/clinem/dgac119] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Indexed: 12/31/2022]
Abstract
CONTEXT AND OBJECTIVE Thyroid autoimmunity has been reported to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the SARS-CoV-2 vaccination recently. We report a series of patients who presented with new onset or relapse of Graves' disease-related hyperthyroidism shortly after receiving the SARS-CoV-2 messenger RNA (mRNA) vaccine at a single tertiary institution in Singapore. METHODS AND RESULTS We describe 12 patients who developed hyperthyroidism within a relatively short interval (median onset, 17 [range, 5-63] days) after receiving the SARS-CoV-2 mRNA vaccine. The majority were females (11/12) with median age of 35.5 (range, 22-74) years. Six patients had new-onset hyperthyroidism, whereas the other 6 had relapse of previously well-controlled Graves' disease. TSH receptor antibody concentrations ranged from 2.4 to 32 IU/L. The majority of the patients were able to go for the second dose of the vaccine without any further exacerbations. Literature review revealed 21 other similar cases reported from across the world. CONCLUSION Our case series provides insight into the characteristics of individuals in whom Graves' disease was triggered by the SARS-CoV-2 vaccination. Clinicians need to be vigilant of precipitation or exacerbation of autoimmune thyroid disorders in predisposed individuals after exposure to the SARS-CoV-2 vaccination. Further epidemiological and mechanistic studies are required to elucidate the possible associations between the SARS-CoV-2 vaccines and the development of thyroid autoimmunity.
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Affiliation(s)
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital
| | - Wai Han Hoi
- Department of Endocrinology, Tan Tock Seng Hospital
| | - Yingshan Lee
- Department of Endocrinology, Tan Tock Seng Hospital
| | - Brenda Lim
- Department of Endocrinology, Tan Tock Seng Hospital
| | - Han Xin Chin
- Department of Endocrinology, Tan Tock Seng Hospital
| | | | - Yunqing Koh
- Department of Endocrinology, Tan Tock Seng Hospital
| | | | | | - Zhi Han Quek
- Department of Endocrinology, Tan Tock Seng Hospital
| | | | | | | | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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19
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Petchakup C, Yang H, Gong L, He L, Tay HM, Dalan R, Chung AJ, Li KHH, Hou HW. Microfluidic Impedance-Deformability Cytometry for Label-Free Single Neutrophil Mechanophenotyping. Small 2022; 18:e2104822. [PMID: 35253966 DOI: 10.1002/smll.202104822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/03/2022] [Indexed: 06/14/2023]
Abstract
The intrinsic biophysical states of neutrophils are associated with immune dysfunctions in diseases. While advanced image-based biophysical flow cytometers can probe cell deformability at high throughput, it is nontrivial to couple different sensing modalities (e.g., electrical) to measure other critical cell attributes including cell viability and membrane integrity. Herein, an "optics-free" impedance-deformability cytometer for multiparametric single cell mechanophenotyping is reported. The microfluidic platform integrates hydrodynamic cell pinching, and multifrequency impedance quantification of cell size, deformability, and membrane impedance (indicative of cell viability and activation). A newly-defined "electrical deformability index" is validated by numerical simulations, and shows strong correlations with the optical cell deformability index of HL-60 experimentally. Human neutrophils treated with various biochemical stimul are further profiled, and distinct differences in multimodal impedance signatures and UMAP analysis are observed. Overall, the integrated cytometer enables label-free cell profiling at throughput of >1000 cells min-1 without any antibodies labeling to facilitate clinical diagnostics.
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Affiliation(s)
- Chayakorn Petchakup
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Haoning Yang
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Lingyan Gong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Linwei He
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Hui Min Tay
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Rinkoo Dalan
- Endocrinology Department, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng Road, Singapore, 308433, Singapore
| | - Aram J Chung
- School of Biomedical Engineering, Korea University, Seoul, 02841, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, 02841, Republic of Korea
| | - King Ho Holden Li
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Sciences Building Level 11, Singapore, 308232, Singapore
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20
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Abstract
ABSTRACT Anastomosing hemangioma (AH) is a rare benign vascular lesion that primarily involves the genitourinary tract. Cases have also rarely been reported in other organs. AH is often discovered incidentally and resembles angiosarcoma histologically. On imaging, it may mimic other vascular lesions such as renal cell carcinoma and neuroendocrine tumors. We present a case of a 32-year-old woman with incidentally detected AH involving the kidneys, adrenal glands, liver, and retroperitoneum, initially presumed to be neuroendocrine tumors based on imaging findings on CT and 68Ga-DOTATATE PET scans.
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Affiliation(s)
- Wei Ming Chua
- From the Division of Radiological Sciences, Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital
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21
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Leong SY, Ong HB, Tay HM, Kong F, Upadya M, Gong L, Dao M, Dalan R, Hou HW. Microfluidic Size Exclusion Chromatography (μSEC) for Extracellular Vesicles and Plasma Protein Separation. Small 2022; 18:e2104470. [PMID: 34984816 DOI: 10.1002/smll.202104470] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/02/2021] [Indexed: 05/04/2023]
Abstract
Extracellular vesicles (EVs) are recognized as next generation diagnostic biomarkers due to their disease-specific biomolecular cargoes and importance in cell-cell communications. A major bottleneck in EV sample preparation is the inefficient and laborious isolation of nanoscale EVs (≈50-200 nm) from endogenous proteins in biological samples. Herein, a unique microfluidic platform is reported for EV-protein fractionation based on the principle of size exclusion chromatography (SEC). Using a novel rapid (≈20 min) replica molding technique, a fritless microfluidic SEC device (μSEC) is fabricated using thiol-ene polymer (UV glue NOA81, Young's modulus ≈1 GPa) for high pressure (up to 6 bar) sample processing. Controlled on-chip nanoliter sample plug injection (600 nL) using a modified T-junction injector is first demonstrated with rapid flow switching response time (<1.5 s). Device performance is validated using fluorescent nanoparticles (50 nm), albumin, and breast cancer cells (MCF-7)-derived EVs. As a proof-of-concept for clinical applications, EVs are directly isolated from undiluted human platelet-poor plasma using μSEC and show distinct elution profiles between EVs and proteins based on nanoparticle particle analysis (NTA), Western blot and flow cytometry analysis. Overall, the optically transparent μSEC can be readily automated and integrated with EV detection assays for EVs manufacturing and clinical diagnostics.
