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數位學習之創新變革高醫大心電圖互動式電子書能有效提升護生學習效率

簡介:

重症護理學在護理系的課程中,是一門比較艱深的課程,其中心電圖是學生認為最困難的單元,目前常見的心電圖教學法有課堂講授、工作坊、擬真學習等,然而在疫情時代,這些需要面對面教學的方法就不太適用,因此發展有效的數位學習教材來提升學生學習成效,實為至關重要的教學任務。

高醫護理系教師依據學習動機理論,發展心電圖互動式電子書,功能包含目錄超連結、多媒體、遮罩功能、互動式練習題及強制學習等。並將之應用於重症護理教學中,學生可經由網路或手機應用程式隨時隨地進行個人化的學習,增進自主學習。在經過兩年的研究,發現使用互動式電子書的學生及使用傳統紙本講義的學生,在考試成績上雖無顯著差異,但在學習時間上卻有顯著差異。使用互動式電子書的學生用較少的學習時間,卻能達到相似的學習成效,也就是說,使用心電圖互動式電子書可以幫助學生更有效率地學習複雜抽象的概念。

在學習滿意度方面,大部分的學生都滿意互動式電子書對提升其學習動機(73.1%)、自主學習(77%)、和學習成效(88.5%)的幫助。訪談學生時,學生更表示電子書在學習方便性、有效性及擴充性是讓他們最滿意的。雖然有少數學生在使用上會遭遇到一些技術上的問題,但教師若能提供即時的幫助,可降低學生因技術困難而產生的學習挫折。未來醫護教育中,可以更廣泛的應用互動式電子書來提升學生的學習效率及滿意度。

圖形摘要

〈電子書頁面範例〉

A210705 圖形摘要Graphic abstract 

應用與亮點:

1.        根據動機理論製作的互動式電子書可作為有效提升醫護學生線上學習成效的教學工具。

2.        互動式電子書可應用於其他醫護課程或做為臨床醫護人員線上在職教育的學習教材。

3.        未來可建立互動式電子書線上圖書館供學生做跨領域學習或供社會大眾使用,提升其利用率。

4.        未來可根據學生或業界需求,結合遊戲學習,發展更好的互動式教學教材。

【研究團隊】

團隊成員:劉怡 Yi Liu、李碧娥 Bi-oh Lee、周碧玲 Pi-Ling Chou

代表單位:護理系

團隊簡介:

劉怡副教授關注護理教育及護理職場議題,獲得108教育部教學實踐計畫醫護學門績優計畫。李碧娥教授為外傷照護、護理教育及跨領域研究的專家。周碧玲副教授為心衰竭照護、癌因性疼痛及創新課程的專家。

研究聯繫Emailgn94yliu@kmu.edu.tw

【論文資訊】

論文出處:

Nurse Education Today, 90 (July), 104424 (2019 SSCI, Nursing, IF:2.49, 7/121= 5.78%)

全文下載:

https://www.sciencedirect.com/science/article/pii/S0260691719316399?via%3Dihub

Abstract:

Critical care nursing is a difficult course in the nursing curriculum. Electrocardiography (ECG) interpretation has been considered the most difficult since the concept of ECG is complex and abstract. Currently, the common teaching methods for ECG learning include lectures, workshops, and simulation, etc. However, in the pandemic era, the face-to-face teaching method may not be applicable. It is important to develop digital learning material to enhance students’ digital learning.

To enhance nursing students’ digital learning effect, an interactive ECG eBook based on motivation theory was developed. The interactive functions included hyperlink index, multimedia, cover-up, interactive exercises, and forced learning, etc. This eBook was applied in the critical care nursing course. Students could have individualized learning anytime and anywhere via the internet or the mobile application program, which would further enhance students’ self-directed learning. After a two-year comparison study, it was found that the learning achievements were not significantly different between the group using the eBook and the group using traditional paper handouts. However, the study time was significantly less in the eBook group. It indicated that nursing students could learn in a more efficient way using an interactive e-book.

