Interview with Dr. Michael Glogauer

📷 University of Toronto

Journalist: Rajpreet Chakkal

Raj: Welcome to SciSection my name is Raj and I'm a journalist for the SciSection radio show broadcasted on platform CFMU 93.3 FM we're here today with Dr. Michael Glogauer thank you for taking the time and meeting with us and welcome to our show!

Dr. Glogauer: Thank you for the invitation.

Raj: To begin off can you tell the listeners about your field of research and of medicine and what exactly is it that you specialize in?

Dr. Glogauer: Sure, so I'm a dentist whose specialty is something called periodontology or paranormal surgery which involves the treatment of gum disease and placing dental implants and bone grafting. I'm also a full-time professor at the faculty of dentistry at the University of Toronto. I'm the head of dentistry at the University Health Network and the head of dentistry at the Princess Margaret cancer center. So, my research focuses on the impacts of oral health and cancer at that interface and also trying to understand how oral infections can impact systemic health.

Raj: Well that's very impressive! So, what exactly inspired you to also like conduct research instead of just being like a purely practice focused dentist?

Dr. Glogauer: So, I was very attracted to science and research from my initial time during undergrad. I did two years of undergrad and was a summer student throughout that period of time. So, the first time I spent time in a lab I was completely hooked on science I just thought it was amazing that you could go into an environment ask questions and really get be the first person to ever know the answers to those questions. So, I sort of found that super exciting and so I was hooked on science right from the beginning and some advice was given to me by one of my early research mentors that if I was very serious about research and a research career that I should become a clinician as well. That helps focus the questions and makes it a little bit easier to get funding as well as a dental clinician, so I chose dentistry for a number of reasons and I haven't really looked back. I have never regretted the choice for a moment, research and clinical research being a dental clinician-scientist has been one of the best decisions I ever made.

Raj: Definitely I can see coming from a science background that is actually really fun, and so there's a recent paper that just came out that the mechanism behind how periodontal disease relates to other inflammatory conditions has just been found and it was with you and your team. Can you just briefly explain the process of what your team went through to find the answer to this?

Dr. Glogauer: Absolutely, so it's recognized now that there's an association between oral infections and periodontal disease or gum disease in particular and a number of other inflammatory diseases including cancer and heart disease diabetes, and the list goes on. So, one of the questions I and many of my colleagues in research would have wondered is how is it that a gum infection could have these potential effects on these other distant clinical inflammatory diseases? So, we set out to sort of answer that question and the interest of the great thing about this paper is that it uses both a mouse model to get to the mechanism and then we're able to also do this in humans to get a sense of what we see in the mouse is it also true in the humans. So, in the mice, we induce periodontal disease and we use something called a double hit model whereby we either have mice that don't have periodontal disease or the mice that do have periodontal disease which we induce. Then what we do is we induce an acute infection within the peritoneum or peritonitis and then we study how that peritonitis resolves. How does the immune system or react to that infection that that acute infection? What we found is that in the mice with the periodontal disease appears to prime or pre-activate the white blood cells in circulation so that they give an over-exuberant or two too much of a response to that peritonitis. So, that suggests that having this chronic disease, this chronic inflammatory disease, like periodontitis in the mouse may prime the white blood cells so that when they do have a second hit as it were with and that could be somebody who has cardiovascular disease afro sclerosis, it could be somebody who is a diabetic, it could be somebody who has cancer. Where the immune system will play a role in that disease if the periodontal disease primes that the immune system could create problems for that person in their other disease process that's taking place. So, the question is that's what we saw in the mouse and we saw in the mouse that a lot of cytokines are being produced in circulation due to periodontal disease and these static kinds are undoubtedly the mechanism. We will come back in a few minutes and talk about how this may impact COVID were set of kinds are big factors but now if we go into the humans how can we do this in a human ethically? So, we have this model in my lab called experimental gingivitis and that's where we take healthy young people and we have them not brush for three weeks we actually pay them not to brush their teeth. Then they come in every week and we take blood and we look at their mouths we collect samples from the mouth we collect their blood as I mentioned and we have this assay or this test that we do is that we take an aliquot of their blood and we add an activator of the white blood cells. What we found is the advantage of this is that we can take one person we can look at them when they're healthy cause we get their blood with their healthy, and then we can take their blood as they're developing gingivitis which is periodontal disease, inflammation in the gums, and so we're getting blood from them all throughout and then they start brushing teeth their teeth again we clean them up and then they get healthy again. So, all the way along there we could be testing their blood, and what we found is that as they give develop gingivitis their white blood cells actually become hyperactivated to that secondary stress that we add directly to the blood. So, that's very exciting because that shows exactly what we saw in the mouse also happens in humans with gingivitis. Their white blood cells have the potential, it's called priming or has the potential to become hyper-activated when they get a second hit. This is all very exciting because what it suggests is that even a gum disease as early or as mildest gingivitis has the potential to activate white blood cells and what does that mean for patients and what does it mean for dentists and hygienists? It means that we need to do everything we can to make sure that the mouth stays healthy and that even a little gingivitis in the wrong person who has potential risk factors for other diseases could be quite problematic so that was sort of the excitement. Now, if we bring it back to COVID you know there's this subset of patients with COVID who have a turn for the worse they seem there's something that seems to differentiate a very small percentage of the population where they get COVID and end up in the hospital. Never the problem so the question is what it about those patients is and oftentimes what you'll hear they'll say oh that person was completely healthy. Well, I think that that may be true but obviously, there's something else going on and you know with all due respect to everybody who says well that person was completely healthy. I'm almost positive no one ever looked in their mouth, no one ever sees did that person have the potential to develop gum disease. It's the last place anybody, except a dentist and hygienist, looks to see if there actually is a disease process. So, what is starting to come out now is that some of these people actually have pretty severe gum disease. Again, if we match that with what we've just found that patients with gum disease have higher levels of certain cytokines we know that and their white blood cells are primed and we know that when things go bad in COVID patients there are more cytokines there's something called a cytokine storm. We know that these cells called neutrophils these white blood cells are hyperactivated and cause a problem we there's the potential there that gum disease at least in a small subset of these patients may be playing a role.