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Affiliation(s)
- Sheng Yuan Leong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Hong Boon Ong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Hui Min Tay
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Fang Kong
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore, 637551, Singapore
| | - Megha Upadya
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore, 637551, Singapore
| | - Lingyan Gong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Ming Dao
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore, 637551, Singapore
- Department of Material Science and Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - Rinkoo Dalan
- Endocrine and Diabetes, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Sciences Building, Singapore, 308232, Singapore
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Sciences Building, Singapore, 308232, Singapore
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22
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Su L, Kong X, Loo S, Gao Y, Liu B, Su X, Dalan R, Ma J, Ye L. Thymosin beta-4 improves endothelial function and reparative potency of diabetic endothelial cells differentiated from patient induced pluripotent stem cells. Stem Cell Res Ther 2022; 13:13. [PMID: 35012642 PMCID: PMC8751378 DOI: 10.1186/s13287-021-02687-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Prior studies show that signature phenotypes of diabetic human induced pluripotent stem cells derived endothelial cells (dia-hiPSC-ECs) are disrupted glycine homeostasis, increased senescence, impaired mitochondrial function and angiogenic potential as compared with healthy hiPSC-ECs. In the current study, we aimed to assess the role of thymosin β-4 (Tb-4) on endothelial function using dia-hiPSC-ECs as disease model of endothelial dysfunction. Methods and results Using dia-hiPSC-ECs as models of endothelial dysfunction, we determined the effect of Tb-4 on cell proliferation, senescence, cyto-protection, protein expression of intercellular adhesion molecule-1 (ICAM-1), secretion of endothelin-1 and MMP-1, mitochondrial membrane potential, and cyto-protection in vitro and angiogenic potential for treatment of ischemic limb disease in a mouse model of type 2 diabetes mellitus (T2DM) in vivo. We found that 600 ng/mL Tb4 significantly up-regulated AKT activity and Bcl-XL protein expression, enhanced dia-hiPSC-EC viability and proliferation, limited senescence, reduced endothelin-1 and MMP-1 secretion, and improved reparative potency of dia-hiPSC-ECs for treatment of ischemic limb disease in mice with T2DM. However, Tb4 had no effect on improving mitochondrial membrane potential and glycine homeostasis and reducing intercellular adhesion molecule-1 protein expression in dia-hiPSC-ECs. Conclusions Tb-4 improves endothelial dysfunction through enhancing hiPSC-EC viability, reducing senescence and endothelin-1 production, and improves angiogenic potency in diabetes.
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Affiliation(s)
- Liping Su
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, 169609, Singapore
| | - Xiaocen Kong
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Szejie Loo
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, 169609, Singapore
| | - Yu Gao
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Bingli Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China.
| | - Lei Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, 169609, Singapore.
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Dalan R, Bornstein SR, Boehm BO. Cushing's Disease Management: Glimpse Into 2051. Front Endocrinol (Lausanne) 2022; 13:943993. [PMID: 35872988 PMCID: PMC9299426 DOI: 10.3389/fendo.2022.943993] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Major advancements are expected in medicine and healthcare in the 21st century- "Digital Age", mainly due to the application of data technologies and artificial intelligence into healthcare. In this perspective article we share a short story depicting the future Cushings' Disease patient and the postulated diagnostic and management approaches. In the discussion, we explain the advances in recent times which makes this future state plausible. We postulate that endocrinology care will be completely reinvented in the Digital Age.
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Affiliation(s)
- Rinkoo Dalan
- Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- *Correspondence: Rinkoo Dalan,
| | - Stefan R. Bornstein
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
- Division of Diabetes and Nutritional Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, University Hospital, Zürich, Switzerland
| | - Bernhard O. Boehm
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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24
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Su C, Chuah YJ, Ong HB, Tay HM, Dalan R, Hou HW. A Facile and Scalable Hydrogel Patterning Method for Microfluidic 3D Cell Culture and Spheroid-in-Gel Culture Array. Biosensors (Basel) 2021; 11:bios11120509. [PMID: 34940266 PMCID: PMC8699815 DOI: 10.3390/bios11120509] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 05/14/2023]
Abstract
Incorporation of extracellular matrix (ECM) and hydrogel in microfluidic 3D cell culture platforms is important to create a physiological microenvironment for cell morphogenesis and to establish 3D co-culture models by hydrogel compartmentalization. Here, we describe a simple and scalable ECM patterning method for microfluidic cell cultures by achieving hydrogel confinement due to the geometrical expansion of channel heights (stepped height features) and capillary burst valve (CBV) effects. We first demonstrate a sequential "pillar-free" hydrogel patterning to form adjacent hydrogel lanes in enclosed microfluidic devices, which can be further multiplexed with one to two stepped height features. Next, we developed a novel "spheroid-in-gel" culture device that integrates (1) an on-chip hanging drop spheroid culture and (2) a single "press-on" hydrogel confinement step for rapid ECM patterning in an open-channel microarray format. The initial formation of breast cancer (MCF-7) spheroids was achieved by hanging a drop culture on a patterned polydimethylsiloxane (PDMS) substrate. Single spheroids were then directly encapsulated on-chip in individual hydrogel islands at the same positions, thus, eliminating any manual spheroid handling and transferring steps. As a proof-of-concept to perform a spheroid co-culture, endothelial cell layer (HUVEC) was formed surrounding the spheroid-containing ECM region for drug testing studies. Overall, this developed stepped height-based hydrogel patterning method is simple to use in either enclosed microchannels or open surfaces and can be readily adapted for in-gel cultures of larger 3D cellular spheroids or microtissues.
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Affiliation(s)
- Chengxun Su
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore; (C.S.); (Y.J.C.); (H.B.O.); (H.M.T.)
- Interdisciplinary Graduate School, Nanyang Technological University, Singapore 639798, Singapore
| | - Yon Jin Chuah
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore; (C.S.); (Y.J.C.); (H.B.O.); (H.M.T.)
| | - Hong Boon Ong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore; (C.S.); (Y.J.C.); (H.B.O.); (H.M.T.)
| | - Hui Min Tay
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore; (C.S.); (Y.J.C.); (H.B.O.); (H.M.T.)
| | - Rinkoo Dalan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
- Endocrinology Department, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore; (C.S.); (Y.J.C.); (H.B.O.); (H.M.T.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
- Correspondence:
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25
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Lee BWW, Bundele MM, Tan R, Fu EWZ, Chew AS, Wong JSH, Siew CCH, Lim BSP, Dalan R, Lim MY, Gan YJ, Li H. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore. Ann Acad Med Singap 2021; 50:903-910. [PMID: 34985102 DOI: 10.47102/annals-acadmedsg.2021243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) on the risk of malignancy (ROM) in fine-needle aspiration cytology (FNAC) per The Bethesda System for Reporting Thyroid Cytopathology has not been well reported in Singapore. METHODS We retrospectively identified 821 thyroid nodules with preoperative FNAC from 788 patients out of 1,279 consecutive thyroidectomies performed between January 2010 and August 2016 in a tertiary general hospital in Singapore. Possible cases of NIFTP were reviewed for reclassification and the impact of NIFTP on ROM was analysed. RESULTS The incidence of NIFTP was 1.2% (10 out of 821). If NIFTP is considered benign, ROM in Bethesda I through VI were 8.6%, 3.5%, 26.3%, 20.0%, 87.7%, 97.0% versus 8.6%, 4.2%, 28.1%, 26.7%, 89.2% and 100% if NIFTP is considered malignant. Eight patients with NIFTP had follow-up of 15 to 110 months. One had possible rib metastasis as evidenced by I131 uptake but remained free of structural or biochemical disease during a follow-up period of 110 months. None had lymph node metastasis at presentation, nor locoregional or distant recurrence. CONCLUSION Classifying NIFTP as benign decreased ROM in Bethesda II through VI, but the benignity of NIFTP requires more prospective studies to ascertain. The impact of NIFTP on ROM in our institution also appears to be lower than that reported in the Western studies.
