Periodontal Research

In the periodontal disease area, a major strand of research is focussed on unravelling the complex stress response pathways which occur during periodontal inflammation at the molecular, cellular and clinical levels.

Identifying the mechanisms underpinning disease pathogenesis and the inter-relationships between periodontal inflammation and other chronic inflammatory diseases (such as rheumatoid arthritis and chronic kidney disease) and the ageing immune system are key goals. Translation is a priority through clinical trials to provide novel diagnostics and host-modulating therapies. Indeed we have completed the first ever randomised phase 3 controlled trial of a phytonutrient supplement, designed for periodontitis treatment and developed over the last 6 years in collaboration with Unilever.

Characterisation of the saliva and crevicular fluid proteome for the first time in health, gingivitis, mild and severe periodontitis, is being undertaken in a project designed at novel biomarker discovery for both human and canine veterinary fields with industry collaborators.

The development, implementation and outcomes of a novel online risk and disease assessment system through our spinout company “Oral Health Innovations”, that drives patient care pathways and capitation fee banding is now active in over 700 Denplan practices with over 40,000 assessments performed by summer 2015. Longitudinal patient monitoring will provide powerful data for public health service planning and profits from OHI Ltd have already funded 3 competitive grants in 2015 through donations to the UK’s Oral and Dental Research Trust.

Overview

The Periodontal Research Group is active in identifying mechanisms underpinning the pathobiology of the inflammatory periodontal diseases at the cellular and molecular levels, by focussing upon novel pathways in the regulation of innate immune responses and how they become perturbed in response to infection. This naturally involves exploring clinical and mechanistic links between periodontitis and systemic diseases of ageing, including Rheumatoid Arthritis, Type 2 Diabetes, Chronic Kidney Disease, Chronic obstructive Pulmonary Disease, Systemic Lupus Erythematosus, Sjogrens syndrome. A major focus is in biomarker discovery for disease diagnosis and progression and also the development of novel therapeutic approaches to managing periodontitis, that are based upon our basic research and discovery.

Our research group

We are approaching this with four strands of research:

  1. We are embracing stratified medicine approaches to investigating the inter-relationships between periodontal inflammation and other chronic inflammatory diseases (such as chronic kidney disease, rheumatoid arthritis and COPD). This involves large longitudinal cohorts, phenotyped for periodontal status as well as medical status and the elucidation of the impact of periodontal interventions upon hard outcomes of the relevant medical co-morbidities. Biological samples collected are permitting mechanistic research into potential pathobiological contributions of periodontal inflammation to these systemic diseases.
  2. Biomarker discovery is also a major initiative, exploiting the accessibility and non-invasive collection of oral fluids like saliva and crevicular fluid. We utilise state-of-the art mass spectrometry techniques in association with the Advanced Mass Spectrometry Facility (http://www.birmingham.ac.uk/facilities/advanced-mass-spectrometry/index.aspx) to quantitatively assess oral fluids. Two US patents were filed in 2013/2014 (PCT/IB2013/058342 & PCT/IB2013/058431), testimony to our desire to impact positively upon patient care in primary care practice environments.
  3. Fundamental research into neutrophil biology is unravelling key abnormalities that appear to have a common origin in redox biology. Specifically, work on the production and release of reactive oxygen species, cytokines and other signalling molecules by peripheral blood neutrophils. The production, removal and functionality of neutrophil extracellular traps (NETs) and neutrophil directional chemotactic accuracy is yielding exciting new insights into the role of this dominant cell in periodontal pathology.
  4. Translation is a priority through clinical trials to provide novel diagnostics and host-modulating therapies. Indeed we have completed the first ever randomised phase 3 controlled trial of a phytonutrient supplement, designed for periodontitis treatment and developed over the last 6 years in collaboration with NSA LLC (Chapple et al. J Clin Perio 2012). The work is based upon our fundamental research into micronutrient approaches to modulating the redox environment of the cell as a novel approach to periodontal therapy and has recently moved into to a large European multicentre trial (ClinicalTrials.gov:NCT01229631). Fundamental research in collaboration with Dr Addison’s group and ENT is exploring potentially novel mechanisms through which transmucosal/dermal titanium osseointegrated implants may fail under the challenge of infection.

Staff within the group

Professor Iain LC Chapple
Dr Melissa Grant
Dr John B Matthews
Dr Mike Milward
Dr Martin Ling
Mrs Nicola Ling-Mountford
Mr Praveen Sharma
Miss Zehra Yonel

Key collaborating colleagues within the School of Dentistry are:

Professor Thomas Dietrich
Professor Paul Cooper
Professor Owen Addison