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  1. Fulltext Is Malaysia Ready for Human Gene Editing: A Regulatory, Biosafety and Biosecurity Perspective
    Kalidasan V, Theva Das K
    Front Bioeng Biotechnol, 2021;9:649203.
    PMID: 33777918 DOI: 10.3389/fbioe.2021.649203
    Gene editing platforms have revolutionized the field of genetics with a direct impact on the public health system. Although there are apparent benefits, it is often accompanied by public debates over its uncertainties and risks. In the Malaysian context, modern biotechnology has raised questions about how to best govern gene editing in regulations, biosafety, and biosecurity. Even though standards and guidelines on stem cell and cell-based therapies have been developed, there are no appropriate legal frameworks available for gene editing yet. Nevertheless, biosafety regulations were established to balance promoting biotechnology and protecting against their potential environmental and human health risks. There is also a need to address the potential of genetically modified organisms (GMOs) as bioweapons. Numerous frameworks from several international organizations may provide valuable input in formulating documents on gene editing. By establishing comprehensive guidelines, legal policies, and standards to tackle the challenges and risks associated with gene editing, Malaysia can successfully apply this modern technology in this country.
  2. Fulltext Lessons Learned From Failures and Success Stories of HIV Breakthroughs: Are We Getting Closer to an HIV Cure?
    Kalidasan V, Theva Das K
    Front Microbiol, 2020;11:46.
    PMID: 32082282 DOI: 10.3389/fmicb.2020.00046
    There is a continuous search for an HIV cure as the success of ART in blocking HIV replication and the role of CD4+ T cells in HIV pathogenesis and immunity do not entirely eradicate HIV. The Berlin patient, who is virus-free, serves as the best model for a 'sterilizing cure' and many experts are trying to mimic this approach in other patients. Although failures were reported among Boston and Essen patients, the setbacks have provided valuable lessons to strengthen cure strategies. Following the Berlin patient, two more patients known as London and Düsseldorf patients might be the second and third person to be cured of HIV. In all the cases, the patients underwent chemotherapy regimen due to malignancy and hematopoietic stem cell transplantation (HSCT) which required matching donors for CCR5Δ32 mutation - an approach that may not always be feasible. The emergence of newer technologies, such as long-acting slow-effective release ART (LASER ART) and CRISPR/Cas9 could potentially overcome the barriers due to HIV latency and persistency and eliminate the need for CCR5Δ32 mutation donor. Appreciating the failure and success stories learned from these HIV breakthroughs would provide some insight for future HIV eradication and cure strategies.
  3. Advancing Precision Medicine with Gene and Cell Therapy in Malaysia: Ethical, Legal, and Social Implications
    Kalidasan V, Theva Das K
    Hum Gene Ther, 2024 Jan;35(1-2):9-25.
    PMID: 38047523 DOI: 10.1089/hum.2023.139
    A new era of gene and cell therapy for treating human diseases has been envisioned for several decades. However, given that the technology can alter any DNA/cell in human beings, it poses specific ethical, legal, and social difficulties in its application. In Malaysia, current bioethics and medical ethics guidelines tackle clinical trials and biomedical research, medical genetic services, and stem cell research/therapy. However, no comprehensive framework and policy is available to cater to ethical gene and cell therapy in the country. Incorporating ethical, legal, and social implications (ELSI) would be crucial to guide the appropriate use of human gene and cell therapy in conjunction with precision medicine. Policy experts, scientists, bioethicists, and public members must debate the associated ELSI and the professional code of conduct while preserving human rights.
  4. Fermentation and recovery of glutamic acid from palm waste hydrolysate by Ion-exchange resin column
    Das K, Anis M, Azemi BM, Ismail N
    Biotechnol Bioeng, 1995 Dec 5;48(5):551-5.
    PMID: 18623521