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Affiliation(s)
- Bryan Wei Wen Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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26
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Xu C, Yong MY, Koh ET, Dalan R, Leong KP. The impact of diabetes mellitus on treatment and outcomes of rheumatoid arthritis at 5-year follow-up: results from a multi-ethnic Asian cohort. Rheumatol Adv Pract 2021; 5:rkab077. [PMID: 34778702 PMCID: PMC8578689 DOI: 10.1093/rap/rkab077] [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: 03/26/2021] [Accepted: 10/11/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives We evaluated the impact of type 2 diabetes mellitus (T2DM) on RA treatment and outcomes in a longitudinal RA cohort. Methods We analysed data collected in the period 2001-2013 involving 583 RA patients, including demographics, diabetes diagnosis, clinical features, treatment, ACR functional class, HAQ, and quality-of-life measurement using the Short-Form 36. Results Seventy-seven (13.2%) of the RA patients had T2DM. DAS28 was not different in patients with T2DM at 5 years post-RA diagnosis. Fewer T2DM patients received MTX than those without T2DM (51% vs 80%, P < 0.001). Using univariate analysis, T2DM patients were more likely to experience poorer outcomes in terms of ACR functional status (P = 0.009), joint surgery (P = 0.007), knee arthroplasty (P < 0.001) and hospital admissions (P = 0.006). Multivariate regression analyses showed more knee arthroplasty (P = 0.047) in patients with T2DM. Conclusion Fewer patients with T2DM received MTX compared with those without T2DM. Patients with RA and T2DM were at higher risk of knee arthroplasty than RA patients without T2DM.
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Affiliation(s)
- Chuanhui Xu
- Department of Rheumatology, Allergy and Immunology
| | - Mei Yun Yong
- Department of Rheumatology, Allergy and Immunology
| | - Ee Tzun Koh
- Department of Rheumatology, Allergy and Immunology
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
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Dalan R, Mina T, Nur Azizah NA, Tong T, Loh M, Wansaicheong G, Chambers J. Sex modifies the association between body mass index and carotid artery intima media thickness in the multi-ethnic Singapore population. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aims
Globally cardiovascular disease (CVD) risk is higher in men than in women in the younger age group but the risk is attenuated in later life with an unexpected higher risk in women in some populations. A better understanding of sex differences in CVD is needed. Carotid artery intima-media thickness (CIMT) has been proposed for CVD risk assessment in individuals at intermediate risk. We study the gender interactions in the associations of the traditional cardiovascular risk factors with CIMT.
Methods
We performed carotid ultrasonography in the large population health study-HELIOS conducted in Singapore. Measurements were performed as per Mannheim consensus, at the far wall of bilateral common carotid artery at 8 sites in each participant. We report the average of all measurements (avgCIMT) and maximum value (maxCIMT). We analysed 2061 healthy participants recruited between 2018–2020. Inclusion criteria for this analysis: non-smokers, not known to have diabetes, hypertension, hyperlipidemia or ischemic heart disease. Individuals with systolic blood pressure >160 mm Hg or fasting glucose >7.0 mmol/L on recruitment were excluded. Multivariable linear regression analysis was performed to examine the association between CIMT and cardiovascular risk factors in the healthy population adjusting for age, sex and ethnicity. All analysis was performed using Stata version 16.0.
Results
After exclusion, 1407 healthy participants were included in the analysis. Median (IQR) avgCIMT: 0.56 (0.50, 0.65) in men; 0.54 (0.50, 0.58) in women. Median (IQR) maxCIMT: 0.64 (0.57, 0.76) in men; 0.61 (0.54, 0.70) in women. The avgCIMT and the maxCIMT were higher in males when compared to women and all traditional cardiovascular risk factors associated with CIMT after adjustment for age, sex and ethnicity (P<0.05) (Table 1). Interaction tests in multivariable model adjusted for age, ethnicity, pulse pressure, non HDL-C and HbA1c showed a significant interaction between sex and body mass index (BMI) with predicted effects on avgCIMT and maxCIMT being relatively higher in males at the same BMI when compared to females (P-interaction <0.01) (Figure 1).
Conclusion
Sex modifies the relationship between BMI and CIMT in Singapore's multi-ethnic population. Understanding the intermediary mechanisms involved will help in developing personalized preventive strategies.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- R Dalan
- Tan Tock Seng Hospital, Endocrinology, Singapore, Singapore
| | - T Mina
- Lee Kong Chian School of Medicine, Cardiovascular Epidemiology, Singapore, Singapore
| | - N A Nur Azizah
- Lee Kong Chian School of Medicine, Cardiovascular Epidemiology, Singapore, Singapore
| | - T Tong
- Lee Kong Chian School of Medicine, Cardiovascular Epidemiology, Singapore, Singapore
| | - M Loh
- Lee Kong Chian School of Medicine, Cardiovascular Epidemiology, Singapore, Singapore
| | | | - J Chambers
- Lee Kong Chian School of Medicine, Cardiovascular Epidemiology, Singapore, Singapore
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Sun L, Goh HJ, Verma S, Govindharajulu P, Sadananthan SA, Michael N, Jadegoud Y, Henry CJ, Velan SS, Yeo PS, Lee Y, Lim BSP, Liew H, Chew CK, Quek TPL, Abdul Shakoor SAKK, Hoi WH, Chan SP, Chew DE, Dalan R, Leow MKS. Metabolic effects of brown fat in transitioning from hyperthyroidism to euthyroidism. Eur J Endocrinol 2021; 185:553-563. [PMID: 34342595 PMCID: PMC8428075 DOI: 10.1530/eje-21-0366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Brown adipose tissue (BAT) controls metabolic rate through thermogenesis. As its regulatory factors during the transition from hyperthyroidism to euthyroidism are not well established, our study investigated the relationships between supraclavicular brown adipose tissue (sBAT) activity and physiological/metabolic changes with changes in thyroid status. DESIGN Participants with newly diagnosed Graves' disease were recruited. A thionamide antithyroid drug (ATD) such as carbimazole (CMZ) or thiamazole (TMZ) was prescribed in every case. All underwent energy expenditure (EE) measurement and supraclavicular infrared thermography (IRT) within a chamber calorimeter, as well as 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography/magnetic resonance (PET/MR) imaging scanning, with clinical and biochemical parameters measured during hyperthyroidism and repeated in early euthyroidism. PET sBAT mean/maximum standardized uptake value (SUV mean/max), MR supraclavicular fat fraction (sFF) and mean temperature (Tscv) quantified sBAT activity. RESULTS Twenty-one (16 female/5 male) participants aged 39.5 ± 2.5 years completed the study. The average duration to attain euthyroidism was 28.6 ± 2.3 weeks. Eight participants were BAT-positive while 13 were BAT-negative. sFF increased with euthyroidism (72.3 ± 1.4% to 76.8 ± 1.4%; P < 0.01), but no changes were observed in PET SUV mean and Tscv. Significant changes in serum-free triiodothyronine (FT3) levels were related to BAT status (interaction P value = 0.04). FT3 concentration at hyperthyroid state was positively associated with sBAT PET SUV mean (r = 0.58, P = 0.01) and resting metabolic rate (RMR) (P < 0.01). CONCLUSION Hyperthyroidism does not consistently lead to a detectable increase in BAT activity. FT3 reduction during the transition to euthyroidism correlated with BAT activity.
