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Regenerative

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12/19/19

Exosomes

Can you benefit from regenerative injections if you are in your 50s, 60s, 70s and beyond?

This question has vexed me. it seems like a cruel twist of fate: patients who need regenerative treatments the most have the least amount of stem cells in their bone marrow and adipose tissue.

Then there are the controversies of using frozen and thawed live stem cells from perinatal tissues, namely umbilical cord blood. There are still questions on whether the cells survive the freezing and thawing or not, and whether they can cause rejection reactions. Add this to the publicized adverse reactions with these types of stem cells and you quickly have a negative stigma. Whether stem cells or a faulty manufacturing practice caused this did not seem to matter to our click-bait media.

So, here is the conundrum: besides platelet-rich plasma, is there any other stronger regenerative product that can benefit older patients? Enter the exosomes.

What are the exosomes?

Exosomes are tiny packets contained in stem cells. They have a lipid membrane and consist of proteins, messenger RNA, and micro RNA from their parent stem cell. They are synthesized from stem cells, and once placed in the body, they traffic or “home" to areas of injury and inflammation. From here, they penetrate the existing cells with the aid of their protein content and signal the cell mechanisms to repair and regenerate. If the stem cells are the bees, then the exosomes are the honey (courtesy of Doug Spiel, MD).

How are they used?

We deliver research-grade, purified exosomes from placental tissue into the injured area with precise radiologic and/or ultrasound guidance. In combination with growth factors from platelet-rich plasma, exosomes have a regenerative effect on bone, cartilage, disc material, nerve, and tendon. We use the platelet-rich plasma as a scaffold to limit traffic out of the injection site.

Exosomes are able to bypass the immune system; hence they do not cause rejection reactions. They do not contain DNA; hence they cannot cause cancer. They do not need more invasive bone marrow extraction or liposuction either.

Best of all, exosomes come from healthy young donors, and therefore are not limited by the age of the recipient. This of course, solves my conundrum. I can use them regardless of the age of the patient.

Future implications

Although the use of exosomes is restricted to musculoskeletal administration, they can travel throughout the body without the risk of clumping. They do not get stuck in the lungs like the stem cells do, can easily cross the blood-brain barrier because of their small size, and can reach the central nervous system without issue.

This makes possible intra-venous administration, intra-thecal administration, intra-peritoneal (inside the abdomen) administration, and intra-nasal delivery. These various routes open up vast new possibilities of treatment not previously available in regenerative medicine. Here are some of the conditions that might benefit from exosome administration:

• Musculoskeletal - joints, discs, muscles, bones, ligaments, tendons

• Neurodegenerative - multiple sclerosis, Parkinson’s, Alzheimer’s, Huntington’s, ALS, cerebellar ataxia

• Central nervous system injury/trauma - stroke, chronic traumatic encephalopathy, traumatic brain injury, spinal cord injury, transverse myelitis)

• Burns, scars, ulcers

• Heart disease - myocardial infarction, angina, congestive heart failure

• Lung disease - COPD, pulmonary fibrosis

• Liver disease

• Kidney disease

• Inflammatory bowel disease - ulcerative colitis, Crohn’s

• Alopecia

• Neuropathy

• Erectile dysfunction

• Urinary incontinence

• Peripheral vascular disease

• Aesthetics

• Depression/bipolar disorder

• Drug addiction

• Type 2 diabetes mellitus

• Infertility

• Aging

Impressive right? Well, in the spirit of full disclosure, we can’t know definitively that exosomes really improve all the conditions above, of course. But the scientific potential is there, and there is ongoing experimentation with each one of those maladies.

So the answer is YES! You can benefit from Regenerative Medicine past the age of 50 and well beyond. Cheers!

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