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Early detection of disease is a goal that many areas of medicine and dentistry strive for: it decreases the potential for poor outcomes for patients and limits costs associated with those for the health service. Often a biological marker – referred to as a biomarker – can detect disease in samples of blood, serum or plasma. This has been the gold standard for many years, decades even, however the sampling of other fluids such as saliva are desirable as they are non-invasive.

Saliva is a fascinating fluid that comprises proteins and chemicals that reflect both oral and systemic health. The use of oral fluids in understanding mechanisms of disease and in creating diagnostics is not new but is a burgeoning field of research with potential for lasting impact.

At the University of Birmingham, there are many academics using saliva in research: from measurement of stress markers in ageing, to biomarkers for diagnosis of concussion and to protein biomarkers for detection of gum (periodontal) disease. In the latter case, the Periodontal Research Group, led by Professor Iain Chapple and myself, has discovered novel biomarkers for differentiation of different forms of gum disease, which will help to stratify patients. These biomarkers have the potential to detect this highly prevalent disease in ‘at risk’ groups, such as those with rheumatoid arthritis and chronic kidney disease – where dental treatment can make a considerable difference to patient well-being.

In some patients groups provision of periodontal or gum disease treatment is akin to adding an extra medicine (drug) regime. Being able to detect gum disease could therefore be transformative for patients by increasing quality of life after successful treatment. The Periodontal Research Group is working with international partners to lead globally on this area of research and has already discovered a panel of biomarkers that are currently undergoing intellectual property protection.

In October, Professor David Wong, of the University of California Los Angeles, visited the University of Birmingham for a Distinguished Visiting Fellowship with the Institute of Advanced Studies. Professor Wong, a world-leading expert of biomarker discovery in saliva, has been a major recipient of funding from the National Institutes of Dental Research (NIDCR) of the National Institutes of Health (NIH) in the USA on this topic.

His research has been in basic and translational sciences for oral cancer, spearheading salivary diagnostics research development for the past 12 years contributing to the scientific foundation and translational development and definitions of the salivary transcriptome (extracellular RNA), miRNA, proteome, microbiome and metabolome. He and his team have also developed the EFIRM-Liquid Biopsy (eLB) technology, which provides near-perfect detection of actionable mutations in lung cancer patients. During the visit, he advised on the creation of the University of Birmingham’s potential world-class network and centre on the analysis of oral fluids, with particular focus on saliva.

Looking to the future, point of care handheld tests using saliva biomarkers discovered at the University of Birmingham could be used in dental or medical primary care surgeries or in secondary care settings to aid non-expert stratification of patients in the greatest need to facilitate access to the most appropriate care pathways.

Dr Melissa Grant
Senior Lecturer in Biological Sciences, School of Dentistry, University of Birmingham