Proposal FYP Haikal 20212022 Edited Latest
Proposal FYP Haikal 20212022 Edited Latest
Proposal FYP Haikal 20212022 Edited Latest
(BHCL18049605)
Supervisor:
October 2021
Table of Contents
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3.5 Source Population ....................................................................................... 10
3.6 Sampling Frame .......................................................................................... 10
3.7 Subjects Population and Site Selection ....................................................... 11
3.8 Inclusion Criteria .......................................................................................... 11
3.9 Exclusion Criteria ......................................................................................... 11
3.10 Estimation of Sample Size ......................................................................... 11
3.11 Study Procedures ...................................................................................... 12
3.11.1 Genotyping of ADIPOQ +45T>G (rs2241766) and +276G>T
(rs1501299) Polymorphisms ........................................................................ 12
3.12 Flowchart of the Study Activities ................................................................ 14
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Chapter 1: Introduction
Metabolic Syndrome (MetS) is a collection of risk factors for type 2 diabetes mellitus
(T2DM), coronary heart disease (CHD), and other atherosclerotic cardiovascular disease
(CVD) (Kassi et al., 2011). MetS has been recognized as a serious global health problem
with significant health implications (O'Neill et al., 2016). This major public-health issue is
escalating as a result of urbanization, increase in obesity and sedentary lifestyle routines
(Mohamud & Suraiami, 2010). The prevalence of MetS is different based on the
populations studied. The increased risk of both the MetS and its individual components is
influenced by variability in genetic makeup, diet, levels of physical activity, population age
and gender, levels of over- and undernutrition, and body habitus (Cameron et al., 2004).
MetS potentially increases the risk on developing T2DM up to five times, whereas in a
systematic review of 37 studies involving over 170,000 patients found that MetS doubles
the risk of cardiovascular events (Ramli et al., 2010). Despite of the previous history of
cardiovascular events, MetS patients are having two to four-fold of increased risk for
stroke, a three to four-fold increased chance for myocardial infarction (MI) and a two-fold
risk of dying to such event compared to those without MetS.
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this relocated OA tends to develop lifestyle-associated diseases or health condition
including MetS. Therefore, this study aims to investigate the association of genetic
polymorphisms of ADIPOQ +45T>G and ADIPOQ +276G>T with susceptibility risk of
MetS among OA Temiar in Kuala Betis, Gua Musang, Kelantan.
MetS is a health condition and a collection of risk factors, which include elevated
blood pressure, obesity and raised blood sugar level. It relates to most of the lifestyle-
associated diseases. Presence of SNPs of ADIPOQ in the genetic make-up of individuals
may increase the risk on developing this health condition. Early diagnosis of MetS by
detection of this polymorphisms would lead to improvement for the disease management
and prevention. Exposure of unhealthy lifestyle of urban living on the OA community has
increased the risk on getting MetS condition or its associated diseases. This would
eventually increase the expenditure and demand for healthcare services for this
population.
This study on the specified polymorphisms will provide new understandings about
the molecular mechanism of MetS and its pathophysiological implication on chronic
diseases such as CVD. Considering that MetS diagnosis is complicated, it is frequently
be unnoticed and eventually untreated until the condition become more severe. These
polymorphisms have potential to serve as the biomarker for early diagnosis of MetS
among OA Temiar community. Early diagnosis is possible through the detection of
potential biomarker in primary prevention strategy, such as early screening of MetS based
on individual’s genetic make-up. This will improve the management of MetS, enable early
intervention and prevention, preventing the progression of more severe diseases, and
improve quality-of-life.
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1.4 Research Questions
1.5 Hypothesis
1. To determine the genotype and allele frequency of ADIPOQ +45T>G and ADIPOQ
+276G>T among OA Temiar sub-tribe in RPS Kuala Betis, Gua Musang, Kelantan.
2. To investigate the risk association of variant genotypes of ADIPOQ +45T>G and
ADIPOQ +276G>T polymorphisms with susceptibility to MetS.
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Chapter 2: Literature Review
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≥130 mmHg and/or diastolic blood pressure ≥85 mmHg) or currently use antihypertensive
drugs; impaired fasting blood glucose level (fasting plasma glucose ≥5.6 mmol/L) (Moy &
Bulgiba, 2010). The modified NCEP ATP III criteria are shown to be much reliable than the
IDF criteria as shown in a study of MetS diagnosis among Malays in Kuala Lumpur, as
7.6% of the Malays with MetS as defined by modified NCEP ATP III were failed to be
diagnosed with MetS when using IDF criteria (Moy & Bulgiba, 2010). Thus, modified NCEP
ATP III is believed to show reliable result even when applied in a study involving different
Malaysia ethnics.
