Perio-Dx: Bad Gums = Bad Kidneys + Bad Heart

Project Background/Scope: Inflammation is a central driver of chronic disease affecting the kidney and heart. Inflammation typically drives acceleration of vascular disease – notably atherosclerosis, leading to a decline in blood perfusion of these vital organ. In addition, inflammation can directly affect cell and tissue function in these organs directly. In recent years increasing efforts have been focused on identifying sites and causes of inflammation in the body that can drive accelerated Kidney and Heart Disease.

It has been increasingly recognized recently that inflammation in the mouth, specifically periodontal inflammation – involving the specialized tissues that surround and support the teeth, is a potent site of inflammation with spillover effects accelerating disease in the body. Specific associations between periodontal inflammation and the progression of kidney and heart disease have been noted. In the periodontal space inflammation leads to the release of a range of inflammatory proteins – e.g. β-glucuronidase (βG), MMP-8, MMP-9, IL-6, IL-1β and Cystatin, which are detectable in a fluid termed the “gingivocrevicular fluid (GCF),” which is released and seeps into the “periodontal pocket,” - the area at the base of the tooth. Despite these new findings the ability to accurately measure periodontal inflammation, i.e. the release of these biomarkers in GCF, particularly via a means that can be readily performed rapidly at home does not exist.

Requirements: In the present project the advance of paper microfluidics will be utilized to design a system for rapid detection point-of-care detection and serial follow-up of recognized inflammatory markers in GCF, the system integrating a cell phone for data capture, analysis, quantitation, readout and telemetry.

As such requirements include: 1. A paper microfluidic wick system will be designed to accurately and rapidly collect GCF rather than ordinary saliva. 2. Embedded in the paper microfluidic element will be an ELISA system to allow reaction and detection of specific inflammatory markers including β-glucuronidase (βG), MMP-8, MMP-9, IL-6, IL-1β and Cystatin. 3. The system will be designed with a colorimetric readout suitable for cell phone imaging. 4. A program/app will be developed for image/data recording and relative intensity detection under uniform lighting (or with an intensity reference). 5. The program/app will have a user friendly readout/graphic user interface which will allow data display and serial plotting of data. 6. The system will allow for data telemetry for health provider access and integration in the electronic health record (EHR).