Diabetes and stroke

3 June 2017

Dr Gary Tse (Croucher Research Fellowship 2015) is a clinician-scientist with research interests in the molecular and physiological mechanisms of cardiovascular diseases.

Tse was born in the Prince of Wales Hospital where he now works as Assistant Professor at the Department of Medicine and Therapeutics within the Faculty of Medicine, The Chinese University of Hong Kong.

His parents decided he should be educated in the UK. “By Year 10 I saw myself maybe a medical physicist or a computer programmer,” he says but later decided to apply for a place to read medicine at the University of Cambridge.

“When I applied to read medicine at Cambridge my real interest was the scientific basis of medicine, not just the clinical side,” he says and this dual interest in academic science and clinical medicine has defined his career to date. After three years of his six-year medical degree, Tse’s career took a slight diversion when he was selected for the Frankl Award (Trinity Hall, University of Cambridge), The Wellcome Trust and The Physiological Society Scholarships for cardiovascular research at Cambridge. These enabled him to undergo further laboratory training during his vacations outside of term-time as an undergraduate. He subsequently spent three years pursuing PhD studies focused on cardiac electrophysiology, the electrical activity of the heart and its relationship to arrhythmia (abnormal heartbeat).

After six years studying in Cambridge, he felt ready for a lifestyle change and took advantage of an opportunity to transfer to Imperial College, London to complete his clinical degree where he also conducted research in cardiovascular MRI at the Royal Brompton Hospital, in London.

His first position was in the South Thames London Deanery where again, he combined his career progression in medicine with research, by successfully completing a distance learning degree in public health from the University of Manchester.

“In the hospital I worked at, there was plenty of senior medical experience and supervision to call upon,” he says and while the job was both challenging and enjoyable Tse confesses the experience did not further his research career.

Tse was settled in England and had no plans to return to Hong Kong but saw a job advertised for an assistant professor position on the teaching track at the University of Hong Kong (HKU) which had been created following a Croucher Senior Fellowship award to Professor Jin Dong-yan.

Tse was appointed to the position and started lecturing in pre-clinical medicine in 2015 but after an enjoyable year, he felt ready to resume his career in medical research. Despite his impressive CV, his unconventional fusion of academic research and clinical work and his overseas medical registration that is not applicable in Hong Kong meant he did not seem to fit the bill.

By chance, the chairman of the Department of Medicine Therapeutics at the time and the Dean of Medicine of CUHK were very supportive. “We discussed how my basic scientific background would fit into the department’s research objectives,” he says.

Tse subsequently became the most junior medical doctor ever to be appointed as an assistant professor and lead investigator, when he joined the Li Ka Shing Institute of Health Sciences within CUHK's teaching hospital, the Prince of Wales Hospital, in 2016, with the support of a Croucher Foundation junior clinical research fellowship.

“I am fortunate to be on the clinician-scientist track, which allows me to have a 50/50 split between academic research and clinical medicine,” he says and explains that this was all made possible due to the Dean’s innovative idea of initiating such a track.

The department’s faith in him is paying dividends. Since joining CUHK, Tse’s group has published more than 30 articles and has further submitted 40 manuscripts for peer review. He has returned to his core interest in understanding the mechanisms of the two types of cardiac arrhythmias: atrial fibrillation, the irregular and often rapid heart rate that can increase the risk of stroke or heart failure, and the rarer and more life threatening, ventricular arrhythmias, abnormal heart rhythms that originate in the bottom chambers of the heart, the ventricles. In terms of impact he is particularly proud of two breakthroughs, published over recent weeks.

In one study published by the Journal of the American Heart Association, Tse and his team, in collaboration with investigators from the Tianjin Medical University, discovered that the drug Alogliptin, which is a dipeptidyl peptidase-4 inhibitor used to treat diabetes, can prevent atrial fibrillation by reversing electrophysiological abnormalities, improving mitochondrial function, and promoting mitochondrial biogenesis. The link between atrial fibrillation and diabetes is known and this study using diabetic rabbits, established that this drug has the additional benefit of protecting the atrium and preventing atrial fibrillation.

“It’s a breakthrough in terms of mechanism but diabetics are more prone to atrial fibrillation so potentially, clinicians could prescribe this drug in preference to others because of the beneficial side effects,” he explains.

The second recent breakthrough was more of a “number crunching” exercise by pooling results from previous studies to look for specific electrocardiographic indices for risk stratification. Of these, Tse has been interested in the Tpeak – Tend interval. In this systematic review and meta-analysis, it was discovered that in the general and diseased populations, a prolonged Tpeak – Tend interval predicted arrhythmic or mortality outcomes. This was recently published in the leading journal on cardiac arrhythmias, the Heart Rhythm Journal.

“If the Tpeak – Tend interval is prolonged, it represents a higher dispersion of repolarization, and this should alert clinicians to monitor these patients more closely, due to a higher risk of developing potentially lethal ventricular arrhythmias,” he says.

When asked about research methods, Tse says he does not prefer one over another, be it laboratory or epidemiological.“As long as it answers an important research question, it doesn’t really matter what research method you use. Both basic science and clinical studies are equally important.”

Dr. Gary Tse is a clinician-scientist with research interests in the molecular and physiological mechanisms of cardiovascular diseases. He has received numerous scholarships and awards including the Claringbold Medicine Scholarship, the Gregon and Benn Award (Trinity Hall, University of Cambridge), the Frankl Award (Trinity Hall, University of Cambridge), The Wellcome Trust and The Physiological Society Scholarships for cardiovascular research at Cambridge, and a Master’s scholarship for MPhil study in Computational Biology from the Cambridge-MIT Institute. In August 2015, Dr. Tse was appointed Assistant Professor in Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong. In 2016, he was awarded a Clinical Research Fellowship by The Croucher Foundation and subsequently joined the Department of Medicine and Therapeutics of the Faculty of Medicine, The Chinese University of Hong Kong. Dr Tse is a Principal Investigator in the Faculty’s Li Ka Shing Institute of Health Sciences.

To view Dr Tse’s Croucher profile, please click here