Detecting heart injuries: Profiling protein biomarkers
Published on 10 July 2024
A/Prof Choi Hyung Won’s research looks at predictive cardiac biomarkers in the hope of speeding up diagnosis and treatment decisions for patients.
One of the most common challenges faced when facing a large amount of data in medical research is cutting through the ‘noise’. Data can contain random variations or inconsistencies, and they simply make it difficult to identify meaningful patterns.
As a data scientist, A/Prof Choi Hyung Won’s passion has always been in developing methodologies that “make complex data clean to work with and easy to interpret.” Since completing his postdoctoral training, he and his team have done a lot of work in this area, mostly for mass spectrometry analysis of functional molecules such as proteins and small molecules.
As an associate professor at the Cardiovascular Research Institute (CVRI), Yong Loo Lin School of Medicine (NUS Medicine), A/Prof Choi is actively engaged in research centered on the discovery of cardiac biomarkers. He said that his research on post-MI (myocardial infarction also known as a heart attack) prognostic markers of adverse outcomes can be challenging. His work focuses on “circulating proteome and cardiac imaging in post-MI outcomes”.
In plain terms, he studies detailed heart imaging and blood markers — including circulating protein and lipid levels — in patients who have had a heart attack. A/Prof Choi’s aim is to identify innovative approaches to stratify patients based on factors such as plasma protein levels and genetic predispositions.
Predicting the severity of a patient’s heart condition
The ideal outcome of A/Prof Choi’s research is to identify new biomarkers which can help with long-term outcome prediction in patients with heart injury symptoms. “A standardised blood test is the best predictive tool for screening at the population level. Blood is accessible and allows you to measure biomarkers at an increasingly low cost,” he said, adding that a standardised blood test would allow doctors to “make a treatment decision, diagnosis and prognosis”, including dosage levels and the specific types of drugs depending on the markers present. The research is still in its early stages.
The team’s work has already shown some unexpected results. “To our surprise, we discovered discrepancies between cardiac imaging indices and blood protein profiles,” A/Prof Choi shared, contrary to the team’s initial expectation of a stronger correlation between a patient’s blood markers and imaging scan findings. “However, it’s important to note that we’re still analysing preliminary data sets.” He remains optimistic that advances in assay technologies and ongoing research will yield more refined methods for categorising patients based on their readings.
One specific area where predictive knowledge would come in handy is in interpreting the levels of cykotines (a type of proinflammatory signalling proteins) in the blood. A/Prof Choi highlighted that while recent post-heart attack treatment includes anti-inflammatory drugs to counter excessive inflammation, a more tailored treatment plan would be ideal. “Some people simply don’t produce as much cytokines as others.” A/Prof Choi explained that customising anti-inflammatory drugs per patient basis can help avoid excessive treatment, which may have adverse effects. Even without the ability to predictively profile patients, he noted that patients “are still able to receive good treatment, but that treatment would be standardised and uniform otherwise.”
A wider impact beyond cardiology
While his blood marker research is on heart patients and predicting heart disease, A/Prof Choi believes that it is the beginning of a broader exploration. He shared plans for a ‘phase two’ of this research, which will investigate secondary diseases in heart attack patients. “For a cardiologist, the specialty training revolves around treating the heart,” he said. “However, various organs communicate with one another. When there’s a decline in heart function, other organs like the liver and brain need to adjust for reduced oxygen supply and materials exchange.”
He hopes that these additional markers can reveal what will happen to the liver function of heart attack patients. “What about liver disease? Because if your oxygen supply is reduced, it’s going to have an impact on the liver. How do we identify those patients after a heart attack? That can only be done using something like a blood test,” he noted. While they have yet to acquire human-level data on the subject, he shared that they already have animal-level data that proves the point.
The importance of research in advancing Singapore’s healthcare
A/Prof Choi firmly believes that research is an unavoidable part of medical science. “In the modern era, research and healthcare are inseparable,” he said. He cited his work at the Singapore Lipidomics Incubator at the Life Sciences Institute and CVRI, where his team develops molecular assays (investigative or analytical procedures) and predictive algorithms. The knowledge and the tools from this work have great potential to be part of patient care and precision health in the near future.
These profiling technologies already allow physicians to routinely monitor a patient’s metabolic state or drug adherence pattern (if they are actively following through on their medication and taking responsibility for their well-being), all based on a small volume of blood samples. “I can confidently tell you that the next-generation patient care is bound to be technology-driven,” said A/Prof Choi.
In consultation with A/Prof Choi Hyung Won, Cardiovascular Research Institute (CVRI), NUHS; Department of Medicine, NUS Medicine.