Regarding students’ learning satisfaction, most nursing students were satisfied with the ECG interactive eBook for promoting their learning motivation (73.1%), self-directed learning (77%), and learning achievement (88.5%). In the interview, students reported they were most satisfied with the convenience, effectiveness, and extensiveness of the eBook. Few students mentioned that some technical problems were encountered. It was suggested that teachers need to provide prompt assistance to help students with technical difficulties to decrease their frustration. In the future, the application of interactive eBooks in medical and nursing education should be extensively encouraged to promote students’ learning efficiency and satisfaction.

Graphical Abstract

 

 A210705 圖形摘要Graphic abstract

Application and Highlights:

1.        The interactive eBook based on the motivation theory can be a learning tool for promoting students’ digital learning efficiency.

2.        The interactive eBook can be applied to other medical and nursing courses or to continuing education courses for clinical health care providers.

3.        In school, a digital library for interaction eBooks can be built for students’ interdisciplinary learning or for the public to promote the usage of digital learning materials.

4.        The interactive eBooks can further combine with gamification learning to create advanced interactive learning based on the needs of students and fields.

Research Team Members: Yi Liu, Bih-O Lee, and Pi-Ling Chou

Representative Department: School of Nursing

Introduction of Research Team:

Yi Liu (associate professor) focuses on nursing education and workplace issues and was awarded “Excellent Performance” in the Ministry of Education Teaching Practice Research program. Bih-O Lee (professor) is an expert in trauma, nursing education, and interdisciplinary research. Pi-Ling Chou (associate professor) is an expert in heart failure, cancer pain, and innovative education.

Contact Email: gn94yliu@kmu.edu.tw

Publication:

Nurse Education Today, 90 (July), 104424 (2019 SSCI, Nursing, IF:2.49, 7/121= 5.78%)

Full-Text Article: (URL)

https://www.sciencedirect.com/science/article/pii/S0260691719316399?via%3Dihub

應用藍光LED來合成具藥物活性的骨架

簡介:

大家耳熟能詳的藍光LED常見於做為高效率燈泡,高醫大研究團隊開發以藍光照射引起自由基級聯環化反應以合成吡咯烷(一種藥物骨架)。該反應以極其溫和的室溫條件下,用藍光LED照射1,6-烯炔類反應物,進行環化產生三個新的化學鍵形成吡咯烷。本方法具有極高的位向和化學選擇性,更重要是原子經濟,綠色又環保,是合成藥物新方向。具有吡咯烷骨架的藥物有:NicotineCaptopril (抗高血壓藥)NK3 antagonist (巴金森症)TACE inhibitor (抗癌藥) 等等,希望這方法可做為相關藥物合成新選擇。

圖形摘要:

A210704 圖形摘要應用與亮點:

1.     以藍光LED照射合成吡咯烷,此類化合物結構常見於諸多藥物。

2.     本方法具有極高的位向和化學選擇性,更重要是原子經濟,綠色又環保,是合成藥物新方向。

3.     反應的官能基耐受性廣泛且為環境友善的條件,符合永續的概念。

【研究團隊】

團隊成員:王志鉦教授Mohana Reddy Mutra博士

代表單位:高雄醫學大學醫藥暨應用化學系

團隊簡介:高雄醫學大學醫藥暨應用化學系 王志鉦 教授

電話:+ 886-7-3121101分機2275,電子郵件:jjwang@kmu.edu.tw

高雄醫學大學醫藥暨應用化學系 Mohana Reddy Mutra 博士後研究員

電話:+886-7-3121101分機2275,電子郵件:mohan.mohan2060@gmail.com

【論文資訊】

論文出處:Green Chem., 2020, 22, 2288-2300

全文下載:https://pubs.rsc.org/en/content/articlehtml/2020/gc/d0gc00321b

Alkene versus alkyne reactivity in unactivated 1,6-enynes: regio- and chemoselective radical cyclization with chalcogens under metal- and oxidant-free conditions

 

Abstract:

Herein, we have developed metal and oxidant-free visible light-promoted alkene vs. alkyne regio- and chemoselective radical cascade cyclization of electronically unbiased 1,6-enynes with chalcogens to synthesize substituted pyrrolidines bearing chalcogens. The reaction generated three new bonds, namely, C–SO2, C–C, and C–Se under extremely mild conditions. Furthermore, we achieved regio- and chemoselective mono-addition of aromatic thiophenols with unactivated 1,6-enynes.

