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Data Analysis

World Heart Day takes place on 29 September every year which focuses on creating heart-healthy environments this year. Cardiovascular disease (CVD) is the leading cause of death and disability in the world today: over 17.3 million people die from cardiovascular disease each year. According to REPORT ON CARDIOVASCULAR DISEASES IN CHINA 2014, there are 290 million people suffering from cardiovascular disease in China and one in every five adults suffering from it. An estimated 3.5 million people die each year from cardiovascular disease, namely 9,590 death every day. People find out that 80 percent of cardiovascular disease is caused by coronary heart disease and its complications such as heart failure, valvular heart disease and congenital heart disease, which can also lead to sudden death. However, the current standard treatments like coronary artery bypass surgery, intervention and drug therapy can only delay the development of the disease but not cure it. These three treatments are also have some shortcomings such as the high risk of failure, limited treatment effect and a wide variety of side effects.

Facing the grim situation of cardiovascular disease, we wish to solve a particular problem of cardiovascular disease through the methods of synthetic biology. Before designing project, we read a lot of literature and statistical reports of cardiovascular disease. Then we read all iGEM projects in health and medicine track in the past five years and analyze the types of diseases and their treatments that were concerned in different regions each year. We analyze the following five topics from Health and Medicine track of interest to us: cardiovascular disease, cancer, detection or fighting against pathogens, drug carrier and obesity. It has played a very important role in our project designing that allows us to propose a specific project design idea by combining the design concept of synthetic biology and the current situation of the treatment of cardiovascular disease. The following is the analytical report of the projects of these five topics.

A. Cardiovascular Diseases

In 2009, team NTU-Singapore worked on an in vivo approach to visualize and degrade atherosclerotic plaque. Team Queens developed an E. coli chassis delivering anti-atherosclerotic substances to the site of plaque in vasculature. In 2012, team Slovenia implanted cells to produce different types of drugs to treat hepatitis C or heart attack. In 2013, HUST-China combined bio-oscillator with propionate-producing enzyme gene, trying to build a gut probiotic which can release propionate periodically in accordance with the rhythm of human blood pressure, team UFMG_Brazil precocious diagnosis for Acute Coronary Syndrome (ACS) based on 3 biomarkers: Brain Natriuretic Peptide (BNP), Trimethylamine-N-Oxide (TMAO) and Ischemia Modified Albumin (IMA). Team UIUC_Illinois’project is the prevention of cardiovascular disease by reducing the metabolism of dietary L-carnitine within the digestive system. In 2014, ATOMS-Turkiye desired to build two different devices which work synergistically and fix these two distinct situations, hypoxia and oxidative stress. Team ITESM-CEM a preventive gene therapy for atherosclerosis, based on the use of microbial enzymes.

Since cardiovascular disease is strongly associated with atherosclerotic plaque, three teams chose this disease to design their projects. Their solutions are expressing some key enzymes to degrade atherosclerotic plaque, the same with some treatments. Apart from atherosclerosis, hypertension is also the leading risk factor for mortality worldwide. One Asian designed their project as the treatment of hypertension. In consideration of versatility of cardiovascular disease, one team paid attention to prevention of cardiovascular disease, its scope becomes larger. The same with our project: the prevention and treatment of myocardial ischemia, it can solve a few kinds of cardiovascular disease. They used genetically-engineered bacteria or reform cell. However, we use adenovirus to transfer into HEK293 cell lines. The project about treatment much than prevention, may caused by the serious status of cardiovascular disease. There is no question that all of them try to solve the problems than haven’t been settled by the medical profession. It is really challenging and significant.

Meanwhile, as the Reports of cardiovascular diseases in China in 2014 show:

a. Prevalence of cardiovascular disease

The prevalence of cardiovascular disease in China is on the rising stage. Currently, an estimated 290 million cardiovascular disease patients across the country, including 270 million hypertension patients, stroke patients at least 7 million, 2.5 million patients with myocardial infarction, congestive heart failure patients with 4.5 million, 5 million patients with pulmonary heart disease, rheumatic heart disease patients with 2.5 million, 2 million patients with congenital heart disease. With 1 out of every 5 adults suffer from cardiovascular disease.

b. Chinese cardiovascular mortality

Cardiovascular disease mortality in rural and urban areas in 2013 is 293.69 / 100,000 and 259.40 / 100,000 respectively ( figure 1 ) ; death of cardiovascular diseases account for residents of diseases constitute 44.8 per cent in rural area and 41.9 per cent in cities, ranks first in the various diseases, higher than the tumors and other diseases.

c. The upward trend of cardiovascular mortality

The upward trend of cardiovascular mortality is due primarily to the increasing of ischemic heart disease (IHD). National disease surveillance system 2004-2011 mortality surveillance data shows that people over 35 years old of IHD mortality rates showed a clear upward trend in various parts of the China, IHD mortality annual rates for men 5% women 3.65%. Rural residents increased IHD mortality is fast, whether male or female, rural residents in IHD mortality are rising in 2004 to less than city residents as 2011 years higher than that of urban residents.