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Affiliation(s)
- Lijuan Sun
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Hui Jen Goh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Sanjay Verma
- Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Priya Govindharajulu
- Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Yaligar Jadegoud
- Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Christiani Jeyakumar Henry
- Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine
| | - S Sendhil Velan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research (A*STAR), Singapore
- Departments of Physiology & Medicine, National University of Singapore (NUS), Singapore
| | - Pei Shan Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Yingshan Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Brenda Su Ping Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Huiling Liew
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Chee Kian Chew
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Timothy Peng Lim Quek
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Shaikh A K K Abdul Shakoor
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Wai Han Hoi
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Ek Chew
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Rinkoo Dalan
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
| | - Melvin Khee Shing Leow
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital (TTSH), Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
- Correspondence should be addressed to M K Leow Email
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Dalan R, Liew H. Correlation of glycine with cardiometabolic variables and carotid atherosclerosis. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Dalan R, Seow C. Apelin concentrations are associated with carotid atherosclerosis in type 2 diabetes. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liew H, Watt T, Nan L, Tan AWK, Chan YH, Chew DEK, Dalan R. Psychometric properties of the thyroid-specific quality of life questionnaire ThyPRO in Singaporean patients with Graves' disease. J Patient Rep Outcomes 2021; 5:54. [PMID: 34236563 PMCID: PMC8266927 DOI: 10.1186/s41687-021-00309-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Graves’ disease is the most common cause of hyperthyroidism. It results in accelerated tissue metabolism with multi-organ involvement ranging from cardiovascular to neuropsychological function. This results in a negative impact on the quality of life (QOL) of the individual patient. We aim to evaluate the psychometric properties of ThyPRO, a Thyroid-related Patient Reported Outcome questionnaire, and validate its use in our multi-ethnic Asian patients with Graves’ hyperthyroidism. Methods Forty-seven consecutive Graves’ hyperthyroidism patients answered the ThyPRO questionnaire at baseline and at 4 months after treatment initiation. Data were recorded for thyroid related symptoms and signs, thyroid function tests and thyroid volume. We analyzed the internal consistency using Cronbach’s alpha, construct validity by evaluating relationship between clinical variables and ThyPRO scales, ceiling and floor effects, and responsiveness of ThyPRO to treatment based on Cohen’s effect size. Results Correlations between individual scale scores and free thyroxine concentrations were moderate and statistically significant: 0.21–0.64 (p < 0.05). There was high internal consistency between the items in this instrument, Cronbach’s alpha > 0.7 for all scales. ThyPRO was responsive to the changes in QOL after treatment (Effect Size: 0.20–0.77) in 9 of the 14 scales including the hyperthyroid symptoms and psychosocial scales (Tiredness, Cognitive complaints, Anxiety, Emotional susceptibility, Impact on Social, Daily and Sex life). Conclusion This study provides evidence that ThyPRO has satisfactory measurement properties in hyperthyroid Graves’ disease patients in Singapore population with the potential to complement clinical care. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00309-x.
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Affiliation(s)
- Huiling Liew
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Torquil Watt
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Luo Nan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alvin W K Tan
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel Ek Kwang Chew
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rinkoo Dalan
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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32
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Affiliation(s)
| | - Alvin Wei Choon Koh
- Metabolic Medicine Lee Kong Chian School of MedicineNanyang Technological University SingaporeSingapore
| | - Joyce Xia Lian
- Department of EndocrinologyTan Tock Seng HospitalSingapore
| | - Rinkoo Dalan
- Department of EndocrinologyTan Tock Seng HospitalSingapore
- Metabolic Medicine Lee Kong Chian School of MedicineNanyang Technological University SingaporeSingapore
| | - Bernhard Otto Boehm
- Department of EndocrinologyTan Tock Seng HospitalSingapore
- Metabolic Medicine Lee Kong Chian School of MedicineNanyang Technological University SingaporeSingapore
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33
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Tay HM, Leong SY, Xu X, Kong F, Upadya M, Dalan R, Tay CY, Dao M, Suresh S, Hou HW. Direct isolation of circulating extracellular vesicles from blood for vascular risk profiling in type 2 diabetes mellitus. Lab Chip 2021; 21:2511-2523. [PMID: 34042931 DOI: 10.1039/d1lc00333j] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Extracellular vesicles (EVs) are key mediators of communication among cells, and clinical utilities of EVs-based biomarkers remain limited due to difficulties in isolating EVs from whole blood reliably. We report a novel inertial-based microfluidic platform for direct isolation of nanoscale EVs (exosomes, 50 to 200 nm) and medium-sized EVs (microvesicles, 200 nm to 1 μm) from blood with high efficiency (three-fold increase in EV yield compared to ultracentrifugation). In a pilot clinical study of healthy (n = 5) and type 2 diabetes mellitus (T2DM, n = 9) subjects, we detected higher EV levels in T2DM patients (P < 0.05), and identified a subset of "high-risk" T2DM subjects with abnormally high (∼10-fold to 50-fold) amounts of platelet (CD41a+) or leukocyte-derived (CD45+) EVs. Our in vitro endothelial cell assay further revealed that EVs from "high-risk" T2DM subjects induced significantly higher vascular inflammation (ICAM-1 expression) (P < 0.05) as compared to healthy and non-"high-risk" T2DM subjects, reflecting a pro-inflammatory phenotype. Overall, the EV isolation tool is scalable, and requires less manual labour, cost and processing time. This enables further development of EV-based diagnostics, whereby a combined immunological and functional phenotyping strategy can potentially be used for rapid vascular risk stratification in T2DM.