Graphical Abstract

 A210704 Graphical Abstract

Application and Highlights:

1. Pyrrolidine is a versatile structural scaffold with diverse pharmacological applications and it exists in many natural products introducing the chalcogen functionality into the pyrrolidine skeleton may provide an opportunity to enhance the reactivity of native compounds or drugs.

2. Metal and oxidant-free mild conditions of visible light-promoted radical cascade cyclization.

3. The key features of this protocol are broad substrate scope, environment-friendly conditions, operational simplicity, atom economy, and amenability to gram-scale synthesis. The mechanistic studies corroborate that the reaction proceeds via a radical pathway.

 

Research Team Members:

Dr. Jeh-Jeng Wang and Mohana Reddy Mutra

Representative Department: Department of Medicinal and Applied Chemistry, Kaohsiung Medical University

Introduction of Research Team:  

Dr. Jeh-Jeng Wang, Professor, Department of Medicinal and Applied Chemistry, Kaohsiung Medical University. Tel: +886-7-3121101(Ext: 2275), E-mail: jjwang@kmu.edu.tw

Dr. Mohana Reddy Mutra, Postdoctoral fellow, Department of Medicinal and Applied Chemistry, Kaohsiung Medical University. Tel: +886-7-3121101(Ext: 2275), E-mail: mohan.mohan2060@gmail.com

Contact Email: jjwang@kmu.edu.tw

Publication: Green Chem., 2020, 22, 2288-2300

Full-Text Article: https://pubs.rsc.org/en/content/articlehtml/2020/gc/d0gc00321b


以永續又環保方法合成藥物

簡介:

聚乙二醇(PEG)常應用於化妝品與藥物添加劑等用途,是無毒無害的試劑,高醫大研究團隊利用聚乙二醇在對甲苯磺酸與氧氣存在下進行雜芳香族甲基化和乙醯化的新穎且有效的合成途徑。本方法的特點是聚乙二醇不僅做為溶媒,且是這些合成藥物的一個碳或兩個碳來源,許多臨床用藥都具有這類骨架,如: Raltitrexed (抗癌藥物)Balaglitazone (糖尿病用藥)Diproquqlone (中樞神經系統抑制劑)等。相信這環保、低價、又有效率的方法能應用到製藥業,提供這類藥物合成的另一種選擇。

圖形摘要:

 A210703 圖形摘要

應用與亮點:

1.   聚乙二醇不僅為綠色溶媒,更是低價的化妝品與藥物添加劑。本方法使用聚乙二醇不僅可做為溶媒,又可提供雜環藥物一個碳或兩個碳來源。

2.   這是第一個使用聚乙二醇作為碳源的合成雜環化合物。許多臨床用藥都具有這類骨架,相信這環保且低價的方法能應用到製藥業,提供藥物合成的另一種選擇。

3.   我們也利用有效率一鍋化來合成這類化合物,效果非常好。

 

【研究團隊】

團隊成員:王志鉦教授和Vishal Suresh Kudale博士

代表單位:高雄醫學大學醫藥暨應用化學系

團隊簡介:高雄醫學大學醫藥暨應用化學系 王志鉦 教授

電話:+ 886-7-3121101分機2275,電子郵件:jjwang@kmu.edu.tw

高雄醫學大學醫藥暨應用化學系 Vishal Suresh Kudale 博士

電話:+886-7-3121101分機2275,電子郵件:vishalkudale90@gmail.com

研究聯繫Emailjjwang@kmu.edu.tw

【論文資訊】

論文出處:Green Chem. 2020 May; 22: 3506-3511.