According to the data，we know the grim situation of ischemic heart disease, at the same time，we know more about the current conventional therapies such as drug treatment for ischemic heart disease (nitrates, and antithrombotic drugs, calcium channel blockers, etc), percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG). Based on these data, combined with our expertise, we have decided to utilize synthetic biology to the prevention and treatment of myocardial ischemia.

B. Obesity

Obesity is among the ten chronic diseases than determined by the World Health Organization. With the increasing level of living, obesity can lead to various diseases and is closely linked to lifestyle. Being dependent on the United States, time magazine reported that over the past more than 30 years, obesity rates have been high around the world.

C. Drug Delivery

With the development of medical science, menace caused by disease is falling flat. However, cancer, cardiovascular disease, bacterial infections are still grave problems which troubled both patients and doctors. There are always new types of drugs appears. Meanwhile, the delivery of a new drug is challenged. To keep drug activity in the transfer process, reduce drug side effects and improvement of the target. Since European medical treatments developed more, the carrier of the drug is intended to explore more, to go to a higher level of progress.

D. Cancer

Cancer is likewise a heated topic in the Health and Medicine track. In this field, Asia leads the most entries overall, a total of 8.In other regions of the world, North America has 7 entries followed by Europe and South America each with 4 entries, while Africa has only 1 entry. The total number of projects is increasing every year. At the same time, we have conducted research on cancer. According to the corresponding estimates from the International Agency for Research on Cancer (IARC) ,the total cancer deaths in 2012 were 8.2 million (about 22,000 cancer deaths a day) – 2.9 million in economically developed countries, and 5.3 million in economically developing countries. And there were 14.1 million new cancer cases in 2012 worldwide, including 8 million occurred in economically developing countries. However, the place with more new cases does not always have higher mortality. In our opinion, the difference can be attributed to several factors. Different population densities in different regions creating the great difference of new cases. Moreover, the different levels of development between the various regions of the world which lead to non-uniform medical standards result in difference detection and treatment of cancer. What’s more, the risk of being diagnosed with cancer increases substantially with age, so there will be more newly diagnosed cancer cases in developed countries than in developing countries. According to IARC, the top3 regions have the highest incidence of cancer is Asia, Europe and North America, which fit the regional distribution of the projects.

As a matter of fact, a considerable amount of cancer can be prevented and cured. Through investigation, we found that some cancers are caused by the following factors: tobacco use and heavy alcohol consumption, overweight or obesity, physical inactivity, and/or poor nutrition. So people can change their habits to keep them. In addition, many of the cancers related to infectious agents, such as human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Helicobacter pylori (H. pylori), could be prevented through behavioral changes and infection controlling. Reducing unnecessary sun exposure can also prevent skin cancer effectively. At the same time, regular physical examination can help detecting early cancer. Thereby greatly increasing the survival rate, this could also be the reason for half of the teams focus on detecting cancer. The primary modalities of cancer treatment are surgery, chemotherapy, radiotherapy, hormone therapy, immune therapy, and targeted therapy, so it is innovative for the iGEM teams to treat cancer with synthetic biology.

E. Antibiosis

In the statistics, we found that projects focusing on Antimicrobial accounted the largest proportion in the Health and Medicine track, which shows the public attention in this area. According to our data, the amount of antibacterial projects are increasing year by year, and maintains a high level all the time. There are 37 projects in total of which most occur in North America, Europe and Asia. Thus, we looked into this area and find some interesting things. In the survey, we found that infectious disease, such as tuberculosis, meningitis, bacterial meningitis, cholera and influenza caused by bacteria, has a great impact on human health. There is also a big difference in their level of health care that it is difficult to prevent pathogen infection effectively in some areas because of different levels of economic development among regions. As a result, some of these projects try to prevent disease by detecting specific bacteria in vitro. Besides, antibiotic resistance is also a threat to us. Since the overuse of antibiotics, some bacteria have evolved resistance characteristics. For example, there were about 480 000 new cases of multidrug-resistant tuberculosis (MDR-TB) in 2013 and extensively drug-resistant tuberculosis (XDR-TB) has been found in 100 countries. Antibiotic resistance greatly hinders the prevention, control and treatment of infectious diseases and therefore new treatments against pathogens have been a focus of attention. Actually most of these projects have involved the treatment of communicable disease or killing pathogens. Some of them even involve a detection module to avoid breaking the ecological balance in vivo. We assume that there will be more teams study in this area and make further exploration to fight pathogens through synthetic biology.