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involving the indigenous people with MetS had been conducted especially the study that
relate their genetic components with this health condition.
There are two main receptors for adiponectin, namely AdipoR1 and AdipoR2.
AdipoR1 has high affinity for globular adiponectin and low affinity for full-length
adiponectin in skeletal muscle. Meanwhile, in the liver, AdipoR2 generates intermediate
affinity towards both globular and full-length HMW adiponectin. AdipoR1 can be found
mainly in skeletal muscle, synovial firoblasts, endothelium, and atrial cells, whereas
AdipoR2 is expressed mainly in the liver, which able to inhibit "peroxisome proliferator-
activated receptors type alpha" (PPAR-α) receptors, promotes insulin sensitivity (Kayvan
Khoramipour et al., 2021).
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2.3.2 Function of Adiponectin
Human ADIPOQ gene is located on chromosome 3q27.3 that spans 15,790bp with
three exons and two introns, responsible to encode adiponectin hormone. Genetic
variants in ADIPOQ gene may cause substantial changes in adiponectin levels, which
provides convincing evidence that the genetic code alterations can significantly affect the
health (Sanchez et al., 2019). Single nucleotide polymorphisms (SNPs) at the ADIPOQ
loci are shown to be associated with the risk of T2DM and MetS in some prospective
epidemiological studies involving various population groups, but often with contrasting
results. The 276G>T (rs1501299) and 45T>G (rs2241766) SNPs of ADIPOQ gene are
the ones that are most studied (Laclaustra et al., 2007).
The relationship between ADIPOQ 45T>G polymorphism with MetS are variable
according to different studies. Some of the studies have reported the insignificance
association between 45T>G polymorphism and adiponectin concentrations, as it only
involves synonymous mutation (Gly15Gly) in exon 2. However, there are studies that
show the significance results between the 45T>G SNPs with MetS. For Example, Berthier
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et al. and Vasseur et al. in Quebec and France respectively have reported a significant
association between the G minor allele with lower adiponectin level (Berthier et al., 2005;
Vasseur et al., 2005). Apart from that, a study involved a large cohort (SAFIR) of French
Caucasians by Fumeron et al. has found that the G minor allele was associated with
weight gain (Laclaustra et al., 2007).
Studies have reported, with some level of consistency, the minor T allele at the
276G>T polymorphism in intron 2 has been significantly associated with higher plasma
adiponectin level. However, there are still studies that correlate this polymorphism with
MetS components. Mohammadzadeh et al. have found that T allele of SNP 276G>T
associated with the risk of CAD in among subjects with T2DM (Mohammadzadeh et al.,
2016). A large case control study conducted by Filippi et al. also have shown a significant
association between SNP 276G>T in ADIPOQ gene with CAD (Filippi et al., 2005).
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the application of restriction enzyme, amplicons with ADIPOQ 45T>G that were cleaved
by BspHI would generate three genotypes: homozygous wild type (T/T) would be
produced as two fragments, heterozygous (T/G) would be shown as three fragments, and
homozygous variants (G/G) would be presented as one fragment only since the restriction
enzyme assigned would not cleave the G allele. The amplicons with ADIPOQ 276G>T
that were cleaved by BsmI would also generate three genotypes: homozygous wild type
(G/G) as three fragments, heterozygous (G/T) as four fragments, and homozygous
variants (T/T) as a single fragment since T allele would not being cleaved by BsmI (Zahary
et al., 2020). These fragments can only be observed after performing gel electrophoresis
and analysis.
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Chapter 3: Methodology
The study design for this project is cross-sectional study on relocated OA Temiar subtribe
in Rancangan Pengumpulan Semula (RPS) Kuala Betis, Gua Musang, Kelantan.
The study period is estimated to be conducted within the whole two semester or eight
months of the final year: 15/10/2021 – 16/6/2022.
The participants blood sample are collected at RPS Kuala Betis, Gua Musang, Kelantan,
and will be processed at Universiti Sultan Zainal Abidin, Kampus Perubatan, Jalan Sultan
Mahmud, 20400 Kuala Terengganu, Terengganu.
The reference population for this study is OA Temiar subtribe group in Malaysia.
