Improving treatment for patients with diseases associated with low-grade inflammation (LGI)
Excellent translational research is key when the aim is to improve treatment for patients with diseases associated with LGI. The foundation is strong collaborations between researchers at universities and clinicians at hospitals and together they create the basis for new insights, innovation, and implementation in clinical practice with direct value and impact on patient care.
Clinical Professor and CAG Chair, Peter Riis Hansen and Professor and CAG Vice-Chair, Palle Holmstrup started CAG LOGINFLAM in 2019. CAG LOGINFLAM aims to improve treatment for patients with diseases associated with LGI and strengthen the understanding that oral/periodontal inflammation can be associated with many noncommunicable diseases.
LGI is implicated in most noncommunicable diseases, e.g. type 2 diabetes, cardiovascular disease, periodontitis, neurodegenerative diseases and cancer. These diseases account for massive direct and indirect health costs; thus, LGI represents a substantial societal burden.
Also, traditional chronic inflammatory diseases, e.g. periodontitis, rheumatoid arthritis, psoriasis, and inflammatory bowel disease, as well as adverse effects of therapeutic interventions, e.g., transfusions or surgery, are linked with LGI. These diseases frequently share inflammatory pathways and coexist in individual patients, suggesting that treatment of one LGI-dependent disease may favorably affect another comorbidity.
“The CAG collaboration has helped place periodontitis in the context of other inflammatory diseases. This has strengthened the understanding that disease in one part of the body can affect other parts of the body. It emphasizes the importance of holistic care, i.e., looking at patients as whole people, and can contribute to an enhanced interdisciplinary effort in daily clinical work”, says CAG Chair, Professor Peter Riis Hansen.
The CAG vision is to establish an internationally recognized center of LGI research with a track record of excellent scientific results, education and innovation that has improved understanding of LGI-associated pathologies and contributed to a reduction of their individual and societal burden.
The importance of excellent research and strong collaboration
CAG LOGINFLAM aims to provide novel and clinically relevant data on the importance of LGI in human disease by adopting a translational approach based on a formalized collaboration between investigators from basic science, clinical specialties and epidemiology. By joining the forces of research of proven excellence, the CAG creates synergies that promote high-quality LGI research, teaching, innovation and clinical implementation.
CAG LOGINFLAM has received exclusive access to nation-wide data from practicing dentists in Denmark, which gives them a unique open gateway to studies aimed at correlating the oral/periodontal status with systemic comorbidities, on a population scale. The CAG also has an on-going randomized controlled trial of periodontal treatment of patients with rheumatoid arthritis, with primary endpoints including subclinical disease activity in the joints, as well as microcirculatory function parameters.
Furthermore, the CAG is in the planning stage of a randomized study of periodontal treatment of patients with recent myocardial infarction, where endpoints will involve CT coronary angiography assessment of coronary plaques, FDG-PET/CT activity in the aorta, and changes in traditional risk factors (blood pressure, blood lipids etc.).
These two randomized trials and the range of studies utilizing the established data from Danish dentists, are set to bolster and expand the overarching paradigm that oral and periodontal health significantly impacts major systemic diseases, and that periodontal treatment has favorable effects on major periodontitis comorbidities. These results are of obvious clinical relevance for public health in general and they will, for example, support removal of self-payment for dental treatment, highlight the value of multidisciplinary co-work in treatment of these patients, and reduce societal socioeconomic inequality in health and disease.
Implementation in clinical practice – how does it work?
All research performed by CAG LOGINFLAM aims to have a point of depature in a clinical problem and an unmet need in the clinic. This ensures a high degree of relevance, and that implementation of results is an integrated part of the research.
At this point, CAG LOGINFLAM has contributed significantly to the scientific evidence for a relationship between oral health and systemic disease. This evidence is now being implemented in national and international treatment guidelines. Accordingly, medical doctors have become aware that optimal management of systemic diseases is dependent on patients’ oral health, and dentists now acknowledge that adequate management of periodontitis is conditional on patients’ systemic comorbidities. These insights have increased interest in interdiciplinary clinical research aimed at the role of LGI as a driver of comorbidities and are likely to have considerable consequences for future public healthcare.
The CAG LOGINFLAM Team
CAG LOGINFLAM consist of CAG Chair, Clinical Professor Peter Riis Hansen, Department of Cardiology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and CAG Vice-Chair, Professor Palle Holmstrup, Department of Odontology, University of Copenhagen.
Two junior chairs, Associate professor Christian Damgaard DDS PhD, Department of Odontology, University of Copenhagen, and Nikoline Nygaard MS, PhD, Department of Odontology, University of Copenhagen.
Alongside 10 CAG Keymembers from across the Capital Region of Denmark, Region Zealand, University of Copenhagen and DTU.