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Affiliation(s)
- Hui Min Tay
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Block N3, 639798, Singapore.
| | - Sheng Yuan Leong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Block N3, 639798, Singapore.
| | - Xiaohan Xu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Block N3, 639798, Singapore.
| | - Fang Kong
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Megha Upadya
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Rinkoo Dalan
- Endocrine and Diabetes, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore and Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Sciences Building, 308232, Singapore
| | - Chor Yong Tay
- School of Material Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, Block N4.1, 639798, Singapore.
| | - Ming Dao
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore and Department of Material Science and Engineering, Massachusetts Institute of Technology, 182 Memorial Dr, Cambridge, MA 02142, USA
| | - Subra Suresh
- School of Material Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, Block N4.1, 639798, Singapore.
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Block N3, 639798, Singapore. and Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Sciences Building, 308232, Singapore
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Su C, Menon NV, Xu X, Teo YR, Cao H, Dalan R, Tay CY, Hou HW. A novel human arterial wall-on-a-chip to study endothelial inflammation and vascular smooth muscle cell migration in early atherosclerosis. Lab Chip 2021; 21:2359-2371. [PMID: 33978037 DOI: 10.1039/d1lc00131k] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Mechanistic understanding of atherosclerosis is largely hampered by the lack of a suitable in vitro human arterial model that recapitulates the arterial wall structure, and the interplay between different cell types and the surrounding extracellular matrix (ECM). This work introduces a novel microfluidic endothelial cell (EC)-smooth muscle cell (SMC) 3D co-culture platform that replicates the structural and biological aspects of the human arterial wall for modeling early atherosclerosis. Using a modified surface tension-based ECM patterning method, we established a well-defined intima-media-like structure, and identified an ECM composition (collagen I and Matrigel mixture) that retains the SMCs in a quiescent and aligned state, characteristic of a healthy artery. Endothelial stimulation with cytokines (IL-1β and TNFα) and oxidized low-density lipoprotein (oxLDL) was performed on-chip to study various early atherogenic events including endothelial inflammation (ICAM-1 expression), EC/SMC oxLDL uptake, SMC migration, and monocyte-EC adhesion. As a proof-of-concept for drug screening applications, we demonstrated the atheroprotective effects of vitamin D (1,25(OH)2D3) and metformin in mitigating cytokine-induced monocyte-EC adhesion and SMC migration. Overall, the developed arterial wall model facilitates quantitative and multi-factorial studies of EC and SMC phenotype in an atherogenic environment, and can be readily used as a platform technology to reconstitute multi-layered ECM tissue biointerfaces.
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Affiliation(s)
- Chengxun Su
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore. and Interdisciplinary Graduate School, Nanyang Technological University, Singapore, 639798, Singapore
| | - Nishanth Venugopal Menon
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore.
| | - Xiaohan Xu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore.
| | - Yu Rong Teo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore.
| | - Huan Cao
- School of Materials Science & Engineering, Nanyang Technological University, Singapore, 639798, Singapore
| | - Rinkoo Dalan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore and Endocrinology Department, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Chor Yong Tay
- School of Materials Science & Engineering, Nanyang Technological University, Singapore, 639798, Singapore
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore. and Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
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Dalan R, Ang LW, Tan WYT, Fong SW, Tay WC, Chan YH, Renia L, Ng LFP, Lye DC, Chew DEK, Young BE. The association of hypertension and diabetes pharmacotherapy with COVID-19 severity and immune signatures: an observational study. Eur Heart J Cardiovasc Pharmacother 2021; 7:e48-e51. [PMID: 32766831 PMCID: PMC7454507 DOI: 10.1093/ehjcvp/pvaa098] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Siew-Wai Fong
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore.,Department of Biological Sciences, National University of Singapore, Singapore
| | | | - Yi-Hao Chan
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Laurent Renia
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Lisa F P Ng
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Yong Loo Lin School of Medicine, Singapore
| | - Daniel E K Chew
- Department of Endocrinology, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Singapore
| | - Barnaby E Young
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Yong Loo Lin School of Medicine, Singapore
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Chee Y, Toh GL, Lim CJ, Goh LL, Dalan R. Sex Modifies the Association of Fibroblast Growth Factor 21 With Subclinical Carotid Atherosclerosis. Front Cardiovasc Med 2021; 8:627691. [PMID: 33996935 PMCID: PMC8116496 DOI: 10.3389/fcvm.2021.627691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background and Aims: Fibroblast growth factor 21 (FGF21), an emerging metabolic hepatokine, is associated with atherosclerosis. An interaction with sex has been described in various populations. We aimed to study whether sex modulates the relationship between FGF21 and subclinical carotid atherosclerosis in a diabetes-enriched multiethnic population of Singapore. We explore differences in intermediary mechanisms, in terms of hypertension, lipids, and inflammation, between FGF21 and atherosclerosis. Methods: We recruited 425 individuals from a single diabetes center in Singapore, and demographics, anthropometry, metabolic profile, FGF21, and carotid ultrasonography were performed. Multivariable logistic regression models were used to study the association between subclinical atherosclerosis and FGF21 adjusting for age, ethnicity, body mass index (BMI), hemoglobin A1c (HbA1c), systolic and diastolic blood pressures, and low-density lipoprotein (LDL)-cholesterol separately for males and females as two groups after an interaction test. Results: An interaction test assessing interaction by sex on the relationship between subclinical atherosclerosis and FGF21 showed a significant interaction with sex (Pinteraction = 0.033). In the female subgroup, significant independent associations of standardized lnFGF21 with subclinical atherosclerosis were seen, with 1 SD increment in lnFGF21 being associated with 1.48-fold (95% CI: 1.03, 2.12; p = 0.036) increase in risk. In the male subgroup, the association of subclinical atherosclerosis with standardized lnFGF21 was not significant [odds ratio (OR) (95% CI): 0.90 (0.63, 1.28); p = 0.553]. We found sex interactions with pulse pressure being significantly associated in females only and triglycerides and C-reactive protein being associated with males only. Conclusion: FGF21 is positively associated with subclinical carotid atherosclerosis in women, but not in men. The sex–racial patterns in the mechanisms by which FGF21 causes subclinical atherosclerosis needs to be explored in larger population-based studies and mechanistically studied in greater detail.
