Utskrift från Malmö högskolas webbplats www.mah.se

Development of novel multi functional salivary substitutes for "dry mouth" syndrome patients

Contact person: Liselott Lindh
Responsible: Liselott Lindh
Co-workers: Javier Sotres, Thomas Arnebrant, Ida Svendsen, Olga Santos and Marité Cardenas
Funding: Stiftelsen Laryngfonden
Timeframe: 2006-07-01 -- 2012-06-30
Research profile: Biologiska gränsytor
Faculty/Department: Faculty of Health and Society, Faculty of Odontology, The Department of Biomedical Science
Subject: Tvärvetenskap

As a consequence of treatment of many cancers in the mouth/throat region, e.g. extirpation of salivary glands or radiotherapy, the patients suffer from "dry mouth" syndrome. Oral biofilms play an important role in the development of mucositis, caries and periodontal diseases. The salivary film, denoted pellicle, is formed by selective binding (adsorption) of proteins present in saliva. This film has many protective functions and thus promotes e.g. oral health. Due to the natural surface activity of proteins, adsorption usually takes place at almost any type of surface in contact with a biological fluid. It is well known that this initial layering monitors subsequent biofilm growth; thus the formation of the initial protein layer is an important clue in order to understand and control biofilm growth. Some of the known salivary pellicle key proteins are known to have multifunctional properties, e.g. lubrication as well as modulation of the oral microflora. Furthermore, some proteins are also known to play role in regulation of mineral homeostasis.

AIMS
•  Analysis of the film structure and density profile of adsorbed films, as well as evaluation of the protective functions of films formed by proteins/polymers/existing salivary substitutes adsorbed at surfaces,
• Development of new salivary substitute products that will give lubrication comfort for those patients that suffer from “dry mouth syndrome”, as well as decrease the risk of carious lesions and remineralize the enamel if needed.
• Clinical testing is planned with healthy and “dry mouth suffering” participants. Their saliva will be examined with respect to film forming capacity and quality of the film formed due to the aetiology of their mouth dryness symptoms. Further, they will get the opportunity to test novel formulations as well as commercially available salivary substitutes.

SIGNIFICANCE
Since patients with "dry mouth" syndrome (with varying aetiology e.g. extirpation of salivary glands, radiotherapy, heavy medication or Sjögrens' syndrome) suffer daily from problems related to chewing, swallowing and talking, as well as problems wearing dentures. This will decrease the quality of life for these persons. Additionally, the lack of saliva will unfortunately also result in oral diseases as mucositis and rampant caries. Thereby those patients are in immense need for treatments to prevent further severe impairment of their oral health.
This is a growing world wide clinical problem as our population is both increasing in age and numbers, and thus, also escalating costs for the society for treatments. The artificial salivary products available today are not sufficient according to the patients’ comments: "they do not last long enough", i.e. their film forming capability is insufficient. It has been shown that the presence of pellicles, formed from human whole saliva, largely reduce the friction between surfaces. Hence understanding of the mechanisms behind lubricating properties of saliva could be used as a basis for development of salivary substitutes. Furthermore, it would also be beneficial for patients to use one product that will both lubricate the oral cavity and prevent demineralisation of the enamel.

Beskrivning på svenska

Patienter med till exempel spottkörtelcancer eller larynxcancer lider ofta av nedsatt salivsekretion som en följd av terapeutiska åtgärder såsom strålbehandling och operativa ingrepp. En konsekvens av detta är problem med smörjning i munhåla och svalj med åtföljande problem med att tala, tugga och svälja föda, tandslitage, slemhinneinflammation och eskalerande karies. För att underlätta den dagliga tillvaron för dessa patienter är tillgång till adekvata saliversättningsmedel nödvändig. Föreliggande projekt syftar till utveckling av multifunktionella sådana där såväl smörjande som t ex kariesförebyggande effekter kombineras. Vi har i tidigare studier visat att naturliga salivfilmer har goda skyddande egenskaper specifikt avseende smörjning. Vi tar detta som utgångspunkt genom att initialt undersöka sådana naturliga filmers struktur och egenskaper för att förstå mekanismerna bakom naturens sätt att lösa problemet. Dessa studier omfattar användning av avancerad ytkemisk metodik bland annat tekniker som ellipsometri, atomkraftmikroskopi och neutronreflektans för att belysa strukturella egenskaper hos salivfilmer. Med denna kunskap som bas är målet att utveckla nya saliversättningsmedel, med förmåga att bilda filmer på ytor i munnen och svaljet med egenskaper liknande de hos naturliga salivfilmer, men med utgångspunkt från kommersiellt tillgängliga komponenter t ex passande proteiner och polymerer. En viktig del av projektet är sedan att undersöka hur dessa saliversättningsmedel fungerar på patienter i klinisk tillämpning. För att adekvat kunna angripa denna problemställning ingår såväl klinisk som fysikalisk - kemisk kompetens i projektgruppen.

Senast uppdaterad av Magnus Jando