Čeprav poročajo o ogromno pozitivnih učinkih uporabe DPSCs za namen celične terapije pri različnih boleznih, pa mehanizmi delovanja teh celic še niso povsem razjasnjeni. Ve se, da DPSCs in SHED celice lahko diferencirajo v različne celične tipe, kar je bilo tudi potrjeno v raziskavah. Transplantirane celice lahko migrirajo v tkivo gostitelja in na ta način prispevajo k regeneraciji tkiva. Poročajo tudi o parakrinem delovanju DPSCs, kar so prav tako potrdili s številnimi študijami. Matične celice zobne pulpe torej lahko migrirajo na poškodovane predele in z različnimi molekulami stimulirajo celice tkiva k okrevanju, brez da bi se pri tem diferencirale in integrirale v tarčno tkivo. Terapevtske lastnosti DPSCs so verjetno posledica tako regeneracije tkiva, kot tudi parakrinega delovanje, vendar so za boljše razumevanje mehanizmov delovanja potrebne nadaljnje študije na tem področju.
Zaradi pomanjkanja podatkov o mehanizmih delovanja matičnih celic, se bazične in predklinične raziskave na modelnih živalih odvijajo v bistveno večjem številu kot klinične raziskave na ljudeh. Da bi z gotovostjo lahko potrdili klinično uporabnost DPSCs bo potrebno opraviti dodatne študije na ljudeh. Največji izziv v terapevtiki še vedno predstavlja striktna regulacija in visoki stroški celotnega procesa priprave in aplikacije celic. V vsaki od bazičnih študij uporabljajo nekoliko drugačne pristope za izolacijo, čiščenje, namnožitev in precepljanje matičnih celic. Uporabljajo se tudi različni nosilci in dostavni sistemi za celične terapije, zato bi bilo potrebno za namen varne množične uporabe optimizirati in standardizirati postopke.
Potrebna bo tudi optimizacija na področju priprave visoko kakovostnih celic, določitev optimalnega števila transplantiranih celic in ocena dolgoročne varnosti uporabe. Pri uporabi avtolognih celic problem predstavlja dolgotrajnost procesa priprave ustreznih celic za transplantacijo, kar lahko dodatno poslabša stanje pacienta in zato bi bil potreben razvoj strategij shranjevanja matičnih celic in postopkov presaditve avtolognih matičnih celic.
16 6 ZAKLJUČEK
Poznanih je več vrst matičnih celic, ki jih lahko razdelimo na embrionalne, odrasle matične celice in inducirane pluripotentne matične celice (iPSCs). V praksi se v regenerativni medicini trenutno uporabljajo predvsem mezenhimske matične celice, ki spadajo v skupino odraslih matičnih celic. Inducirane pluripotnentne matične celice se prav tako postopoma uvajajo v klinične poskuse zdravljenja določenih boleznih. Embrionalne matične celice v bazičnih raziskavah sicer kažejo obetavne rezultate, vendar način njihovega pridobivanja odpira resna etična vprašanja, kar omejuje njihovo aplikativno uporabo.
Zaradi odličnih proliferacijskih sposobnosti so DPSCs zanimive za klinično uporabo. Ker se jih lahko pridobi iz tistih stalnih zob, ki bi jih bilo tako ali tako potrebno odstraniti (vraščene osmice, ortodontsko zdravljenje ipd.), ali celo povsem neinvazivno iz mlečnih zob, ko ti izpadejo, se pri njihovem pridobivanju povsem izognemo etičnim pomislekom. Njihov neverjetno širok spekter diferenciacije bi v prihodnosti lahko pripomogel k bistvenemu povečanju kvalitete življenja ljudi s kroničnimi in drugimi degenerativnimi boleznimi, kot so bolezni oči, živčevja, jeter, ustne votline, mišic, imunske bolezni in diabetes. Kljub temu, da je možnost uporabe DPSCs za alogene terapije še izredno slabo raziskana, verjetno tudi zaradi precej okrnjenega poznavanja HLA sistema pri matičnih celicah, verjamem, da bo v prihodnjih letih prišlo do razmaha tudi na tem področju.
Kot sem že omenila se večina raziskav za uporabo DPSCs v regenerativni medicini za zdaj izvaja na živalskih modelih. Odprtih je sicer kar nekaj kliničnih študij, ki kažejo obetavne rezultate, ampak bo potrebnega še veliko dela, da se do potankosti razišče mehanizme terapevtskih učinkov DPSCs, preden se jih prične uporabljati kot rutinski način zdravljenja določenih bolezni. Gotovo pa lahko trdimo, da imajo potencial, da postanejo močno orodje v regenerativni medicini.
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ZAHVALA
Za nasvete, pomoč in vodenje pri pisanju diplomskega dela se iskreno zahvaljujem mentorju Jerneju Ogorevcu ter somentorju Marku Strbadu. Posebej bi se zahvalila staršem in fantu za vso izkazano podporo in prijateljem, ki mi vedno stojijo ob strani.