Excellence in collaboration
Centre of excellence
The University of Dundee’s status as a world-leading centre for dental research was confirmed once again in October, when it received UK Government-endorsed redesignation as a World Health Organisation (WHO) Collaborating Centre until 2018. In particular, this provides further endorsement of the pioneering work on cleft lip and palates being carried out by Professor Peter Mossey and his colleagues at the University.
The Collaborating Centre system is an important part of the WHO approach. As Mossey explained: “WHO depends on the developed world or, as it says, ‘high-income countries’ to help them with research initiatives in other parts of the globe. The Centres are able to transfer technology and knowledge to areas of the world where it is less accessible.”
Among other things, the system can be of use in times of crisis. For example, the current outbreak of ebola virus in West Africa is being tackled by medical personnel on the ground and by experts in infectious diseases around the world, such as CDC (Centers for Disease Prevention and Control) in Atlanta, and Collaborating Centres in the UK and Europe and other parts of the developed world where acknowledged expertise exists.
Universities and academic departments benefit from the prestige associated with WHO Collaborating Centre status. As well as providing recognition that they have a certain level of expertise, it confirms their capacity to deliver services to the developing world. Equally important, if a department or discipline within a university is seen as a world leader by virtue of it being approached to become a Collaborating Centre, there are significant advantages when it comes to international grant funding applications.
Mossey said: “At Dundee, we are recognised as having international expertise on certain birth defects, in particular cleft lip and palate. Our original designation was in 2004. At that time it was purely for craniofacial abnormalities, quite a specialised area.
“In fact, the University of Dundee and the University of Manchester are the only two Collaborating Centres in the world specifically dedicated to this discipline. Redesignation became necessary when the department of genetics at WHO central headquarters in Geneva was closed down.
“I was approached by WHO HQ in Geneva and asked if I would wish to continue to work for the WHO as a Collaborating Centre, and furthermore if it would be acceptable to Dundee for this expertise to be channelled into the WHO’s department of oral health. As well as moving from one WHO department to another, the redesignation allowed us to expand our area of focus.”
As Mossey said, the redesignation brings in other areas of public dental health and acknowledges Dundee’s expertise in dental health services provision, perhaps most obviously seen through its world-renowned Dental Health Services Research Unit (DHSRU), led by Professors Jan Clarkson and Ruth Freeman, which – adding to its existing expertise – recently became home to the UK Centre for Evidence-Based Dentistry.
The long-standing Collaborating Centre status enjoyed by the University of Dundee has helped Mossey establish research programmes in India, sub-Saharan Africa and Brazil.
He said: “In December, I am heading to India to finalise the analysis of a pilot project we have been carrying out there. At Dundee, we identified that maternal smoking, which is a significant risk factor for cleft lip and palate in the Western world, is not so prevalent in India and in other parts of the developing world. However, it could be that environmental pollution due to domestic cooking and heating contamination is the surrogate of smoking there. We are monitoring maternal exposure to smoke in the domestic environment, and the presence of carbon monoxide, nitrous oxide, sulphur dioxide and particulate matter, to determine if these are responsible for babies being born with cleft lip and palate.”
Mossey’s research over the past 20 years has in large part been fuelled by the question he was asked most often by the parents of cleft lip and palate babies during the time he was on call as a registrar in the Victoria Hospital in Kirkcaldy: “Why did this happen and is it likely to happen again?” It was that basic theme that prompted his decision to focus on genetics when he undertook his doctorate at the University of Glasgow in 1989.
“We knew that genetics was a very significant component, but did not know the specific genetic factors. I have been investigating this area since ı994. Equally important to recognise is that most chronic diseases – cancer, cardiovascular disease, diabetes, obesity and respiratory diseases and so on – have environmental elements as a contributory factor. Birth defects are no different and we have taken that into account in our work as we look at interactions between genes and environment.”
According to Mossey, Dundee’s redesignation is the culmination of 10-12 years of hard work. He said it has come at a very opportune time when the University is looking at inter-disciplinary collaborative initiatives, and it gives additional status to the Dental School, both in the University and the wider world.
From a personal perspective, even though the status throws up new opportunities, Mossey is content to concentrate on tasks he has in hand. “I have programmes not only in India but sub-Saharan Africa and Brazil, and although I have been asked to assist in research programmes elsewhere, each opportunity needs to be evaluated in terms of capacity, and these programmes that are running at the moment will continue to be top of my list.
“Overall, we are making a very significant contribution to cleft lip and palate in terms of improving surveillance systems in places where these do not currently exist, improving knowledge on both genetic and environmental risk factors, improving care delivery, and promoting the concept of cleft prevention, which is now becoming a realistically achievable goal.”
Dedicated to eliminating dental health inequality
“There has been an explosion in the knowledge in the area of genetics in chronic and non-communicable diseases over the last few years,” observed Peter Mossey. “I’ve been fortunate to have seen these developments and make a contribution to some of them.
“While working with a collaborative European group, we were the first unit in the world to publish a genome-wide association study for cleft lip and palate.”
Mossey grew up on a farm in rural Ireland, near the village of Gortin in Co Tyrone. After studying at the Christian Brothers grammar school in Omagh, he applied to study dentistry at the University of Dundee Dental School.
When he qualified in 1983, he went into general dental practice and practised on both sides of the Irish border, in Enniskillen, Co Fermanagh and Ballyshannon, Co Donegal. He said: “What I witnessed then was some of the most stark examples of dental health inequalities in populations living a few miles apart, by virtue of different health administrations, and I have never forgotten that.”
Recognising the need to expand his skills in surgical practice, he returned to the hospital system and carried out house officer and senior house officer posts in Dundee. After attaining registrar level, he was offered the opportunity to do specialist training in orthodontics and be first on call for patients born with cleft lip and palate. He subsequently went on to the University of Glasgow to undertake higher specialist training in orthodontics.
On completion of his PhD and higher specialty training between 1989 and 1994, he took up a lectureship at Dundee. In 2003, he attained Professorship and WHO Collaborating Centre status in his area of specialist expertise was achieved by the University the following year.
“Birth defects surveillance has revealed that many children born with clefts in the developing world do not survive and raising awareness of how to feed can save their lives,” said Mossey. “We can do very satisfactory surgical repairs at the moment, but we cannot completely eradicate the disorder in everyone.
“The incremental improvement in knowledge about risk factors gives great hope that we will be able to prevent at least some cases of cleft lip and palate in the future.
“The ultimate humanitarian and scientific objective would be prevention. The knowledge we have gained in the genetic and environmental fields have put us within touching distance of that goal.”
Mossey believes Scotland’s unique healthcare system has provided an advantage to his research. “I use it to good effect when I am going around the world. The managed clinical networks we introduced in 2000 are regarded as the gold standard for organising multi-disciplinary care.
“Cleft lip and palate was the first registered MCN in Scotland, so we have the longest experience of running that system. It has provided an excellent example to the rest of the world on how to organise cleft lip and palate services. And it has recently been refined – instead of a multi-centre initiative, we now have one overall administrative centre with two surgical sites in Edinburgh and Glasgow, where infants with clefts of the lip and palate receive excellent care.”
Alongside this is the Scottish Oral Health Research Collaboration, a unique collaborative research initiative where complementary areas of expertise at universities across Scotland are brought to the same forum to optimise the power and impact of their work.