Exosomes: The rising stars of regenerative medicine

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“Is this the fountain of youth?” I ask Mayo Clinic dermatologist, Saranya Wyles, about exosomes. The rising star in regenerative medicine, Dr. Wyles’ field of expertise, exosome therapy offers enormous potential in the treatment of a host of chronic conditions. And when it comes to skin health, a good exosome regimen promises to diminish redness, improve pigmentation and reduce wrinkles. “It’s about slowing down the aging process by contributing to holistic regeneration,” says Dr. Wyles.

Saranya P. Wyles, M.D., Ph.D., is a dermatologist at Mayo Clinic with a specialty in regenerative medicine and an additional focus on skin aging: ”We’re starting to see that products like platelet-derived exosomes target cell senescence, the root cause of aging, and that’s part of the mechanism that’s boosting collagen and elastin production and creating a healthy skin environment.”

So, what are exosomes and what is regenerative medicine? The human body has the remarkable capacity to repair itself. Cuts heal, broken bones mend and the liver has a unique ability to redevelop. Heart disease, diabetes and osteoarthritis on the other hand, are examples of long-lasting diseases that do not resolve on their own. Symptoms are managed with medication or medical procedures. Regenerative medicine goes beyond disease management, aiming to support the body in repairing, regenerating and restoring itself to a state of well-being.

“Regenerative medicine has created a paradigm shift from fighting illness like cancer and heart disease to focusing on restoring health,” explains Dr. Wyles. “The goal is to help our bodies accelerate its potential to achieve natural regeneration.”

There are several options in the regenerative medicine tool kit – those that are cell-based like stem cell therapy and those that are acellular. The latter is the realm of exosomes. “Exosomes are messages that cells secrete, communicating with each other,” elaborates Dr. Wyles. “They say ‘Here’s how you regenerate. Here’s the full recipe of how to create skin renewal.’”

Exosomes are tiny sac-like structures formed inside a cell and containing some of the cell’s proteins, DNA and RNA. These cellular carriers are released into the bloodstream and relay messages to other parts of the body. Because they originate from many different types of cells, including diseased cells, their source and purity is of paramount importance. Illustration: International Journal of Molecular Sciences.

Adding to their potency, exosomes not only carry messages, but they can also be loaded with messages. They can be stocked with “Vitamin C or Retin A or any of these other factors that we know already contribute to skin health and renewal,” reveals Dr. Wyles. “They can go to targeted sites with the loaded messages and create a better response.”

Leslie Baumann, M.D. is a Miami-based, board-certified dermatologist and clinical researcher: “This is the most exciting thing in skincare since growth factors hit the market. However, the science with exosomes is so much more powerful and the results more predictable than with growth factors.”

But, just as the messages coursing through the bloodstream can be positive, leading to healing and rejuvenation, they can also be harmful, signaling inflammation, aging and even disease, including cancer. That is why, when evaluating an exosome product, a consumer needs to ask three critical questions, advises Dr. Wyles:

• Purity – is there anything else other than exosomes contained in the product?

• Source – different cells can create different exosomes. As stated, there are good exosomes and bad exosomes, depending on where they originated. So, how do you capture the good messages? Cell-sourced exosomes, specifically stem cell-sourced exosomes, have to be significantly expanded in a lab culture. Such expansion can cause the cells to take on different shapes from the original source. This type of instability is undesirable, explains Dr. Wyles. What you want is consistency.

This is where platelet-derived exosomes come in. Platelets are a preferred source of exosomes for a variety of reasons. They are the first responders to the site of an injury, such as a cut, signaling cells to begin the healing process. They can be pooled from different sources and remain stable. And they are safe. “We do blood transfusions all the time in medicine,” says Dr. Wyles. “We give red blood cells, we give platelets to patients. It’s been done for decades and we know the safety of platelets is there and it’s a really good safe profile. We haven’t seen any adverse reactions there.”

• Batch consistency – The production process is also important and consumers should check that the company selling the product has data on every batch of exosomes, the same number and the same activity.   “In the field of regenerative aesthetics, there’s a lot of hype and hope and to be skeptical is a good thing. I would encourage consumers, physicians and anybody interested in this area, to ask these questions, to ask to see the science behind these new products,” advises the dermatologist.

Alisa Lask, CEO of Rion Aesthetics: “Our products don’t just do one thing. They do several things. I think women will be able to take a few bottles out of their medicine cabinet, replace them with one bottle and get results that they haven’t really seen in anything else.”

Rion Aesthetics and its exosome brand, (plated) SkinScience receives both doctors’ seal of approval, not least because “we are the first and only company that’s producing platelet-derived exosomes,” reveals Rion Aesthetics CEO, Alisa Lask. Those platelets are sourced from FDA-licensed blood banks. Co-founded by Dr. Atta Behfar, Director of Cardiac Regeneration at Mayo Clinic, Rion has a good deal of science behind its products. According to Dr. Wyles – who was the Primary Investigator for (plated) SkinScience’s first clinical trial — 15 years of research went into discovering how to viably isolate and preserve exosomes from platelets.

And the results bear out the years of research. The clinical trial that was presided over by Dr. Wyles shows that exosomes honed into the collagen fibrils in the deep dermis, creating thicker collagen. Examination of aged tissue before and after treatment revealed that cellular senescence — a phenomenon characterized by the cessation of cell division and a hallmark of aging – was successfully targeted across patient populations, aged 40-80 years old.

Set to officially launch in the third quarter of 2022, the two (plated) products are in early pilot stages, currently available through Rion’s e-commerce site and at select plastic surgeons’ and dermatologists’ offices and at high end med spas. The Revitalizing Essence (2X concentration) is for everyday use while the Intensive Repair Serum (4X concentration) is more appropriate for damaged skin or post-procedure skin.

According to Dr. Baumann, “the Rion product is like a skin cream with PRP that actually gets into the skin. Most ingredients such as peptides are larger than 500 kDa [a unit of molecular mass] and cannot get into the skin. That’s why I’m not a peptide fan. Growth factors [cell-stimulating biological substances produced by the body’s cells, also found in skin care] may not be safe. They can stimulate skin cancers. But exosomes, with platelet-derived ingredients, have a wonderful anti-aging benefit without risk of growth factors and without the inflammation of retinoids. I will use them with retinoids in my patients because the Rion product reduces redness.” While Rion is not the only supplier of exosomes, “not all exosomes are the same,” says Dr. Baumann. “Think of an exosome  as a container. It is what is in it that matters. Many of the other [exosome products] don’t impress me because of their ingredients.”

For Dr. Wyles, Rion’s products have very good purity and the company has data on batch consistency. “But being a scientist and dermatologist, competition is good and I’m excited to see other exosome products on the market too,” says Wyles who is also passionate about the promise of exosomes in hair restoration and in disease-fighting therapeutics. “We’re just getting started. In the next 5-10 years, we’re going to see exosomes front and center. We are getting close to the fountain of youth with this,” posits the scientist.

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