全文下載:https://doi.org/10.1039/D0GC01183E

Metal-free C–H methylation and acetylation of heteroarenes with PEG-400

 

Abstract:

The generation of a methyl carbon source from renewable and cheap sources is challenging. Herein, we describe a novel and an efficient route for methylation and acetylation of aza-heteroarenes using PEG-400 under O2 and TsOH·H2O for the first time by tuning the reaction conditions using a different set of starting materials. The key features of the current protocol are oxidative C–O and C–C bond scission under metal-free conditions with good functional group tolerance, and a broad substrate scope. The potential applicability of the designed methodology was demonstrated for the synthesis of central nervous system (CNS) depressant and anticonvulsant drug molecules by a one-pot strategy.

Graphical Abstract:

 A210703 Graphical Abstract

Application and Highlights:

Introduction of a methyl group may have a remarkable impact on the biological properties of original molecules. Here we used PEG-400 as the reaction medium. Surprisingly, we observed unusual C-H methylation of quinazolinone and acetylation of other electron-deficient heteroarenes via oxidative C–C and C–O bond cleavage. N-Heteroarenes are important structural moieties observed in pharmaceuticals, natural products, and ligand scaffolds. Quinazolinones are prevalent structural species, and they have immense applications commonly found in medicinal and pharmaceutical chemistry with pharmacological activities, including anti-tumour, anti-inflammatory, anticonvulsant, and antimicrobial activities. A brief literature survey showed that the presence of a methyl group at the C2-position and a substituted aromatic ring at the C3-position are essential functionalities required for CNS depression and anticonvulsant activities of compounds. Advancements using PEG-400 have been achieved because it is environmentally benign in nature; recyclable; is a phase-transfer catalyst; is stable at high temperature; is easily available, has a low cost; and is biodegradable. The PEG-400 used in this work is more eco-friendly than the previously reported methylating reagent. This is the first report to use PEG-400 as a carbon source. Moreover, we demonstrated the potential applicability of the designed protocol for the construction of CNS depressant and anticonvulsant drug compounds from 2-amino-N-arylylbenzamide via sequential Csp2-Csp3 activation in a one-pot manner.

Research Team Members:

Dr. Jeh-Jeng Wang and Vishal Suresh Kudale

Representative Department: Department of Medicinal and Applied Chemistry, Kaohsiung Medical University

Introduction of Research Team:

Dr. Jeh-Jeng Wang, Professor, Department of Medicinal and Applied Chemistry, Kaohsiung Medical University. Tel: +886-7-3121101(Ext: 2275), E-mail: jjwang@kmu.edu.tw

Vishal Suresh Kudale, Doctoral fellow, Department of Medicinal and Applied Chemistry, Kaohsiung Medical University. Tel: +886-7-3121101(Ext: 2275), E-mail: vishalkudale90@gmail.com

Contact Email: jjwang@kmu.edu.tw

Publication: Green Chem. 2020 May 13; 22: 3506-3511.

Full-Text Article: https://doi.org/10.1039/D0GC01183E

合成碳奈米粒子應用於螢光快篩臨床用藥deferasirox之血中濃度

  現行「快篩」已是所有檢測的發展重點,例如COVID-19的病毒檢測,就希望以快篩的方式快速了解病人是否染疫,因此建立快速、及時、準確的快篩技術於診斷科學上已是相當重要的發展項目,而本研究即是開發一種可以快速且準確分析血漿中的deferasirox之技術。“Deferasirox”俗稱排鐵劑,常用於一些須輸血治療之疾病,以排除因輸血所造成的體內鐵離子過高的問題;但是太多的deferasirox又會造成過量鐵離子排除,並會造成肝臟與腎臟的毒性,因此即時監測deferasirox之血中濃度即是臨床治療相當重要的步驟。本研究開發只要單存攜帶一簡單之螢光儀,即可對病人測定deferasirox之血中濃度,可以快速得到結果,對於病人提供更快速的診斷且即時做相關對應變化,對於目前強調的精準醫療,可提供一個診斷平台。

