Exosomes: the next “small” thing?

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‘Exosomes’ were a buzzword at the IMCAS conference in Paris. Talks on elucidating their remarkable healing effects took centre stage, with applications ranging from age-reversal, anti-inflammatory, and scar repair to hair loss. Despite the presented clinical benefits, the FDA has yet not approved its use for any applications. However, given cosmetics use is not regulated by the FDA, topical application for cosmetics-use contain exosomes. 

Despite the FDA ban, many clinics around the world showcased the effect of injecting human-derived exosomes into the dermis with US/ European clinics highlighting the effect of topical exosomes for age-reversal in conjunction with laser treatment to augment the positive outcomes. 

I was personally blown away by the amount of exosome use in clinics while it remains unapproved by the FDA.

Here we review what exosomes are and the clinical evidence presented at IMCAS. 

Exosomes are nanosized particles that cells release to communicate with other cells. They are like a van; carrying all the machinery and data necessary to influence the behaviour of a neighbouring cell. Exosomes often contain transcription factors, miRNAs, proteins and other metabolite molecules. Upon receiving the cargo, biological activity is promoted in the neighbouring cells. Exosomes can be found in bodily fluids such as blood, saliva, urine, breast milk where they can be extracted. They can also be derived from C-section placenta or stem cells. I even met a company that was promoting a DIY device to turn any bodily fluids to exosomes.

At the conference, many dermatologists showcased the clinical effect of topical exosomes (both human-derived or animal / plant-derived) for skin tightening and wound healing, although the FDA has not allowed any injection of exosomes into body tissues. 

A dermatologist showed data from his clinic on the use of exosomes in conjunction with RF microneedling for acne scars and anti-eczema therapy. For age-reversal, a clinic described the use of laser resurfacing and topical application of exosomes.

One study showcased the effect of stem-cell-derived exosomes on skin aging.

Moreover, a London-based clinic, highlighted a clinical study comparing exosomes-liposomes derived from calf blood (hybrosome) and retinol. Whereby hybrosome outperformed the retinol for removal of wrinkles and rejuvenation.

A Philippine-based clinic showed the injection of exosomes in the dermis for skin rejuvenation which is prohibited in the US and EU.

One application of exosomes is the removal of senescence. During skin aging, the accumulation of senescent cells is mediated by miRNA dysregulation. Exosome therapy acts on oxidative stress and inflammaging pathways. In-vitro studies have shown that exosome treatment could protect cells from UV-B damage by decreasing inflammatory markers. These mechanisms led to a reversal of fibroblast senescence with upregulation of collagen I, elastin, and fibronectin production and decreased expression of collagen III.

However, the concern with exosome is that there is insufficient data to predict what the exosomes could do to the body in the long term. Injecting exosomes when they could carry promoters of abnormal cell development could lead to cancer. Furthermore, injecting them to an immune-compromised person could be fatal.

There were reports on serious adverse effects after patients in Nebraska were treated with unapproved stem cell products containing exosomes.

In summary, exosome-based therapies are growing. As of May 2023, there were 73 clinical trials on exosomes on human application. However, their use must be limited to a research protocol and topical applications. Further research, standardisation, and economies of scale need to be developed before exosomes will be ready for widespread adoption.

You can find all the speakers here who presented on exosomes.

Disclaimer: Mitra Bio does not endorse the use of exosomes nor rejects them. This article is written for informational purposes only and must not be taken to diagnose, treat any conditions. Always consult with a physician before.

Mitra Bio is building a non-invasive skin diagnostics platform capable of measuring skin ageing.  We believe solving skin ageing could be a gamechanger to the field of ageing as it is a biomarker that is very visible externally. 

 At the moment biopsies are necessary to get good skin ageing measurements which makes clinical trials expensive and hard to recruit for. 

With cheaper/easier skin ageing diagnostics, we will start to see better data around the efficacy of potential anti-ageing dermatological treatments which may help both accelerate the development of such therapies and improve adoption once therapies are developed.

Reviewed by Dr. Cristiana Banila, PhD, Chief Scientific Officer (CSO) and Co-Founder of Mitra Bio

As a molecular biologist, Cristiana contributed to development of an epigenetic test for cervical cancer screening which is currently in trial by the NHS. She is translating her know-how to developing epigenetic skin tests for Mitra Bio. She is Oxford and Princeton alumna.

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