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.