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COULD SIMPLY-ADAPTED TECHNOLOGY PROVIDE A RAPID, LOW COST ALTERNATIVE FOR COVID-19 DETECTION?

May 5th, 2020

A simple mouth swab and rinse with testing technology adapted from a common viral detection method, the pap smear, could provide an easy, low cost and rapid diagnostic tool for COVID-19 infections, says Michael Glogauer, professor at the Faculty of Dentistry and head of dental oncology at Princess Margaret Cancer Centre. Glogauer, along with partners at Sunnybrook Health Sciences Centre, North York General Hospital, Sinai Health Systems and UHN’s Princess Margaret Cancer Centre, has been given permission by the University of Toronto to research the viability of the platform.

Recently, Canada has launched a number of detection platforms to help with the fight against COVID-19, including a new platform developed by a U of T alumnus. Some detection methods, like the Spartan Portable Cube, require specialized technology and laboratory equipment. Others, like the common nasopharyngeal swab method, utilize certain chemicals for testing, of which currently are in global short supply.

Most testing sites, Glogauer points out, miss the mouth.

Mouths more accessible

Increasingly, evidence suggests that the mouth is an ideal site for taking samples for COVID-19 testing – although few testing methods do. SARS-CoV-2, the virus that causes COVID-19 infections, invades epithelial cells, such as those lining the lungs.

But these epithelial cells are also prevalent in large numbers in the mouth, and especially on the tongue, where respiratory droplets are expelled. COVID-19 binds to the body’s epithelial cells through ACE-2 receptors.

And, as Glogauer notes, “It just so happens that the tongue expresses extremely high levels of ACE-2 receptors.”

That makes the mouth, which is also one of the most easily accessible sites on the body —requiring no needles, and unlike the nose, causing no pain when swabbed — an ideal place from which to cull samples.

“The tongue is a big net. It will always be positive if an infection is present,” says Glogauer.

But it’s a testing platform already in use which could make a significant difference in making testing widely available around the world: the pap smear.

“The tongue is a big net. It will always be positive if an infection is present.” 

Adapting simple tests

The common denominator between pap smears and the novel coronavirus is epithelial cells.

“Pap smears show viral changes and inflammation in epithelial cells,” Glogauer explains, exactly what technicians are on the hunt for with COVID-19.

Common to women the world over, the test is also routine and simple: epithelial cells are scraped, mounted onto slides, stained and viewed under a microscope. The cost? Approximately $30 per test.

Glogauer also notes that laboratories around the country could rapidly mobilize to this testing platform.

“All labs are set up to do pap smears,” he says.

The process of adapting the test would be virtually painless, too: samples could be easily collected by giving subjects an oral rinse and brushing their tongue. Results can be returned in a matter of hours.

Importantly, the smear test could represent an easy ally for COVID-19 detection in developing nations, where lab technology is limited.

“If it works it will be a real game changer for everyone,” says Glogauer.

Still, Glogauer cautions that the technology needs to be fine-tuned to be able to weed out false positives – currently, the test will indicate other forms of viral infection, as well. But as a fast and relatively inexpensive tool in the arsenal to find and detect COVID-19?

“Ideally, you want different testing modalities,” says Glogauer. “This could be one of them.”

Minimally Invasive Diagnostic Tools in the Diagnosis of Periodontal Disease

August 16th, 2019

January 11, 2018
by Zahra Dorna Mojdami, HBSc, DDS; Michael Glogauer, DDS, Dip Perio, PhD; Amir Azarpazhooh, DDS, MSc, PhD, FRCD(C)