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Affiliation(s)
| | | | | | | | - Rinkoo Dalan
- Tan Tock Seng Hospital, Singapore, Singapore.,Department of Metabolic Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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37
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Dalan R. Letter to the Editor from Dalan: "Vitamin D Supplementation for Prevention of Type 2 Diabetes Mellitus: To D or Not to D?". J Clin Endocrinol Metab 2021; 106:e1922-e1923. [PMID: 33432973 DOI: 10.1210/clinem/dgaa967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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38
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Lian X, Dalan R, Seow CJ, Liew H, Jong M, Chew D, Lim B, Lin A, Goh E, Goh C, Othman NB, Tan L, Boehm BO. Diabetes Care During COVID-19 Pandemic in Singapore Using a Telehealth Strategy. Horm Metab Res 2021; 53:191-196. [PMID: 33530117 DOI: 10.1055/a-1352-5023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Singapore currently has one of highest number of confirmed COVID-19 cases in Southeast Asia. To curb the further spread of COVID-19, Singapore government announced a temporary nationwide lockdown (circuit breaker). In view of restrictions of patients' mobility and the enforcement of safe distancing measures, usual in-person visits were discouraged. Here we describe how diabetes care delivery was ad hoc redesigned applying a telehealth strategy. We describe a retrospective assessment of subjects with diabetes, with and without COVID-19 infection, during the circuit breaker period of 7th April to 1st June 2020 managed through Tan Tock Seng Hospital's telehealth platform. The virtual health applications consisted of telephone consultations, video telehealth visits via smartphones, and remote patient monitoring. The TTSH team intensively managed 298 diabetes patients using a telehealth strategy. The group comprised of (1) 84 inpatient COVID-19 patients with diabetes who received virtual diabetes education and blood glucose management during their hospitalisation and follow-up via phone calls after discharge and (2) 214 (n=192 non-COVID; n=22 COVID-positive) outpatient subjects with suboptimal glycaemic control who received intensive diabetes care through telehealth approaches. Remote continuous glucose monitoring was applied in 80 patients to facilitate treatment adjustment and hypoglycaemia prevention. The COVID-19 pandemic situation mooted an immediate disruptive transformation of healthcare processes. Virtual health applications were found to be safe, effective and efficient to replace current in-person visits.
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Affiliation(s)
- Xia Lian
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Cherng Jye Seow
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Michelle Jong
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Daniel Chew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Brenda Lim
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Anita Lin
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Eunice Goh
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Christina Goh
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | | | - Lucy Tan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Bernhard O Boehm
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Dalan R, Boehm BO. The implications of COVID-19 infection on the endothelium: A metabolic vascular perspective. Diabetes Metab Res Rev 2021; 37:e3402. [PMID: 32871617 DOI: 10.1002/dmrr.3402] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/10/2020] [Accepted: 08/26/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Bernhard O Boehm
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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40
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Dalan R, Lim C, Boehm B. Alpha-tocopherol concentrations correlate with carotid artery intima-media thickness in type 2 diabetes. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Dalan R, Lim C, Boehm B. Gender differences in arterial stiffness in type 2 diabetes. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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42
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Menon NV, Su C, Pang KT, Phua ZJ, Tay HM, Dalan R, Wang X, Li KHH, Hou HW. Recapitulating atherogenic flow disturbances and vascular inflammation in a perfusable 3D stenosis model. Biofabrication 2020; 12:045009. [PMID: 32650321 DOI: 10.1088/1758-5090/aba501] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Blood vessel narrowing and arterial occlusion are pathological hallmarks of atherosclerosis, which involves a complex interplay of perturbed hemodynamics, endothelial dysfunction and inflammatory cascade. Herein, we report a novel circular microfluidic stenosis model that recapitulates atherogenic flow-mediated endothelial dysfunction and blood-endothelial cell (EC) interactions in vitro. 2D and 3D stenosis microchannels with different constriction geometries were fabricated using 3D printing to study flow disturbances under varying severity of occlusion and wall shear stresses (100 to 2000 dynecm-2). Experimental and fluid simulation results confirmed the presence of pathological shear stresses in the stenosis region, and recirculation flow post stenosis. The resultant pathological flow profile induced pro-inflammatory and pro-thrombotic EC state as demonstrated by orthogonal EC alignment, enhanced platelet adhesion at the stenosis, and aberrant leukocyte-EC interactions post stenosis. Clinical utility of the vascular model was further investigated by testing anti-thrombotic and immunomodulatory efficacy of aspirin and metformin, respectively. Overall, the platform enables multi-factorial analysis of critical atherogenic events including endothelial dysfunction, platelets and leukocyte adhesion, and can be further developed into a liquid biopsy tool for cardiovascular risk stratification.
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Affiliation(s)
- Nishanth Venugopal Menon
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 639798, Singapore. Equal contribution
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43
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Tay HM, Yeap WH, Dalan R, Wong SC, Hou HW. Increased monocyte-platelet aggregates and monocyte-endothelial adhesion in healthy individuals with vitamin D deficiency. FASEB J 2020; 34:11133-11142. [PMID: 32627899 DOI: 10.1096/fj.202000822r] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/26/2020] [Accepted: 06/15/2020] [Indexed: 12/31/2022]
Abstract
Vitamin D deficiency is a major public health problem worldwide, linked to several chronic diseases including cardiovascular diseases. While immunomodulatory effects of vitamin D on monocytes have been reported in cardiovascular and metabolic diseases, there is limited understanding on monocyte phenotype in healthy individuals with suboptimal vitamin D levels and without any clinical diseases. In this work, we performed label-free, microfluidic isolation of monocytes, and characterized their functional phenotype using flow cytometry and in vitro vascular models in healthy subjects with (n = 7) and without vitamin D deficiency (n = 16). Vitamin D deficient (VitD-Def) subjects (25(OH)D3 level < 26 ng/mL) expressed significant downregulation of vitamin D receptor (VDR) on monocytes as compared to controls (P < .0001), and VDR expression was well-associated with serum 25(OH)D3 levels. Increased monocyte-platelet aggregates (MPA), a marker for platelet activation, were also observed in VitD-Def subjects (P < .05) which suggests a pro-inflammatory monocyte phenotype. Monocyte adhesion to endothelial cells, an early-stage atherosclerosis event, was also higher in VitD-Def individuals, and inversely correlated to serum 25(OH)D3 level (P < .05). Taken together, these results indicate the pro-inflammatory state and atherogenic potential of monocytes in VitD-Def healthy subjects, and propound the use of vitamin D supplementation as a prospective immunomodulatory and anti-inflammatory therapy in atherosclerosis.
