RSU tenured professor from India: the microbiome is like a city inside the body

Writer: Linda Rozenbaha, RSU Public Relations Unit
Photo: Courtesy of RSU

Continuing our series of articles on tenured professors at Riga Stradiņš University (RSU), we now introduce Shaju Jacob Pulikkotil, a tenured professor at the Faculty of Dentistry.

Shaju Jacob Pulikkotil’s journey in academia and research has been fascinating. Armed with a PhD in Oral Epidemiology and Biostatistics from the University of Madras, he has spent over two decades as a lecturer in dentistry, finding joy in learning alongside his students. Now a tenured professor at RSU, he continues to inspire learners with his passion for teaching and research. His childlike curiosity makes every discussion an adventure, where no question is too small and no idea too big to explore.

In this interview, Tenured Professor Shaju Jacob Pulikkotil discusses his research, which has contributed to improving people's health. He also shares insights into his life in Latvia, where he has been working at RSU for just over two months—and where, for the first time in his life, he has seen snow!

Could you share your journey in science? What inspired the direction you've taken?

Curiosity and enquiry are science for me.

Science answers a lot of my questions, questions which I didn’t know existed.

Learning with students inspired me to take the direction of research. I learnt about research during my post graduate studies and understood the impact and power of it during my interactions with different kinds of learners. Career progression was an external motivation, but I realised the purpose of research by interacting with people.

One of my key research projects was with Baxter, a multinational American healthcare company based in Illinois. I proposed an evaluation of Tisseel, a trademarked fibrin sealant of Baxter. Tisseel is made from blood products and is used as a tissue adhesive. It contains fibrin, a binding blood protein that stops bleeding. But what happens to Tisseel when used to seal wounds? After a few days, the body naturally "digests" it, and the wound heals. Additionally, it resorbs with little or no inflammation. I proposed assessing the use of this fibrin glue, under the Tisseel trademark, in oral tissues. “If it's used in the intestines, why not use it in the mouth?” At that point, they had not yet tested its effectiveness in the mouth. 

Baxter awarded me the Baxter BioSciences Grant for a clinical trial and provided the product for testing. I evaluated it in oral tissues and found that it promotes good healing, better than conventional sutures.

Another important field of research I conducted was for a rural remote community in India. I conducted a large population-based study and identified factors that cause oral disease by screening and examining 3,000 adults. I recommended actions to the health authorities and this has led to reduction in the occurrence of common oral diseases among the rural population.

Another fascinating area for me is one that is called evidence-based research, where I search for the best evidence that can be recommended to doctors for day-to-day patient care. I have conducted and been part of important systematic reviews that combined a lot of studies to find the best evidence for clinical care.

What motivated you to apply for the position of tenured professor at RSU? What attracted you to RSU?

Latvia is an important EU member and RSU is the primary health university here. The opportunities I get by working here are enormous. I have access to advanced facilities that help me conduct research according to the local needs. EU is the hub for collaborative cutting edge science, which I have access to by working at RSU. The offer from RSU was very good that gave me an open approach and adequate facilities to develop research for better oral health in Latvia and other EU partners. I get easy access to experts and leaders in oral health research.

I see that RSU is spearheading significant initiatives that is making an impact in Latvia and outside. It seamlessly combines Latvian ethos and international outlook to position itself as a global university that can compete and collaborate with top institutions. This is a direction I feel aligned with. I believe leadership from RSU is making a significant impact to make our world better.

Could you describe the research topics you are currently working on as a tenured professor? Why did you choose this theme?

My research interests focus on population-based oral health.

Latvia is a mature society with a robust public health service that addresses the nation’s health needs. However, the presence of dental cavities and gum infections here is notably higher than in neighbouring countries.

What are the reasons for this? Could it be the Latvian diet, with its higher sugar intake? Or oral hygiene habits, such as brushing only once a day? Or genetic factors, or perhaps the specific bacteria present in the mouths of the Latvian population? All these factors are potential causes, but their significance and contributions may vary. Once we identify the most influential factors, we can focus on targeted interventions. I am currently working towards a large study to find the causes of these diseases in our population.

Another area I am working on is understanding why some of our children in Latvia develop so many dental cavities that they have no teeth left by the age of ten or twelve. Together with our colleagues in Institute of Stomatology (Stomatoloģijas Institūts), we aim to identify successful strategies for cavity prevention and adopt them to reduce the occurrence of such severe dental issues in the younger generation.