The source population of this study is OA Temiar subtribe in RPS Kuala Betis, Gua
Musang, Kelantan.
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3.7 Subjects population and Site Selection
RPS Kuala Betis is located at around 30km from Bandar Gua Musang. It consists of 22
villages with a total population of over 2,000 people, and about 1260 of them are adults.
This site was pragmatically chosen due to the capability of ensuring appropriate
representation of Temiar sub-tribe population that had experience urbanization and
modernization. Application for ethical approval will be requested from UniSZA Human
Research Committee (UHREC) together with written permission from Jabatan Hal Ehwal
Orang Asli (JHEOA) and head of each village for the study to be conducted.
The inclusion criteria for this study are the participants with:
The exclusion criteria for this study are the participants with either one of the following
issues:
1. Psychiatric illness
2. Neurological deficit
3. Body dysmorphic
4. Individuals who refuse to participate in the study
𝑧 2
𝑛 = ( ) 𝑃(1 − 𝑃)
∆
n: sample size
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∆: precision (generally at 0.05)
The value of p was taken from Wan Nazaimoon and Suraiami, 2010.
1.96 2
n = (0.05) 0.22(1 − 0.22)
n = 264
However, for the purpose of FYP study, the sample size used will be reduced to 50. It
means that 50 individuals’ data will be randomly choose from the exact sample size.
In order to reduce variability in data collecting methods, investigators and interviewers will
be trained in the standardization of research protocols prior to the start of the study.
Demographic data such as gender, age, occupation, and smoking status will be collected
using standardized interviewer-based questions. Recruitment of the participants will be
done with announcements and invitations through the villages’ leader via JHEOA. The
goal of the study will be informed to the participants. They will be asked to not eat or drink
for eight hours before screening. The purpose of screening is to sort-out eligible subjects.
The participants will be given information pamphlets about the study and written consent
will be obtained.
This study uses the ADIPOQ genotyping procedure including the primers design
applied by Zahary et al. (2020) in their study of increased risk of metabolic syndrome with
genetic polymorphism of ADIPOQ among a Temiar population in Malaysia. The
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genotyping procedure comprises three parts, namely DNA extraction, polymerase chain
reaction-restriction fragment length polymorphism (PCR-RFLP), and gel electrophoresis.
DNA extraction will be performed on collected venous blood of the participants
using QIAamp DNA Blood Mini kit to extract the genomic DNA.
The genotyping of the ADIPOQ polymorphisms by PCR-RFLP on the extracted
genomic sample will be performed using master mix, specific PCR primers, and specific
restriction enzymes (BspHI and BsmI).
Gel electrophoresis will be used for ADIPOQ polymorphisms analysis and
detection in a 2% agarose gel.
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3.12 Flowchart of the Study Activities
Source population:
OA Temiar subtribe from RPS Kuala Betis,
Gua Musang, Kelantan.
Sampling frame:
Simple random
sampling
Study subjects identification.
Ethical clearance
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Chapter 4: Expected Results
These are the examples of gel electrophoresis image of PCR-RFLP analysis of ADIPOQ +45T>G
and ADIPOQ +276G>T. Both images retrieved from Zahary et al. (2020).
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Table 2: Risk association of ADIPOQ +45T>G (rs2241766) and +276G>T (rs1501299)
polymorphisms with MetS susceptibility
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Chapter 5: Gantt Chart and Milestone
5.1 Gantt chart
Period 2021 2022
Activities Oct. Nov. Dec. Jan. Feb. Mac. Apr. May. Jun.
Project discussion
Proposal writing
Proposal presentation
Purchasing chemicals,
reagents, accessories
DNA extraction
Genotyping of
ADIPOQ +45T>G
(rs2241766) and
+276G>T (rs1501299)
polymorphism via
PCR-RFLP
Gel electrophoresis
Report writing
Final result
presentation
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5.2 Milestone Table
Activities Completion Date Cumulative Project
Completion Percentage
(%)
Project discussion November 2021 10
Proposal writing November 2021 30
Proposal presentation December 2021 35
Purchasing chemicals, December 2021 45
reagents, accessories
DNA extraction December 2021 50
Genotyping of ADIPOQ January 2022 65
+45T>G (rs2241766) and
+276G>T (rs1501299)
polymorphism via PCR-
RFLP
Gel electrophoresis January 2022 70
Report writing May 2022 95
Final result presentation June 2022 100
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