    Glutamic acid produced from palm waste hydrolysate by fermentation with Brevibacterium lactofermentum ATCC 13869 is produced with a remarkably high yield compared with that produced from pure glucose as a carbon source. The produce yield is 70 g/L with glucose, wherease, when palm waste hydrolysate is the fermentation medium in the same bioreactor under same conditions, it is 88 g/L. The higher yield may be attributed to the fact that this organism has the ability to convert sugars other than only glucose present in the hydrolysate. Bioreactor conditions most conducive for maximum production are pH 7.5, temperature of 30 degrees rmentation period of 48 h, inoculum size 6%, substrate concentration of 10 g per 100 mL, yeast extract 0.5 g per 100 mL as a suitable N source, and biotin at a concentration of 10 pg/L. Palm waste hydrolysate used in this study was prepared by enzymic saccharification of treated palm press fiber under conditions that yielded a maximum of 30 g/L total reducing sugars. Glutamic acid from fermentation broth was recovered by using a chromatographic column (5cm x 60 cm) packed with a strong ion-exchange resin. The filtered broth containing glutamic acid and other inorganic ions was fed to the fully charged column. The broth was continuously recycled at a flow rate of 50 mL/min (retention time of 55 min) until glutamic acid was fully adsorbed on the column leaving other ions in the effluent. Recovery was done by eluting with urea and sodium hydroxide for total displacement of glutamic acid from the resin. The eluent containing 88 g/L of glutamic acid was concentrated by evaporation to obtain solid crystals of the product. (c) 1995 John Wiley & Sons, Inc.
  5. Expression of neuropeptide Y and gonadotropin-releasing hormone gene types in the brain of female Nile tilapia (Oreochromis niloticus) during mouthbrooding and food restriction
    Das K, Ogawa S, Kitahashi T, Parhar IS
    Peptides, 2019 02;112:67-77.
    PMID: 30389346 DOI: 10.1016/j.peptides.2018.10.009
    A cichlid fish, the Nile tilapia (Oreochromis niloticus), is a maternal mouthbrooder, which exhibits minimum energy expenditure and slower ovarian cycles during mouthbrooding. The objective of this study was to observe changes in the gene expression of key neuropeptides involved in the control of appetite and reproduction, including neuropeptide Y a (NPYa), reproductive neuropeptides: gonadotropin-releasing hormone (GnRH1, GnRH2 and GnRH3) and kisspeptin (Kiss2) during mouthbrooding (4- and 12-days), 12-days of food restriction and 12-days of food restriction followed by refeeding. The food restriction regime showed a significant increase in npya mRNA levels in the telencephalon. However, there were no significant alterations in npya mRNA levels during mouthbrooding. gnrh1 mRNA levels were significantly lower in mouthbrooding female as compared with females with food restriction. gnrh3 mRNA levels were also significantly lower in female with 12-days of mouthbrooding, 12-days of food restriction followed by 12-days of refeeding when compared with controls. There were no significant differences in gnrh2 and kiss2 mRNA levels between groups under different feeding regimes. No significant changes were observed in mRNA levels of receptors for peripheral metabolic signaling molecules: ghrelin (GHS-R1a and GHS-R1b) and leptin (Lep-R). These results suggested that unaffected npya mRNA levels in the telencephalon might contribute to suppression of appetite in mouthbrooding female tilapia. Furthermore, lower gnrh1 and gnrh3 mRNA levels may influence the suppression of reproductive functions such as progression of ovarian cycle and reproductive behaviours, while GnRH2 and Kiss2 may not play a significant roles in reproduction under food restriction condition.
  6. Unveiling the anti-giardial properties of Andrographis paniculata leaf extract through in vitro studies
    Haldar T, Sardar SK, Ghosal A, Das K, Saito-Nakano Y, Dutta S, et al.
    Trop Biomed, 2024 Sep 01;41(3):319-327.
    PMID: 39548787 DOI: 10.47665/tb.41.3.013