    本研究設計使用螢光奈米粒子「碳奈米點」(carbon dots, CDs)來進行deferasirox之血中濃度快篩。「碳奈米點」為近幾年來一種新穎的材料,其製備過程相較於一般奈米粒子便利,僅需利用單純物質甚至咖啡渣,即可製造出具有螢光之碳奈米點。碳奈米點是一種微小的碳奈米粒子,其大小範圍為1-10奈米,主要由碳原子構成,因此具有良好的導電性、高化學穩定性、環境汙染程度低、相當寬的光吸收帶及高螢光量子產率等特點;且碳材取得容易、價格低廉,因此製作成本相對其它種類的奈米量材料更便宜;由於以上的特性,使得「碳奈米點」為近年來越來越受重視與應用。

 A210702 Fig1

圖一、「碳奈米點」合成後之液體顏色,與紫外燈下的強烈螢光表現。

    本研究以簡單的化學原料(尿素和檸檬酸),利用水熱法合成出高螢光之碳奈米點,之後將碳奈米點表面衍生接上多巴胺(dopamine),而此合成材料在於有銅離子存在之環境時,其螢光會被大量的淬滅,但當有deferasirox存在時,其淬滅的螢光又可以恢復,且具有專一性,因此即可利用表面衍生化之碳奈米點的螢光恢復程度,應用於專一且快速的定量deferasirox;且該檢測皆使用血漿檢體進行,並不會因血漿中的雜質干擾而影響deferasirox之偵測。本法最後也應用到真實服用deferasirox之病人,其所偵測到之deferasirox血中濃度與一般臨床檢測結果相符,該結果證實此方法可快速且專一性得檢測deferasirox血中濃度,不僅使檢測變得更快速且方便,也可利用快速的檢測結果做後續的治療或用藥評估,對於現代強調的精準醫療,可提供一個強而有力的檢測平台。

圖形摘要

 A210702 圖形摘要Graphic abstract

應用與亮點:

1.   該表面衍生化之碳奈米點具有高螢光特性,可應用於多種領域。

2.   此合成材料在於有銅離子存在之環境時,其螢光會被大量的淬滅,但當有deferasirox存在時,其淬滅的螢光又可以恢復,且具有專一性。

3.   利用表面衍生化之碳奈米點的螢光恢復程度,可應用於專一且快速的定量deferasirox

4.   該法應用到真實服用deferasirox之病人,其所偵測到之deferasirox血中濃度與一般臨床檢測結果相符,該結果證實此方法可快速且專一性得檢測deferasirox血中濃度。

5.   該法不僅使檢測變得更快速且方便,也可利用快速的檢測結果做後續的治療或用藥評估,對於現代強調的精準醫療,可提供一個強而有力的檢測平台。

 

【研究團隊】

團隊成員:王俊棋、黃柏蒼、柯黃盛、吳秀梅

代表單位:高雄醫學大學 藥學系

團隊簡介:該研究團隊長年來致力於毛細管電泳法、藥物分析、基因分析、特殊探針及引子設計、奈米粒子合成及應用等,已開發出多項藥物監測或基因檢測之技術,且獲得多項專利。

研究聯繫Emailchunchi0716@kmu.edu.tw

 

【論文資訊】

論文出處:Sensors & Actuators: B. Chemical, 2020, 311: 127916.

