Clinical Therapeutics/Volume 37, Number 3, 2015
Editorial Bringing Salivary Diagnostics Into the 21st Century The integration of a noninvasive platform for disease surveillance into clinical care has been a long-sought-after goal of modern medicine. Saliva and its diverse constituents are known for both their healing and diagnostic potential. Combined with its ease of collection, saliva, in theory, is an ideal biofluid to noninvasively assess a patient’s health status, particularly when the feasibility of blood draws is limited or in remote locations where infections are numerous, resources are scarce, and timely diagnosis is essential for improved outcomes. However, although the concept of analyzing saliva for infection or disease may seem straightforward, the reality of integrating it into clinical practice has proven difficult. Not only must informative salivary biomarkers be identified and validated across large patient populations and demographics, but also technological advances must permit their rapid identification and quantification. Furthermore, patients, caregivers, and insurers must be assured that salivary diagnostic tests are better than current standard of care and may ultimately improve patient outcomes while reducing health care costs. Only once each of these goals is achieved can salivary diagnostics Jill L. Maron, MD, MPH become a mainstay of our health care system. In October 2014, the first annual North American Salivary Symposium was held at the Tufts School of Dental Medicine in Boston, Massachusetts. For 3 days, multidisciplinary expert investigators, leaders in industry, and executive officers of insurance companies gathered to share ideas, form collaborations, and identify ongoing limitations to salivary diagnostics that could be targeted to expedite their integration into patient care. The meeting not only highlighted emerging salivary research and technological advances but also aimed to engage relevant stakeholders who will ultimately play a large role in its applicability and translatability to the bedside. Such comprehensive conferences are an essential and much needed aspect of ensuring the successful translation of this rapidly emerging field. In this issue of the Clinical Therapeutics, we highlight the research findings presented at the North American Salivary Symposium. Salivary research is moving well beyond detection of oral diseases and microbial infections and is delving into assessment of systemic disease. Research presented at the meeting included the use of saliva to better understand disrupted developmental patterns and infectious risks in the vulnerable preterm newborn1 and the development of real-time platforms to assess stress reactivity and regulation in psychobiological research.2–4 Exploration of cell-to-cell communication through the analysis of salivary exosomes is providing investigators with a noninvasive window to further our understanding of complex biological mechanisms.5 Finally, the emergence of point-of-service devices that are capable of rapid identification of protein, microbial, and/or gene targets is laying the foundation to finally bring the reality of salivary diagnostics into the 21st century.6 Jill L. Maron, MD, MPH Tufts Medical Center, Boston Massachusetts
Scan the QR Code with your phone to obtain FREE ACCESS to the articles featured in the Clinical Therapeutics topical updates or text GS2C65 to 64842. To scan QR Codes your phone must have a QR Code reader installed.
496
Volume 37 Number 3
Editorial
REFERENCES
1. Iyengar A, Maron J. Detecting infection in neonates: promises and challenges of a salivary approach. Clin Ther. 2015;37:523–528. 2. Shirtcliff EA, Buck RL, Laughlin M, et al. Salivary cortisol results obtainable within minutes of sample collection correspond with traditional immunoassays. Clin Ther. 2015;37:505–514. 3. Peres JC, Rouquette JL, Miočević O, et al. Novel techniques for augmenting saliva collection: bacon rules and lozenge drools. Clin Ther. 2015;37:515–522. 4. Wren ME, Shirtcliff EA, Drury SS. Not all biofluids are created equal - chewing over salivary diagnostics and the epigenome. Clin Ther. 2015;37:529–539. 5. Wong DTW. Salivary extracellular non-coding RNA: emerging biomarkers for molecular diagnostics. Clin Ther. 2015;37:540–551. 6. Walt DR, Khanna P. Salivary diagnostics using a portable point-of-service platform: a review. Clin Ther. 2015;37:498–504.