Raj: Wow that's really interesting and so throughout this whole testing and going through from mice to humans and what were the complications or challenges that you faced along the way?

Dr. Glogauer: Right, so I think you know we've been working on this for quite a number of years we have a number of papers in this field. One of the things that we wanted to do is well my surname excellent model the real challenge was trying to show this, trying to develop a human system that we could get by ethics and want to obviously you can't induce periodontal irreversible but this severe forms of periodontal disease are actually irreversible. So, there's no way ethically you can do that, and trying to find patients who had periodontal disease and then treat them as too long a process. So experimental gingivitis which is expensive it's an expensive model because obviously, we have to pay people, we need to they need to come in every week. I will say that we are grateful that we were able to do this these study before COVID came along because as I'm sure you're aware the laboratories at the universities were shut down for a period of time. I get patients to coming out getting volunteers to come now is very challenging because the universities are being quite strict about what can be done during this period because they don't want to put people at risk. So, I would say the challenges could have been greater if this had been done during COVID but fortunately we were able to finish this off early and you know I think we were the surprising thing is I really thought at the beginning that I would take something like this severe forms of periodontal disease and periodontitis to see the effect in circulation. It was somewhat of a shock to see that even the milder forms of gingivitis could induce this effect which quite disturbing but also interesting from a research standpoint.

Raj: Okay and so you said that the people that came in they wouldn't brush for three weeks so prior to them being tested were they like relatively healthy people?

Dr. Glogauer: Right so that's a great point, so the model sometimes we do two weeks sometimes we do three weeks. There are very strict criteria that we have to go through the ethics review boards and the patients have to be perfectly healthy. So, usually, most of our subjects were in the 20, 30-year-old range. Most of them were students at the university you know we give about $900 or $1000 to these people for the period. So, usually, it's somebody who has free time say between courses and needs you to know $800, $900, $1000, they get their teeth cleaned before they get their teeth cleaned after. So, if you've got the time it's a good model but again yes everybody was healthy before sometimes, they actually get cleaned before they get a dental cleaning because we want to make sure everybody starts at the same place. So, not everybody is perfect you know some people had a little bit of gingivitis we clean them up get them perfectly healthy, and then they started in the study.

Raj: During the period of the study was there at any point where one subject had to stop being tested on because they developed something severe afterward for not brushing for a long time?

Dr. Glogauer: Great question so, that's the beauty of this model the answer that is no we always have one or two dropouts who for whatever reason they find out okay no. It may sometimes the thought of not brushing for three weeks you can think about it when you're actually in the middle of it's for some people so we had I think we had one or two people out of the I think 20 or 30 I can't remember how many people were in it but who end up dropping out. We always account for that but for the most part, you know everyone seems to do okay.

Raj: Okay that's great and so you said that you were happy that you started this before COVID hit because the labs were like they got shut down for a while. Is everything like other lab testing or anything else you're doing is it back to normal speed? Or is it still like a slow trend towards normal research?

Dr. Glogauer: Right, I mean most of the projects are up and going up my lap fairly well. The ethics review boards that we have to go through there's a lot of extra questionnaires that we have to give to subjects, there's a lot of extra precautions in place that makes a little bit more labor-intensive. Besides that, at this point for the most part everything's is up and going and we hope it stays that way based in the next few months.

Raj: Yeah for sure and has COVID affected productivity in any way cause everything is shifted online but lab testing is obviously still in person, but in terms of other ways that you have to work like when you have to look at the data and then share with other people and like the number of people that can work in a lab. So how has productivity been affected and how have you gotten around that?

Dr. Glogauer: Right, I mean that's a good question I can tell you at the university at there's certainly more hoops there's more paperwork. There more restrictions, the fact that a lot of my staff work some of them from a distance. Science is very collaborative, and you get ideas walking around talking to people in that setting. When we walk into the lab it's fairly empty now because people are only there exactly for their experiments and then have to leave. So, the collaborative approach people walking talking sharing ideas that certainly has been curtailed significantly. I think we are going to pay we are paying a small price for that, in terms of moving some projects forward. I hope we're going to sort of be able to figure it out, I could you know as a university professor and having to do meetings and thesis defense is being able to do things by zoom actually saves me time, not having to go into rooms, and not having to travel time is sort of changed. I just you know for the most part get to sit in my office in the hospital and do things at the university, where I would physically have to move so you know I think there are some upsides. I think hopefully some of these things I think we’ll get to keep but I envisage that meetings at universities that administrative tasks those sorts of things even some of the teaching that I'm doing is now online. So, I think some of these things I hope we're here to stay because they certainly do help us save time.

Raj: So hopefully now research is up and going and you're saving time so hopefully you get to be as productive as you possibly can, and I wish you the best of luck with further research.

Dr. Glogauer: Thank you, Raj.

Raj: It was a pleasure to have you on the show Dr. Glogauer and thank you for joining us today.

Dr. Glogauer: Thank you for having me.

Raj: Alright guys that's it for this week of SciSection make sure to check out our podcast available on global platforms for our latest interviews.

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