全文下載:https://www.sciencedirect.com/science/article/pii/S0925400520302641

Synthesis of the carbon dots for fast fluorescently sensing deferasirox in plasma

Currently, "quick screening" has been the focus of all testing development. For example, the virus detection of COVID-19, it is hoped to quickly understand whether a patient is infected with the disease in a quick screening method. Therefore, the rapid, timely and accurate quick screening technology has been fast developed in the diagnostic science. Therefore, this research is to develop a technology that can quickly and accurately analyze deferasirox in plasma. "Deferasirox" is commonly known as an iron excretion agent. It is often used in some diseases that require blood transfusion to eliminate the problem of excessive iron ions in the body. However, too much deferasirox will cause excessive iron ions to be eliminated and cause liver and renal toxicity. Thus, immediate monitoring of the blood concentration of deferasirox is a very important step in clinical treatment. In this research, the blood concentration of deferasirox can be easily measured on the patient just by a fluorescent spectrometer. The result can be obtained quickly, and the patient can be provided with more information. Rapid diagnosis and immediate corresponding changes can provide a diagnostic platform for the current emphasis on precision medicine.

 This research is designed to use fluorescent nanoparticles, "carbon dots" (CDs) to quickly screen the blood concentration of deferasirox. CDs is a novel material in recent years, and its preparation process is more convenient than ordinary nanoparticle. Only simple substances or even coffee grounds can be used to produce fluorescent CDs. CDs are tiny carbon nanoparticles with a size range of 1-10 nanometers. They are mainly composed of carbon atoms. Therefore, they have good electrical conductivity, high chemical stability, low environmental pollution, and a wide range of light. CDs are easy to obtain and low in price, so the cost is cheaper than other kinds of nanometer materials. Due to the above characteristics, CDs have become more and more important and applicable in recent years.

 A210702 Fig1     

Fig. 1. The color of the liquid after the synthesis of "carbon dots", and the strong fluorescence performance of the "carbon dots" under ultraviolet light.

This research uses simple chemical raw materials (urea and citric acid) to synthesize high-fluorescence CDs by hydrothermal method, and the CDs were then coated with dopamine. When the copper ions exist, fluorescence of CDs will be largely quenched.  However, in the presence of deferasirox, the quenched fluorescence can be specifically restored. The degree of fluorescence recovery is used for specific and rapid quantification of deferasirox in plasma samples. Finally, this method was also applied to patients who actually took deferasirox. The detected blood concentration of deferasirox by this method was consistent with the clinical testing results. That confirmed that this method can quickly and specifically detect deferasirox in vivo, which not only makes the detection faster and more convenient, and the rapid test results can also be used for follow-up treatment or drug evaluation. For precision medicine, it can provide a powerful test platform.

Graphical Abstract

 A210702 圖形摘要Graphic abstract

Application and Highlights:

1. The surface-derivative CDs have high fluorescent quantum yield and can be used in various fields.

2. When this CDs is in the presence of copper ions, its fluorescence will be largely quenched. However, when deferasirox is present, its quenched fluorescence can be specifically restored.

3. By using the fluorescence recovery degree of CDs, the deferasirox in plasma can be specifically and fast quantified.

4. This method was also applied to patients who actually took deferasirox. The detected blood concentration of deferasirox by this method was consistent with the clinical testing results.

5. This method not only makes the detection faster and more convenient, but can also use the rapid detection results for follow-up treatment or medication evaluation. It can provide a powerful detection platform for precision medicine.

 

Research Team Members: Chun-Chi Wang, Po-Tsang Huang, Hwang- Shang Kou, Shou-Mei Wu

Representative Department: School of Pharmacy, College of Pharmacy, Kaohsiung Medical University

Introduction of Research Team: The team has been committed to capillary electrophoresis, pharmaceutical analysis, genetic analysis, special probe and primer design, nanoparticle synthesis and application, etc. for many years. They have developed a number of technologies for drug monitoring or genetic testing, and obtained a number of patents.

Contact Email: chunchi0716@kmu.edu.tw

Publication: Sensors & Actuators: B. Chemical, 2020, 311: 127916.