http://dx.doi.org/10.1016/j.clinthera.2015.02.007
March 2015
497
Editorial Bringing Salivary Diagnostics Into the 21st Century The integration of a noninvasive platform for disease surveillance into clinical care has been a long-sought-after goal of modern medicine. Saliva and its diverse constituents are known for both their healing and diagnostic potential. Combined with its ease of collection, saliva, in theory, is an ideal biofluid to noninvasively assess a patient’s health status, particularly when the feasibility of blood draws is limited or in remote locations where infections are numerous, resources are scarce, and timely diagnosis is essential for improved outcomes. However, although the concept of analyzing saliva for infection or disease may seem straightforward, the reality of integrating it into clinical practice has proven difficult. Not only must informative salivary biomarkers be identified and validated across large patient populations and demographics, but also technological advances must permit their rapid identification and quantification. Furthermore, patients, caregivers, and insurers must be assured that salivary diagnostic tests are better than current standard of care and may ultimately improve patient outcomes while reducing health care costs. Only once each of these goals is achieved can salivary diagnostics Jill L. Maron, MD, MPH become a mainstay of our health care system. In October 2014, the first annual North American Salivary Symposium was held at the Tufts School of Dental Medicine in Boston, Massachusetts. For 3 days, multidisciplinary expert investigators, leaders in industry, and executive officers of insurance companies gathered to share ideas, form collaborations, and identify ongoing limitations to salivary diagnostics that could be targeted to expedite their integration into patient care. The meeting not only highlighted emerging salivary research and technological advances but also aimed to engage relevant stakeholders who will ultimately play a large role in its applicability and translatability to the bedside. Such comprehensive conferences are an essential and much needed aspect of ensuring the successful translation of this rapidly emerging field. In this issue of the Clinical Therapeutics, we highlight the research findings presented at the North American Salivary Symposium. Salivary research is moving well beyond detection of oral diseases and microbial infections and is delving into assessment of systemic disease. Research presented at the meeting included the use of saliva to better understand disrupted developmental patterns and infectious risks in the vulnerable preterm newborn1 and the development of real-time platforms to assess stress reactivity and regulation in psychobiological research.2–4 Exploration of cell-to-cell communication through the analysis of salivary exosomes is providing investigators with a noninvasive window to further our understanding of complex biological mechanisms.5 Finally, the emergence of point-of-service devices that are capable of rapid identification of protein, microbial, and/or gene targets is laying the foundation to finally bring the reality of salivary diagnostics into the 21st century.6 Jill L. Maron, MD, MPH Tufts Medical Center, Boston Massachusetts
Scan the QR Code with your phone to obtain FREE ACCESS to the articles featured in the Clinical Therapeutics topical updates or text GS2C65 to 64842. To scan QR Codes your phone must have a QR Code reader installed.
496
Volume 37 Number 3
Editorial
REFERENCES
1. Iyengar A, Maron J. Detecting infection in neonates: promises and challenges of a salivary approach. Clin Ther. 2015;37:523–528. 2. Shirtcliff EA, Buck RL, Laughlin M, et al. Salivary cortisol results obtainable within minutes of sample collection correspond with traditional immunoassays. Clin Ther. 2015;37:505–514. 3. Peres JC, Rouquette JL, Miočević O, et al. Novel techniques for augmenting saliva collection: bacon rules and lozenge drools. Clin Ther. 2015;37:515–522. 4. Wren ME, Shirtcliff EA, Drury SS. Not all biofluids are created equal - chewing over salivary diagnostics and the epigenome. Clin Ther. 2015;37:529–539. 5. Wong DTW. Salivary extracellular non-coding RNA: emerging biomarkers for molecular diagnostics. Clin Ther. 2015;37:540–551. 6. Walt DR, Khanna P. Salivary diagnostics using a portable point-of-service platform: a review. Clin Ther. 2015;37:498–504.
http://dx.doi.org/10.1016/j.clinthera.2015.02.007
March 2015
497