Introduction

The most common chronic inflammatory conditions worldwide and collectively the most common diseases known to mankind, are inflammatory periodontal diseases.1 Periodontal diseases include gingivitis, where the inflammation confined to the gingiva is reversible with good oral hygiene, and periodontitis, an extension of the inflammation that results in tissue destruction and alveolar bone resorption.1 Periodontitis is very common with 10-15% of adults being afflicted with severe periodontitis and 40-60% being affected by moderate periodontitis.2 Several forms of periodontitis have been recognized; however, the predominant category is chronic periodontitis (CP) which remains the number one cause of tooth loss in adults worldwide.3 The goal of periodontal diagnostic tools and procedures is to provide useful information to the clinician on the periodontal disease type, location, and severity. This information will serve as the basis for treatment planning and monitoring of disease.4 Traditional periodontal clinical diagnostic parameters include probing depths, bleeding on probing, clinical attachment levels, plaque index, and radiographs.5 The strengths associated with these traditional tools are that they are easy to use, cost-effective, and are relatively non-invasive.5 However, these traditional diagnostic procedures are limited in that only disease history, not current disease status and activity, can be assessed and identified.5,6 For example, clinical attachment loss readings by the periodontal probe and radiographic evaluation of alveolar bone loss measure damage from past episodes of destruction and require a 2 to 3 mm threshold change before a site can be identified as having experienced a significant anatomic event.5 Even in instances when patients’ treatments are monitored over time it can be difficult to use these clinical parameters to make a definitive periodontal diagnosis.5 As another example, does a patient who has been treated with non-surgical periodontal treatment and now has several sites with residual probing depths that bleed on probing still have periodontitis that requires further active therapy or surgical treatment, or is the condition stable and the disease in remission?7 Moreover, other limitations such as the difficulty in precisely duplicating the insertion force, probe placement and angulation exist.8 Radiographs, a key factor in determining the severity of periodontitis and bone-related damage, have limited sensitivity and only reveal change in bone after 30% to 50% of bone loss has occurred.8 Furthermore, radiographs cannot be taken at each visit due to excess radiation exposure to the patient.8 Advances in oral and periodontal disease diagnostic research are consequently moving forward toward methods whereby periodontal diagnosis and risk can be identified and quantified by measures that are objective7, minimally invasive, less technique sensitive, less time consuming and that are able to identify active and potential periodontal disease. New developments in periodontal diagnostic research will be discussed below.

https://www.oralhealthgroup.com/features/minimally-invasive-diagnostic-tools-diagnosis-periodontal-disease/

 

DENTISTRY’S PROFESSOR MICHAEL GLOGAUER AWARDED CAHS FELLOWSHIP

August 8th, 2019

Dentistry’s Professor Michael Glogauer, DDS 9T3, PhD 9T9, has been awarded a prestigious Canadian Academy of Health Sciences (CAHS) Fellowship.

Induction into the CAHS as a Fellow is considered one of the highest honours within Canada’s academic community and focuses on bringing together Canada’s top-ranked health and biomedical scientists and scholars to make a positive impact on the urgent health concerns of Canadians.

“This is a real privilege,” says Dr. Glogauer. “Being a clinician-scientist is the best job in the world. There is creativity and problem solving involved and we get to work towards answering important questions.”

Within CAHS, there is a select group of dental clinicians. Dr. Glogauer joins University of Toronto’s Dr. Christopher McCulloch, as well as Dr. Chris Overall from University of British Columbia and Dr. Paul Allison from McGill University in the Dentistry stream of CAHS.

Dr. Glogauer says this will afford him the opportunity to demonstrate how important funding is to the work of dental clinician scientists – and to the lives of Canadians. “The oral cavity is connected to the rest of the body where health problems can be initially detected by dentists. For example, diabetes often presents with an infection in the mouth,” he says. “With improved communication between the dentist and the rest of the health care team, we can potentially carryout earlier detection of new cases of diabetes, improve patient health, and reduce costs to the healthcare system.”

