Pioneering AIDS Researcher Receives Major Accolade

John Greenspan, BDS, PhD, considers himself naturally curious. When he started seeing a rare form of cancer of the lymphatoid system in young San Francisco men during the early 1980s, he was intrigued.

“It’s called Burkitt’s lymphoma, and I thought this was strange,” said Greenspan, a distinguished professor of oral pathology with the UCSF Department of Orofacial Sciences, and the associate dean for Global Oral Health with the UCSF School of Dentistry. “We typically saw it in Africa. But in this country, we only used to see it rarely, for example, in immunosuppressed patients, such as kidney transplant recipients. So we ended up seeing one of the first AIDS lymphoma patients reported in the world.”

His tenacity led to major research breakthroughs in the oral aspects of AIDS and the role of viruses in oral lesions.

In recognition of Greenspan’s work, the American Dental Association (ADA) this week named him the recipient of its 2012 ADA Gold Medal Award for Excellence in Dental Research, one of the top honors in the field of American dentistry.

“I’ve known most of the people who have received this award, and several of them are my personal heroes,” Greenspan said. “So there is a tremendous sense of pride.”

It is also a source of pride for the UCSF School of Dentistry.

“The award of this prestigious medal by the ADA to Dr. Greenspan not only recognizes his groundbreaking work but also sets aside UCSF and the UCSF School of Dentistry as an institution where such work is fostered and conducted,” said John Featherstone, MSc, PhD, dean of the UCSF School of Dentistry. “It brings honor and prestige to both the recipient and to UCSF.”

Identifying Oral Lesions

During the early days of the AIDS crisis, Greenspan worked closely with his wife Deborah Greenspan, BDS, DSc, now chair of the UCSF Department of Orofacial Sciences. In her clinical practice, she started seeing a white lesion on the tongue of gay men. She consulted with her pathologist husband, who suggested a biopsy to find out what was causing it. That work led to the Oral AIDS Center here at UCSF. It was instrumental in teaching physicians, nurse practitioners and other clinicians how to identify oral lesions associated with HIV infection.

“At the same time my colleagues in the medical AIDS clinics and labs wanted me to start a specimen bank of serum and tissue of these patients,” Greenspan said. “I was willing to do it because I was already getting interested in the issues, the problems and saw this as a chance to make a contribution.”

He started the UCSF AIDS Specimen Bank, which will celebrate its 30^th anniversary in December. This repository has been a crucial part of the HIV/AIDS research programs at UCSF and led to his role as director of the AIDS Research Institute at UCSF for nine years.

Greenspan and his wife have made major contributions to HIV research and care including the discovery of hairy leukoplakia — an oral viral lesion that appears as raised white areas of the tongue — and its link to AIDS.

“These were regular moments in a regular working day of a working year,” Greenspan said. “Starting in late 1981, there was a ten-year period of discovery. Our work was very, very gradual and that was on top of what we do during a normal working week.”

Major Breakthroughs and Prejudice

Greenspan’s finding linking oral lesions with HIV-positive gay men in San Francisco made headlines after it was published in 1984 by The Lancet, a weekly peer-reviewed general medical journal. Then a year later, he and his wife identified a connection between hairy leukoplakia and Epstein-Barr virus (EBV), a virus that is most commonly known to cause infectious mononucleosis and some types of cancer such as forms of non-Hodgkin’s lymphoma.

By late 1985, they were heavily identified with AIDS.

“We were met with jokes, fears, homophobia and fear of contagion,” said Greenspan. “We just sailed through that with the argument that whatever we do has to be based on science, and if you base it on science, it will protect you. So it became not so much about fighting stigma, but setting an example.”

The Greenspans’ research has helped change dental standards in the United States.

“The work of Dr. Greenspan and his colleagues has provided guidelines that enable dentists to recognize early oral manifestations of HIV/AIDS and thereby assist with early diagnosis and referral for treatment,” Featherstone said.  “This is of particular importance in the global health world.”

Changing Dentistry Culture

The ADA adopted standardized universal infection control policies, including upgrading facilities so that hand instruments and dental hand pieces could be sterilized.

“There was a huge controversy because sterilization destroys the hand pieces. So they had to redesign the device and dentists had to buy new hand pieces and new equipment. So dentistry is completely different post the AIDS period,” he said. “The ADA did a wonderful job of basing their recommendations to their members and patients on data.”

Greenspan will receive his award from the ADA in October during a formal presentation in San Francisco.

“While I appreciate the acknowledgment, there’s a whole team of people who did the work,” he said. “Sometimes I was the leader and sometimes I wasn’t. A big team of faculty investigators, fellows and students — probably over a hundred collaborators — we’ve worked with over the years. And then there are the patients and in the early days, we lost many of them along the way. They deserve the acknowledgment as well.”

The ADA Gold Medal Award for Excellence in Dental Research was established in 1985 and is presented once every three years to honor individuals who contribute to the advancement of the dental profession or who help improve the oral health of the community through basic or clinical research.  The honoree receives $25,000 and a gold medallion. Additionally, the recipient serves a three-year term on the ADA Council on Scientific Affairs.

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