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Affiliation(s)
- Hui Min Tay
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Wei Hseun Yeap
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Rinkoo Dalan
- Endocrine and Diabetes, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Siew Cheng Wong
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Abstract
Hypertension and Diabetes are the most common comorbid conditions in patients with COVID-19 and has been shown to adversely impact prognosis globally. It has been shown that hyperglycemia is one of the factors that increases the risk of poor outcomes in these patients. These patients are usually on multiple medications and recently a series of discussion on how Dipeptidyl peptidase 4 inhibitors (DPP4i) may be beneficial in these patients has been presented. This commentary presents a nuanced debateon why the DPP4i may not bebeneficial in COVID-19 and that caution needs to be addressed in making any judgementsuntil real world data is available.
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Affiliation(s)
- Rinkoo Dalan
- Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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45
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Affiliation(s)
- Rinkoo Dalan
- Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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46
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Abstract
Type 2 diabetes mellitus and hypertension are the most common comorbidities in patients with coronavirus infections. Emerging evidence demonstrates an important direct metabolic and endocrine mechanistic link to the viral disease process. Clinicians need to ensure early and thorough metabolic control for all patients affected by COVID-19.
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Affiliation(s)
- Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany.
- Department of Diabetes, School of Life Course Science & Medicine, King's College London, London, UK.
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, University Hospital, Zürich, Switzerland.
| | - Rinkoo Dalan
- Tan Tock Seng Hospital, Department of Endocrinology, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - David Hopkins
- Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
| | - Geltrude Mingrone
- Department of Diabetes, School of Life Course Science & Medicine, King's College London, London, UK
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernhard O Boehm
- Tan Tock Seng Hospital, Department of Endocrinology, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Abstract
COVID-19 is a rapidly spreading outbreak globally. Emerging evidence demonstrates that older individuals and people with underlying metabolic conditions of diabetes mellitus, hypertension, and hyperlipidemia are at higher risk of morbidity and mortality. The SARS-CoV-2 infects humans through the angiotensin converting enzyme (ACE-2) receptor. The ACE-2 receptor is a part of the dual system renin-angiotensin-system (RAS) consisting of ACE-Ang-II-AT1R axis and ACE-2-Ang-(1-7)-Mas axis. In metabolic disorders and with increased age, it is known that there is an upregulation of ACE-Ang-II-AT1R axis with a downregulation of ACE-2-Ang-(1-7)-Mas axis. The activated ACE-Ang-II-AT1R axis leads to pro-inflammatory and pro-fibrotic effects in respiratory system, vascular dysfunction, myocardial fibrosis, nephropathy, and insulin secretory defects with increased insulin resistance. On the other hand, the ACE-2-Ang-(1-7)-Mas axis has anti-inflammatory and antifibrotic effects on the respiratory system and anti-inflammatory, antioxidative stress, and protective effects on vascular function, protects against myocardial fibrosis, nephropathy, pancreatitis, and insulin resistance. In effect, the balance between these two axes may determine the prognosis. The already strained ACE-2-Ang-(1-7)-Mas in metabolic disorders is further stressed due to the use of the ACE-2 by the virus for entry, which affects the prognosis in terms of respiratory compromise. Further evidence needs to be gathered on whether modulation of the renin angiotensin system would be advantageous due to upregulation of Mas activation or harmful due to the concomitant ACE-2 receptor upregulation in the acute management of COVID-19.
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Affiliation(s)
- Rinkoo Dalan
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University
Singapore, Singapore
| | - Stefan R. Bornstein
- Lee Kong Chian School of Medicine, Nanyang Technological University
Singapore, Singapore
- Department of Medicine III, University Hospital Carl Gustav Carus,
Dresden, Germany
- Division of Diabetes & Nutritional Sciences, Faculty of Life
Sciences & Medicine, King's College London, London,
UK
- Klinik für Endokrinologie, Diabetologie und Klinische
Ernährung, University Hospital, Zürich,
Switzerland
| | - Ali El-Armouche
- Department of Pharmacology and Toxicology, Medical Faculty Carl Gustav
Carus, Technische Universität Dresden, Dresden, Germany
| | - Roman N Rodionov
- Division of Angiology, Department of Internal Medicine III, University
Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden,
Germany
| | - Alexander Markov
- Department of General Physiology, Saint-Petersburg State University,
Saint-Petersburg, Russia
| | - Ben Wielockx
- Institute of Clinical Chemistry, University Hospital Carl Gustav Carus,
Technische Universität Dresden, Dresden, Germany
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische
Ernährung, University Hospital, Zürich,
Switzerland
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität
München, Munich, Germany
| | - Bernhard O. Boehm
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University
Singapore, Singapore
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48
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Dalan R, Goh LL, Lim CJ, Seneviratna A, Liew H, Seow CJ, Xia L, Chew DEK, Leow MKS, Boehm BO. Impact of Vitamin E supplementation on vascular function in haptoglobin genotype stratified diabetes patients (EVAS Trial): a randomised controlled trial. Nutr Diabetes 2020; 10:13. [PMID: 32341356 PMCID: PMC7186220 DOI: 10.1038/s41387-020-0116-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/09/2022] Open
Abstract
AIMS Vitamin E (Vit-E) may preferentially improve cardiovascular risk in haptoglobin 2-2 (Hp2-2) genotype diabetes individuals. We studied the impact of Vit-E supplementation on vascular function in diabetes individuals stratified by haptoglobin genotype in Singapore. METHODS In this 24-week, double blind, placebo-controlled RCT, we recruited 187 subjects (101 Hp2-2, 86 non-Hp2-2). INTERVENTION alpha-tocopherol-400 IU. PRIMARY OUTCOME Change in EndoPAT-derived reactive-hyperaemia index (RHI) and augmentation index (AIx); Secondary Outcomes: Pulse-Wave velocity (Sphygmocor-PWV), carotid intima media thickness (CIMT), inflammation (hsCRP), derivatives of reactive-oxygen metabolites (dROMs), biological antioxidant-potential (BAPs), HbA1c, LDL-C, HDL-C and oxidised LDL-C (ox-LDL). RESULTS Overall, with Vit-E supplementation no significant change in RHI, PWV, CIMT, hsCRP, dROMS, BAPs, HDL-C and HbA1c was observed (p > 0.05); an increase in LDL-C with concomitant decrease in ox-LDL, and incidentally increase in eGFR was observed (p < 0.05). No interaction effect with haptoglobin genotype was seen for all outcomes (p > 0.05). Subgroup analysis: In the non-Hp-2-2 group, Vit-E supplementation led to a higher EndoPAT-derived AIx, accompanied by higher LDL and ox-LDL concentrations (p < 0.05); Hp2-2 group: Vit-E supplementation led to higher eGFR when compared to the non-Hp2-2 group (exploratory) (p < 0.05). We observed an interaction effect for baseline haptoglobin concentration (threshold > 119 mg/dl) with intervention in terms of increased EndoPAT-derived AIx in the Hp > 119 mg/dl group whereas no change in the group with Hp ≤ 119 mg/dl. CONCLUSION Vit-E supplementation did not show any preferential benefit or deleterious effect on vascular function in Hp2-2 diabetes subjects in Singapore. A possible deleterious effect of an increase in arterial stiffness in individuals with Hp > 119 mg/dl was observed. Future studies should consider personalisation based on baseline Hp concentrations in patients with T2DM rather than just Hp2-2 genotype to evaluate impact on the detailed lipid pathways, cardiac and renal physiology. The impact of ethnic differences needs to be explored in greater details.