Dr. Glogauer is a leader in oral innate immunity in health and disease. As a dental clinician scientist, he focuses on understanding how oral disease impacts on general health. The Glogauer lab has revealed novel concepts of distinct neutrophil (an immune cell that is one of the first cell types to travel to the site of an infection to help fight infection) activation states in oral health and periodontal disease and how shifts in neutrophil activation can be used as a diagnostic biomarker for early detection of periodontal diseases and furthermore, how oral disease can impact systemic health. He uses this knowledge to understand the impact of socio-economic status and lack of dental care access on overall health.

Dr. Glogauer is also an internationally-recognized leader in the fields of innate immunity, neutrophil function, and periodontal diseases. His research, which focuses on neutrophils, has resulted in important publications describing regulators of neutrophil function, immune regulation of periodontal disease, and alveolar bone loss. This work has led to two patents, one license, and two license disclosures.

It has also has led to the development of a novel non-invasive oral rinse test for periodontal disease, the leading inflammatory condition in humans. This test is based on 10 years of research in his lab (12 publications; 15 students) and has resulted in the creation of technology licensed to a Canadian company (Oral Sciences Inc.) for a diagnostic rinse test called PerioMonitorTM. It is in the final phase of clinical testing as required by the FDA and Health Canada for approved use in medical and dental offices. This rinse will be the first tool to allow for rapid screening for periodontitis in a non-dental setting.

This test builds on Dr. Glogauer’s goal of overcoming the “dental disease blind spot” in the Canadian health care system that impacts the overall health and quality of life of Canadians. Dr. Glogauer’s focus on connecting oral health to general well-being is also highlighted by his monthly speaking and teaching engagements to stakeholders in the healthcare community.

Dr. Glogauer is also the recent recipient of a grant from the Network for Canadian Oral Health Research (NCOHR): New Frontier Seed Grant Program (2018) for his work entitled: “Monetite biomaterial grafts loaded with a novel bone anabolic conjugate C3 conjugate drug to achieve more predictable and greater bone regeneration.

https://www.dentistry.utoronto.ca/news/professor-michael-glogauer-awarded-cahs-fellowship

 

Role of Fibroblast Populations in Periodontal Wound Healing and Tissue Remodeling

August 1st, 2019

Abstract

After injury to periodontal tissues, a sequentially phased healing response is initiated that enables wound closure and partial restoration of tissue structure and function. Wound closure in periodontal tissues involves the tightly regulated coordination of resident cells in epithelial and connective tissue compartments. Multiple cell populations in these compartments synergize their metabolic activities to reestablish a mucosal seal that involves the underlying periodontal connective tissues and the attachment of these tissues to the tooth surface. The formation of an impermeable seal around the circumference of the tooth is of particular significance in oral health since colonization of tooth surfaces by pathogenic biofilms promotes inflammation, which can contribute to periodontal tissue degradation and tooth loss. The reformation of periodontal tissue structures in the healing response centrally involves fibroblasts, which synthesize and organize the collagen fibers that link alveolar bone and gingiva to the cementum covering the tooth root. The synthesis and remodeling of nascent collagen matrices are of fundamental importance for the reestablishment of a functional periodontium and are mediated by diverse, multi-functional fibroblast populations that reside within the connective tissues of gingiva and periodontal ligament. Notably, after gingival wounding, a fibroblast sub-type (myofibroblast) arises, which is centrally involved in collagen synthesis and fibrillar remodeling. While myofibroblasts are not usually seen in healthy, mature connective tissues, their formation is enhanced by wound-healing cytokines. The formation of myofibroblasts is also modulated by the stiffness of the extracellular matrix, which is mechanosensed by resident precursor cells in the gingival connective tissue microenvironment. Here, we consider the cellular origins and the factors that control the differentiation and matrix remodeling functions of periodontal fibroblasts. An improved understanding of the regulation and function of periodontal fibroblasts will be critical for the development of new therapies to optimize the restoration of periodontal structure and function after wounding.

Author information

Smith PC1, Martínez C1, Martínez J2, McCulloch CA3.

Front Physiol. 2019 Apr 24;10:270. doi: 10.3389/fphys.2019.00270. eCollection 2019.

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