Full-Text Article: https://www.sciencedirect.com/science/article/pii/S0925400520302641

變性血脂是引起蝴蝶斑病人出現血管過早老化及心血管疾病的原因 

紅斑性狼瘡 (Systemic Lupus Erythematosus; SLE,又稱蝴蝶斑好發於30~40歲的年輕族群,血液中壞膽固醇指數 (low-density lipoprotein; LDL) 不高,但卻非常容易發生血管過早老化、動脈粥狀硬化及其他心血管疾病,這是過去臨床醫師沒法解釋的重要議題。高醫附設中和紀念醫院血脂生科研究中心與過敏免疫風濕內科、心臟內科醫師團隊基於陰電性低密度脂蛋白 (electronegative low-density lipoprotein; L5 LDL,又稱變性血脂的特色研究,共同探討可能的致病原因。

A210701 Fig1

圖一:以電泳及液相層析法證實蝴蝶斑病人的變性血脂陰電性增加

蝴蝶斑病人的變性血脂主要促使發炎反應的成分 

變性血脂的主要特殊成分為高濃度的溶血磷脂 (lysophosphatidylcholine; LPC) 與血小板活化因子 (platelet-activating factor; PAF),這些生物活性脂質容易造成血管內皮細胞老化與細胞凋亡,也會引起免疫細胞與血小板活化,與心腦血管、內分泌代謝、癌症…等疾病都息息相關。其中,溶血磷脂主要是經由磷脂酶 (phospholipase A2)所產生代謝物,而蝴蝶斑病人就是代謝增加或者來不及清除,所以堆積在血液中而引起一連串的發炎病理現象。

A210701 Fig2

圖二:以液相層析質譜儀分析蝴蝶斑病人變性血脂的生物活性脂質

生物活性脂質會增加發炎的白血球與造成血管老化

我們的研究發現,生物活性脂質會讓白血球分化、增生為CD16+單核球細胞(發炎的白血球),同時會破壞血管內皮細胞,透過兩種細胞的交互作用 (CX3CL1-CX3CR1)發炎的白血球會浸潤在血管內皮層,讓血管功能失調、血管老化。這個病理現象可以解釋為什麼蝴蝶斑病人往往有心血管疾病的病發症,也提供可以改變未來治療的策略。

結論 

蝴蝶斑病人的變性血脂濃度增加,並具有高濃度的生物活性的脂質溶血磷脂血小板活化因子,這會引起白血球分化成傾向發炎反應的細胞,並導致血管內皮細胞活化,透過分子交互作用使血管功能失調與血管老化。這個病理現象的發生不會侷限於蝴蝶斑病人,倘若任何民眾有心血管疾病的疑慮,擔心血管老化及血管粥樣硬化,應到醫學中心安排進一步檢查血管功能及變性血脂濃度,並諮詢醫師研擬個人化的治療策略。

圖形摘要 

A210701 圖形摘要Graphic abstract  

應用與亮點 

1.     蝴蝶斑病人的變性血脂濃度增加,具有高濃度的生物活性的脂質溶血磷脂血小板活化因子。

2.     變性血脂引起白血球分化成傾向發炎反應的細胞,也會讓血管內皮細胞受傷,藉由兩種細胞的交互作用CX3CL1-CX3CR1使血管功能失調與老化。

3.     若有心血管疾病的疑慮,擔心血管老化及血管粥樣硬化,應到醫學中心安排進一步檢查血管功能及變性血脂濃度,並諮詢醫師研擬個人化的治療策略。

【研究團隊】 

團隊成員:柯良胤顏正

代表單位:健康科學院/醫學檢驗生物技術學系

團隊簡介:醫技系柯良胤副教授與過敏免疫風濕內科顏正賢教授、血脂生科研究中心詹華蓁博士…等人共同發表的研究論文「Role of low-density lipoprotein in early vascular aging associated with systemic lupus erythematosus」,該論文受到Nature Reviews 期刊編輯Joanna Clarke的關注與採訪,並隨即發表於Nature Reviews Rheumatology研究亮點,文章題目為LDL subfraction linked to vascular ageing and heart disease in SLE

研究聯繫Emailkly@gap.kmu.edu.tw  

【論文資訊】 

論文出處:Arthritis & Rheumatology 2020 June.72(6):972-984.