Does poor oral health in Latvia result from habits passed down from generation to generation? During the Soviet times, thorough dental care was not so good.

I come from a different part of the world, so I had to learn the context when I arrived in Latvia. I knew that Latvia was under Soviet occupation until 1990, but I didn’t fully understand what occupation meant. In India, where I am from, my generation grew up with independence. We are not a rich country, but we had our own struggles. When India was under the British rule, I have heard that we were always under the watchful eye of the “Big Brother.”

It was a big revelation for me to learn about the Soviet “Big Brother” and I could understand. There is still a generation that remembers life under Soviet rule and its effect can affect the health of the current generation. We can do research to study the effect and if it is there, try to reduce or reverse through innovative solutions.

I want to stress that my research is not about blaming anyone. It’s not about blaming the Soviet era, our guardians, or even our children. The goal is to understand where the problem lies, what is causing it, and what can be done about it. 

We need to find the right solutions that suit our country and introduce those changes gradually, without forcing them. People can be afraid of change, and it is human behaviour. Many things were imposed during dark times, which only led to resistance and unhappiness. We must consider these aspects and explain everything in a transparent, simple manner. This will lead to better compliance to recommendations from research and hence good health. For this, I also work with social scientists in RSU, who are experts in understanding human behaviour. 

How did you manage to implement changes in India when you studied poorer regions? 

We found that certain foods and hygiene contributed to more dental diseases. Food in India is a very important and culturally sensitive topic. Food also has important implications in our overall health. So,

we cannot simply go and say, for example: ‘please, change your diet, it is good for your teeth!’

India is a country with a large population of vegetarians, and meat products are not commonly consumed – about 70% of the population mainly consumes vegetarian food. Understanding the population is very important to change behaviour. Therefore, we focused on changing hygiene habits, encouraging people to think: ‘Improve your brushing – if you’re brushing once, aim for twice.’

We encouraged the teachers to supervise their students’ brushing, for example, by having children bring their toothbrushes once a week. The teachers can observe how they are brushing and gently say: ‘You didn't brush this side.’ They can also ask, ‘Did you look in the mirror? Now, do you see how white your teeth are?’ This is what we call supervised brushing.

Small changes lead to bigger ones, and the results will take few years. When making changes in public health, the results cannot be seen immediately. It is very important that social science researchers who understand human behaviour and policymakers step in. We need to bring people to change with understanding.  

Another area of your research, which is quite modern, is related to the microbiome... 

Yes, one of the areas I am working in now is the fascinating world of oral microbes! About 20 years ago, we thought that bacteria caused cavities. Now we know that bacteria and other small organisms are part of us, not against us. They live in our mouth, skin, gut, and form something like a community, a city. They prevent bad bacteria that can colonise us and cause disease. They make some essential nutrients which are not found in our diet. On our part, we give our microbe partners shelter and nutrition. But if something goes wrong, they can stop helping us and we become sick. My current research is to find out how this city of microbes can be better understood. I am searching for clues that can tell us when they are not helping us, how to make them help us become healthy, which will lead to less disease and good health. 

In my current research, I am trying to understand how this microbial "city" functions, how to recognise when it becomes harmful, and how to transform it to improve health and reduce illness.

In reality, it’s more complicated, as the distinction between good and bad bacteria is not always clear. I compare this bacterial ecosystem to a real city: some people remove the snow, others handle the trash, some treat patients, while others act as psychologists. Similarly, in bacteria, everyone plays a role, which makes the environment very dynamic. However, sometimes, as humans, our actions—how we interact with the bacteria—can send negative signals, causing the bacteria to change into something that can harm us. For example, smoking can gradually alter the bacteria in a way that no longer benefits us. It's not about bad bacteria, but rather how our behaviour influences the microbial city. By changing habits, like exercising more and reducing smoking, we can improve the balance of this microbial community. 

The microbiome is like a city within us, and the mouth is no exception. This microbial city needs to be structured in a way that benefits our health. The plan is for our research team to collect data from a large number of adults, while my colleagues in the laboratory will study the microbiome samples in the research. They will assess the composition of the microbiome in our oral cavity, and I will determine whether it is generally beneficial or harmful, investigating the underlying reasons for it. While I don’t work directly in the laboratory, I focus on designing the study, analysing the data and identifying patterns. 

