Expression of heat shock protein 70 into an integrated heat health risk framework for vulnerable populations in urban and rural Klang Valley, Malaysia

Excessive exposure to heat can lead to adverse effects on human health, especially among vulnerable groups that are often linked to acclimatization deficiency. However, there is still a gap in understanding the background of the heat stress defense mechanism exhibited by Heat Shock Protein (HSP), which commonly known as a stress proteins that regulated for cells to survive and inhibit apoptosis. Thus, this study aims to evaluate heat shock protein 70 (HSP70) expression towards heat exposure and suggest an integrated heat-health risk framework among urban and rural vulnerable populations. A comparative cross-sectional study and multistage sampling design were conducted, involving a total of 108 respondents from Klang Valley areas (Kuala Lumpur and Hulu Langat). This study consists of seven (7) parts: Part I: Sampling area measurement of residential characteristics, Part II: Questionnaire, Part III: Heat exposure monitoring using Wet-bulb Globe Temperature (WBGT) and classification of heat exposure level using Universal Thermal Climate Index (UTCI), Part IV: Physiological monitoring of core body temperature, heart rate, and blood pressure, Part V: Blood sample collection, Part (VI): Laboratory analysis of HSP70 expression levels using Enzyme-linked Immunosorbent Assay (ELISA) and Reverse-transcription Quantitative Polymerase Chain Reaction (RT-qPCR), and Part (VII): Heat health risk framework modification. Urban areas recorded higher UTCI heat exposure levels (32.1oC) than rural areas (31.0oC). There was a significant association between UTCI heat exposure level with the HSP70 gene and protein expressions in urban and rural areas (p<0.001). Also, there was a significant association between UTCI heat exposure level and heart rate in rural areas (p<0.05). Principal component analysis (PCA) revealed that the individual factors (existing health problems and medicine intake) contributed the highest variances in urban respondents (18.2%). In contrast, environmental factors (building type, building age, green plot ratio, and ceiling availability) contributed the highest variances in rural respondents (25.4%). A different integrated heat health risk framework were proposed since urban and rural vulnerable populations demonstrated different patterns of HSP70 expressions and physiological responses due to the influence of different heat exposure levels and heat health contributing factors. This new integrated heat health risk framework can enhance the existing mitigation response to reduce the morbidity and mortality rates related to heat for future extreme heat event.

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