    Giardiasis, caused by the parasite Giardia lamblia, is a prevalent and serious public health concern, particularly affecting children worldwide. The primary mode of transmission for the parasite is through contaminated food and water sources and often leads to the onset of diarrhoea in infected individuals. However, the present medications for Giardiasis treatment often come with numerous side effects, while the growing problem of drug resistance adds a significant complication. Therefore, there is an urgent need for alternative treatments. In this study, we explored the in-vitro potential of Andrographis paniculata leaf extract as a possible alternative treatment for Giardiasis. Our investigation involved assessing the impact of the ethanolic extract on Giardia trophozoites through the analysis of parameters such as cell death, morphological alterations, adherence, ROS generation, and cell cycle dynamics. A. paniculata leaf extracts demonstrated significant inhibitory activity against the growth of Giardia trophozoites. After being incubated for 24 hours, the test results revealed an IC50 value of 51.26µg/ml (95% CI 37.17- 65.35) for inducing cell death in Giardia trophozoites. We observed a substantial degradation of DNA, alteration in morphology, inhibition in adherence, ROS generation and inhibition of the cell cycle in Giardia trophozoites. The findings indicate that A. paniculata extract has the potential to be used as a therapeutic treatment for giardiasis. This approach aims to offer a natural therapeutic solution for giardiasis, minimizing side effects and reducing the risk of drug resistance.
  7. Fulltext Genome-wide identification of Aedes albopictus long noncoding RNAs and their association with dengue and Zika virus infection
    Azlan A, Obeidat SM, Theva Das K, Yunus MA, Azzam G
    PLoS Negl Trop Dis, 2021 01;15(1):e0008351.
    PMID: 33481791 DOI: 10.1371/journal.pntd.0008351
    The Asian tiger mosquito, Aedes albopictus (Ae. albopictus), is an important vector that transmits arboviruses such as dengue (DENV), Zika (ZIKV) and Chikungunya virus (CHIKV). Long noncoding RNAs (lncRNAs) are known to regulate various biological processes. Knowledge on Ae. albopictus lncRNAs and their functional role in virus-host interactions are still limited. Here, we identified and characterized the lncRNAs in the genome of an arbovirus vector, Ae. albopictus, and evaluated their potential involvement in DENV and ZIKV infection. We used 148 public datasets, and identified a total of 10, 867 novel lncRNA transcripts, of which 5,809, 4,139, and 919 were intergenic, intronic and antisense respectively. The Ae. albopictus lncRNAs shared many characteristics with other species such as short length, low GC content, and low sequence conservation. RNA-sequencing of Ae. albopictus cells infected with DENV and ZIKV showed that the expression of lncRNAs was altered upon virus infection. Target prediction analysis revealed that Ae. albopictus lncRNAs may regulate the expression of genes involved in immunity and other metabolic and cellular processes. To verify the role of lncRNAs in virus infection, we generated mutations in lncRNA loci using CRISPR-Cas9, and discovered that two lncRNA loci mutations, namely XLOC_029733 (novel lncRNA transcript id: lncRNA_27639.2) and LOC115270134 (known lncRNA transcript id: XR_003899061.1) resulted in enhancement of DENV and ZIKV replication. The results presented here provide an important foundation for future studies of lncRNAs and their relationship with virus infection in Ae. albopictus.
  8. Fulltext The Effects of Lentivirus-Mediated Gene Silencing of RARβ on the Stemness Capability of Non-Small Cell Lung Cancer
    Abu Halim NH, Zakaria N, Theva Das K, Lin J, Lim MN, Fakiruddin KS, et al.
    J Cancer, 2021;12(12):3468-3485.
    PMID: 33995625 DOI: 10.7150/jca.50793
    Retinoic acid receptor beta is a nuclear receptor protein that binds to retinoic acid (RA) to mediate cellular signalling in embryogenic morphogenesis, cell growth, and differentiation. However, the function of RARβ in cancer stem cells (CSCs) has yet to be determined. This study aimed to understand the role of RARβ in regulating cell growth and differentiation of lung cancer stem cells. Based on the clonogenic assay, spheroid assay, mRNA levels of stem cell transcription factors, and cell cycle being arrested at the G0/G1 phase, the suppression of RARβ resulted in significant inhibition of A549 parental cell growth. This finding was contradictory to the results seen in CSCs, where RARβ inhibition enhanced the cell growth of putative and non-putative CSCs. These results suggest that RARβ suppression may act as an essential regulator in A549 parental cells, but not in the CSCs population. The findings in this study demonstrated that the loss of RARβ promotes tumorigenicity in CSCs. Microarray analysis revealed that various cancer pathways were significantly activated following the suppression of RARβ. The changes seen might compensate for the loss of RARβ function, CSCs population's aggressiveness, which led to the CSCs population's aggressiveness. Thus, understanding the role of RARβ in regulating the stemness of CSCs may lead to targeted therapy for lung CSCs.
