According to Gregory W. Chernoff, MD, exosomes have a powerful role to play in aesthetic medicine, including fibroblast stimulation, wound angiogenesis, collagen extracellular matrix production, inflammation/immune response, hair follicle growth, and dermal papilla cell regeneration.
The field of regenerative medicine is exciting, particularly when it comes to exosomes and the promise they hold for aesthetics, says Gregory W. Chernoff, MD, who presented “The Powerful Role of Exosomes in Facial Plastic and Reconstructive Surgery” at the 2020 American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) Annual Meeting.
Chernoff describes exosomes as tiny protein packets that allow cells to communicate with each other. Ranging from 50 nm to 150 nm in size, these extracellular vesicles use messenger RNA as the “ON” switch for regenerative mechanisms, anti-inflammatory cytokines, angiogenic growth factors, and anti-prostaglandin signals. Their micro RNA is the “OFF” switch for matrix catabolic enzymes, chronic inflammatory cytokines, and other signals.
“Most importantly, exosomes are rich in growth factors, particularly TGF-β3, VEGF, IL-10, as well as TIMPs-1 and -2, relating particularly to skin issues,” says Chernoff.
Clinical trials are currently examining the effects of exosomes on several indications, he says, including skin aging, acne scarring, wound healing, burn therapy, surgical incision sites, surgical beds, scar therapy, and stretch marks.
“The current trials that we've been doing over the last three years involve over 100 patients looking particularly at… aging skin, acne, wound healing, and scar therapy,” he says.
Mesenchymal stem cell (MSC) exosomes offer several skin effects, including fibroblast stimulation, wound angiogenesis, collagen extracellular matrix production, inflammation/immune response, hair follicle growth, and dermal papilla cell regeneration, Chernoff says.
“Results of our studies on the skin showed that exosomes were tremendous at stimulating both fibroblasts proliferation and migration as well as increasing extracellular matrix production and deposition,” says Chernoff. “We also have seen angiogenesis promoted, and we've seen hair follicles increase in the growth phase.”
In patients with burns, he’s seeing second-degree burns heal more quickly and dramatically compared with conventional therapies.
“In the acne scarring population, uniformly we saw a reduction in pustules, in comedones, particularly with cystic acne.”
Exosomes can be delivered into the skin using a variety of tailored protocols, from microneedling or wound bed injection to nasal inhalation or intravenous.
“We know we can inject them intradermally, subcutaneously—if you have a sterile preparation—also intravenously,” says Chernoff.
Where exosomes come from also matters.
“The exosome landscape is very broad right now with many different companies offering different sources of exosomes so you really have to know what the source is, and this will tell you them where and when you can utilize them,” says Chernoff, who discussed the examples and sources in his presentation: culture-expanded placental MSCs (Kimera Labs), donated bone marrow (Direct Biologics), lyophilized donor adipose (ExoCoBio/Benev), placental MSCs (Vitt Labs and XOStem), neural (ArunA Biomedical).
Notably, exosomes do not contain DNA.