HIPÓTESES
6 CONCLUSÃO GERAL
A revisão de literatura que compôs o capítulo 1 do presente trabalho nos permitiu ratificar que o reparo tecidual é um processo biológico finamente regulado por células e moléculas sinalizadoras, entre as quais, destacam-se as proteínas da via Hedgehog. No entanto, há escassez de estudos que abordam a participação desta via sob a influência da laserterapia.
A técnica de imuno-histoquímica contribuiu para a visualização da expressão fenotípica das proteínas estudadas na fase tardia da cicatrização fotobiomodulada.
Observou-se que no modelo experimental de cicatrização cutânea, houve uma diminuição inicial de células T CD8+ no grupo submetido ao laser com posterior aumento destas até o período de 28 dias, o que sugere a sua ação imunoreguladora neste processo biológico, em especial no tocante à sua inter-relação com as células T CD68+.
Na fase de remodelamento do reparo tecidual houve continuidade do processo de neoangiogênese confirmado através da presença de células CD31+, actina alfa de músculo liso e NG2+ no microambiente da área de fibroplasia, tanto para os animais controle quanto os tratados com laser. Contudo, no grupo irradiado, este evento ocorreu mais precocemente.
Os níveis sanguíneos de IL-2 e IL-10 foram indetectáveis em ambos os grupos experimentais e não houve diferenças estatisticamente significativas no perfil de expressão de IL-4 e IFN ɣ entre os grupos de estudo. Tal fato sugere que na etapa tardia da cicatrização, o efeito sistêmico desencadeado pelo TLBP seja atenuado e que as alterações locais sejam mais evidentes e se perpetuem por mais tempo a partir da dosimetria inicial empregada no tecido.
Os eventos que ocorrem no reparo tecidual parecem ser cíclicos e continuam se desenvolvendo no tecido, independente do aspecto clínico da lesão que evidencia o seu fechamento e completa cicatrização.
Houve indícios da ativação da via de sinalização Hedgehog na etapa de remodelamento da matriz, haja vista a presença de células Ptch +, Ihh+ e Gli-2+. Porém, a expressão de Ihh e Ptch parece não ter sido fotobiomodulada, uma
vez que não houve diferenças estatisticamente significativas entre os grupos experimentais.
Em relação à ativação da via de sinalização Hedgehog no estudo realizado em mucosa oral humana, observou-se que esta pareceu influenciar positivamente a transformação neoplásica, uma vez que houve aumento progressivo de células Hedgehog positivas nas lesões pré-cancerizáveis presentes no mesmo indivíduo. Tanto o epitélio quanto a matriz conjuntiva participaram deste processo.
Os resultados preliminares do presente estudo experimental, referentes à via de sinalização Hedgehog, fortalecem a necessidade da realização de investigações que contemplem os períodos iniciais do processo de cicatrização cutânea.
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