Exosomes, What, When and Why

Exosomes, What, When and Why.  There has been increasing hype about the benefits of Exosomal therapy for a wide variety of medical conditions ranging from regenerative medicine applications to systemic disease such as Lyme.   But what are exosomes?  They are most easily thought of as a soup of extra-cellular messengers.  They are growth factors, facilitators and initiators, and anti-inflammatory agents.  They typically come from mesenchymal stem cells in amniotic fluid that has been sterilized and filtered.   They are rich by products of stem cells and frequently referred to as the responsible agents that make stem cells work.   Many studies suggest that stem cells work because they extrude exosomes.  If not for exosomes no regenerative response would occur.

So don’t be surprised if exosomal therapy is represented as better, safer, or even more effective then stem cells (both exosome and stem cell products however require special FDA regulatory clearance).  Because stem cells are still considered to be native tissue many concerns about hidden infections, immune response, or tissue manipulation can be mitigated by using exosomes instead of stem cells.   Exosomes do not contain any HLA antigens for example.  While there may be some truth to that, nothing is sure fire.   Processing of exosomes is reported to be easier as you are not trying to retain whole cells.

Since exosomes are smaller than stem cells (they are nanometers in size) it is also easier to make sure larger molecules such as other foreign tissue are removed during preparation.  But that does not mean anything is full proof.  And the risks associated with stem cell have shown to be very small to begin with.  In most instances where inflammation or infection has occurred with stem cell it was not due to the stem cells but rather due to improper technique in their administration.

So why use them?  One big reason is regulatory.   With increased stringency from the FDA, access to both exosomes and stem cells are reduced, however there is reason to believe the hurdle is not as high to jump with exosomes.  But there is more to it than that.  Due to their smaller size exosomes are thought to have the potential to get into places that stem cells cannot, including crossing the blood – brain barrier.   If that proves to be true, a host of new indications may potentially be on the horizon.   But for now the most common, and least controversial, indications will remain for arthritic conditions like osteoarthritis.

The promise of greater safety in preparation is always a good thing too, even if there are only incremental gains compared to current methods for stem cell preparation.  Plus, as the signals given out by stem cells, exosomes offer the possibility of getting closer to making use of the actual responsible agent that make stem cells attractive to begin with.  An additional potential advantage of using an exosomal preparation instead of deriving benefit from those that are naturally extruded by stem cells is that processing allows for administration of much higher numbers of exosomes then would be possible if they came from administered stem cells alone.

There are many studies under way that are looking at exosomal therapy for conditions beyond degenerative joint.  Research at major medical institutions include Acute and Chronic Ischemic Heart Disease, Heart Failure with Preserved Ejection Fracture, Cardiomyopathies, Pulmonary Hypertension, and Stroke.  Because their anti-microbial and anti-inflammatory properties may reduce the chances of infection and diminish pain, and their anti-adhesion properties may reduce and prevent scarring, chances are good you will be hearing a lot more about exosomes.

As with any other regenerative product, if you think you may have an indication for exosomal therapy, consult with your physician to discuss if they make sense for you.  At Piedmont Physical Medicine and Rehabilitation, PA we offer an entire product line of regenerative medicine treatments and do our best to inform you of the current regulatory status of each.   Come see us to find out if one of them is right for you.