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Affiliation(s)
- Rinkoo Dalan
- Tan Tock Seng Hospital, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
| | | | | | | | | | - Cherng Jye Seow
- Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Lian Xia
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Daniel E K Chew
- Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Melvin K S Leow
- Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Bernhard O Boehm
- Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Lum ZK, Khoo ZR, Toh WYS, Kamaldeen SAK, Shakoor A, Tsou KYK, Chew DEK, Dalan R, Kwek SC, Othman N, Lian JX, Bte Sunari RN, Lee JYC. Efficacy and Safety of Use of the Fasting Algorithm for Singaporeans With Type 2 Diabetes (FAST) During Ramadan: A Prospective, Multicenter, Randomized Controlled Trial. Ann Fam Med 2020; 18:139-147. [PMID: 32152018 PMCID: PMC7062498 DOI: 10.1370/afm.2500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE We aimed to evaluate the efficacy and safety of use of the Fasting Algorithm for Singaporeans with Type 2 Diabetes (FAST) during Ramadan. METHODS We performed a prospective, multicenter, randomized controlled trial. The inclusion criteria were age ≥21 years, baseline glycated hemoglobin (HbA1c) level ≤9.5%, and intention to fast for ≥10 days during Ramadan. Exclusion criteria included baseline estimated glomerular filtration rate <30 mL/min, diabetes-related hospitalization, and short-term corticosteroid therapy. Participants were randomized to intervention (use of FAST) or control (usual care without FAST) groups. Efficacy outcomes were HbA1c level and fasting blood glucose and postprandial glucose changes, and the safety outcome was incidence of major or minor hypoglycemia during the Ramadan period. Glycemic variability and diabetes distress were also investigated. Linear mixed models were constructed to assess changes. RESULTS A total of 97 participants were randomized (intervention: n = 46, control: n = 51). The HbA1c improvement during Ramadan was 4 times greater in the intervention group (-0.4%) than in the control group (-0.1%) (P = .049). The mean fasting blood glucose level decreased in the intervention group (-3.6 mg/dL) and increased in the control group (+20.9 mg/dL) (P = .034). The mean postprandial glucose level showed greater improvement in the intervention group (-16.4 mg/dL) compared to the control group (-2.3 mg/dL). There were more minor hypoglycemic events based on self-monitered blood glucose readings in the control group (intervention: 4, control: 6; P = .744). Glycemic variability was not significantly different between the 2 groups (P = .284). No between-group differences in diabetes distress were observed (P = .479). CONCLUSIONS Our findings emphasize the importance of efficacious, safe, and culturally tailored epistemic tools for diabetes management.
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Affiliation(s)
- Zheng Kang Lum
- Department of Pharmacy, Faculty of Science, National University of Singapore
| | - Zi Rui Khoo
- Department of Pharmacy, Faculty of Science, National University of Singapore
| | | | | | - Abdul Shakoor
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Keith Yu Kei Tsou
- Department of Family Medicine, National University Polyclinics, Singapore
| | | | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Sing Cheer Kwek
- Department of Family Medicine, National University Polyclinics, Singapore
| | - Noorani Othman
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Joyce Xia Lian
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | | | - Joyce Yu-Chia Lee
- Department of Pharmacy, Faculty of Science, National University of Singapore .,Department of Pharmacy, Tan Tock Seng Hospital, Singapore
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50
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Tan NC, Goh SY, Khoo EYH, Dalan R, Koong A, Khoo CM, Tan TS, Jain AB, Gadekar AV, Bee YM. Self-reported hypoglycaemia in insulin-treated patients with diabetes mellitus: results from the Singapore cohort of the International Operations Hypoglycaemia Assessment Tool study. Singapore Med J 2020; 61:129-136. [PMID: 32488272 PMCID: PMC7905111 DOI: 10.11622/smedj.2019081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Hypoglycaemia constitutes a significant barrier to achieving glycaemic control with insulin in both Type 1 (T1DM) and Type 2 diabetes mellitus (T2DM). The International Operations Hypoglycaemia Assessment Tool (IO HAT) study was designed to determine the incidence of hypoglycaemia in insulin-treated patients with T1DM and T2DM. METHODS The IO HAT study retrospectively and prospectively assessed the incidence of hypoglycaemia in patients with insulin-treated diabetes mellitus in nine countries. This sub-analysis included patients from Singapore with T1DM or T2DM who were aged ≥ 21 years and had completed two self-assessment questionnaires (SAQ1 and SAQ2). RESULTS Of the 50 T1DM and 320 T2DM patients who completed the SAQ1, 39 T1DM and 265 T2DM patients completed SAQ2; 100% and 90.9%, respectively, experienced at least one hypoglycaemic event prospectively. The incidence rates of any hypoglycaemia were 49.5 events per patient-year (EPPY) and 16.1 EPPY for T1DM and T2DM patients, respectively, in the four-week prospective period. Hypoglycaemia rate did not differ in terms of glycated haemoglobin level. The vast majority of T1DM or T2DM patients (92.0% and 90.7%, respectively) knew the overall definition of hypoglycaemia before study participation, although over half of the patients (T1DM 54.0%, T2DM 51.9%) defined hypoglycaemia based only on symptoms. CONCLUSION High proportions of insulin-treated patients with diabetes mellitus in Singapore reported hypoglycaemic events prospectively, showing that they had underreported hypoglycaemic episodes retrospectively. Patient education can help in improving hypoglycaemia awareness and its management in the region.
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Affiliation(s)
- Ngiap Chuan Tan
- Department of Endocrinology, SingHealth Polyclinics, Singapore
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Eric Yin-Hao Khoo
- Department of Endocrinology, National University Hospital, Singapore
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Agnes Koong
- Department of Endocrinology, SingHealth Polyclinics, Singapore
| | - Chin Meng Khoo
- Department of Endocrinology, National University Hospital, Singapore
| | - Teck Shi Tan
- Department of Endocrinology, SingHealth Polyclinics, Singapore
| | | | | | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore
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