F. Reference

[1] World Health Organization Health Topics-Drug resistance http://www.who.int/topics/drug_resistance/en/
[2] World Health Organization Media centre-Antimicrobial Resistance
http://www.who.int/mediacentre/factsheets/fs194/en/
[3] Previous iGEM Competitions https://igem.org/Previous_iGEM_Competitions
[4] World Heart Day http://worldheartday.org/
[5] REPORT ON CARDIOVASCULAR DISEASES IN CHINA 2014 National Center for Cardiovascular Diseases, China
[6] https://2009.igem.org/Team:NTU-Singapore
[7] https://2009.igem.org/Team:Queens
[8] https://2012.igem.org/Team:Slovenia
[9] https://2013.igem.org/Team:HUST-China
[10] https://2013.igem.org/Team:UFMG_Brazil
[11] https://2013.igem.org/Team:UIUC_Illinois
[12] https://2014.igem.org/Team:ATOMS-Turkiye
[13] https://2014.igem.org/Team:ITESM-CEM
[14] Global Cancer Facts & Figures 3rd Edition IARC
[15] World Health Organization Health topics-cancer http://www.who.int/topics/cancer/en/
[16] 10 facts about cancer www.who.int/features/factfiles/cancer/en/

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-             <p>World Heart Day takes place on 29 September every year which focuses on creating heart-healthy environments this year. Cardiovascular disease (CVD) is the leading cause of death and disability in the world today: over 17.3 million people die from cardiovascular disease each year. According to <i>REPORT ON CARDIOVASCULAR DISEASES IN CHINA 2014</i>, there are 290 million people suffering from cardiovascular disease in China and one in every five adults suffering from it. An estimated 3.5 million people die each year from cardiovascular disease, namely 9,590 death every day. People find out that 80 percent of cardiovascular disease is caused by coronary heart disease and its complications, such as addition, heart failure, valvular heart disease, congenital heart disease, which can also lead to sudden death. However, the current standard treatments like coronary artery bypass surgery, intervention and drug therapy can only delay the development of the disease but not cure it. These three treatments are also have some shortcomings such as the high risk of failure, limited treatment effect and a wide variety of side effects. </p>
+             <p>World Heart Day takes place on 29 September every year which focuses on creating heart-healthy environments this year. Cardiovascular disease (CVD) is the leading cause of death and disability in the world today: over 17.3 million people die from cardiovascular disease each year. According to <i>REPORT ON CARDIOVASCULAR DISEASES IN CHINA 2014</i>, there are 290 million people suffering from cardiovascular disease in China and one in every five adults suffering from it. An estimated 3.5 million people die each year from cardiovascular disease, namely 9,590 death every day. People find out that 80 percent of cardiovascular disease is caused by coronary heart disease and its complications such as heart failure, valvular heart disease and congenital heart disease, which can also lead to sudden death. However, the current standard treatments like coronary artery bypass surgery, intervention and drug therapy can only delay the development of the disease but not cure it. These three treatments are also have some shortcomings such as the high risk of failure, limited treatment effect and a wide variety of side effects. </p>
              <p>Facing the grim situation of cardiovascular disease, we wish to solve a particular problem of cardiovascular disease through the methods of synthetic biology. Before designing project, we read a lot of literature and statistical reports of cardiovascular disease. Then we read all iGEM projects in health and medicine track in the past five years and analyze the types of diseases and their treatments that were concerned in different regions each year. We analyze the following five topics from Health and Medicine track of interest to us: cardiovascular disease, cancer, detection or fighting against pathogens, drug carrier and obesity. It has played a very important role in our project designing that allows us to propose a specific project design idea by combining the design concept of synthetic biology and the current situation of the treatment of cardiovascular disease. The following is the analytical report of the projects of these five topics.</p>
          </div>

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