  9. Fulltext Investigating D-Amino Acid Oxidase Expression and Interaction Network Analyses in Pathways Associated With Cellular Stress: Implications in the Biology of Aging
    Kalidasan V, Suresh D, Zulkifle N, Hwei YS, Kok Hoong L, Rajasuriar R, et al.
    Bioinform Biol Insights, 2024;18:11779322241234772.
    PMID: 38425413 DOI: 10.1177/11779322241234772
    D-amino acid oxidase (DAO) is a flavoenzyme that metabolizes D-amino acids by oxidative deamination, producing hydrogen peroxide (H2O2) as a by-product. The generation of intracellular H2O2 may alter the redox-homeostasis mechanism of cells and increase the oxidative stress levels in tissues, associated with the pathogenesis of age-related diseases and organ decline. This study investigates the effect of DAO knockdown using clustered regularly interspaced short palindromic repeats (CRISPR) through an in silico approach on its protein-protein interactions (PPIs) and their potential roles in the process of aging. The target sequence and guide RNA of DAO were designed using the CCTop database, PPI analysis using the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses, Reactome biological pathway, protein docking using GalaxyTongDock database, and structure analysis. The translated target sequence of DAO lies between amino acids 43 to 50. The 10 proteins that were predicted to interact with DAO are involved in peroxisome pathways such as acyl-coenzyme A oxidase 1 (ACOX1), alanine-glyoxylate and serine-pyruvate aminotransferase (AGXT), catalase (CAT), carnitine O-acetyltransferase (CRAT), glyceronephosphate O-acyltransferase (GNPAT), hydroxyacid oxidase 1 (HAO1), hydroxyacid oxidase 2 (HAO2), trans-L-3-hydroxyproline dehydratase (L3HYPDH), polyamine oxidase (PAOX), and pipecolic acid and sarcosine oxidase (PIPOX). In summary, DAO mutation would most likely reduce activity with its interacting proteins that generate H2O2. However, DAO mutation may result in peroxisomal disorders, and thus, alternative techniques should be considered for an in vivo approach.
  10. Fulltext Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study)
    Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, et al.
    World J Emerg Surg, 2015;10:61.
    PMID: 26677396 DOI: 10.1186/s13017-015-0055-0
    BACKGROUND: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression.
    METHODS: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study.
    RESULTS: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p 
  11. Prospective Observational Study on acute Appendicitis Worldwide (POSAW)
    Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L, et al.
    World J Emerg Surg, 2018;13:19.
    PMID: 29686725 DOI: 10.1186/s13017-018-0179-0
    Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.

    Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study.

    Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%.

    Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.

  12. Fulltext WSES guidelines for management of Clostridium difficile infection in surgical patients
    Sartelli M, Malangoni MA, Abu-Zidan FM, Griffiths EA, Di Bella S, McFarland LV, et al.
    World J Emerg Surg, 2015;10:38.
    PMID: 26300956 DOI: 10.1186/s13017-015-0033-6
    In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.
  13. The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?
    De Simone B, Abu-Zidan FM, Chouillard E, Di Saverio S, Sartelli M, Podda M, et al.
    World J Emerg Surg, 2022 Dec 16;17(1):61.
    PMID: 36527038 DOI: 10.1186/s13017-022-00466-4
    BACKGROUND: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not.

    METHODS: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not.

    RESULTS: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p 

  14. Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago
    Perrone G, Giuffrida M, Abu-Zidan F, Kruger VF, Livrini M, Petracca GL, et al.
    World J Emerg Surg, 2024 Apr 16;19(1):14.
    PMID: 38627831 DOI: 10.1186/s13017-024-00543-w
    BACKGROUND: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA.

    METHODS: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up.

    RESULTS: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P 

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