Endodontide Mezenkimal Kök Hücre Kaynaklı Eksozomların Biyolojik ve Terapötik Rolü

Ayşegül Mendi

doi:10.37609/akya.4123

Yazarlar

Ayşegül Mendi

https://orcid.org/0000-0001-6705-3770

DOI: https://doi.org/10.37609/akya.4123.c6503

Özet

Diş pulpası, yüksek derecede innervasyon ve vaskülarizasyon ile karakterize edilen, dişin canlılığını, duyusal fonksiyonlarını ve bağışıklık yanıtlarını düzenleyen özelleşmiş bir bağ dokusudur. Geleneksel kök kanal tedavisi, enfekte veya nekrotik pulpa dokusunun uzaklaştırılmasını esas almakta ve dişin biyolojik canlılığının geri dönüşümsüz kaybı ile sonuçlanmaktadır. Bu sınırlılıklar, pulpa–dentin kompleksinin biyolojik fonksiyonlarını yeniden kazandırmayı amaçlayan rejeneratif endodonti yaklaşımlarının geliştirilmesine zemin hazırlamıştır.

Rejeneratif endodontide mezenkimal kök hücreler (MKH), doku onarımını destekleyen temel hücresel bileşenler olarak öne çıkmaktadır. Son yıllarda artan kanıtlar, MKH’lerin rejeneratif etkilerinin büyük ölçüde parakrin mekanizmalarla, özellikle hücre dışı veziküller arasında yer alan eksozomlar aracılığıyla gerçekleştiğini göstermektedir. Eksozomlar; mikroRNA’lar, proteinler ve lipidler gibi biyolojik olarak aktif moleküller taşıyarak inflamasyonun modülasyonu, anjiyogenez ve odontojenik farklılaşmanın düzenlenmesinde kritik roller üstlenmektedir. Bu kitap bölümünde, eksozomların biyogenezi, biyolojik özellikleri ve hedef hücrelerle etkileşim mekanizmaları ele alınmış; dental pulpa kökenli ve diğer MKH kaynaklı eksozomların endodontik mikroçevredeki etkileri in vitro ve in vivo çalışma bulguları ışığında değerlendirilmiştir. Ayrıca, eksozomların biyomateryal ve skafold sistemleri ile kombinasyonuna dayalı stratejiler, kontrollü salım ve mikroçevreye özgü tasarım yaklaşımları çerçevesinde tartışılmıştır. Mevcut klinik çalışmaların sınırlılıkları ve translasyonel zorluklar eleştirel bir bakış açısıyla incelenmiş;standardizasyon, eksozom mühendisliği ve klinik uygulamaya yönelik gelecek perspektifleri sunulmuştur. Sonuç olarak, eksozom temelli stratejiler, hücresiz ve biyolojik olarak rasyonel yaklaşımlar olarak rejeneratif endodontinin geleceğinde önemli bir potansiyel taşımaktadır.

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