What scientific disciplines will be represented in your research team, and what are their roles? 

Currently, we are we are going to put a grant for the Fundamental and Applied Research Program (FLPP) with the planned team. In our proposed research, we aim to be a team consisting of specialists from various fields, focusing on improving public health by using effective technological advances.

I work with: 

• Microbiologists specialising in microbiome research,
• Molecular biologists studying the interaction between microbes and humans, 
• Bioinformaticians managing big data and creating AI models, 
• Social scientists designing methods to gather information from people, 
• Epidemiologists and statisticians (like myself) integrating all components for people-centred research, 
• Policy researchers who translate our findings into practical solutions for the public. 

Now we are actively preparing the project to be sent to the government. The rest will depend on whether we receive the grant. 

How do you envision the future development of RSU as a research university? 

One of the main strengths of RSU is that it is people focused, improving the health of Latvia and beyond through education and cutting-edge research. RSU always interacts with its stakeholders, the public, who fund it and who benefit from the services. I see RSU as a great gentle force that guides our world to be a better, healthier, fun place to live. 

Who is a scientist or person that inspires you the most in your work? 

I’ll take a philosophical approach to this question—many personalities have inspired me. I think public health research has the greatest impact, and real-world successes motivate me. When I was a teenager, smoking was fashionable in my country. I remember the then health minister promised to reduce smoking in my country —and achieved quite visibly. I am also inspired by everyday innovators, like the gentleman who manually cleared snow so efficiently from the pedestrian paths of Vanšu Tilts one Saturday morning that I wondered how he managed it.

Scientists and problem-solvers are all around us, and I look up to them.

What is your motto or guiding principle in science? 

Science is for the well-being and happiness of humans, animals, and plants—this is my guiding principle. For me, true science benefits; if it harms, it is not science. 

In your opinion, how has the role of scientists evolved in today’s world? 

Translation or bringing research into everyday life is an important part of discovery.

Scientists are no longer in a bubble.

They are influenced and motivated by everyday issues around them. Scientists are interacting with the stakeholders who benefit by the cutting-edge research to make it more humane and useful.

What excites you, outside of science? 

For the past few years, I have managed to integrate work and life more effectively. I have realised that I cannot separate them neatly. I think about my research while strolling in the snow and plan games that generate ideas in my audience while I am cooking. 

Indiešu ēdieni ir bagāti garšām, un man jābrīdina – to smarža iet cauri sienām un var iekarot daudzu sirdis.

I love cooking Indian food and tasting cuisines from around the world. Indian cooking is incredibly flavourful, and I should warn you—the aromas can cut through concrete walls and melt hearts! Biryani is one dish I aspire to master, and there are thousands of variations, each culture adding its own unique touch.

(Author’s note: Biryani is a spiced rice dish popular in Indian cuisine, typically made with chicken, lamb, or veal, and often including vegetables or citrus fruits.) 

My children inspire me to keep improving—whether in cooking or work. They are my best critics and my best friends.

I am here with my son, who has started studying at a public school. My daughter is currently in Malaysia doing a degree in marketing. When I got the opportunity to work here, I decided to come with my son to experience the people and the nature. Although I’ve been to Europe before, this is my first time in Eastern Europe. 

How do you feel about the weather in Latvia, and how have you adjusted overall to life here? 

This is the first time I've seen snow!

India does have snow, but only in the northern regions, and I haven't been there. My son and I were excited because we could see snow, feel snow, and finally understand what it is. We’ve heard so much about it.

The weather has actually been good. Everyone was saying that February was going to be unusually warm, and that this has been the warmest winter ever. 

My son and I are learning Latvian so that we can understand and talk to people. We are learning the language to understand people better, gain a deeper insight into their lives and needs. This will also help with my research. 

I am an introvert, but I enjoy talking to people, especially those who want to talk to me. I always ask: ‘Do you want to talk to me?’ If they say yes, I talk a lot [laughs]. But I respect and understand when they say, ‘I don’t have time’. 

I find people here are very helpful. They are there when you need help or in trouble and make sure everything is fine.   I also find people here are very sensitive and respect the ‘personal space’. Maybe that’s why I didn’t draw much attention, whereas in my country, we are very curious and talk to anyone looking ’different’. My son and I smile at everyone here and get few smiles back.