全文下載:https://onlinelibrary.wiley.com/doi/epdf/10.1002/art.41213

L5 LDL linked to vascular aging in patients with Systemic Lupus Erythematosus (SLE)

SLE patients often have atherosclerotic complications at a young age but normal low-density lipoprotein (LDL) levels. Thus, this study was aimed to explain the paradoxical findings of early vascular aging (EVA) and normolipidemia in patients with SLE. In KMU, we focused on a different approach: the electronegative LDL. Human plasma LDL can be separated into five subfractions. L5 LDL, in particular, has been shown to be atherogenic, independent of LDL cholesterol. From here, we investigated the mechanisms of vascular aging in SLE patients.

 A210701 Fig1

Figure 1. SLE patients show elevated levels of atherogenic lipoproteins, L5 LDL.

The mass spectrometric analysis revealed that lysophosphatidylcholine (LPC) and platelet-activating factor (PAF) were increased in SLE-LDL and L5.

LPC and PAF are bioactive lipids, showing the capability to induce inflammatory changes in vascular cells both in vivo and in vitro. In this study, repeated injections of SLE-LDL, LPC or PAF to apoE-/- mice led to increases in IMT, collagen deposition, fatty-streak areas in the aortic wall, and cell senescence in the aortic endothelium.

 A210701 Fig2

Figure 2. LPC and PAF were increased in SLE-LDL and L5.

SLE-L5 induces CD16+ expression in monocytes and monocyte adhesion to ECs through CX3CL1-CX3CR1 interactions.

Flow cytometric analysis showed that SLE-L5 lipids, but not SLE-L1 lipids, induced an increase in the percentage of CD16+ monocytes, which are CX3CR1 expressing cells. On the other hand, SLE-LDL induces CX3CL1 expression in activated endothelial cells. Through CX3CL1-CX3CR1 interactions, SLE-L5 induces early atherosclerotic changes in young apoE-/- mice. SLE-L5 induced significant atherosclerotic lesion formation in the aortic arch of the mice as well as collagen deposition and elastic fragmentation in aortas.

Conclusion

L5 LDL (the most electronegative subfraction) is increased in SLE patients. By mass spectrometry, results showed that L5 LDL is an LPC- and PAF-rich lipoprotein. Through CX3CL1-CX3CR1 interactions between ECs and CD16+ monocytes, L5 LDL promotes atherosclerosis. Our findings suggest that the L5 level, not the total LDL concentration, should be a therapeutic target for preventing EVA and atherosclerosis in patients with SLE.

Graphical Abstract

 A210701 圖形摘要Graphic abstract

Application and Highlights:

1.     Through CX3CL1-CX3CR1 interactions between ECs and CD16+ monocytes, L5 LDL promotes atherosclerosis.

2.     An increase in plasma L5 levels, not total LDL concentration, may promote early vascular aging in SLE patients, leading to premature atherosclerosis.

3.     The L5 level should be a therapeutic target for preventing early vascular aging and atherosclerosis in patients with SLE.

Research Team Members:

Liang-Yin Ke, Jeng-Hsien Yen

Representative Department:

Department of Medical Laboratory Science and Biotechnology, College of Health Sciences

Introduction of Research Team:

Liang-Yin Ke (from the Department of Medical Laboratory Science and Biotechnology), Jeng-Hsien Yen (from Graduate Institute of Medicine), the first author Hua-Chen Chan (Center for Lipid Biosciences) and colleagues published the above-named paper in the Arthritis & Rheumatology this year. Immediately, the paper got great attention. The editor of Nature Reviews, Joanna Clarke, interviewed with the corresponding authors, and later she wrote a “research highlight” editorial and published in Nature Reviews Rheumatology, entitled as “LDL subfraction linked to vascular aging and heart disease in SLE.”

Contact Email: kly@gap.kmu.edu.tw

Publication: Arthritis Rheumatol. 2020 Jun;72(6):972-984.

Full-Text

Article: https://onlinelibrary.wiley.com/doi/epdf/10.1002/art.41213

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